3 ms·

I agree with you on the insanity of the current system, but I have two problems that prevent me from believing that single payer is the simple answer to our hea

I agree with you on the insanity of the current system, but I have two problems that prevent me from believing that single payer is the simple answer to our health care cost problem: 1) "Europe" is not single payer, England is while the two largest EU countries, Germany and France, are not. 2) Medicare is already an enormous single payer system, covering the demographic that consumes the most health care services, and does not have costs anywhere in line with Europe. So, I think copying Europe would be reasonable, but that maybe it would be better to draw inspiration from one of the non-single-payer systems instead. The results don't seem to be any worse and it seems a bit safer to have more choices.

keenmaster 7y ago
Medicare sets reimbursement rates at around 80% of what insurance companies pay. The government couldn’t go lower because Medicare patients are elderly. Doctors simply would not take Medicare patients if they got significantly less than 80% per procedure (on average) because they take more time and resources than the average patient. If the pool included younger and healthier patients (most of the rest of America) its cost basis would be lower than Medicare. Additionally, I’m aware that there are different gradations of government healthcare in Europe. All of them would be better than the current system, though I’m a fan of single-payer. I was just simplifying.
- throwaway34241 7y ago
  Even if you can save 20% on younger people (by paying doctors/hospitals 20% less) that's still a long way away from bringing costs in line with Europe. Single payer doesn't sound like a crazy idea to me, I'm just skeptical that it will necessarily solve the cost problem. A single payer system that is very expensive and continually increasing seems like a real possibility to me. I guess you could achieve cost savings by cutting reimbursement rates even further if you prohibit any alternatives. Hospitals can and do go bankrupt but it seems likely that physician salaries could also be cut. I'm sure this will drive many doctors that were borderline into retirement but I guess we're facing a physician shortage anyway. I think there's a number of other things we could do to contain health care costs. We could expand the role of nurses and physician assistants (possibly with the aid of computer diagnostic systems). We could increase the number of doctors produced (which will in general lower salaries). We could subsidize medical education more, so doctors graduate with less debt, in exchange for accepting a lower salary later. We could have better conversations around end-of-life care, since many patients choose treatment plans that doctors would not chose for themselves, but might not if things were explained better. We could have official guidelines to establish when certain tests are necessary using evidence-based medicine, to limit thoughtless CYA testing for liability purposes if it isn't medically warranted. So, my feelings on single payer are tied to whether it will make it more or less likely that we can explore these things. Given the current state of our political discourse I'm not encouraged.
  - keenmaster 7y ago
    “The AMA controls state boards of licensing, limiting the number of physicians in each state and preventing competitors from treating patients. The United States has 50 percent fewer practicing physicians per capita than Sweden or Germany. Unsurprisingly, US doctors also work fewer hours while earning much higher salaries.“ https://fee.org/articles/the-medical-cartel-is-keeping-health-care-costs-high/ https://fee.org/articles/the-medical-cartel-is-keeping-healt... We absolutely need more physicians. Med school should be cheaper and shorter in duration, but the AMA has been fixing the supply of doctors like a cartel in the name of “quality.” They’re defending the economic moat for current physicians by using a false front, nothing more. Also, people started believing that end-of-life care is a problem in the U.S. partly because of misleading statistics. Let’s say your grandma is 75 and has complications due to pneumonia. The situation spirals out of control and she becomes a really costly patient. However, she has a reasonable chance of living to 85, giving you 10 more (quite valuable) years with her. No one will argue that we should give up on her. However, if she dies after all that expense, she will feed that stupid statistic about X% of Medicare spending in the last X months/years. Many people die when they have a reasonable probability of living. There are edge cases, like people that somehow enter a catatonic state or get some rare disease, but they’re overblown. Lastly, there is a subgroup of people that you just can’t “control costs” on, like Alzheimer’s patients. What kind of sick society would give up on them? End-of-life care is a red herring in the U.S. healthcare debate, as is overconsumption of diagnostic screening. It is certainly true that America has a culture of screening but 1. MRIs shouldn’t cost $1500, so its hard to fairly compare the magnitude vs. Europe where the healthcare system isn’t broken 2. Excessively high treatment costs are so much more of a problem that this is a small factor in comparison 3. There are benefits to screening which obviously net out the cost to some degree. Screening really shouldn’t feature much in the debate at all in my opinion, nor should healthcare consumption levels for that matter. For some perspective, a study estimated that $45 billion is spent on “defensive medicine” meant to avoid lawsuits out of the $2.3 trillion spent on healthcare in 2008. However, if you ask some industry insiders why healthcare costs are so high, they might quickly inform you of defensive medicine and medical liability. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3048809/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3048809/
    - 7y ago
dragonwriter 7y ago
> Medicare is already an enormous single payer system No, it's not. It's a multipayer component (it involves both federal government and non-federal — both private and state government — payers, the latter, private specifically, exclusively for Part D, and both together in an arrangement loosely similar to the ACA with a default public option for the combination of Parts A-C) of a multipayer system, with the government part forbidden to use it's buying power to negotiate drug prices but instead required to accept prices set by other participants in private markets.

keenmaster 7y ago

Medicare sets reimbursement rates at around 80% of what insurance companies pay. The government couldn’t go lower because Medicare patients are elderly. Doctors simply would not take Medicare patients if they got significantly less than 80% per procedure (on average) because they take more time and resources than the average patient. If the pool included younger and healthier patients (most of the rest of America) its cost basis would be lower than Medicare. Additionally, I’m aware that there are different gradations of government healthcare in Europe. All of them would be better than the current system, though I’m a fan of single-payer. I was just simplifying.

throwaway34241 7y ago
Even if you can save 20% on younger people (by paying doctors/hospitals 20% less) that's still a long way away from bringing costs in line with Europe. Single payer doesn't sound like a crazy idea to me, I'm just skeptical that it will necessarily solve the cost problem. A single payer system that is very expensive and continually increasing seems like a real possibility to me. I guess you could achieve cost savings by cutting reimbursement rates even further if you prohibit any alternatives. Hospitals can and do go bankrupt but it seems likely that physician salaries could also be cut. I'm sure this will drive many doctors that were borderline into retirement but I guess we're facing a physician shortage anyway. I think there's a number of other things we could do to contain health care costs. We could expand the role of nurses and physician assistants (possibly with the aid of computer diagnostic systems). We could increase the number of doctors produced (which will in general lower salaries). We could subsidize medical education more, so doctors graduate with less debt, in exchange for accepting a lower salary later. We could have better conversations around end-of-life care, since many patients choose treatment plans that doctors would not chose for themselves, but might not if things were explained better. We could have official guidelines to establish when certain tests are necessary using evidence-based medicine, to limit thoughtless CYA testing for liability purposes if it isn't medically warranted. So, my feelings on single payer are tied to whether it will make it more or less likely that we can explore these things. Given the current state of our political discourse I'm not encouraged.
- keenmaster 7y ago
  “The AMA controls state boards of licensing, limiting the number of physicians in each state and preventing competitors from treating patients. The United States has 50 percent fewer practicing physicians per capita than Sweden or Germany. Unsurprisingly, US doctors also work fewer hours while earning much higher salaries.“ https://fee.org/articles/the-medical-cartel-is-keeping-health-care-costs-high/ https://fee.org/articles/the-medical-cartel-is-keeping-healt... We absolutely need more physicians. Med school should be cheaper and shorter in duration, but the AMA has been fixing the supply of doctors like a cartel in the name of “quality.” They’re defending the economic moat for current physicians by using a false front, nothing more. Also, people started believing that end-of-life care is a problem in the U.S. partly because of misleading statistics. Let’s say your grandma is 75 and has complications due to pneumonia. The situation spirals out of control and she becomes a really costly patient. However, she has a reasonable chance of living to 85, giving you 10 more (quite valuable) years with her. No one will argue that we should give up on her. However, if she dies after all that expense, she will feed that stupid statistic about X% of Medicare spending in the last X months/years. Many people die when they have a reasonable probability of living. There are edge cases, like people that somehow enter a catatonic state or get some rare disease, but they’re overblown. Lastly, there is a subgroup of people that you just can’t “control costs” on, like Alzheimer’s patients. What kind of sick society would give up on them? End-of-life care is a red herring in the U.S. healthcare debate, as is overconsumption of diagnostic screening. It is certainly true that America has a culture of screening but 1. MRIs shouldn’t cost $1500, so its hard to fairly compare the magnitude vs. Europe where the healthcare system isn’t broken 2. Excessively high treatment costs are so much more of a problem that this is a small factor in comparison 3. There are benefits to screening which obviously net out the cost to some degree. Screening really shouldn’t feature much in the debate at all in my opinion, nor should healthcare consumption levels for that matter. For some perspective, a study estimated that $45 billion is spent on “defensive medicine” meant to avoid lawsuits out of the $2.3 trillion spent on healthcare in 2008. However, if you ask some industry insiders why healthcare costs are so high, they might quickly inform you of defensive medicine and medical liability. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3048809/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3048809/
  - 7y ago

dragonwriter 7y ago

> Medicare is already an enormous single payer system No, it's not. It's a multipayer component (it involves both federal government and non-federal — both private and state government — payers, the latter, private specifically, exclusively for Part D, and both together in an arrangement loosely similar to the ACA with a default public option for the combination of Parts A-C) of a multipayer system, with the government part forbidden to use it's buying power to negotiate drug prices but instead required to accept prices set by other participants in private markets.