I spent over a decade doing software support for proprietary medical billing software (got laid off a few weeks ago). So I was the tech guy you called when you had a problem with our software but also 90% because you had a problem with how you billed something. I know a bit about medical billing because I needed to understand it pretty thoroughly to be able to troubleshoot issues in regards to it. What you are saying is correct but there's a lot more to it.

Basically, Medicare has lagged behind the "market rate" in the last 20 years. Some is because of the government trying to save on costs and some is the industry trying to undermine Medicare. It's not just one thing. Another element is how our system as a whole is set up around completely made up pricing because everyone is trying to suck everyone else dry. The episode of Adam of Ruins Everything where he talks about pricing and fees being completely made up is largely true. While you can absolutely make the case that pricing has inflated over 20 years what you must realize is that whatever percentage you see on that actual inflation is just made up. We can say for sure healthcare costs have actually increased but nobody, and I mean nobody, knows by how much. Give me a number between 5 and 200 and that number could potentially be more accurate to reality as what the number was on this image. Or not. Nobody knows.

I think the last person to blame here is doctors, however. For a lot of doctors, running a practice is not very lucrative. Well, not comparatively to other fields that require their level of education and legal responsibility. In the past 5-10 years in the particular part of the industry we serviced, I'd see practices go under regularly and that's part of the reason my company laid off people. Our customer base of independent practices is dying out. More often they get gobbled up by hospital groups who already have their own software suite that they replace us with as ours does not and can not integrate with those. Those larger groups right now love to complain about this issue but at the same time are taking advantage of the squeeze because they can afford to absorb the thin margins for Medicare and Medicaid patients while independents struggle. So while they complain from one side of their mouths while the other side is expanding. As they gobble up market share they are now going to push back on Medicare. It will either have to cut more coverage or increase payouts and most likely both will happen because the supplementary insurance industry wants to create more market share out of Medicare patients and then suck them dry like the vampires they are.

There is a big problem with this whole scenario in that when you talk about Medicare4All to providers like doctors, especially those who have experience in independent practices, see Medicare as wholly insufficient and as it currently exists they are correct in that assessment. Most doctors know the problems enough to know they exist but aren't doing medical billing themselves to realize the underlying issues. For them Medicare pays too little and fights you too much and that leaves a real sour taste in their mouths. Now, anyone who advocates for such a thing knows that M4A means overhauling the system as well but the big players know that adding extra steps that M4A advocates need to explain to sell their platform is a big hinderance in the current soundbite driven political atmosphere we live in. Additionally, most M4A advocates don't understand enough about the actual medical billing and payment issues to really engage pushback there. I have never heard a M4A advocate talk about sequestration, takebacks, audits or anything like that. These are things people with medical practices hate with a passion because it's all headaches for them and 9 times out of 10 they go through the pain just to be justified in their billing and treatments.