[Spooky23]

It’s more complex. Medicare is outcome-based. Providers who do a shitty job don’t get paid, which is why hospitals complain about reimbursement.

Medicaid is like an ATM machine for providers in many states. There is usually little or no correlation between outcome and payment, and poor fraud controls. That’s why you always hear about providers in NYC and Miami who “visit” 900 patients a day. Additionally, you have the institutional racism aspect of Medicaid where services are unavailable in some red states.

IMO, the biggest issues in healthcare are for profit institutions and insurers and the trade guild practices associated with Doctors.

Single payer or regional systems supported by taxes are the way to go. Medicaid should be an institution that is replaced by something better.

[ianai]

The market would work better if everyone was paying the same prices without "denial-based" inflation.

I think the solution would be to give citizens disease/disorder "endowments." i.e. a yearly health stipend account - it's money they can spend at doctors, but they can't spend on unrelated goods/services (i.e. food). On top of that, additional "stipends" for major life ailments. The trick would be in finding budgets for those stipends. Once individuals have money, though, they have the ability to do the relative value assessment for various treatments.

[snaily]

You may want to read up on Singapore's Central Provident Fund system, as a real-life implementation of something similar: https://en.wikipedia.org/wiki/Central_Provident_Fund

[aaavl2821]

actually, most medicare is not outcome based today, although that is the vision.

"value based care" has many meanings. simply using patient satisfaction surveys can be considered value based care, while participating in a double sided risk sharing ACO also qualifies. as of 2016, only 36% of physiicans participated in ACOs, under 30% in patient centered medical homes, 31% in bundled payments (which only impact a subset of diseases). howver, 75% used patients satisfaction surveys, 55% used PQRS, and 64% achieved meaningful use [0]

so the reality is that outcomes based care is still the minority, and real risk-bearing (two-sided risk sharing, full capitation) arrangements are even less common. most care is still reimbursed as FFS. and even as value based care is becoming more common, cost of healthcare is still not decreasing

and yes, medicaid can be fraudulent in some cases, but not always

[0] https://physiciansfoundation.org/wp-content/uploads/2017/12/...