You are paying $2100/month minimum out-of-pocket?
Wow, $25k a year? OMFG!!!
Generally, the answer to both of your questions is that the US system is so much more expensive because it is set up to need a very, very large number of people working in jobs and with tasks that do not exist in other systems. Or at least are minute compared to the bloated US setup. And because it involves a lot of duplication of effort and overprovision.
Basically, a system change would involve cuts to what to other systems appear to be busywork, rather than the wages of health care providers. Differences in wage levels just are not a big contributor to the differences, and some UHC systems pay doctors more than the US do.
You may find that this does involve cuts in drug prices though, that bit is, I suspect, correct.
Um no, we are out of pocket the $700/month. The rest is covered by my wife’s employer currently (the State)
But for the purpose of what this discussion was about, was the determine how much money the State or the Feds have to have to make a workable UHC system. If they took that money that the employers already pay and the money that individuals pay, then what?
What we as a people would hate to have happen (and which already did happen with the Affordable Act) was that the individual picked up a lot more of the tab.
I did a back-of-the-envelope calculation in another thread a while back:
These numbers were on expanding Medicare, but they do serve to illustrate a point: Currently, US government spending on health care is about as much as it costs to run a full UHC system for everyone. It just doesn’t manage to cover everyone due to an incredibly inefficient setup with multiple systems.
WADR that does not entirely address the issue.
Assuming we are talking about Medicare for All, the Mercatus report mentioned above assumes that there would be significant administrative savings vs. private insurance. Whether or not this is the case is not as straightforward as one might think. However, let’s assume that it is. The Mercatus and Urban Institute reports did make that assumption.
Even including that, significant cuts to reimbursements to health care providers, and cuts in drug prices, and a doubling in payroll taxes for corporations and individuals, would still be necessary, and those tax increases would not be sufficient to cover the costs, even if they replaced insurance premiums completely. Further, assuming that Medicare as it stands does include those administrative savings. It still causes doctors and hospitals to lose money on their Medicare patients most of the time.
So administrative overhead is not the reason that US health care costs so much, and reducing administrative overhead, even if it happens, will not bring US health care costs into line with other countries with UHC. Certainly overhead is a factor, but that does not address the elephant in the room.
We spend too much in the US on health care because we spend too much in the US on health care. In order to spend less, we have to spend less. Which, again WADR, this -
doesn’t quite address the issue. If Medicare reimbursements rates are too low now, and doctors lose money by treating their Medicare patients, then they would have to be raised under M4A so that doctors don’t lose money. And the reports already cited assume that they will not be raised. So either we keep the rates, and doctors lose money, or we raise the rates, and we don’t save money.
Perhaps it is possible to come up with some combination of spending cuts and reimbursement increases that will actually allow a sustainable version of M4A. But the current proposals aren’t that, and Medicare as it stands isn’t that either - doctors lose money on it, and that doesn’t strike me as sustainable.
Regards,
Shodan
Thing is, that report does not seem to factor in systemic savings. While it does assume administrative savings due to simplified administrations, from my reading of it it seems to assume the same actors persisting in the system. Only paid for by the government rather than out-of-pocket.
So the reason you do not see any savings due to fewer people doing makework is that the report assumes the same number of people working in the system. So medicare for all still means the same number of employees gatekeeping, working in health insurance, negotiation between insurance and hospitals etc.
In my view, this is an assumption that is pretty unrealistic and rather kills the concept of reform. “We’re going to look at the results of a reform, but assume most of the major unnecessary costs stay the same”
Additionally, Mercatus calls themselves that because the name means “market”. The bill themselves as “Mercatus research focuses on how markets solve problems” While that does not necessarily make them wrong, I think it warrants as somewhat skeptical approach to their work in a case where the general scholarly opinion is that markets do not work.
Also, it only refers to “Medicare for all”. UHC consists of a lot of different approaches.
The report says pretty explicitly that they assume significant administrative savings. So no, I don’t think this is correct. Whether it is the same number of people working for less money, or fewer people working for the same money, overall the report assumes significantly reduced administrative overhead in their calculations.
As mentioned, the Urban Institute said the same thing.
See also my Politifact cite on Bernie Sanders’ claim of how much we would save in administration, which both overstated the amount and its impact overall.
Regards,
Shodan
Here’s a good write-up about the relative reimbursement levels of Private insurance, Medicare and Medicaid in the US. This blog is not a right-wing blog, and in fact it’s a great source of healthcare information at the state level.
The author used to think that Medicare was 80% of private, and Medicaid was 50% of private. Now, after more examination, he’s edited his views. It’s worth the read, and the relative reimbursements vary a lot by specialty and region. The final punchline:
*In any event, it sounds like I’m going to have to modify my prior “80% Medicare, 50% Medicaid” rule of thumb into something a bit more complex:
Medicare reimburses providers roughly 60% as much as private insurance
Medicaid reimburses hospitals roughly 60% as much as private insurance (45% + 15% supplemental)
Medicaid reimburses doctors roughly 45% as much as private insurance
I may modify this a bit, but it sounds reasonable for use to make general points about reimbursement rates and sweeping healthcare policy change impact, anyway.*
Here’s a different perspective on “reimbursement rates”. I find it rather silly to cite “X government program reimburses at y% of private insurance” as if it was some universal law of nature. You know what the government single-payer system reimburses doctors and hospitals where I live? 100% of the pre-negotiated published fee schedule, from which doctors earn a comfortable living similar to that of US doctors.
The actual dollar amount of those fees is usually much less than the various secretive fictions that pass for medical fees in the US, and that’s because doctors have none of the costs and hassles of dealing with insurance companies and with taking losses due to non-payment. It’s just silly to look at what Medicare (for instance) pays compared to private insurance today, and assume that this is just an inviolable law of nature! If you’re proposing reforms, you have to take a holistic look at the entire system, which if properly structured will have tremendous opportunities for systemic cost savings. Otherwise such reforms are just unrealistic fictions. Countries vary greatly in how they have implemented UHC, but no country in the world has ever done it by just having the government take over and fund a broken overpriced dysfunctional system like the US model.
The payout to doctors per patient will probably decrease.
However, if they have to have less staff to take care of insurance paperwork, the reimbursement method changes from tests and procedures and drugs ordered to actual patient outcome, and medical malpractice insurance is eliminated or reduced, then the doctor himself need not see any reduction in his income.
Even with a minor reduction in income, I don’t see doctors giving up the practice. Given how competitive it is to get into medical school, and how all the slots are always full, I don’t think that we need to worry too much about incentivizing people to become doctors either.
Reducing the cost of medical school and increasing the number of slots available would also reduce the doctor’s financial needs. With less investment, there is less need to charge more to pay it off. With more doctors, there is less contratint on the supply, also lowering prices.
There is also a place for your positions that are not quite doctors, like LPNs and the like. There is no real reason to go to a full doctor for a cold or flu or minor injuries. That can act as a much lower cost point of medical care.
How is malpractice insurance going to be eliminated or reduced?
The data so far don’t indicate that it would work that way. The idea was that we would replace expensive visits to the emergency room with less-expensive visits to doctors if more people were covered. Instead, eergency room visits AND visits to PHP went up under Obamacare.
Which is a largely unaddressed part of UHC - utilization will almost inevitably go up. Increased demand doesn’t generally cause costs to go down. So we are very likely, not merely to provide the same health care for less money, to have a demand for more health care for less money.
Regards,
Shodan
When UHC is initially adopted healthcare utilization does, indeed, increase. That’s because a whole bunch of people who couldn’t access medical care before enter the system, and some of them have conditions that have been neglected awhile and thus become more expensive to treat than they would be otherwise. It does take some time for that bulge to work through the system.
Long term it should help control costs.
In my state we saw a bit of this when Medicaid/Obamacare started providing dental coverage. People who hadn’t seen a dentist for 10 or 20 years showed up, and instead of needing just routine cleanings or fillings they wound up needing root canals, extractions, dentures… Took a couple years to get those folks caught up.
Ummm, this is really simple. The reason that you sue a doctor for medical malpractice is to cover the medical bills that are caused by his error. If you don’t have any medical bills, you don’t need to sue to pay for them.
That means that the only reason to sue a doctor is if they engage in actual negligence or maliciousness, not because they made a mistake.
Except that that doesn’t relate to my point whatsoever about moving minor illnesses and colds to LPNs or such.
Plus, you are looking at the short term effects of a long term plan. Of course when people finally are able to get that growth they’ve bene worried about looked at, or get that pain that’s been bothering them checked out, they are all going to go in the first bit after they have finally gotten insurance. That there was a spike in people seeking healthcare that they were previously denied should not be a surprise.
Well, yeah, to the extent that there were people out there suffering or even dying from conditions that they cannot see a doctor about, when they can see a doctor to alleviate their condition, they will do so.
It’s not unaddressed, it is the entire point.
I suppose you’ve never heard of economies of scale.
You could have a compelling argument that UHC saving money would be impossible if it were not for the fact that every other industrialized nation on earth has done so.
I think you are mistaken - people sue for a lot more than their medical bills when they sue for malpractice. I think the term is “damages”.
And I don’t see how UHC is going to reduce the number of lawsuits for mistakes vs. negligence. People sue doctors for mistakes all the time, as well as for bad outcomes in general.
I suspect it is not as simple as you seem to think.
But think it thru. I go to the doctor for treatment, something goes wrong, I think it’s the doctor’s fault. Why am I less likely to sue if the government pays my bill than if the insurance company pays the bill?
I would not be suing the government or the insurance company - I would be suing the doctor. Thus he would need malpractice insurance in either case. And the cost of that insurance has to come from somewhere.
Regards,
Shodan
It relates to it directly, actually. Lower cost visits to PHPs did not replace higher-cost visits to the emergency room - both types of visits went up. So this indicates that lower cost visits to physician’s assistants and other kinds of allied health provider would not replace higher-cost visits to PHPs - the data indicates that both would go up.
The point we were discussing was saving money overall. Utilization would go up, therefore cost would go up. So if the entire point is to save money, the entire point isn’t going to be achieved.
Yes, I have heard of that, usually in connection with manufacturing. Could you explain how a doctor treats say, forty patients a day more efficiently than he now treats, say, thirty? Especially when he loses money on all of them?
Regards,
Shodan
Shodan is right on this point.
“Medical malpractice” is just another term for negligence. If you’re harmed by the doctor’s negligence, you can sue for all the injury you’ve suffered. That can include medical bills to pay other doctors to fix it, but it can also include pain and suffering, loss of income if you can’t work as a result of the negligent treatment ( which can be long-term or short-term, depending on the injury), compensation for the long-term effects of the negligent treatment, and so on.
It’s true that in some UHC systems there may be less incentive to sue for medical expenses, but that depends on the way the UHC is set up. In some systems, the government single-payer may decide as a matter of policy not to try to recover the medical costs, but if it’s a UHC system based on private insurers, I could see them trying to recover the costs of the medical bills they’ve paid on your behalf.
But certainly, if the doctor negligently nicks your spinal cord during a routine procedure, leaving you partially paralyzed, you would sue for malpractice, because that’s a life-changing injury. That’s an extreme hypothetical, but other less serious ones can be imagined.
UHC doesn’t eliminate malpractice suits, nor the need for malpractice insurance.
mm
mm
Over what period of time are we talking? Seriously, things change, and before they can even settle, you are looking to see that there are some hiccups in the transition. People kept going to the medical services that they had been going to.
Then there is the fact that you had many people who let medical problems build up, as they couldn’t afford to do anything with them, and they started coming in now that they had a way of affording it.
Is your actual desire that fewer people see a doctor? Given the assumptions and assertions that you have made in this thread, the only way to get healthcare costs down is to deny more and more people access to medical care.
Are you actually looking to deny more and more people access to medical care? If so, then great, we’re done here. If not, then how would you go about controlling costs without reducing or denying care?
The cost per patient can be decreased substantially. If the doctors are not billing based on procedures or tests, but on outcomes, if they are not ordering procedures and test as a CYA, if they are not recommending the very latest and priciest drug when a cheap generic would do, then costs would go down.
Do you want details on exact flow throughs, or are you actually saying that you do not think that having more patients would allow a doctor to treat of them each more efficiently?
Can you at least understand that not having to deal with several insurance companies, each with several plans, and having to determine what is covered and how to get remittances from those insurance companies whose very business model relies on limiting those remittances as much as possible would make things more efficient? If not, then there really is no convincing someone who has chosen to not listen to any new information, and will simnopy repeat the same debunked lines over and over again.
Or are you saying that a doctor could not treat 40 patients in the same amount of time that he could treat 30? This would be true, but in order to be relevant, you’d have to be making some rather unfounded assumptions that you have not bothered to even claim, much less justify.
It has been explained to you on several occasions in this very thread that that is not the case. You have not actually had a counter argument when that assertion is challenged, but you re assert it over and over again anyway, even though you have to know by this point that it is simply untrue and it’s not going to convince anyone at all.
Okay, would you say that a doctor in Canada pays more or less for medical malpractice than a doctor in the US? In the US, they pay differently based on state, but a quick google gets me a range of 4k to 34k. For Canada, a quick google gets me 2k to 12k, with often times it being at least partially reimbursed. Do those numbers sound right at all?
As far as set ups, I was talking about a system where the govt pays. As it is, insurance companies in the US will sue if they cover something that they feel was caused by negligence. The govt doesn’t need to do that in order to recoup costs, so any penalties towards the doctor would be specifically punitive in nature.
I know that there are many people in the US that sue for negative outcomes, not because they felt that the doctor did anything particularly negligent, but because they have to in order to get what has gone wrong fixed.
Medical malpractice is just one of many things that would be aided by having a UHC, especially single payer. But, at the same time, malpractice only contributes a small fraction of the cost to our medical system.
They not only kept going to the medical services they had been going to - emergency rooms - they also went to PHPs in addition. So this is incorrect.
Before they had coverage, they went to the emergency room. Then they got coverage, and they continued to go to emergency rooms, and also went to the doctor. So they started coming in more than they did before. Visits to PHPs did not replace visits to emergency rooms, and thus did not save money.
Yes, we will have to implement rationing in some form.
You can’t.
Yes, I need details, and I do not believe that having more patients automatically leads to more efficient care.
Facts are things that don’t go away, even if you don’t believe in them. That doctors lose money on 25-40% of their Medicare patients is a fact. This has been cited several times in the past.
The counter-argument is that this is an actual, true, documented fact. Deny it if you like, stick your fingers in your ears if you like, do the “I CAN’T HEEEEAR YOU” as loud as you like. That changes nothing.
Regards,
Shodan