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But capitalism. . . freedom. . .

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Hi Weldon:

I see my friend Jack has made it here already.

It has been a while since I have authored anything major on healthcare. Let state it in the beginning, healthcare should be available for all and not just the majority who can afford some version of it. I would not pick Fee-for-Service Medicare as the alternative. I would choose Single Payer.

Medicare does take care of me along with the Supplemental plan and Part D for pharma. But, that is the problem with FFS Medicare. It is incomplete and always has been. Congress has blocked it from supplying those additional benefits we now get with Part A and B.

I am stating this not so much for you as I am for others. I would guess you have Medicare (hopefully). I am not sure all people understand the dynamics which lead up to the situation you are describing in your example.

The competitor to FFS Medicare is Medicare Advantage, the commercial version run nu healthcare insurance companies and endorsed by AARP which sponsors MA as supplied by United Healthcare. With MA plans, you get everything all wrapped up neatly in one plan. Sounds great and just like traditional healthcare insurance most of us had in the past.

Amazing plans offering many freebies to attract oldsters into it. MA plans overcharged AMC to the tune 0f ~$12 billion in 2020 as reported by MedPac chapter 12. CMS has reported their overcharges since it became a major supplier of healthcare to oldsters. We or they love it until we or they start to get the same runaround you described for the child needing an advanced and better treatment.

FFS Medicare has its own issues with payment to healthcare doctors, pharma, and hospitals. FFS Medicare overpays commercial healthcare providers and it is complex. Try to follow how pharma gets to the drugstore from the manufacturer. It is complex and makes little sense. Everyone in between gets their cut of the pie. If you are fortunate, your drugs are a tier 1 or 2 and your deductible is lower. An old game is to set the deductible high and charge list price until it is satisfied. If you only have 1 or 2 drugs, you never hit the deductible even paying list as determined by the insurance plan.

That was the negative.

The positive is when I have to get 4 doses of Rituxan which lists for $28,000 per given dose. The last time I looked Medicare and whatever were paying $8000/dose. Even is a give way for an older drug. What happens is companies such as Roche will search for new uses of Rituxan. If the find one, they can up the price again. The ICER which studies drug pricing for legitimacy will approve or disapprove the new usage based upon the new info. It is not a mandatory approval needed to market. The companies do leap through many hoops to get the approval.

My point? FFS Medicare is better than commercial Healthcare Insurance or Medicare Commercial Advantage. Single Payer is far better than all of them as it does more with lowering the costs such as administration which is worth and ~15% cut in costs. Pretty heffy cut when you are talking about $2-3 trillion dollars a year, I would talk about more of the this except you may already know this. I do not want to bore you either. Good person to read is Kip Sullivan PNHP. I have sponsored his articles on single payer healthcare.

Sorry for the legth of this.

Bill

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