Hasten down the wire is linking to the NRA/BCBS law suit, pointing to NRA's contention that usual, customary, and reasonable charges for dialysis are $2,900 per treatment as evidence in support of single payer health care reform.
The reimbursement discrepancy—US$200 on the one side and US$9,000 on the other—is, quite simply, the best argument to date for universal single-payer healthcare in the United States. That the government can negotiate a maximum payment of US$250 for a service that the private sector can’t negotiate for less than US$2,900 says volumes about the value of having a single entity negotiating for all patients.
First a quibble - $200 isn't a Medicare reimbursement average - with case mix adjustment and geographic wage adjustment Medicare's allowed treatment rate varies from about $130 to $220. The $130 being a small frame 65 year old women in rural Georgia; the $220 being a large BMI 40 year old male in a high cost city (Seattle, NY, etc.). Including Medicare reimbursement for EPO (given ever treatment) adds $10 per 1000 units, average US dose is around 7,000 units +/- 4,000 units. I am going on the assumption that the $2,900 is for treatment and does not include routine medications so the comparison would be the Medicare average of about $150 (the Medicare approved rate, Medicare pays 80%) with $2,900.
If dialysis was a true single payer system; if there was no MSP could all dialysis be reimbursed at the Medicare rate without impacting the level of care delivered? No. Not a chance. Right now the level of care that is delivered at the sharp end of the needle is based on a unit's average reimbursement rate. At NRA the average reimbursement rate is greater than 100% of Medicare - the lawsuit states that $2,900 is "in line with the reimbursement National Renal received (and continues to receive) from other commercial payors."
If we were to do away with Medicare's secondary payer provision tomorrow, making dialysis a true single payer system, the Medicare approved reimbursement rate would have to be increased from the current $150 average to the range of $200 to $240 per treatment in order to fund the current level of service. Not only would the numbers of Medicare beneficiaries increase without MSP the per treatment cost to Medicare of existing beneficiaries would increase (it the level of service is kept the same).
Medicare has used it's market dominance to demand services above what it pays for; the only way this can work is if there are private payers who are compelled to make up the difference. Since this is done in the shadows with a wink and a nod, it opens the door for dialysis providers like NRA to take advantage of the situation while Medicare looks away. Rather than saying this case is an argument for single payer I would say this case is an argument for transparency.
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