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Jayapal and Sanders Medicare for All Bills: One Is a Lot Better Than the Other
- maxxxxx 8y agoLet’s not make this into another stupid polarized fight. Sanders is a pragmatic guy who I am pretty sure would entertain other thoughts if they really addressed the real problems unlike most republican proposals.
- toomuchtodo 8y agoThe crux is hospitals and doctors don’t want their pay cut, when it should be cut (Sanders’ bill does this). This is the result of the AMA attempting to keep wages high through quotas (as well as bloated hospital admins), and the resulting policy required to fix cost inflation. Healthcare is a utility, not a profit center, of course we’re going to compress unnecessarily high wages (or cut unnecessary non-provider jobs ruthlessly).
- maxxxxx 8y agoYep. There are a lot of people making good money off the current system. They see no need for change unless it makes them even more money.
- pen2l 8y ago> They see no need for change unless it makes them even more money. I think even "they" would appreciate the efficiency of consistent single-payer system. Just imagine the incredible overhead of bureaucracy that would be achieved, no more need of departments set to deal with insurance problems and all. Surely they appreciate how this will all be streamlined and made efficient.
- maxxxxx 8y agoThe unneeded departments are also quite powerful and want to survive. We call them “deep healthcare”....
- charliesharding 8y agoCompressing "unnecessarily" high wages will inevitably cause less people to want to assume large amounts of debt for the necessary education and training to become doctors. The doctors that I know chose their career explicitly because of the salary and status that comes with being a doctor. Remove the incentive and you will diminish the supply. Diminishing the supply while also promising free care to all (increasing demand greatly) will result in very long wait times and diminished quality of care.
- toomuchtodo 8y agoThose folks can depart the system and we’ll put an express lane visa in for doctors who want to immigrate to the US. Lots of highly educated healthcare professionals in the world who would want to immigrate to the US and aren’t anchored to unreasonably high wages. Those doctors you mention picked the wrong career for fat cash and prestige. We can’t allow a broken system to continue because of previously made bad decisions.
- charliesharding 8y agoInteresting solution - I don't know how the visa system works but if these doctors decided to switch careers after they got here in order to provide better for themselves/their family is there anything stopping them? It still seems like it's misaligning the incentive structure to produce the desired results. At the base of the issue is that being a doctor is a difficult, stressful job that requires high intelligence and sometimes even high physical dexterity. While it's nice to think that people would choose to do it because it's moral to take care of people, I don't think it's fair to expect that these people wouldn't want to be appropriately financially rewarded for their gifted skillset.
- zaroth 8y agoAh yes, the best of both worlds; socialized medicine provided at rock bottom prices through mass immigration undercutting the salaries of US citizens that are paying billions towards non-dischargable loans taken in good faith. Sarcasm of course. In my opinion, these are two great ideas for getting Trump re-elected.
- technofiend 8y ago>The crux is hospitals and doctors don’t want their pay cut Whether hospitals and doctors are really charging fair prices aside can't cost reductions also be accomplished by cutting out middlemen? I think there's going to be far more pushback from those rent seekers than the service providers.
- toomuchtodo 8y agoOf course. Current middlemen are around 9% of healthcare expenditures.
- gremlinsinc 8y agoThe mentioned 15-20% off the top for insurance, but the insurance/billing industry is two sided, wouldn't there also be a ton of administrative savings by having a fraction of the 'billing/coders'? They'd only have to deal w/ the U.S. government which isn't going to be as nitpicky and litigious over every little line item.
- nradov 8y agoOn the contrary. Medicare is extremely nitpicky on every claim line item.
- gremlinsinc 8y agoOnly because they can be, if hospitals and law-makers meet in the middle come up w/ across the industry iron-clad rates for services, or hell -- what if hospitals just get a flat average monthly lump sum -- no piecemeal at all, just based on # of patients that go through their door in a month? Dr's get x% based on patients they saw + hours booked in the OR. Hospital administrators would have pay caps of 1 million per year. Hospitals that struggle could get grants and loans while the system corrects and adjusts to pay them more so they meet their budget constraints.
- nradov 8y agoYes capitation is already being tried in some areas as one approach to shifting the market from a fee-for-service model to value-based care. However provider organizations still struggle with it because most lack the data, tools, and expertise to properly price the risk. Medicare administrators and lawmakers already do set iron-clad rates for service. The rates are relatively low, which is why there's a shortage of doctors willing to treat Medicare patients. And being nitpicky on claims isn't so much a matter of pricing. Instead the insurers are trying to prevent waste, fraud, and abuse.
- john-radio 8y agoThe essayist seems to agree with you, writing: > I write this essay as both a long-time organizer, writer and speaker for a single-payer (the older name for “Medicare for all” system) and a strong supporter of Senator Sanders.
- gremlinsinc 8y agoYeah I'm a Sanders' supporter, and I got the vibe that he just has technical problems w/ Sander's implementation, of course I can see on HN a shitstorm of politics coming up, so he op could've been aiming his comment pre-emptively at Sanders-haters. At this point I'm in favor of anything that moves the need towards full coverage for everyone, of course being able to pay for it and having a stronger law will make it last and endure the test of time, so that's better.
- gok 8y agoWhere "better" here means "allows doctors to continue to earn much more money than they do in other countries for performing the same services".
- influx 8y agoHow much should they be allowed to earn?
- deleted 8y ago[deleted]
- gok 8y agoHowever much they can get someone to pay them! So long as they're aren't also using their cartel power to reduce the availability of medical care. Which they are.
- charliesharding 8y agoHow would they get anyone to pay anything if their services are being offered by the government as a basic human right? They lose all bargaining power if they can't refuse their services.
- zaroth 8y agoIf the government offers too little money, the supply drops and you get quotas, waiting lists, and denied treatments.
- british_india 8y agoUnlike many other highly-paid individuals, modern doctors are not innovating anything. They are essentially body plumbers. They are not doing anything unique enough to justify quarter-million-dollar salaries.
- axaxs 8y agoI'm all for free healthcare, but this is a legitimate concern due to exorbitant education costs. Doctors often enter the field with high 6 figure or low 7 figure debts, with the expectation they'll make enough to pay it off quickly. I can't see a fair path to lower salaries without subsidizing outstanding debts.
- sanderjd 8y ago> S 1129 contains the clause that every true single-payer bill contains – a clause stating that on a certain date after the bill becomes law insurance companies may not sell policies that duplicate the coverage of the Medicare For All program. I'm a single payer noob. Can someone explain to me why such a clause is necessary? If people are already paying for health care coverage from a federal system through taxes, why would they pay more to purchase a plan that duplicates that coverage from a private insurer? And if nobody is paying for that duplicate coverage, why is it necessary to outlaw it (rather than just letting insurance companies decide it doesn't make sense to sell it anymore)? It makes me suspicious that they need to outlaw something that would appear to be unnecessary under the rest of the system they're creating. It makes me think the outlawed coverage might actually be useful for some reason, in which case it would be a bummer for it to be outlawed.
- Youden 8y ago> Can someone explain to me why such a clause is necessary? Because legally, such a plan offers you literally nothing and there is no rational reason why you should purchase it. To purchase it would be irrational and likely a result of someone trying to swindle you out of your money. > why would they pay more to purchase a plan that duplicates that coverage from a private insurer? A few reasons I can think of: - They're continuing a plan they've had for years and would rather keep paying for it than accept change. - Marketing tricks them into it despite it being a stupid idea (see timeshares for evidence this happens in reality). - Because it comes as an add-on to a larger package with something that _does_ have value.
- cosmie 8y agoIt also prevents some of the anticipated benefits of the single-payer system. - Providers don't realize the anticipated reductions in administrative overhead, since they may still need to retain the same complexity in billing but just with a radically different distribution of claims. - Consumers may still end up having issues with providers accepting plans. Especially if you leave a loophole that allows providers to decline the single-payer option but accept the private versions that cover the same service. - Consumer confusion can come into play related to covered services. One potential draw of the private version would be lax qualification standards for a specific coverage item. But if they decline coverage and the consumer tries to fallback on the single payer system, they may not have gotten the proper approvals or step therapy to have the procedure covered. The private company will have a marketing department to ensure negative consumer sentiment ends up falling on the lap of the single payer system. - Economies of scale. The single payer system has market power specifically explicitly because of the fact that they own the whole consumer pool. If you allow it to remain fragmented, it lowers the single payer's negotiating power. - Risk pool. The private company is more likely to skim off the healthiest consumers from the risk pool, and leaving the unhealthiest. This causes all kinds of issues from a political standpoint. The private companies can offer more attractive "perks" (like covering the same procedure, but streamlining the qualification process) because their risk pool is less likely to actually need that procedure. This would incentivize the top end of the market to purchase the plans (or offer as employee benefits, such as now), who would then feel negatively about the single-payer option because they're being forced to pay into that while not actively using it since it appears "worse" (even though it covers the same things). At the end of the day, the clause isn't strictly necessary for a single payer system. But without that clause, you introduce quite a few failure modes and unnecessary friction points that can be completely avoided by simply disallowing duplicative private policies from being sold.
- british_india 8y agoI trust Bernie Sanders.