Trump’s Commonsensical Food-Stamp Rule

ProV1 said:
LOL...Medicare determines what they will pay. The rest of the industry prices for the broad market including providers for procedures and insurance companies for premiums. Don’t be silly.
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No, they don't. Private insurance companies offer reimbursements on a percent basis compared to what Medicare pays. For example, Aetna may offer 110% of Medicare reimbursement or Anthem may offer 120% of Medicare reimbursement.

Providers and hospitals don't set there own prices. Procedures, beds, nursing staff, treatments, labs, etc cost what the market has determined they cost. Medicare, or any insurance company, gets the bill and pays the hospital what they think is appropriate.
 
Gh0st said:
No, they don't. Private insurance companies offer reimbursements on a percent basis compared to what Medicare pays. For example, Aetna may offer 110% of Medicare reimbursement or Anthem may offer 120% of Medicare reimbursement.

Providers and hospitals don't set there own prices. Procedures, beds, nursing staff, treatments, labs, etc cost what the market has determined they cost. Medicare, or any insurance company, gets the bill and pays the hospital what they think is appropriate.
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? First, that is hogwash. A third of providers in this country are for profit. They set their price. They decide if they will accept a lesser a private insurance payment or not. If the insurance companies are dictating what the market rate is at 120% of Medicare or whatever then THEY are setting the price. This is basic business and economics 101. I hope you don’t do this for a living.
 
ProV1 said:
? First, that is hogwash. A third of providers in this country are for profit. They set their price. They decide if they will accept a lesser a private insurance payment or not. If the insurance companies are dictating what the market rate is at 120% of Medicare or whatever then THEY are setting the price. This is basic business and economics 101. I hope you don’t do this for a living.
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Actually, he does. He's also right. Private insurers negotiate the price that they will pay with the provider, for many services it is tied to the Medicare rate - Medicaid is usually a fraction of the Medicare rate. Both the insurer and the provider are regulated, they don't get to set their prices without government controls - state insurance commissioners, etc. My dad was an auditor for the state insurance commissioner, his job was to verify how they negotiated, what they paid, how much profit they were able to generate and even what they did with those profits (a large part had to be invested in reserves so they could cover catastrophic losses in the event of a natural disaster - like a hurricane), insurance companies actually produce smaller profits compared to other industries. At the end of his career he was auditing things like nursing homes and caregivers to insure that they were actually delivering what they were supposed to.

Profit isn't a bad thing, even in healthcare, it encourages innovation and expansion, and even allows for some things to happen for free. Without profit there is little investment.
 
SWMCinci said:
Actually, he does. He's also right. Private insurers negotiate the price that they will pay with the provider, for many services it is tied to the Medicare rate - Medicaid is usually a fraction of the Medicare rate. Both the insurer and the provider are regulated, they don't get to set their prices without government controls - state insurance commissioners, etc. My dad was an auditor for the state insurance commissioner, his job was to verify how they negotiated, what they paid, how much profit they were able to generate and even what they did with those profits (a large part had to be invested in reserves so they could cover catastrophic losses in the event of a natural disaster - like a hurricane), insurance companies actually produce smaller profits compared to other industries. At the end of his career he was auditing things like nursing homes and caregivers to insure that they were actually delivering what they were supposed to.

Profit isn't a bad thing, even in healthcare, it encourages innovation and expansion, and even allows for some things to happen for free. Without profit there is little investment.
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I’m not sure what all that means but at the end of the day, the effective price is what gets paid. Medicare does not determine that for the majority of the market. The insurer and the provider does.
 
ProV1 said:
? First, that is hogwash. A third of providers in this country are for profit. They set their price. They decide if they will accept a lesser a private insurance payment or not. If the insurance companies are dictating what the market rate is at 120% of Medicare or whatever then THEY are setting the price. This is basic business and economics 101. I hope you don’t do this for a living.
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Jesus. Providers and hospitals bill insurance companies. The companies determine what they will reimburse for a particular service, not the provider or hospital. The best the hospitals can do is get as close to the actual cost of performing a service from the insurance company and potentially bill the patient for the rest. All companies base reimbursement standards off of what Medicare will reimburse and use it as a base. If Medicare decides to reimburse more, less, or not reimburse altogether other companies will follow suit.

I interact with insurance companies on a daily basis and I have nothing to do with setting prices that my patients pay.

Why would a provider not be for profit? Do you work for a profit?
 
ProV1 said:
I’m not sure what all that means but at the end of the day, the effective price is what gets paid. Medicare does not determine that for the majority of the market. The insurer and the provider does.
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You don't know what that means but you know he's wrong and you're right.

Lol
?‍♂️
 
There are a few people on here who believe that they are experts on everything, yes everything, the amount of arrogance that takes is both astounding and amusing.
 
Gh0st said:
Jesus. Providers and hospitals bill insurance companies. The companies determine what they will reimburse for a particular service, not the provider or hospital. The best the hospitals can do is get as close to the actual cost of performing a service from the insurance company and potentially bill the patient for the rest. All companies base reimbursement standards off of what Medicare will reimburse and use it as a base. If Medicare decides to reimburse more, less, or not reimburse altogether other companies will follow suit.

I interact with insurance companies on a daily basis and I have nothing to do with setting prices that my patients pay.

Why would a provider not be for profit? Do you work for a profit?
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I never said that a provider would not be for profit. The point is that Medicare does not establish the price for a procedure for the bulk of the healthcare market. The fact that the price is set off a Medicare baseline does not mean that Medicare is establishing the price. By your own argument, it is only a basis for the bill and the “companies” determine what gets paid.
 
ProV1 said:
I never said that a provider would not be for profit. The point is that Medicare does not establish the price for a procedure for the bulk of the healthcare market. The fact that the price is set off a Medicare baseline does not mean that Medicare is establishing the price. By your own argument, it is only a basis for the bill and the “companies” determine what gets paid.
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Yes, it absolutely does. The companies determine what percentage of Medicare reimbursement they can pay. It's still based on what CMS determines is reasonable to pay. If Medicare offered a higher or lower reimbursement as of tomorrow for a certain good or service, other companies would do the same. Medicare is the standard for what is paid for every service in healthcare.
 
Gh0st said:
Yes, it absolutely does. The companies determine what percentage of Medicare reimbursement they can pay. It's still based on what CMS determines is reasonable to pay. If Medicare offered a higher or lower reimbursement as of tomorrow for a certain good or service, other companies would do the same. Medicare is the standard for what is paid for every service in healthcare.
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First...it is not what they CAN pay. It is what they WILL pay to maximize their profits. Second, unless they are paying exactly what Medicare pays, they are determining what they want to pay relative to the Medicare standard.
 
ProV1 said:
First...it is not what they CAN pay. It is what they WILL pay to maximize their profits. Second, unless they are paying exactly what Medicare pays, they are determining what they want to pay relative to the Medicare standard.
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What? It's not as if it's a realistic scenario that they can reimburse less than what Medicare would pay. Nobody would buy it because hospitals and clinics wouldn't accept it. Medicare absolutely sets the bottom line for insurance companies. You have a very fundamental misunderstanding of how this works. If Medicare were to suddenly start covering a drug or service, they would have to as well. If Medicare raised their reimbursement, they would have to as well or they wouldn't stay in business.
 
Gh0st said:
What? It's not as if it's a realistic scenario that they can reimburse less than what Medicare would pay. Nobody would buy it because hospitals and clinics wouldn't accept it. Medicare absolutely sets the bottom line for insurance companies. You have a very fundamental misunderstanding of how this works. If Medicare were to suddenly start covering a drug or service, they would have to as well. If Medicare raised their reimbursement, they would have to as well or they wouldn't stay in business.
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No I don’t misunderstand. Medicare might function much like a cost of goods sold in another business as an analogy. It might be a baseline but unless the private insurance industry is paying exactly what Medicare pays, you can’t say Medicare is setting the prices. Simple question....why do prices vary widely for the same procedures depending on who the provider is?
 
ProV1 said:
No I don’t misunderstand. Medicare might function much like a cost of goods sold in another business as an analogy. It might be a baseline but unless the private insurance industry is paying exactly what Medicare pays, you can’t say Medicare is setting the prices. Simple question....why do prices vary widely for the same procedures depending on who the provider is?
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Because health care still has some private sector influences because it hasn't been 100% socialized yet. Cost tends to vary based on cost of living and the laws of supply in demand. In Alaska it may cost you more to get surgery because there's very few surgeons in the state and some equipment may have to be flown in. There's only been recent studies showing discrepancies in certain prices and the first one getting involved in equalizing prices was CMS.

Again, third time I've said it, it's not shocking people are trying to work for profit but Medicare absolutely sets the standard and it's reimbursements vary from state to state. I can say Medicare sets the prices, because the private companies can't reimburse less than Medicare and stay in business. That is Economics 101, specifically the chapter on price floors and how they disrupt market equilibrium.
 
Gh0st said:
Because health care still has some private sector influences because it hasn't been 100% socialized yet. Cost tends to vary based on cost of living and the laws of supply in demand. In Alaska it may cost you more to get surgery because there's very few surgeons in the state and some equipment may have to be flown in. There's only been recent studies showing discrepancies in certain prices and the first one getting involved in equalizing prices was CMS.

Again, third time I've said it, it's not shocking people are trying to work for profit but Medicare absolutely sets the standard and it's reimbursements vary from state to state. I can say Medicare sets the prices, because the private companies can't reimburse less than Medicare and stay in business. That is Economics 101, specifically the chapter on price floors and how they disrupt market equilibrium.
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You just said exactly what I have been saying with the exception of “Medicare sets the prices”. Setting a “standard” or “reference point” or even a “basis“ is not setting the prices. The providers and insurers use that Medicare data point and their own cost and competitive pressures and their profitability requirements and then establish what they will price or pay based on all that data. Medicare be may factor but they do not set the prices.
 
ProV1 said:
You just said exactly what I have been saying with the exception of “Medicare sets the prices”. Setting a “standard” or “reference point” or even a “basis“ is not setting the prices. The providers and insurers use that Medicare data point and their own cost and competitive pressures and their profitability requirements and then establish what they will price or pay based on all that data. Medicare be may factor but they do not set the prices.
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Because Medicare sets a price floor, market equilibrium does not determine the price of a good/service in health care. There is no company that can reimburse less than Medicare, even if they wanted to. If Medicare decides to raise the price floor (aka start reimbursing or reimburse more), the amount paid for a good or service goes up across the board. Private companies cannot reimburse less than Medicare because they are private companies and are subject to the laws of supply and demand. Their reimbursement models have to be attractive to consumers, but they are absolutely confined by what Medicare pays for and how much they pay for it. The only insurance offers less is Medicaid and it should be easy to understand why. It's not a data point, it's a hard floor.

You haven't said any of that, to remind you, this is what you said:

The for profit healthcare system in this country will eventually collapse. The insane cost increases and corruption across the board is not sustainable. It will take significant reform. Unfortunately, the only people that seem to recognize it are those who get sick and bankrupt themselves in the process. As that begins to effect more and more people, our hope is that the will to get something done comes before it kills the economics of the country.
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Your solution is what? Socializing health care? The system you apparently despise is already heavily socialized and it's clearly not done anything to lower health care prices. When Obama tried to move it more to the left, costs sky rocketed.
 
Gh0st said:
Because Medicare sets a price floor, market equilibrium does not determine the price of a good/service in health care. There is no company that can reimburse less than Medicare, even if they wanted to. If Medicare decides to raise the price floor (aka start reimbursing or reimburse more), the amount paid for a good or service goes up across the board. Private companies cannot reimburse less than Medicare because they are private companies and are subject to the laws of supply and demand. Their reimbursement models have to be attractive to consumers, but they are absolutely confined by what Medicare pays for and how much they pay for it. The only insurance offers less is Medicaid and it should be easy to understand why. It's not a data point, it's a hard floor.

You haven't said any of that, to remind you, this is what you said:



Your solution is what? Socializing health care? The system you apparently despise is already heavily socialized and it's clearly not done anything to lower health care prices. When Obama tried to move it more to the left, costs sky rocketed.
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Again, I'm not arguing the influence that Medicare has but they don't set the price. If they did all providers would price the same. We all know that individual companies have other factors that influence their prices. I stand by the statement that healthcare costs will eventual bankrupt the country if something dramatic is not done. Costs are out of control. The US spends something like 9 or 10 times the money of other industrialized countries and gets worse outcomes. As bad as the system is, it is not feasible to go to a single payer model given where we are. Since federal government already insures old people and poor people, it is not extreme to add a public option for those that can not get affordable coverage in the private sector.
 
ProV1 said:
…...I stand by the statement that healthcare costs will eventual bankrupt the country if something dramatic is not done. Costs are out of control. …...
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The ever increasing cost of public funded giveaways will bankrupt us before healthcare will. Government spending increases at a rate above inflation and is being funded by fewer and fewer people. Medicaid costs increase geometrically. Welfare subsidies and wealth transfer scams increase at a rate faster than actual working income. Education costs rise faster than inflation or the income of Taxpayers. We were taxing business more than every other country on the planet and they were transferring jobs in order to hold costs down - what happens if the Democrats raise corporate taxes again? What happens after Sanders or Warren run out of millionaires and billionaires?

Obamascam was wrong because it effectively tried to normalize health insurance for people that don't pay for it. Food stamps used to be actual stamps, now it's a debit card so people using food stamps aren't embarrassed that they are on welfare. Obamascam attempted to do the same thing for people on Medicaid, give some people something that looked like insurance so they wouldn't feel like they were suckling at the teat of other people. It just moved money, it didn't do anything to lower costs. Health insurance doesn't lower costs, just like giving unions more and more money for less and less work never makes an industry more efficient. People either have to do more to deliver the same or they have to get less to do it.
 
SWMCinci said:
The ever increasing cost of public funded giveaways will bankrupt us before healthcare will. Government spending increases at a rate above inflation and is being funded by fewer and fewer people. Medicaid costs increase geometrically. Welfare subsidies and wealth transfer scams increase at a rate faster than actual working income. Education costs rise faster than inflation or the income of Taxpayers. We were taxing business more than every other country on the planet and they were transferring jobs in order to hold costs down - what happens if the Democrats raise corporate taxes again? What happens after Sanders or Warren run out of millionaires and billionaires?

Obamascam was wrong because it effectively tried to normalize health insurance for people that don't pay for it. Food stamps used to be actual stamps, now it's a debit card so people using food stamps aren't embarrassed that they are on welfare. Obamascam attempted to do the same thing for people on Medicaid, give some people something that looked like insurance so they wouldn't feel like they were suckling at the teat of other people. It just moved money, it didn't do anything to lower costs. Health insurance doesn't lower costs, just like giving unions more and more money for less and less work never makes an industry more efficient. People either have to do more to deliver the same or they have to get less to do it.
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Healthcare costs are rising 3-4 times faster than inflation. That’s a big problem.
 
SWMCinci said:
Changing it to Taxpayer-funded doesn't change that. Just makes it a Taxpayer problem instead of someone's personal problem.
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It is already a taxpayer funded problem.....Medicare and Medicaid. For the life of me, I don’t understand folks who think healthcare is a personal problem but are the first to jump on Medicare the second they are eligible.
 
ProV1 said:
It is already a taxpayer funded problem.....Medicare and Medicaid. For the life of me, I don’t understand folks who think healthcare is a personal problem but are the first to jump on Medicare the second they are eligible.
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Probably because they paid for it over their working lives.
It's a benefit that working people paid for.
 
ProV1 said:
And they would also pay for a public option.
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Given a choice, people prefer NOT to give the government anymore of their money. They know it's a bad investment.
The people clamoring for a public option would vote against it if it was their money being spent and not other people's money.
 
SWMCinci said:
Given a choice, people prefer NOT to give the government anymore of their money. They know it's a bad investment.
The people clamoring for a public option would vote against it if it was their money being spent and not other people's money.
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Then you must support giving the people a choice. If it is as bad as you think, nobody will want it.
 
ProV1 said:
Then you must support giving the people a choice. If it is as bad as you think, nobody will want it.
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I have no problem giving people a choice, they can spend their money how they want to. If you can get some minimum wage clerk to fork over 10-20% of their income and provide them with a meaningful insurance program that doesn't require subsidies from Taxpayers that have their own coverage, I'm all for it.
 
Gh0st said:
It's not a trick question. Medicare determines prices, not any of the for profit companies you despise.
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Absolutely accurate- think back to when we were kids and what it cost to get a cast, for instance. Now look up the “cost” for one now. Private Insurance didn’t create this Monster of a system- Medicare and government involvement did. And it will only get worse if the Dems take control.

And to add- lawsuit happy country as well added to costs. And then the huge, money sucking HR departments all large companies have to have now that didn’t exist 30+ years ago.
 
ProV1 said:
And they would also pay for a public option.
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Well, under Obamacare they didn't. They paid the penalty. It was cheaper than their premiums were.

I can't understand people that can't acknowledge that this experiment has already been tried and it immediately failed.
 
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