Single Payer

[ShockerPrez]

In the end, I admit, it doesn't matter. The U.S. will have single payor at some point.

[ShockCrazy]

I just dont see that incentive to enter the medical field as a doctor or a business increasing. And single payor will inevitably lead to rationing, I fear.

Even Obama admitted that.

Here's a thing to consider. We already have rationing and it's based on ability to pay. Maybe it's more maybe it is less, but certainly already exists.

[Aargh]

Adam Ruins Everything had a interesting take on this recently. I'll see if I can find the clip.

Here it is:

they sort of have to do that to cover the cost of the uninsured people who show up in the ER for routine medical treatment. We're paying for the uninsured now, it's just hid in the costs of service to any who can pay or who have insurance.

If we would have universal coverage, it would take an act of Congress (probably literally) to get hospitals to budge off of those prices to reflect the savings of not having to provide free service to the uninsured and indigent.

[ShockerPrez]

I'm not sure I understand what you're saying. Perhaps I wasn't clear in my statement. I'm merely saying uninhibited capitalism without government intervention is not always the best method to provide goods and services. It depends on the situation. For years the best method to send a letter across town or across the country was the USPS, a quasi-governmental agency. Having tens, or hundreds, or thousands of private postal services would have been impractical. Likewise, having every mile of roadway in this country a private toll road also makes no sense.

It seems to me that ShockerPrez is advocating the free market is a fix for everything, especially healthcare. I disagree.

I am not for complete free market. I believe that a mandate to buy catastrophic insurance makes sense, for instance. And Im not in favor of cutting medicaid and medicare. There needs to be an avenue for those that need it.

At the same time, I do believe that those willing to pay should be able to have the best doctors and services, and the option to attain their medical needs privately should not be infringrd upon.

I would also be in favor of perhaps mandating medical students serve their residency years in low income clinics and hospitals to increase access in those underserved areas.

Drug prices could decrease by reducing FDA standards in bringing them to market and reducing patent periods until generics come online.

Tort reform would also help. Reducing malpractice insurance costs would help.

[CBB_Fan]

I am not for complete free market. I believe that a mandate to buy catastrophic insurance makes sense, for instance. And Im not in favor of cutting medicaid and medicare. There needs to be an avenue for those that need it.

At the same time, I do believe that those willing to pay should be able to have the best doctors and services, and the option to attain their medical needs privately should not be infringrd upon.

I would also be in favor of perhaps mandating medical students serve their residency years in low income clinics and hospitals to increase access in those underserved areas.

Drug prices could decrease by reducing FDA standards in bringing them to market and reducing patent periods until generics come online.

Tort reform would also help. Reducing malpractice insurance costs would help.

Private insurance still exists in every country with socialized health insurance. In most Western countries (ie France, Finland, etc.) it represents about 30% of the insurance market. In countries with significantly more government intervention it is smaller, but still exists. For instance, about 8% of the UK utilize private healthcare.

Even communist China has private insurance. In fact, China's private market is booming thanks to an expanding middle class and increasingly inadequate public options, and is expected to produce a GDP of $744B by 2020. Russia, Cuba, etc. all have private insurance markets offering comprehensive coverage.

So while single payer will heavily hurt private insurance, it won't kill it. But I will say that the potential lost jobs and companies should be a concern to any that want to move to a single payer system. If we enact a poorly thought out single payer system it will significant negative downsides in the short-term.

[Kung Wu]

Yes I know it's still government but at least it's more efficient.

More efficient than what?

[MoValley John]

they sort of have to do that to cover the cost of the uninsured people who show up in the ER for routine medical treatment. We're paying for the uninsured now, it's just hid in the costs of service to any who can pay or who have insurance.

If we would have universal coverage, it would take an act of Congress (probably literally) to get hospitals to budge off of those prices to reflect the savings of not having to provide free service to the uninsured and indigent.

The hospital billing nightmare started with medicare, not private insurance, but Adam Ruins everything had a few things right. Negotiated insurance plays a big part of inflated pricing. What the clip didn't discuss is billable and non-billable services. If you look at your bill, you won't find any charges for nurses, but a nurse is utilized in just about everything- at around $50 hr. Depending on the cost, some dressings are not billable, nor are many disposable items. All non-billable items are made up in the $10 Tylenol. It is easier just to inflate prices than to charge for nurses by the hour or tape and needle consumption. Plus, medicare won't pay for either. Hospital billing is confusing and many community colleges offer classes in medical coding. Coding is how insurance determines what to pay, it has its roots in medicare.

The whole system is a mess regardless of free market or single payor.

[Kung Wu]

I absolutely would prefer another country. Seriously you are fine with the fact that twice as many infants die per 1000 infants born compared to any other industrial country? It's laughable you think that auto accidents would have enough statistical impact on this number at this scale. We are talking millions of births in a year. And nearly three times as many women die in child birth or in child birth related complications compared to any other industrial country, in what insane scenario is this OK?

The reason the US has higher infant mortality rates, is because we have the most advanced technology to handle PREMATURE births! We have more premature births in the world, and we count each of those births as a live birth. In nearly every other country listed, a baby born less than 500 grams is not considered a viable child and their death is not counted against them! Many of those countries listed also consider a kid that dies within 24 hours to be a "stillbirth" (regardless whether it had a heartbeart) and does not count them in their statistic. Not the US -- we count every one of them. Our advanced medicine allows us to take on these substantially riskier efforts, and that shows up in our stats, while it is completely ignored in all those other countries.

If you have a child with a complication, there is absolutely no better place to be than in the U.S., period, and honestly, it's not even close.

[Kung Wu]

Private insurance still exists in every country with socialized health insurance.

Why?

[Kung Wu]

https://www.drugabuse.gov/related-to...nence-syndrome

https://www.google.com/amp/www.bbc.co.uk/news/amp/37851654

The number of addicted babies born in The US vs. England isn't even close. We are birthing addicted babies at a shocking rate.

And this is just one reason our infant mortality rate is high.

We do a GREAT job of keeping crack babies alive! We have the technology. We just can't keep them from becoming teenagers.

[Aargh]

I specced out an accounting system for a CPA firm that specialized in working with hospitals over a 3-state area. The amount of detail they had to be able to provide to justify costs to Medicare and Medicaid was insane. As I recall everythoing was based on a cost-plus basis, and incredibly nit-picking detail was required for every cost. Without the documentation to back up a cost, the cost was denied.

For some odd reason accountants on one side of a transaction tend to never trust the accountants on the other side of the transaction.

[Aargh]

On the subject of babies...

...I worked with a man whose wife ended up on fertility meds in order to become pregnant. She ended up with triplets. They were born prematurely. One of them will be on a feeding tube her entire life.

The bill for that was over $250,000 and that was well over 10 years ago.

Is that a cost that should be shared among all of us, or is that an example of behavior known to lead to medical complications (risky behavior) and should be the responsibility of those engaging in that risky behavior?

[MoValley John]

On the subject of babies...

...I worked with a man whose wife ended up on fertility meds in order to become pregnant. She ended up with triplets. They were born prematurely. One of them will be on a feeding tube her entire life.

The bill for that was over $250,000 and that was well over 10 years ago.

Is that a cost that should be shared among all of us, or is that an example of behavior known to lead to medical complications (risky behavior) and should be the responsibility of those engaging in that risky behavior?

The baby should be covered, the fertility treatments and ivf should not.

[SHOXJOCK]

The VA is actually single-provider, versus Medicare which is single-payer. It is well worth pointing the difference because in practical terms they represent two fairly different levels of government intervention.

In a single payer system, the government pays. You go to the hospital, get treated, and eventually the hospital gets the money for the service from the government (and them, from tax payers). There is a still a private market of hospitals, insurers, and pharmaceutical companies competing to keep costs low.

In single provider, the government provides. They run the hospitals, the run the pharmaceutical companies, they run the research. If they don't think a procedure is worth paying for, you can't turn to a competitor because the government is the only option.

A big reason the VA is so inefficient (even over other government programs) is that the government directly administers VA Medical Centers. This results in all sorts of silly mandated inefficiencies. For example, the government makes VA doctors translate medical records from one hospital to another themselves (a big problem when every military branch has its own set of medical records). Private hospitals hire medical records specialists, which is far more efficient and doesn't force doctors into doing needless paperwork. Then you have use-it-or-lose budgeting, impossible to fire administrative employees, long wait times, etc.

Even if we do go to single-payer, it will be more like Medicare and less like the VHA, and it isn't really a choice. To have something like the VHA or NHS the government would need to essentially buy out or bring in every hospital and private practice. Just the dealing with the laws of 50 different states would make it difficult, let alone trying to bring in 4,862 hospitals and about a million doctors into the federal system (which currently has 212 hospitals, to give some idea to the scale).

Totally agree on your take on the VA being inefficient. If you take all of the budget that the VA spends on medical and hospital care of veterans and give it to Medicare. Then move the veteran's over to Medicare, Veterans will be better off and we could close all of the VA hospitals and get rid of thousands of federal employees, not overnight maybe over 3 years. A win for Veterans and the smaller government people like myself.Yes I know it's still government but at least it's more efficient.

Yes I know it's still government but at least it's more efficient.

More efficient than what?

I was trying to edit my first post and posted the edit.

[Kung Wu]

I specced out an accounting system for a CPA firm that specialized in working with hospitals over a 3-state area. The amount of detail they had to be able to provide to justify costs to Medicare and Medicaid was insane. As I recall everythoing was based on a cost-plus basis, and incredibly nit-picking detail was required for every cost. Without the documentation to back up a cost, the cost was denied.

For some odd reason accountants on one side of a transaction tend to never trust the accountants on the other side of the transaction.

A fine example of why we must never, ever go to single payer.