Home Forums Discussions General Discussion The future of medicine

Hi everyone,

The intention of this thread is to consider the future of medicine in the next administration. It is not intended to turn into a political discussion.

It appears that Democrats will control the White House, House, and Senate. Your thoughts on what, if any, changes will occur to the healthcare system as a result of this? Specifically, will Medicare for all be pushed? And would that be a good thing or a bad thing?

Thanks

Gene

The Democrats are not "Radical Socialists". Joe Biden is a Delaware corporatist, and strongly believes in corporate control of the medical system, run by giant insurance companies and hospital chains, and their parasitic hangers- on, the Pharmacy "Benefit" managers. So no, we will not have Medicare for All, if you mean a government run program.

Cosmetic changes to existing "Affordable" Care Act will be made, because the optics are really bad right now for the American medical "system".

The perceived problem with Medicare is that it is subject to corruption and politics -- which of course is true. But I can't really see that it is overall any worse than the "free market" system we currently "enjoy" in that regard. And it is certainly easier to deal with than the infinitely shifting sands of insurance company whims.

Medicare For All: Interesting idea for young progressives who have never been on Medicare! It doesn't matter for the politicians, they exempted Blue Cross Federal which was not singled out for destruction as a "cadillac plan" under Obamacare. My patients with AK Railroad, who worked hard all their lives, their BCBS plan was too Cadillac and "unfair." They got their deductible changed I think from 200 dollars to 5000 dollars. BC Federal, they got to keep their Cadillac plan. So Medicare for All will be for the plebeians, and the ruling oligarchy will still get their fat cat plan.

I have one first requirement before we even discus this: medicare for all MUST be Medicare For ****ALL*****

Did you know the PBM's get to choose if it's ProAir or Ventolin? Then they get a cash kick back from the drug manufacturers that goes against all anti-corruption laws in this country. Congress decided to exempt them from anti-kickback laws hoping it would lower prices. In reality, it vastly increased prices on many drugs, and most of the increase is all kick backs. This is just one example of why so many people are talking about corruption in our government, draining the swamp, etc. That's at least one good thing Trump tried to do: pass an executive order to stop this madness. He wont' get any credit for it.

From HHS.gov: Directed by President Trump's July 24, 2020 Executive Order on "Lowering Prices for Patients by Eliminating Kickbacks to Middlemen," the Department of Health and Human Services Secretary Alex Azar and the HHS Office of Inspector General (OIG) have finalized a regulation that encourages lower list prices and reduced out-of-pocket spending on prescription drugs.

Welcome to the Swamp

Trump campaigned on draining the swamp -- but he turns out to be another swamp creature, and an anti-democracy plutocrat to boot

Miscellaneous ramblings
I'm in Pediatrics, so I really don't see Medicare (which is a shame because IL Medicaid only pays about 60% of Medicare) I would look forward to Medicare for all as a boost in income.
I unfortunately see the other side of medicine. Many of my parents are young and they have no clue of how to navigate the insurance system.

As a result often my patients have periods with NO insurance or Insane deductible insurance (>10-20% of the salary).
I see many late teens and twenties with no insurance because they have been dropped from Medicaid and have not obtained other coverage.
I have found that many of my parents make too much to qualify for Medicaid under "Obamacare" and won't pay hundreds of dollars for plans.

Can we really afford to have 15% of the population uninsured and probably another 20% underinsured?
The byzantine system system of copays/deductibles/coinsurance/coverage issues is absurd and changes from provider to provider. It's a shell game to make it difficult to get paid and aimed at not paying for care and denying care.
It doesn't have to be Medicare for all. It could be Blue Cross for all. The lack of paying administrative overhead for 400+ insurance companies would go a long way toward paying for those who are not insured.
But real medicine does not have a voice in congress, instead we have the AMA selling us out and making money off the CPT system.
The insurance companies are well represented. This is why they are are greater percentage of the medical dollar than primary care.

When you factor in Medicare, Medicaid, Obamacare subsidies, Tricare and the tax deductions on employer provided health care, the federal government pays most of the cost of health care anyway. Why do we have to fractionate it. I do understand that a single payor becomes a monopoly, but perhaps that will be better than the shell game we currently engage.

Wendell -- that was as concise and complete and articulate summary of the problem as any I have seen. Thank you.

I see mostly adult patients -- geriatric now that we have all aged together. Medicare is mostly much easier to deal with than most of the insurance companies, and they almost never play the GOTCHA games with me that the private insurance does. It is true that some of the private companies pay more for services than Medicare -- but not always. And Medicare seems to set a floor under the fee structure that private companies strive to meet.

It is insane to base the insurance system on family policies paid for by employers - this is an era of broken families and gig-workers whose employers spend billions to avoid paying health insurance.

People who really need health insurance (cancer, major anomalies, premature births, injuries caused by drunks) will quickly find themselves with no insurance when they can't work -- even if you put 30 years into a company, you can be left high and dry if you have a serious illness or injury.

And finally, for the "free market" crowd -- Medicine is not a free market, it is a tightly controlled monopoly run by the Mob. Independent practitioners such as I am are being rapidly squeezed out

I used to work as a cellist in the State Opera of Flanders (Belgium) in the 1980s. At one point I ended up flat on my back in the hospital for 3 weeks (compressed vertebrae due to an accident). I never saw a hospital bill. I had previously purchased a $20/month supplemental insurance plan which entitled me to a private room. Of course, part of my taxes went to the National health system. But when I couldn't work for the better part of 2 months, I did not have to worry about hospital bills, and I automatically received sick pay. The hospital had all my information already, as I was in the national database (similar to the VA system in the USA), and don't forget, this was the 1980s - early days for computer networks.
Just contrast that experience to one typically encountered in "The Best Medical System in the World". My wife, a solo family doc in CT, typically sees at most 3 or 4 patients per hour, often fewer, and her patients appreciate the time she takes with them. As her office manager, I can attest to the fact that we have to keep our overhead to an absolute minimum in order to stay in business. I'm sure that working in Canada or in the UK for the national health isn't always a dream job, but it must be nice not to have to fight for reimbursement!

We theoretically have lower taxes in the US. But when we look at the additional cost of health care (including the "oops" charges of copays, coinsurance, deductibles, and other out of pocket charges) as well as Social Security and FICA and then state local and real estate taxes, are we really paying that much less in taxes?

And what are we receiving for out money? Our system that does not cover 20+ percent of the population and probably does not adequately cover another 10-20 percent of the population. There are things that capitalism does well, but apparently it is not the ideal funding model for health care.

I agree with everything Wendell said. Medicaid is easier to deal with than private insurance. Luckily, in Houston, the two largest Medicaid HMOS are nonprofits and working with them is much easier than working with UHC, BCBS, etc. I also used to work for a surgeon so I did some Medicare billing and also agree with Tom. I'd rather have the clarity of Medicare policies than wading through different policies, forms, formularies of private insurances. To get a fee for a procedure from medicare or medicaid, I just have to look at the right webpage. To get a fee schedule from a private insurance company usually involves multiple steps, taking many days, sometimes weeks or calling and emailing different people.