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sscovil / medical-corps

A BILL To establish a Medical Corps in the Department of Health and Human Services.
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Where will the money come from? #3

Open sscovil opened 7 years ago

sscovil commented 7 years ago

Facebook user Scuba Fork asked this question on July 23rd:

So the big question is, where is funding coming from? The VA serves a tiny sliver of the population.

sscovil commented 7 years ago

This is the big question that will need to be answered. At a high level, based on some (questionable) math in #2 using the Veterans Health Administration (VHA) annual budget and estimated number of patients served, a fully operational Medical Corps would require an annual budget of roughly $2.35 trillion.

On the bright side, a fully operational Medical Corps would eliminate the need for Medicare, Medicaid, the Children's Health Insurance Program, health insurance subsidies and related spending. Those programs have a combined projected cost of over $1 trillion in 2017[1]. It would also reduce the cost of health care services over time by increasing the supply of trained medical, nursing, and allied health professionals; and by ensuring access to preventative health care for all.

sscovil commented 7 years ago

Facebook user Scuba Fork added this comment on July 26th:

I was thinking about this question again(and dont have a github account so i say it here), but theres a couple points on the math .

The va treats about 9 million people, but about 20 million are eligible for va coverage. I dont know if its fair to say they dont consume va healthcare because they dont need it or get it through private means. But i would make a few assumptions about this-

  1. I would assume VA care, by nature, assumes a higher cost per patient than most other per patient pools. (Elderly and pre-natal are probably more expensive, but the bulk of population is cheaper).
  2. Assumptions about the price likely factor in the high cost of medical expertise, which is what the plan primarily addresses. The cost of medical expertise is often inflated to compensate for the high cost of medical training.
  3. The plan also incorporates training into its budget, but that number is not accounted for in va budgets, as their doctors arrive already trained. Since half of this plan is free medical education, the funding for this needs to be accounted for. Perhaps the VA is not the best model. (Quick google search says tuition and fees is about 35-60k per year per student-but volume pricing would surely bring that down) The initial costs of this would be front loaded, as education demand would soar to meet the market need. Id also assume in order to get the program started and made available to already trained healthcare professionals some sort of debt striking would have to be done.

I suspect the training portion adds more to the overall price than the revised coverage assumptions, bit it feels like the margin of error is several hundred billion per year.

sscovil commented 7 years ago

In 2015, U.S. health care spending reached $3.2 trillion, or $9,990 per person. Health spending was broken out by type of product or service as follows:

2015 U.S. National Health Expenditure by Category

Source: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/downloads/highlights.pdf

Quick Definitions for National Health Expenditure Accounts (NHEA) Categories

The following list is a quick reference to definitions of some of the type-of-expenditure and source-of-fund categories used in the NHEA. More detailed definitions can be found at the following web address: http://www.cms.gov/NationalHealthExpendData/downloads/dsm-15.pdf

Hospital Care

Covers all services provided by hospitals to patients. These include room and board, ancillary charges, services of resident physicians, inpatient pharmacy, hospital-based nursing home and home health care, and any other services billed by hospitals in the United States. The value of hospital services is measured by total net revenue, which equals gross patient revenues (charges) less contractual adjustments, bad debts, and charity care. It also includes government tax appropriations as well as non-patient and non-operating revenues. Hospitals fall into NAICS 622 – Hospitals.

Physician and Clinical Services

Covers services provided in establishments operated by Doctors of Medicine (M.D.) and Doctors of Osteopathic Medicine (D.O.), outpatient care centers, plus the portion of medical laboratories services that are billed independently by the laboratories. This category also includes services rendered by a doctor of medicine (M.D.) or doctor of osteopathic medicine (D.O.) in hospitals, if the physician bills independently for those services. Clinical services provided in freestanding outpatient clinics operated by the U.S. Department of Veterans’ Affairs, the U.S. Coast Guard Academy, the U.S. Department of Defense, and the U.S. Indian Health Service are also included. The establishments included in Physician and Clinical Services are classified in NAICS 6211-Offices of Physicians, NAICS 6214-Outpatient Care Centers, and a portion of NAICS 6215-Medical and Diagnostic Laboratories.

Other Professional Services

Covers services provided in establishments operated by health practitioners other than physicians and dentists. These professional services include those provided by private-duty nurses, chiropractors, podiatrists, optometrists, and physical, occupational and speech therapists, among others. These establishments are classified in NAICS-6213 Offices of Other Health Practitioners.

Dental Services

Covers services provided in establishments operated by a Doctor of Dental Medicine (D.M.D.) or Doctor of Dental Surgery (D.D.S.) or a Doctor of Dental Science (D.D.Sc.). These establishments are classified as NAICS 6212 Offices of Dentists.

Other Health, Residential, and Personal Care

This category includes spending for Medicaid home and community based waivers, care provided in residential care facilities, ambulance services, school health and worksite health care. Generally these programs provide payments for services in non-traditional settings such as community centers, senior citizens centers, schools, and military field stations. The residential establishments are classified as facilities for the intellectually disabled (NAICS 62321), and mental health and substance abuse facilities (NAICS 62322). The ambulance establishments are classified as Ambulance services (NAICS 62191).

Home Health Care

Covers medical care provided in the home by freestanding home health agencies (HHAs). Medical equipment sales or rentals not billed through HHAs and non-medical types of home care (e.g., Meals on Wheels, chore-worker services, friendly visits, or other custodial services) are excluded. These freestanding HHAs are establishments that fall into NAICS 6216-Home Health Care Services.

Nursing Care Facilities and Continuing Care Retirement Communities

Covers nursing and rehabilitative services provided in freestanding nursing home facilities. These services are generally provided for an extended period of time by registered or licensed practical nurses and other staff. Care received in state & local government facilities and nursing facilities operated by the U.S. Department of Veterans Affairs are also included. These establishments are classified in NAICS 6231-Nursing Care Facilities and NAICS 623311-Continuing Care Retirement Communities with on-site nursing care facilities.

Prescription Drugs

Covers the “retail” sales of human-use dosage-form drugs, biological drugs, and diagnostic products that are available only by a prescription.

Durable Medical Equipment

Covers "retail" sales of items such as contact lenses, eyeglasses and other ophthalmic products, surgical and orthopedic products, hearing aids, wheelchairs, and medical equipment rentals.

Other Non-Durable Medical Products

Covers the "retail" sales of non-prescription drugs and medical sundries.

Source: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/quickref.pdf