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Yeah, and they all generally get there by paying practitioners much less than the US does (by integer multiples). Single-payer, which this working paper equates
by tptacek 2mo ago
Yeah, and they all generally get there by paying practitioners much less than the US does (by integer multiples). Single-payer, which this working paper equates with "universal coverage", is in fact not the norm among universal systems; besides using Medicare to ration the supply of practitioners, the original sin of our system is employer-based coverage, not payer structure.
Health care is an absolutely massive industry (everywhere, not just in the United States), and slashing compensation in a massive industry by top-down fiat is in fact not an especially easy thing to do.
- moregrist 2mo agoFunny how one of the arguments against Medicare in the 60s was that providers wouldn’t accept it. Turns out when you have the choice of accepting lower payment per patient for Medicare or having a lot fewer patients, you choose the lower payment per patient. I would expect the same situation here. Doctors would grumble, but no one would force them to accept patients on whatever “Medicare for all” would be called. Nothing other than market forces. A number of things would probably have to change, including the cost of medical school. But the system right now is expensive and essentially unsustainable. So change is inevitable.
- nradov 2mo agoNope. More and more providers are dropping out of Medicare, or imposing limits on the number of Medicare patients that they're willing to see. It's tough to sustain a financially viable medical practice on Medicare rates, especially for primary care in HCOL areas. Medicaid is even worse. There are a lot of patients who nominally have coverage but in practice are functionally uninsured because they can't find a local doctor to take them on.
- bigmadshoe 2mo agoWhy do doctors need to be paid integer multiples more in the US than every other country on earth? This is not rhetorical, I mean it sincerely. And I’m aware that medical debt is a big issue, but it seems like a chicken-or-the-egg type problem. Of course you can charge $500k for a medical degree when the doctor can make it back and then some in 5-10 years.
- tptacek 2mo agoThey don't! It's a huge problem! It's probably the problem in US health care, which, despite my own belief that single-payer is bad policy, is in fact a total shitshow.
- cwmoore 2mo agoI think there's also the gamified confusion of over how much goes to the physician versus how much goes to administrating orgs and liability coverage.
- tptacek 2mo agoWe have numbers for this, we don't need to derive them axiomatically. Practitioner compensation is the largest component of health provider spending. Liability coverage is the second largest component of admin spending, which is 25% of provider spending.
- cwmoore 2mo ago“We have numbers” is always refreshing, especially in a shell game. Cost of all licensed medical practitioners? Or overweighting incomes of outlier CEO physicians? 25% is a steep tax on health in any case.
- tptacek 2mo agoAt the point where you're just dismissing the CMS NHE, you're well into the terrain of unfalsifiability.
- cwmoore 2mo agoFair enough, but it is a political topic, and there are different and more confusing slices of the healthcare system exposed to patients than org spending breakdowns. Not sure how many of this thread's comments could hold water if falsification were universally applied.