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Comment by jbooth | Hacker News Reader

I sincerely doubt that the bean-counters at hospital are losing a ton of money on medicare but are too confused by the large 'revenue' figure to subtract a larger 'expenses' figure and realize they're making a loss.

As a matter of fact, I can't recall ever reading an op/ed or anything by a hospital administrator complaining that they're being fleeced by medicare and losing a bunch of money on it. But I've seen a billion op/eds in the same template as TFA, bemoaning the byzantine and obfuscatory private insurance regime as something that completely destroys any market forces that should exist in the industry. I mean, one hospital charged one thousand times as much as another for the same treatment.

I have to conclude that bringing up medicare while the private insurance industry system is this flagrantly broken is nothing but a red herring.

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And I'm telling you that my wife is that bean counter. Her job is (a) budgeting, and (b) getting reimbursement from Medicare and Medicaid. As well as anyone in the organization (which is to say, not too well, because of the deficiencies with cost accounting that I mentioned), she knows those numbers.

I don't think a month goes by when I don't ask her this question. Something always comes up, where she's saying "Medicare just denied another $500K payment" or somesuch. And I'll say to her "you live by the sword, you die by the sword".

She admits that the net profit via Medicare is negative. But the decisions makers don't want to consider it. In this case, it's possible that they consider it their mission because they are a Catholic hospital. I can't see any answer in the general case.

Well, I'll take your word for it. I do think that the major problems come from being in a halfway-space between public and private sector for the whole industry, combined with the fact that the entirely-private insurance system breaks any market forces which could lower prices.

I've worked as the IT guy in a hospital, and have talked to our "finance guy", and he says the same thing--outpatient surgeries and childbirths pay for Medicare (in)patients and the ER.

And yes, there is inefficiency unrelated to Medicare, and yes, I've seen the anecdote about how doctors who own an MRI machine refer patients to get MRIs six times more frequently.

But Medicare underpaying, alongside what I remember hearing was a "bad payor mix" from ER patients, hurts.

If you're truly curious about how healthcare works, follow this blog http://histalk2.com/ and get a flavor for what's concerning IT people (which oftentimes is money).

Eh? Every source I've read on the subject says Medicare doesn't cover the cost of service. And that is, in part, the reason for the "byzantine and obfuscatory private insurance regime". When you go to the hospital you're paying for the medicare patient in the next bed, and you're paying for the indigent guy in the bed beyond.

But they can't very well give you a bill that with a line item that says "shifted costs from the old guy in bay 3 - $900".

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