On Tue, 21 Jul 2009, Shane Mage wrote:
>> http://www.pnhp.org/blog/2009/07/20/bait-and-switch-how-the-%e2%80%9cpublic-option%e2%80%9d-was-sold/
>>
>> [It's interesting how much emphasis in the following is placed on
>> cutting payments to providers. That is normally glossed over by Single
>> Payer advocates.]
>
> How so?
According to the fellow who wrote this article, who seems quite knowledgeable (and certainly very dedicated to single payer), one of the essential motors of Medicare's cost savings is its ability to pay providers 20% less than the industry average and force them to accept it. And according to him, it would be just as essential to single payer or to any "public option" that was supposed to be medicare in larval form -- such that without it, the cost savings of any such plan would be minimal.
> I don't think that the CNA is in favor of cutting payments to
> nurses.
I'm quite sure they're not.
There's probably a worked out logic to this. Perhaps in an alternative universe where all providers had to accept 20% less, all hospitals would be public hospitals and private hospitals would go out of business.
Another line of argument is hinted at the end of this piece. In the author's thought experiment about how a public option might "work," he mentions that one of the big stumbling blocks is that when an insurance company dominates a particular market, the hospitals routinely give them 30-40% discounts. In which case perhaps this is a case in which nobody pays retail except the uninsured (a huge group), and the 20% "forcing" is simply a variant of standard practice? Perhaps there is a distinction between hospital services discounts and individual specialist doctor discounts?
I have no idea. That's why I mentioned it -- I've never seen it mentioned before, it seems centrally important if it's true, and I'd love to learn more from someone who knows more. How medicare reimbursement works systemically seems like a kind of complex question. But I'm sure it must be explained somewhere.
Michael