The problem with Medicare for all is the false assumption that Medicare is working now.

[newtothegame]

I work in a non-profit cancer center providing medical oncology and radiation oncology. We are reimbursed ~$.51 on the dollar for Medicare patients and ~$.38 on the dollar for Medicaid patients. Contrary to many DU'ers beliefs about healthcare, this is on our COSTS, NOT CHARGES. So we are losing $.49 for every dollar on Medicare patients (treatments usually costs tens of thousands of dollars) and $.62 for every dollar on Medicaid patients. Medicare and Medicaid make up 70% of our patients. We are the only cancer treatment option for 90 miles around, and being extremely rural, our average patient is over 60 years old.

As a non-profit, we don't need or want a profit. But we do need to cover costs to keep our doors open. Buy the medicines, pay the workers, etc. And covering costs would not cover purchasing of new medicines, or new technology, or expanding our space as we see more patients.

We also lose money on most commercial insurers, but it isn't nearly as bad. We get ~$.80 on the dollar for our costs for commercial payers.

The only reasons we're still open is because 1) we have a benefactor who passed away in the mid 90's but whose foundation still regularly donates and 2) we as staff take barebones pay and do everything we can to keep expenses to a minimum because we care so much about this place and our patients, and realize how devastating it would be to see it go.

So my question to the "Medicare for All" folks is, if our government can't afford to reimburse Medicare care at more than $.51 on the dollar NOW, how the HELL would we stay open to treat patients if ALL our patients were Medicare/Medicaid? Our doors would be closed within 60 days and the only provider of cancer care in 30 counties would be gone.

The ONLY reason Medicare seems like such a great and affordable program to so many is because Medicare isn't actually paying for care at all. It's affordable to you because it's BANKRUPTING hospitals and clinics. Medicare for All is not a realistic cry at this point unless the government decides to make Medicare a TRUE reimburser of care.

On edit: :rant: Sorry for the rant, but this issue really upsets me and I think there's a lot of misinformation amongst those who don't actually work in healthcare.

[stray cat]

1. And that means people paying to fully fund Medicare

[NNN0LHI]

8. How is my memory on this?

When Dennis Kucinich and some others came out in favor of Medicare for all last year didn't everyone say, "Yea, buddy, sure sounds good to me.", until the costs for such a program were revealed?

As I recall, and I may be wrong, the price was between $600 and $800 per person per month, depending on the state. At that point everyone became unexcited about DK's idea?

Am I remembering this right? Or did I dream that?

Don

[Recursion]

10. Yep. We worked that out several times on the board

And the $600 to $800 per person only gets the level of under-reimbursement that the OP is having to deal with.

But, at some point, supporting single payer as an idea became more important than finding a way that we could actually afford to pay for the healthcare of an obese, unhealthy, and economically unequal nation.

[tabbycat31]

11. I think the causes of high health costs need to be tackled

In your post you mentioned obesity.... good place to start. A good portion of healthcare costs come from chronic diseases like diabetes (which is linked to obesity in many).

Why not tackle the issue of obesity in relation to the costs-- I know Michelle Obama is starting to, but I lost about 40 lbs when I eliminated HFCS from my diet. How about we end the government subsidies of HFCS and put a 1% sales tax on any items with it and use the $$ to fund health care.

[Recursion]

13. I'm all for changing ag policy to stop subsidizing unhealthy food

That will be a political bloodbath but I'm all for doing it.

There are about a million other issues, too. Guns. Cars. Drug use. Sedentary lifestyles (TV and the Interwebs). Ignorance about reproductive health. Guns I'll leave be for now, not wanting to threadjack. Cars? Well, fixing this would involve re-working how we view cities and suburbs and making walkable communities linked by public transit. Sedentary lifestyles? Not even sure how to start to address that. The list goes on.

The health care system is kind of like the kidneys: it collects all the shit from all the other parts of the system. And you have to clean the whole thing to get it back working.

[tabbycat31]

23. I think it will never be done politically

as long as the presidential election first and foremost starts in Iowa.

[Recursion]

24. I hadn't even thought of it that way

Excellent point

[truedelphi]

75. I love the idea of a $ 1 tax on all things with

HFCS. I have cleaned up my diet, but there are literally only two or three foods I can purchase from the processed foods section. These are pumpkin in cans, pineapple in cans and tomatoes in cans. All the other processed items contain HFCS, and/or MSG. This means I have to bake whatever bread I eat, whatever cookies I eat and all that. Usually Ihave tomake granola also.

[wilt the stilt]

16. so fund it higher

$600-$800 gets us th the same situation as now. We all pay in the neighborhood of $1200- $1400 now between our employer based and our money we put in. This doesn't even include our copays, deductibles and money we pay because our services are above customary charges.

[Recursion]

19. Delete

Retracting

[stevenleser]

59. Interesting point but I would love to see the math fully done out on this and other options

the other thing that Medicare for all has going for it is that it is business enabling. I mean that in a good way. If I am going to start a new small business, the huge amount of $$$$ I am going to have to pay every month to fund healthcare for my employees is a serious issue and may make the difference between whether it makes sense to go forward with the enterprise at all or whether it survives.

[lumberjack_jeff]

64. Healthcare, the entire system, costs about $7000 per person per year.

The cost will never be reduced so long as private companies are able to drive up prices.

Medicare for all implies that it'd be funded by income taxes.

[wilt the stilt]

65. does that include the 50 million not

paying into the system? In other words are you taking the total amount paid in premiums and dividing by 308,000 or by 258,000. The 50 million who don't pay receive no benefits. Also are you including the 2.9% of our wages paid to medicare? How did you arrive at that figure?

[lumberjack_jeff]

66. Yes.

http://www.reuters.com/article/idUSTRE54Q3RG20090527

Those who don't pay may or may not receive benefits.

15.9% of gdp divided by the total US population = about $6700

[Recursion]

71. 7k per head means per every man, woman, and child period

Assuming it's the same calculation I've seen before. It's literally just dividing the amount spent on actual medical care by the population. (2.6 trillion or so by 350 million or so)

[wilt the stilt]

73. figured it out once i saw the later post

[jtown1123]

2. They can certainly afford it. They just would rather spend the money on defense

and tax cuts for the rich. Just another example of class warfare and who our government truly serves.

[grahamhgreen]

5. +1

[tavalon]

3. Yeah, having just helped hubby give away his medicare in favor of an HMO

so he can actually get care, I've been rather appalled. I do want single payer but I also want the "healthcare system" to be government owned and controlled. But then, I'm not just a nurse, I'm a socialist. I really believe the biggest problem is the leeches upon the system.

[dixiegrrrrl]

12. How does one "give away Medicare" in favor of HMO?

Being on Medicare, I am curious.

[Recursion]

15. I think they used to be called Medicare+ Choice or something like that

Then "Medicare Advantage". You give up your Part B benefits and join an HMO. This changed drastically under HCR, though I don't know how it would affect individuals (basically, the HMOs are about to get more expensive).

[enough]

26. OK, I get it. I actually am on a Medicare Advantage program. One still pays the

basic Medicare premium, plus an extra premium for the HMO part. So I think of myself as still being "on Medicare," with hopefully more of the out-of-pocket expenses paid, especially with long a hospitalization, etc.

Not sure how well it works, since we've never really put it to the test, and I hope we won't have to. I'd be interested in other people's experience with it.

[tavalon]

18. Starting in January he will be with Puget Sound Partners

an HMO that our doctor accepts. Our doctor no longer accepts Medicare because as was mentioned in the OP, Medicare is reimbursed in a half assed manner. They will get the amount that he pays to Medicare and they will provide certain hmo proscribes services.

[Cleita]

47. Medicare Advantage.

You sign away your Medicare rights in favor of a private insurance company. It seems like a good deal until you actually run into one of their caveats like my husband did when he had a stroke and we were on vacation. I had to call an ambulance to get him to the hospital and I called to get approval after the fact from the insurer. They denied everything almost $10,000 of care because of that. Medicare wouldn't pay anything because he had signed away his rights.

Also, a lot of the expense of the Medicare system is because of the privatization of Medicare and the money being leeched to the private sector. We also found out when we got home that no doctor in our area was accepting the advantage programs, but they did and still do take traditional Medicare. It turns out the private companies were paying less to doctors and hospitals than the government was on traditional Medicare.

A

[pitohui]

70. i used to be in an HMO, i wouldn't expect to get any care

HMOs always have some reason why they don't cover that

the folks i know w. medicare at least get care -- and some of them get excellent care (like my parents)

i'm lucky to be alive, having gone 15 years w. any insurance, then getting into a worthless HMO for another couple years...HMO is something that is wonderful and modern just because it's an acronym, it's pretty much a scam from what i can tell

[enough]

14. I too am curious what you mean by "give away his medicare in favor of an HMO."

I'm also on Medicare. What strategy are you suggesting here? Thanks.

[Recursion]

17. Not to put words in Tavalon's mouth, but that sounds like Medicare Advantage

You stop receiving Part B benefits and use your Part B premiums to join a subsidized HMO. But those subsidies are being decreased by HCR.

[tavalon]

20. Correct words placed

Puget Sound Partners to be exact. We resisted but when he needed to see the doctor last year, it cost him nearly 500.00.

[Recursion]

22. Are the subsidy cuts problematic?

I haven't heard from anybody on MA and I'm hoping some of the horror stories the Advantage HMOs spun in advance of HCR aren't true.

[jtown1123]

57. Basically, a lot of MA plans were wasteful and those subsidies were being picked

up by taxpayers and seniors on just basic Medicare. HCR is forcing those plans to be accountable and spend a majority of their money on care instead of profits or overhead.

Here is a pretty good explanation: http://www.youtube.com/nationalcommittee#p/u/19/vrQCtXgbdKE

Some MA plans are good, some are bad. HCR is trying to get rid of the bad ones.

[grahamhgreen]

4. We will do it the same way it is done in the rest of the civilized world.

If they can do it at half he cost, so can we

[Recursion]

7. Then we have to do A LOT of things

And making a single payer system isn't even the most important.

We have to get rid of the AMA's stranglehold on med school class sizes.

We have to make med and nursing school free or at least affordable.

We have to negotiate much drug prices with pharma (but remember, currently our overpaying is subsidizing all of the other industrialized countries' drug prices). And medical device manufacturers.

We would have to get rid of the bourgeois' attitude that they can see any doctor they want, at any time they want, and get any treatment they want without waiting.

We would need to change our ag policy so that unhealthy foods are no longer unrealistically cheap at the cash register

And we would need fewer cars, guns, and, not to put too fine a point on it, fat poor people -- those are some of the biggest factors differentiating our health care costs and health care outcomes from those of western Europe.

[TreasonousBastard]

29. You make fine points, and I would add...

it's my understanding that most Europeans have gone from the fee-for-service model we use to a "treat-the patient" model that reduces much of the testing and leads to more efficiencies in diagnosis and treatment. Pregnancy and childbirth are one example-- here we charge by the visit and procedure for everything, but in better systems once a woman becomes pregnant she is guaranteed complete pre- and post natal care, reducing potential problems and reducing overall costs. (To say nothing of being better for the mother.)

I've noticed every hospital patient seems to have a parade of doctors at the foot of the bed reading the chart for no other reason than to submit a bill. Some consultation is a good thing, but this is too much like the old lawyer's habit of showing up at any deposition or hearing they might conceivably have an interest in when there are no other billable hours available. The health providers should be paid for what they do, but they have to find realistic ways to cut expenses. The hated insurance companies have been on top of this (and fraud prevention) but the more they do the more they are attacked. Somewhere there has to be a reasonable middle ground.

It would also take a sea change to get away from the big cloud of dust as newly minted doctors run from low-paying family practice and try to get into dermatology residencies. Not having that albatross of half a million in student loans to get that far would certainly help.

Talk of "death panels" clouds the issue and adds too much emotion to a very serious subject-- there are simply not enough resources to treat everyone for everything on demand. Worse, as the population ages, we'll see some seriously budgetbusting expenses in end-of-life care, and we have to have some plan to deal with this.

With the large number of people all looking out for their often competing self-interests and some holding almost religious beliefs in one policy or another, it will not be easy to come up with a good plan to cover 300 million people spread over a continent.

[customerserviceguy]

46. How about fewer lawsuits

that sap the strength of the existing healthcare system? If I recall correctly, the countries that provide healthcare for less than we do don't have the antiquated tort system to deal with malpractice.

[Recursion]

49. That's the GOP's line, but I'll grant them that

I'm not down with "tort reform" as it's usually presented, but certainly liability insurance and the tort system as they are have something to do with the problem.

[customerserviceguy]

53. There are ways to effectuate tort reform without caps

First, if we had something like a Workers Comp board to take malpractice cases, people could be assured getting the healthcare they needed while the cause was being looked into.

The tort system as it stands today simply provides great uncertainty for both the injured parties, and the wrongfully accused. It leads to 'defensive' medicine that wastes scarce resources, it clogs our civil court system, it makes lawyers rich off of others' misery, and it keeps the results secret by the use of gag orders. Do they do that in Europe?

[grahamhgreen]

58. One of the great things about Medicare for All is that all claims relating to future medical costs

are already covered.

This helps to reduce compensatory damages, and insurance costs.

This is even more true with car insurance.

[JVS]

6. Maybe single payer isn't enough. Maybe our system is so fucked up we need to do national health...

like the UK

[Ron Green]

9. It's simple, if not easy:

1) Everybody in, nobody, out. Medicare for all.

2) Quit subsidizing Big Corn, and Big Soy and make policy that truly builds the public health.

3) Have a realistic dialog about death and all the kinds of end-of-life issues that have been driven for decades by the AMA, Big Pharma and other corporate players. Look at "hospice" rather than "hospital" as a first choice.

[county worker]

25. No it is not simple.

I was a controller at a medical clinic. What the OP says was true for us too.

You have no idea of the problems involved so for you it is no skin off your ass to say "it's simple."

People have to pay for the care whether in taxes or something else. Nothing is free.

[Ron Green]

55. You didn't even read the title of my post.

I said, "not easy."

Of course care has to be paid for. That's why we must quit paying for corporate systems that enslave people or kill people, detach human happiness from economic growth, and lots of other things including the three elements I outlined in my post.

[Lint Head]

21. Big pharmacy and outrageous mark ups for medical services

is also a large part of the problem. I had a kidney removed because of a tumor. The MRI charge was ridicules. They charged $1500 for a what they termed "a different view " . They did one damn scan. The average is 40% of a doctors income is Medicare. I have been witness to doctor complaints regarding Medicare. When they are ask to stop taking Medicare money they say nothing more.

[iamtechus]

27. That's it, blame the old, the indigent and the government.

When these systems are out-of-balance it surely couldn't be that you are being gouged by the vendors of goods and services you use. :sarcasm:

[hfojvt]

28. approximately how much is "barebones pay"?

Enquiring minds want to know.

[newtothegame]

36. I can't speak for all my colleagues but I am an oncology nurse and I do the billing as well. $31k.

Schooling is paid off, but more from taking side jobs than from the salary I make here.

[dixiegrrrrl]

30. Data-base of free/low cost med clinics in USA:

I post because some here may not have health coverage yet
and/or
some of these clinics do take Medicare/Medicaid.

http://www.needymeds.org/free_clinics.taf

Hopefully the law under which these clinics operate will remain intact for some time.

[Recursion]

34. Don't forget FQHCs!!!

http://findahealthcenter.hrsa.gov/GoogleSearch_HCC.aspx

Federally-funded health centers care for you, even if you have no health insurance. You pay what you can afford, based on your income. Health centers provide
checkups when you're well
treatment when you're sick
complete care when you're pregnant
immunizations and checkups for your children
dental care and prescription drugs for your family
mental health and substance abuse care if you need it
Health centers are in most cities and many rural areas. Type in your address and click the 'Find Health Centers' button to find health centers near you.

[dixiegrrrrl]

61. Bookmarked, with thanks.

[Recursion]

62. Sanders managed to sneak a huge increase in funding for them into HCR

It's why he eventually went along and voted for it.

[enough]

67. Thank you so much for this link! My son-in-law is uninsured and though he's very healthy,

I sometimes wake up in the night wondering what would happen if he needed a doctor.

[Recursion]

72. I have no idea why this isn't more widely advertised

Though maybe HRSA thinks the clinic system couldn't take the influx of patients if it were.

This, incidentally, is a way I could see our healthcare going and have it work. Federally subsidized providers with patient payments based on a sliding affordability scale.

[area51]

31. This is part of the problem.

You mentioned, "... if our government can't afford to reimburse Medicare care at more than $.51 on the dollar...". But we can afford to pay decent prices to medical professionals. There's money, but it's being funneled into two wars of choice, keeping multiple military bases running that aren't necessary, buying more and more war toys, and giving money to Israel to buy said war toys. There would have to be a lot of talk engaging the general population bringing up the point that all this military spending is not making us safe, just the opposite. Note that a recent claim by our govt. is that al-Qaeda was planning on poisoning our food supply. Don't think it isn't noticed by others that this country's health care delivery system is broken, with health care rationed on personal wealth, and it's a good place to attack. End the wars, cut the military budget, and start investing in infrastructure, which includes Medicare, expanded to all U.S. citizens, and paying a decent amount of money.

[truedelphi]

76. Yep, you've nailed it. In fact, just the other day on DU,

There was a topic devoted to discussing some 68 billion bucks that no one can account for over in Afghanistan. That would go a long way to helping a couple of hundred clinics help their patients and get 100 cents for every dollar of cost involved.

But no, we have to have these endless wars.

[Javaman]

32. Got to love the hit and run posts. nt

[ItNerd4life]

41. Like yours? nt

[newtothegame]

43. Thank you. I'm actually right here reading and appreciating people's thoughts and comments.

Apparently that poster is one of those that is on DU more in a desperate search for trolls than they are to actually use this as a discussion board.

[Javaman]

78. Yup. Like mine. :)

Have a nice day, won't you? LOL

[shimmergal]

33. The only way is to have a cramdown

in charges for those new medicines, new technology etc.

I'd be surprised if 90% of what it costs you isn't pure profit to the companies who sell you the medicines and devices.

[newtothegame]

42. Understood. But why is Medicare's reaction to underfund us instead of regulating those prices? nt

[Dappleganger]

44. Quite honestly I think it's because the gov't is afraid of big corporations

They know who breads their butter.

[qb]

35. VA Care for all has also been suggested. From my perspective VA medical care is phenomenal.

I know some VA medical centers have had bad reports, but in Minnesota it's first rate.

[Recursion]

37. It depends on what you need

I've had good luck with routine physicals, and my buddies with TBI say they're getting a lot of attention. I think it's the chronic care stuff in between those two that can have problems (that's the same thing that's having problems in Medicare and the private system, too: diabetes, autoimmune disorders, etc.)

[rucky]

38. Bankrupting, or cutting into profits?

How many hospitals and clinics go bankrupt over Medicare?

[Recursion]

39. OP said "non-profit"

And in this case only surviving based on a grant from a foundation.

[bhikkhu]

74. ...which really makes no sense

If serving medicare patients is bankrupting a non-profit, how is it that we still have a majority of for-profit hospitals serving medicare patients? The only plausible explanation would be that for-profits just overcharge everyone else to make up the difference, or something is wrong with the numbers.

[Recursion]

77. The former

The only plausible explanation would be that for-profits just overcharge everyone else to make up the difference

Yes. Those of us with private insurance subsidize Medicare and especially Medicaid because providers charge us more to make good their losses. Medicare is great for cash flow (the government is reliable) but bad for the bottom line.

[ItNerd4life]

40. I notice many posts are only insulting to you

and they don't try to answer the question.

Medicare and Medicaid are national healthcare plans, and they don't work well.

My questions to you are:
Republicans say changing the 'legal' system would help lower the doctors insurance costs. Is this true and would it lower your costs?
What can be done to make insurance companies pay more than $.80 on the dollar, for your costs?
What is your clinics cost per operating hour?

I would love to know more and hear what else you have to say.

[newtothegame]

60. Thanks for your reply. To your questions:

1) Yes, there are ways to change the legal system to lower medical malpractice insurance costs. I don't follow this debate that closely but it would likely involve a maximum recovery amount. I don't think that capping recovered dollars would affect our costs that much, but making doctors more comfortable to NOT image, test, etc. would. I can only speak for our center, but the medical industry as a whole way over-treats out of concern that an overzealous attorney will shoot for an 8 figure settlement if we misdiagnosis a patient. So someone smarter than me would need to develop a better system in which patients can sue when need be, but the penalties aren't so astronomic that it negatively alters the way a doctor practices. I strongly believe that we can't rabidly defend malpractice suits but also complain about overtesting.

On a side note, if we were to change the legal system, the change I'd like to see is punitive damages going to charity, across all legal cases. If the plaintiff is already getting a chunk of money when they win a case, and the punitive damages are merely intended to send a message to other potential offenders, why do this additional money need to go to a defendant? Why can't it go towards a good cause?

2) For the private insurance companies, there's not much negotiating on that $.80. It's great that they're getting a lot closer to cost than Medicare/Medicaid, but it's certainly not charity and they certainly aren't getting a Christmas card from me :). There's a common misbelief that providers and insurance companies sit down annually/once every few years and negotiate rates. This may happen if a provider is big enough (think health system), but for the rest of us, we basically get a letter saying "this is what we're paying you this year."

3) Operating cost per hour is a fascinating question, one to which I have no answer, sorry! I can tell you that as a team, we've come together through lean/six sigma activities to shorten treatment times and waiting times, so we can be more efficient with our resources. I know this is a contention of a lot of folks, that there's some magical 50% margin of waste that hospitals can get rid of. Unfortunately, at least in our case, that's not true; we're about as lean as we can get without shutting the doors!

[customerserviceguy]

45. You make an important point

Medicare works only because people like you are willing to make sacrifices, and there are patients with private insurance out there who can pay costs that are third-partied on to them.

[Recursion]

50. Yes. That's the "hidden subsidy" to Medicare

Hospitals charge private insurance more in order to make up the Medicare (and especially Medicaid) losses. As I read OP's post they don't have the private insurance customers to do that to, so they have to rely on private benefactors.

[Vinca]

48. I think when people say "Medicare for all" they mean use the basis

of what exists to create a decent healthcare delivery system in this country. Medicare as we know it now would not stay the same because, suddenly, there would be younger and healthier people in the mix. I appreciate the fact that you work for a nonprofit, but that doesn't make you immune from being screwed by big pharma and other providers of the means you need to treat patients. The whole system needs to go under the microscope because there are obscene profits being made in some sectors.

[Cleita]

52. Well said Vinca.

That is exactly the reason it has to be for everyone. First you need the mix of young and healthy in the pool. But also, when everyone is getting the same benefits, they demand better. When all the doctors and other providers must rely on the reimbursements for their income they will demand better across the board too. Also, the Big PhRMA prices are negotiated in every other country in the world except by our Medicare Part D although the VA negotiates. The Republican governments who have shot holes in the system have succeeded in crippling it if not breaking it, but it can be fixed if there is the will of our elected Reps to do it.

[Cleita]

51. Look at it this way.

You wouldn't even have those patients if there wasn't some way of paying for it. In Canada, doctors and hospitals negotiate for fees with the provincial governments running their Medicare so that they can meet expenses. This is what is needed here.

[JCMach1]

54. Medicare is failing because health care can never work as a for profit enterprise...

You can't have capitalist competition without choice...

For the vast majority of people with healthcare, there simply are no choices any more.

[jtown1123]

56. I don't think you should necessarily blame Medicare as a whole. Cancer treatment is pretty different

and more specialized than the rest of the functions of Medicare. Cancer treatments provides much more challenges and costs to Medicare than regular GP check ups, diabetes, heart conditions, etc.

[lumberjack_jeff]

63. I need to see the math before I can agree with you.

How much money for a treatment which directly costs the center how much?

I fully accept that medicare/medicaid pay less for procedures ("reimburse"? Do I reimburse the grocery store for a sack of potatoes?) than private insurance, or worse... what the provider will charge an uninsured individual, but until I know what the charge is and what the related costs are, this is an anecdote.

Something else that might be helpful; How much does the executive director for your nonprofit take in salary? Do the boardmembers take a salary? To whom and for how much is the facility leased? I've often seen "non-profit" used in a way that suggests it's something that it isn't.

Don't misunderstand what I'm saying. I'm thankful that your organization exists to serve your community, but I've noticed a complete blindness in medical care providers and their employees to understand what "bare bones" really is - they become numb to the vast sums of money which flow visibly and invisibly through their system.

Despite the fact that the US government tries to control costs, we spend nearly $7000 per person, almost twice anyone else.

[newtothegame]

68. I don't think an argument over semantics is a good use of our time, but ok, I'll play that game.

The term "reimbursement" is appropriate when we get money 90 days+ after providing services. This is common terminology in the medical field. We are not "paid" for anything we do. That would imply that there is an exchange of payment upon services rendered. That, however, is not the case.

We provide a service, at our cost, and the government "reimburses" us a fraction of that cost 2-3 mo. down the road. I'm accepting that fact because I won't walk away from our patients, but I will damn well stand up and shout that MEDICARE FOR ALL would be a disaster if all that means is a current expansion of the reimbursement system to every patient.

As for your other questions, you can read about our salaries in another post of mine above. We do not have an executive director, but a volunteer board who ultimately makes decisions for the center on behalf of the patients in our 30-county service area.

Yes, alot of vendors we work with probably make a profit. Yes, we probably waste. But the medicines we buy from those vendors are CRITICAL for our patients. The government bankrupting us will not make the medicines from the vendor any cheaper.

P.S. I am in favor of single-payer. But single-payer at 51% of costs or worse will close every clinic door in America. So instead of the MEDICARE FOR ALL cries on DU, how about SINGLE-PAYER WITH A WAY TO FUND IT!

[eomer]

79. Re: Medicare-for-all vs. single payer with a way to fund it

Your points make sense to me and as I think about it, it seems that Medicare-for-all may be a good way to brand it but is not really possible to do literally.

Medicare currently has mechanisms based on the fact that it is only a piece of a larger system. If you made it the entire system then those mechanisms would fall apart. So Medicare-for-all could not be just a simple bill that applies Medicare as it currently exists to everyone. Rather, it would have to be something similar to Medicare but with significant changes that are obviously required if it is the entire system. Maybe it then essentially ends up being the same as what you're calling single-payer with a way to fund it.

[pitohui]

69. it's working better than not treating people at all for their cancer

which is what happens if you're too young for medicare and too old for private insurance

and don't even bother to tell me it doesn't happen, as i know better

they don't have to do anything but stabilize you if you don't have insurance or medicare...and they don't even have to stabilize you if they don't have an emergency room!!!