Would "Medicare for All" help OD's???

[Uncle Fester]

I'm not sure if OD's on their sites have discussed this but what would happen if we had a single payer system where routine eye exams were covered at a set rate under a single payer system?

Wouldn't that pull the rug out from under insurances combining eyeglass benefits to exams?

To my way of thinking an OD would now be free to create matching eyeglass benefits with less (no) insurance eyewear paperwork and greater profit if the insurance company is now out of the picture.

What's wrong with this picture from an OD's point of view?

[For-Life]

Just to give some background. The government here used to pay for all eye exams (you got them once a year under 20 and over 65, and twice between). They stopped covering between 20 and 64 (with the exception of an eye condition) in 2005. Now, I think some ODs are doing better, because they can charge a little more, but the insurance companies have never dominated our market.

The way insurance works here is your plan will cover you for up to a certain amount for eyeglasses every two years (I think the average is $300). The patient goes whereever they want and buy whatever they want, and the plan will reimburse them.

So the insurance companies have no control over us.

I think a big reason why is the insurance companies have less power here where they do not dominate health care coverage. Since the government pays for most health care, only fringe benefits are covered by health insurance companies (eyeglasses, eye exams, chiropractor, etc).


In is interesting that a system with socialized medicine provides more freedom to the small business person than one where it is insurance driven.

[chip anderson]

Not when someone checks up and sees the cost vs sale price vs. quality on the junk being dispensed for these poor people.
No Government ever pays anything for anything. Only us poor working slobs (sometimes correctly referred to as tax payers) pay for things. Insureance companies don't pay either only the policy holders do.

Chip

[Uncle Fester]

No Government ever pays anything for anything. Only us poor working slobs (sometimes correctly referred to as tax payers) pay for things. Insureance companies don't pay either only the policy holders do.

Chip

My point exactly! We are paying for this one way or another.

Why not cut out the middle man (insurance)?

[braheem24]

Why not cut out the middle man (insurance)?

You want a check box on your tax return allocating funds to a federally established healthcare system, free to all who check the box?

[chip anderson]

Why not elimininate both middlemen, de govment N de insurance? Go to a you want it, you pay for it out you own pocket system?
The present one has resulted in steadily elevating pricing for all medicine to the point where it is no longer affordable to the general population.

Chip

[fjpod]

Well...back to the original question.

It's a fairly well established fact that giving coverage to people will bring them in for care more often than if they are self pay. So frequency of exams and treatment of eye disease would go up. And usually, payment per encounter in these situations, goes down.

But what kind of plan would it be? If it is a Managed Medicare Plan, similar to the ones that exist today, then there will be a comprehensive eyewear component included. So, there will be some increased profit in that, but limited.

I doubt if it will be like traditional medicare. I think it will be more like medicaid. If the plan...whatever it is...does not include eyewear, you will find that many of these patients don't want the goods at any price. They want what's free.

So when you say, "will it benefit ODs?" Yes, in the sense that we will be seeing more people for exams and treatment. The eyewear end of it is almost immaterial. But this is all IMHO...

[tdnod]

The problem with the system today is that most OD's do the same work as an MD for a routine eye exam and get paid maybe 1/3 of the the reimbursement rate under the managed care systems. More than half of these patients have some sort of medical problem that must be referred out to the MD because the managed care company will not pay the OD to see the patient for the problem. Because the problem is a covered benefit, the patient will not pay the OD to perform the test or treatment needed. Under a "Medicare for All" system, and if administered like medicare, medicare doesn't pay for prescription eye wear unless after cataract extraction. And Medicare pays for an OD to treat medical conditions, the patient could feel comfortable enough to choose their OD, without having to lay the costs out of their pockets or choose an MD if they are inclined.

In a managed care system, once the exam is completed more than 80% pick from their selection of frames and only get the bare minimum needed to get by. Very few upgrade their lenses even when given the benefits of the upgrades. Then when the glasses are ready to dispense, they complain that it took too long, the lenses are too thick, and the frame is junk. Many office hours wasted on deflection and understanding the patient's frustrations. Another year goes by and the process starts all over again.

As for the Medicaid system, it is even better than managed care. I would pick a "medicare for all" policy anyday over the money sucking HMO system that is killing both our government and our doctors ANYDAY! The managed care industry has put more problems on the health care industry than any other insurance.