Atul Gawande on the importance of preventative care and the disastrous Senate "health" bill

boing
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Emphasis mine, because I keep hearing the rhetoric of “choice” from Americans opposed to universal health care. As in apparently my government system doesn’t give me any.

Really. Because if I don’t like Dr. X, I can go see Dr. Y or Dr. Z or Dr. Who-ever because all of them are covered. I don’t have to ask if they’re in my network, I don’t have to worry what _they’ll _ charge my insurance company… and I don’t have to worry about caps on that, either (on some of my supplemental insurance / extended medical, sure. But that’s things like massage therapy or glasses, not going to see a doctor because I broke my arm or got cancer). Oh, I guess they’re right… I do lose choice: I lose that choice between seeing the doctor for my thyroid, or a concussion, because I can do both without worrying that it’ll bankrupt me.

It sickens me looking at what’s going on in your country. I am genuinely scared about what is going to happen to people.

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A stitch in time saves nine.

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It’s been proposed.

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Because there would be no one left to cost shift to in order to cover the costs that Medicare doesn’t.

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And how is shifting the burden to the people least able to shoulder it a workable strategy?

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  1. While I wouldn’t go so far as to say that costs would plummet if everyone was covered under Medicare, it can be said with a fair amount of certainty that the rate at which the increase would be dramatically slowed, particularly if the Medicare administration has wide latitude to set prices and negotiate with drug companies and hospitals. We’ve seen this happen everywhere else that there’s a single payer market.

  2. Even in the highly unlikely case that 1 doesn’t happen, there are plenty of ways to raise funds to cover the costs of universal Medicare. Some of them are called “taxes”. Some of them could be referred to as “bonds”. It sure beats the current system of prayers, charity and gofundme’s for individual cases.

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On your point 1, you would see the kinds of large savings that come from standards-based efficiencies and negotiating power. For example, a doctor with a busy practice who doesn’t have to keep two full-time medical billing specialists on staff to negotiate fifty cents on the dollar for every claim with half a dozen insurance companies is saving $60-80k per year and also would spend less time focusing on her business’s cash flow and more time on practising medicine.

Most Libertarians, though, either can’t or won’t understand those kinds of basic business and finance issues.

Perhaps he favours a Malthusian solution, as in this famous fictional exchange:

“Many can’t go there; and many would rather die.”

“If they would rather die,” said Scrooge, “they had better do it, and decrease the surplus population.”

Say what you will about the Senate bill, denying benefits to tens of millions of people, including those with pre-existing conditions, is an effective means toward that end.

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Despite having every appearance of being a free-market worshipper, you sure do have a fixed notion of ‘cost’.

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