Alex_Falk's picture


from people's policy project: pushback on the report released by urban institute / commonwealth fund


traveler's picture

From personal experience, and

From personal experience, and from the raw numbers, Medicare is perhaps one of the least efficient, least cost-effective ways to deliver health care. Mom spends at least twice as much time arranging care as getting it. But, reflecting, that factor might be closer to three or four hours' arranging and negotiating per hour of care, which wears her out, and the bureaucrats, and the doctors, and their staff too. If Mom weren't so fully-functional, bright-eyed, and in such excellent shape, Medicare would crush her.

All of which is wasted time and energy for everyone, designed to discourage people from seeking and getting care. It's inhuman.

It's also extremely fiscally wasteful. Mom's care should cost less than half of what the bumbling bureaucrats at Medicare wind up actually paying. They deny necessary, economical measures, and gladly approve outrageously expensive unnecessary, even harmful and dangerous things.

Meanwhile, if you do the math, Medicare's 2018 spending was $11,967 per enrollee. (link...)

When you consider that Medicare is heavily subsidized by private care -- private patients pay considerably more, to make up for doctors' losses from seeing Medicare patients -- Medicare winds up looking even worse.

R. Neal's picture

Is your experience with an

Is your experience with an Advantage plan or traditional?

Alex_Falk's picture


if i recall correctly -- Mr. Neal had an observation threads ago that branding a proposed new single-payer healthcare system with the name of the existing medicare system is a PR mistake. that seems spot on to me, too late to change the branding now though!

traveler's picture

But isn't the mistake more

But isn't the mistake more fundamental than merely PR? It seems to me the more fundamental mistake is in assuming that medical care costs less if we just pay each others' bills, and that replacing private administration with professional federal bureaucrats earning double the private sector's pay and benefits, can administer health care for less.

The problem is fundamentally single-payer in nature -- one payer can never know enough to make good decisions for everyone.

Alex_Falk's picture

are markets efficient?

whether or not you think profit-based private healthcare versus public/single payer systems are more 'efficient' depends entirely upon what assumptions you make about how a new system would work as well as your selection of parameters for which one maximizes 'efficiency'.

the assumption that a single payer system would replace "private sector positions" with "professional federal bureaucrats earning double the private sector's pay and benefits" is, pretty clearly, an assumption (though perhaps you were being intentionally hyperbolic). just like the series of assumptions that went into the study quoted in the original post's linked article which was then reported and headlined as referring to 'medicare for all'

you are right to have anxiety around navigating bureaucracy any kind of current or future healthcare system, particularly knowing that any change to the existing system could complicate your current efforts to navigate your own family's care --- but that is a fundamentally conservative & ultimately selfish position to take if you are applying those personal anxieties to your appraisal of proposals to redesign the entire system.

traveler's picture

Assumptions? I was reporting

Assumptions? I was reporting actual personal experience from the actual system, remarking that it's quite wasteful in practical experience, and then checking how much they spend overall and finding that--as their observed behavior would suggest--Medicare is also very expensive. Those are empirical observations. Our Medicare spends nearly $12,000 a year per enrollee. That's a lot of money, and it seems reasonable to wonder why it's so much.

Any system has to be administered, so yes, one assumes a federal system means replacing private workers with higher-paid unionized federal civil service workers -- isn't that the point of federalizing something? (Or would you keep everyone -- and still expect lower cost?) The question is how federal bureaucrats could administer the same claims more cost-effectively than the current set of people who process claims and approve benefits following the same federal rules, isn't it?

I believe federal civil service workers earning twice as much as civilians, on balance, is a commonly-reported fact. But even if the 2x figure were mistaken, replacing private employees with government workers does not, of itself, address the cost problem.

Alex_Falk's picture


it is a for-profit system, working as designed.

nothing about it is optimized to serve the needs of human beings.

R. Neal's picture

I believe federal civil

I believe federal civil service workers earning twice as much as civilians, on balance, is a commonly-reported fact.

The head of Medicare/Medicaid services makes $165,300 per year. The CEO of Bluecross Blueshield TN makes $1.65 million.

traveler's picture

That'a a good question. I

That'a a good question. I suspect it's 'Advantage', but Mom's not sure. All the branding and nomenclature don't make much of an impression on her, she's just a foot soldier fighting for her ration.

In life, she's constantly appealing to doctors, Medicare bureaucrats, and her plan's administrator; the common factor is always getting Medicare to approve something.

bizgrrl's picture

Medicare Advantage is private

Medicare Advantage is private insurance regulated by the federal government, just like any private insurance. Original Medicare can be a mixture of public insurance and private insurance. For example, if you get Medicare Part A and B and nothing else you are covered by public/government run insurance. If you elect to add Medicare Part D and/or Medigap/Supplement insurance to your Original Medicare, you are purchasing private insurance regulated by the federal government, just like any private insurance.

traveler's picture

The administration is

The administration is nominally by a private company. And they have their inefficiencies, to be sure. But most of the flailing and waste we see centers on the Medicare core at the center of it, specifically, getting Medicare to approve Every. Little. Thing. In Advance. Or Else.

Everyone -- doctors, hospitals, pharmacies, testing labs, you name it -- grinds to a halt and waits for Medicare's folks to scrutinize and pre-approve every step first, which often (usually?) takes weeks to months. That's Medicare overhead.

The people are all very nice and do their best to be courteous and helpful -- Medicare people included. They often agree that it's maddening and the rules are arbitrary and wasteful. The insiders frequently suggest creative ways to re-cast submissions for easier approval. But in the end no one has the power to do anything except wait for it to all filter through the system, after which it's almost always all approved (after an appeal or two, sometimes). Very wasteful.

The whole practice of medicine has been distorted to cater to these arbitrary external requirements.

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