Download How to Fix Medicare: Let's Pay Patients, Not Physicians (Aie by Roger Feldman PDF

By Roger Feldman

Should still Medicare pay for sufferer charges the way in which vehicle insurers pay for car_repair debts? Medicare's present approach to paying physicians units charges for greater than 8,000 separate techniques and companies, totaling over $60 billion every year. With Medicare's formulation underpaying for a few providers and overpaying for others, this advanced method is an inefficient use of assets that daunts using fundamental care in want of costlier forte providers. supplied with almost limitless clinical companies at low or free of charge, sufferers this present day have little incentive to decide on their care correctly. In how you can repair Medicare: Let's Pay sufferers, now not Physicians, overall healthiness economist Roger Feldman argues radical shift in Medicare coverage isn't just attainable yet crucial. less than Feldman's 'medical indemnity' concept, Medicare may pay each one sufferer a hard and fast sum of money, booking higher subsidies for sicker humans. sufferers, in flip, would choose their very own clinical companies from companies who may set their very own aggressive charges. A clinical indemnity method could eliminate the distortion in sufferers' incentives wrought by means of traditional Medicare assurance. Given a hard and fast amount of cash to spend on treatment, sufferers could have robust incentives to buy the mix of companies, companies, and costs that the majority heavily meet their wishes.

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2 As reviewed by Feigenbaum, the evidence indicates that indemnities once existed, but they were driven out of the market by the concerted opposition of hospitals and physicians who favored “traditional” insurance for financial reasons. Changing medical technology might have played a role in the disappearance of medical indemnities, but it was not the primary explanation. Feigenbaum wrote, “In the first decade of [the twentieth] century voluntary mutual societies underwrote large numbers of ‘sickness’ policies, offering workers a means by which they could indemnify themselves for income losses due to adverse health events” (1).

Before proceeding, we need to distinguish between “unavoidable” and “avoidable” medical expenses. Part of the reason the cost of the auto repair could vary so much is that some policyholders may install unnecessarily expensive parts. The decision to spend $10,000 might be avoidable in the sense that a perfectly decent repair could be done for $2,000. The difference between $10,000 44 HOW TO FIX MEDICARE TABLE 4-2 INITIAL TREATMENT COSTS FOR CANCER IN ELDERLY MEDICARE BENEFICIARIES AND ESTIMATES OF THE COST OF RISK-BEARING Type of cancer Number of cases Mean cost Standard deviation Variance of cost Total cost of risk-bearing Breast 1,952 $12,141 $10,434 $108,868,356 $33,722–$44,160 Colorectal 2,563 $24,910 $14,870 $221,116,900 $68,491–$89,691 Lung 3,331 $21,351 $14,813 $219,424,969 $67,967–$89,004 Prostate 3,179 $14,361 $11,216 $125,798,656 $38,966–$51,027 SOURCES: Number of cases, mean cost, and standard deviation from Penberthy et al.

If a plan—including FFS Medicare—bids above the benchmark, the beneficiary will pay the difference between the plan’s bid and the benchmark. 6 Capitation has the potential to be a powerful method for determining how much to pay Medicare health plans, including traditional fee-for-service Medicare. In our book, we recommended that Medicare take bids and set the government contribution to premiums equal to the lowest bid submitted by a qualified plan in a local market area (Dowd, Feldman, and Christianson 1996, 67).

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