How would "Medicare for All" affect the PA profession?

[Endeavor]

Hey guys, in your opinion how would "Medicare for All" affect the PA profession, and other medical professions (physicians, nursing, PT/OT etc.) Some topics that come to my mind include provider well-being, compensation, workload, job market, patient care and anything else you can think of. I would like to hear both perspectives if possible! Thank you.

[rev ronin]

1 hour ago, Endeavor said:

 I would like to hear both perspectives if possible!

Get 10 PAs in a room, you have at least 12 opinions.

[Endeavor]

31 minutes ago, rev ronin said:

Get 10 PAs in a room, you have at least 12 opinions.

Haha, I guess I meant those who are for it and those who are against it. Which now that I think about it might be irrelevant to the original question. Or maybe not, we're always detained by our own biases. Still would love to hear the differing opinions!

[MedicinePower]

Not having to become enrolled in 10,000 different insurance plans and having one standard would be a delight. Medicare covers everything I do in the ED while private insurance has gaping holes.

[LT_Oneal_PAC]

Well, if it’s make it like it was for me in Tricare, I’ll love it. 

[rev ronin]

I would rather everyone be uninsured, frankly, and get rid of EMTALA, and get rid of intellectual property law protections for lifesaving measures (e.g. COPD medications) to boot.

Then you would see which hospital systems are in it for the money, and which are in it to help people.  Then you would be forced to have some sort of consumer-driven cost sharing solution. Then you would have consumers making their own decisions about which medications they can afford, and pharmaceutical companies pricing accordingly.

Would it be better than the current system?  Almost certainly!  Would it be perfect? Certainly not!

But I'm already dealing with MULTIPLE stupidly unresponsive insurance bureaucracies that won't pay for Tadalafil 5 mg qd for BPH, and pharmacies that tell them it will cost $300/month when GoodRX shows it closer to $25 (they're quoting branded Cialis, of course, rather than the Tadalafil I prescribed).  When there's a single unaccountable bureaucracy, why think anything will ever change?  How long has it taken to get DME prescribing rights through medicare for PAs?  Do we really want that ONE payer to determine our professional status?

I want CARE for everyone. I don't see MEDICARE for everyone contributing to that.

[GetMeOuttaThisMess]

My experience with Tricare recipients was that no one took it.  Almost as bad, if not as bad, as Medicaid in the private sector.  This is another advantage to employer based healthcare (employee clinics) is that you don't have to mess with coding, insurance forms, etc.  I've been fortunate to have spent 13 years in such a setting.

 

 

Edited September 29, 2019 by GetMeOuttaThisMess

[mgriffiths]

I'll give this a go...but it is such a wide, complex topic that it is impossible to fully comprehend how this would effect our profession and healthcare in general...just look at the implementation of the ACA - no one had actually read the bill in its entirety before passing it through.  I 100% do NOT support a pass it and see what it says form of government.

1. I LOVE the idea of only having one insurance to deal with as a provider.  It simplifies the process.  You learn what the insurance wants in terms of getting imaging/meds/etc. covered.  BUT, from a patient's (with health insurance) perspective, I don't see how it is a positive thing.  Wait times will become a reality.  I have MANY patients who have previously had European/Canadian style "insurance" and they hated it.  Were some things better...ABSOLUTELY.  But every single one is in agreement that our system is better.  It's a relatively small sample size, but still it is 100%.
2. Medical bankruptcy - it seems that this would become a thing of the past...which is a HUGE positive in my mind.
3. Reimbursements - if done correctly, I could see "Medicare for All" being nice because you would NEVER have a patient who "pays" nothing.  As a provider you see a patient and chart/bill appropriately you will get paid.  There will be no "eating" a charge.  But, again, my concern is how something like 80% of hospital CEO's claim they would be bankrupt within months (NOTE: I've read some things that questions the validity of this, but it's still a concern).
4. PATIENT RESPONSIBILITY - this is the last piece I will get into.  But, if we have universal coverage (which in theory sounds wonderful) what stops people from flooding the ED because they won't receive a bill?  What pushes a DMII to make lifestyle changes instead of just getting their crazy expensive GLP-1s, SGLT-2s, etc. and because they don't have to pay...WHO CARES!?!?  This is the part I have the biggest problem with.  Yes, it is a pessimistic point of view, but I HATE freeloaders.

So, in conclusion, what is the perfect answer?  Personally, I don't think there is one.  We live in an imperfect world, how can we possibly expect to have a perfect answer?  Would "Medicare for All" be a step in the right direction?  Maybe...but I think it has to do more with how it is implemented than the actual "theory" itself.

If I were in charge I would make the following changes immediately:

1. Cut administrative stupidity - the amount of waste in administration is astonishing
2. Delete Press Ganey scores forever
3. Force insurance companies AND pharmaceutical companies to be more transparent

I am 100% confident these three changes would make our current health system functional in an amazing way.  Absolutely there are other changes that need to be made, but these 3 would be a HUGE start.

Edited September 29, 2019 by mgriffiths

[Boatswain2PA]

15 hours ago, Endeavor said:

Hey guys, in your opinion how would "Medicare for All" affect the PA profession

Our taxes would likely double.

 

Edited September 29, 2019 by Boatswain2PA

[GetMeOuttaThisMess]

As I’ve said numerous times before, this country, with its current demographics and other governmental spending priorities, cannot afford universal healthcare as many try to portray it. Catastrophic coverage to avoid financial bankruptcies would be more practical.

[MedicinePower]

22 minutes ago, Boatswain2PA said:

Our taxes would likely double.

This opinion is not supported by any one of the research groups which have calculated the cost of implementing Medicare for All. Why in the world would you think taxes would double?

[Boatswain2PA]

12 hours ago, LT_Oneal_PAC said:

Well, if it’s make it like it was for me in Tricare, I’ll love it.

Until April 15th comes around.

 

3 hours ago, GetMeOuttaThisMess said:

My experience with Tricare recipients was that no one took it.  

Yes.  And don't forget, Tricare is simply contracted out to another insurance carrier.  I expect to spend 2 hours on the phone with Tricare tomorrow to (attempt to) work out an issue with a bill.

 

2 hours ago, mgriffiths said:

Medical bankruptcy - it seems that this would become a thing of the past...which is a HUGE positive in my mind.

Except for the people who thought their visit/procedure would be covered, but it's not.  And no longer have the ability to shop around for a policy that would cover it.

 

2 hours ago, mgriffiths said:

you would NEVER have a patient who "pays" nothing.  As a provider you see a patient and chart/bill appropriately you will get paid.

Slight correction...you would ONLY get paid what some bureaucrat says you should get paid, and no ability to not take that insurance.

 

2 hours ago, mgriffiths said:

what stops people from flooding the ED because they won't receive a bill? 

Nothing.  In fact in encourages it, see multiple studies that show increase in ED visits after implementation of Obamacare.

 

2 hours ago, mgriffiths said:

What pushes a DMII to make lifestyle changes instead of just getting their crazy expensive GLP-1s, SGLT-2s, etc. and because they don't have to pay...WHO CARES!?!? 

Which goes back to my statement that all of these arguments are all about how we ration care, yet we (as a nation) don't want to have the politically uncomfortable discussion about how we transparently ration care.  AND, with Medicare for all, we will be at the whim of Congress or courts mandating coverage for outrageously expensive things (like they did for dialysis for ESRD in the early 70s, thus greatly expanding the cost of Medicaid).  No way your Congresscritter or 9th circuit Judge will deny little Johnny his million-dollar-a-year cancer therapy, no matter how uneffective it is.

 

2 hours ago, mgriffiths said:

So, in conclusion, what is the perfect answer?  Personally, I don't think there is one. 

Come up with a way to transparently ration care.  See the Oregon Health Plan in early 90s.

[Boatswain2PA]

18 minutes ago, MedicinePower said:

This opinion is not supported by any one of the research groups which have calculated the cost of implementing Medicare for All. Why in the world would you think taxes would double?

Common sense.

Who would pay for Medicare for all?

[MedicinePower]

14 minutes ago, Boatswain2PA said:

Common sense.

Who would pay for Medicare for all?

They're called "premiums". Everyone on Medicare pays them and I'm confused and concerned you didn't know this. Every research study shows lower premiums for a better healthcare system under Medicare for All.

[Boatswain2PA]

15 minutes ago, MedicinePower said:

They're called "premiums". Everyone on Medicare pays them and I'm confused and concerned you didn't know this. Every research study shows lower premiums for a better healthcare system under Medicare for All.

In 2014 premiums paid for a whopping 14% of Medicare.  From quick google search that found a MotleyFool article:  https://www.fool.com/retirement/2016/06/26/how-is-medicare-funded.aspx

41% came from General Tax revenue.  38% from payroll taxes.

Yeah, our taxes will be going up.  A LOT!

 

Edited September 29, 2019 by Boatswain2PA

[MedicinePower]

1 minute ago, Boatswain2PA said:

In 2014 premiums paid for a whopping 14% of Medicare.  From quick google search that found a MotleyFool article:  https://www.fool.com/retirement/2016/06/26/how-is-medicare-funded.aspx

41% came from General Tax revenue.  38% from payroll taxes.

Yeah, our taxes will be going up.  A LOT!

 

You don't seem to understand what you are citing. Go back and reread.

[LT_Oneal_PAC]

31 minutes ago, Boatswain2PA said:

Until April 15th comes around.

 

Yes.  And don't forget, Tricare is simply contracted out to another insurance carrier.  I expect to spend 2 hours on the phone with Tricare tomorrow to (attempt to) work out an issue with a bill.

 

Except for the people who thought their visit/procedure would be covered, but it's not.  And no longer have the ability to shop around for a policy that would cover it.

 

Slight correction...you would ONLY get paid what some bureaucrat says you should get paid, and no ability to not take that insurance.

 

Nothing.  In fact in encourages it, see multiple studies that show increase in ED visits after implementation of Obamacare.

 

Which goes back to my statement that all of these arguments are all about how we ration care, yet we (as a nation) don't want to have the politically uncomfortable discussion about how we transparently ration care.  AND, with Medicare for all, we will be at the whim of Congress or courts mandating coverage for outrageously expensive things (like they did for dialysis for ESRD in the early 70s, thus greatly expanding the cost of Medicaid).  No way your Congresscritter or 9th circuit Judge will deny little Johnny his million-dollar-a-year cancer therapy, no matter how uneffective it is.

 

Come up with a way to transparently ration care.  See the Oregon Health Plan in early 90s.

You must not remember Tricare when you were in correctly. Perhaps being a coastie you never went to the MTF, but it was always covered, no exclusions.  Never one red cent was paid. No copay, no deductibles. What o said happened, and it happened then without question. No prior auth. I may have had to give a medical reason for a very expensive medication if there was a cheaper alternative, but it was always accepted.

i would be okay with a tax increase for better insurance and better practice environment. I don’t see any evidence it would double though.

[Boatswain2PA]

8 minutes ago, LT_Oneal_PAC said:

You must not remember Tricare when you were in correctly. Perhaps being a coastie you never went to the MTF, but it was always covered, no exclusions.  

Yes, went to some MTFs.  Just like the VA, some were good, some were terrible.  Saw more than a few of my sailors get terrible care and had no recourse.
 

[rev ronin]

5 minutes ago, MedicinePower said:

Every research study shows lower premiums for a better healthcare system under Medicare for All.

They're not research studies, because Medicare for All hasn't happened.  They're projections; models. All models are built on multiple assumptions, and the output of any model is strongly constrained by the assumptions on which it is built.  In addition to Evidence Based Medicine, I think it would be great if every medical provider, or at least everyone playing in the public health policy space, took a graduate level course on modeling; I have.

Models can be wrong in a couple of ways:

1) Things don't scale right.  Even if we have good observations about when X is between 1 and 2, the behavior may change radically if X is larger than 4.  Many things in real life aren't linear.

2) Confounders aren't anticipated.  This is a broad category of things that aren't going to go right. Errors in measurement, logic, new actors, new constraints...

3) Novel behaviors emerge.  We won't know about them before they happen, because they haven't been seen before, and thus, unlike 1, we don't even know we're making assumptions about them which may be incorrect.

https://en.wikipedia.org/wiki/Cobra_effect
 

[Boatswain2PA]

12 minutes ago, MedicinePower said:

You don't seem to understand what you are citing. Go back and reread.

I'm citing a MotleyFool article that states that in 2014 41% of Medicare monies came from the general tax revenue (that would be your income tax), and 38% from your payroll tax (otherwise known as CMS - Centers for Medicare and Medicaid Services -  tax).

It's been a while since I've gotten my MPH using more academic sources, but Medicare/Medicaid has always relied on general tax revenue to stay in the black.  Any expansion of these services will require more money to fund, which means higher taxes.

Where exactly do you think I'm lacking an understanding?  

[Boatswain2PA]

14 minutes ago, rev ronin said:

All models are built on multiple assumptions, and the output of any model is strongly constrained by the assumptions on which it is built.  In addition to Evidence Based Medicine, I think it would be great if every medical provider, or at least everyone playing in the public health policy space, took a graduate level course on modeling; I have.

Models can be wrong in a couple of ways:

....and then there is the selection bias with publication.  Vast, vast, vast majority of those in academia (who control the publications) are uber-liberals if not total leftists, and their selection bias would only allow them to publish "models" that would show single-payer would be "cheaper".

This is where common sense must apply.  Unfortunately common sense isn't very common anymore.

[LT_Oneal_PAC]

30 minutes ago, Boatswain2PA said:

Yes, went to some MTFs.  Just like the VA, some were good, some were terrible.  Saw more than a few of my sailors get terrible care and had no recourse.
 

There are good and bad private hospitals too, and when people can’t afford care they don’t have any recourse. You friends had recourse, they just couldn’t pay for it. While in the military, you always have recourse. You can be seen by any provider at any MTF for free. Just go to the next provider, or the next MTF.

[Boatswain2PA]

27 minutes ago, LT_Oneal_PAC said:

There are good and bad private hospitals too, and when people can’t afford care they don’t have any recourse. You friends had recourse, they just couldn’t pay for it.

Of course.  Capitalism works.  That's why the Canadian minister came to Boston for his cardiac procedure.

But Medicare for all is the furthest thing from capitalism.

 

27 minutes ago, LT_Oneal_PAC said:

While in the military, you always have recourse. You can be seen by any provider at any MTF for free. Just go to the next provider, or the next MTF.

Unless that next MTF was a few hundred miles away.

Edited September 29, 2019 by Boatswain2PA

[Cideous]

1 hour ago, Boatswain2PA said:

Our taxes would likely double.

 

And your premiums, co-pays, co-insurance, deductibles and maximum out of pocket would disappear.  A more than acceptable trade off.

 

As for me...I would love it, and those that fight against it are terrified.  Terrified that once implemented it would be and remain INCREDIBLY popular.  Just like it is in every other western developed country.

They are terrified because of what happened with the ACA and pre-existing conditions.  You guys remember those right?  When your Ins company could deny you life saving treatment today because you were seen 2 years ago for a cough at your PCP?  I lived through that nightmare as a patient and as a provider.  And good F-ing riddens to "pre-exsisting conditions" as an exclusion and reason to deny treatment.  You have the ACA to thank for getting rid of pre-existing conditions.  Period...full stop.

So here we are again. Close to taking another giant step forward into the 21st century of healthcare and fear mongers are terrified again.  The thought of drastically reducing medical bankruptcy for Americans who have the audacity to become sick or get injured....? 

Terrifying.... 

[Boatswain2PA]

7 minutes ago, Cideous said:

And your premiums, co-pays, co-insurance, deductibles and maximum out of pocket would disappear.

Do folks with Medicare have premiums, co-pays, co-insurance, and deductibles?  

8 minutes ago, Cideous said:

those that fight against it are terrified. 

I'm not terrified.  I just understand the fundamental problem with healthcare which is not addressed by the "medicare for all would be great and solve all of our problems" crowd.

12 minutes ago, Cideous said:

You have the ACA to thank for getting rid of pre-existing conditions.  Period...full stop.

Young people without any pre-existing conditions also have the ACA to thank for the tremendous increase in premiums and required deductibles they must now pay for, or the penalty imposed upon them for NOT paying it.  Period....full stop.

13 minutes ago, Cideous said:

Close to taking another giant step forward into the 21st century of healthcare and fear mongers are terrified again.

Now if we can just get past the name-calling of others who may not agree with us.

 

14 minutes ago, Cideous said:

The thought of drastically reducing medical bankruptcy for Americans who have the audacity to become sick or get injured....

What is wrong with bankruptcy laws?  I know several people who have declared bankruptcy, had all/most of their debts wiped clean, and started from scratch to build great lives.

On the other end of the spectrum, what is wrong with paying for the medical care (or other services) you receive?