4 ms·

The AMA killed the single payer option in the ACA under Obama, and they'll do their damndest to keep it dead under Biden: https://www.nytimes.com/2009/06/11/us

The AMA killed the single payer option in the ACA under Obama, and they'll do their damndest to keep it dead under Biden: https://www.nytimes.com/2009/06/11/us/politics/11health.html https://www.nytimes.com/2009/06/11/us/politics/11health.html https://www.modernhealthcare.com/physicians/ama-maintains-its-opposition-single-payer-systems https://www.modernhealthcare.com/physicians/ama-maintains-it...

lumost 6y ago
Single payer makes US healthcare a monopsony, a market with only one buyer. All sellers/providers inherently hate that as the single buyer can check each companies margin, and dictate a lower price in the future.
- baryphonic 6y ago
  The problem with monopsony in theory is that it reduces the actual wage below the market-clearing wage, which results in a lower quantity of labor supplied. A better arrangement in such cases is usually a bilateral monopoly (think of how sports leagues negotiate with players' unions), which results in wages and labor supplied much closer to market clearing amounts (again, in theory). In many ways, the US already has a soft form of monopsony, given the total dominance of CMMS in determining everything from reimbursements to billing codes to proper medical procedures. We shouldn't be surprised by the already significant shortages within US medical professions given this situation. CMMS regulation has also resulted in large hospital groups absorbing private practices such that most physicians now work for some large hospital group, and most of the rest work for larger companies focused on one or a few specialities.
  - dredmorbius 6y ago
    Access, not quality, is the principle determinant of health outcomes. Since 1960, life expectancy advances have been greatest among minority, poor, and under-served populations. Not wealthy whites.
    - baryphonic 6y ago
      Assuming that this extremely simplified model ("access is all you need!"), how can you improve access if there are fewer doctors? I didn't say much about quality, but quantity. Hence, access. Access to professional medical care is a minor factor anyway. Increases in life expectancy are not not primarily due to medical care, but to other improvements like better nutrition, better drinking water, better sleep, safer neighborhoods, even things like better financial security. And as it turns out, the effect of access to health care on life expectancy or better health outcomes for the poor is much weaker for the groups you mentioned. In a real sense, access to care itself matters mostly to the middle & wealthy classes (of whatever "race"). Also, I'd quibble that wealthy whites aren't also improving. Poor whites seem to be suffering, but by all indications, wealthy whites are also doing well.
- mindslight 6y ago
  Anecdotally my ophthalmologist has told me that they would actually prefer single payer, as it would make their finances more predictable for investing in new equipment. My personal bias is wanting to fix healthcare by fixing its price signals, so this surprised me.
  - wutbrodo 6y ago
    > My personal bias is wanting to fix healthcare by fixing its price signals, so this surprised me. The problem is that we're very far from market signals, and "quality of the healthcare system" is not a monotonic function of market-orientation. If we were to go all the way to a fully market-oriented system, a lot of the obscene inefficiencies and horrors of the healthcare system would be addressed. There may even be people by whose chosen measure, our healthcare system functions better than it does today. But we'd have new horrors around access that we as a society have chosen not to accept, which means we're in this grotesque inefficient middle-ground where we have neither the advantages of a centralized system nor the advantages of a system where market signals aren't choked off at every turn. It's completely plausible that we're at the part of the curve where more centralization moves us up the U-shaped curve instead of down
    - mindslight 6y ago
      I tried to word that as nonargumentatively as I could, as single payer does seem like the best concrete plan for moving forward despite it not being my preferred style. I just think there's a lot of low hanging fruit that would reform the system bottom up, such as stopping providers from making up fictitious bills and prosecuting the ones that attempt to defraud customers with them. Requiring providers to set uniform prices across all payers and publish their price list would go a long way. And even moving towards a "single payer" system, this dynamic is still going to exist for many kinds of care. If by "new horrors around access" you just mean the poor not being able to pay for care, I see that as orthogonal and have no problem with subsidies. Of course I acknowledge the realpolitik would be different.
      - wutbrodo 6y ago

lumost 6y ago

Single payer makes US healthcare a monopsony, a market with only one buyer. All sellers/providers inherently hate that as the single buyer can check each companies margin, and dictate a lower price in the future.

baryphonic 6y ago
The problem with monopsony in theory is that it reduces the actual wage below the market-clearing wage, which results in a lower quantity of labor supplied. A better arrangement in such cases is usually a bilateral monopoly (think of how sports leagues negotiate with players' unions), which results in wages and labor supplied much closer to market clearing amounts (again, in theory). In many ways, the US already has a soft form of monopsony, given the total dominance of CMMS in determining everything from reimbursements to billing codes to proper medical procedures. We shouldn't be surprised by the already significant shortages within US medical professions given this situation. CMMS regulation has also resulted in large hospital groups absorbing private practices such that most physicians now work for some large hospital group, and most of the rest work for larger companies focused on one or a few specialities.
- dredmorbius 6y ago
  Access, not quality, is the principle determinant of health outcomes. Since 1960, life expectancy advances have been greatest among minority, poor, and under-served populations. Not wealthy whites.
  - baryphonic 6y ago
    Assuming that this extremely simplified model ("access is all you need!"), how can you improve access if there are fewer doctors? I didn't say much about quality, but quantity. Hence, access. Access to professional medical care is a minor factor anyway. Increases in life expectancy are not not primarily due to medical care, but to other improvements like better nutrition, better drinking water, better sleep, safer neighborhoods, even things like better financial security. And as it turns out, the effect of access to health care on life expectancy or better health outcomes for the poor is much weaker for the groups you mentioned. In a real sense, access to care itself matters mostly to the middle & wealthy classes (of whatever "race"). Also, I'd quibble that wealthy whites aren't also improving. Poor whites seem to be suffering, but by all indications, wealthy whites are also doing well.
mindslight 6y ago
Anecdotally my ophthalmologist has told me that they would actually prefer single payer, as it would make their finances more predictable for investing in new equipment. My personal bias is wanting to fix healthcare by fixing its price signals, so this surprised me.
- wutbrodo 6y ago
  > My personal bias is wanting to fix healthcare by fixing its price signals, so this surprised me. The problem is that we're very far from market signals, and "quality of the healthcare system" is not a monotonic function of market-orientation. If we were to go all the way to a fully market-oriented system, a lot of the obscene inefficiencies and horrors of the healthcare system would be addressed. There may even be people by whose chosen measure, our healthcare system functions better than it does today. But we'd have new horrors around access that we as a society have chosen not to accept, which means we're in this grotesque inefficient middle-ground where we have neither the advantages of a centralized system nor the advantages of a system where market signals aren't choked off at every turn. It's completely plausible that we're at the part of the curve where more centralization moves us up the U-shaped curve instead of down
  - mindslight 6y ago
    I tried to word that as nonargumentatively as I could, as single payer does seem like the best concrete plan for moving forward despite it not being my preferred style. I just think there's a lot of low hanging fruit that would reform the system bottom up, such as stopping providers from making up fictitious bills and prosecuting the ones that attempt to defraud customers with them. Requiring providers to set uniform prices across all payers and publish their price list would go a long way. And even moving towards a "single payer" system, this dynamic is still going to exist for many kinds of care. If by "new horrors around access" you just mean the poor not being able to pay for care, I see that as orthogonal and have no problem with subsidies. Of course I acknowledge the realpolitik would be different.
    - wutbrodo 6y ago