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> The elephant in the room in US health care costs is inefficiency on the provider side. Payer-side reforms have limited impact, because contrary to rhetoric fr

> The elephant in the room in US health care costs is inefficiency on the provider side. Payer-side reforms have limited impact, because contrary to rhetoric from both sides of the debate, we could probably zero out administrative costs entirely and still deliver little more than a grocery store discount to American consumers. Certain kinds of payer-side reforms (e.g. single payer) could allow the providers to be bullied by the payer until they're forced to get their acts together. The only thing that couldn't really address is doctor shortages, but that can (slowly) be addressed by a change in medical education regulation. Right now it's basically controlled by the AMA (basically the doctor's union), which limits the supply of seats to keep graduate salaries up.

tptacek 7y ago
This is a very popular argument in favor of single-payer. But Medicare already has authority over the most expensive and intensive segment of the health care market and has not effectively "bullied" providers down. It's not my argument that a single payer system can't do this, but rather that it doesn't appear to matter whether you have single payer or not; either way, radical change will be required from providers, and those changes are not intrinsic to the payer system.
- CharlesColeman 7y ago
  Those are two separate questions: whether the payer has enough power to bully the providers into reforming, and whether it actually chooses to use that power to do so. Medicare may have the power, but may not have the will to use it (for instance, IIRC, it's forbidden by law to use its market power to secure better drug prices). A payer reform like single-payer will get us a lot closer to solving provider cost problem, but it won't get us all the way there.
  - tptacek 7y ago
    That's a dodge. How does it get us any closer to solver provider costs, when the evidence available suggests it has never done so before despite having enormous authority to do so in the existing system? Remember that the argument isn't that single-payer is bad. It's that it's not actually relevant to the current problem. There may be a variety of reasons why single-payer is better than private; "will automatically solve provider-side costs" can't, from what I see, be one of them. If there's some reform that occurs after M4A that gets provider costs in line, let's just do that reform first.
    - CharlesColeman 7y ago
      It isn't a dodge, and I'm not claiming a single-payer system "will automatically solve provider-side costs" (which is an odd thing for you to put in quotes, since I said no such thing). What I am saying is that such a system opens up avenues to pressure providers that aren't available in other systems (or are more easy for providers to escape [1]), and that potential gets us closer to solving those problems. After that, it's a question of political will to use those powers. [1] e.g. by refusing to accept Medicare patients or by charging non-Medicare patients more to compensate. The alternatives to the single-payer for providers (e.g. concierge medicine) are likely to be far more limited.
      - tptacek 7y ago
        Sorry, I didn't mean to attribute those words to you, but I could have been clearer. What I'm saying is that there's no evidence that an M4A system would have any more ability to push back on provider costs than new federal regulations that didn't switch to a single payer model wouldn't be able to do, and further, no evidence that any of the existing M4A plans really target costs at all.

tptacek 7y ago

This is a very popular argument in favor of single-payer. But Medicare already has authority over the most expensive and intensive segment of the health care market and has not effectively "bullied" providers down. It's not my argument that a single payer system can't do this, but rather that it doesn't appear to matter whether you have single payer or not; either way, radical change will be required from providers, and those changes are not intrinsic to the payer system.

CharlesColeman 7y ago
Those are two separate questions: whether the payer has enough power to bully the providers into reforming, and whether it actually chooses to use that power to do so. Medicare may have the power, but may not have the will to use it (for instance, IIRC, it's forbidden by law to use its market power to secure better drug prices). A payer reform like single-payer will get us a lot closer to solving provider cost problem, but it won't get us all the way there.
- tptacek 7y ago
  That's a dodge. How does it get us any closer to solver provider costs, when the evidence available suggests it has never done so before despite having enormous authority to do so in the existing system? Remember that the argument isn't that single-payer is bad. It's that it's not actually relevant to the current problem. There may be a variety of reasons why single-payer is better than private; "will automatically solve provider-side costs" can't, from what I see, be one of them. If there's some reform that occurs after M4A that gets provider costs in line, let's just do that reform first.
  - CharlesColeman 7y ago
    It isn't a dodge, and I'm not claiming a single-payer system "will automatically solve provider-side costs" (which is an odd thing for you to put in quotes, since I said no such thing). What I am saying is that such a system opens up avenues to pressure providers that aren't available in other systems (or are more easy for providers to escape [1]), and that potential gets us closer to solving those problems. After that, it's a question of political will to use those powers. [1] e.g. by refusing to accept Medicare patients or by charging non-Medicare patients more to compensate. The alternatives to the single-payer for providers (e.g. concierge medicine) are likely to be far more limited.
    - tptacek 7y ago
      Sorry, I didn't mean to attribute those words to you, but I could have been clearer. What I'm saying is that there's no evidence that an M4A system would have any more ability to push back on provider costs than new federal regulations that didn't switch to a single payer model wouldn't be able to do, and further, no evidence that any of the existing M4A plans really target costs at all.