Medicare reimburses health care providers according to a schedule of payments. A “Prospective Payment” that is based on the world’s largest and most realistic data set for locally-adjusted health care costs. Some health care providers, private nonprofit and for-profit providers mostly, grouse at the low reimbursement. Why? Because the Prospective Payment schedule does not provide for huge allowances for bloated and unnecessary administrative salaries, marketing, profit, and other costs that have nothing to do with patient care.

This is why Medicare for All is so necessary to reduce spiraling health care costs.

So how do hospitals and insurance companies determine the cost of services? The answer is the black box known as Chargemaster. See the description Chargemaster here:

Chargemaster intentionally obscures medical costs for patients and defends as a trade secret the inputs and formulas used to derive these costs. Costs are purposely, massively over-inflated. These over-inflated prices are then used as a starting point of negotiation for insurance companies (mostly), so that when you receive your over-inflated medical bill, your insurance company can boast of how much lower the price is because of their negotiation. Consider though, that this lower cost still contains surplus enough to sustain huge executive salaries for insurance companies, and that these huge salaries are rewards not for ensuring affordable patient care. No, these salaries reward maximization of shareholder value, unearned income for investors, as a priority over your health care. 

Medicare for All is the solution. This is a nationwide solution. In the mean time, at the state level, you can be empowered to know what the cost would be under Medicare for every medical bill you receive. You should know something more than what your insurance company (in essence) talked down from Chargemaster. As Senator, I would introduce legislation to make this reporting a requirement

In addition, I would introduce legislation that would require an estimate of cost for uncomplicated elective procedures to be within 10% of the final charge. The source for this estimate can be from Chargemaster or any source the health care provider may choose, but it must also present the Medicare Prospective Payment charge. 

You should know what you are paying for, as much as is possible, before you are charged for it. You should know how much you would be paying above and beyond Medicare’s Prospective Payment. This knowledge would go far in exposing the secretive and deadly scam that is Chargemaster’s medical billing. It would go far in generating popular support for Medicare for All. 

See Eben Rose Webpage:
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