5 ms·

Let’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

Let’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 7y ago
The 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 7y ago
  Yep. 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 7y 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 7y ago
      The unneeded departments are also quite powerful and want to survive. We call them “deep healthcare”....
- charliesharding 7y ago
  Compressing "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 7y ago
    Those 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 7y ago
      Interesting 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 7y ago
      Ah 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 7y 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 7y ago
    Of course. Current middlemen are around 9% of healthcare expenditures.
  - gremlinsinc 7y ago
    The 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 7y ago
      On the contrary. Medicare is extremely nitpicky on every claim line item.
      - gremlinsinc 7y ago
        Only 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 7y ago
        Yes 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 7y ago
The 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 7y ago
  Yeah 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.

toomuchtodo 7y ago

The 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 7y ago
Yep. 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 7y 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 7y ago
    The unneeded departments are also quite powerful and want to survive. We call them “deep healthcare”....
charliesharding 7y ago
Compressing "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 7y ago
  Those 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 7y ago
    Interesting 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 7y ago
    Ah 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 7y 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 7y ago
  Of course. Current middlemen are around 9% of healthcare expenditures.
- gremlinsinc 7y ago
  The 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 7y ago
    On the contrary. Medicare is extremely nitpicky on every claim line item.
    - gremlinsinc 7y ago
      Only 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 7y ago
        Yes 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 7y ago

The 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 7y ago
Yeah 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.