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<\/figure>\n\n\n\nRecently,\nthe Gallop Organization released a poll that reported, \u201cAmericans without\ninsurance rises to 4-year high.\u201d The\nfinding noted 13.7% of Americans have identified themselves as uninsured (see nearby graph)<\/em>. The report went on to state, \u201cwomen and\nadults under 35 had the highest rates, 12.8 and 21% respectively.\u201d This sampling is based on random contact to\n28,000 adults. <\/p>\n\n\n\n In 2017,\nthe Kaiser Foundation did a study on healthcare and the uninsured (see nearby graph)<\/em>. The report, if close\nto accurate, said that 22% were between jobs, 22% were losing Medicaid or\nchanging status, and 2% said they did not need it. We can extrapolate that maybe a quarter of the\ntotal uninsured are between jobs or undergoing other life and qualification\nstatus changes. We still have a lot of\npeople that cannot pay for healthcare or health insurance, and no question\nabout it, we need to find a way!<\/p>\n\n\n\n One of\nthe admitted challenges with Medicare is that there are no gate keepers (for\nthe most part). Like insurance\ncompanies, Medicare has no method to either pre-approve or redirect care \u2013 Medicare\nprovides no direct services. As long as\neverything is well documented, there are no real filters in the cost or intensity\nof the care given. Sometimes the cost is\nhigher because higher-end procedures are applied; when in reality, there are lower\ncost procedures available or at least a stepping stone to more advanced work. <\/p>\n\n\n\n In most\ncases, Medicare does not negotiate prices; generally, Medicare rates are\nbetween commercial insurance and Medicaid however, not always. <\/p>\n\n\n\n Most\nhealthcare providers, including hospital, ancillary providers and doctors, at\nbest break even on providing care on Medicare. \nIn many cases, the cost of care exceeds the cost to provide the care. <\/p>\n\n\n\n This is\nnot theoretical to me. We have tracked\nthis disparity for years with historical cost accounting analysis. Why did we continue to provide the care? So long as we had more commercial insurance\npatients, the method works. For one,\nMedicare generally pays faster than traditional insurance. If you noted from our last blog, EBITDA, a\nnon-profit hospital was a meager 1.5% of collected revenues. <\/p>\n\n\n\n Today,\nit is the commercially insured patient that is subsidizing traditional fee for\nservice (FFS) for both Medicare and Medicaid. This means that there are billions of cost\ntransfers going on today at every level of healthcare from commercial to\nMedicare and Medicaid. <\/p>\n\n\n\n A very\nrecent survey of members of the Medical Group Management Association (MGMA) reported\nthat 67% of its members (respondents) cost of providing care was higher than\nthe payment they received from Medicare, and 17% said the costs were equivalent\nto reimbursement. Only 16% said they\nmade a profit providing medical care to Medicare beneficiaries. <\/p>\n\n\n\n This\nleads us to question \u2013 how long can an industry provide a service if 84% of the\ntime the cost was less than or equal to the service provided? Are we talking about putting more patients\nthough this system? I am not surprised\nif the numbers are same or marginally better at the hospital level. No industry can survive under only those\nconditions. <\/p>\n\n\n\n One\noption is to increase the reimbursement to providers and hospitals. I would estimate that would require about\n40-60% increase in reimbursement. <\/p>\n\n\n\n If we\nallow Medicare for All and do not increase reimbursement, we will see a\nhistorically unprecedented contraction in caregivers, and the failure of hundreds\nand thousands of hospitals. <\/p>\n\n\n\n Recently,\nthe Mayor of New York City held a news conference promising $100 million to\ncover the care of an estimated 600,000 New Yorkers without insurance. Someone who has been in care delivery as long\nas I have been, could quickly do the math from the headline alone \u2013 calculate $100,000,000\ndivided by 600,000 equals $166.67 per uninsured New Yorker per year. So, relate that to the annual cost of\nhealthcare per capita (average cost, not the higher cost in NYC) of $10,661.43.\n<\/p>\n\n\n\n We can\nquickly determine that at the best-case scenario, that huge amount of money may\npay for one physical a year, and maybe some OTC medication for each of the\n600,000 people. Don\u2019t get me wrong, that\nis better than what they have, and it will save many lives.<\/p>\n\n\n\n We must\nface the facts that it will not solve the issue of 600,000 uninsured; it might help\nin getting people to qualify\/apply for other programs like Medicaid. The take away is that the primary care\ncomponent will consume the entire $100M. To have some measurable mass impact, that\nnumber will have to be close to $1 billion. <\/p>\n\n\n\n Others\nhave told me that Canada, United Kingdom, Finland and other developed and\nprosperous countries have made it work, why not the United States of America? <\/p>\n\n\n\n We will discuss that in our next installment of this series. <\/p>\n\n\n\n -Noel J. Guillama, President <\/p>\n","protected":false},"excerpt":{"rendered":" In our last blog, we started to frame the issue and disclose the undisputable numbers regarding how much healthcare costs, how many are insured\/uninsured, and what the per-capita cost for healthcare is in the United States. Additionally, we talked about how attractive the idea is just to extend Medicare to all Americans. Well, some could say that maybe it means that Medicare will be only extended to the uninsured. It is a reasonable idea to insure the 28.5 million uninsured Americans. How many companies will just drop insurance if that […]<\/p>\n","protected":false},"author":6,"featured_media":3922,"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":[],"class_list":["post-3918","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-uncategorized"],"jetpack_sharing_enabled":true,"jetpack_featured_media_url":"https:\/\/pwer.com\/wp-content\/uploads\/2019\/02\/AdobeStock_63332481.jpeg","_links":{"self":[{"href":"https:\/\/pwer.com\/index.php?rest_route=\/wp\/v2\/posts\/3918","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=3918"}],"version-history":[{"count":2,"href":"https:\/\/pwer.com\/index.php?rest_route=\/wp\/v2\/posts\/3918\/revisions"}],"predecessor-version":[{"id":3923,"href":"https:\/\/pwer.com\/index.php?rest_route=\/wp\/v2\/posts\/3918\/revisions\/3923"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/pwer.com\/index.php?rest_route=\/wp\/v2\/media\/3922"}],"wp:attachment":[{"href":"https:\/\/pwer.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=3918"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/pwer.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=3918"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/pwer.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=3918"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}![\"\"](\"http:\/\/803.557.mywebsitetransfer.com\/wp-content\/uploads\/2019\/02\/blog-2.png\")
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