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> I don't know enough about the reason for the shortage of doctors but I'd go out on a limb and say its probably not because they don't get paid enough. So not

> I don't know enough about the reason for the shortage of doctors but I'd go out on a limb and say its probably not because they don't get paid enough. So not cheaper. > It won't, and it shouldn't. Patents for pharma don't preclude successful implementations of universal healthcare anywhere else. So not cheaper. > By regulating fees for services, by lowering the price of drugs via negotiation and bulk purchase agreements, by eliminating marketing budgets, by eliminating insurance billing departments and by capping executive compensation. Hospitals and doctors are public servants elsewhere in the world, not elite rockstars who can bill as they so choose. That doesn't mean they're not well compensated. Rationing. (It makes it cheaper, but also reduces the amount of care given out). Shutting down hospitals is probably not the way to go on the space, but its one way to reduce spending. > By having a single table of rates that apply to everyone. Ideally with a single payer. This makes billing much, much easier. Also rationing. If you have a single table of rates, you can get 3 results: you pay less than today, and thus you will have rationing of services (for example, less convenient locations, less services, etc), you pay the same (so no gain) or you pay more (more spending). Billing is a big pain, but billing medicare is the biggest pain of all. Medicare pays less and has more admin costs for providers, which is a big part of why its not covered. Its virtually impossible in the US to force doctors into single rates, so what you would get is that insurance has very low coverage, and cash-pay will dominate healthcare services. > Everything I indicated above put together. If you want a concrete example Medicare does most of the above (they can't negotiate drug prices, and they're not single payer, and they haven't socialized malpractice insurance) but they're substantially more efficient. Medicare spends 2-5% of the budget on administrative, where private plans spend 12-18%. That's without recognizing some of the other savings I pointed out. [2] Medicare uses these statistics with great trickery. First of all, medicare does not do collections administration: its hidden in other government agencies that collect the payroll tax. Second of all, these statistics have some other biases like using total cost of spending but not per patient, where medicare is actually not that much ahead. And finally but not least, what people will always love about medicare is that its dirt cheap to the patient: the average social security benefit is 1400~, and the standard premium of medicare is 135. But turns out that medicare costs about 11k a year per patient: if you took away 1000 out of those 400, you would not find great support for medicare from retired people! Finally but not least, medicare services have severe rationining elements, and potentially cost shifting: doctors make 1/2 with medicare than without. This means that: doctors that offer medicare are the ones starving for patients, and doctors that take a bit of medicare are actually putting some of the cost unto regular insurances.

arcticbull 8y ago
You can forcefully restate your opinions all day long, but facts are facts. The first world countries that offer socialized medicine do strictly better than the US on basically every metric. Pick one. Access to treatment? Better. Infant mortality? Better. Mothers mortality? Better. Life expectancy? Better (the US used to be 1 year above average, it's now 2 years below, and falling). Bankruptcies due to medical bills? Better. They’re also cheaper. Your opinions do not line up with reality. America’s at the bottom of the OECD for many of these things, and at the top by a country mile for cost. [1] There's no medicare statistics trickery lol, all those government services being leveraged have to do almost nothing incrementally to support medical fees. They're still collecting payroll taxes, they're still collecting income taxes, one way or the other. By your own measure this makes the work they do duplicative of the insurance industry making the insurance industry the wasteful one. This is also failing to take into account the waste of employers managing employee healthcare -- why on earth are they doing that? OF COURSE medicare is expensive we already addressed that in another thread. The US doesn't have free market healthcare. The young, healthy and cheap are forced into expensive market plans, privatizing the gains, while the old, sick and poor are handed off to the government to look after, socializing the losses. It's absurd. The young, healthy and wealthy should be paying for the old, sick and poor. You can’t saddle the socialized program with all the worst customers, hamstring it’s ability to negotiate drug prices then point to how much it costs. Doctors in Canada make hundreds of thousands of dollars per year providing socialized cover. They're civil servants. They do fine. So what if it's less than doctors are paid now, the question is are they compensated fairly, and they are. Last I couldn’t help but notice you totally sidestepped my point about reduced costs by offering preventative care. [1] https://www.oecd.org/unitedstates/Health-at-a-Glance-2017-Key-Findings-UNITED-STATES.pdf https://www.oecd.org/unitedstates/Health-at-a-Glance-2017-Ke...
- conanbatt 8y ago
  > You can forcefully restate your opinions all day long, but facts are facts. The first world countries that offer socialized medicine do strictly better than the US on basically every metric. Pick one. Access to treatment? Better. Infant mortality? Better. Mothers mortality? Better. Life expectancy? Better (the US used to be 1 year above average, it's now 2 years below, and falling). Bankruptcies due to medical bills? Better. They’re also cheaper. Your opinions do not line up with reality. Why doesn't medicare, the already socialized medicine of the US, have the same results as socialized medicine in other countries? > There's no medicare statistics trickery lol, all those government services being leveraged have to do almost nothing incrementally to support medical fees You could also use payroll taxes to pay private insurance, that's not a benefit of medicare, it's a benefit of the current tax implementation that is granted monopolistically to medicare. I know of at least one country that collects payroll taxes that go to private health companies. The question is: is medicare administration truly cheaper that private administration for the same service. > This is also failing to take into account the waste of employers managing employee healthcare -- why on earth are they doing that? Because the federal government makes it tax exempt to give healthcare through the employer, which is a 260 billion a year regressive tax benefit, denounced and criticized decades ago by prominent economists. You dont need to socialize medicine to stop that, you just need to stop handing out federal money. In fact, the tax-subsidy is higher than the combined profits of all insurance companies together. > The US doesn't have free market healthcare. Glad we agree on that one! > The young, healthy and cheap are forced into expensive market plans, privatizing the gains, while the old, sick and poor are handed off to the government to look after, socializing the losses. It's absurd. The poor also pay medicare taxes for the rich. The sick that don't make it to retirement ages pay medicare tax their entire life and die before receiving any benefit. Taxes always have this thing that they make things unfair for someone by law. Adverse selection and information asymmetry are real issues, but socialized medicine brings other issues like reduced coverage, rationing, etc. I am always surprised how the debate over healthcare ends up being arguing about capitalism as a method of efficient economic organization. It works for almost everything else, yet the arguments for socialized medicine are like arguing capitalism doesn't work. Its bonkers, and easy to refute because otherwise you would have to argue the same for food, for education, for transport, for everything, and none of those work better run by the government. > ...Doctors in Canada make hundreds of thousands of dollars per year To make doctors in the US root for socialized medicine, the state will have to offer greatly increased income. Thats how it happened historically in europe a century ago. Considering the AMA has killed socialized medicine laws multiple times in history, I would say the "screw the doctors" policy has a high chance of failure.

arcticbull 8y ago

You can forcefully restate your opinions all day long, but facts are facts. The first world countries that offer socialized medicine do strictly better than the US on basically every metric. Pick one. Access to treatment? Better. Infant mortality? Better. Mothers mortality? Better. Life expectancy? Better (the US used to be 1 year above average, it's now 2 years below, and falling). Bankruptcies due to medical bills? Better. They’re also cheaper. Your opinions do not line up with reality. America’s at the bottom of the OECD for many of these things, and at the top by a country mile for cost. [1] There's no medicare statistics trickery lol, all those government services being leveraged have to do almost nothing incrementally to support medical fees. They're still collecting payroll taxes, they're still collecting income taxes, one way or the other. By your own measure this makes the work they do duplicative of the insurance industry making the insurance industry the wasteful one. This is also failing to take into account the waste of employers managing employee healthcare -- why on earth are they doing that? OF COURSE medicare is expensive we already addressed that in another thread. The US doesn't have free market healthcare. The young, healthy and cheap are forced into expensive market plans, privatizing the gains, while the old, sick and poor are handed off to the government to look after, socializing the losses. It's absurd. The young, healthy and wealthy should be paying for the old, sick and poor. You can’t saddle the socialized program with all the worst customers, hamstring it’s ability to negotiate drug prices then point to how much it costs. Doctors in Canada make hundreds of thousands of dollars per year providing socialized cover. They're civil servants. They do fine. So what if it's less than doctors are paid now, the question is are they compensated fairly, and they are. Last I couldn’t help but notice you totally sidestepped my point about reduced costs by offering preventative care. [1] https://www.oecd.org/unitedstates/Health-at-a-Glance-2017-Key-Findings-UNITED-STATES.pdf https://www.oecd.org/unitedstates/Health-at-a-Glance-2017-Ke...

conanbatt 8y ago
> You can forcefully restate your opinions all day long, but facts are facts. The first world countries that offer socialized medicine do strictly better than the US on basically every metric. Pick one. Access to treatment? Better. Infant mortality? Better. Mothers mortality? Better. Life expectancy? Better (the US used to be 1 year above average, it's now 2 years below, and falling). Bankruptcies due to medical bills? Better. They’re also cheaper. Your opinions do not line up with reality. Why doesn't medicare, the already socialized medicine of the US, have the same results as socialized medicine in other countries? > There's no medicare statistics trickery lol, all those government services being leveraged have to do almost nothing incrementally to support medical fees You could also use payroll taxes to pay private insurance, that's not a benefit of medicare, it's a benefit of the current tax implementation that is granted monopolistically to medicare. I know of at least one country that collects payroll taxes that go to private health companies. The question is: is medicare administration truly cheaper that private administration for the same service. > This is also failing to take into account the waste of employers managing employee healthcare -- why on earth are they doing that? Because the federal government makes it tax exempt to give healthcare through the employer, which is a 260 billion a year regressive tax benefit, denounced and criticized decades ago by prominent economists. You dont need to socialize medicine to stop that, you just need to stop handing out federal money. In fact, the tax-subsidy is higher than the combined profits of all insurance companies together. > The US doesn't have free market healthcare. Glad we agree on that one! > The young, healthy and cheap are forced into expensive market plans, privatizing the gains, while the old, sick and poor are handed off to the government to look after, socializing the losses. It's absurd. The poor also pay medicare taxes for the rich. The sick that don't make it to retirement ages pay medicare tax their entire life and die before receiving any benefit. Taxes always have this thing that they make things unfair for someone by law. Adverse selection and information asymmetry are real issues, but socialized medicine brings other issues like reduced coverage, rationing, etc. I am always surprised how the debate over healthcare ends up being arguing about capitalism as a method of efficient economic organization. It works for almost everything else, yet the arguments for socialized medicine are like arguing capitalism doesn't work. Its bonkers, and easy to refute because otherwise you would have to argue the same for food, for education, for transport, for everything, and none of those work better run by the government. > ...Doctors in Canada make hundreds of thousands of dollars per year To make doctors in the US root for socialized medicine, the state will have to offer greatly increased income. Thats how it happened historically in europe a century ago. Considering the AMA has killed socialized medicine laws multiple times in history, I would say the "screw the doctors" policy has a high chance of failure.