re: Why do moderate dems claim a public option health plan could coexist with private plans?

A public plan by itself would not eliminate private insurers. The feds would have to make private insurance illegal for that to happen.

The main problem with the OPs reasoning is that he incorrectly assumes private plans still pay providers significantly more than Medicare. I do not take Aetna in my area because they pay 89% of Medicare’s fee schedule. None of the Medicare Advantage plans (run by private insurers) have fee schedules equal to Medicare. They all pay less than Medicare. BCBS is the only network which still pays me significantly more than Medicare and it’s only 120% of what Medicare would pay. I can count on one finger the number of primary care physicians who refer to me and don’t take Medicare.

Basically, I make around 110% of what Medicare would pay for a given patient encounter, on average. It’s a race to the bottom and physicians are either accepting the terms because we are an incredibly disorganized profession...or folks are going to work for their local healthcare/hospital megacorp where they don’t care about fee schedules as it doesn’t affect their pay directly.

Medicaid is another story. Those rates are criminally low. I am not a medicaid provider in my state. And I refuse medicaid consults in the hospital.

quote:

---

This will be true for any third-party payer. Do you think it's easy to get CMMS reimbursements?

---

Good point. Though I do spend significantly more money fighting BCBS, United and Cigna for money than I do CMS. Medicare will basically pay anything you bill as long as its coded correctly.

Of course, if you have incorrectly billed Medicare and they catch it, they will get their money back. If you were dumb enough to fraudulently bill the feds, they will put you in jail.