5 ms·

The word "negotiation" is a euphemism here: > The most important source of cost savings under single-payer is that large government entities are able to negoti

The word "negotiation" is a euphemism here: > The most important source of cost savings under single-payer is that large government entities are able to negotiate much more favorable terms with service providers. If there are no other options for clients, it's essentially the government telling doctors how much their services are worth.

leepowers 9y ago
Yes, it's a euphemism for price controls. Which may or may not be a no-go depending on your political bent. Another issue here is termination shock - if a provider comes up under the current system, getting into massive student debt in anticipation of a highly remunerative medical career, how will price controls effect him?
- tanderson92 9y ago
  By my back of the envelope account it might cost about $36 Billion to forgive the student debt (say $200k average) of a fifth (early career) of all physicians in the US (28 patient care docs per 10,000)
dv_dt 9y ago
It's not just doctors, its drug and health insurance companies, etc... but really? Is the argument is that we as a nation should pay double what other modern nations pay so doctors can be well paid? Edit: Here's a deal, lets pay for doctor's educations, implement universal healthcare and call it even.
- peterhadlaw 9y ago
  You're still telling people what their time and efforts are worth rather than if there were no artificial restrictions.
  - dv_dt 9y ago
    No, if we're implementing universal healthcare, they're negotiating in a labor market which has decided to collectively bargain for the purchase of services. Consider it the physcians version of labor globalization. Or workers labor negotiations vs ever larger corporations. Only this time its for a public good.
- krath94 9y ago
  Sounds like a great deal for everyone but the taxpayer
  - pas 9y ago
    ??? Look at other countries, where taxes are higher, but total income expenses (tax, plus healthcare costs) are lower (with better level of care).
- methodover 9y ago
  Is it that the USA is paying more than we should? Or is it that other nations are paying less than they should? Also, doctors aren't the only thing we should be talking about. That's probably the easiest subject to think about. It's much, much more difficult to talk about drug and device prices. Should the government dictate how much a new drug or device costs? What are the risks and downsides of doing that?
  - pas 9y ago
    Other nations pay less for more. So, probably the USA pays a lot more than it should.
  - dv_dt 9y ago
    The risk is that compared to single payer universal health care in other nations, thousands of people die in the US who aren't covered or poorly covered due to their inability to pay for their health care. Millions probably endure worse health than necessary with cost discouragements to getting the care they already pay to carry as insurance. Should profit margins dictate how much a new drug or medical device costs?
lb1lf 9y ago
Living in what is essentially a single-payer health care system (Norway), I assure you we don't see many MDs sleeping in cardboard boxes under freeway overpasses. On a more serious note - education and skills tend to pay off. Around here, doctors with their own practice are reimbursed by the state via several mechanisms, the two most significant ones are probably a fixed sum for each patient they are responsible for (they get this regardless of whether the patient sees them or not) and a fixed sum for each treatment, prescription filled &c. Anecdotally, an MD with his own practice earns approx. $100k-$150k annually before taxes; this is 2-2,5 times the national average. (Very roughly speaking, but in the right ballpark)
- peterhadlaw 9y ago
  I don't think I ever made a claim that "doctors would be sleeping in boxes".
  - lb1lf 9y ago
    Oh, you didn't - and I hope my flippant comment didn't mislead anyone into thinking you did. There's already so many factors distorting the health care market that it is imho hardly an argument against single payer that doctors would have to negotiate compensation against a powerful customer. (It would, after all, at the same time remove a number of other distortions from the mix - while unlikely to leave doctors in the gutter in the process.) External circumstances change in a lot of professions all the time; for instance, I do not expect the government to help me out (working in the petroleum industry) now that oil prices are more than halved from their peak - that's life. Better adjust to it.
- peterhadlaw 9y ago
  I said that the government would be dictating what a doctor's time and efforts would be worth instead of letting it figure itself out without any artificial restrictions
- DrScump 9y ago
  How is medical school funded? It's not uncommon for medical school grads in the USA to graduate with six-figure student loan debt.
xemdetia 9y ago
This doesn't stop lobbyists and special interests from moving the goalposts for how much a thing is worth or whether a new procedure should be covered. It does solve a medical office having to hire X administrators to cover his own health care just to negotiate with all of the insurance providers so they can get paid at all. To me what we have already doesn't feel like a market. It's not like I feel doctors are being paid net/15 and that is why they get a discount. Or that they invest in their health care networks so costs are reduced for them in the long run. Insurance company hedges their bets so that they have the money to pay, but then when you get to a certain age you are chucked to the curb and then society has to pay for it. I just don't see where insurance companies are being fantastic middlemen or support networks for medical professionals or linking those who need care and appropriate medical professionals and producing value above and beyond what a single-payer system provides elsewhere. They just seem to complicate the costs significantly and do not create a market where resources feel distributed efficiently. To me the biggest weirdness of health insurance is why they are a for-profit industry or largely for profit in the non-competing model they have right now. I want the employees of a insurance company to be smart, paid well and distribute all the resources in a smart way, but instead the goal is making money. If the market was competitive like it is for car insurance and other insurances that is fine because there are actual competitors but the whole equation doesn't work because most individuals making health insurance purchasing decisions have effectively the same amount of choice as whether or not you have Comcast.

leepowers 9y ago

Yes, it's a euphemism for price controls. Which may or may not be a no-go depending on your political bent. Another issue here is termination shock - if a provider comes up under the current system, getting into massive student debt in anticipation of a highly remunerative medical career, how will price controls effect him?

tanderson92 9y ago
By my back of the envelope account it might cost about $36 Billion to forgive the student debt (say $200k average) of a fifth (early career) of all physicians in the US (28 patient care docs per 10,000)

dv_dt 9y ago

It's not just doctors, its drug and health insurance companies, etc... but really? Is the argument is that we as a nation should pay double what other modern nations pay so doctors can be well paid? Edit: Here's a deal, lets pay for doctor's educations, implement universal healthcare and call it even.

peterhadlaw 9y ago
You're still telling people what their time and efforts are worth rather than if there were no artificial restrictions.
- dv_dt 9y ago
  No, if we're implementing universal healthcare, they're negotiating in a labor market which has decided to collectively bargain for the purchase of services. Consider it the physcians version of labor globalization. Or workers labor negotiations vs ever larger corporations. Only this time its for a public good.
krath94 9y ago
Sounds like a great deal for everyone but the taxpayer
- pas 9y ago
  ??? Look at other countries, where taxes are higher, but total income expenses (tax, plus healthcare costs) are lower (with better level of care).
methodover 9y ago
Is it that the USA is paying more than we should? Or is it that other nations are paying less than they should? Also, doctors aren't the only thing we should be talking about. That's probably the easiest subject to think about. It's much, much more difficult to talk about drug and device prices. Should the government dictate how much a new drug or device costs? What are the risks and downsides of doing that?
- pas 9y ago
  Other nations pay less for more. So, probably the USA pays a lot more than it should.
- dv_dt 9y ago
  The risk is that compared to single payer universal health care in other nations, thousands of people die in the US who aren't covered or poorly covered due to their inability to pay for their health care. Millions probably endure worse health than necessary with cost discouragements to getting the care they already pay to carry as insurance. Should profit margins dictate how much a new drug or medical device costs?

lb1lf 9y ago

Living in what is essentially a single-payer health care system (Norway), I assure you we don't see many MDs sleeping in cardboard boxes under freeway overpasses. On a more serious note - education and skills tend to pay off. Around here, doctors with their own practice are reimbursed by the state via several mechanisms, the two most significant ones are probably a fixed sum for each patient they are responsible for (they get this regardless of whether the patient sees them or not) and a fixed sum for each treatment, prescription filled &c. Anecdotally, an MD with his own practice earns approx. $100k-$150k annually before taxes; this is 2-2,5 times the national average. (Very roughly speaking, but in the right ballpark)

peterhadlaw 9y ago
I don't think I ever made a claim that "doctors would be sleeping in boxes".
- lb1lf 9y ago
  Oh, you didn't - and I hope my flippant comment didn't mislead anyone into thinking you did. There's already so many factors distorting the health care market that it is imho hardly an argument against single payer that doctors would have to negotiate compensation against a powerful customer. (It would, after all, at the same time remove a number of other distortions from the mix - while unlikely to leave doctors in the gutter in the process.) External circumstances change in a lot of professions all the time; for instance, I do not expect the government to help me out (working in the petroleum industry) now that oil prices are more than halved from their peak - that's life. Better adjust to it.
peterhadlaw 9y ago
I said that the government would be dictating what a doctor's time and efforts would be worth instead of letting it figure itself out without any artificial restrictions
DrScump 9y ago
How is medical school funded? It's not uncommon for medical school grads in the USA to graduate with six-figure student loan debt.

xemdetia 9y ago

This doesn't stop lobbyists and special interests from moving the goalposts for how much a thing is worth or whether a new procedure should be covered. It does solve a medical office having to hire X administrators to cover his own health care just to negotiate with all of the insurance providers so they can get paid at all. To me what we have already doesn't feel like a market. It's not like I feel doctors are being paid net/15 and that is why they get a discount. Or that they invest in their health care networks so costs are reduced for them in the long run. Insurance company hedges their bets so that they have the money to pay, but then when you get to a certain age you are chucked to the curb and then society has to pay for it. I just don't see where insurance companies are being fantastic middlemen or support networks for medical professionals or linking those who need care and appropriate medical professionals and producing value above and beyond what a single-payer system provides elsewhere. They just seem to complicate the costs significantly and do not create a market where resources feel distributed efficiently. To me the biggest weirdness of health insurance is why they are a for-profit industry or largely for profit in the non-competing model they have right now. I want the employees of a insurance company to be smart, paid well and distribute all the resources in a smart way, but instead the goal is making money. If the market was competitive like it is for car insurance and other insurances that is fine because there are actual competitors but the whole equation doesn't work because most individuals making health insurance purchasing decisions have effectively the same amount of choice as whether or not you have Comcast.