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The Times Picayune has this up on one of the latest ideas being floated in the Senate: Medicare expansion proposed in Senate draws opposition from Louisiana doctors

Dr. Patrick Breaux, a New Orleans cardiologist and president-elect of the Louisiana Medical Association, said as a provider he would have a major objection to expanding Medicare — mainly because it covers only about 80 percent of costs.

As a result, he said, it’s likely that the kind of expansion being considered by the Senate would force providers and insurance companies to pass on the shortfalls in reimbursements to privately covered plans and patients, meaning bigger increases for people who already have coverage.

Paul Salles, president and CEO of the Metropolitan Hospital Council of New Orleans, said an expansion of Medicare would cause a big financial hit for his 17-member hospitals because of the reimbursement rates.

You have to wonder if these people understand that getting 80% is better than getting 0%. The coverage, as near as anyone can tell, is for people who have no coverage at all. Making up a possible 20% shortfall is much easier than a 100% shortfall. Doctors and hospitals do charge patients for the difference, which is why people buy the highly regulated “Medi-Gap” insurance policies.

Doctors and hospitals are free to refuse Medicare clients for anything other than emergencies. It’s just another insurance program, not a government mandate. They are also free to lobby for improved rates, and 100% coverage of the costs, but that might help people other than doctors and hospitals, or the residents of their gated communities, or the people at the country club.


1 Badtux { 12.10.09 at 3:01 pm }

But right now for any non-emergency care for uninsured patients they can just shove the patients off onto the local public hospitals. Granted, now that Big Charity is closed there is a shortage of public hospital beds in New Orleans, but that’s not their problem. Illegal patient dumping is rampant in Louisiana and the supposed state regulators who are supposed to stop it from happening just wink and nod as hospitals fire any whistle-blowers who report it to the regulators. (And this is not just a hypothetical, it happened to a relative, the whistle-blowing-then-fired bit that is).

Note that one requirement of accepting Medicare is that you accept the Medicare price for the full cost of a covered procedure. You’re not allowed to charge the Medicare customer any more than what the Medicare price is. Medi-Gap pays the 20% of a covered procedure that Medicare doesn’t pay, it doesn’t pay beyond that, because it would be illegal to charge more than that to a Medicare patient. And if you accept Medicare, you accept Medicare — you can’t turn away a Medicare patient just because the particular procedure he needs would not be profitable for you, if you do that’s a violation of your Medicare contract which can then be yanked.

So yeah, I can understand why they’re screaming and yelling. Old people are profitable even at Medicare reimbursement rates because of sheer volume, Medicare may cover only 80% of the cost of the first procedure but if you can bundle 5 procedures the other four procedures don’t cost anywhere near as much as the Medicare reimbursement rate for them and you make decent profit from them. But younger people aren’t yet sick enough to make money by volume that way, and it’s far cheaper for them to dump those younger people onto the collapsing Louisiana public health system.

As for Dr. Patrick Breaux, he doesn’t care about that, he only cares about how much money he can save by dumping those patients into the ditch in front of LSU Medical Center rather than losing money by treating them. My opinion of a doctor who cares more about profit than about patient health is unprintable.

– Badtux the Medical Penguin
.-= last blog ..70’s oldies blogging =-.

2 Bryan { 12.10.09 at 4:29 pm }

I’m aware of the restrictions on accepting Medicare patients, but they still have the option of not taking Medicare, they just can’t pick and choose among Medicare patients. It’s amazing how some hospitals and doctors seem to thrive on Medicare payments, but others don’t seem to be able to make it. I’ve noticed that the for-profits seem to have most of the problems. Maybe if they cut executive compensation… of course, they can’t possibly do that, so it must be time to lay off some of the cleaning crew and nurses.

3 Badtux { 12.10.09 at 4:51 pm }

Bryan, it’s all about volume. Medicare is *very* profitable even for the for-profits *if* they can get sufficient volume or “churn” out of a single patient. But if a patient comes in for a single procedure, gets that procedure, then they don’t see him again for another year, that’s where they lose money… and that’s the deal for most of the 50-somethings, they don’t actually require a lot of medical care compared to 80-somethings who are in and out of the hospital or clinic every month or two for some ailment or another, so they can’t get that volume churn.

What they’re *really* carping about is that they can’t make obscene profits off of 80-somethings if they can’t dump those 50-somethings onto the public hospitals the way they currently do. Yes, they don’t “have” to take Medicare… but then they’d give up those obscene profits from the 80-year-olds. Oh the horror, the horror I say, of some government bureaucrat coming between a private corporation and its ability to profit from government welfare! Why, that’s COMMUNISM!

– Badtux the Snarky Penguin
.-= last blog ..Medicare is good, except it’s bad =-.

4 Bryan { 12.10.09 at 9:44 pm }

I’m not arguing with with you, Badtux, I’m just being somewhat sarcastic, and more than slightly pissed off that these people, who I have to deal with because of my Mother, never seem interested in improving patient care, only in improving their bottom line.

I’m dealing with my Mother’s specialists who have had to join group practices because of the cost of dealing with insurance companies, which means that every time you call the office you are talking to someone new because the management of the group practice can’t keep employees with its crummy pay and part-time scheduling.

Single payer would be unbelievably beneficial to doctors, but so many just don’t see it. They are buying into the misinformation they have been fed by the insurance propagandists.

If people weren’t making money, they wouldn’t take Medicare.

5 Comrade Kevin { 12.12.09 at 9:51 am }

Medicare usually works very well, but Medicaid can be a disaster, since it relies on state funding. In red states, it pays out roughly 1/3 of that which a private carrier would provide, and often delinquently. This is what they’re all afraid of, honestly.
.-= last blog ..Saturday Video =-.

6 Bryan { 12.12.09 at 10:54 am }

Florida’s Medicaid system was another privatization project of our former governor, John Ellis Bush, and is another of his expensive give-aways to corporations that are many times more expensive than necessary, and don’t provide the services required. The insurance companies are they only people happy with the results that provide profits without any performance. It is definitely a “welfare” program, but it is structured as “corporate welfare”, not the welfare of the client base. Patients and health care providers get screwed, and insurance executives get bonuses.