10 ms·

Nah, let's just replace the whole thing with Medicare for all. The federal government can then negotiate prices which will be far lower than any smaller org can

by mempko 7y ago

Nah, let's just replace the whole thing with Medicare for all. The federal government can then negotiate prices which will be far lower than any smaller org can do. Works in Japan where prices are super low and the system is very good (far more private doctors per capita than in USA).

sailfast 7y ago
I'm interested to know why you think the government is incentivized to negotiate the best pricing for citizens. They would fill the same role as existing insurers, but instead of multiple black boxes there would be one. There is no way to tell if the price we are paying is at all good value for money compared to what it could cost. I'm not sure this solves our health care cost escalation problem, and the government would still be fighting against providers that would continue to grow and merge together so they would be able to negotiate with the government. This reduces overall service and competition.
- mempko 7y ago
  I think that because it happened in Japan and other places. Japan has a single payer health insurance system called NHS. The government pays 70 percent of the cost of all health procedures, if you’re a low-income or elderly resident, it pays as much as 90 percent. The remaining 30 percent is covered by private health insurance. The government is EXTREMELY good at negotiating prices. In other words, there are already examples of it working really well, so it's pretty clear it can work well here too with enough care. Japan is known for really high-quality care that is insanely cheap and has more doctors per capita than in the USA. So the worry that overall service and competition would decline is unfounded. So let's take really good working examples and try them here. The USA can do so much better, it's not even funny. https://www.bloomberg.com/opinion/articles/2017-09-19/want-a-better-health-care-system-check-out-japan https://www.bloomberg.com/opinion/articles/2017-09-19/want-a...
  - ekianjo 7y ago
    High quality care in Japan? this claim is debunked when you see doctors dont spend more than 5 minutes with patients, barely do any tests before giving out medications by the dozen for most medical conditions. If that is high quality care it is seriously laughable.
    - dboreham 7y ago
      To be sure you'd have to run a study where you compare outcomes vs spending a bunch of time with each patient and doing a bunch of tests.. Oh wait...
  - tdfx 7y ago
    One issue that's talked about less frequently is how high US doctor incomes are compared to other countries. The average doctor in Japan made ~$105,000 USD [1] in 2014, whereas in the US the average primary care doctor made $195,000 and the average specialist made $284,000 [2]. Anecdotally, I had an eye infection in Mexico and was seen by an ophthalmologist the same day for an $8 consult fee and treated with antibiotics that cost $20, using the exact same techniques and equipment that would have cost me hundreds of dollars in the US. We're paying our doctors sometimes double what they make in other countries and receiving inferior health outcomes. It's easy to vilify the AMA but our doctors also have an unusually high amount of risk and obligation when it comes to malpractice, which wouldn't go away if everyone magically was on Medicare For All tomorrow. To reduce health care costs, someone needs to get squeezed... but who? Reducing doctor salaries will lead to a shortage of doctors unless there's some additional action on easing the education burden they presently have to take on. [1] http://nbakki.hatenablog.com/entry/Annual_Salary_by_Occupation http://nbakki.hatenablog.com/entry/Annual_Salary_by_Occupati... (2014) [2] https://www.businessinsider.com/how-much-salary-does-a-doctor-make-2015-4 https://www.businessinsider.com/how-much-salary-does-a-docto... (2014)
    - assblaster 7y ago
      Healthcare admin jobs should be drastically curtailed.
    - IG_Semmelweiss 7y ago
      in the US, you are allowed to buy a ferrari or a geo. in mexico, they only make geos. So prices reflect that. in the US, you are only allowed to supply healthcare if you buy into $500,000 of loans and give up 6 years of your life. The AMA and government have mandated it to be so. That's the price of a ferrari. US Medical salaries reflect that medical ferrari
    - lenkite 7y ago
      The AMA most certainly needs to be vilified. It actively lobbied to limit the number of residency slots thus leading to doctor shortage and higher prices. It even indulged in price-fixing and opposed retail clinics that could offer competitive pricing. https://washingtonmonthly.com/magazine/julyaugust-2013/special-deal/ https://washingtonmonthly.com/magazine/julyaugust-2013/speci... https://mises.org/library/how-government-helped-create-coming-doctor-shortage https://mises.org/library/how-government-helped-create-comin... https://www.washingtonexaminer.com/thanks-to-doctors-there-arent-enough-doctors https://www.washingtonexaminer.com/thanks-to-doctors-there-a...
- naasking 7y ago
  > They would fill the same role as existing insurers, but instead of multiple black boxes there would be one. Because larger purchasers have more leverage to negotiate better discounts/bulk rates. When your choice is, "take the offer or you don't get any payment", you take the offer.
- moorhosj 7y ago
  ==I'm interested to know why you think the government is incentivized to negotiate the best pricing for citizens. I can think of two. First, so they can spend the money on other things they want (military, social security, education, etc.). Second, is so they can get re-elected by those same citizens. ==There is no way to tell if the price we are paying is at all good value for money compared to what it could cost. We could look at the dozens of other developed countries who work like this, should give us some clues.
  - zdragnar 7y ago
    I don't think "frugal" fits the description of many or any of our lawmakers. With few exceptions, they all want either higher taxes or higher debt to pay for their favorite things.
  - cheald 7y ago
    > I can think of two. First, so they can spend the money on other things they want (military, social security, education, etc.). Second, is so they can get re-elected by those same citizens. Respectfully, is there any reason to think that the US government would actually do this, based on past behavior? Government spending is famously wasteful, both parties spend like it's going out of style when it aligns with their interests, government debt continues to explode, and spending continues to grow year-over-year effectively unchecked. I may just be overly cynical here, but I don't think that responsible spending is the primary election issue for hardly anyone today.
  - kryogen1c 7y ago
    > Second, is so they can get re-elected by those same citizens. American politicians are not elected by voters or citizens, they're elected by contributors. This unhinging is either a root or partial cause to many problems.
    - magduf 7y ago
      Sorry, that's total BS. Complain all you want about "campaign contributions", but the politicians absolutely are elected by voters on Election Day. The only thing contributors can do is try to change opinions by funding campaigns which goes to advertising. The final choice is made by the voters, and they are the ones ultimately to blame for the results.
- wbronitsky 7y ago
  We know it works because we have examples. It is quite frustrating to see you not even try to go and get those examples. It only takes a simple google search. Here are three good ones: the UK, Japan and Canada. All different systems, all providing medical care for much less cost than we do in the US. Additionally, your reasoning is flawed at best. The government can legislate that providers can only charge $x for y service, which private actors cannot. 300 million+ people is a very large market to leave just because you are slipping on profits. There are many other levers a single payer who is the government can pull as well.
  - Fjolsvith 7y ago
    "The U.S. has higher prices for most health care services and prescription drugs, according to available internationally comparable data." "While available data are limited to select services and drugs, we find that higher prices – more so than utilization – explain the United States’ high health spending relative to other high-income countries." [1] Perhaps the US is closer to those other countries than you claim. 1. https://www.healthsystemtracker.org/chart-collection/how-do-healthcare-prices-and-use-in-the-u-s-compare-to-other-countries/#item-start https://www.healthsystemtracker.org/chart-collection/how-do-...
- henryfjordan 7y ago
  We like to talk about healthcare like it's a free market but it's not. If I'm at the hospital I'm there for treatment. I'm not leaving until I get it, damn the cost. I will not consume less healthcare because the price is higher when the other option is death. We need some price setting regulation to protect consumers from getting fleeced. When the hospital knows that I'm going to say yes, why not price every surgery at $100k? We've tried letting the insurance companies regulate the price, but they've proven themselves incapable either because there are so many secrets making the market not fair or because they don't have an incentive. It is time to try something else. The government is our mechanism for regulation. Let's use it.
  - cheald 7y ago
    You're describing inelasticity of demand, which has nothing to do with whether or not a market is free in the economic sense (that is, whether supplier competition and consumer substitution are possible). It's also incorrect to pretend that all healthcare goods have the same elasticity of demand, as well as to pretend that even emergency healthcare is perfectly inelastic. The reason this matters is that we don't see the same problems in other inelastic markets - for example, automotive gasoline is highly inelastic (estimated to be at -0.02 - https://www.eia.gov/todayinenergy/detail.php?id=19191 https://www.eia.gov/todayinenergy/detail.php?id=19191), but we don't have the same pricing pathology with it that we do with healthcare (emergency healthcare estimated to be at -0.04 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5600717/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5600717/). Therefore, we can't conclude that the problems are specifically due to inelasticity.
    - drieddust 7y ago
      > You're describing inelasticity of demand, which has nothing to do with whether or not a market is free in the economic sense (that is, whether supplier competition and consumer substitution are possible) Next time when a bone in broken in your body, go comparison shopping because it's a free market and you should get the best deal while your bones hang freely. Health care is a special case not comparable with any other market.
umeshunni 7y ago
>> The federal government can then negotiate prices which will be far lower I'm not convinced that the government can get a better rate - especially when you look at other sectors where government contracting has become a lucrative business like IT, military or space where the private sector does things much cheaper than what the government does. >> Japan where prices are super low ... far more private doctors per capita than in US I think the real reason in Japan might be that costs are low because there is more competition due to more private doctors. The cost of becoming a doctor are lower (lower education costs, lower malpractice insurances costs etc) and that incentivizes more people to become doctors and they are able to charge a lower fee as a result.
- grey-area 7y ago
  Let's look at the data. https://www.statista.com/statistics/268826/health-expenditure-as-gdp-percentage-in-oecd-countries/ https://www.statista.com/statistics/268826/health-expenditur... https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita https://en.wikipedia.org/wiki/List_of_countries_by_total_hea... The US is an outlier, because the US system is broken. IMO the US healthcare market either needs to be properly regulated, or it should be converted to single-payer (a system which many other countries use with great success) - other developed countries are spending significantly less per capita for better outcomes while still allowing private healthcare for those who want it and can afford it.
  - jessaustin 7y ago
    This is all interesting but not responsive to GP comment. It is in fact quite plausible that lower costs for physicians could lead to more physicians and more price competition among physicians, even in USA.
    - grey-area 7y ago
      It is in fact quite plausible that lower costs for physicians could lead to more physicians and more price competition among physicians, even in USA. It doesn't matter what seems plausible to you, what matters are the hard facts of how much is spent for what outcome, and as you'll see from those graphs, the evidence is overwhelming that the US spends a lot (both per capita and as % of GDP), and gets less in return.
ekianjo 7y ago
In Japan the social security is deep in the red and everyone knows it is unsustainable. Really bad example.
- mempko 7y ago
  Why is it unsustainable? Japan can run a deficit indefinitely. It's the magic of owning your own currency. There is hardly any inflation in Japan despite this, and they are trying hard.
  - chris11 7y ago
    Japan has a serious issue with it's declining birth rate. https://www.theguardian.com/world/2018/dec/27/japan-shrinking-as-birthrate-falls-to-lowest-level-in-history https://www.theguardian.com/world/2018/dec/27/japan-shrinkin...
    - magduf 7y ago
      I was just in Japan, and I saw no shortage of children and young people while I was there. In fact, I saw far more children than I ever do in cities here in the US. The difference over there is that kids are born into families that are at least middle-class, while here in the US a huge number of children are born in poverty and raised by single parents. I don't think having a higher birthrate is going to turn out well in the long run when that's the case, compared to a country where children have a much better upbringing. In Japan, they have to worry about the younger generations supporting the elderly. In the US, we have to worry about the productive generations (the ones of working age) supporting both the elderly AND all the children and families in poverty and not having that bite us in the ass when those kids become adults (e.g., committing crimes, something that Japan doesn't have much trouble with).
      - michaelmrose 7y ago
        " I was just in Japan, and I saw no shortage of children and young people while I was there. In fact, I saw far more children than I ever do in cities here in the US." I would prefer to trust actual stats compared to your powers of observation. In this case 1.4 births per female in Japan vs 1.8 in the US. +0.7% annual population for the US vs -0.2% for Japan. The point is that the Japanese system isn't inherently flawed its dealing with the consequences of there being fewer working age people supporting a greater number of older individuals. This has nothing to do with your opinion on the relative social mores of the 2 countries.

by mempko 7y ago

sailfast 7y ago

I'm interested to know why you think the government is incentivized to negotiate the best pricing for citizens. They would fill the same role as existing insurers, but instead of multiple black boxes there would be one. There is no way to tell if the price we are paying is at all good value for money compared to what it could cost. I'm not sure this solves our health care cost escalation problem, and the government would still be fighting against providers that would continue to grow and merge together so they would be able to negotiate with the government. This reduces overall service and competition.

mempko 7y ago
I think that because it happened in Japan and other places. Japan has a single payer health insurance system called NHS. The government pays 70 percent of the cost of all health procedures, if you’re a low-income or elderly resident, it pays as much as 90 percent. The remaining 30 percent is covered by private health insurance. The government is EXTREMELY good at negotiating prices. In other words, there are already examples of it working really well, so it's pretty clear it can work well here too with enough care. Japan is known for really high-quality care that is insanely cheap and has more doctors per capita than in the USA. So the worry that overall service and competition would decline is unfounded. So let's take really good working examples and try them here. The USA can do so much better, it's not even funny. https://www.bloomberg.com/opinion/articles/2017-09-19/want-a-better-health-care-system-check-out-japan https://www.bloomberg.com/opinion/articles/2017-09-19/want-a...
- ekianjo 7y ago
  High quality care in Japan? this claim is debunked when you see doctors dont spend more than 5 minutes with patients, barely do any tests before giving out medications by the dozen for most medical conditions. If that is high quality care it is seriously laughable.
  - dboreham 7y ago
    To be sure you'd have to run a study where you compare outcomes vs spending a bunch of time with each patient and doing a bunch of tests.. Oh wait...
- tdfx 7y ago
  One issue that's talked about less frequently is how high US doctor incomes are compared to other countries. The average doctor in Japan made ~$105,000 USD [1] in 2014, whereas in the US the average primary care doctor made $195,000 and the average specialist made $284,000 [2]. Anecdotally, I had an eye infection in Mexico and was seen by an ophthalmologist the same day for an $8 consult fee and treated with antibiotics that cost $20, using the exact same techniques and equipment that would have cost me hundreds of dollars in the US. We're paying our doctors sometimes double what they make in other countries and receiving inferior health outcomes. It's easy to vilify the AMA but our doctors also have an unusually high amount of risk and obligation when it comes to malpractice, which wouldn't go away if everyone magically was on Medicare For All tomorrow. To reduce health care costs, someone needs to get squeezed... but who? Reducing doctor salaries will lead to a shortage of doctors unless there's some additional action on easing the education burden they presently have to take on. [1] http://nbakki.hatenablog.com/entry/Annual_Salary_by_Occupation http://nbakki.hatenablog.com/entry/Annual_Salary_by_Occupati... (2014) [2] https://www.businessinsider.com/how-much-salary-does-a-doctor-make-2015-4 https://www.businessinsider.com/how-much-salary-does-a-docto... (2014)
  - assblaster 7y ago
    Healthcare admin jobs should be drastically curtailed.
  - IG_Semmelweiss 7y ago
    in the US, you are allowed to buy a ferrari or a geo. in mexico, they only make geos. So prices reflect that. in the US, you are only allowed to supply healthcare if you buy into $500,000 of loans and give up 6 years of your life. The AMA and government have mandated it to be so. That's the price of a ferrari. US Medical salaries reflect that medical ferrari
  - lenkite 7y ago
    The AMA most certainly needs to be vilified. It actively lobbied to limit the number of residency slots thus leading to doctor shortage and higher prices. It even indulged in price-fixing and opposed retail clinics that could offer competitive pricing. https://washingtonmonthly.com/magazine/julyaugust-2013/special-deal/ https://washingtonmonthly.com/magazine/julyaugust-2013/speci... https://mises.org/library/how-government-helped-create-coming-doctor-shortage https://mises.org/library/how-government-helped-create-comin... https://www.washingtonexaminer.com/thanks-to-doctors-there-arent-enough-doctors https://www.washingtonexaminer.com/thanks-to-doctors-there-a...
naasking 7y ago
> They would fill the same role as existing insurers, but instead of multiple black boxes there would be one. Because larger purchasers have more leverage to negotiate better discounts/bulk rates. When your choice is, "take the offer or you don't get any payment", you take the offer.
moorhosj 7y ago
==I'm interested to know why you think the government is incentivized to negotiate the best pricing for citizens. I can think of two. First, so they can spend the money on other things they want (military, social security, education, etc.). Second, is so they can get re-elected by those same citizens. ==There is no way to tell if the price we are paying is at all good value for money compared to what it could cost. We could look at the dozens of other developed countries who work like this, should give us some clues.
- zdragnar 7y ago
  I don't think "frugal" fits the description of many or any of our lawmakers. With few exceptions, they all want either higher taxes or higher debt to pay for their favorite things.
- cheald 7y ago
  > I can think of two. First, so they can spend the money on other things they want (military, social security, education, etc.). Second, is so they can get re-elected by those same citizens. Respectfully, is there any reason to think that the US government would actually do this, based on past behavior? Government spending is famously wasteful, both parties spend like it's going out of style when it aligns with their interests, government debt continues to explode, and spending continues to grow year-over-year effectively unchecked. I may just be overly cynical here, but I don't think that responsible spending is the primary election issue for hardly anyone today.
- kryogen1c 7y ago
  > Second, is so they can get re-elected by those same citizens. American politicians are not elected by voters or citizens, they're elected by contributors. This unhinging is either a root or partial cause to many problems.
  - magduf 7y ago
    Sorry, that's total BS. Complain all you want about "campaign contributions", but the politicians absolutely are elected by voters on Election Day. The only thing contributors can do is try to change opinions by funding campaigns which goes to advertising. The final choice is made by the voters, and they are the ones ultimately to blame for the results.
wbronitsky 7y ago
We know it works because we have examples. It is quite frustrating to see you not even try to go and get those examples. It only takes a simple google search. Here are three good ones: the UK, Japan and Canada. All different systems, all providing medical care for much less cost than we do in the US. Additionally, your reasoning is flawed at best. The government can legislate that providers can only charge $x for y service, which private actors cannot. 300 million+ people is a very large market to leave just because you are slipping on profits. There are many other levers a single payer who is the government can pull as well.
- Fjolsvith 7y ago
  "The U.S. has higher prices for most health care services and prescription drugs, according to available internationally comparable data." "While available data are limited to select services and drugs, we find that higher prices – more so than utilization – explain the United States’ high health spending relative to other high-income countries." [1] Perhaps the US is closer to those other countries than you claim. 1. https://www.healthsystemtracker.org/chart-collection/how-do-healthcare-prices-and-use-in-the-u-s-compare-to-other-countries/#item-start https://www.healthsystemtracker.org/chart-collection/how-do-...
henryfjordan 7y ago
We like to talk about healthcare like it's a free market but it's not. If I'm at the hospital I'm there for treatment. I'm not leaving until I get it, damn the cost. I will not consume less healthcare because the price is higher when the other option is death. We need some price setting regulation to protect consumers from getting fleeced. When the hospital knows that I'm going to say yes, why not price every surgery at $100k? We've tried letting the insurance companies regulate the price, but they've proven themselves incapable either because there are so many secrets making the market not fair or because they don't have an incentive. It is time to try something else. The government is our mechanism for regulation. Let's use it.
- cheald 7y ago
  You're describing inelasticity of demand, which has nothing to do with whether or not a market is free in the economic sense (that is, whether supplier competition and consumer substitution are possible). It's also incorrect to pretend that all healthcare goods have the same elasticity of demand, as well as to pretend that even emergency healthcare is perfectly inelastic. The reason this matters is that we don't see the same problems in other inelastic markets - for example, automotive gasoline is highly inelastic (estimated to be at -0.02 - https://www.eia.gov/todayinenergy/detail.php?id=19191 https://www.eia.gov/todayinenergy/detail.php?id=19191), but we don't have the same pricing pathology with it that we do with healthcare (emergency healthcare estimated to be at -0.04 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5600717/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5600717/). Therefore, we can't conclude that the problems are specifically due to inelasticity.
  - drieddust 7y ago
    > You're describing inelasticity of demand, which has nothing to do with whether or not a market is free in the economic sense (that is, whether supplier competition and consumer substitution are possible) Next time when a bone in broken in your body, go comparison shopping because it's a free market and you should get the best deal while your bones hang freely. Health care is a special case not comparable with any other market.

umeshunni 7y ago

>> The federal government can then negotiate prices which will be far lower I'm not convinced that the government can get a better rate - especially when you look at other sectors where government contracting has become a lucrative business like IT, military or space where the private sector does things much cheaper than what the government does. >> Japan where prices are super low ... far more private doctors per capita than in US I think the real reason in Japan might be that costs are low because there is more competition due to more private doctors. The cost of becoming a doctor are lower (lower education costs, lower malpractice insurances costs etc) and that incentivizes more people to become doctors and they are able to charge a lower fee as a result.

grey-area 7y ago
Let's look at the data. https://www.statista.com/statistics/268826/health-expenditure-as-gdp-percentage-in-oecd-countries/ https://www.statista.com/statistics/268826/health-expenditur... https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita https://en.wikipedia.org/wiki/List_of_countries_by_total_hea... The US is an outlier, because the US system is broken. IMO the US healthcare market either needs to be properly regulated, or it should be converted to single-payer (a system which many other countries use with great success) - other developed countries are spending significantly less per capita for better outcomes while still allowing private healthcare for those who want it and can afford it.
- jessaustin 7y ago
  This is all interesting but not responsive to GP comment. It is in fact quite plausible that lower costs for physicians could lead to more physicians and more price competition among physicians, even in USA.
  - grey-area 7y ago
    It is in fact quite plausible that lower costs for physicians could lead to more physicians and more price competition among physicians, even in USA. It doesn't matter what seems plausible to you, what matters are the hard facts of how much is spent for what outcome, and as you'll see from those graphs, the evidence is overwhelming that the US spends a lot (both per capita and as % of GDP), and gets less in return.

ekianjo 7y ago

In Japan the social security is deep in the red and everyone knows it is unsustainable. Really bad example.

mempko 7y ago
Why is it unsustainable? Japan can run a deficit indefinitely. It's the magic of owning your own currency. There is hardly any inflation in Japan despite this, and they are trying hard.
- chris11 7y ago
  Japan has a serious issue with it's declining birth rate. https://www.theguardian.com/world/2018/dec/27/japan-shrinking-as-birthrate-falls-to-lowest-level-in-history https://www.theguardian.com/world/2018/dec/27/japan-shrinkin...
  - magduf 7y ago
    I was just in Japan, and I saw no shortage of children and young people while I was there. In fact, I saw far more children than I ever do in cities here in the US. The difference over there is that kids are born into families that are at least middle-class, while here in the US a huge number of children are born in poverty and raised by single parents. I don't think having a higher birthrate is going to turn out well in the long run when that's the case, compared to a country where children have a much better upbringing. In Japan, they have to worry about the younger generations supporting the elderly. In the US, we have to worry about the productive generations (the ones of working age) supporting both the elderly AND all the children and families in poverty and not having that bite us in the ass when those kids become adults (e.g., committing crimes, something that Japan doesn't have much trouble with).
    - michaelmrose 7y ago
      " I was just in Japan, and I saw no shortage of children and young people while I was there. In fact, I saw far more children than I ever do in cities here in the US." I would prefer to trust actual stats compared to your powers of observation. In this case 1.4 births per female in Japan vs 1.8 in the US. +0.7% annual population for the US vs -0.2% for Japan. The point is that the Japanese system isn't inherently flawed its dealing with the consequences of there being fewer working age people supporting a greater number of older individuals. This has nothing to do with your opinion on the relative social mores of the 2 countries.