How Medicare payment cuts are hurting health care AI transcript and summary - episode of podcast Marketplace
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Episode: How Medicare payment cuts are hurting health care
Author: Marketplace
Duration: 00:29:48
Episode Shownotes
Adjusted for inflation, Medicare pays doctors almost 30% less than it did in 2001, the American Medical Association says. And unless Congress intervenes, physicians will take another 3% cut in January. That decline in payment rates has a ripple effect through the health care system. Also in this episode: Investors
celebrate Trump’s treasury secretary pick, print magazines are making a comeback and not everyone is thrilled with the outcome of COP29.
Summary
This episode discusses the impending 3% cut to Medicare payments for doctors, despite rising healthcare costs. The American Medical Association highlights that adjusted for inflation, Medicare pays nearly 30% less than in 2001, creating challenges for independent medical practices. The repercussions of these cuts extend throughout the healthcare system, forcing many physicians to limit their Medicare patient load. Additionally, the episode touches on migration trends to the Midwest, where cities like Kansas City and Columbus see an influx of people attracted by affordability and job opportunities.
Go to PodExtra AI's episode page (How Medicare payment cuts are hurting health care) to play and view complete AI-processed content: summary, mindmap, topics, takeaways, transcript, keywords and highlights.
Full Transcript
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00:01:04 Speaker_14
On the show today, we've got three M's, not the company. Markets, magazines, and murals. From American Public Media, this is Marketplace. In Baltimore, I'm Amy Scott, in for Kai Riesdahl. It's Monday, November 25th. Good to have you with us.
00:01:32 Speaker_14
We talk about the bond market a lot on this show because the $28 trillion Treasury market tells us a lot about the global economy and where investors think it's headed.
00:01:43 Speaker_14
And that's where we're going to start as the market reacts to President-elect Donald Trump's choice for Treasury Secretary, hedge fund billionaire Scott Besant.
00:01:52 Speaker_14
Bond yields had been rising steadily since September, as strong economic data and then Trump's re-election had investors worrying about inflation. But as Marketplace's Mitchell Hartman reports, yields have been coming down more recently.
00:02:08 Speaker_18
Up until the announcement of hedge fund manager Scott Besant as Trump's Treasury pick, investors were focused intensely on inflation and whether it might soon surge higher again.
00:02:19 Speaker_18
In part because of what the incoming Trump administration is expected to do, says Thomas Urano at Sage Advisory.
00:02:26 Speaker_20
tax cuts, tariffs, immigration, the market generally proceeding the Trump administration to embark on policy that might add to inflationary pressures, add to growth, but also add to the deficit.
00:02:39 Speaker_20
Brings into question whether the Fed is going to continue cutting rates.
00:02:42 Speaker_18
There's a bit less worry now that investors expect Scott Besant to hold the most important economic position in the new administration, says Urano.
00:02:51 Speaker_20
It's just a little bit of a relief rally. He's viewed more as a moderating force on some of the tax tariffs and deficit concerns.
00:02:59 Speaker_18
In particular, Besson is seen as ready to advocate for a balance between Trump's stimulatory wish list and fiscal reality, says Jennifer Lee at BMO Capital Markets.
00:03:10 Speaker_06
He said his first priority is delivering on all the tax cuts the president-elect has promised instead of tariffs. The fact that he also wants to cut spending is also encouraging as opposed to spending like there's no tomorrow.
00:03:23 Speaker_18
Besant is on the record favoring gradual implementation of tariffs, which could reassure companies and consumers worried about higher import prices hitting right away.
00:03:33 Speaker_18
Some of the relief in markets comes simply from the fact that Besant is a seasoned Wall Street hand at a time when the federal deficit is high and likely going higher, says Quincy Crosby at LPL Financial.
00:03:46 Speaker_00
the need to raise money to pay for that deficit via auctions, for example, you need to have someone highly experienced. I mean, that's something that the market was in essence demanding.
00:03:59 Speaker_18
But the Besant rally may not last, says Crosby. We get more inflation data later this week. And if the news isn't good, Treasury yields could shoot up again. I'm Mitchell Hartman for Marketplace.
00:04:10 Speaker_14
On Wall Street, you know what people say about Mondays. Yeah, not today. We'll have the details when we do the numbers. COP 29, the annual UN climate summit, came to a close over the weekend in Baku, Azerbaijan.
00:04:44 Speaker_14
Expectations were low, given the absence of top world leaders from some of the largest greenhouse gas emitters, including the United States, China, and France, and the fact that for the third year in a row, a petrostate hosted the meeting after Egypt and the UAE.
00:05:02 Speaker_14
In the end, there was some progress. Developed countries agreed to commit $300 billion a year to help poorer countries adapt to climate change by a decade from now. That's three times what wealthy countries had been contributing.
00:05:17 Speaker_14
But as Marketplace's Kayleigh Wells reports, it's far less than experts say is needed.
00:05:22 Speaker_13
Developing countries and their advocates wanted to see a $1.3 trillion per year commitment. American University Environment Professor Dana Fisher calls this year's conference a carbon-infused nothing burger.
00:05:35 Speaker_08
Anybody who expected this 29th round of climate negotiations in a petrostate, theoretically to stop the climate crisis, was fooling themselves.
00:05:46 Speaker_13
And Fisher says it's not like there's an agreed-upon punishment if countries don't fork over their share of that money.
00:05:52 Speaker_08
It's green smoke and mirrors. I mean, it's just it's just performative climate action at this point.
00:05:58 Speaker_13
President-elect Trump pulled the U.S. out of the Paris climate agreement during his first administration, and he has promised to reverse President Biden's decision to recommit to the treaty.
00:06:08 Speaker_13
Daniel Brissett, president of the climate nonprofit Environmental and Energy Study Institute, went to the conference and didn't come away too worried.
00:06:17 Speaker_03
The rest of the world has kind of been to this rodeo before and has found ways to cope.
00:06:22 Speaker_13
Plus, just because the federal government pulls out doesn't mean the whole country has to.
00:06:27 Speaker_03
One thing that was hard to miss was the sort of the state and local government, the U.S. subnational message was, we're still in.
00:06:37 Speaker_13
Anne Brissett says much of the corporate and private sector is still in, too. There's nothing legally binding about the $300 billion deal, says Kava Gillenpoor of the think tank Center for Climate and Energy Solutions.
00:06:49 Speaker_19
But... There are political and moral repercussions, and I'm pretty confident that they will deliver against that.
00:06:57 Speaker_13
Gillenpoor was also at the conference, where he says cop leaders produced a blueprint for their next meeting.
00:07:03 Speaker_19
which is essentially tasked with getting the incoming COP30 presidency of Brazil to think about how you do move from these billions to the wider trillions."
00:07:14 Speaker_13
Meaning that $1.3 trillion per year target is still on the table for next year's conference in Belém, Brazil. I'm Kayleigh Wells for Marketplace.
00:07:27 Speaker_14
As you may have heard, we have a Marketplace podcast focused on climate change policy solutions and your questions. You can find how we survive wherever you listen to podcasts.
00:08:00 Speaker_14
Starting next year, doctors will earn about 3% less money caring for older patients with Medicare unless Congress intervenes before January. And that's even though the cost of providing care is projected to rise by about 3.5%.
00:08:16 Speaker_14
Every year, by law, the Centers for Medicare and Medicaid Services makes adjustments to what's called the physician fee schedule, which determines how much doctors get paid for different services.
00:08:28 Speaker_14
The American Medical Association and other groups representing doctors are pushing back against the cuts and say they're making the math of being in private practice increasingly difficult. Marketplace's Samantha Fields has more.
00:08:42 Speaker_05
Everything about running a medical practice has been getting more expensive, especially in the last few years.
00:08:48 Speaker_02
Staff salaries have gone up. Our rent has gone up. All of our equipment.
00:08:53 Speaker_05
Bruce Scott is an ear, nose, and throat doctor in Louisville, Kentucky, and current president of the American Medical Association.
00:08:59 Speaker_02
At the same time, what Medicare has paid us has gone down.
00:09:04 Speaker_05
Adjusted for inflation, Medicare now pays doctors almost 30% less than it did in the early 2000s, according to the AMA. And Scott says that ripples through the entire health care system. Private insurance tends to pay significantly more than Medicare.
00:09:18 Speaker_05
But when Medicare rates go down, private insurance rates often do, too.
00:09:23 Speaker_02
As a result, physicians have made difficult choices. In some cases, it's to limit the number of Medicare patients that they're willing to see, to stop accepting new Medicare patients, or close their practice completely.
00:09:38 Speaker_05
That's an issue in Stillwater, Oklahoma, where Mary Clark works as a family doctor.
00:09:43 Speaker_11
We see a lot of people having a hard time finding a physician who is accepting new Medicare patients. And I hear that from my staff on a weekly basis.
00:09:52 Speaker_05
She also hears it from colleagues in other rural areas. If you're a small, independent practice, you need at least some patients with private insurance to make the math work.
00:10:02 Speaker_11
You can't see every Medicare patient. It's not financially possible.
00:10:06 Speaker_05
Michael Chernew, a professor of health policy at Harvard Medical School, says nationally, people with Medicare report they have as good, if not better, access to doctors than people with commercial insurance.
00:10:17 Speaker_05
That's according to a recent survey from MedPAC, the Medicare Payment Advisory Commission, which he chairs.
00:10:22 Speaker_23
It can be hard to find doctors that take Medicare. It can also be hard to find doctors that take commercial insurance.
00:10:27 Speaker_05
There are huge variations in how all of this is playing out around the country and for big hospital systems versus private practices. And Robert Berenson at the Urban Institute says not all specialties are paid the same.
00:10:39 Speaker_16
There's doctors who interpret images. There's doctors who do surgery. There's doctors who spend time on office visits.
00:10:46 Speaker_05
And some of those services are paid more highly than others.
00:10:49 Speaker_16
Have you ever had a liquid nitrogen applied to a ward? It takes about a minute.
00:10:55 Speaker_05
And Medicare pays dermatologists roughly $165 to do it.
00:10:59 Speaker_16
Meanwhile... A payment for 40 minutes with a very complex patient who probably has one or more chronic conditions is about the same, $177.
00:11:09 Speaker_05
Berenson says the whole process is broken.
00:11:14 Speaker_16
It results in overpayment for procedures and imaging and tests and underpayment for time spent with patients.
00:11:21 Speaker_05
Even with the overall decline in rates, he says plenty of doctors are doing just fine. And big hospitals have leverage to negotiate higher rates with insurance companies. But small practices like Dr. Bruce Scott's do not.
00:11:34 Speaker_05
In Louisville, he says, one insurance company covers about 60 percent of patients with commercial plans. And that company?
00:11:41 Speaker_02
has actually offered us rates less than Medicare now, and we can't even bring them to the table to talk because they know that we can't really say no.
00:11:52 Speaker_05
Earlier this year, Scott says a major cyber attack on the payment processing company Change Healthcare meant his practice didn't have any revenue coming in for about six weeks.
00:12:02 Speaker_02
Our practice had to take out a loan to be able to pay our staff and pay our rent and all of our bills. And the physicians stopped taking paychecks for several pay periods. That's how close to the edge we are.
00:12:18 Speaker_05
Which is why he says every reduction in reimbursement rates matters. I'm Samantha Fields for Marketplace.
00:12:46 Speaker_07
Coming up... Over time, the hanging upside down became my trademark.
00:12:52 Speaker_14
Everyone has their thing. But first, let's do the numbers. The Dow Jones Industrial Average rose 440 points, 1%, to finish at 44,736. The Nasdaq added 51 points, a quarter percent, to close at 19,054.
00:13:01 Speaker_14
And the S&P 500 gained 18 points, three times percent, to end at 5,987. At least $132 million worth of small package delivery expenses never made it onto the books at Macy's.
00:13:23 Speaker_14
The retailer reported today that a lone employee intentionally made bogus accounting entries. worth at least that much between the second half of 2021 and this month.
00:13:33 Speaker_14
It also reported that while sales are looking pretty good in the current quarter, they weren't great during the third quarter. Shares gave up 2.2%. Per Mitchell Hartman's story, bond prices rose. The yield on the 10-year T-note fell to 4.27%.
00:13:47 Speaker_14
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00:16:28 Speaker_14
This is Marketplace. I'm Amy Scott. If you were to move, maybe to another part of town, maybe another region in the United States, where would you go?
00:16:38 Speaker_14
The Sun Belt gets a lot of attention for the large numbers of people relocating and buying homes in states like Arizona, Texas, and Florida.
00:16:47 Speaker_14
But a new survey from the National Association of Realtors shows another part of the country is getting a lot of love too, the Midwest. Marketplace's Elizabeth Troval explains.
00:16:58 Speaker_10
People moving to the Midwest are coming to cities like Kansas City and Columbus, where there's been lots of development, says Jonathan Rappa with Brokerage Advisory Service MMG REA.
00:17:09 Speaker_21
The confluence of factors that has really kind of seen development tick up in the Midwest.
00:17:17 Speaker_10
Take Columbus, Ohio, where Intel is opening up a new semiconductor plant nearby, and home sales have been strong. Sean Simpson is a real estate agent there.
00:17:27 Speaker_25
We're seeing a lot of people come in from California, you know, the D.C., the New York, who are looking for a little bit more of an opportunity with a little bit more of an affordable housing aspect.
00:17:38 Speaker_10
He says these newcomers are also willing to move further from urban centers in exchange for other perks.
00:17:45 Speaker_25
You get the schools they want, the parks they want, the amenities they want. And also a lot of them are bringing cash.
00:17:51 Speaker_10
Some people are also moving back to the Midwest after moving away, says Matt Christopherson with the National Association of Realtors.
00:17:59 Speaker_09
It was about a quarter of movers to the Midwest moved back somewhere where they previously lived.
00:18:05 Speaker_09
So combining that with the point that they're really driven by being close to family and friends, they're most likely moving back to their home, maybe hometown, or at least where their family lives.
00:18:18 Speaker_10
People have also moved away from the Midwest, but states like Ohio and Indiana have been seeing net migration gains, with affordability playing a role, says economist Ralph McLaughlin at Realtor.com.
00:18:31 Speaker_24
Places like Akron and St. Louis and Cleveland and Indianapolis, those are the places where you only need to make $50,000 to $70,000 to buy the median priced home.
00:18:44 Speaker_10
And he says those markets are likely to stay affordable since they're less constricted by geography and zoning laws that limit new construction. I'm Elizabeth Troval for Marketplace.
00:19:23 Speaker_14
Earlier this fall, The Atlantic, the American magazine publisher, did something surprising It announced plans to increase the number of print editions it puts out each year. That's right, increase from 10 magazines to 12.
00:19:37 Speaker_14
The Atlantic isn't the only magazine investing in print these days. This year, SAVR, if I'm saying that right, Sports Illustrated and Vice have all committed to restarting their physical editions.
00:19:49 Speaker_14
Amanda Mull wrote about it in Bloomberg Businessweek the other day. Amanda, good to have you back. Thanks for having me. All right. So several magazines have actually restarted their print publications, and there are some newcomers. What is going on?
00:20:06 Speaker_14
Right.
00:20:06 Speaker_04
So we're probably all pretty familiar with the decline of print over the past 10, 15, 20 years. Over that period of time, a lot of longstanding publications that had started as print magazines
00:20:19 Speaker_04
you know, decades or even a century prior, had phased out their print editions and tried to funnel everybody online. In the past couple of years, some of those publications have started to think twice about that decision.
00:20:33 Speaker_04
Just in, you know, recently, Field & Stream, Nylon, Savor, Sports Illustrated, Vice, all of these companies are like, well, hold on a second. Why don't we bring back a little bit of print magazine and see how it goes?
00:20:47 Speaker_14
And why do you think that is? Were readers clamoring for a print copy to hold in their hands again?
00:20:55 Speaker_04
Well, I think that fundamentally the issue is that people didn't stop buying print magazines, and companies didn't stop printing print magazines because consumers hated them.
00:21:06 Speaker_04
They stopped printing them because the economics of printing physical editions of a magazine became sort of untenable.
00:21:13 Speaker_04
And I think that what we're seeing is the realization among publishers of periodicals that they may have moved a little too swiftly to kill off this entire arm of their business.
00:21:25 Speaker_04
And it turns out that advertisers really like print magazines as well, so you might not be able to print a weekly magazine anymore, and some of these companies probably can't print a monthly magazine anymore.
00:21:36 Speaker_04
But maybe like a quarterly magazine, there's demand for it among readers, there's demand among advertisers, so like why not give it a try and see if it works.
00:21:45 Speaker_14
You mentioned that advertisers like appearing in magazines. How are these ads different than what they might pay for online?
00:21:53 Speaker_04
Well, I remember when I was a kid reading magazines, there were lots of advertisements, especially in the fashion realm, but also in consumer technology, in beauty, in lots of different industries that were downright artistic, that people would tear out of magazines and put on their walls.
00:22:09 Speaker_04
These were advertisements for products, but people didn't encounter them as an inconvenience or as something that was trying to get in their way. That is still the case. In fact, it might be even more so the case.
00:22:22 Speaker_04
The bad online advertising or bad technology in implementing online advertising can make people think worse of your publication or of your product if you're the advertiser.
00:22:32 Speaker_04
And you really don't get that same capacity for blowback in a print publication because it is just a lot more standardized. It's a different user experience. And there's a lot more upside.
00:22:43 Speaker_04
So especially for high-end brands and advertisers, going that direction gives you as an advertiser a lot more control over how your ad appears, over how obtrusive it is to people, and ultimately more control over what they might think of you as a result.
00:23:01 Speaker_04
So there's a lot of upside for advertisers.
00:23:05 Speaker_14
Well, and it's not just the advertisers who are high end, right? You mentioned that a lot of the readers are going to be higher income, more educated. It's become kind of a luxury good.
00:23:16 Speaker_04
Yes, I think that a really beautifully designed magazine full of interesting, freshly reported stories is something that a lot of these publications look at as particularly marketable toward a higher-end subscriber, somebody who might pay $100 or $120 for an annual subscription.
00:23:34 Speaker_04
And then when you make a sophisticated
00:23:41 Speaker_04
a high-minded product that you can better sell to this cohort of the population, you then make a publication that can make a really great pitch toward advertisers who are looking for people with disposable income, who are looking for that same cohort of the population, essentially.
00:23:59 Speaker_14
Are you subscribing to anything in print that you might have read online previously?
00:24:04 Speaker_04
Oh, I subscribe to tons of things. My mailman is extremely busy.
00:24:12 Speaker_14
All right. Well, Amanda Mull, it's always good to talk to you. She writes at Bloomberg Businessweek, which has a print edition.
00:24:19 Speaker_04
We do. It's beautiful.
00:24:21 Speaker_14
Amanda, thanks so much. Thank you. Speaking of art, when was the last time you saw a good mural? I'm lucky to live in a city full of them, giving life to an otherwise dull concrete wall or office space, telling a story, making you think.
00:25:05 Speaker_14
For this next installment of our series, My Economy, we hear from someone who creates these works of art for a living.
00:25:12 Speaker_07
My name is Cindy Fletcher Holden. I am a muralist, an artist, and a sign painter, and I live in Annapolis, Maryland.
00:25:22 Speaker_07
I graduated with a degree in painting and not quite sure what I was going to do with that, but so I got a job in a sign shop and I learned the trade of hand-painted lettering and got involved right away into the full career of painting names on boats.
00:25:39 Speaker_07
The interesting thing then was to learn the trade of sign lettering, my employer would cut out a stencil and I would literally go and hang upside down off the back of the boat and use the brush to form the letters.
00:25:53 Speaker_07
And over time, the hanging upside down became my trademark. My aunt asked me if I wanted some of my grandfather's art supplies. So when I went to go get them, I was shocked to see that we had all the same supplies that I had.
00:26:16 Speaker_07
He had lettering brushes, he had gold leaf supplies, he even had the same one-shot sign paint. And as I went through his art supplies, I realized that we did the same thing. He did truck lettering, signs, and murals. And I did not know this until
00:26:33 Speaker_07
that point. It made me realize that this whole lettering mural painting is in my DNA. I do murals in businesses, in private homes, in private schools, in public schools. I've done a couple of public murals as a result of a contest.
00:26:58 Speaker_07
They're all a challenge, each one is different. Even some of the ones that I've done that are the same logo, they might be on a different surface, some are outside. So each job requires a whole different attitude. Some are hot, cold, high up in the air.
00:27:17 Speaker_07
I have to learn how to drive all kinds of lifts and climb scaffolding. So I love the challenge. I'd like to keep on going for as long as I can. It's physically fun. It's great to see it finished and have people tell me that they like it, of course.
00:27:39 Speaker_07
So I'm very lucky. I have not had a slow down for a couple years at all. So I hope it keeps going.
00:27:53 Speaker_14
Cindy Fletcher Holden, muralist in Annapolis, Maryland. You know, we can't do this series without you. Tell us what's happening in your economy at marketplace.org slash my economy.
00:28:25 Speaker_14
This final note on the way out today, did you catch Glickid over the weekend? Yeah, it's no Barbenheimer, but Wicked and Gladiator 2 each did a pretty respectable business at the box office over the weekend.
00:28:38 Speaker_14
Wicked was by far the bigger attraction, bringing in $114 million, the biggest opening ever for a Broadway adaptation. The Gladiator sequel brought in $55.5 million. That's a lot of popcorn.
00:28:53 Speaker_14
Our daily production team includes Andy Corbin, Nicholas Guillaume, Alize Hasan, Maria Hollenhorst, Sarah Leeson, Sean McHenry, and Sofia Terenzio. I'm Amy Scott, hope to see you back here tomorrow. This is APM.
00:29:24 Speaker_12
I'm Sasha Pawlikow-Ceransky, Deputy Editor at Foreign Policy. And in my new show, I bring together diplomats, journalists, academics, and activists from across the globe. I think it's an act of war. Lots of countries go to war.
00:29:36 Speaker_12
And give them the chance to debate serious issues that really get to the heart of the world's biggest dilemmas.
00:29:41 Speaker_11
That's not true. That's not true. Look, diplomacy has been going on.
00:29:45 Speaker_12
That's CounterPoint, a new podcast from Foreign Policy in partnership with the Doha Forum. Available now wherever you get your podcasts.