Well if you find out how, I will be happy to read about it. I understand removing the profit motive to deny services, though.
~Max
Medicare Advantage was a Republican giveaway to the insurance companies. I looked at them when I went on Medicare, and none of the available plans covered my doctors. Plus, I had to worry about how much I was covered when going to visit my kids in other parts of the country.
They don’t really fit with MFA unless they were forced to pay for treatment anywhere.
I doubt an expensive and inaccurate test for a rare disease would be medically appropriate for general screening purposes, though. But something like breast cancer isn’t super rare, as far as diseases go. I think the statistic is one in eight women will develop breast cancer. Sort of like prostate cancer for men, we get those icky prostate exams, women have to deal with mamograms. The cost isn’t prohibitively expensive either, it should be under $200 (depending on region). I think prostate exams are under $100. If you need biopsies of either the breast or prostate, that is where things go into multiple thousands of dollars, and those have a nasty false positive rate.
~Max
I’m talking fee schedules. If the doctor charges $200 for a visit today, then presumably with single payer that rate is going down since a doctor will only have to bill for one insurance now, which reduces the doctor’s overhead, so the insurance doesn’t need to factor as much overhead into the allowable fee; ergo, the average doctor fires the billing staff and comes out the same as before single-payer.
~Max
Which would be fine. The concern I thought was that using Medicare pricing would make the doctor come out worse. As you said, the fee could go down and the doctor be just as profitable. Which is what we want.
To reply to the question about how much profit motive there is in the Canadian system:
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None in the funding system;
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Little in the hospital system;
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Plenty in the medical clinics.
Here’s what I mean.
- The single-payer is a government service. The government Medicare* agency in each province is allocated a budget, just like other government agencies, based on the government’s projections for health spending. That agency negotiates a complex fee-for-service agreement with the doctors in that province. During the term of the agreement, doctors bill according to that agreement and the Medicare service pays them. The Medicare system does not have a profit motive, just like police services, fire services and public schools don’t have a profit motive. There is no incentive to deny payment to save money.
- there’s no single health funding agency for the whole country. Each province and territory has its own funding system, and they all use a different name, but we’ll call it Medicare for the purposes of discussion. But, it’s not a federal payer, like the VA in the States.
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Hospitals are a mixture of publicly owned and operated; charitable non-profits; and the occasional private hospital. The publicly owned and the charitable ones don’t have a profit motive. The publicly owned ones are like other government services that don’t have a profit base, while the charitable ones have to comply with income tax laws that prevent them from turning a profit, or building up large retained earnings. The occasional private ones are an outlier. They do operate for profit, but are generally a pretty small piece of the pie. They tend to be highly specialized, like the one in Ontario that does nothing but hernia surgeries, and only for hernias in a particular range of medical risk. They get paid the same amounts from the Medicare funding agency as the publicly owned and the charitable ones. (One of your senators came to the Ontario hospital to have his hernia fixed, it f I remember correctly.)
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Je te clinics are privately run for a profit, by the individual doctors. They buy or rent the building, hire all their staff, and run it at a profit, being paid fee-for-service.
This arrangement is consistent with the findings of health care economists, which is a highly specialized field of economics. They have found that the usual rules of the market don’t work with the funding systems for health care, for reasons mentioned in this thread. The goal of insurance companies is to maximize profits, and one way to do that is to reduce coverage for expensive cases. Insurance companies’ profitability also goes up the larger the reserved funds they have to invest, which again counts against actually paying for treatment. Maximizing premiums, minimizing payments, is a clear road to profit.
That doesn’t happen when funding is provided by the government, as a public service, for the purpose of paying for health care. The purpose isn’t to make a profit, but to ensure people get health care.
At the second level, hospitals, the same analysis applies. Hospitals are so big and so costly that the profit motive is a distortion in the social goal of ensuring health care. Private hospitals can’t provide the same level of service while being paid the same rates as public hospitals and also needing to make a profit. That’s why only a few highly specialized private hospitals can make a go of it.
Service delivery - here, market rules work well to encourage service delivery by doctors. If there’s an area in a city that doesn’t have a clinic, that’s an opportunity for some young doctors to set up a clinic to meet a need. If there’s no clinics in town that are open late on weeknights, or at all on weekends, that’s a market opportunity for some clinic doctors to extend their hours and meet that need.
And, most crucially, the profit motive at service delivery means that the patient has choice in their doctor. You’re not assigned a doctor by the health agency. You choose your doctor based on word of mouth, location, reputation; just like any other professional service. You don’t like your doctor or the clinic hours, you go to another clinic. And if your GP needs to refer you to a specialist, the GP says something like «There’s three specialists in this city who provide this procedure. Who do you want me to refer you to?»
Now, there’s access issues. Small towns, rural areas, the north, the interior, those areas have trouble attracting doctors - because doctors are free to locate as they see fit, and they’ll make more money and generally prefer the lifestyle of larger centres. But that’s not caused by single-payer. It’s just like other professional services, like lawyers and accountants, who tend to settle inlarger centres for the same profit and lifestyle options as motivated the doctors.
I don’t think so. Take something simple like an MRI. The US had 37.56 units per million people in 2017. Canada had 9.97. The UK had 7 in 2014 so lets round that up to 8 per million.
She had surgery over the weekend? I don’t think so. Feel free to cite that. Again, in the space of 2 weeks I saw my gp twice to change pain meds, a hospital visit with xray/MRI and a consultation with a surgeon who operated the same day as the office visit.
I just jumped on theNHS website and this is the first thing that popped up:
Essential parts of the NHS in England are experiencing the worst performance against waiting times targets since the targets were set. This includes the highest proportion of people waiting more than four hours in A&E departments since 2004, and the highest proportion of people waiting over 18 weeks for non-urgent (but essential) hospital treatment since 2008.
The target for treating cancer patients within 62 days of urgent GP referral has not been met for over 5 years, and survey evidence suggests more people are experiencing lengthening delays in getting GP appointments.
I haven’t looked at the numbers for breast cancer, so I don’t have an opinion on it, though I’ve seen the arguments.
For prostate cancer, I have experience. My PSA which was trending up, hit the limit, and I got an icky exam, which was positive. I did an MRI before my biopsy (hurray for Medicare!) and it wasn’t a false positive. But it was not very advanced, and I had time to decide on the proper treatment, which was cheaper (one hour of surgery, no hospital stay) and which had no side effects.
The issue there is that prostate cancer spreads so slowly that if you are old and say have 10 years to live, it doesn’t pay to treat it.
My biopsy was more accurate thanks to good coverage which let me afford an MRI. I have plan F, no co-pay so I could really afford it.
But once something is detected, then you can decide on the best course of treatment. I think the problem with breast cancer screening is the impact of false positives.
This is purely anecdotal, but I have had 2 MRIs in the past year, and the MRI department, with multiple machines, was a ghost town both times. Maybe we have too many.
I believe you. But who is in charge over there? Tories, right?
poor people don’t have money but they get sick.
I’m sorry but WTF? I had a hospital visit, 2 doctors visits, an X-ray, an MRI, and surgery within the space of 2 weeks.
Are you under the assumption that kidney stones are immediately treated with surgery?
And to answer your other question, my misery was being on opioids. I don’t like them. Not only did the surgeon give me the option of surgery the same day but if I didn’t like his choiices I could walk around him with a phone call.
This is what saved my leg. I didn’t have to wait to see a doctor so I could wait to see a specialist so I could wait to see a surgeon. I bypassed the specialist with a phone call and got a new test the same day as the call. Surgery was the next day.
Thank you. There is somebody on another board (an American) who is trying to spread the word that Canadians have to be assigned a physician by the government. He’s pointed out and cited how there are sign-up sheets online to be assigned a physician in various provinces. Apparently, his “Canadian relatives,” (scary quotes because I don’t believe he has any) included a pregnant woman relative who had to wait six months to be “assigned” a primary care physician, let alone an OB/GYN, in Quebec.
My investigation of these cites indicates that they are for those too lazy to pick up the phone, and call around. Sure, you can sign up for a PCP in Quebec (though you don’t have to), but I can pick up the phone here in Alberta–and I bet I can do the same in Quebec, for that matter–and get an appointment with any physician of my choosing tomorrow. Heck, local physicians advertise in the flyers that appear in the Sunday paper, that they are taking new patients. Or I can go to a walk-in clinic without an appointment.
I’ve given up engaging him over there at that other board. He’s doing a great job at convincing Americans who believe there is no choice of physician under UHC, that you are assigned a physician whom you may or may not like, but you’re stuck with, and it takes months to be assigned a physician at all. It’s BS of course, but there you go.
As a Doper, I enjoy fighting ignorance, but my gosh, sometimes it feels so good to just stop, and let the ignorant wallow in their ignorance.
They were first seen for severe symptoms on a Friday and had been operated on by the Monday. unless elves were involved I’m going to assume that a medical procedure was involved.
the same day as the office visit? I don’t think so. (see how that works?)
It’s totally beyond our national capabilities!
Lol.
This is the argument frequently used by people supporting NCAA rules prohibiting scholarship athletes from making money.
Yeah, you had to wait two weeks for the surgery.
From my understanding, in Canada and the UK, referrals involve you, your doctor, and the specialist that you are being referred to.
In my situation (and in Medicare Advantage), there is a fourth party. That fourth party was not a healthcare professional, nor did they have any personal stake in the outcome.
And because we had to go through that fourth party, I have new issues that I will have to deal with for the rest of my life, and the insurance company ended up paying hundreds of thousands of dollars more than if they had just approved the referral from the get-go.
Oh, and I also still owe around $9000 because while I was unconscious on the operating table, an issue arose that had to be fixed right then. The insurance company refused to pay because that doctor was out of network.
And, as another anecdote, I had gall stones. Woke up in excruciating pain and drove to the hospital at about 10am. Was full of pain meds by 1040 (the 40 minutes includes the drive to the hospital and the triage process), x-rayed by 2pm, offered surgery that night at about 430pm. Surgery at 7pm.
Great service for a Canadian hospital.
I’m a conservative but on the fence about single-payer. I’ve spent the last 10 years working in small, 25-bed hospitals and have gotten a bird’s eye view of the hoops hospitals have to jump through to receive payment.
It’s considered a win to most smaller hospitals if they can stay below $1million in debt to keep the doors open. The hospital before my current position was between $2-3 million in the red, all the time. These hospitals bill enough to turn a profit but simply don’t get paid. Single payer would stop smaller hospitals from closing and enable them to provide more services to their communities. It’s undoubtedly a good thing for hospitals.
What single payer won’t do is decrease costs. Physician wages are by far the largest expense for medical facilities and it’s the doctors which hold the political power in these organizations. A key physician leaving a clinic/hospital can cause financial ruin (a single orthopedic surgeon can generate 20-30% of total annual revenue). Someone has to get paid less for costs to go down and doctors won’t let it happen. Nurses have unions which protect their wages which leaves administration and the non-essentials. You can guess how likely it is for administration to voluntarily take a pay cut. The non-essentials’ wages can be cut but they’re a very small piece of the pie.
Both healthcare costs and taxes will probably go up under single-payer. It’s probably also the right thing to do.
Again, not a doctor.
It’s an incremental process with breast cancer, too. Unfortunately there is no equivalent to the PSA for breast cancer. Scientists are working on such blood tests to replace mammograms as the first line of screening for breast cancer, but that is early research. So the first line of defense is either a physical exam (noticing a lump) or the mammogram, sometimes an ultrasound, biopsy, sometimes an MRI, and finally surgery and radiation therapy. Or, sometimes you have the MRI instead of a mammogram if the patient has a history of breast cancer.
The problem with false positives isn’t that the patient is free of cancer, it is that the cancer is detected so early that nobody can tell whether the it will actually advance into a more serious form before, say, the patient dies of old age. The flipside is that treatment (eg: lumpectomy often followed by radiation therapy) at this early stage is extremely effective. But treatment also comes with a host of possible side- and after-effects.
~Max