I’m sure I do go to the doctor at least 50% more often than I would if I didn’t have insurance. But that doesn’t mean I go for every sniffle. It does mean I went to the doctor after the second time my heart started racing for no apparent reason- which I probably wouldn’t have done if I didn’t have insurance in which case, I wouldn’t have found out about my heart issues until I had a heart attack and probably would have needed bypass instead of a stent. It means I get screening tests when the doctor recommends them, which I probably wouldn’t do if I didn’t have insurance.
When I didn’t have insurance, if I got sick, I dealt with it myself. That almost killed me when I developed pneumonia. Finally, someone got me to go to an urgent care.
A $100 doctor visit 50% more often is not what will be costing money. It is the massive increase in the cost of treating something that didn’t get caught until it was in late stages, because the patient didn’t go to a doctor until they were unable to ignore their condition any more.
I bet the number of insured who receive chemotherapy, open heart surgery, or transplants is much higher among the insured than the uninsured. Are they just doing that because they want to waste resources, or are the uninsured not doing that because they have fewer health problems?
I’ve no doubt that this is true, but it’s also a good example of what I mean by the structural differences in a truly universal system. In a true UHC system, what would the paperwork be for? Here’s how it works in the single-payer system that I’m familiar with. When I go to the doctor I present my health card. When we’re done the doctor or his assistant enter the code(s) for the service(s) performed – for example, A005 for a general consultation – and submits it electronically to the health plan. At the end of the month all the submissions are paid by the plan and the funds transferred by EFT. What “paperwork”? As long as the health card is valid there’s nothing to quibble over and nobody to do the quibbling.
So? I’m surprised that people without insurance go to the doctor at all. The question you should be asking is, which group gets the appropriate level of medical care.
And all they have to do is check up on a small random sampling of patients that the doctor billed for to ensure that billing is accurate, if fraud is a concern. Much easier to detect than our current system. I assume that in Canada, doctor’s practices are prosecuted rather severely when they are found to be committing fraud?
The uninsured go to the doctor when they have no other choice. When they are in so much pain or in so much disability that they are unable to function in their daily lives anymore. At this point, the cost of treating them is generally going to be significantly higher than if they had come in when they were just “having the sniffles”. Patient outcomes can be fairly disappointing then, especially given the cost.
Around here, we have urgent care, which charges a flat $100 to see a doctor. They don’t do a whole lot, they poke you a bit and write a prescription, but that is really what 90% of doctor visits are anyway.
I’m not sure you are reading this paper correctly. Table 1 is the only one which shows the non-insurance case, but less than 1% of those surveyed have no insurance (since this is an elderly population) so conclusions about them are a bit iffy. The authors note the 1% number and say that this shows the prevalence of insurance for the elderly, which is not what you are getting out of it.
I didn’t find anything about particular visits. You only have a complaint if increased insurance coverage pays for spurious visits, not for useful ones which would not happen with decreased coverage. It looks to me like hospital admissions track doctor visits reasonably well. Since hospital admissions are not self-initiated, that would show that doctor visits are reasonably justified.
Medicaid patients have more visits, but also worse health. (p. 135) Also the ones with private coverage are wealthiest and have the best health with fewer doctor and hospital visits. Rich people are healthier than poor people - not exactly surprising, is it?
Now if Figure 3 there is an increase from no insurance to Medicaid. The significance is dubious thanks to the low size of the no insurance population. But you’d think no insurance would have a similar wealth distribution as Medicaid. Their doctor visits are much lower, but their hospital admissions is close to Medicaid and above Medicare only. That would seem to indicate that their underlying health is close to those of Medicaid patients, but costs keep them from the doctor.
Look how low the dental visits are. Since regular checkups would be covered, but can be skipped because of financial reasons, it would seem the no insurance people are skipping preventative care because of money.
In Section 6.1 they report that health is correlated with seeing a doctor, with those in worse health seeing doctors more than those in good health. Since the poor have worse health on average than the rich, poor patients with insurance should see the doctor more often than richer patients, as is borne out by the Medicaid numbers. If no insurance patients are poorer, they should see the doctor more often also. If they do not, it must be because they can’t afford to.
A similar thing happened to me. I got rejected trying to donate blood because of a racy pulse. Since I had drank a lot of Mountain Dew for lunch, I was sure it was that, and went to the doctor to get a note allowing me to donate again. Surprise, I had AFib. If I put off going to the doctor because I couldn’t afford it, I might be dead today.
I think the main argument against “Medicare for All” is that it wouldn’t save nearly as much as people think. Matter of fact, early on, it might cost more, at least until it’s had a few years to settle. And it would be too disruptive to our current system. Our system is not perfect and efficient, but getting out of it would dislocate a lot of people from their jobs and it would probably drive a lot of doctors out of the profession if they thought they would be taking a big paycut.
Also, in the face of Trump, I’m glad that our Health Insurance system is state-based. I’d be worried that a Medicare for All scheme would be targeted and dismantled under the wrong set of political leaders. And so, I’d like to keep state-based, with a lot of private insurers in the game. I like private involvement in healthcare, both from the insurer and provider side, as it drives more innovation, too.
We could take the current system we have, which is a patchwork of public and private, and get to over 95% insured if we did a few things: 1) get more states into the Medicaid expansion, which is slowly happening; 2) increase the income level that qualifies for premium subsidies under the ACA, to make it a better deal for the middle-class who don’t get their insurance through their job.
I’d prefer to keep what we have, and just make it better. I know that politically that is not currently possible. But I think over time, Medicaid expansion will be the law of the land, and I think that a few smart adjustments to the ACA would make it more acceptable to everyone.
Been there, done that. Every one of those arguments was made when the province of Saskatchewan was switching over to the first single-payer health care coverage system in Canada. Every single one. Except that “drive a lot of doctors out of the profession” was “drive every last doctor out of Saskatchewan”. None of them turned out to be true. Not one. OK, except for some people in the private insurance industry losing their jobs, but the unfortunate fact is that those people work for a parasitic industry that is a cancer on the practice of health care, sucking away resources and adding absolutely no value. They need to find honest work.
And if not saving a lot of money is the “main argument” against UHC, then the argument is already hopelessly lost. Every universal health care system in the world operates at just a fraction of the exorbitant per-capita cost of US health care. Canada’s system costs about half as much per capita, the OECD average is barely more than a third as much.
It’s fine from the provider side, as long as it’s well regulated. What meaningful medical innovation has ever emerged from the insurance side? What people want from a bill-payer is to pay the bills. It’s not complicated. When they need medical care, they expect it to be covered. It’s not a complicated model and doesn’t require innovation. Paying the bills is the one thing that you need and are entitled to expect your health care insurer to do, consistently and unconditionally, and it’s the one thing that private insurance fails to do. Whenever they question a claim, cut down a claim, or deny a claim, they are failing in that essential obligation. It’s the nature of their business, which is why they shouldn’t be in that business.
It would definitely dislocate a lot of people out of their jobs - but I’m not all that certain most doctors would be taking a paycut. According to this
blog*, it seems that Medicare does not actually pay less than other insurers and I’m sure few if any uninsured patients actually pay the inflated bills in full. That of course doesn’t mean doctors wouldn’t *think *they were taking paycuts - according to the blog author , most doctors don’t actually know how much they are paid to see a patient because the system is so complex.
- The blog is interesting- now I know why my doctor used to bill my insurance company $175 for an office visit when he charged self-paying patients $70. I say “used to” because his office doesn’t currently participate in my network. Not because he had a problem with my insurance, but because he sold his practice to a hospital that wasn’t in my network and is now an employee. And he did that because he wanted to spend more time being a doctor and less time trying to get paid.
I don’t think Saskatchewan would be very analogous to the US. I think that it’s a very different situation, with much more of a diversity of experience & coverage in healthcare in the US. It’s such a huge part of our economy, I wonder if the dislocation is worth it, and how easy could costs actually be cut in a sector that’s so ingrained in our economy.
And I noticed you didn’t address my point about state-based regulation being preferable as part of “Trump-proofing” a system. I’m worried about a nationwide single-payer system being under the thumb of people like Trump or McConnell. I think having a diversity of approaches via the states is uniquely American, and I’d prefer that to Medicare for everyone. When the federal government forces everyone into one system, I worry about how well that holds up over time as the politics of the nation ebbs and flows.
I think private insurance schemes have been very helpful at times to help control costs, experimenting with networking, contracting, care organizations, and the like. It’s also allowed different employers to attract good employees. It’s different than just paying bills. Companies have come up with a variety of approaches that can help. And having private providers and insurers gives an opportunity for more experimentation, especially within different state markets.
If I were designing something from scratch, I wouldn’t have the US system. But it’s what we have, and I think it’s not as bad as people make it out to be. 90% of people are covered with something, and about 85% of them are happy with what they have. In any other issue, that’s a strong consensus.
Yeah, that’s kinda the point of universal health coverage. :rolleyes:
As wolfpup, and Spoons, and muffin and I, and numerous other Canadian posters have repeatedly said over the years, the federal government in Canada doesn’t run the healthcare system. Don’t set that up as strawman argument to knock down the Canadian system. There may be other issues with our system, but that isn’t one of them.
Like you, we’re a federation. We don’t have a nation-wide single-payer system. We have 13 different systems, one for each province and territory, which means that each province and territory gets to design their health care system for their local needs; “diversity”, if you will. The feds pay a big chunk of the costs, and set the very general guidelines for the provinces and territories to get paid, but don’t run the healthcare systems. The Ontario system, with its huge population, is different from Prince Edward Island’s system. Saskatchewan’s system, with our mixture of medium-size cities and huge areas of sparse population, is different from more compact provinces like Nova Scotia. And so on.
That’s the strength of a federation, whether Canada or the US: a mixed system where both the feds and the provinces/states are involved in different aspects of the system.
I cannot figure out what those words are supposed to mean. It sounds suspiciously like “what works in every advanced country in the world won’t work here because … reasons.” The Canadian provinces among them have some of the most diverse populations in the world. As for “diversity of coverage”, whatever that’s supposed to mean, there is only one satisfactory kind of health care coverage: full coverage for all medically necessary procedures, always, and without condition. In this need, and in all other respects of health care coverage, the US is no different than anywhere else in the world.
Health care is a huge part of the economy everywhere. That’s why it’s so important for its implementation to be efficient.
I didn’t address it because it’s immaterial to the discussion. There’s no reason that an American single-payer system could not be state-administered, and in fact it almost certainly would be, as it is in Canada. But there should also be federal coordination with respect to basic standards, and provision of subsidies for smaller or poorer states.
I asked for a single specific example of how private insurance has ever provided a meaningful medical innovation, and you still haven’t given one. Their futile attempts to control costs are not an “innovation”, they’re an impediment to access, and moreover, they don’t work; if they worked, the US wouldn’t have by far the highest health care costs in the world. Provider “networks” are a direct impediment to access. There’s no such thing in single-payer, where I can see any doctor, go to any hospital, use any provider I want, and always be assured that any service will be covered. How is being limited to the insurance company’s choice of provider any kind of benefit to the patient?
Access to health care is a basic human right, in my view, in the view of the United Nations charter of human rights, and in the view of every civilized country in the world. Holding it out as a carrot and as a condition of employment is hardly a benefit or a feature; it’s barbaric, more like a form of indentured servitude. It also discourages independent entrepreneurship and greatly exacerbates the hardships of job loss, as well as imposing needless costs and administrative burdens on employers.
No, health care coverage in its purest form is just about paying the bills – not scrutinizing them, not questioning them, not meddling between the patient and their doctor, just paying them. There are of course many other important aspects of health care related to the regulation and administration of providers, and government health departments perform those functions, too, but those are separate and distinct from the payments unit that just pays the bills.
If the private health care system in the US works to control costs, why are you paying a greater share of your GDP for health care than any western country with Universal Health care?
If the private health care system in the US works to control costs, why are you paying more public dollars, as a percentage of GDP, than other western countries with UHC, and yet can’t reach 100% coverage, of every single American?
Here’s a great experiment with networks: one network for the entire country.
Canada has one network. I can walk into any clinic, any ER, any hospital, anywhere in Canada, and I’m in network. And so are all the MDs, nurses, techs, and physios in those ERs and hospitals. My Saskatchewan health card works in Toronto. Tuktoyaktuk. Baie Comeau. Labrador City. Halifax. Hudson Bay. Iqualuit.
Wherever there’s a doctor, I’m covered. What’s the better network that private insurance in the States has developed?
I’d never heard of networks until the health care debates started up here on the SDMB.
No idea what that means.
If I have a great idea tomorrow and want to quit my job and start up my own business, I’m going to have to worry about a lot of things, like financing, paying the bills, hiring staff, marketing - making my idea work.
The one thing I won’t have to worry about is losing my health insurance. I can walk out whenever I want, and I’m covered, because my health care isn’t linked in any way to my job.
How is tying someone to a job, not because they want the job, but because they need the health care, and restricting their ability to be an entrepreneur, or just switch jobs, a good thing?
Tell me, that 85% happiness ratio: is that saying that 855 of people who have an insurance plan are happy with it? Or is it that 85% of the people who’ve tried to make a claim on their insurance are happy? Often, the issues with your insurance only come to light when you want to make a claim.
In other words: Cite, please.
Then there’s the fraud to gain access to massive amounts of opioids to sell…
There is plenty of fraud in that respect, most of it involving the drug companies selling these drugs and the small number of doctors who write significant numbers of prescriptions. These doctors get recruited by the drug companies and get rewarded with big speaking fees even if no one is in the audience.
A single payer plan might help in that these doctors would stand out, and be easier to catch.
I love the ads from the opioid makers: we make these drugs, why would we want to abuse the system? To sell more you idiots!
Medicare is one big network, with even more market power than the biggest insurer. Networks today lead to things like massive bills when someone involved in an operation is out of network, and you are never told and never know until the bill comes.
HMOs are an innovation, but not a new one. My father was in an HMO when I was born in 1951.
Well, they could just pay more when health coverage is not an issue. And those not lucky enough to be qualified for good jobs with insurance won’t get screwed the way they do today.
Innovation possible when someone can start a new business without worrying about health insurance has already been mentioned. But US companies who have to build health costs into their product costs are at a competitive disadvantage with foreign companies who don’t.
Please give some examples of good experiments that wouldn’t happen automatically in a single payer plan. I can’t think of any except nurse lines. I wonder how often they get used. I never have.
That is just like the fact that most Americans like their Congressperson in particular but hate Congress in general.
I’m intrigued by this argument that medical insurance companies are involved in health care innovation and development.
If so, it’s not like other insurance companies.
If you get in a fender bender and need repairs, you go to a good body shop. They may be the innovators, with new equipment and techniques. The insurance company just pays. Has there ever been a case where the insurance company has innovated in new repair equipment and techniques, and the body shop learns from the insurance company?
Same if your roof blows off in a windstorm. You ask around for a good roofer who can fix it. It’s not the insurance company that comes up with new roof repair systems and expertise. They just pay the bills to the roofer.
Innovation happens just as much in a nationalised system. It helps that the system, by its nature, creates a vast clinical database. I don’t know what the arrangements are in relation to the commercial application of any innovations that result, but my guess is that it’s sufficiently focussed on sharing the benefits to make it easier all round to adopt something beneficial.
As to the risks of a national service being at the mercy of changes of political whim at the centre, all I can say is that while our NHS goes through periods of fiscal squeeze and catch-up, with the squeezes mostly associated with one party and the catch-ups with the other, and governments of all stripes go through fits of reorganising the ways and levels of organisation in which budgets are distributed and local plans and priorities set, no-one of any consequence ever openly suggests a privatised system would be better (though there is an ongoing debate as to whether sub-contracting assorted NHS services to private providers is a disguised back-door route to privatisation). It was a Conservative who said (possibly ruefully) that the NHS was the nearest thing to a real national religion that we’ve got, but it means that anyone who did favour privatisation knows they would never get away with it politically. And this despitemassive opposition from the the Conservatives and from within the medical professions in the run-up to the creation of the NHS: but the medical professions were essentially brought round by financial incentives, and now there are very few in the provider professions who would wish to return to an essentially private system.
But one thing I only recently discovered was that the minister who got it all set up recognised from the outset that ‘Expectations will always exceed capacity. The service must always be changing, growing and improving – it must always appear inadequate.’ So if perfection is not an option, what would you compromise on?
Paperwork-wise, it works pretty much in the same way over here : the doctor swip my health card and enter codes corresponding to whatever he did. However, contrarily to Canada, we pay doctors upfront and are reimbursed later (by wiring on our bank account).
Typically, there’s one admnistrative assistant/secretary in a cabinet, taking the phone calls and such. I assume they have administrative duties too, but I wouldn’t know what exactly needs to be done in a doctor’s cabinet. More and more doctors entirely dispense with staff nowadays, relying instead on call centers for appointments and such (and since there are no nurses or assistants involved in anything medical, like taking vitals, in cabinets here, you typically have only the doctor and his secretary or just the doctor).