For instance why is that someone on say Kaiser for example tends to get appointments faster and at (usually) way nicer facilities in nicer parts of town than say somebody on Medi Cal
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This answer doesn’t mean I agree iwth the premise, only that some people do.
When anyone can access something easily they take it for granted and tend to overschedule its use. For example, if there was a test you could take to detect if you have cancer that was free without limitation, most people would want to take that test very often. There is no downside to them personally. But if that test is expensive people will wait until they really need to know before they take the test. Overall it rations the tests to those who need it most.
People who say what you’re asking about think public healthcare will be like unlmited cancer tests – it will clog the system and there is no personal detriment to take one but it will slow down the availibility for people who really need it.
As someone who has a health insurance plan from working for a state organization I can say, supposedly we have very good insurance but there are a lot of places that won’t accept it because apparently the government isn’t good at paying their bills. I was told “It’s like pulling teeth getting reimbursed from the state”. That was from one of the places that wont accept it. It’s the only time in my life I’ve had health insurance so I don’t know how accurate that is though
Kaiser especially runs their own clinics. So they’ve got the docs and the equipment, they’re a private company, they can do what they want with it.
Public stuff doesn’t have a huge budget for “lookin nice”, we used to put a lot of artform into public buildings, from the architecture to the furniture, but that’s gone away for the more utilitarian and cheaper government aesthetics you get today.
So that’s where you see the discrepancy in appearances at least. As far as wait times and such, I’m sure the answer is much more complicated than I can get into, but I work in an industry that has a similar state/private discrepancy so I imagine part of it too is that Kaiser has to MARKET to people, so stuff like minimal wait times is a way to attract new customers.
Every insurance carrier has to negotiate their own contracts with facilities. Those facilities can choose to sign a contract, or not, with whatever carriers they want.
In Toledo where I live medical care is essentially split between two major provide networks, ProMedica and Mercy. Some insurance plans have contracts with both provider networks. Other have just Mercy or just ProMedica.
Frankly it’s a bunch of bullshit. It means that when you switch jobs, if your doctors were all part of ProMedica, you damn well better hope your new health insurance isn’t just a Mercy plan or you have to find all new healthcare providers.
I work in healthcare so here’s a good behind the scenes for at least my state.
We set the minimum rates to pay for something. Let’s call it $1000 a day for that service. The managed care organizations (insurance companies) decide they want to have a leg up getting appointments for their insurees, so they pay $1150 a day. By law, we’re not allowed to ask them what they pay for the service. We just give them a whole bunch of money to manage Medicaid, and they go do it.
Now, in a lot of urban places there are multiple insurance companies competing for these slots. The free market idea here is that competition breeds healthy reimbursement for providers. What happens though, is Medicaid sets the bare minimum rate for something to be acceptable. Now private insurance companies (who often have Medicaid divisions) offer to pay $1750 for that same service. They pass the cost onto the companies or individuals who buy the insurance, so there’s no negative change to their earnings for that service to be more “expensive.”
This is where private insurance ends up being a lot more expensive for individuals in the long run, compared to a public health option. I don’t have the number in front of me because I’m not a robot, but it’s something like 1.2-1.3 times more expensive for a consumer to have private insurance in general, and that’s excluding things like major surgeries or births. Because for Medicaid, we guarantee no co pay and no cost sharing. So for me to get a surgery, it’s $11k on my admittedly good state employee health plan. For my cousin who works at Costco it’s $30k. If I had a foster kid, it would be free to me because all fosters are on Medicaid.
Tldr: some doctors won’t take Medicaid unless they get an incentive to do so, meaning they have a more exclusive clientele.
Medi-Cal is California’s Medicaid system.
On Medi-Cal you get to choose different providers and networks. In many parts of California, people on Medi-Cal can choose Kaiser.
When you pay someone, you get leverage over them. If you have an employee, you can scold them for being late. If someone volunteers, you have to be thankful because they don’t need you and can leave whenever they want.
Private providers want your money, so they give you nice stuff. In communist countries, people often weren’t able to get good things and didn’t have that much choice because the government was paying for it.
If you pay cash, you can get the best healthcare. If you have insurance, now the insurance has leverage and has to approve/deny services.
With EPO or PPO insurance, you get some leverage over the provider because they get paid by your insurance for what they do. As a result these doctors want to do more for you which can be good or bad.
With HMO insurance, the doctor usually receives a salary. They want to get you done and over with as soon as possible. This can also be good or bad.
With HMO – if you need a refill on your diabetes – you can easily get it done and over with a phone call, email, etc. If your knee hurts, good luck getting a referral for a knee specialist or getting an MRI.
Kaiser claims their good, because they’ll be done with you in the fewest visits. However for big issues, this might be too rushed.
With PPO/EPO – if you need a refill, they might ask if you stop by their office. If your knee hurts, your doctor will gladly refer you to a knee specialist, the specialist might refer you for an MRI and for physical therapy.
These are good because they care more and want to do more for you. But it’s also bad, because more visits can be inconvenient. However if your knee hurts, you could go straight to the knee specialist without a referral. Whatever issue you have, you could go straight to the right doctor.
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