The fact that Medicare has been put on a sound financially footing – for the first time in its history – has never appeared in any official government announcement. Ditto for the fact that the disabled and the elderly may bear a heavy cost along the way.
These facts have not been in the headlines of any major newspaper. They have not been addressed in any news article. To my knowledge they have never been discussed in any opinion editorial. Even more surprising, they are repeatedly ignored by scholars and in scholarly reports at think tanks around the country (other than my own).
Here is a third thing l bet you don’t know. Although Republicans have criticized the “Obama cuts in Medicare spending” as threatening access to care for the elderly, the GOP alternative essentially does exactly the same thing.
What no one bothered to discuss was the much bigger budget story: an enormous reduction in future Medicare spending and its impact on the health and financial well-being of the 54 million people in Medicare.
More important than the revenue shift is who would be the catalysts for a much higher performing system as measured by the Quadruple Aim. In this list, I highlight the game-changers. Some may also be big revenue winners but that isn’t the point of this list. After all, there are plenty of organizations profiting from today’s wasteful system, so revenue is only one metric of success. Rather, the actions of the organization are putting the wheels in motion for a massive transformation of the industry.
#1 MassMutual will slow healthcare’s heist of retirement accounts
In this self-perpetuating cycle, all of the dollars get sent through tightly controlled and mandated billing channels making it nearly impossible to render care or receive medical care unless you subjugate yourself to the process. All of this, of course, is being fueled by exorbitant health plans premiums.
The billing and payment system in healthcare is an economic joke and is indefensible. Given all that occurs in medical billing, it is impossible to make sense of pricing, thus the value proposition is incomprehensible.
Determining patient responsibility is not the same as knowing the price. Why should any payer (if they are paying the majority or all of the bill) pay more for strep throat in the ER than if treatment was rendered in a doctor’s office? It is precisely the low cost of entry to high cost venues for non-serious problems that allows this to happen, which is a direct result of the way we bill and pay for care.
In the ideal world, the advent of innovative payment models would arise out of the quest to find the “sweet spot”. That spot would seek to align incentives while balancing risk, maximizing efficiency, increase quality of service & outcomes and control costs. Our current system looks NOTHING like what I just described and it can never achieve those goals. So why do we put up with it?
There is nothing wrong with a little friendly financial heads-up advice regarding insurance. But below the surface, what does all this advice say about the inflated costs of the healthcare system in which we are obliged to navigate, specifically the role of “insurance” in driving those costs?
But there is something more telling about the underlying dysfunction of our third-party billing system based the advice many are doling out, and something you won’t find when evaluating cost-savings strategies in any other industries.
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