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I work in public health at a state government, in a western state. The biggest hurdle I see is that America has freedom of movement and residency. If my state c

by cmh89 3y ago

I work in public health at a state government, in a western state. The biggest hurdle I see is that America has freedom of movement and residency. If my state creates truly affordable health care, we will of course have refugees from conservative states coming here for medical care. We'll probably end up with a public option of some kind that will somewhat function like health insurance but who knows.

bravura 3y ago
This is an interesting point. And perhaps worse yet, high quality doctors will have the freedom to move out of your state. I'm an American living and Germany and sadly, my GP who is also a personal friend of mine, will be shutting down their practice at the end of the year because their small practice simply isn't financially sustainable. They will instead start treating the prison population, which apparently pays more / is more consistent. So I can also imagine how doctors in your state would feel if suddenly their rates are dramatically capped by the state. I'm not aware of any public health care systems where medical care services are as expensive as in the United States, but perhaps it's possible to maintain relatively similar doctor pay as currently exists AND provide socialized health care benefits. I really don't know enough about this topic and the financials of American (non-public) health insurance companies to comment accurately on whether that would be feasible.
- cmh89 3y ago
  There is no chance that the state would cap rates, I'm not sure they even could. The real pull would be trying to expand Medicaid, which is free,creating a single payer system and raising taxes, or creating public health insurance, or some combination of both. The public option would be the best in a vacuum, but if its truly affordable, we will still attract uninsured and under-insured people who come here when they get sick.
- sharts 3y ago
  Prices could probably drop if the market was saturated with doctors. And the best way to do that would be eliminating medical-school debt.
  - ffhhttt 3y ago
    I thought the limited number of residencies was the real bottleneck?
    - patmorgan23 3y ago
      Both
    - patmorgan23 3y ago
      Both are important. The high cost of medical school means people are only going to try and go for the specialties that pay the most (surgery, oncology, radiology, etc) leaving a shortage of Drs in other specialties like primary care/family medicine. Primary care reimbursement rates also need to be raised and we need more preventative treatments that insurance is required to pay for.
  - bravura 3y ago
    I'm comparing to the best public healthcare system I'm personally familiar with (Germany) and saying: * Medical-school debt is not a thing here. * Prices are low. * I know doctors who can't make a sustainable income to keep their small practices open. Somewhat puzzlingly, for a handful of services, there can a medium length delay in getting an appointment because of how busy the doctors are. This is definitely all much better than the situation is in Canada, where the typical person struggled even to get a GP, and friends with cancer would be forced to wait a life-imperiling year to get a routine scan that be the difference between life and death.
patmorgan23 3y ago
This is a challenge. It would be unconstitutional to out right ban individuals from getting the benefits, but maybe a waiting period would be constitutional(i.e. must be a resident for 1 year to sign up).

by cmh89 3y ago

bravura 3y ago

This is an interesting point. And perhaps worse yet, high quality doctors will have the freedom to move out of your state. I'm an American living and Germany and sadly, my GP who is also a personal friend of mine, will be shutting down their practice at the end of the year because their small practice simply isn't financially sustainable. They will instead start treating the prison population, which apparently pays more / is more consistent. So I can also imagine how doctors in your state would feel if suddenly their rates are dramatically capped by the state. I'm not aware of any public health care systems where medical care services are as expensive as in the United States, but perhaps it's possible to maintain relatively similar doctor pay as currently exists AND provide socialized health care benefits. I really don't know enough about this topic and the financials of American (non-public) health insurance companies to comment accurately on whether that would be feasible.

cmh89 3y ago
There is no chance that the state would cap rates, I'm not sure they even could. The real pull would be trying to expand Medicaid, which is free,creating a single payer system and raising taxes, or creating public health insurance, or some combination of both. The public option would be the best in a vacuum, but if its truly affordable, we will still attract uninsured and under-insured people who come here when they get sick.
sharts 3y ago
Prices could probably drop if the market was saturated with doctors. And the best way to do that would be eliminating medical-school debt.
- ffhhttt 3y ago
  I thought the limited number of residencies was the real bottleneck?
  - patmorgan23 3y ago
    Both
  - patmorgan23 3y ago
    Both are important. The high cost of medical school means people are only going to try and go for the specialties that pay the most (surgery, oncology, radiology, etc) leaving a shortage of Drs in other specialties like primary care/family medicine. Primary care reimbursement rates also need to be raised and we need more preventative treatments that insurance is required to pay for.
- bravura 3y ago
  I'm comparing to the best public healthcare system I'm personally familiar with (Germany) and saying: * Medical-school debt is not a thing here. * Prices are low. * I know doctors who can't make a sustainable income to keep their small practices open. Somewhat puzzlingly, for a handful of services, there can a medium length delay in getting an appointment because of how busy the doctors are. This is definitely all much better than the situation is in Canada, where the typical person struggled even to get a GP, and friends with cancer would be forced to wait a life-imperiling year to get a routine scan that be the difference between life and death.

patmorgan23 3y ago

This is a challenge. It would be unconstitutional to out right ban individuals from getting the benefits, but maybe a waiting period would be constitutional(i.e. must be a resident for 1 year to sign up).