First\nand foremost, happy new year! <\/p>\n\n\n\n
I have\ntaken a break from writing these blogs for several reasons. One, I have been super busy with new projects.\n Two, I needed a break to get a wider\nperspective after the U.S. midterm elections. \nLastly, I needed to figure out how to address this new wave of\nhealthcare reform called \u201cMedicare For All\u201d (MFA).<\/p>\n\n\n\n
First, I\nwill admit that I have some internal conflicts. In my earlier life in this profession, I loved\nproviding care to those that needed the most care \u2013 our elderly. I have managed companies that provided care\ncollectively to 40,000 Medicare and Medicaid beneficiaries. It was an amazing experience, and will likely\nbe again, as we renew our business interest in that segment of healthcare as a\nMedicare Advantage provider of services. <\/p>\n\n\n\n
I am\nconflicted, because I have real empathy for those who are uninsured. In my own life experience, I have had gaps in\ninsurance coverage that have both scared me and had a major financial impact on\nme. I also know how much this revised\nMFA will cost. We will talk more about that\nlater in this blog. <\/p>\n\n\n\n
One last\nconflict is that I turned 59 during the (U.S) holidays last year, and though\nretirement has not entered my mind, I will be eligible for Medicare until 2025.\n That is scary and remind me of the tidal\nwave of retirees that will hit Medicare in the next decade. <\/p>\n\n\n\n
Medicare\nexpects a record enrollment in Medicare from baby boomers in 2024 to be exact\u2013\nthe peak 65th<\/sup> anniversary or the peak year for our generation. Therefore, I predict the next 10 years in\nhealthcare will be the most stressful and likely the most innovative. Remember that baby-boomer doctors are retiring\nat record numbers, as well, and that will impact access to healthcare for\nnearly everyone. However, that is a\nstory for another day. <\/p>\n\n\n\n Since\n1991, when I entered into healthcare in South Florida (where millions have come\nto retire), Medicare or Medicare Advantage has been the main concentration. First in just traffic, and later when I was in\n100% managed care, it represented equally 100% of revenues. Collectively, those 40 medical centers had\nthousands of Medicare visits a month. Additionally,\nI managed several ancillary providers, third-party administrators, and even\nserved on the board of a hospital for six years. I note this only to reference that I have widespread\nhealthcare delivery experience.<\/p>\n\n\n\n The\nbattle cry for a \u201csingle-payer\u201d<\/strong>\nhealthcare system in the United States goes back decades. The most recent and loudest voice today is\nthat of recently elected United States House of Representative Alexandria\nOcasio-Cortez or \u201cAOC\u201d, as her fans refer to her. I have watched her emergence into the\nheadlines with pride as a Hispanic American<\/a>,\nsurprised as a businessperson, and with serious concern as a taxpayer. My biggest concern as a healthcare executive,\nis understanding the facts and our system of care today is near the breaking\npoint. We cannot immolate a single payer\nlike most countries with socialized medicine, because the demographic impact today,\nis crushing. It was a totally different\nexperience for Europe and Japan coming out of the Second World War with\nexploding populations and rebuilding of industries, like healthcare, from the\nground up. <\/p>\n\n\n\n I have a\nfascination for flying, so I will use that type of analogy to explain. Adopting MFA today in the 21st century, would\nbe like trying to change an airplane engine while the plane is in mid-flight. It may not be impossible; however, who would\nvolunteer to be a passenger on that first attempt? <\/p>\n\n\n\n I could\nexplain all the pros and all the cons, and at the end, give the reader of this\nblog a summary; or I could just state the conclusion first and then explain the\nreasoning behind it. I have many friends\nand colleagues and even some critics that have literally asked me to use my 28\nyears of experience in healthcare (at nearly all levels as mentioned earlier)\nto give them my opinion.<\/p>\n\n\n\n Without\na single doubt, MFA will be catastrophically crippling economically, as well as\ndestroy the current quality of care given today, to all Americans. Let\u2019s amend that last part \u2013 to most Americans. Because the rich and wealthy will always have\nthe best healthcare, regardless of whether we have a single-payer system or\nnot. We can look at the examples of\nthose wealthy American citizens and residents of many of the socialized\nhealthcare world that come to the United States for the best care available\nanywhere. That\u2019s not nationalism; that\u2019s\njust fact. Headlines have been full of such examples, since I have been reading\nnewspapers.<\/p>\n\n\n\n I would\nexpect that MFA will have a material and detrimental impact on current\nbeneficiaries of Medicare. We are already\nexperiencing pressures in providing care to Medicare beneficiaries, for two\ntectonic reasons. First, the aging\nphysician baby boomers are either limiting their practice times or restricting\nMedicare access due to continued cuts in reimbursements, technology\nrequirements, and reporting requirements. Secondly, they are leaving healthcare in\nstaggering numbers. We have talked about\nthis many, many times in our blogs.<\/p>\n\n\n\n The\neconomic challenges are also overwhelming. We are convinced most Americans and most\nemployers providing care to their employees, will not want to be part of an MFA\nprogram. <\/p>\n\n\n\n Let\u2019s\nlook at the gross numbers (all 2018\/2019);<\/p>\n\n\n\n First and foremost, happy new year! I have taken a break from writing these blogs for several reasons. One, I have been super busy with new projects. Two, I needed a break to get a wider perspective after the U.S. midterm elections. Lastly, I needed to figure out how to address this new wave of healthcare reform called \u201cMedicare For All\u201d (MFA). First, I will admit that I have some internal conflicts. In my earlier life in this profession, I loved providing care to those that needed the most care […]<\/p>\n","protected":false},"author":6,"featured_media":3915,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"om_disable_all_campaigns":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[1],"tags":[47,343],"class_list":["post-3913","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized","tag-medicare","tag-mfa"],"jetpack_sharing_enabled":true,"jetpack_featured_media_url":"https:\/\/pwer.com\/wp-content\/uploads\/2019\/01\/AdobeStock_180613991.jpeg","_links":{"self":[{"href":"https:\/\/pwer.com\/index.php?rest_route=\/wp\/v2\/posts\/3913","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pwer.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/pwer.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/pwer.com\/index.php?rest_route=\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/pwer.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=3913"}],"version-history":[{"count":1,"href":"https:\/\/pwer.com\/index.php?rest_route=\/wp\/v2\/posts\/3913\/revisions"}],"predecessor-version":[{"id":3914,"href":"https:\/\/pwer.com\/index.php?rest_route=\/wp\/v2\/posts\/3913\/revisions\/3914"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/pwer.com\/index.php?rest_route=\/wp\/v2\/media\/3915"}],"wp:attachment":[{"href":"https:\/\/pwer.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=3913"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/pwer.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=3913"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/pwer.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=3913"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}\n Total\n U.S. Population\n <\/td> \n 328,285,992\n <\/td><\/tr> \n Total\n U.S. Insured Population\n <\/td> \n 300,000,000\n <\/td><\/tr> \n Total\n U.S. Un-insured Population\n <\/td> \n 28,500,000\n <\/td><\/tr> \n Total\n Beneficiaries in Medicare\n <\/td> \n 60,000,000\n <\/td><\/tr> \n Total\n Protected in Medicaid\n <\/td> \n 73,000,000\n <\/td><\/tr> \n Total\n Insured by ACA aka Obamacare\n <\/td> \n 8,500,000\n <\/td><\/tr> \n Total Healthcare paid by US\n Gov.\n Medicare & Medicaid (inc. U.S. Military)<\/em>\n <\/td> \n $1,500,000,0000,000\n <\/td><\/tr> \n State Contributions to Medicaid\n (+\/-)\n <\/td> \n $350,000,0000,00\n <\/td><\/tr> \n U.S.\n Per Capita (per person)\n <\/td> \n $10,661.43\n <\/td><\/tr> \n Total\n U.S. Doctors active (+\/-)\n <\/td> \n 1,000,000\n <\/td><\/tr> \n Number\n of doctors over age 56\n <\/td> \n (48%)\n 480,000\n <\/td><\/tr> \n Number\n of U.S. Hospitals (inc. VA)\n <\/td> \n 6,210\n <\/td><\/tr> \n Average\n EBITDA US Non-Profit\n <\/td> \n 1.5%\n <\/td><\/tr> \n Average\n EBITDA ALL hospitals\n <\/td> \n 6%\n <\/td><\/tr><\/tbody><\/table>\n\n\n\n
\nMedicare for All is an attractive idea, but also a fool\u2019s gold rush. Medicare as a system works well, as it\nprovides care to those that need the most and complicated care. I have seen it and lived it. It also is relatively efficient, with less\nadministrative cost than traditional insurance. \nThe dark side of Medicare is that it generally does not pay providers\nthe cost of care. I have also lived\nthis. If the entire country\u2019s healthcare\nsystem was paid Medicare rates, we would likely have a catastrophic failure in\nhospitals and a massive contraction in providers, in what is now the largest\nindustry in the U.S. (and the world). We\nwill talk about the good and bad of that in the next blog. <\/p>\n","protected":false},"excerpt":{"rendered":"