re: The cost of Medicare

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When Medicare/Medicaid were first proposed, the AMA opposed it. They were against government intervention and the socialization of healthcare.

Didn't take doctors long to become prostitutes for the government dime once they realize the system is a limitless spigot of dollars.

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Yikes!
There is so much wrong here in such a short post, it's deserving of HOF status.

AMA Background

(1) LBJ needed the AMA on board with Medicare. So in 1965 his people approached the AMA highlighting the need for efficient and effective determination of physician reimbursement. Their pitch was, consistent and accurate reimbursement requires a common language of medical procedures, and the American Medical Association (AMA) was just the player to take that challenge on ... and oh ... btw .... there could be licensing fees involved. The government would commit to use the AMA's "common language of medical procedures." So the Current Procedural Terminology (CPT) system was born.
(2) Johnson was brilliant at using politics and payola to divide groups. At the time the AMA was heavily funded by annual MD dues. With the CPT licensing proposal to the AMA, the government was able to separate AMA interests from the doctors it was supposed to represent. MD AMA membership dropped from 75-80% in 1965, to around 7-9% of practicing MD's now.
(3) Meanwhile, the AMA is now pulling in about $150 million/year in CPT Licensing fees alone

MD Medicare Reimbursement

(1) Despite CV19 PR, I suspect a majority of MDs still abhor big government.
(2) At inception, Medicare reimbursement was close to private insurance. Over time that changed (as with any socialized system) and the gap widened dramatically. E.g.,
• Medicare typically pays 40% of what private insurers pay for imaging services.
• Medicare typically pays 30-50% of what private insurers pay for OPT procedures.
• Medicare's Diagnosis-Related Group (DRG) payments are as much as 50-70% lower than private insurance payments for Hospital inpatients.
• Reimbursement differences in the ER can be up to 200-300% between Medicare and private insurers, particularly for high-acuity cases.

I could go on, but hopefully you'll be a little more informed on the topic going forward.

I would dearly love for DOGE to say "Why are we paying for an antiquated code system designed for 1970's computer systems, and giving away licensing fees to boot? Let's develop our own system, and charge licensing fees to help fund CMS!" It would make great fiscal sense, and it would crush the AMA as a non-representative medical organization.

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Medicare isn’t the problem. Greedy doctors and hospitals are.

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It's more a problem with monopolies. Hospitals have different names but most are run by 3 or 4 gigantic corporations. They charge rates in tandem instead of from competition so they can make more profit. Now if medicare did not exist then they would be limited because individuals can't pay that much out of pocket.

Cath and a stent in 2020

115k

Thank goodness for my BCBS supplement

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Medicare isn’t the problem

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Medicare is socialized medicine. The worst doctor gets paid identically to the best for the same procedure. You think that is not a problem?

Medicare punitive reimbursement interactions with hospitals over patient's gradation of post-treatment pain were directly responsible for the Obama opioid crisis. You think that is not a problem?

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They would much rather treat commercially insured patients.

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Altruism still plays a great role in the field, but an increasing number of MDs now put the kibosh on accepting any new CMS patients

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$550,000

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Medicare probably paid $5k on the reimbursement and the hospital wrote it off as a loss of $545k.

Medicare probably pays 15%of the bill, Medicaid pays 10%of it, commercial insurances pay 30% of it, while operation cost is 20% of it.

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Then you don't want good doctors doing medicare.

CMS reimbursement absolutely sucks.

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Amen. People don't realize how this stuff works, and how could they when it's so ridiculous??

I'm an analyst at a large GA health system - not only has CMS reimbursement been going down, but the wRVUs per procedure have also changed dramatically since 2021. Doctors that struggled to meet their productivity threshold are now earning huge bonuses, and the additional CMS reimbursement is not even close to enough to cover the difference. The last few CMS table changes have been gargantuan projects for us just to keep things solvent.

Small example of the corruption in the medical billing / insurance fraud arena...

I was in a wreck a few weeks ago and broke a revibrate in my back. My orthopedic doctor recommended a brace until they could get and MRI approved to see if i needed surgery. I was given the brace and then they went over the options.
1) if billed thru insurance the brace was $938 dollars of which my insurance paid $318 and i had to pay the balance.
2) if i paid cash the cost was $325 dollars

I asked why the huge difference? the person told me that insurance demanded they bill at the higher amount.

What sense does this make for the two to collude to fleece the insured?

We have to get some common sense into this system somehow...