By Jack Bernard
The Star-Ledger (Newark, NJ), Aug. 20, 2013
As stated in various newspaper articles, there is a national concern with hospital billings. Specifically, charges vary tremendously from facility to facility for the same services and procedures, as shown by the Centers for Medicare & Medicaid Services data that was released in May 2013.
For those employed in the hospital and insurance fields, none of this comes as any surprise whatsoever. The ābilling versus actual reimbursementā scenario is a long-standing nonsensical game played by providers and third-party reimbursers.
But, the articles miss the larger point. The true underlying problem with Medicare/Medicaid is escalating, uncontrolled national health care expenditures. This excessive increase is caused in large part by our insurance system (as well as providers of care, to a lesser extent), and not by wildly varying charges by service providers ā charges that are simply disregarded by third-party payers.
After spending 25 years in the health care field, most of it related to making hospitals more efficient, I have become skeptical of most Washington reform efforts. I am especially wary of the supposed āreformsā proposed by my party, the Republican Party.
The GOP and Rep. Paul Ryan (R-Wis.), the fiscal policy leader of the party, want to talk about only the federal budget and shifting health costs to seniors, as opposed to true systemic cost containment for the nation. Maybe this reflects the fact that Ryan has never spent any significant time in the private sector and is solely a creature of Washington.
Experts in health care economics may differ on many things, depending on how conservative or liberal they may be. But, one thing they all agree on is that raising the age for Medicare will do virtually nothing to reduce the overall cost of health care in this nation. Cost shifting is not cost reduction.
Under the Affordable Care Act, everyone must have insurance, so theoretically the seniors cut out of Medicare under the Ryan plan would just get private insurance.
Medicare has a 3 percent administrative overhead while the private sector is now at 28 percent and trying to eventually come down to 20 percent. Raising the age to join Medicare simply shifts the insurer from the government to less efficient private providers. The national cost of care remains the same; only the insurer has changed for a small group of seniors.
In fact, the cost per capita for Medicare itself will actually rise because the remaining pool of Medicare enrollees will be older and, therefore, sicker than they are now. Plus, the Republican proposal dumps the extra cost into the lap of seniors 65-67, many of whom may well be unemployed/unemployable, according to national statistics.
The real solution to the American health care dilemma is obvious to Canadians, Australians and Europeans, but apparently not to us. Forget what bombastic politicians say about the United States having the best care in the world. Other developed countries have better health care outcomes, according the World Health Organization, and much lower costs. For example, Canada has superior mortality and morbidity statistics compared with ours. Per-capita cost for health care is $4,445 in Canada versus $8,233 in our nation.
How did they do this? Through a single-payer system, otherwise known as Medicare for All. Details can be found at the Physicians for a National Health Program website.
Under single payer, every provider would be paid the same for like procedures, adjusted for intensity. More efficient hospitals would survive. Less efficient ones would go under. That is consistent with the free-market principles that my party advocates … and better for our countryās future.
Jack Bernard was a senior executive with several national health care firms before retiring and worked with various hospital systems around the nation regarding cost containment.
http://blog.nj.com/njv_guest_blog/2013/08/tackling_our_uncontrolled_heal.html