I’m just sore at the same system that you are trapped in … and I’m sore that doctors are a power/wealth position (often) and still are trapped like the rest of us.
I’m sorry if that came off too sharp.
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This I understand. And yes, I am aware i have significant privileges, don’t have to worry about feeding and housing my family, etc. Worth keeping in mind that most of us now are employees, and our employers enjoy a rather significant degree of control over our practices. If I don’t see X number of patients and generate $Y per quarter, my employment status can come into question fairly rapidly. Again, the system is busted and will collapse under its own weight if something is not done. Just keeping the status quo is not a viable option.
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It’s important to remember that the US system costs more public dollars per capita than Canada’s system, not just private dollars. If we had a magic wand to implement Canadian healthcare in the US not only would everyone keep every single dollar they are spending on healthcare currently, but also the governments would save $200B a year. People ask how to pay for single payer healthcare, there’s just no reality-based reason to think it’s not cheaper.
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I mean, I’d argue there is a perfectly rational argument against it.
The healthcare provider lobby is ridiculously powerful and will never allow Congress to lower its revenue. After all, Medicare right now is more than large enough to command reimbursement rates as low as Canada’s. The only thing that has stopped it is Congress.
A perfect example of that power is the “doc fix” that was passed every year for a decade. What the doc fix really did was prevent a cost-control system in Medicare from ever lowering reimbursement rates, so even during recessions, rates went up.
Heck, states used to have price controls for hospitals in the 70s. The healthcare lobby not only got them eliminated in the 70s and 80s, but got patients to argue on their behalf by telling them their local hospital might close or not be able to get a new x-ray machine.
Single payer only lowers costs to Canada’s level by lowering spending on care itself. Dropping administrative overhead and pharmaceuticals will help (assuming Congress wouldn’t fold to the phara lobby), but ultimately we need all the cost control mechanisms that sane developed countries have - choosing cost efficient care options over more expensive ones with similar efficacy, limiting unnecessary medicine and lowering reimbursements.
Of course, if one could remove Congress’ ability to interfere with cost control measures or the healthcare lobby from spending billions to corrupt Congress, then that argument goes away.
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If you accept that the government is too corrupt to take on rich lobby groups as a starting point then the whole discussion is pointless because they will never take on the insurance lobby that would be even more opposed than the healthcare provider lobby. To get from here to there we have to assume that a government decides to do something in the best interests of the country. Once you’ve assumed that, I stand by my claim that it will be cheaper.
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Actually it is more that I assume that some future Congress will be too weak to stand up to the healthcare lobby. A single Congress I believe could pass something.
There are models from countries that would work even if a future Congress is weak.
France’s comes to mind. They have public and private insurance. Public insurance is run by quasi-government organizations (think: the Fed) so they have a bit more autonomy than Medicare does here. They cover a percentage of bills scaled by someone’s income (for poor or severely sick, it covers 100%). Private insurance covers the remainder.
What’s interesting about it though is that reimbursement rates are negotiated together every year with private and public insurers sitting on one side and healthcare providers on the other so there is one rate. Since private insurers have to pay a percentage of the negotiated rate, they fight to negotiate lower rates keeping the public side from bowing to pressure.
The private insurance industry essentially acts like a force to counter the healthcare providers. They don’t have the power to deny coverage to people as public insurance decides that, so they push for more efficient healthcare and healthier people instead.
I don’t see how relying on the private insurers would keep costs down. The current state of costs in the US is because of the private insurers. Getting private insurers to negotiate the price of healthcare is sort of like asking your fire insurance company to negotiate the price of your house. Insurance companies make more money the larger that asset that they insure. It is in the interest of private insurers that healthcare costs as much as possible so that they can justify higher premiums.
Obviously that breaks down when there is an adequate public option because people can bow out of private insurance if the premiums get too high. But it is the public option that reins in the price of private insurance, not the other way around, unless the government starts thinking of the public option as a revenue stream.
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It is in the interest of private insurers to have the lowest premium possible to attract more customers. The idea that insurers try to get healthcare providers to charge them more to justify higher premiums is nonsense. That’s like arguing Walmart tries to get vendors to charge it more so it can justify raising store prices.
A quarter of Americans get insurance through a nonprofit insurer for goodness sake. What possible justification would say, the Blues, have to go along with such a scheme?
Insuring thing is not the same business as selling goods. Insurers make more money the more valuable the thing they insure is. Insurers who insure homes make more money when homes go up in value. Insurers who insure art make more money when art goes up in value. In my example of a society where people couldn’t negotiate their own home prices but instead had to rely on fire insurers to do it for them, do you think that would result in lower home prices because the insurers would want people to get the best price? Doesn’t it seem like even rudimentary self-interested behaviour would converge on a strategy indistinguishable from collusion between the insurers and the home builders?
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This part is not evenly distributed or reported on. Large mega hospital systems that are near monopoly in geographic areas are charging more and making profits, they’re also what gets reported on most. This is simply consolidation and reduction of competition, like any other market would face.
All the smaller hospitals, the community hospitals that were gobbled up by the mega hospital corporation are a different story. Part of the reason it happened is that those hospitals have a very hard time making money, which makes them vulnerable to takeover. When you see stories about this type of hospital, it’s inevitably one of these items “being taken over by the mega hospital”, “losing money and shutting down”, or “disappearing from the landscape”.
There are far less independent community hospitals left. Either gone completely, or become part of a mega hospital group. If you’re near a city, this means higher costs as there are less regional hospitals, all owed by the same company. If you’re in a rural area, this means the nearest hospital is probably a regional one a long distance away. The local community one, didn’t make enough money to survive and is simply gone, never to show up in the news again.
I feel like I’m having the same conversation in multiple threads (I guess because talk of healthcare and the economy all converge on the same central issue). You’ve got a massively unequal economy, so I’ve person can afford to spend $1M to save their life and another can’t afford $5k. Then the cost of keeping a human alive is where the supply and demand curve cross. That leaves a massive number of people underwater, with a kind a life debt, as if they took out a mortgage they can’t pay in their health when they were born.
So the market says the world is better of with you dead than alive (not really, it’s more like you aren’t worth repairing if you break). Single payer is saying, “humans aren’t god damned commodities”.
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Agee, we should have saved the local community hospitals long ago.
Lots of stuff we do, at the local geographic level doesn’t make money on its own, but we do it anyway and subsidize the cost.
In the case of the local community hospital, while it might not have made money, it helped to keep people healthy and contributing to the community and economy. All good stuff. The loss of them makes living outside major regional areas harder, which creates other problems.
I’m confused. Stores also make more money the more they sell stuff for.
In no universe do car insurance companies try to pressure mechanics to charge them more because they need to justify themselves to consumers let alone health insurance companies trying to negotiate higher reimbursement rates with medical providers.
It makes no sense. They’d just inviting a competing insurer to steal all their customers by negotiating sanely and undercutting them on premiums.
Given every state in the US has a nonprofit insurer, often the dominant insurers in the state, what you’re suggesting would be corporate suicide for their for-profit competitors.
In my example of a society where people couldn’t negotiate their own home prices but instead had to rely on fire insurers to do it for them, do you think that would result in lower home prices because the insurers would want people to get the best price
If only a handful of companies competing with each other bought 99% of all properties on behalf of their clients? Absolutely. The only time they wouldn’t is if they were colluding to keep prices high illegally.
Competing and colluding aren’t very different. And when we’re talking about oligopolies we don’t even need fancy math. The fact that oligopolies effectively collude without explicitly colluding was covered in highschool economics and is as traditional a theory as you can get.
And we’re not talking about a handful of companies that set the price, pay it, and then are done. We’re talking about a handful of companies that set the price and then collect a percentage of that price every year. Insurance companies are the house in a casino, they don’t lose. It is in their interest to maximize the bet.
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