Name: The Difference between Bernie's and Yang's Healthcare Plan
Uploaded: 2020-01-12T19:07:45.000Z
Duration: 7 min 37 s
Description: Thousands of YouTube videos with English-Chinese subtitles! Now you can learn to understand native speakers, expand your vocabulary, and improve your pronunciation...

Modal verbs - A2

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

To-infinitive

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.