[tptacek]

Anthem proposed to apply the precise guidelines Medicare uses to pay for anesthesiology, including references to those CMS guidelines. Billing for anesthesiology has been a hot button issue: the search you want is [anesthesia surprise billing]. Anesthesiology is one of the highest-paid specialties in American medicine.

You cannot reasonably support Medicare and claim that Anthem was doing something unconscionable, because Anthem was adopting Medicare's own policies.

Medicare's admin cost ratio is a function of who it covers. Somewhere in the comment history on HN, there's a short writeup I did of how the math works out if you extend Medicare to the whole population; the admin overhead, for obvious reasons, shoots up --- people pay the same amount of money but require far fewer services, reversing the "advantage" Medicare has in the metric currently.

[jmyeet]

Insurers use the Medicare schedule as a weapon to simply reduce how much providers get paid and/or increase how much patients have to pay out-of-pocket.

The Medicare schedule is generally low because of the negotiating power of the Federal government so when Anthem (or whoever) says something like "we'll pay Medicare rates" or "we'll pay 120% of the Medicare rate" they're really just cutting payments and increasing patient costs. Nothing more.

In the recent BCBS case, all they were doing was saying "it may take 8 hours for the surgery but we're only going to pay you for 3". They haven't made the surgery cheaper to provide. They just wanted to pay out less.

Also, if we're going to simply do everything based on Medicare, why exactly do we even need private insurers? Just expand Medicare to everyone if the schedules are good, right?

[tptacek]

You're saying "the Medicare schedule" as if it's an abstraction, but it is literally the payment process used by the largest buyer of medical services in the country. What Medicare pays matters more than what anybody else pays, because most medical services are performed for Medicare patients. So I'll ask directly: how is it unconscionable for Anthem to use those policies, but not for Medicare to use them?

You are exactly right that Anthem is demanding providers charge less for surgeries, not for surgeries to take less time. Providing "less anesthesia" is not a thing. This is entirely about preventing health providers from charging more money to Anthem and, in turn, their customers. That's why Medicare does the same thing.

[adgjlsfhk1]

The fundamental difference between Anthem and Medicare is that when Medicare cuts reimbursement, that cost isn't passed on to patients, but when Anthem does, it is. Medicare's rates are arguably too low, but low Medicare rates are getting a good deal for the country. Low Anthem rates are passing costs onto consumers and profits onto shareholders.

[tptacek]

That is not how any of this works. Insurers and health chains are in a continuous process of rate-sheet negotiation, and the result of that negotiation is reflected in your premium costs. Most people's out-of-pocket costs are capped, and even the most routine surgeries (like a tonsillectomy) exceed the out-of-pocket cap (I checked! This is a number people report.)

This is about the trade association for anesthesiologists deputizing angry people on Twitter to go to bat for them overcharging for their services.