How is universal care going to reduce the shortage of primary care doctors?
How is universal care going to eliminate patents for pharma?
How is universal care going to make non-profit hospitals cheaper?
How is universal care going to eliminate fee-for-service, which has the administrative costs that are the woes of care providers?
How is universal care going to reduce healthcare spending?
Medicare is justs as opaque, and also distortive: Medicare costs 11k a year, but retirees pay less than half its cost as it is.
The main reason pricing is opaque is because patients dont have freedom to compare between insurance companies, and because insurance companies are not a good model for frequent care. If you had High-deductible plans, you would make a much better system but people hate those plans.
You need a big change in popular sentiment to make pricing work well. (i am all for HDPs)
With a high deductible plan they still will give you no estimate or something like "between 1000 and 200000 dollar". All actual prices that got paid need to be published.
Transparency is kind of irrelevant, if I'm bleeding out unconscious somewhere in the street, I'm in no position to make hospitals compete for my business. This isn't buying a new cell phone, these are peoples' lives.
Transparency is important to choose any service and care is one of them. The vast majority of healthcare services are not urgent. There's a case for price insensitivity for emergency care, but that is also resolved by choosing insurance before hand: the same way there is price sensitivity to life insurance.
A bigger problem to me than transparency is distortion: the value of the service being public means little if the patient is not paying for it. A patient that has 20% co-insurance or 20$ copay have completely different price sensititivities. They are also price-insensitive when they select insurance because they get it through the employer that picked it and payed it for them.
As a patient, the price tag on a service is relevant to you depending on insurance: validating insurance is much more important than seeing the price.
A socialized medicine scheme will have the same problem: if a patient is shielded from the actual cost of the visit, then he is more likely to use it and thus over-use it.
Complex dermatology assessment in Ontario (A020)? $49.95CAD
I visited family in Canada and went in without insurance for a small hour-long outpatient procedure. Nothing major. They billed me $90CAD ($67USD) -- and were incredibly apologetic they charged me in the first place.
>>> A socialized medicine scheme will have the same problem: if a patient is shielded from the actual cost of the visit, then he is more likely to use it and thus over-use it.
That's the most patently absurd argument proponents of the current model utilize. This isn't some ice cream shop. Nobody goes to the doctor and demands one of each with sprinkles. If I told you all your healthcare was free what on earth would you get done?! Are you planning on shattering your femur just to maximize the value you draw from the system? If the answer is some legitimate healthcare procedure, go with God, you have my full support. If not, I'd imagine this is similar to the "5 million illegals voted last time" -- did you see one? nope! But I know in my gut they're there. Feel free to cite me some studies though.
Especially as under socialized systems medically unnecessary treatments such as purely cosmetic plastic surgeries aren't covered, for exactly this reason. This risk is further limited because most socialized systems use a Kaiser-type model where a primary care physician refers you to a specialist. Self-referring to a specialist is a very private medicine thing -- you're not a doctor, you've got no medical training, you have no idea whether you should be using the valuable time of a specialist -- let alone which one, so we defer that decision to someone who is: your GP or primary care physician. More waste reduction, cost reduction, efficiency improvement.
This horse has been beaten so long its basically a horseburger now; these are very much solved problems. By all means, have at those windmills though.
Most Americans can’t afford $500 in case of an emergency, which is why high deductible plans are a non starter to provide coverage. For them a $5000 deductible is as good as not being covered in the first place.
Health insurance costs 800$ a month so not having 500$ means you dont have insurance. Thats another level of poverty, for the which there is medicaid and a different set of programs and way to deal with those cases.
That's not true. First of all $800/month is what you'd expect to pay if you were young and healthy and with moderate deductibles. Good luck being older or sicker. The $500 that I'm referring to is $500 beyond what they budgeted for after their monthly expenditures. No, Medicaid doesn't always apply to these people, you should look into it. It also requires extreme levels of financial hardship. Medicaid takes a lien against your house to recover their costs. Not to mention the donut hole for whom having their house taken isn't even an option. It's brutal.
When I said most of America, I meant it. It's fifty seven percent of America. [1] Are you going to put them all on Medicaid and take their houses? I thought you were arguing for private cover :) This is the kind of thinking that pushes up costs. Creating barriers to seeking care early makes everything more expensive as the longer you wait, the more it costs to resolve.
Let's be rational about this. The US median individual income is $39,336. [2] Your take-home pay would be approximately $2614 per month after tax assuming you save nothing toward your retirement. Taking out $800 leaves you with $1814. The US median rent is $1500 per month [3]. This leaves you with $314 for food, gas, transportation, electric, water and sewer combined. And this is the best possible case: you're single. Then you want them to handle a $5000 deductible?!
It doesnt change the math to charge 5000U$S in advance through a payroll tax, than to have a 5000U$S deductible afterwards. The key metric is if the healthcare services are better utilized and are cheaper.
Sorry, would you require everyone get a raise in the amount of their health insurance benefits? Sounds like interventionist overreach into the free market to me. Remember how the 2017 tax windfall for companies would yield huge raises for everyone, but instead, only lead to stock repurchases? What makes you think this would be any different?
Since you also suggested in a different thread that it'd no longer be tax deductible, that $5000 would drop immediately to $3000 or less -- $250/mth. That's still dancing on a razor's edge.
Your key metric of "cheaper" and "more available" and "better utilized" is provably solved with a socialized model. There's no active private care model that outperforms one of the OECD socialized models, or else you'd have at least mentioned it by now. Instead, we keep revisiting unsubstantiated ideological libertarian talking points. I've got real world implementations to support my theories.
(1) How is universal care going to reduce the shortage of primary care doctors?
I don't know enough about the reason for the shortage of doctors but I'd go out on a limb and say its probably not because they don't get paid enough.
(2) How is universal care going to eliminate patents for pharma?
It won't, and it shouldn't. Patents for pharma don't preclude successful implementations of universal healthcare anywhere else. There's a perception that in Canada "drugs are cheap" -- prescription drugs administered outside of hospitals largely aren't covered by OHIP. Provinces act as bulk buying groups and negotiate prices with pharma companies. You want to partake in the market, great, let's figure something out. It works surprisingly well. Patents are your temporary monopoly on creating an invention in exchange for sharing it with the world.
(3) How is universal care going to make non-profit hospitals cheaper?
By regulating fees for services, by lowering the price of drugs via negotiation and bulk purchase agreements, by eliminating marketing budgets, by eliminating insurance billing departments and by capping executive compensation. Hospitals and doctors are public servants elsewhere in the world, not elite rockstars who can bill as they so choose. That doesn't mean they're not well compensated.
Oh, and by socializing malpractice insurance. In the US high-cost states OBGYNs pay $85-200K/yr just in medical malpractice insurance. [1] In Ontario it's around $70K CAD.
(4) How is universal care going to eliminate fee-for-service, which has the administrative costs that are the woes of care providers?
By having a single table of rates that apply to everyone. Ideally with a single payer. This makes billing much, much easier.
(5) How is universal care going to reduce healthcare spending?
Everything I indicated above put together. If you want a concrete example Medicare does most of the above (they can't negotiate drug prices, and they're not single payer, and they haven't socialized malpractice insurance) but they're substantially more efficient. Medicare spends 2-5% of the budget on administrative, where private plans spend 12-18%. That's without recognizing some of the other savings I pointed out. [2]
Further to (2) by affording preventative care to everyone, people in the early stages of serious diseases can obtain preventative care and coverage thereby eliminating expensive treatments later on. In the US if you walk into a hospital near death they're required to look after you -- not so much if you walk in seeking preventative care. Imagine if they spent the $5 early on to treat you instead of the tens of thousands when you're near death? It's yet another reason why universal healthcare is a good, cheaper thing to have.
Since you specifically wanted me to answer about this topic: Preventative care has some nuance. Increased preventative services are not necessarily better, there is an actual ongoing debate about annual physicals in the medical community (http://time.com/5095920/annual-physical-exam/)
From an economic perspective, its not clear pushing for preventative will lower cost or increase quality. (many times it even has negative value, as reassuring a patient of being healthy when they aren't).
Fundamentally, if preventative cares are good people will naturally choose to invest in their own health. There is research showing that people are pretty good about healthcare utilization if they bear the cost (except poor peoeple)
You're absolutely right about that. Also with regards to increased frequency of tests; finding the inflection point between where the risk and adverse effects of false-positive tests out-weight the benefits of early detection. Point taken.
> I don't know enough about the reason for the shortage of doctors but I'd go out on a limb and say its probably not because they don't get paid enough.
So not cheaper.
> It won't, and it shouldn't. Patents for pharma don't preclude successful implementations of universal healthcare anywhere else.
So not cheaper.
> By regulating fees for services, by lowering the price of drugs via negotiation and bulk purchase agreements, by eliminating marketing budgets, by eliminating insurance billing departments and by capping executive compensation. Hospitals and doctors are public servants elsewhere in the world, not elite rockstars who can bill as they so choose. That doesn't mean they're not well compensated.
Rationing. (It makes it cheaper, but also reduces the amount of care given out). Shutting down hospitals is probably not the way to go on the space, but its one way to reduce spending.
> By having a single table of rates that apply to everyone. Ideally with a single payer. This makes billing much, much easier.
Also rationing. If you have a single table of rates, you can get 3 results: you pay less than today, and thus you will have rationing of services (for example, less convenient locations, less services, etc), you pay the same (so no gain) or you pay more (more spending). Billing is a big pain, but billing medicare is the biggest pain of all. Medicare pays less and has more admin costs for providers, which is a big part of why its not covered.
Its virtually impossible in the US to force doctors into single rates, so what you would get is that insurance has very low coverage, and cash-pay will dominate healthcare services.
> Everything I indicated above put together. If you want a concrete example Medicare does most of the above (they can't negotiate drug prices, and they're not single payer, and they haven't socialized malpractice insurance) but they're substantially more efficient. Medicare spends 2-5% of the budget on administrative, where private plans spend 12-18%. That's without recognizing some of the other savings I pointed out. [2]
Medicare uses these statistics with great trickery. First of all, medicare does not do collections administration: its hidden in other government agencies that collect the payroll tax. Second of all, these statistics have some other biases like using total cost of spending but not per patient, where medicare is actually not that much ahead. And finally but not least, what people will always love about medicare is that its dirt cheap to the patient: the average social security benefit is 1400~, and the standard premium of medicare is 135. But turns out that medicare costs about 11k a year per patient: if you took away 1000 out of those 400, you would not find great support for medicare from retired people!
Finally but not least, medicare services have severe rationining elements, and potentially cost shifting: doctors make 1/2 with medicare than without. This means that: doctors that offer medicare are the ones starving for patients, and doctors that take a bit of medicare are actually putting some of the cost unto regular insurances.
You can forcefully restate your opinions all day long, but facts are facts. The first world countries that offer socialized medicine do strictly better than the US on basically every metric. Pick one. Access to treatment? Better. Infant mortality? Better. Mothers mortality? Better. Life expectancy? Better (the US used to be 1 year above average, it's now 2 years below, and falling). Bankruptcies due to medical bills? Better. They’re also cheaper. Your opinions do not line up with reality.
America’s at the bottom of the OECD for many of these things, and at the top by a country mile for cost. [1]
There's no medicare statistics trickery lol, all those government services being leveraged have to do almost nothing incrementally to support medical fees. They're still collecting payroll taxes, they're still collecting income taxes, one way or the other. By your own measure this makes the work they do duplicative of the insurance industry making the insurance industry the wasteful one. This is also failing to take into account the waste of employers managing employee healthcare -- why on earth are they doing that?
OF COURSE medicare is expensive we already addressed that in another thread. The US doesn't have free market healthcare. The young, healthy and cheap are forced into expensive market plans, privatizing the gains, while the old, sick and poor are handed off to the government to look after, socializing the losses. It's absurd. The young, healthy and wealthy should be paying for the old, sick and poor. You can’t saddle the socialized program with all the worst customers, hamstring it’s ability to negotiate drug prices then point to how much it costs.
Doctors in Canada make hundreds of thousands of dollars per year providing socialized cover. They're civil servants. They do fine. So what if it's less than doctors are paid now, the question is are they compensated fairly, and they are.
Last I couldn’t help but notice you totally sidestepped my point about reduced costs by offering preventative care.
> You can forcefully restate your opinions all day long, but facts are facts. The first world countries that offer socialized medicine do strictly better than the US on basically every metric. Pick one. Access to treatment? Better. Infant mortality? Better. Mothers mortality? Better. Life expectancy? Better (the US used to be 1 year above average, it's now 2 years below, and falling). Bankruptcies due to medical bills? Better. They’re also cheaper. Your opinions do not line up with reality.
Why doesn't medicare, the already socialized medicine of the US, have the same results as socialized medicine in other countries?
> There's no medicare statistics trickery lol, all those government services being leveraged have to do almost nothing incrementally to support medical fees
You could also use payroll taxes to pay private insurance, that's not a benefit of medicare, it's a benefit of the current tax implementation that is granted monopolistically to medicare. I know of at least one country that collects payroll taxes that go to private health companies.
The question is: is medicare administration truly cheaper that private administration for the same service.
> This is also failing to take into account the waste of employers managing employee healthcare -- why on earth are they doing that?
Because the federal government makes it tax exempt to give healthcare through the employer, which is a 260 billion a year regressive tax benefit, denounced and criticized decades ago by prominent economists. You dont need to socialize medicine to stop that, you just need to stop handing out federal money. In fact, the tax-subsidy is higher than the combined profits of all insurance companies together.
> The US doesn't have free market healthcare.
Glad we agree on that one!
> The young, healthy and cheap are forced into expensive market plans, privatizing the gains, while the old, sick and poor are handed off to the government to look after, socializing the losses. It's absurd.
The poor also pay medicare taxes for the rich. The sick that don't make it to retirement ages pay medicare tax their entire life and die before receiving any benefit. Taxes always have this thing that they make things unfair for someone by law.
Adverse selection and information asymmetry are real issues, but socialized medicine brings other issues like reduced coverage, rationing, etc. I am always surprised how the debate over healthcare ends up being arguing about capitalism as a method of efficient economic organization. It works for almost everything else, yet the arguments for socialized medicine are like arguing capitalism doesn't work. Its bonkers, and easy to refute because otherwise you would have to argue the same for food, for education, for transport, for everything, and none of those work better run by the government.
> ...Doctors in Canada make hundreds of thousands of dollars per year
To make doctors in the US root for socialized medicine, the state will have to offer greatly increased income. Thats how it happened historically in europe a century ago. Considering the AMA has killed socialized medicine laws multiple times in history, I would say the "screw the doctors" policy has a high chance of failure.
>>> Why doesn't medicare, the already socialized medicine of the US, have the same results as socialized medicine in other countries?
Again, we addressed this. It's literally all the old, sick and dying in a single pool allowing private insurers to be profitable. It's not comparable. It's like asking why a government-run fire insurance program that takes in only buildings that are already on fire is expensive. They only insure buildings already on fire against fire damage and they're not allowed to negotiate the price of water used to put the fires out. That's not how risk pooling works. It's not insurance, it's just a structured payouts program for the country's worst customers.
>>> You could also use payroll taxes to pay private insurance, that's not a benefit of medicare, it's a benefit of the current tax implementation that is granted monopolistically to medicare. I know of at least one country that collects payroll taxes that go to private health companies. The question is: is medicare administration truly cheaper that private administration for the same service.
Now the government is being leveraged to further enrich private industry instead of the people. The incremental cost is almost nothing. The only distortion of statistics here is that the private insurers don't have to deal with bad customers because they get socialized away (poor to Medicaid, old and sick to Medicare). I'm pretty sure you're thinking of Switzerland, which is the second-most expensive country in the OECD (they still manage to cover everyone, though).
And yes, it's cheaper, every other country shows that. Even the "$32T" cost estimate of medicare for all is actually lower than what's being spent today over the same time period.
>>> Because the federal government makes it tax exempt to give healthcare through the employer, which is a 260 billion a year regressive tax benefit, denounced and criticized decades ago by prominent economists. You dont need to socialize medicine to stop that, you just need to stop handing out federal money. In fact, the tax-subsidy is higher than the combined profits of all insurance companies together.
Yes I agree, it's regressive and should be removed. Socializing cover is good for other reasons as stated above.
>>> Glad we agree on that one!
Definitely :)
>>> The poor also pay medicare taxes for the rich. The sick that don't make it to retirement ages pay medicare tax their entire life and die before receiving any benefit. Taxes always have this thing that they make things unfair for someone by law.
Yep, that's not ideal. It should be charged progressively like it is in other countries.
>>> Adverse selection and information asymmetry are real issues, but socialized medicine brings other issues like reduced coverage, rationing, etc.
It doesn't, though. Rationing is fine. There's either not enough to go around or you make the pool bigger, both are options. It's explicit, it's done fairly and it's done impartially. Rationing by making care too expensive is cold and unfair. I'm also unclear on why you think there's a finite pool of medical care.
Either way your argument holds no water when every other program in the OECD is socialized, cheaper, and performs better on every metric.
>>> To make doctors in the US root for socialized medicine, the state will have to offer greatly increased income. Thats how it happened historically in europe a century ago. Considering the AMA has killed socialized medicine laws multiple times in history, I would say the "screw the doctors" policy has a high chance of failure.
Doctors in Canada hated the idea of socialized medicine in the 1970s too. You won't find a single one speaking out against it today. It was a huge fight. And yet, the entire country loves their system. Everyone in America hates theirs. There's something to this. Take a deep breath, it'll be okay. 60-75% of Americans are now interested in a public plan [2].
Tommy Douglas who championed socialized medicine in Canada was in 2004 named the greatest Canadian haha. [1]
FWIW, a socialized option does not preclude private care. Single payer isn't the only way forward, many European countries offer two-tier care. Australia offers two-tier care. If you're so sure that private care is less expensive, better and more efficient, why not allow it to compete with a government run plan? I speculate that it's because it's just not.
Sorry, man, you're on the wrong side of this one. The evidence shows it.
