Part C is pricier because insurers are gaming RAF. BCBS is upcoding the shit out of every member encounter submission, I am sure, even though they're probably the second least evil insurer after KFHP.

The Biden admin stepped on this behavior a bit for the upcoming year, so the disparity will probably drop.

medicare-for-all would absolutely devastate doctor salaries across the country

Well I wasn't in favor, but you make a pretty compelling case.

>do you think medicare is literally magic? lmao

It should be obvious I'm not some twitter lib blindly singing the praises of this program. I understand Medicare very well. There is no gargantuan bureaucratic layer between patients and care as there is in the private insurance world. CMS treats cost control as a population-level concern. The complexity is abstracted away from the patient, and in spite of this simplicity for members it is more efficient and costs the taxpayer less.

This isn't a small matter. If you are a grandma leaving the hospital after a slip and fall, CMS will let you go straight to a subacute rehab, while a private payor will ask you to prove you need to fix that hip. It might be justified if asking for proof saved money, but as I said, Part C patients cost the taxpayer more.

>doctors send claims to medicare too bb, they just hate doing it bc they don't get paid nearly as much

Medicare is the best payor, and it's not even close. They are by far the most provider-friendly payor. The MACs pay promptly, predictably, and apply rules in a straightforward fashion. The RAC auditors follow a pattern and explain their rationale when making demands. They have a very large patient population. Their reimbursement rates are not much lower than the commercial world; it is Medicaid which pays relatively little. Every single annoying Medicare behavior (like distant audits for long-completed services) is also performed by the private insurers. That's why every single HMO and provider group requires their employees to participate in Medicare. You cannot even get a job as a doctor without it; the LEIE is a mark of death.

ironically medicare-for-all would absolutely devastate doctor salaries across the country

naija doctors soon dey japa ->

>You think Medicare never has issues with "in network" status or the ability to get care someone thinks they need?

I wouldn't say Medicare is perfect. My claim is more narrow:

Let's outline the process for UM in two separate systems

I am not dissembling at all here. CMS doesn't do UM. When "Medicare" does UM, it's under a Part C plan, which is actually private insurance purchased with your Medicare premium. CMS itself doesn't ask for notes or demand prior auth requests. They really do just pay. That's a big deal for sick old people in need of care. It's also why your aunt the nurse tells you not to sign up for Medicare Advantage.

The size of the Medicare population and the reimbursements at a population level mean there is nearly always a provider who will see you. This isn't the case for Medicaid, where the rates are truly tiny and thus the number of providers is much more modest.

As a caveat: CMS is now doing some stuff around DME, but that's because the Scooter Store's hellspawn are alive and well in Florida.

He presents two scenarios:

• One in the private insurance world where basically everything has gone wrong

• One in the Medicare world where everything has gone right

As you can see, Medicare is obviously better. Stay tuned for my writeup on why vacationing in Paris and having everything go wrong is worse than vacationing on a Carnival cruise ship and having everything go right.

yea and i read up on the somali healthcare system and compared to the usa. systems can suck no matter their setup or ideology. i would also rather live in the ussr than yemen

Public health system here. When my pensioner grandmother was diagnosed with cancer, she started treatment 72 hours after her diagnosis.