NEVER GONNA FORGET IT!

In the meantime, we fight. We fight all this crap.

Instead of making progress. We fight regress.

Clinton's Administration (1997).

Much of that article and Request for Information is about alternatives to the fee-for-service system that most people blame for much of the uncontrolled Medicare, Medicaid and private insurance expenditures. Obama was a big proponent to alternative payment mechanism that promote quality, not more services that physicians and hospitals profit from.

Physicians have been able to opt-out of Medicare for years through so-called "private contracts." Very few do. Most that do are Ron/Rand Paul types who are philosophically opposed to government programs -- in other words they are so stupid you wonder how they became physicians. Some cater to the wealthy. But it's less than 10,000, and personally, even if I could afford it, I would not want to see them. Physicians who have opted out have to clearly notify patients -- through very specific, written contracts -- that they are opted out and Medicare will not pay anything toward their care with that physician.

We've talked about getting the profit out of health care. This is one way to do it, by designing reimbursement systems that incentivize cost efficient, high quality care.

To even think about as sustainable Medicare-for-All, with no copays or deductibles, free choice of any provider, picking up millions of uninsured, etc., we are going to have to change the payment mechanism that allow doctors to order tests they profit from that are questionable.

The 5 year program was started July 2016, and our local hospital was one of maybe 30 across the country to test teh new program, which is geared to a slightly different payment system based on outcomes.
A large for profit cancer institute in Mobile sends a dr. up here every Tuesday ( doctors rotate the job, so you seldom see the same one more than a couple of times).
The institute bills for the actual chemo drugs, but ancillary drugs you can buy with prescription locally.
The idea is to see if private/Gov. can lower costs,and the Medicare program pays a small incentive fee.

I know all this because I was diagnosed with breast cancer 2 weeks after the program started, and if it were not here, I would have had to drive 180 miles round trip to Mobile, in the summer heat, for 3x week chemo for 6 months. ( the surgery is available at the hospital here, thank god.)

My cost was the annual deductible, plus the 20% co-pay for surgery ( billed as outpatient, thank god, hospitalization is a lot more out of pocket)
and for follow up visits, blood tests, various physical exams ( pap test, mammogram, etc). and teh hospital allows no interest, low monthly payments,
The hospital has built an almost completed new ward for oncology dept. so I think they plan on sticking around for a few years, hopefully until I hit 5 year remission cycle.

I do not think that Medicare for all will be free of deductibles and co-pays. Private insurance charges for that, so does ACHA,
only Medicaid is "free" to the patients but they still have out of pocket prescription costs.

groups like this are an important part of getting care to people, nowadays. Part of that is because government alone often moves too slowly if they have to set up the funding and infrastructure, etc., needed to move these projects along.

The reason I mentioned no copays/deductibles is because that is in Sanders' Medicare-for-All Bill.

Take care.

His no co-pay/deductible is most likely a negotiating point.