He is blaming the high costs of medical care on expensive hospital care (as opposed to say primary care physicians.) I know this is an old argument. When they started Neighborhood Health Plan in New York (about 20 years ago? They changed names) it was a sort of medicaid expansion. The rationale they gave in the papers was that hospitals were expensive, and the uninsured would go to hospitals for ‘routine care’.
Now these insurers engage in their own little scandals and scams… NY medicaid btw has excellent coverage now (at what financial cost I don’t know) - I rarely see self-pay patients come in anymore when there used to be a couple every day.
He’s a hospitalist, if he says there’s a lot of waste I’ll believe him. I was told a certain large, prestigious hospital had a head nurse in charge of discharging the poor insurance people. I used to review medical records from the hospital for new appointments. It’s very common - guy feels something weird in the heart, goes to the ER. If they had medicaid or no insurance they’d get a checkup, maybe an EKG and discharged… If they had BCBS or a nicer insurance they got the echo, maybe a diagnostic cath/angiogram… I know of this egregious example The doctor sent them to the ER with instructions to get caths done. IIRC he was responsible for a huge percentage of Mt Sinai’s cath lab referrals. It’s big money. He was getting kickbacks in the form of rent money for a little room. The original report is in bloomberg but it’s paywalled now. I heard a rumor the FBI was investigating them but that was 10 years ago and nothing’s happened… so they skate again.
Insurance is a form of waste. It is not the only reason. It would help and it’s a step in the right direction!
If we had medicare for all we’d hit other issues of ‘waste’. The way I figure physician time is a limited resource. Even if they were unpaid robodoctors there’s only so much they can work in one day… We’d still see steering towards profitable procedures (cardiac stents are the big thing now… They’re what, 40k a pop? I think I saw a scandal where one doctor put the One man’s experimental, medically dubious procedure is another man’s cutting edge life-saving cure.)
Any rational, fair system would need some sort of triage system determining who gets what care. I can only assume our Northern cousins have figured it out, as have most of other countries (fewer procedures, lower costs, same outcomes in mortality…)
The problem with Medicare is that the shit is controlled by a captive Congress so they have zero incentive in health cost control. It’s true what some rightists say, they basically pay for everything and it’s an honor system. That said, BCBS, UHC, Aetna and all those medicare HMOs have zero incentive to do fraud checking cuz it’s government money… They even hire companies to go through records and find more diagnosis on patients so they get a higher yearly lump sum. (It’s called risk-adjustment and it’s a very good idea in principle because otherwise insurers will try to kick out expensive, sick members.) Various large and regional insurers got caught doing bullshit adjustments. Unitedhealthcare got fined or something for it, but like big enough doctors and hospitals they pay pennies to the dollar…
Even a high profile case like Melgen (the florida doctor that was friends with NJ Dem senator Melendez) he paid $42 million out of $136 million prosecutors allege was stolen.
Risk adjustment is interesting, so the average medicare member is worth about 6k a year. Diabetes would be worth 3k more. Depression is worth 4k more. So the insurers scan lines of doctor’s notes looking for keywords like ‘tired’ and use that to code in depression. It’s a third-party thing now. I think the big insurers don’t do it anymore, but most of the regional ones we use still do it. They send a nurse to scan 50-100 records at a time to upcode. That’s why I’m convince EHR is a scam for insurers to get more medical data and the freaking technocrats will use ‘outcome scores’ to pay doctors more or less. It’s gonna be bullshit like how schools game their student’s test scores.
