Assuming they don't have w2 employer coverage

(http://www.autoadmit.com/thread.php?thread_id=5788636&forum_id=2,#49366095)

presume if you need major doctor work the real value is beyond what you can pay, and you'd die... and presume we all say thats fucked up, we should pool it somehow

how to do this

(http://www.autoadmit.com/thread.php?thread_id=5788636&forum_id=2,#49366550)

can you explain this?

(http://www.autoadmit.com/thread.php?thread_id=5788636&forum_id=2,#49366634)

Medicare and Medicaid pricing significantly influences private insurance costs due to the dynamics of healthcare reimbursement and cost-shifting. Here’s a clear explanation of how this works:Low Reimbursement Rates: Medicare and Medicaid, as government-funded programs, typically pay hospitals, doctors, and other providers at rates lower than the actual cost of care or what private insurers pay. For example, Medicare often reimburses at rates 10-30% below private insurance rates, and Medicaid rates can be even lower, sometimes covering only 60-80% of the cost of services.

Cost-Shifting to Private Insurers: To offset losses from treating Medicare and Medicaid patients, healthcare providers often increase charges for privately insured patients. This practice, known as cost-shifting, means hospitals and providers raise their negotiated rates with private insurers to compensate for the shortfall from government programs. Studies, like one from the American Hospital Association, estimate that hospitals lose billions annually on Medicare and Medicaid patients, pushing them to recoup costs elsewhere.

Higher Private Insurance Premiums: As providers charge private insurers more to cover these losses, insurers pass these costs onto consumers through higher premiums, deductibles, and co-pays. For instance, a 2019 study by the Kaiser Family Foundation found that cost-shifting could account for a significant portion of private insurance premium increases, with some estimates suggesting it adds 10-15% to private payer costs.

Market Dynamics and Negotiation Power: Medicare and Medicaid cover a large portion of patients (over 50% of hospital revenue in some cases), giving them significant leverage to set lower reimbursement rates. Private insurers, with less market power, often face higher negotiated rates because providers know they can’t afford to lose private patients, who are more profitable.

Administrative and Regulatory Costs: Medicare and Medicaid’s complex billing and compliance requirements also increase providers’ overhead costs. These expenses, while partially absorbed by government payments, often get passed onto private insurers through higher charges, further driving up private insurance costs.

In summary, the low reimbursement rates of Medicare and Medicaid force providers to shift costs to private insurers, who then raise premiums and out-of-pocket costs for their customers. This interplay is a key driver of rising private insurance costs, though other factors like drug prices, administrative overhead, and demand for advanced treatments also contribute. If you’d like me to dig deeper into specific data or studies, let me know!

(http://www.autoadmit.com/thread.php?thread_id=5788636&forum_id=2,#49366674)

I'm on the board (chair in fact) of a non-profit behavioral health care provider organization. Most of our clients come in with either Medicaid or nothing. We treat everyone, regardless of ability to pay. We manage to recoup our losses from state and federal funding sources and private donations of various kinds, which requires nearly constant grant submission, reporting and compliance.

Medicaid by itself does not pay enough to cover the costs of treatment. If we were 100% financed by Medicaid we would go out of business. Medicare is better. Medicare reimbursements, provided we also get paid by a supplement or out of pocket, might cover our costs - barely. Private insurance is a mixed bag. We have to negotiate a payment schedule with each provider, and there are a zillion of them. Some of the payments are worse than Medicaid, so whether you can survive on private insurance depends upon the portfolio you have. A huge problem with private insurers is that they routinely deny claims, which then have to be constantly resubmitted. Some of them seem to play a game of "we'll wear you down and we'll never pay." Medicaid and Medicare are very automated and pay quickly and reliably at least.

We recently gave up trying to do our own billing and outsourced it to a third party billing firm. They are expensive, but have increased our private insurance payments significantly.

I notice in my personal dealings with physicians that they do a lot of gaming of the payments system. Every time I go to the ENT he sticks a scope up my nose for 15 seconds which triples his payment from Medicare. My organization has stayed very honest in our billing practices, but the temptation is there for fraud and I bet a lot of it goes on.

The administrative costs of health care have spiraled upward steeply. It's not just because of Medicaid and Medicare, but it's also because of equally onerous requirements of the private insurers. The latest thing we've been doing is to incorporate AI case notes into our automation systems to allow providers to see more patients. In our field a payment claim cannot be submitted until the provider writes up detailed case notes. Pre-AI there is so much paperwork to do that the most effective providers spend only half their time with patients. We're hoping the AI system will raise that. And yes, the AI program we're using is compliant with all the federal privacy laws and regs.

I have compared notes with our local hospital CEO. He has the same problems we do, but on a larger scale. The very large hospitals seem to be able to actually make money. The big ones here seem to make about 10% of gross revenue in a good year. I assume the big hospitals may be able to negotiate more favorable terms with private insurers than we small fry. We strain really hard not to go broke, and we would were it not for grants and donations. I personally put a fair amount of money into the organization every year to help it stay afloat.

Bernie's idea of Medicare for all seems appealing on some level, yet Medicare is also just as expensive as private insurance. I think the fundamental problem is that due to government meddling there is no healthcare marketplace. Almost nobody pays directly for the services they receive. As a result, healthcare has become inefficient. Administrative cost bloat alone is monumental.

(http://www.autoadmit.com/thread.php?thread_id=5788636&forum_id=2,#49366900)

The healthcare delivery system of Pakistan is complex because it includes healthcare subsystems by federal governments and provincial governments competing with formal and informal private sector healthcare systems.[3][2]

Syria's public healthcare system aims for free care, but in reality, quality is low and access is a major challenge due to the ongoing civil war. While government facilities are intended to be free, the system is severely impacted by damaged infrastructure, a shortage of medical personnel and equipment, and a lack of resources.

(http://www.autoadmit.com/thread.php?thread_id=5788636&forum_id=2,#49366744)

Bluntly, the point is this: They keep you fighting both at home and abroad, while implementing the policies they have convinced you are economically infeasible.

(http://www.autoadmit.com/thread.php?thread_id=5788636&forum_id=2,#49366734)