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Obviously, Steve, SS lacks the will to develop and maintain prudent, rigorously applied processes that we, the residents, can rely upon. Several years ago, I challenged City leaders to try to imagine what Lincoln Avenue, downtown, would look like in 20 years. No takers then, maybe now?
Scott, et al--You raise, I guess inadvertently, an interesting issue, which i would express as a question, especially to those who favor CC--Beginning from when you are age 18 or 22, working, how much would you be willing to pay annually, over the course of your entire life, for health care?
Thank you Dr. Iversen for your reply to my questions. You have helped improve my understanding of the issues. Now, I think, from your comments that private insurers did, and in some cases may still, pay more than either Medicare and Medicaid reimbursements. Again, thanks.
Dr. Iversen--Thank you for sharing your opinions on Amendment 69 and providing an opportunity to better understand the medical provider's point of view. It has been reported that some providers no longer accept Medicare patients or perhaps are not taking new Medicare patients. The rationale appears to be that the Medicare reimbursements are insufficient to cover costs.
You state that the insurers--that is not Medicare--are your problem, providing inadequate reimbursements. This seems to imply that either you have no Medicare patients, or that Medicare pays more than the insurers do. Would you please clarify for us? Thank you.
Chris--I am not sure what you mean by 'sustainable'. We know that Medicare is underfunded. I do not know why so many like Medicare, but I have to guess that it is because it costs a good deal less than commercial insurance. But we already know that Medicare reimbursements do not cover the full cost of a docs business, so something must give there, less service? As before, I do know from personal conversations with more than a few docs that they are no longer taking new Medicare patients. I really would appreciate someone providing numbers. Nancy--what is the risk you are willing to take? I understood that you will be paying less under CC, so I think I know your incentives. But, again, what will keep the docs in practice here? I understand Norwegian docs might not leave Norway, but that is not the same as a doc moving practice to another state. BTW, any business, not satisfied with a system or a process of the magnitude we are talking about would never make a wholesale change, but would test in a disciplined manner perturbations while assuring that 'customer service' would not be damaged !
One need only look where differential tax or other cost regimes exist, to see the huge potential for problems that Colorado Care presents. Look for example at the tax structure on booze and tobacco products in Canada vs the US and see who is buying what in the border towns before they cross back north. Ditto vis a vis US states in the east and say DC. Or further south in the tobacco states. Why are duty free shops successful?
Meanwhile, I see nothing which says that docs can exist on Medicare payments, nor do I see anything describing the rate at which docs are leaving Medicare, here or in other states. I know that they are, so we are in a period of medical disequiibrium, and it isn't obvious where the balance lies.
Such a healthcare system may or may not be working in Saskatchewan, but I have great doubts folks will be moving there from say Vancouver or Toronto, while I have no problem thinking that the folks from CA and elsewhere thinking about moving here will be further incentivized to do so. CO is much more appealing than Sas.
And, I am very unsure exactly what risk Nancy is taking and would like her to explain for the rest of us.
Nancy--I know this is pedantic, but Colorado doesn't spend $30B annually--$30B is spent by individuals, making thousands of decisions every day. Saying Colorado spends makes it sound very statist, very government controlled. I haven't gotten a response to my question above so I have to believe in general, docs are leaving Medicare, so I wonder what the fall back position is if the savings are not there? Who is gong to do what, to whom, how quickly? $5B is roughly $500 million a month, so what if after three months the savings are not being realized? To make this kind of a discontinuous step, I believe the individuals making those thousands of decisions every day would expect, would need to have essentially 100% assurance that nothing will fall thru the cracks. Can you give that kind of assurance with respect to continued service and realized savings?
Dan Shores--What precisely is the problem, in one declarative sentence, please?
Do any of the contributors here have a very recent fix on the number of doctors no longer accepting Medicare patients? I believe I know the direction that has been heading but would appreciate independent verification.
James--You and I are fully aligned. Time needs to be spent arriving at an agreed upon problem definition before even listing ANY potential solutions. We (even here in SS) waste more time because we start with a 'solution', and inevitably have to retreat, turn around, stop, spend money, etc.. I continue to wonder why, especially in SS why time cannot be spent arriving at an agreed up problem.
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