You cite this as thought it is clearcut that a higher rate of screening is automatically a good thing. Amusingly, some scholars think mammograms, even if free, often do more harm than good! Here’s one of the first Google hits: “Mammography screening is harmful and should be abandoned.”
Medicare currently operates on an 80/20 split. Are you comparing the cost of our current healthcare system (100% of healthcare expenses) with only a fraction of the cost of a future healthcare system (80% of future healthcare expenses)?
The study cited appears to assume about 80% coverage, from page 11: “The plan does not charge premiums but has a sliding-scale cost-sharing schedule based upon income (the same schedule used for simulations 1 through 5 and shown in table 2, column 5). The base actuarial value for the plan is80 percent, with people with incomes below 400 percent of FPL eligible for higher actuarial value coverage, consistent with the schedule described above.”
They did estimate the cost with 100% coverage, at $4+ tn.
~Max
Out of order, the current recommendation is to have the annual mammogram after 50, sometimes as early as 40 if there is a history of breast cancer, biannual after 55. There is a risk of a false positive so I think they follow up with additional tests, and sometimes a biopsy. My cite is me, waiting on hold to schedule patients for radiology… also the ACS. As far as I can tell, the paper you have cited represents a minority view.
~Max
I had to wait a month to see a specialist and I had cancer. During that month, the cancer spread. Instead of one somewhat minor surgery, I had to have the minor surgery, 9 weeks of chemo, and major surgery that had some side effects that will be with me the rest of my life.
The reason for that delay? Insurance company wouldn’t approve the referral because it did not come from my primary care manager. She was out of the country on vacation.
Well, plus supplemental insurance in many cases. And the reason for not being a meltdown is that the losses doctors incur are covered by higher costs to other patients.
So it’s not so much a matter of Medicare melting down, as Medicare for All melting down.
Regards,
Shodan
So when Americans talk about some sort of single payer system, they always speak of it as if it were some sort of crazy untried radical idea that could never work. Except that literally every other rich country in the world does better than us. Technically not all are single payer, but even the ones that aren’t are so highly regulated as to be a lot closer to single payer than our system.
Go out and interact with those people. Tell them the differences between systems. Ask anyone if they’d prefer ours. Almost universally, they would not. In my decades on the internet, I’ve interacted with hundreds of foreigners who think our system is a horror show, and I’m not sure I’ve ever interacted with one who was jealous of it.
And it’s cheaper! They pay less, and yet everyone is covered. And they never have to worry about their insurance companies denying treatment and hoping they’ll die before they can force their insurance company to pay what it’s supposed to. They have a literal fucking profit motive to deny you treatment so that you die and don’t need treatment anymore, and we think that’s normal and okay. Insanity.
This “how are we going to pay for it” argument is a sham. Every country pays less than we do in terms of GDP. People freak out and say “OMG it would cost 3 trillion a year! How could we afford that!” - by paying LESS than the ~4 trillion we currently pay per year. There are insane people in the US who’d rather pay $1000 out of their own pockets to an insurance company than pay $1 more in taxes, and somehow they dominate the discussion. Single payer would reduce the cost burden on most individuals while simultaneously pulling us out of the “you got sick? you’re fucked” lottery. Hundreds of thousands of medical bankruptcies are filed in the US every year, and the majority of those are from people who have insurance.
Administration costs in the US are around 35%. 35% of our medical spending goes to doctors paying an army of people to argue with insurance companies so they get paid what they’re owed, while the insurance companies hire their own army of people to try to get out of paying what they’re owed. More than a third of the money we spend on medical care goes into propping up this incredibly inefficient system, not to actual medical treatment. In other countries, administrative cost is under 10%. And if you think that’s somehow impossible in America, social security administration costs are about 1.3%. Now, obviously, SS is easier to administrate than a medical system, but the American Exceptionalism For Incompetence myth, that the US is somehow uniquely unable to implement things that every other rich country in the world does, is bullshit.
We already pay, publically, for the highest cost patients, through medicaid, medicare, and reimbursement for write off care, leaving the least problematic and most profitable demographics in our health care system to be exploited for profit by the insurance companies. Our current system is the worst of all worlds. Everywhere else in the developed world would laugh off the idea of adopting any of our system, and would be absolutely horrified to have to implement it.
This isn’t some crazy new idea. Every other developed country in the world does it better than we do. That we cling to a horrifying system that burdens and murders people in the name of profit is a horror show propped up only by ignorance of the rest of the world and some weird pride in the idea that American exceptionalism also means we’re somehow exceptionally unable to do what the rest of the developed world can do.
Increase. More people getting more medical care due to effective and universal health coverage means more medical expenses. Sure, having one payer cuts overhead, but not by all that much. Most of our overhead is complying with CMS regulations and dealing with things Medicare doesn’t cover - like prescription medications or home health services - presumably none of that is going away under a single-payer system.
Actually billing different private insurers isn’t a big deal, especially with computers. We’re talking about a single-digit percentage overhead here. But most of our patients are on Medicare, my view might be biased.
Those weren’t talking points, it was a pro-con analysis. Costs in one area, savings in another. I don’t have numbers though, so I don’t know how to weigh the two.
I don’t know anything about the breakdown of expenses for drug companies. Even if I take what you say as fact, I don’t see how that’s connected to my concerns. If the insurance industry is replaced with a single entity, I would expect to see consolidation in the prescription drug industry so both sides are on more equal footing when it comes to reimbursement rate negotiations. Consolidation means less competition means less innovation, at least under the traditional theory of capitalism.
Are you saying doctors will have carte blanche to decide what treatment the government will pay for? I thought it would be some committee, a la CMS coverage determinations.
~Max
In all the discussion here that I’ve read, in the countries where they have somehow miraculous did something that you think is impossible, the doctors decide what treatment is medically necessary and then it gets paid for. I don’t remember reading anything about committees.
No, the savings from cutting out insurance companies and billing staff are already counted. Those savings are not going to the doctors, they are being used to reduce the cost of single-payer.
~Max
It seems to me that the profit motive to deny coverage is very different from the profit motive to provide actual medical care. I think you mixed the two up, and unfortunately that means I can’t understand your argument.
~Max
I mean the profit motive for the entire industry – if hospitals lose money by treating certain kinds of patients, then they have an incentive to refrain from treating those kinds of patients. Same goes for insurance companies. And it goes the other way too, at least for hospitals – if certain treatments are very, very profitable for hospitals, then they have an incentive to do those treatments over and over again, even if they aren’t needed.
Some patients just won’t be profitable for insurance companies (if they cost lots of money to treat), or even for hospitals (if they don’t have good insurance and can’t pay for needed treatment). Because this profit motive exists. Take out the profit motive and you don’t have to worry about these incentives that directly conflict with the Hippocratic oath (and the entire purpose of health care) any more. There’s no profit motive for firefighting – but there still is a profit motive for inventing new technology that would aid firefighting, because the inventor could still get patents, royalties, etc. So health care could and should be more like firefighting. No profit motive for actual treatment of illness and injury, but retaining the profit motive for innovation in technology and pharma that aids treatment.
- Wait times do
- No idea
- Maybe? There’s a lot of consolidation as it is, but I have no idea about trends in R&D.
- Probably not; of course
~Max
I don’t think fee-for-service is fundamental, but I was also under the impression that single-payer proposals retain the fee-for-service model.
~Max
You have the option of going off the employer health insurance and paying for individual insurance, in which case your employer stops deducting the premium from payroll. But it is more expensive since the employer isn’t contributing, either.
~Max
That was before my time, geezer. 
Anyways, thanks, Obama.
~Max
Preventative care does save money, or are you going to argue with that old proverb, a stitch in time saves nine? It’s just that universal health coverage loses money faster, in the short term.
Also, your cites were in the other thread.
~Max
My insurance is through the employer. I didn’t have a choice about what plan they offer, but I did have the choice of taking it.
~Max
Policy… goals? I mean, we can all agree that more people getting medically necessary healthcare is a good thing, right? But I’m not going to support a program that isn’t sustainable.
I think… that’s about it.
~Max
This is a problem with Medicare advantage programs, too. Is it safe to assume that such practices will be absent from a single-payer healthcare model?
~Max
Do you think that the current health care system in the US is sustainable? We already have the most expensive care, by far, and our year over year increase is a higher rate than most other countries.