That pretty much sums it up IMO.
Though I wouldn’t go with “never”.
Near future…yeah, not happening.
I never thought I’d never see gay marriage or legal pot in my lifetime.
I bet some form of “death panels” and euthanasia become acceptable as Gens X/Y/whatever face the prospect of taking care of a bunch of doddering senile boomers. Hell, the boomers I know are having enough trouble with the financial and emotional costs of warehousing barely (or non-) sentient relatives while something as simple as O2 and a pacemaker keeps their carcasses twitching near indefinitely. Just wait till all us fat boomers are in that state.
I like that joking prediction that in a few years 1/2 the American population will be on dialysis, and the other half will be employed administering it to them! 
Well, yeah that or die a beet us treatments 
Single-payer is a long way from the NHS.
But yes, the law firms I litigate against have any number of billing clerks, and my agency has none. We still have a large infrastructure for paying our costs, handling settlements paid in and out, and so forth. It’s just not as visible.
Or to put it another way, every other industry has accounting departments, and yet no one’s costs go spiraling out of control because of them.
Its easy to say we should just go to the single payer system when you don’t work in the healthcare field. There are many healthcare professionals like me who have recently spent several hundred thousand dollars on our educations. Moving to a single payer system will further reduce the amounts professionals are reimbursed for their treatment. This means that physicians will start to see even more patients in order to make enough money to turn a profit and your treatment will suffer. Remember that politicians would have to fight with the AMA, ADA, etc to get such a massive overhaul through Congress which won’t be easy.
Also, think about the impact such a move would have on the future generation of Doctors. Its already gotten to the point where the cost of school almost doesn’t make it worth it considering how difficult a job physicians have. We will lose a lot of good clinicians to other careers with a move to the single payer system.
I actually bought and kept a paper copy of Time Magazine’s issue with the article entitled, “Bitter Pill: Why Medical Bills are Killing Us,” which you can find a PDF here. (Sorry, I could only link to this PDF – otherwise you have to go through Time’s pay wall and who the hell pays for content anymore?) Because it very clearly laid out exactly all the factors that go into why our bills are so damn high and why we spend more per person on healthcare than any other first world county. Some costs can’t be controlled but some things can. If you’ve ever gotten a hospital bill and wondered why a single aspirin cost you $58.23, this article explains that. It’s a pity so many people have forgotten about it already.
No, the savings are enormous. A third of US medical waste is 3/4 of the US military budget. It is almost twce planet earths medical research spending.
Whether you actually need to conduct billing at all depends on the system. Some systems do very nearly nothing, others do more. Even the ones that do a lot of billing, such as Germany and Switzerland, still do vastly less than the US. A lot of that is because they have an overarching system, rather than hundreds of entities interacting.
In our system here in Norway, we have co-pays. When I go to the doctor, I pay a co-pay. I do this by stopping by a card machine on the way out. If I forget, I get a bill in the mail. At no point is work involved for anyone in the doctors office. Where I work, we are private health care, and our customers pay us twice yearly. Sending out the bill is a small part of the secretary duties.
I do not believe there is a single person whose job is dedicated to billing, liaising, negotiation, credit-checking or chasing down payments in the public healthcare system in the city. Not one. Any extra work like that which does crop up will be foisted off on a secretary. There won’t be any extra hires. Purchasing supplies is part of the administrators jobs.
There will be a few people centrally dealing with purchasing who negotiates and similar. The point is that the interactions of large numbers of systems and entities in the US creates immense amounts of red tape. I expect the average US hospital may well have more people and man-hours dedicated to these things than many developed nations.
That is not at all what I said.
I pointed out that the average hospital employs hundreds of people to do work which is unrelated to actual health care delivery, and which other systems simply have no need of.
Waste is things like doing an expensive intervention which does not improve outcomes, or leaving off doing things for someone without insurance, resulting in an expensive emergency room incident down the line. Reducing waste would absolutely reduce medical costs. It is one of the chief ways of keeping costs under control in the world.
Why do you think other developed nations cover their entire populations for less money than the US spends on government healthcare?
Not for profit does not mean efficient. A big problem is that each hospital/medical center, profit or non-profit, feels that the need the latest equipment to stay competitive. If you have the latest equipment you need to encourage your staff to get patients to use it. So we have waste. A single payer system that does not discourage this kind of behavior is not going to be as efficient as it could be.
Atul Gawande has written a lot about the source of excess costs. It is not all greed, and a lot of it would stay even if we did have socialized medicine.
That I would have to pay for solar panels for my house in no way means that I won’t get long term savings from doing it.
As much as I appreciate it, unless you want them to drop dead in your waiting room you are going to be stuck treating people who make bad choices. But evidence and outcome based medicine is a good example where you can reduce the amount of treatment without reducing the effectiveness of the treatment.
The buggy whip makers managed.
Why do you think that? I mean, it mystifies me. I mean, is there some magical cause and effect mediated by the Wicked Witch of the West?
Maybe if you got your results up to the level of other developed nations, you could pull that. As it is the people who cannot afford proper healthcare pull down your results so far that its pretty irrelevant whether you see a few more patients or not.
Given how few physicians you have per head compared to many single payer nations, I suspect you see more patients regardless.
A valid point. The vested interests are pretty powerful. This is often advanced as an argument for using the German system as a model.
I suspect if they were only in it for the money, they were hardly first rate clinicians anyway. However, the fact that your medical education is so expensive is a point. Happily, salaries are pretty independent of system.
Yes, but how did the bug whip maker MANAGERS fair?
Yes, but you, as an individual, are not required to contract with a private party in order to access health care. You might have a private company doing administrative work on a government contract (much like Blue Cross does for Medicare) but it is NOT like in the US.
This is kitchen counter chemistry, it would cost less than a dollar to sterilize a liter of salt water at home.
“Could have” is not the same as “should have”.
As an example, when my dad was diagnosed with lung cancer he chose to forego chemo, radiation, and surgery and go straight to palliative care. He did that after testing and consultation with his doctors and realized that aggressive treatment wasn’t really going to buy him anything but misery - his greatest fear was that he’d be out somewhere, collapse, then wind up being treated aggressively in an ICU.
Which is just an example of how we do stupid things NOW. And why the cost cutting question is so damn complex.
When my mom - end stage heart disease, beginning vascular dementia, etc. - was in her 70’s one doctor kept sending her for mammograms? WHY? There was no way she’d survive cancer treatment for breast cancer, the rest of her body couldn’t take it, so what’s the point and why are we spending money on that? (As it happens, my sister the MD put a stop to that). While I’m no fan of arbitrary age cut-offs there comes a time when we SHOULD discuss whether the cost/benefit ratio is worth it, based on the patient’s actual condition. But this gets twisted into “death panels” rather than being patient education and choice.
Heck, there’s another active thread right now discussing whether or not pneumonia can be a “blessing” the frail elderly and whether or not men need testing for prostate cancer.
We’ve got a problem with over-treating medical conditions in this country. Yes, there’s probably a profit motive at work somewhere in there, but no one seems capable of having a rational discussion about it.
Likewise, triage is a valid concept in medicine, except when you speak to an entitled American who expects instant treatment for anything and everything. So maybe you have to wait in line for hernia surgery if your case isn’t a serious risk, or maybe you don’t get an MRI for what is almost certainly just a sprained ankle (of course, if in either case things get worse that’s a different matter).
I’ve had great health insurance at times and gotten first class treatment. I’ve also been without health insurance and had door after door slammed in my face. Why? I’m the same person in either case, why is my health worthy of attention when I have private insurance but not worthy when I don’t have it?
I see people mention that if you’re over X age in a particular country you won’t get, say, a liver transplant… but in the US it doesn’t matter what age you are, if you don’t have insurance you won’t get one. At least the age cut-off arguably has some medical basis (is a 92 year old going to survive that sort of surgery, for example) rather than just saying because you’re poor you’re life isn’t worth saving. How is the latter any better than the former?
OK, but do you know the exact percentage of salt that should be in medical saline? I don’t. Do you? It’s not something to randomly experiment with if you’re ill.
Do you have the skills to keep that saline sterile and uncontaminated until it is delivered?
It’s not just “can you sterilize salt water in a pot on the stove?”. There’s packaging and product quality and integrity that go into this. That’s where some of the additional cost comes in.
Of course, not for profit, does not mean no one is profiting monetarily… Healthcare facilities designated nonprofit, are still operating on capitalist principles, contributing mightily to our fucked up system.
I certainly have no objection to health care providers making a damned fine living. Doctors and nurses should be very well paid. Unfortunately, when I’ve undergone procedures I’ve been dismayed at how little actually goes to the doctor…
Also, tho I’m sure they are a small minority, there are a few docs who fatten their pockets by providing unnecessary treatment, just because it will be compensated.
cracks knuckles
There are 3 meta categories of wasteful spending in the US health care system.
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Administration - our system has lots of red tape, duplication of efforts, contradictory forms, etc. A streamlined, universal administration system would save a lot of money (hundreds of billions a year).
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Lack of market forces - neither public or private forces play much role in driving down cost or driving up quality. Private forces like consumers or insurance companies lack the clout to drive down prices, and the public sector isn’t allowed to negotiate (medicare can’t negotiate for drugs for example). Making insurance companies compete with medicare via a public option, allowing the government to negotiate prices, creating all payer systems, making prices transparent, rewarding consumers for price shopping, allowing importation of medical supplies from foreign countries, etc. would all drive down prices.
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Overutilization - because we are a fee for service system there is a strong incentive to push for the most expensive treatment possible even when it doesn’t work any better than a cheaper intervention or no intervention. People in the US get more surgeries, more scans, etc. In the US you are more likely to get spinal surgery than in other wealthy countries for example, but 2 years out there is pretty much no difference between surgical vs conservative treatment groups other than which one spent more money.
So basically the bulk of why we spend 2x more on health care than any other wealthy country comes down to one of those 3 things.
Why are we not doing anything about it? Because we are a plutocracy and health care is 18% of the economy. The pharmaceutical industry, insurance industry, hospital industry, medical goods industry, etc. all prefer an overpriced system because that means more money for them. That is a big part of it. Politicians aren’t going to piss off all these wealthy groups at once by proposing meaningful reform. Add in the right wing philosophy that the public sector is inherently bad and all the NIMBY people who are afraid reform will hurt them and there is no political will to reform the system.
There is ‘reform’ but it is pretty much token IMO. If the US’s health care were as efficient as what they have in every other OECD nation, we would save 1 to 1.5 trillion a year in health care costs. Is anyone pushing reforms that’ll cut 30-50% off the US’s health care bill? No, they are all pushing pilot programs but the US still spends 18% of GDP on health care.
That may be part of it, but a procedure that costs $1000 in the US may cost $100 in Japan. Daraprim, the drug that Martin Shkreli raised to $750 a pill costs $0.02 a pill in Brazil. So you can treat 37,500 patients in Brazil (going just off of the drug cost) for the cost of treating 1 patient in the US.
This talk of rationing is silly. Rationing happen in our system now. It happens in any system. The question is, “by what criteria do we ration?” Right now we ration by ability to pay. Other systems ration by expected outcome, or other criteria. But nobody and found a way around the death panels. We just use something different to decide who dies.
I just underwent a completely routine, absolutely normal procedure that is absolutely covered by my large, very popular, very normal health insurer.
A few weeks later, I got an $800 bill on the mail. They had decided it wasn’t covered, based on an utterly bizarre interpretation of what happened. To reiterate, this was a routinely covered procedure. My provider process dozens of the exact claim bill to the exact same insurer weekly. It’s one of the most normal things a person can do with insurance. But the moon was in the wrong quadrant of something when they looked at my bill, and they decided they could just decide not to pay it that time and kicked it back to me.
It took me about five hours of my time to sort out what happened between the insurance, the provider, and the provider’s billing company. I bill about $30 an hour, and the people on the phone get paid as well. Eventually, I sorted out the story (no easy feat when the insurance company refuses to actually tell me what is and is not covered), wrote an appeal letter, and was promptly awarded the appeal. This took hours of my time, and hours of their time. To what end?
Where is the efficiency in THAT?
Given that most medical expenses in a person’s lifetime come within their final few months of life - about 50% of Medicare expenses are racked up within people’s final two months of life - we could save a metric crapton of money by instituting a practice of only offering palliative/hospice care to anyone who has lived beyond the average lifespan. The political fallout of that would be super ugly, though.