The NC state employees health plan is trying to get hospitals to accept Medicare X 1.82

[dsc]

as reimbursement for serving the 77,000 state employees. So far, and the deadline was 1 July, 3 hospitals have agreed. One in Randolph County (west part of the state about equidistant from Charlotte and Asheville) one in Durham, and one in Williamston which is in the inner banks north east of Greeneville. I am one of the lucky ones, I would have only an 81 minute commute to one of them and about 90 minutes to another. By October we will be enrolling for next year. If we can't get hospitals to accept nearly twice the Medicare rate, then how is Medicare for all going to work? We need to be honest about this.

https://www.wral.com/deadline-passed-but-standoff-continues-between-hospitals-state-health-plan/18489278/

[Farmer-Rick]

1. The power of a crowd

For awhile, pharmacies on Tri-Care, Express Scripts, the military health insurance, were refusing to take Tri-Care because it didn't pay enough. Tri- Care called their bluff. First WalGreens refused And a year later low and behold you could use Tri-Care at WalGreens again. Then CVS did it, and sure enough, a year later they were back. Neither pharmacy closed and both backed down.

They lost so much business by refusing the insurance their capitalist kings who owned them objected, plus it was bad PR.

That's why we need a federal government program for health care. If the hospital refuses their prices, they will lose a whole lot of business. That is the power of organizing into a large group.

[dsc]

2. we have to be the largest group in NC other than Medicare and Medicaid

we have 77,000 insured. It is teachers, and all other state employees.

[Farmer-Rick]

5. Yeah, the reason Walgreens and CVS thought it was a good idea to stop taking military health care

aside from the higher prices they wanted, was they thought they coud get the politicians to submit.

In NC, they probably think they can get the politicians to submit and they get to keep their higher prices. Turns out, the barely disguised bribes they call campaign contributions were just not enough. It maybe in NC. But eventually, if voters and the masses hold steady, even this advantage will be squashed.

[dsc]

6. the problem is that hospitals will be out of network to us until this is rectified

and if I have need of a hospital in that time I can't shop around.

[Farmer-Rick]

10. Oh, I see that

At least with pharmacies, one of them dropping out is no big problem because there are so many others to choose from.

Regional monopolies prevent competition and really screw up a market.

[watoos]

3. Democrats who are for single payer health care

should have stayed with that nomenclature. They shifted to Medicare for all to make it sound more appealing which IMO was a mistake.

Medicare basically pays 80%, so if your hospital bill is $1,000.00 Medicare will pay $800.00 and you will either have to pay the difference or pick up a secondary insurance plan. I'm pretty sure that this private state insurance plan isn't offering to pay hospitals double what Medicare pays. They would be paying $1,600 for a $1,000 hospital bill.

[dsc]

4. yeah it is offering that

or at least 1.75 (that was the figure I saw in other reports). Hospitals charge different patients different amounts depending upon their plan or lack thereof. I am also on 80/20 but only in network.

[Farmer-Rick]

9. I don't know about that.

Around here in east TN, Medicare has a really good reputation. And we have a lot of Trump voters roaming around.

But when you talk to people and ask about Medicare they get confused with Medicaid. But once you explain the difference, they have a better opinion of Medicare. There is a lot of Kidney disease here (though it is reported as obesity or diabetes deaths) and Medicare picks up dialysis. So, they generally have positive views of Medicare for keeping their grandparents alive.

[Celerity]

13. Yes, it was a marketing move by Bernie, but his plan is far beyond Medicare.

Pure single payer, with zero co-pays, zero premiums, zeo deductibles, zero pharma costs, free dental, so nothing out of pocket ever, except the increased federal tax. He also bans all private insurance except for luxury/elective policies (ie for cosmetic surgery, etc.).

It is a pipe dream for the US. Even the Nordics don't have that (Sweden is close, but dental is not free (there is a subsidy scheme that is far too complicated to get into here, but it is very robust), and you do have to pay around 120 usd per year (max, and many never hit that) for all medical care, unlimited coverage including any hospital stays, any operations, and around 240 usd a year (max) for unlimited pharma, even if it is ultra expensive boutique drugs.

The big lobbies (doctors, hospitals, private insurance, and big pharma) will never allow it (Berniecare) to pass. They will spend billions to make sure. Too many vindictive, mis-informed, greedy, hateful, selfish people who inhabit the vox populi as well. The lobbies will wind them up into a blood rage.

Over the next decade the US will spend close to 50 TRILLION USD or so on healthcare. That's around 2 and a half times the entire national debt. The oligarchic class of systemic controllers will never allow their talons to be removed from that golden egg-laying goose.

[WillowTree]

14. "....... so if your hospital bill is $1,000.00 Medicare will pay $800.00......." Ummmm.......no.

This is totally misleading and inaccurate.

For most outpatient charges, Medicare pays 80% of the amount that Medicare allows for the given service, and the allowable amount is usually far less than the hospital's usual charge for the same service. So if the hospital's usual charge to any other insurer is $5000 but Medicare only allows $1500, they will only pay 80% of $1500 or $1200 (assuming the Part B deductible has been met. Otherwise that will have to be deducted and then the payment would be 80% of the remaining balance.) And by law, the hospital cannot bill anyone for the $3500 that Medicare disallowed. What the State is asking is that the hospitals accept 1.82 times the Medicare allowable amount as the full charge, so instead of the allowable charge being $1500 and the plan paying $1200, the allowable amount under the plan would be $2730 and the plan would pay its benefit based on that amount. So if the plan also pays at the rate of 80%, they would pay $2184 leaving a balance of $546 for the patient to pay. This is similar to the way many insurance plans negotiate fees with hospitals.

For inpatient charges, it's a different and more complicated computation, but just to give a real life example, when my Dad was in the hospital, their usual charges for that stay amounted $43,931.36. Of that amount, Medicare disallowed $31,892.64 and by law, no one...….not my father, not his Medicare Supplement...….no one can be billed for that amount. The hospital just has to eat it. Then, of the $12,038.72 balance, Medicare paid $11,235.10, leaving $803.62 that was billed to and paid by his supplement. Under the State's proposal, they would allow $21,910.47 and the insurance would pay their benefits based on that amount instead of the full $43,931.36.

[cbdo2007]

15. "the hospital has to eat it" The hospital can write it off as a business loss.

That's one reason why they bill such high amounts they know they won't get. All the "losses" are offsetting their profits at tax time.

Imagine if you went to the grocery store and a loaf of bread was listed at $10. Then you get up to the register and it only rings up at $1.95 and they were able to take a $8.05 loss on that loaf of bread.

All parties are complicit in the ridiculous health care scam - Medicare, Insurance, IRS, Hospitals, Doctors, Pharmacies. The only thing that can lead to true change is an overhaul of the whole system, rather than pointing fingers at any specific part of it.

[JCMach1]

7. Make it mandatory to accept ANY Federal funds, or insurance

Accept all, or go 100% private should be the law.

[SouthernProgressive]

8. .

https://www.democraticunderground.com/1287203655#post3

[area51]

11. You might want to take a look

at various articles on the PNHP website; this physicians' group has looked into issues like this. I find it interesting some feel as if this is an impossible task; other countries have transitioned to various forms of public healthcare and not had all their hospitals close or refuse patients.

[dsc]

12. In Canada hospitals are non profit for the most part

http://www.cwhn.ca/en/node/39754

In Germany it is 55% government owned, 38% non profit, 7% for profit

https://www.justlanded.com/english/Germany/Articles/Health/German-hospitals

In France it is 62% government owned, 18% non profit, 18% for profit.

https://en.wikipedia.org/wiki/Health_care_in_France#Hospitals

I think that explains the difference.