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Comment by richwater | Hacker News Reader

If Medicare reimbursement rates actually mirrored market prices, this wouldn't be necessary. Doctors and especially hospitals rely on private markets to fill the gap that Medicare refuses to pay.

https://www.aha.org/2024-01-10-infographic-medicare-signific...

https://www.cancernetwork.com/view/rising-prices-and-lower-m...

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If medicare increases payouts then the payoff to this sort of behavior only increases.

Fair enough. However, I still think with better aligned incentives you could drive down undesirable behavior.

Cost-shifting from Medicare to private coverage has been roundly debunked many times over. Citing the AHA is laughable.

Call it whatever you'd like but it's a fact that medicare reimbursements are absolutely terrible and the government keeps _reducing_ reimbursements in real value, forget about even keeping pace with inflation.

https://www.kff.org/medicare/issue-brief/what-to-know-about-...

https://www.reuters.com/markets/us/us-health-insurers-slide-...

Utter nonsense. The AMA and AHA absolutely love that people buy their propaganda though

You are bringing nothing to this discussion while I've given you numerous sources.

Because like I said this is a widely debunked myth that the industry has been slapping down over and over again for a long time. I've been in this industry working on these problems for 20+ years. You are trying to sell alchemy to a chemist

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3160596/ https://www.coloradohealthinstitute.org/research/cost-shift-... https://www.healthcaredive.com/news/myth-diagnosis-do-hospit... https://washingtonmonthly.com/2023/06/19/dont-blame-medicare...

I read a few of your articles and just have some parting statements.

If the article on Healthcare Dive, the conclusion includes the statement: > Grundling said there has to be a breaking point somewhere so long as government rates fail to keep up with medical inflation

So regardless if cost-shifting is occurring or not, reimbursement rates are not doing the job.

The article in Washington Monthly seems to operate under the assumption that Medicare reimbursement rates are the "fair" value and anything above that is driven by greed. Instead it primarily blames monopolistic power as the cause of high prices, which is a power granted to them by.... the government.

So excuse my hesitation when I have a strong disbelief that more government intervention will solve this problem, given the above statements.

The provider side skates by with very little scrutiny in the US, when they make more than anywhere else in the world while also crying poverty and whining about Medicare/caid reimbursements. They're gonna have to figure out how to make it work with those rates because commercial spending levels are unsustainable, and the rate of medical inflation is unsustainable.

I haven't said anything about "more government intervention". Hospitals, doctors, and device makers are making bank, and are still greedy for more. They are the ones causing medical inflation higher than general inflation, it is not a fact of nature. It's on them to figure it out and to learn to live within a smaller budget.

You lost me at greedy.

Why is it greedy for doctors to seek reimbursement for a career that included hundreds of thousands of school debt, living off junk food at odd times, and losing your best years trapped in monolithic buildings with poor ventilation ? And then getting calls from patients are 10pm on a saturday night for the rest of their life because patients are anxious about an article they read online ?

Sorry, doctors should be making as much as they are now and then some, if the govt insists on having lamborghini healthcare standards in the US.

How we pay for it is another story, but how we got here is certainly not the doctor's fault. (or insurers, for that matter).

Or lets bring it close to home since this is HN. Is anyone calling developers greedy? Last I checked, US devs make more than a mid-level in the US, with zero sacrifices. Are devs greedy ?

The reality is that older generations and their representatives in congress got us in that mess, and shifting blame to others that are providing valuable service is a copout from actually putting your finger on the wart that is bureaucrat-managed lamborghini healthcare.

Yes, greedy. Spare me the noble sacrifice theme when they are all choosing high-paying specialties and not primary care. And no sympathy for the debt when they chose the profession willingly and then make 250k+ once they start working. It is nuts to me to say they should make this much or even more when our spending is completely unsustainable. We can't continue to outpace general inflation.

And it's not just the docs themselves, it is the entire provider side. "Non-profit" hospital just means a bunch of execs keep the profits. Playing games with ER/urgent care to squeeze both payers and the patients. They are the bureaucrats managing the lamborghini healthcare, because they want to charge a lot of money for it.

You are conflating too many things and casting a wide net. You are right in that there's too many specialists, but again, they are behaving like rational actors in a game that is rigged against them. Why not understand how the rigged game came to be instead ?

Do you know the history of why hospitals are nonprofits ? Do you know the history of socialized medicine ? Hint: its not pretty, at all. What other industries you see outpacing inflation ? Hint: its not cell phones, cars, or airplane tickets.

I'd recommend looking deeper into those 3 if you really want to understand the causes and the philosophy that is driving spending in lamborghini healthcare. Because what you are advocating is going to literally break patient service. We are already seeing a version of that disaster in the UK, and more recently, in CAN.

Its lovely to waive the "they are too greedy" index finger. Its simple. It is comforting because it is binary and assigns blame. Yet the world is more complicated than that.

But who's not greedy ? Are you not greedy as a dev with 250K ? Who are these angels that are not greedy? Where do these angels live ? Its funny that its always the other person that is greedy, its never the one saying the word.

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