Under the current system, beneficiaries are largely shielded from both regional differences in spending and from the way their health care is delivered. Medicare picks up the tab for 80 percent of the cost of care, and most patients don’t know the difference between necessary and unnecessary care. Under the Ryan plan, those regional differences might come into focus when seniors are forced to buy their insurance on the private market. #

A few different things could happen: Either patients in places like Miami would suffer, or they would lobby Congress for money, or, if things work out well, insurers could succeed in reigning in costs: #

Much of the difference in spending [.pdf] can be attributed to disorganization among providers in high-spending regions, and their habit of delivering exceptionally aggressive care at the end of life. These regions generally have a high number of specialists per capita, and a high ratio of specialists to primary care providers. Greed is also part of the problem. The amount of fraud makes south Florida look a little like the intersection between medicine and the “Pirates of the Caribbean.” #

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