| The math isn’t checking out…
Multicare CFO James Lee thinks the U.S. healthcare system is on a path toward separate and unequal care as a result of decades of underpayment by CMS. “If you go back to 1997 when the Balanced Budget Act was passed in Congress almost 30 years ago, Medicare started to pay healthcare organizations less than cost. Fast forward to now, and we are getting paid approximately 80% of our cost — that's for Medicare. For Medicaid, depending on the state, we're getting paid somewhere between 50-70% of our cost. Fundamentally, our government doesn't believe healthcare organizations should be paid fairly,” he remarked. Hospitals have historically offset the government’s underpayment by charging commercial health plans more, but Lee noted employers are becoming increasingly unwilling to fund this. “I think that's a fundamental problem. If this continues, my guess is that we're going to end up creating a two-tier system: one for commercial payers and those who can afford to pay out of pocket, and a different system for Medicare and Medicaid patients,” he declared. New inequities incoming
Lee foresees a future in which health systems will “start creating some type of prioritization” for patients with commercial coverage, which means CMS-covered patients will have to wait longer for care. Breaking point
U.S. products are becoming globally uncompetitive in part because healthcare costs are baked into their price, Lee pointed out. Because American companies have to factor expensive health benefits into the price of their goods, they lose ground to foreign competitors. — By Katie Adams |
No comments