Yes, I already mentioned in my post that they bitch about cost & about the overall system, etc. When they turn on the TV, all they see every day is someone on TV telling them this and that about the “awful” US healthcare system.
But as for their own healthcare…3 out of 4 like it. It’s alot like people being quizzed on congress. Most people hate congress, but like their own congressman. I’m not going to re-engineer a system where 3 out of 4 like what they have.
As for Canada’s satisfaction, I couldn’t care less. I’m not on this board hoopin’ and hollerin’ about what Canada needs to do to get better. You, OTOH, sure want to take the reins down here, and tell us poor rubes in the US what to do with our insurance. Come on down to DC, and educate our congressmen about your plans. I’m sure you’ll have no trouble getting them to buy in. (eyes roll)
I’m curious. Does anyone know someone who had brain surgery to cure intractable epilepsy in any Medicare system? Because I was given a choice: brain surgery or barbiturates for life.
Would any single-payer system pay for a very expensive surgery that is not guaranteed to work when a pharmaceutical solution, even though far from ideal, is available?
And would you want brain surgery in a system that doesn’t reward the best doctors more than the less effective ones?
@gtyj: Your post #181 is not responsive to the issues I raised. The comparison with Canada is relevant because it’s an almost identical socioeconomic system, but one with a very different approach to health care. I use it as a counterexample because it’s the system I know the most about, but I could just as well use many European examples like Germany, France, the UK, or Scandinavia. My loyalty isn’t to any particular system, as they all have their strengths and weaknesses, but to an accurate presentation of the facts about how these systems work.
As for presenting to Congress, yeah, much smarter people than me have presented the arguments for single-payer (and for the ACA public option) to Congress, just like much smarter people than me have presented to Congress the scientific arguments for climate change. The result has been even greater intransigence and digging-in by the reactionary side, the typical doubling-down on ignorance and ideology spurred on by the usual lobbyists representing hugely profitably industries. If you think this represents great wisdom on the part of Congress you are, to put it gently, mistaken.
I think 3 out of 4 who like their healthcare is self-evidently responsive to your post. It said that this roughly applied to employees as well as the general public. That’s a poll that’s more recent than the polling you linked. And I’m not going to re-engineer a system where most people like their healthcare.
Also, when I correctly pointed out numerous examples of UHC systems that actually have a lot of their population buying supplemental or using some sort of other private insurance to upgrade, you didn’t seem to be all that interested in the accurate presentation of facts then.
I know our congress is a bunch of idiots. And this is the group that you would have write the bill for single-payer, and then fix the bill once they saw problems? And you want to hand the keys to these guys to re-engineer healthcare, when we already have a system in place that could get us to UHC with minor tweaks? No thanks.
IANAD, and couldn’t judge the particulars of your case even if I was, but it seems clear that the general answer is Yes, single-payer would and does pay for it. And here is an Ontario surgeon who advocates it.
Again, due to the nature of single payer, the payer does not make decisions at the clinical level the way that private insurance does. Private insurance may well decide that they won’t pay for surgery because a pharmaceutical option is available that is cheaper. Single payer either lists this type of neurosurgery on the fee schedule or they don’t, and in this case they do, because they’re ethically obligated to list all broadly accepted medical procedures. It then becomes purely a medical decision by the attending physician, not a bureaucratic one by the payer, as to whether surgery is an appropriate option. The first linked article suggests that physicians have been reluctant to recommend this type of surgery because of the perceived risks, and because it’s not always applicable, and that this reluctance has been common to both the US and Canada. But at least in Canada, with single payer, you won’t have insurance bureaucrats getting in the way if the neurosurgeon thinks the procedure is appropriate.
Why wouldn’t the best doctors be rewarded under single payer? They typically get prestigious highly paid positions in renowned hospitals, which in some cases may be affiliations in conjunction with their private practices, and, if they are so inclined, their reputations might attract large grants for world-class research.
Serious question. Is that insurance linked to your employment? Like if you were fired would you have the chance to keep that insurance anyway at a reasonable monthly fee?
When choosing your surgeon did you pick the one who had the highest percentage of successful outcomes and, if so, where did you find this information? And were the successful outcomes measured by short term or long term results? Were the results from many years ago or recent?
I had insurance through my employer pay for such surgery. If I hadn’t had that insurance, I would either be in debt forever, or on barbiturates and not posting here.
Doctors have stopped taking Medicare and Medicaid because they don’t get paid enough. People actually do want to get paid for their hard work, and want to get paid more for better work. When the government dictates how much people get paid without considering merit, human nature will make many inclined to stop striving for excellence.
There are so many things wrong with those statements that I barely know where to start. First of all if Medicare and Medicaid payments are too low, that’s only relative to the cost structure that the private insurance system has imposed on the entire health care system, which is what makes being a doctor so hard and stressful in the US, and indeed is driving many doctors out of the profession and causing aspiring medical students to have second thoughts. Providers fees are regulated in one way or another pretty much everywhere in the civilized world outside the US, and if this caused doctors to be as seriously underpaid or disincentivized as you suggest, then they would all have quit or moved elsewhere. But they haven’t.
Next, you seem to be under the impression that doctors do just fine in the mercenary environment of private insurance, and do badly when the evil government gets its grubby mitts on them. This is absolutely false. In fact private insurance is responsible for many aspects of the major stresses on doctors’ professions that is driving many doctors right out of the area of clinical practice, most notably the challenges of getting paid. As someone said in another article I was reading on this topic, “you don’t put someone through all those years of medical training and then have them run a claims processing operation for insurance companies.” Some other comments from the above CNN article on doctors leaving:
Perry said she’s “seeking to get out” of her profession because she’s fed up with insurance reimbursement challenges while struggling to cover other costs associated with being a doctor.
“When you get to a point where you feel unappreciated and you’re arguing with people about being paid, it takes away the passion for what you do,” Perry said.
…
Dr. Douglas Evans, 50, a pediatrician based in St. Joseph, Mo., said he’s considering a mid-career change if insurer-provider relations aren’t reformed.
“I had a young football player in my office [this week]. His symptoms indicate a problem with his neck,” he said in an example. “But I have to get authorization from his insurance company first to get an X-ray or an MRI. It’s an example of how insurance companies dictate to me what I have to do.” … And Evans said insufficient reimbursement from insurers is posing a heavy financial burden on his practice.
At some level money is of course a factor in a doctor’s job satisfaction, but considering the extremely high stresses (and high suicide rates, believe it or not) associated with the job, it’s far from the only factor, or the most important one. Doctors want to be left alone to do the things they were trained for and love to do – the practice of medicine, not running accounting back offices that fight with insurance companies, or with malpractice lawyers. And they understandably want to be able to practice medicine with the appropriate clinical autonomy, without the endlessly frustrating meddling of insurance bureaucrats.
If they get that environment, as they do to a large extent everywhere else in the world, then they are naturally more willing to accept lower fees if those fees are reasonable, give them a generous and comfortable living, and leave them free to do what they were trained to do and get satisfaction from doing.
In addition to that, and among the plethora of things that you’ve ignored, is, as I said before, that the best doctors are also free to combine their private practices with prestigious affiliations or permanent positions at leading hospitals, providing significant income and recognition, including work at renowned teaching and research hospitals where they might engage in major research projects. That sure sounds to me like a career package that beats fighting with insurance companies and not being able to make ends meet.
Perhaps it is not that their situation is do great, but it is a result of cognitive dissonance. Someone picking a doctor is going to think that the doctor is good, because otherwise he is a chump for picking a bad doctor.
And I wonder if all those without doctors thanks to no insurance in our system are counted.
Now, when I checked Medicare Advantage plans, the doctors they had in network was quite limited. But that is, remember, more or less private insurance.
I’m very glad you had insurance.
I hope you feel the same about those who would qualify for Medicaid under ACA but are blocked from getting it thanks to red state governors.
We had this debate in the 30s. Your side lost. The rest of us won - we won programs that absolutely should exist and which make the country a better place to live in for everyone, and we won the ability to implement those programs, even if a bunch of old dead guys who lived in a world where the advances we’ve made were literally not even science fiction yet might throw a bit of a hissyfit about it.
Huh, that’s weird. See, the way I read your argument, the main premise is that if everyone has access to medical care, demand will far outstrip supply, and therefore we’ll have to ration. Okay, I get that. Yes, in a healthcare system where demand outstrips supply, we have to ration the product somehow.
But… here’s the thing.
The demand does not magically rise because people can afford it. We already have a healthcare system where demand badly outstrips supply.
If you have 10,000 diabetics and only enough insulin for 9,000, then no matter how you apportion that 9,000, there will be rationing. We don’t generally call it rationing when the free market decides who gets what limited resource… but it is still rationing. It’s just that the product is being rationed by “who can pay the most” rather than by any other means. The question is, is that a good idea when it comes to healthcare? I don’t think so, because of the existing empirical evidence that basically every first-world country has better, cheaper healthcare when they circumvent the market either partially or wholly on healthcare.
Also, to whoever asked, “Well, if it’s such a good idea, why don’t we have it already”, the answer is that one party in the USA is firmly opposed to any expansion of the social safety net, and will fight tooth and nail to prevent it from happening - and has, since at least the 90s. It’s not the only problem the rest of the world has pretty much covered and you seem to be struggling with. Maybe ask yourself why.
Medicaid doctor participation in the US is about 70%. That is, about 70% are accepting new Medicaid patients. The link below lays out some of this, and obviously in a country as large & diverse as the US, the numbers vary.
Private and Medicare are both around 85%.
Medicaid is much more stingy than private and Medicare in what it pays to doctors, hence the lower participating rate. I think doctors will vote with their feet, so to speak, as private is a better deal for them than Medicaid. OTOH, Medicare is a different animal.
Why do you say so? There have been several studies on people’s Medicare decision-making, and their ability to find and enroll in the least costly option is suspect, at best. And once enrolled, they often stick with the same plan even when that plan has a steep increase in price. People have too many options, not enough information and resources, and have generally low health insurance literacy. What they have lots and lots of is advertising.