5 ms·

Ok, why? I'm more than open to being convinced otherwise; I'd love to think no one would be harmed.

by mises 7y ago

beat 7y ago
First, it's unlikely that an influx of new patients due to opening networks and increasing coverage would lead to doctors dropping existing patients. On what grounds would that happen? Second, you're at best arguing that we shouldn't go to a fair system of rationing because it would hurt the beneficiaries of an unfair system of rationing. And to take this sideways... my favorite health care model is the Japanese system. It's actually quite similar to the American system (private employer-provided insurance, private providers), but with one key difference... a government commission fixes the prices for all medical goods and services. No more negotiating between providers and insurers. So no "networks". It leads directly to the situation you described. It also leads to costing half as much as the US, for universal coverage and better outcomes. I'll take that trade, thank you.
- mises 7y ago
  > it's unlikely that an influx of new patients due to opening networks and increasing coverage would lead to doctors dropping existing patients. It wouldn't, but if I needed to get a doctor, I might no longer be able to get a very good one. Remember that cheaper prices for medical care means the smartest, best people may not become doctors. > you're at best arguing that we shouldn't go to a fair system of rationing because it would hurt the beneficiaries of an unfair system of rationing. I don't believe the current system is "unfair". Why is it? Most Americans like what they have; it is the bottom few percent who are unhappy. Is that "unfair"? At what percentage does that become the case? Must most of society change to accommodate a small, dissatisfied minority? Without government regulation, health care would be much cheaper. Why must I purchase coverage for a hysterectomy or for birth control as part of a plan? I will never need these services. Wasted money. What of experimental treatments? I know a person who is alive thanks to an experimental treatment that was reasonably priced. All it amounted to was an antibiotic regimen far outside the bounds of the CDC-recommended one, out-patient. The problem with single-payer is that I cannot do that, because there is a single payer - the feds. I may not pay for my own procedures (and my friend would not have been able to do so), even though this was quite affordable, because it was not on "the list". Fixing prices is a possibility (albeit not one of which I am as fond), though we would need to allow procedures to be done out side of that (for those which were not approved, or for those who could not get availability and could pay). It is basic economics that price ceilings create shortages; who gets treatment? We are back at square one: I think it should be ordered by those who should pay. I trust dollars to be "fairer" than an opaque system, and would rather the coverage I can get be a known quantity than be at the mercy of the whims of a bureaucrat. My biggest question: why do you want to force those who can pay onto the same plan? That is a part of single-payer that makes no sense. Why not let those who like their existing coverage keep it, as most Americans still do? [0] There was an article that surfaced about an Indian hospital that had industrialized common health-care procedures. A four-year degree is not essential for these; why is it required? If we commoditize common and routine procedures via removal of barriers to entry, we can greatly increase the benefit without forcing those who like what they have to become worse off and without hurting more complicated situations. Lastly, the problem with socialized medicine is that it cannot afford to spend beyond a certain amount per-person on average. End-of-life care is enormously expensive in America, but is better than in other places. [1] Many of us may say it is foolish to spend upwards of a million dollars for a few more years of life, but having spoken to a few dying people, most say something to the effect of that they would give every thing they have for a few more weeks (the exception being those in exceptional pain, those with loss of senses, etc.). EDIT: Downvoters care to comment? [0] https://news.gallup.com/poll/245195/americans-rate-healthcare-quite-positively.aspx https://news.gallup.com/poll/245195/americans-rate-healthcar... [1] https://www.forbes.com/sites/cjarlotta/2016/01/19/end-of-life-care-costs-in-us-comparable-to-europe-and-canada/#350a2305ada3 https://www.forbes.com/sites/cjarlotta/2016/01/19/end-of-lif...
  - beat 7y ago
    Access to the best doctors isn't a function of how they're paid for now, unless you're saying the current system is giving them slack in their schedules by keeping patients away. Meanwhile, people are being denied access to good doctors with capacity now, because of a lack of insurance, or in-network restrictions. I've seen friends choose between life-threatening illness and bankruptcy due to networks, many times. As for the "smartest, best" people becoming doctors... I don't think medicine is a path chosen simply because it's lucrative, in most cases. It's chosen because it's challenging (or sometimes, because it's expected). And those in it for the money are in paths of lucrative-but-socially-useless things like cosmetic surgery. High pay is incidental here. Why pay coverage for things you'll never use? Same reason I'm paying for your broken arm. That's how insurance works. Spreading the risk. Single payer systems - like Medicare, for example - are quite capable of covering experimental treatments. Why are you saying they can't? You're ignoring plain facts here. And it's possible that your experimental coverage might not be covered by your private insurer, either. I've been in that boat myself. Fixed pricing is a far, far more transparent system than the current system of negotiating prices for the same things between different providers/insurers, so the same hospital charges $1.10 for aspirin here and $1.25 there. It also solves the problem of localized monopolies, such as rural hospitals, that can charge whatever they want because insurers have no alternative. Why force people onto the same plan? Single payer doesn't do that, necessarily. Again, Medicare. There's a HUGE market for Medicare supplemental insurance (I work in that market). Wealthier people can afford additional coverage above and beyond single player. The single payer provides a guaranteed baseline, and covers basics so private insurers can focus on corner cases, extremes, and luxuries. "End of life care is enormously expensive in America, but it is better than other places." Yeah, Medicare is single payer, right?
    - mises 7y ago
      > Why pay coverage for things you'll never use? Same reason I'm paying for your broken arm. That's how insurance works. Spreading the risk. Insurance is supposed to hedge against risk. You might need a broken arm; I will never need a hysterectomy or birth control (especially not the type covered by insurance). > localized monopolies, such as rural hospitals, that can charge whatever they want because insurers have no alternative. And if the rural hospitals then shut down due to not being able to cover costs? > Why force people onto the same plan? Single payer doesn't do that, necessarily. Again, Medicare. There's a HUGE market for Medicare supplemental insurance The definition of single-payer is in the name - there is a single entity which pays for insurance. A single payer. That means, definitionally, no private/supplemental insurance, no cash payments, no nothing. Experimental treatment may not be covered by private insurance, but at least it can be purchased with cash. A single-payer system definitionally precludes a cash option. > Yeah, Medicare is single payer, right? Wrong; see above. Medicare is also subsidized in no small part by higher-paying patients; because it often reimburses at below-market rates, private coverage is necessary to pick up the slack.

Ok, why? I'm more than open to being convinced otherwise; I'd love to think no one would be harmed.

by mises 7y ago

Ok, why? I'm more than open to being convinced otherwise; I'd love to think no one would be harmed.

beat 7y ago

First, it's unlikely that an influx of new patients due to opening networks and increasing coverage would lead to doctors dropping existing patients. On what grounds would that happen? Second, you're at best arguing that we shouldn't go to a fair system of rationing because it would hurt the beneficiaries of an unfair system of rationing. And to take this sideways... my favorite health care model is the Japanese system. It's actually quite similar to the American system (private employer-provided insurance, private providers), but with one key difference... a government commission fixes the prices for all medical goods and services. No more negotiating between providers and insurers. So no "networks". It leads directly to the situation you described. It also leads to costing half as much as the US, for universal coverage and better outcomes. I'll take that trade, thank you.

mises 7y ago
> it's unlikely that an influx of new patients due to opening networks and increasing coverage would lead to doctors dropping existing patients. It wouldn't, but if I needed to get a doctor, I might no longer be able to get a very good one. Remember that cheaper prices for medical care means the smartest, best people may not become doctors. > you're at best arguing that we shouldn't go to a fair system of rationing because it would hurt the beneficiaries of an unfair system of rationing. I don't believe the current system is "unfair". Why is it? Most Americans like what they have; it is the bottom few percent who are unhappy. Is that "unfair"? At what percentage does that become the case? Must most of society change to accommodate a small, dissatisfied minority? Without government regulation, health care would be much cheaper. Why must I purchase coverage for a hysterectomy or for birth control as part of a plan? I will never need these services. Wasted money. What of experimental treatments? I know a person who is alive thanks to an experimental treatment that was reasonably priced. All it amounted to was an antibiotic regimen far outside the bounds of the CDC-recommended one, out-patient. The problem with single-payer is that I cannot do that, because there is a single payer - the feds. I may not pay for my own procedures (and my friend would not have been able to do so), even though this was quite affordable, because it was not on "the list". Fixing prices is a possibility (albeit not one of which I am as fond), though we would need to allow procedures to be done out side of that (for those which were not approved, or for those who could not get availability and could pay). It is basic economics that price ceilings create shortages; who gets treatment? We are back at square one: I think it should be ordered by those who should pay. I trust dollars to be "fairer" than an opaque system, and would rather the coverage I can get be a known quantity than be at the mercy of the whims of a bureaucrat. My biggest question: why do you want to force those who can pay onto the same plan? That is a part of single-payer that makes no sense. Why not let those who like their existing coverage keep it, as most Americans still do? [0] There was an article that surfaced about an Indian hospital that had industrialized common health-care procedures. A four-year degree is not essential for these; why is it required? If we commoditize common and routine procedures via removal of barriers to entry, we can greatly increase the benefit without forcing those who like what they have to become worse off and without hurting more complicated situations. Lastly, the problem with socialized medicine is that it cannot afford to spend beyond a certain amount per-person on average. End-of-life care is enormously expensive in America, but is better than in other places. [1] Many of us may say it is foolish to spend upwards of a million dollars for a few more years of life, but having spoken to a few dying people, most say something to the effect of that they would give every thing they have for a few more weeks (the exception being those in exceptional pain, those with loss of senses, etc.). EDIT: Downvoters care to comment? [0] https://news.gallup.com/poll/245195/americans-rate-healthcare-quite-positively.aspx https://news.gallup.com/poll/245195/americans-rate-healthcar... [1] https://www.forbes.com/sites/cjarlotta/2016/01/19/end-of-life-care-costs-in-us-comparable-to-europe-and-canada/#350a2305ada3 https://www.forbes.com/sites/cjarlotta/2016/01/19/end-of-lif...
- beat 7y ago
  Access to the best doctors isn't a function of how they're paid for now, unless you're saying the current system is giving them slack in their schedules by keeping patients away. Meanwhile, people are being denied access to good doctors with capacity now, because of a lack of insurance, or in-network restrictions. I've seen friends choose between life-threatening illness and bankruptcy due to networks, many times. As for the "smartest, best" people becoming doctors... I don't think medicine is a path chosen simply because it's lucrative, in most cases. It's chosen because it's challenging (or sometimes, because it's expected). And those in it for the money are in paths of lucrative-but-socially-useless things like cosmetic surgery. High pay is incidental here. Why pay coverage for things you'll never use? Same reason I'm paying for your broken arm. That's how insurance works. Spreading the risk. Single payer systems - like Medicare, for example - are quite capable of covering experimental treatments. Why are you saying they can't? You're ignoring plain facts here. And it's possible that your experimental coverage might not be covered by your private insurer, either. I've been in that boat myself. Fixed pricing is a far, far more transparent system than the current system of negotiating prices for the same things between different providers/insurers, so the same hospital charges $1.10 for aspirin here and $1.25 there. It also solves the problem of localized monopolies, such as rural hospitals, that can charge whatever they want because insurers have no alternative. Why force people onto the same plan? Single payer doesn't do that, necessarily. Again, Medicare. There's a HUGE market for Medicare supplemental insurance (I work in that market). Wealthier people can afford additional coverage above and beyond single player. The single payer provides a guaranteed baseline, and covers basics so private insurers can focus on corner cases, extremes, and luxuries. "End of life care is enormously expensive in America, but it is better than other places." Yeah, Medicare is single payer, right?
  - mises 7y ago
    > Why pay coverage for things you'll never use? Same reason I'm paying for your broken arm. That's how insurance works. Spreading the risk. Insurance is supposed to hedge against risk. You might need a broken arm; I will never need a hysterectomy or birth control (especially not the type covered by insurance). > localized monopolies, such as rural hospitals, that can charge whatever they want because insurers have no alternative. And if the rural hospitals then shut down due to not being able to cover costs? > Why force people onto the same plan? Single payer doesn't do that, necessarily. Again, Medicare. There's a HUGE market for Medicare supplemental insurance The definition of single-payer is in the name - there is a single entity which pays for insurance. A single payer. That means, definitionally, no private/supplemental insurance, no cash payments, no nothing. Experimental treatment may not be covered by private insurance, but at least it can be purchased with cash. A single-payer system definitionally precludes a cash option. > Yeah, Medicare is single payer, right? Wrong; see above. Medicare is also subsidized in no small part by higher-paying patients; because it often reimburses at below-market rates, private coverage is necessary to pick up the slack.