The Largest Purchaser of Domestic Healthcare?

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It’s the Government – Silly

By Ann Miller; RN, MHA

[Executive Director]ERT Prison Healthcare

By far, our federal government is the largest purchaser of healthcare services, according to Robert James Cimasi MHA, AVA, CMP™ of Health Capital Consultants, in St. Louis, MO; and many others.

Obama Care

Although the government faces immense pressure to control healthcare costs, especially during the current HR 3200-3400 debates, it also faces pressure to expend additional funds in order to achieve its ostensible primary mission in its involvement in healthcare, i.e., to expand and improve public health.

Federal Payment Schemes

In many ways the government has led the way for cost control through its development of resource-based reimbursement, prospective payment systems, budget limitations and other payment schemes. However, its conflicting goals have led it to approach these controls in a hesitant and piecemeal manner rather than effecting bold, comprehensive reforms.

Consider, for example, the lack of government intervention in the face of mounting pressure to remove some of the barriers preventing a reduction in US pharmaceutical costs.


Today, most experts agree that Uncle Sam pays for at least 51% of domestic healthcare when Medicare, Medicaid, SHIPS, the VA, Indian and Prison Healthcare Systems are considered. In fact, according to our Publisher-in-Chief, Dr. David Edward Marcinko; MBA:

‘We already have a single payer health system in this country, but most folks just don’t realize it.”


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7 Responses

  1. Republicans Release Their Own Health Care System Reform Bill
    And, it is a 219 page whopper!


  2. State Prison Health Care Spending

    According to The Pew Charitable Trusts and the John D. and Catherine T. MacArthur Foundation, correctional health care spending rose in 41 states from 2007 to 2011, with median growth of 13 percent. Spending on a per-inmate basis also rose in most states during that time, with median growth of 10 percent. In a majority of states, however, total spending and per-inmate health care spending peaked before 2011. Nationwide, prison health care spending totaled $7.7 billion in 2011, down from a peak of $8.2 billion in 2009, after adjusting for inflation. The downturn in spending was due in part to a reduction in state prison populations.

    From 2007 to 2011, the share of older inmates rose in all but two of the 42 states that submitted data. Not surprisingly, states where older inmates represented a relatively large share of the population tended to have higher per-inmate spending.

    Source: The Pew Charitable Trusts and the John D. and Catherine T. MacArthur Foundation


  3. Government Health Insurance [Medicare/Medicaid/etc] Users By Age Group (In Thousands)

    1. Under age 65: (65,913)
    2. Under age 18: (30,410)
    3. Under age 19: (31,557)
    4. Aged 19 to 25: (6,033)
    5. Aged 26 to 34: (6,601)
    6. Aged 35 to 44: (6,214)
    7. Aged 45 to 64: (15,507)
    8. Aged 65 and older: (41,668)

    Source: U.S. Census Bureau, Current Population Survey, 2014 Annual Social and Economic Supplement


  4. Changing How We Pay for Care

    The Obama administration is poised to fundamentally change how we pay for health care in this country.

    The Department of Health and Human Services (HHS) has set a goal that by 2018 half of Medicare’s payments to health care providers will be based on the quality of the care delivered, not the number of services provided.

    Critics often fault the existing fee-for-service system for rewarding doctors for performing more procedures, and HHS wants to change that.

    As the largest payer in the U.S. health care system, Medicare exerts a huge influence on how health care is paid for and delivered. Medicare’s move is expected to trigger larger changes that ripple through the health care system.

    Dr. David Edward Marcinko MBA


  5. Obamacare

    This ME-P is even more true today with the PP-ACA.



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