Replying to a message of Bob Klahn to Bob Ackley:

 BK>  ...

 BK>>>  Oh, and the govt runs the most successful part of our health
 BK>>>  care system, medicare. At least before the right got their
 BK>>>  claws into it.

 BA>> Medicare FORCES providers to give care to the elderly for
 BA>> whatever reimbursement

 BA>> a horrible situation for the providers - which is why
 BA>> increasing numbers of providers are
 BA>> quietly dropping out of the Medicare system.

 BK>  If providers are dropping out then Medicare is not forcing
 BK>  anyone to provide care.

They do if the provider wants to remain in the Medicare system.
Remember that on any given day about sixty percent of any hospital's
inpatient population is Medicare patients and are costing more than
Medicare is paying (but costing less than an empty bed).

Last time I checked - and it was years ago - hospitals were budgeting
for about 40% occupancy (it used to be 80%, and in the early 1980s
there was a period where every hospital in Omaha was packed to the
rafters, every single hospital bed in the city was occupied).  Hospitals
that expect 40% occupancy can't operate for very long at 16% occupancy;
years ago Grape Memoriah Hospital, a 50 bed facility located on the north
edge of Hamburg, in the southwest corner of Iowa (population about 3K)
got into severe financial trouble.  For several weeks their inpatient census
there was *three*; 47 empty beds, there were more people working the night
shift than there were patients.

In the days when occupancy was much higher, low and partial payments weren't
as much of an issue as they are today (and have been for several years);
providers can no longer *afford* to grant (or accept) such discounting.

 BK> All they do is set standards for what
 BK>  they will pay, and the provider gets to say yes or no.

 BK>  Which is exactly what my insurance company does. Everything you
 BK>  listed. Only you can go outside the system, and the insurance
 BK>  company would love it if you pay your own way. However, inside
 BK>  the system the provider is not allowed to bill the patient for
 BK>  the difference, just like Medicare.

 BA>> For well over 25 years Medicare has been infamous for
 BA>> paying late (if at all), disallowing
 BA>> perfectly valid charges and writing itself huge discounts.

 BK>  Exactly what my insurance company does. And 25 years goes right
 BK>  back to Reagan.

Actually it goes back farther than that, I just became aware of it in 1982
or 1983 as an undergraduate majoring in Hospital Administration (and yes,
I did graduate, Southern Illinois University/Carbondale, in December of
1984).

 BA>> When providers billed the patients
 BA>> for unpaid charges, Medicare got congress to make 'balance
 BA>> billing' illegal (so those unpaid charges get factored into
 BA>> everybody else's bills and the price of health care goes up
 BA>> for everybody))  Medicare was doing that sort of thing back
 BA>> in the 1980s.

 BK>  As does my insurance company's discounts. And as does the unpaid 
 BK> from the uninsured.

I have a problem with discounting terms beyond than '10/10, net 30.'  For
those unaware, that means 'if you pay in ten days you can take a 10%
discount, otherwise full payment is due in 30 days.'  That is pretty much a
standard policy in business.  Medicare is usually 120 days or more between
receipt of the bill and writing the check (so is Tricare, BTW); OTOH,
Physician's Mutual in Omaha usually pays within a cuple of weeks, in full.

 BK>  IOW, just about everybody has an unpaid balance that gets
 BK>  factored in. So the cost of medical care goes up for everybody
 BK>  because nobody is paying the full cost.

See my above comment about discounting.

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