If Medicare became the single payer, I would be out of business. In Montana Blue Cross has a conversion factor MUCH higher than Medicare which is essentially matched by several major payers. Medicare does not pay the bills here- unless I limit visits to 15 minutes max and push them out the door and then upcode illegally.
I would strongly consider the patient as the payer in primary care with backup insurance for specialist and hospital coverage. Malpractice reform is required. The patient who has to pay for the MRI out of pocket is not going to demand it despite our counsel that it is not necessary- but now, they do demand it out of their fear of missing a diagnosis and we deliver out of our fear of malpractice..
A recent article I read said the single greatest bloat in healthcare costs was the overuse of technology.. patient as payer takes care of this. The second highest was administrative costs of insuance companies. Patient as payer for primary care services significantly reduces this. For example: Blue Cross offers two versions of a high deductible plan at $6000 per year for a 50 y/o woman. The other offers $500 upfront coverage for primary care at the cost of $7000 per year. I keep telling people to DO THE MATH... choose the $6000 plan and put $1000 in your HSA and get more for your money.. but NO ONE listens.
I envision the ability of primary care providers to contract directly with patients and employers for care delivery that covers acute visits, wellness visits, counseling visits etc all at one relatively low cost per year per patient plus low copays for each visit. Encourages use of primary care services as appropriate but discourages abuse. There is a donut hole where high cost diagnostics are paid out of pocket but when hospitalized or when real disease looms and cost mount, the back up insurance coverage kicks in. Perhaps there could be subsidies for the primary care coverage by the "single payer system government" for the disabled, elderly etc to cover the primary care aspect.
I'm moving to Montana, BC reimbursement in Missouri stinks.
