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What does being the sole payer for services give you, besides a monopoly on payments and all the leverage that comes with it? It should be self-evident, but the
by claudeganon 7y ago
What does being the sole payer for services give you, besides a monopoly on payments and all the leverage that comes with it? It should be self-evident, but the ability to negotiate far better prices from healthcare suppliers. Medicare for All’s (not Medicare’s) “unique ability” is this ability to say do these things or you won’t get paid or paid as much. It’s a big part of what single payer systems do around the world to drive down costs and what allows for consistent care to prevent the development of more expensive conditions.
Medicare doesn’t have this advantage because it is not “universal” in any regard and doesn’t have this leverage. The cost pressure from the ever escalating supplier-insurance war further down the chain bleeds into it, as thaumaturgy outlined. Not the very least in the form of lingering injuries and chronic illnesses in its beneficiaries that could’ve been better managed through a universal system before they came onboard.
Which is related to your point about drug costs - the inability of Medicare to collectively negotiate drug prices allows them to be as ridiculous as they are in the US, which of course leads to horrible outcomes for managing care. When people can’t afford medicine, ration it, etc, their conditions worsen and become more expensive to treat. Even if the medicines themselves are not a large, direct source of upward pressure on costs, their inaccessibility creates the circumstances (and need) for more expensive care. And this happens throughout the system as people self-ration various, necessary forms of care.
TLDR; Because Medicare isn’t universal coverage and it and it’s beneficiaries don’t exist in a vacuum.
- tptacek 7y agoAre we talking about the same Medicare? Because Medicare today absolutely does have the ability to say "do these things or you won't get paid".
- claudeganon 7y agoYes, and as I already mentioned, the existing leverage Medicare has in this regard already puts downward pressure on costs. But it’s insufficient relative to how costs are being driven up further down in the system and quite obviously an orders of magnitude smaller amount of leverage than a universal system and a monopoly on payments.
- tptacek 7y agoMedicare is the near-exclusive provider of medical services to the most lucrative and demanding segment of the market. You're going to need to explain, with specifics, why they've had such a limited ability to hold down costs. Adding a bunch of 30 year olds who see a doctor once every 3 years isn't going to do that automatically.
- claudeganon 7y agoThey can’t hold down costs because they’re just a competing payer in a large, dysfunctional system whose overall costs are determined by the sum total of this dysfunction and the general trajectory of healthcare outcomes it produces. I’m sure you’re quite aware of this, as well as the difference between having a monopoly on payments, continuity of care, and “adding a bunch of 30 year olds” to the system, but feel free to waste more time with these obfuscations. A defense of the status quo isn’t really helped by them.
- tptacek 7y agoNo. Medicare does not in fact meaningfully compete with private insurance in the markets it serves. It is a universal entitlement for US senior citizens.
- claudeganon 7y agoYes, I should’ve been more precise in saying they are one payer in a system of many payers vying for lower prices from healthcare suppliers. But as I’ve stated multiple times and what you seem to be purposefully ignoring to defend your position, the overall costs of these services are determined not only by how they’re consumed by Medicare beneficiaries, but by overall functioning of the healthcare system and continuity of care throughout its beneficiaries’ lifetimes. You can very clearly understand that the price of any given procedure is not determined by how it is consumed and paid for by one segment of the market, but by all of its consumption and the interactions around it. A given surgery or hospital stay is is not something consumed exclusively by Medicare beneficiaries so they are not the sole determinants of its price.