# UHC: Has to be affordable, high-quality, and also \*not\* have long wait times **URL:** \ **Category:** Great Debates\ **Created:** [February 22, 2019, 6:16pm UTC](https://boards.straightdope.com/t/uhc-has-to-be-affordable-high-quality-and-also-not-have-long-wait-times/830033 "2019-02-22T18:16:52Z")\ **Posts on this page:** 20\ **Page:** 16
**Author:** ![k9bfriender](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/k9bfriender/32/3283_2.png) [@k9bfriender](https://boards.straightdope.com/u/k9bfriender)\ **Post date:** [March 7, 2019, 5:09pm UTC](https://boards.straightdope.com/t/uhc-has-to-be-affordable-high-quality-and-also-not-have-long-wait-times/830033/301 "2019-03-07T17:09:50Z")
> [@LAZombie](#): > > Questions: > Could Medicare sell policies? Only to seniors. > [@](#): > > Has anyone proposed lowering the eligibility age gradually? Yes. Repeatedly and often. ---
**Author:** ![Red\_Wiggler](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/red_wiggler/32/13190_2.png) [@Red\_Wiggler](https://boards.straightdope.com/u/Red_Wiggler)\ **Post date:** [March 7, 2019, 6:13pm UTC](https://boards.straightdope.com/t/uhc-has-to-be-affordable-high-quality-and-also-not-have-long-wait-times/830033/302 "2019-03-07T18:13:41Z")
I thought I was the only one suggested a year by year reduction in Medicare’s eligibility age because I haven’t stumbled upon a lick of support for it. It seems like a no brainer to me; there are about 2.3 million citizens in every birth year from 1959-1963. This would seem like a nice way to (1) appeal to a group of voters that Dems often struggle with and (2) ease into the extra administrative burden instead of trying to hammer this system out all at once. ---
**Author:** ![Shodan](https://avatars.discourse-cdn.com/v4/letter/s/9f8e36/32.png) [@Shodan](https://boards.straightdope.com/u/Shodan)\ **Post date:** [March 7, 2019, 6:25pm UTC](https://boards.straightdope.com/t/uhc-has-to-be-affordable-high-quality-and-also-not-have-long-wait-times/830033/303 "2019-03-07T18:25:39Z")
> [@JcWoman](#): > > I didn’t read the whole quote because I stopped at this one which is silly. Today with our ridiculous insurance system doctors have to bill (made up numbers for illustration) $500 for an office visit because they know the insurance company will refuse to pay $400 and the patient is only required to pay a $20 copay. It’s common knowledge that they never get paid their full amount. Medical provider price inflation is in part due to this - doctors trying to be compensated as much as they can because they have to fight tooth and nail with the insurance providers whose sole motive is to not pay out. This is incorrect. Health care providers lose money on most of their Medicare patients because the rates are set by law, and on average, health care providers spend more on treating patients than they are compensated. > [@](#): > > On average, Medicare hospital payment rates are substantially below hospitals’ reported costs of providing services. The CMS Medicare Actuary projects that by 2019, over 80% of hospitals will lose money treating Medicare beneficiaries. If these data are correct, M4A would mean that over 80% of hospitals would lose money when treating all of their patients. [Cite](https://economics21.org/m4a-reimbursements-blahous). > [@](#): > > So in a single payer system as I understand it, there is no silly[Chargemaster (rack rate)](https://thehospitalleader.org/18816-2/) so medical providers don’t have to play silly games to fight the insurance companies. There is one price list for all treatments with realistic/reasonable prices and doctors never have to wonder if they’ll get paid or get screwed. Currently the prices set by law for Medicare treatment do not cover, on average, the full cost of treatment, and are not (in that sense) realistic. > [@](#): > > Sounds to me more like the transformation that doctors would have to go through is an increase in confidence that they’ll be paid and a steadier income stream. The confidence they will experience is the confidence that they will lose money. And a further point - according to the Mercatus report (and also according to a report by the Urban Institute), if we implement the large cuts in payments to health care providers, AND significant cuts in drug prices, AND realize significant cuts in administrative costs AND eliminate health care premiums AND double personal and corporate payroll taxes, this will NOT cover the costs of Medicare for All. Also keeping in mind that the Medicare Sustainability Growth Act was enacted, its provisions were never enforced, and then the bill was repealed. TANSTAAFL. Regards, Shodan ---
**Author:** ![Irishman](https://avatars.discourse-cdn.com/v4/letter/i/b487fb/32.png) [@Irishman](https://boards.straightdope.com/u/Irishman)\ **Post date:** [March 7, 2019, 6:42pm UTC](https://boards.straightdope.com/t/uhc-has-to-be-affordable-high-quality-and-also-not-have-long-wait-times/830033/304 "2019-03-07T18:42:38Z")
> [@Shodan](#): > > This is incorrect. Health care providers lose money on most of their Medicare patients because the rates are set by law, and on average, health care providers spend more on treating patients than they are compensated. [Cite](https://economics21.org/m4a-reimbursements-blahous). > Currently the prices set by law for Medicare treatment do not cover, on average, the full cost of treatment, and are not (in that sense) realistic. The confidence they will experience is the confidence that they will lose money. This is not mutually exclusive with what **JcWoman** described. You may be correct that Medicare reimbursement rates are too low. This would be something that would need to be addressed in a M4A plan, or any single-payer set up. However, **JcWoman** is correct in what she describes. My cite: look at any bill you get from a medical provider. Huge initial cost, huge but not quite as big write off by the insurance company, some copay amount that you have already paid, and some copay amount you still owe. If you have good coverage, that additional balance may also be written off by the insurance company. Sometimes it isn’t, and there isn’t a good explanation why not. (I’m dealing with one of these right now.) ---
**Author:** ![wolfpup](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wolfpup/32/10618_2.png) [@wolfpup](https://boards.straightdope.com/u/wolfpup)\ **Post date:** [March 7, 2019, 6:49pm UTC](https://boards.straightdope.com/t/uhc-has-to-be-affordable-high-quality-and-also-not-have-long-wait-times/830033/305 "2019-03-07T18:49:42Z")
> [@Shodan](#): > > The confidence they will experience is the confidence that they will lose money. Yet, oddly enough, in UHC systems around the world, providers not only have confidence that they will be paid, the payment system is so consistently reliable that doctors can dispense with clerical staff to handle insurance and patient billing issues. Here in Canada doctors get paid by public insurance with the same dependability with which I get my public pension. Paying things by rote happens to be something governments are very good at. That means doctors can make the same net income on lower fees, and concentrate on practicing medicine instead of outwitting insurance bureaucrats. It also means patients are never denied necessary health care by some scheming bureaucrat who, if he screws enough patients out of their health care needs, gets a nifty bonus for it. You appear to be making the convenient but totally unwarranted assumption that UHC would operate within the framework of the present health care clusterfuck, _ **instead of how UHC actually operates in all countries throughout the first world** _. > [@Shodan](#): > > And a further point - according to the Mercatus report (and also according to a report by the Urban Institute), if we implement the large cuts in payments to health care providers, AND significant cuts in drug prices, AND realize significant cuts in administrative costs AND eliminate health care premiums AND double personal and corporate payroll taxes, this will NOT cover the costs of Medicare for All. Exactly the same comment as above. Health care economists have no difficulty explaining why UHC throughout the world costs an average of half as much as what the US pays per capita for an ineffective and broken system that fundamentally centers around what is essentially an unregulated private insurance business model, despite nominal ACA reforms. ---
**Author:** ![wolfpup](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wolfpup/32/10618_2.png) [@wolfpup](https://boards.straightdope.com/u/wolfpup)\ **Post date:** [March 7, 2019, 7:34pm UTC](https://boards.straightdope.com/t/uhc-has-to-be-affordable-high-quality-and-also-not-have-long-wait-times/830033/306 "2019-03-07T19:34:25Z")
> [@survinga](#): > > Everything that I’ve said, I’ve backed up with links. You may or may not like it. But what I’ve said about Canada and healthcare is true. Except for the fact that virtually all of it has been wrong. The links are to articles that have either been misinterpreted by you, or taken out of context, or just flat-out wrong, as others have pointed out. You seem remarkably unmoved by the fact that things that you claim are not covered in Canada, for example, are in fact fully covered, as attested by myself and others. I don’t know if it’s amusing or pathetic that I get to read your claim that home care isn’t covered in Canada, for example, after having had abundant home services provided almost every day at no cost over a span of many years. Instead of incorporating this information into your knowledge and perspective, you choose to ignore it and just plow ahead with the same old tired and incorrect polemics. Consequently, you’re wrong a lot. I’ve refuted every single point you’ve made, and so have others: > [@elbows](#): > > You’re wrong. > [@nelliebly](#): > > To sum up: you’re wrong. > [@Grim\_Render](#): > > I think we know nothing like that actually … So no, I think indications lean heavily the other way. In general you seem allergic to facts that contradict you: > [@survinga](#): > > I don’t care about any studies of Canada and their doctor’s pay. Until you’re prepared to acknowledge basic established facts instead of ignoring them or continuing to contradict them, I see nothing to be gained from further discussion with you. ---
**Author:** ![Shodan](https://avatars.discourse-cdn.com/v4/letter/s/9f8e36/32.png) [@Shodan](https://boards.straightdope.com/u/Shodan)\ **Post date:** [March 7, 2019, 7:48pm UTC](https://boards.straightdope.com/t/uhc-has-to-be-affordable-high-quality-and-also-not-have-long-wait-times/830033/307 "2019-03-07T19:48:28Z")
> [@wolfpup](#): > > You appear to be making the convenient but totally unwarranted assumption that UHC would operate within the framework of the present health care clusterfuck, _ **instead of how UHC actually operates in all countries throughout the first world** _. I am making the assumption that Medicare for All means extending Medicare to all. If you believe that setting up UHC in the US as you believe it operates in other countries in the First World would not involve major cuts in reimbursements to health care providers and in drug prices, could you explain how that works? > [@](#): > > Exactly the same comment as above. Health care economists have no difficulty explaining why UHC throughout the world costs an average of half as much as what the US pays per capita for an ineffective and broken system that fundamentally centers around what is essentially an unregulated private insurance business model, despite nominal ACA reforms. More or less the same comment as above. Perhaps those health care economists could have a go at explaining how the US can cut per capita costs in half without major spending cuts and tax increases. Or if we can’t do it without those cuts and increases, then what I said about Medicare for All remains valid. Regards, Shodan ---
**Author:** ![Kearsen1](https://avatars.discourse-cdn.com/v4/letter/k/3d9bf3/32.png) [@Kearsen1](https://boards.straightdope.com/u/Kearsen1)\ **Post date:** [March 7, 2019, 7:49pm UTC](https://boards.straightdope.com/t/uhc-has-to-be-affordable-high-quality-and-also-not-have-long-wait-times/830033/308 "2019-03-07T19:49:07Z")
> [@wolfpup](#): > > Yet, oddly enough, in UHC systems around the world, providers not only have confidence that they will be paid, the payment system is so consistently reliable that doctors can dispense with clerical staff to handle insurance and patient billing issues. Here in Canada doctors get paid by public insurance with the same dependability with which I get my public pension. Paying things by rote happens to be something governments are very good at. That means doctors can make the same net income on lower fees, and concentrate on practicing medicine instead of outwitting insurance bureaucrats. It also means patients are never denied necessary health care by some scheming bureaucrat who, if he screws enough patients out of their health care needs, gets a nifty bonus for it. > > You appear to be making the convenient but totally unwarranted assumption that UHC would operate within the framework of the present health care clusterfuck, _ **instead of how UHC actually operates in all countries throughout the first world** _. > > Exactly the same comment as above. Health care economists have no difficulty explaining why UHC throughout the world costs an average of half as much as what the US pays per capita for an ineffective and broken system that fundamentally centers around what is essentially an unregulated private insurance business model, despite nominal ACA reforms. I am sure doctors would be on board with that, but who sets rates? Can they be adjusted (with inflation) and lastly, people using medicare reimbursements as the baseline for what a Medicare for All plan would actually cost the tax payers are blowing smoke up everyone’s skirt. Costs, real costs are what is needed to move any of this forward. Costs for, costs against. I’ve seen it’ll save money overall to it’ll cost 11 trillion dollars a year. Both of them cannot be right ---
**Author:** ![survinga](https://avatars.discourse-cdn.com/v4/letter/s/cab0a1/32.png) [@survinga](https://boards.straightdope.com/u/survinga)\ **Post date:** [March 7, 2019, 7:50pm UTC](https://boards.straightdope.com/t/uhc-has-to-be-affordable-high-quality-and-also-not-have-long-wait-times/830033/309 "2019-03-07T19:50:26Z")
> [@wolfpup](#): > > Except for the fact that virtually all of it has been wrong. The links are to articles that have either been misinterpreted by you, or taken out of context, or just flat-out wrong, as others have pointed out. You seem remarkably unmoved by the fact that things that you claim are not covered in Canada, for example, are in fact fully covered, as attested by myself and others. I don’t know if it’s amusing or pathetic that I get to read your claim that home care isn’t covered in Canada, for example, after having had abundant home services provided almost every day at no cost over a span of many years. Instead of incorporating this information into your knowledge and perspective, you choose to ignore it and just plow ahead with the same old tired and incorrect polemics. Consequently, you’re wrong a lot. I’ve refuted every single point you’ve made, and so have others: > > In general you seem allergic to facts that contradict you: > > Until you’re prepared to acknowledge basic established facts instead of ignoring them or continuing to contradict them, I see nothing to be gained from further discussion with you. I was talking about holes in the coverage in Canada. The items I mentioned either only get partial public coverage or none. Home Health is in the partial category, in that government picks up some, but not all. So, some people pay out of pocket. Just because your own situation was different doesn’t negate my point at all. Canada pays about 70% of healthcare costs. The other 30% comes from other places (employers, out-of-pocket). In situations where you experience is different, that doesn’t impress me…just like my experience in the US being different doesn’t seem to impress you. And appealing to the Mob that “agrees” with you, which is what you’re doing, is not an argument. It’s just appealing to the Mob. It doesn’t mean you’ve “won” the argument. ---
**Author:** ![wolfpup](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wolfpup/32/10618_2.png) [@wolfpup](https://boards.straightdope.com/u/wolfpup)\ **Post date:** [March 7, 2019, 8:08pm UTC](https://boards.straightdope.com/t/uhc-has-to-be-affordable-high-quality-and-also-not-have-long-wait-times/830033/310 "2019-03-07T20:08:36Z")
> [@Kearsen1](#): > > I am sure doctors would be on board with that, but who sets rates? Can they be adjusted (with inflation) The process generally is that it’s negotiated between an agency representing the government or other payer(s) and an agency or association representing the doctors. In Ontario, for instance, fees are periodically negotiated between the Ministry of Health and the Ontario Medical Association, producing a Physician Services Agreement (PSA) that sets out a uniform fee schedule. The process is somewhat like collective bargaining. > [@Kearsen1](#): > > and lastly, people using medicare reimbursements as the baseline for what a Medicare for All plan would actually cost the tax payers are blowing smoke up everyone’s skirt. I agree. ---
**Author:** ![GIGObuster](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/gigobuster/32/421_2.png) [@GIGObuster](https://boards.straightdope.com/u/GIGObuster)\ **Post date:** [March 7, 2019, 8:28pm UTC](https://boards.straightdope.com/t/uhc-has-to-be-affordable-high-quality-and-also-not-have-long-wait-times/830033/311 "2019-03-07T20:28:32Z")
> [@survinga](#): > > I was talking about holes in the coverage in Canada. The items I mentioned either only get partial public coverage or none. Home Health is in the partial category, in that government picks up some, but not all. So, some people pay out of pocket. Just because your own situation was different doesn’t negate my point at all. Canada pays about 70% of healthcare costs. The other 30% comes from other places (employers, out-of-pocket). In situations where you experience is different, that doesn’t impress me…just like my experience in the US being different doesn’t seem to impress you.] Dos not impress me and I live in the USA. > [@survinga](#): > > And appealing to the Mob that “agrees” with you, which is what you’re doing, is not an argument. It’s just appealing to the Mob. It doesn’t mean you’ve “won” the argument. Thing is that a significant number of people in the USA do not have a hard time getting access because… a good number do not have it. If I had a choice, I would choose ‘harder to get’ but that I would eventually get it, and that it would not bankrupt many. ---
**Author:** ![survinga](https://avatars.discourse-cdn.com/v4/letter/s/cab0a1/32.png) [@survinga](https://boards.straightdope.com/u/survinga)\ **Post date:** [March 7, 2019, 8:39pm UTC](https://boards.straightdope.com/t/uhc-has-to-be-affordable-high-quality-and-also-not-have-long-wait-times/830033/312 "2019-03-07T20:39:42Z")
> [@GIGObuster](#): > > Thing is that a significant number of people in the USA do not have a hard time getting access because… a good number do not have it. If I had a choice, I would choose ‘harder to get’ but that I would eventually get it, and that it would not bankrupt many. Yes, this is the worst part of USA coverage. We have 9% of our population that’s completely uninsured, which is inexcusable. I think we should round out of system of subsidies within the current framework to get these people all inside the tent, so to speak. Getting to UHC doesn’t require single-payer. But not having UHC to begin with is a huge problem. ---
**Author:** ![survinga](https://avatars.discourse-cdn.com/v4/letter/s/cab0a1/32.png) [@survinga](https://boards.straightdope.com/u/survinga)\ **Post date:** [March 9, 2019, 4:01pm UTC](https://boards.straightdope.com/t/uhc-has-to-be-affordable-high-quality-and-also-not-have-long-wait-times/830033/313 "2019-03-09T16:01:59Z")
> [@Kearsen1](#): > > I am sure doctors would be on board with that, but who sets rates? Can they be adjusted (with inflation) and lastly, people using medicare reimbursements as the baseline for what a Medicare for All plan would actually cost the tax payers are blowing smoke up everyone’s skirt. > > Costs, real costs are what is needed to move any of this forward. Costs for, costs against. I’ve seen it’ll save money overall to it’ll cost 11 trillion dollars a year. Both of them cannot be right No one really knows how much it will save. But that’s the main talking point behind M4A advocates. We’ll have single-payer, and government will set the price levels for doctor & hospital reimbursements at a global level, taking into account the entire US population. And we’ll all get a pony. At the end of the day, in aggregate, M4A will result in lower compensation for doctors. This much is not argued, really. It’s not a glitch in M4A. It’s a feature of M4A. Now, that might be fine with many doctors. They’ll still make good money. But for some doctors, it will not be fine and they’ll probably retire early. ---
**Author:** ![Ann\_Hedonia](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/ann_hedonia/32/319_2.png) [@Ann\_Hedonia](https://boards.straightdope.com/u/Ann_Hedonia)\ **Post date:** [March 9, 2019, 5:01pm UTC](https://boards.straightdope.com/t/uhc-has-to-be-affordable-high-quality-and-also-not-have-long-wait-times/830033/314 "2019-03-09T17:01:08Z")
> [@survinga](#): > > No, you didn’t answer me. You deflected, joked, and then attacked the US system. And you dodged on why 10% of Canadians either have no prescription coverage or not enough. I think prescriptions is a place where Canada has problems. That’s probably why 2/3 of Canadians have to get some sort of private coverage to supplement on the things that Canada doesn’t provide (dental, home health care, ltc, drugs). Lots of holes in Canada. > > One other thing, Canada doesn’t have as good a situation in terms of Cancer survivorship as the US. I didn’t even realize this until I started digging around. > > [https://www.cdc.gov/cancer/dcpc/research/articles/concord-2.htm](https://www.cdc.gov/cancer/dcpc/research/articles/concord-2.htm) > > God forbid I ever get Cancer. If I do, thank God I’m in the US. > > Seems like Canada also has problems with healthcare access for indigenous people. That probably is one of the drivers in differences in expected lifespan between them and the rest of Canada. > > [https://cloudfront.ualberta.ca/-/media/nursing/about/docs/understandinginequalities.pdf](https://cloudfront.ualberta.ca/-/media/nursing/about/docs/understandinginequalities.pdf) Interesting article, but I had a different takeaway. According to the article, the higher US survival rate isn’t found across all cancers. Mostly it’s specific to breast and prostate cancer. Which, IMHO, are highly over diagnosed in the USA. And when you aggressively screen and treat every patient whenever you find single cancer cell, you find and treat a lot of indolent low grade cancer. And these patients survive. Most of them would’ve survived just fine if their cancer had never been caught. And this improves the survival rate. So I actually don’t think these statistics are a clear positive. Now, I think any UHC has to include some sort of copay / cost share or people will overuse the system. The “People don’t go to the doctor for fun, they only go when they really need to” argument doesn’t work for me. Because frequently a doctor visit is a comfort issue. You’re going to survive the cold or mild virus no matter what you do, the doctor can only give you medication to make you more comfortable while the disease runs its course. Or that rash can probably be treated just fine with OTC creams, but that $400 prescription might clear it up a little faster. I know I went to the doctor way more frequently when I had the expensive platinum low copay/ zero deductible plan. I saw a psychiatrist weekly because it only cost me $15 bucks a pop. Think of all the medical advertising that exists purely to get people to go to the doctor for minor conditions. I want to see health care reform in the US, but I think the idea of “anyone can go to any doctor that they want, without authorization or referral, for absolutely any reason, and it’s FREE - is an unreasonable expectation. ---
**Author:** ![Northern\_Piper](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/northern_piper/32/5304_2.png) [@Northern\_Piper](https://boards.straightdope.com/u/Northern_Piper)\ **Post date:** [March 9, 2019, 6:25pm UTC](https://boards.straightdope.com/t/uhc-has-to-be-affordable-high-quality-and-also-not-have-long-wait-times/830033/315 "2019-03-09T18:25:20Z")
> [@Ann\_Hedonia](#): > > Now, I think any UHC has to include some sort of copay / cost share or people will overuse the system. The “People don’t go to the doctor for fun, they only go when they really need to” argument doesn’t work for me. Because frequently a doctor visit is a comfort issue. You’re going to survive the cold or mild virus no matter what you do, the doctor can only give you medication to make you more comfortable while the disease runs its course. Or that rash can probably be treated just fine with OTC creams, but that $400 prescription might clear it up a little faster. Well, the two major single-payer systems that get talked about on these boards, in the U.K. and Canada, don’t have co-pays, and over-use for trivial matters doesn’t appear to be a problem in either one. Do you have something other than your personal opinion to back up your argument? Plus, it seems to me that the two examples you give could be dealt with by expanding the role of nurse practitioners and pharmacists to prescribe. Not everything has to be done by a doctor. For example, if someone has a persistent skin issue, you should have a system that lets a health professional of some type look at it, like a nurse practitioner or pharmacist. Most times, they’ll say “minor matter; OTC should clear it up.” But every so often they might say, “this may be more serious; may need an antibiotic cream; I can prescribe that.” And more rarely yet, they might say, “I’m a bit worried that this could be the start of something serious, maybe even a skin cancer. I’ll book you into the doctor asap.” That strikes me as a better way to manage the routine matters that could, in rare cases, really warrant a doctor’s attention. > [@](#): > > I want to see health care reform in the US, but I think the idea of “anyone can go to any doctor that they want, without authorization or referral, for absolutely any reason, and it’s FREE - is an unreasonable expectation. I think you’re setting up a strawman there. I don’t know of any UHC system that works like that. I confess I’m not a world-wide expert, but I’ve never heard of any country that has that type of system. ---
**Author:** ![Nava](https://avatars.discourse-cdn.com/v4/letter/n/da6949/32.png) [@Nava](https://boards.straightdope.com/u/Nava)\ **Post date:** [March 9, 2019, 6:33pm UTC](https://boards.straightdope.com/t/uhc-has-to-be-affordable-high-quality-and-also-not-have-long-wait-times/830033/316 "2019-03-09T18:33:59Z")
> [@Ann\_Hedonia](#): > > Now, I think any UHC has to include some sort of copay / cost share or people will overuse the system. (…) Think of all the medical advertising that exists purely to get people to go to the doctor for minor conditions. All that revolting medical advertising which is banned in most countries? Yes, I think about it, but I’d rather not do it when I’m about to cook dinner… In countries with UHC, the immense majority of “medical advertising” is from the UHC system. It reminds people about the different symptoms of cold vs flu, reminds people to wash their hands, advertises services such as Nurse By Phone, and generally tries to get people to use the system better. Because like anything else, the better we use it, the better it works. This applies both in single-payer and multi-payer systems. And yep, the immense majority in these countries understand that “more” does not equal “better”. We also understand that doctors aren’t the only part of the system: patients, pharmacists and nurses are part of it too. We are responsible for our own health. Does everybody understand this? No. But most of us do; it’s ingrained, it’s part of the core culture. ---
**Author:** ![doreen](https://avatars.discourse-cdn.com/v4/letter/d/858c86/32.png) [@doreen](https://boards.straightdope.com/u/doreen)\ **Post date:** [March 9, 2019, 6:49pm UTC](https://boards.straightdope.com/t/uhc-has-to-be-affordable-high-quality-and-also-not-have-long-wait-times/830033/317 "2019-03-09T18:49:03Z")
> [@Ann\_Hedonia](#): > > Now, I think any UHC has to include some sort of copay / cost share or people will overuse the system. The “People don’t go to the doctor for fun, they only go when they really need to” argument doesn’t work for me. Because frequently a doctor visit is a comfort issue. You’re going to survive the cold or mild virus no matter what you do, the doctor can only give you medication to make you more comfortable while the disease runs its course. Or that rash can probably be treated just fine with OTC creams, but that $400 prescription might clear it up a little faster. > > I know I went to the doctor way more frequently when I had the expensive platinum low copay/ zero deductible plan. I saw a psychiatrist weekly because it only cost me $15 bucks a pop. Think of all the medical advertising that exists purely to get people to go to the doctor for minor conditions. I am not necessarily opposed to the idea of a copay/cost share- but I don’t actually know that a copay cuts down on unneeded visits and only unneeded ones; Ok, you went to the psychiatrist\* every week because it only cost you $15 bucks. Would you have gone twice a week if it was $0 copay? How often would you have gone if it was $100 copay? Which of those frequencies was the correct one? I have a rash that can probably be treated with OTC- but how will I know that without seeing a medical professional? It’s probably been bothering me a couple of days and not responding to OTC stuff before I decided to go to the doctor and my $20 copay is not the reason I waited those couple of days. I waited because I didn’t want to take off from work/sit in the waiting room - and I wouldn’t have seen the doctor any sooner if it was free. You’d have to get to a significant copay before I’m not going to see the doctor to find out if there’s a prescription that will make me more more comfortable, or to make sure my cold that won’t go away isn’t really something more serious that needs antibiotics. And by the time you get to that copay, I’m also not going to get my A1c tested as often as I should. - which actually surprises me, because most of the people I know who see a psychiatrist see the psychiatrist once a month or so for : “medication management” and see a non- MD more often for therapy. ---
**Author:** ![LAZombie](https://avatars.discourse-cdn.com/v4/letter/l/b38774/32.png) [@LAZombie](https://boards.straightdope.com/u/LAZombie)\ **Post date:** [March 9, 2019, 7:27pm UTC](https://boards.straightdope.com/t/uhc-has-to-be-affordable-high-quality-and-also-not-have-long-wait-times/830033/318 "2019-03-09T19:27:34Z")
> [@Northern\_Piper](#): > > For example, if someone has a persistent skin issue, you should have a system that lets a health professional of some type look at it, like a nurse practitioner or pharmacist. > > Most times, they’ll say “minor matter; OTC should clear it up.” But every so often they might say, “this may be more serious; may need an antibiotic cream; I can prescribe that.” And more rarely yet, they might say, “I’m a bit worried that this could be the start of something serious, maybe even a skin cancer. I’ll book you into the doctor asap.” The Apple watch wanted to do some medical analysis, but the FDA banned it. I would think one could take a photo of a skin issue and analysis it. Is it a freckle or possibly a cancerous growth? I suspect numerous things could determined by simply taking photos. But the FDA won’t allow it; thus forcing us to be at the mercy of the health system. ---
**Author:** ![Ann\_Hedonia](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/ann_hedonia/32/319_2.png) [@Ann\_Hedonia](https://boards.straightdope.com/u/Ann_Hedonia)\ **Post date:** [March 9, 2019, 7:59pm UTC](https://boards.straightdope.com/t/uhc-has-to-be-affordable-high-quality-and-also-not-have-long-wait-times/830033/319 "2019-03-09T19:59:28Z")
> [@doreen](#): > > I am not necessarily opposed to the idea of a copay/cost share- but I don’t actually know that a copay cuts down on unneeded visits and only unneeded ones; Ok, you went to the psychiatrist\* every week because it only cost you $15 bucks. Would you have gone twice a week if it was $0 copay? How often would you have gone if it was $100 copay? Which of those frequencies was the correct one? > I have a rash that can probably be treated with OTC- but how will I know that without seeing a medical professional? It’s probably been bothering me a couple of days and not responding to OTC stuff before I decided to go to the doctor and my $20 copay is not the reason I waited those couple of days. I waited because I didn’t want to take off from work/sit in the waiting room - and I wouldn’t have seen the doctor any sooner if it was free. You’d have to get to a significant copay before I’m not going to see the doctor to find out if there’s a prescription that will make me more more comfortable, or to make sure my cold that won’t go away isn’t really something more serious that needs antibiotics. And by the time you get to that copay, I’m also not going to get my A1c tested as often as I should. > > - which actually surprises me, because most of the people I know who see a psychiatrist see the psychiatrist once a month or so for : > “medication management” and see a non- MD more often for therapy. I don’t take any medication. My provider gave me a list of approved practioneers for talk therapy. A few of the therapists, including the one I selected, had degrees in psychiatry. I realize that this is unusual. I stopped going when I changed insurance plans and the price would’ve changed to $65 a session, so the “answer” is somewhere between $15 and $65. But I had made significant progress with the particular situation I needed help in coping with. ---
**Author:** ![GIGObuster](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/gigobuster/32/421_2.png) [@GIGObuster](https://boards.straightdope.com/u/GIGObuster)\ **Post date:** [March 9, 2019, 8:51pm UTC](https://boards.straightdope.com/t/uhc-has-to-be-affordable-high-quality-and-also-not-have-long-wait-times/830033/320 "2019-03-09T20:51:06Z")
> [@LAZombie](#): > > The Apple watch wanted to do some medical analysis, but the FDA banned it. > > I would think one could take a photo of a skin issue and analysis it. Is it a freckle or possibly a cancerous growth? I suspect numerous things could determined by simply taking photos. But the FDA won’t allow it; thus forcing us to be at the mercy of the health system. Uh, cite for the FDA banning the apple watch for medical analysis? AFAIK the restrictions are outside the USA or if one is less than 22 years old. [Previous page](https://boards.straightdope.com/t/uhc-has-to-be-affordable-high-quality-and-also-not-have-long-wait-times/830033.md?page=15) [Next page](https://boards.straightdope.com/t/uhc-has-to-be-affordable-high-quality-and-also-not-have-long-wait-times/830033.md?page=17)