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  • Can you please explain the difference between Bernie's health care plan and

  • Andrew Yang's health care plan? Ah yes, in order to understand the

  • difference between Bernie's plan and Yang's plan you have to understand

  • Medicare, and Medicare is split into two systems which is traditional Medicare,

  • Medicare Advantage and then we have Yang's plan which is working off of the

  • Capitation model and I'm going to go into all three of these. So there's an

  • issue with our Medicare system and private insurance kind of follows it, so

  • with traditional Medicare we have this issue where claims are accepted almost

  • mmm just for whatever reason--this drives up costs because doctors will prescribe

  • procedures after procedure after procedure whether or not it's necessary

  • or not. So if you go to a doctor and they say that there's a slight error it's

  • like thing with your blood work that didn't go through it wasn't necessary

  • for what you were trying to see but let's go ahead and get your blood work

  • again and so you might go through like three or four visits when you only

  • needed one and this drives up costs so in order to deal with this because this

  • was an issue with traditional Medicare where they just just accepted all claims

  • and costs were really high they came up with Medicare Advantage. Medicare

  • Advantage has a thing where they introduced the idea of medically

  • necessary acceptance so medically necessary is a very vague term and it's

  • basically whatever is necessary and this is where we start denying claims. Under

  • Medicare Advantage claims are denied for very small reasons as such as medical

  • coding issues or whether or not they don't find procedures to actually be

  • necessary and we can go into more about why they would do this later but that's

  • one of the big issues with Medicare Advantage that it saves costs by denying

  • claims. So there's Medicare--traditional Medicare

  • which just accepts claims and it's really expensive, Medicare Advantage

  • saves money because it denies claims and it's very important for you to

  • understand that. The Capitation model takes out the idea of claims in the

  • first place it removes it there will be no claims that will

  • go into the system. Basically the way that doctors will be paid is that they

  • will, say patient will enroll with the provider and then the provider will send

  • their insurance or the government or whoever's on their insurance and say I

  • have this patient enrolled there were their health is like this you're

  • supposed to pay me this much money for this patient and then they pay that

  • money to the doctor for that patient every month whether or not that patient

  • goes in. This does a few things with traditional Medicare they accept

  • everything and so they have all these procedures, with Capitation they have a

  • flat amount and so doctors have to figure out what's the most efficient way

  • for them to deal with their patients. So they need to make sure that their

  • patients are healthy, they need to make sure that they don't visit as often, but

  • they also need to make sure that they have good well-being and good outcomes

  • as well because obviously if you have bad outcomes for your patient, your

  • patient is going to go to a different doctor. With Capitation you change the

  • incentives for providers so they don't offer as many claims for procedures

  • because they only getting a flat amount whether or not you go because they're

  • having multiple people that are enrolled with them-- it's easier for them to get

  • the payments to manage the people who visit and it allows them to us to put

  • incentives to incentivize preventative health--it opens up the whole issue with

  • preventive health. Now with traditional Medicare we don't have any incentive for

  • preventative health the best way to get money is to treat patients as if they're

  • just on a production line. You only value them for the amount of procedures you

  • can prescribe. Now, they don't do this for any malicious intent this is just how

  • the system works. With Medicare Advantage the insurance saves money by preventing

  • doctors from prescribe--from over prescribing procedures but they can be overly

  • scrupulous on this denying claims and you know because the government will

  • have a set amount of money that they can afford for each patient and that number

  • could fluctuate, they might be incentivized to deny claims for whatever

  • reason. The thing with Bernie's plan with these two systems that we don't actually

  • know which one he has. We don't know which is Bernie's uhh? We don't know if

  • Bernie--the way he's accounting for things it's gonna be post-traumatic

  • traditional Medicare or Medicare Advantage or somewhere in between but we

  • don't know that. But even then we can just have we have the idea of Capitation

  • that throws out the whole medium between these two systems, so if you find a

  • medium it you're gonna have the disadvantages of both but at a different

  • different rates. So you have a more expensive system and as it gets more

  • expensive you'll be accepting more claims and that'll be where the medium is.

  • So it'll just get more expensive as you make it less likely that claims will be

  • accepted and you know as it gets more expensive that means higher costs or

  • higher taxes for everyone. With Capitation it's a flat amount, so you can

  • set each citizen or each person that is enrolled in this thing has this like

  • block of money attached to them and wherever they're enrolled that money is

  • get there, So it's really easy for the government to actually account for how

  • much their costs are going to be especially when it comes to prevent

  • preventive medicine. Yang's plan goes beyond just changing the payment system

  • from fee-for-service which is traditional Medicare and Medicare

  • Advantage which is the whole issue that we have with claims and it switches to

  • capitation and he also goes beyond capitation by improving holistic

  • medicine, he has preventive medicine which I've mentioned, before that it's

  • being opened up that we can actually have preventative medicine incentives

  • which is very difficult under fee-for-service and this is something

  • that the world has had an issue with getting their hand getting behind as far

  • as insuring that preventative is the intent-- and so because we're

  • switching to Capitation we can move things there. So there's also a thing with

  • holistic medicine where doctors are incentivized to look at more than just

  • your physical history of like your heart, your lungs, your ears, your nose and just

  • making sure your basic physical goes through. They also have access to

  • psychologists of your choice that you've accepted for them to view or someone

  • that your doctor has recommended so that they can review your medical your,

  • psychological history and say, "hey, you've been depressed and we see that your

  • cholesterol is rising, make sure that you know-- we need to make sure that you get

  • on this or you can talk it over with your psychologist" so it focuses

  • it brings more things in to this so that we can get ahead of certain issues

  • before they get into become-- before they even become an issue. Which are just

  • issues that we just don't know under Medicare Advantage-- under Bernie's plan

  • mmm wow-- okay cool thank you so much. Cool. Yeah.

Can you please explain the difference between Bernie's health care plan and

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A2 初級 美國腔

伯尼'的和楊'的醫療計劃的區別。 (The Difference between Bernie's and Yang's Healthcare Plan)

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    王惟惟 發佈於 2021 年 01 月 14 日
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