I don’t want to make an assumption, Max S., so where are you at?
From a guy just reading this (and I don’t necessarily agree or disagree with you), you seem unmoved in your position. You don’t seem like you want UHC in USA, and you are looking for an excuse to not have it. I am not saying that is your position, it seems that way.
That was a good post, and quoted post. Does this ‘purely doctor<->Medicare’ dispute hold in cases where the doctor holds a bona fide professional opinion as to the medical necessity of a procedure? I am concerned about a possible chilling effect if doctors ever feel the need to stray from official guidelines. Who gets hit with the bill? The ordering doctor, the servicing doctor (if distinct), the facility, the patient, or Medicare (the public)?
~Max
I am of a mixed mind about this. I don’t want to legislate the practice of medicine, but I do think the allocation of scarce resources calls for rationing… on an equitable basis.
In the current system, we do not legislate the practice of medicine. We regulate it, and unfortunately sometimes private corporations make the rules. But the allocation of healthcare is not equitable.
Under a single-payer system, while we could opt for a more equitable distribution of healthcare resources, I fear that this will result in less freedom for doctors to follow their professional judgement. That is why I am interested in Northern Piper’s cites.
~Max
I was under the impression that there were doctors sitting on the panel of rationing and effectiveness* (not the real panel name) in Canada, UK, and other countries that determine what is approved and not approved, vs underwriters and bureaucrats in the USA at the moment. I am not sure that your fears would be realized in that system. I believe that Northern Piper stated that in another thread as well. (I could be not remembering correctly.)
I was expecting even more hospitals to close or consolidate under a single-payer system. We don’t have mostly public hospitals like other countries do, although most of our hospitals are organized as nonprofit corporations.
I recognize that universal coverage means no more uncompensated hospital visits, and probably more utilization too. There is a significant savings in overhead with single-payer, but it hasn’t been made clear to me whether those savings are retained by the hospitals or whether the rates go down. Using the current Medicare-A rates as a baseline, I believe the rates would have to go up significantly in order to pass the break-even point for hospital care, even with universal coverage. Not my expertise, but that’s what I have heard.
~Max
Cite?
My position has not changed much since the original post. Some arguments were presented, notably nelliebly’s argument about the cost going down after single-payer and Magyver’s argument that single-payer has an inefficient risk pool. I believe I have struck down both of the particular arguments presented, though not all arguments leading to those conclusions. I don’t personally find “but other countries did it” to be convincing arguments.
When I see an argument in favor, I look for reasons against. When I see an argument against, I look for reasons in favor. That’s just how I operate, it is not a good indicator of my overall position.
Overall, I am not particularly opposed to single-payer, but I have not yet been convinced to support it. Unfortunately for supporters, my default position is the status quo.
~Max
What do you think of the current system? If you think it sucks, as I do, then the much better statistical outcomes and lower spending of so many other countries with UHC should be enough to convince you.
The same principle is supposed to apply to the U.S. Medicare panel, which is called the Special Society Relative Value Scale Update Committee. They are all real doctors, one from each specialty board, except I think one member is a speech language pathologist. But here on the ground, doctors don’t have such a high opinion of those “politicians”.
When we submit a claim, it is checked by some secret computer process at the local Medicare administrator’s office (in Jacksonville). That process is supposed to follow public guidelines from CMS (developed by real MDs) and the local Medicare administrator (I assume, also developed by real MDs). If codes don’t match up correctly, I’m pretty sure the claim is automatically denied. If we appeal, a doctor working for the Medicare administrator reviews our letter of appeal. The second level of appeal is before an administrative law judge.
You may also be surprised to learn that American insurance companies have real medical/pharmacy doctors (depending on the nature of the claim) and registered nurses adjudicating claims. Even moreso than the RUC, these people are usually held thought of as having sold their souls.
~Max
The way I see it, that’s apples and oranges.
~Max
Or, you prefer the suck that you know vs. the potential suck you can never be sure on.
Seems like with that attitude you wouldn’t change much in your life at all.
I’m not picking on you or anything. Not saying you are right or wrong.
Not quite, I just don’t think the situation is bad enough to risk supporting a plan I don’t understand and agree with. The threshold, in case you are wondering, would be the edge of anarchy.
I sort of explained my thinking on U.S. versus other country in a previous post:
~Max
An important consideration is that most existing universal healthcare systems in the world are not single payer. The terms are not synonymous. There are a host of options that open up to potentially improve health care access and results without supporting single payer.
Yes, but the point was that you were wrong. Hospitals closing is a thing that is happening with no single payer present.
In the Case of California, who expanded medicare, more hospitals in rural places remained open.
Of course that is not Single payer, but clearly improvements in service and access can be reached in a single payer environment. Even in the USA as the VA shows.* Trump wanted to close several VA hospitals but even Republicans complained about that.
I say this on the BBC website today. I know that many of you cannot see the link so I have quoted a part of the piece.
Except of course that the UK does have a private medical infrastructure. Did you not know that? And you can get private insurance if you want to have the option of using it. The UK is not the socialist hellhole some seem to think.
And because that private insurance doesn’t have to cover emergency care and life-threatening conditions like heart attacks and cancer (which are covered by the NHS), it is much, much cheaper than private insurance in the US.
So in fact the UK gets UHC which means everyone has healthcare coverage, and those who want to jump the queue for non-urgent medical procedures can pay extra to do so if they are able to (feeling smug about it remains optional), but if they can’t afford it they still will get the treatment in due course as medical necessity dictates (unlike the US where they may not be able to get it at all). And, altogether, the costs are still less per capita than in the US.
To sum up: universal coverage, lower costs per capita, healthcare prioritized by need rather than ability to pay but rich bastards still can get special treatment if they want. Admittedly it rankles the Conservatives who, unsurprisingly, want to know how they and their rich friends can profit off the NHS but Brits as a whole freaking love the NHS. There was even a virtual love letter to the NHS in the opening ceremony of the 2012 Olympics, to great crowd response.
So, edge of anarchy? Wouldn’t there be a lot more important things to do if the country was on the edge of, uh, anarchy?
If the government was on the edge of anarchy, I doubt we would be able to do much regarding health care.
Even so, my argument was that it would be worse for the economy if more hospitals “shutter” under a single-payer system. I don’t believe you have refuted my argument. You responded by claiming that hospitals would shutter even with our current health insurance system, and I responded by clarifying that I meant more hospitals than our current health insurance system.
I laid out some criteria where a single-payer system might not result in more hospitals shuttering than under our current system. Instead of taking that admission and completing a counterargument, you seem to have reverted to the previous point, which I have already told you is irrelevant. I’m sorry, GIGObuster, but you have lost me here.
I would be interested in cites, if you have them. Both for California expanding Medicare and for a decrease in the closure of rural Californian hospitals.
Even if you mean Medi-Cal (which I suspect you are referring to), and even if there is a direct link between the expansion of Medi-Cal and the solvency of rural hospitals, I’m not sure if that constitutes evidence against my argument. I would also need to understand how the expansion of Medi-Cal and its effects on rural Californian hospitals would be similar to single-payer.
~Max
“Anarchy” can also mean the absence or rejection of order and civility, not necessarily the absence of government. If we had a number of riots over the inadequacy of our health insurance system, or the immediate prospect of such riots, I may be willing to support proposals that I do not fully understand or agree with. You are asking what the threshold is beyond which I abandon skepticism in politics, and that is the threshold.
I’m pretty young, so my opinion may change, but that is how I view things today.
~Max
Sorry, I seem to have overlooked your post. This particular line of replies leads to your claim, [POST=22174184]post #77[/POST], that “doctors would pocket the savings from not having to hire armies of insurance people.” If the fees go down so the doctor who fires billing staff comes out just as profitable as before, that doctor does not pocket any savings from culling his staff.
~Max