Single payer debate no so easy

Slavister · Sep 19, 2018

Part 2 of 2 reply to jaeger19

jaeger19 said:
Sure: View attachment 67240687

Hmmm.. we score 5 in timeliness.. oh and 3.. in effective care... and what did Canada score? Oh that's right.. 7 in effective care.. and oh wait.. 11 in timeliness of care.

First, what's your link for that image? Did you forget?

Second, did you notice that USA is neither #1 nor #2 in ANY of the categories?? You are just helping me to make my point. In case you forgot, my point was "I don't think this is true ... that our medical outcomes or care is that much better or better at all than other countries."

jaeger19 said:
Well first.... how is it "artificially bloated".. please explain how our healthcare system is artificially bloated.

:lamo

I refer you back to your own image quoted above. Did you notice that last line? We spend way more than anyone else per capita and we are not #1 or #2 in any single category measured!

jaeger19 said:
Hmmm So you think buggy riders made up 20-30 % of US GDP.. that's interesting. Nope.. I don't think buggy riders jobs are coming back..

First, from what I found it's 18%. Not 20-30%.

Second, guess what... Buggy riders were basically totally eliminated. You make it sound like single payer is going to destroy 18% of GDP. Noone is saying that. While there would be some layoffs (mostly in insurance industry), healthcare professionals will mostly be still employed, even if they make less money. So no, the damage will not be anywhere close to 18%.

jaeger19 said:
Actually.. that argument has already been made and has been implemented. In fact.. we have the system we do because of the tax industry which does employee a number of folks and it lobbies like heck/

... and I am saying that's crazy and should be eliminated. Are you saying you LIKE this?

jaeger19 said:
I would argue that we don't need to artificially create more jobs.. nor do we need to artificially DECREASE jobs in a growing industry that's growing not because of complexity.. but because of DEMAND for services from aging baby boomers.

You'd say that but that's not what the numbers show. I refer you back to your own chart. We spend a lot more and get something similar or less for that money.

jaeger19 said:
Now.. IF we took your argument.. Since in America.. we pay wages WAY more than say in mexico.. or China.. or many developed countries.. we should purposely artificially lower wages to 1 dollar per hour to be on par with other countries.. Why should I be paying these bloated wages.. when other countries pay so much less???!?!?

That's not my argument. If you pay $1/hour in US to a nurse, noone will want to become a nurse. However, I am guessing pay can get lower than what it is today for nurses and people will still be willing to go into the profession. In any case, more savings will come not from pay reductions but from eliminating health insurance industry for most services and lowering drug costs for pharma (and similarly for device companies), and from eliminating misc administrative overheads that medical professionals have to deal with daily (yes, that does include layoffs of secretaries, people in billing departments, etc.).

jaeger19 · Sep 20, 2018

Slavister said:
Canada single-payer system covers these "elective" join replacement surgeries. So what's your point?
.

IF the government thinks is necessary.

My point was that profits go to zero for the services no longer needed, i.e. most of coverages. Yes, clearly with private insurance companies still needed for non-single-payer services, profits would still be made. However, this would be MUCH LESS of an insurance industry vs what it is today.

Come on man.. be honest.. that's not what you said and that's not what you meant. AND in all likelihood.. we would NOT have "much less of an insurance agency".. Private insurance companies already make a ton of money off of public plans... and in all likelihood.. that will continue. So we will end up with a system where high cost, high risk folks who are middle class or poorer..and the poor.. will end up with a crappy government system that is administered by the private insurance companies... and if you are wanting to get the savings you it will.. it means that the poors coverage will be less than what it gets under Medicaid now. (Just like Canada's government system is less than Medicaid now)... then there will be supplement insurance for the upper middle class to make up what the crappy government insurance covers.. and then private insurance for the rich.

Now.. you will say "well why does it have to be crappy.. why do you think that".. and there is an economic reason.. because to get the savings that you believe you are going to get.. something has to give. OUR government insurances like Medicaid and medicare cover far more and are way more generous than just about any single payer system out there..

You are still misleading people... I randomly decided to fact check you on outpatient physical therapy... Let's see. In US, Medicare covers up to ~$2k in PT expenses, plus it does not pay all but 80% of charges via part B.

Nope.. you are misleading people. First of all Medicare covers far more than 2k in PT expense in outpatient therapy. Because there is an exemption process where patients can get far more than that first 2k. Secondly.. based on medicare allowables.. that means that a patient with a total knee.. will pay about 20 dollars for an hour of therapy.. IF they don't have Medicaid or some other co insurance.. which most folks have. Oh and based on the allowables on medicare? That's about 20 visits of therapy for an hour each time.
Just to get to that 2000 dollars. (depends on your area fee schedule.. but that's close)
Canada? their Government insurance does not pay at all for outpatient therapy.

Sounds like Canada does better at this coverage than USA. Your claim is that Canada has no coverage at all if false, and you forgot about how our government insurance has quite a few limits in its coverage.

Actually no.. the US does a much better job of coverage.. in fact. under obamacare.. insurance companies were required to provide coverage for rehabilitative services. Oh.. and you know that expansion of Medicaid? That covers all those working poor.. they are covered for outpatient services.. not so with Canada.

Yes, some classes are useful and needed indeed. I agree

Oh.. so now we are walking it backwards.

You don't need to waste 4 years on those that are needed

Well accept that its not a waste. In fact.. in many ways its essential to get better more well rounded students into medical fields.

More of that should be implemented. Further, medicine is getting more and more specialized. Everyone here goes through med school first and then specializes. Not ALL of that med school training is needed for every specialty. Most Docs forget a lot of the medical school rotations quickly enough. They are simply not relevant to them.

'

there is the irony here. First.. the reason that everyone specializes is because there is better reimbursement for specialties. They make more money and thus more people go into these specialties. Secondly.. this specialization is what INCREASES THE MEDICAL COST.

More specialists.. mean more costs to as its less efficient..

In addition.. the more you specialize physician training.. then you have high cost specialists.. treating things that before.. were more economically handled by general practitioners. We are seeing that now.. which is what has added to the cost. The less trained and knowledgeable a "gate keeper" or initial provider is..often the more likely they are to refer to a specialist (not to mention more likely to order unneeded tests)..

jaeger19 · Sep 20, 2018

Slavister said:
Part 2 of 2 reply to jaeger19
First, what's your link for that image? Did you forget?
.

Nope.. the source is listed on the bottom of the image.

Second, did you notice that USA is neither #1 nor #2 in ANY of the categories?? You are just helping me to make my point. In case you forgot, my point was "I don't think this is true ... that our medical outcomes or care is that much better or better at all than other countries."

Right.. and did you notice that Canada and many other countries did not score very well either? Wait.. but we scored better when it came to quality care and effective care.. than.. who? Oh yeah Canada. Oh and timeliness of care as well. so its not as clear cut as you want to make it out. most americans.. if they are in the 85% that have insurance.. will choose effective care.. and less wait times.. than "equity of care".. Its just how americans generally feel..

I refer you back to your own image quoted above. Did you notice that last line? We spend way more than anyone else per capita and we are not #1 or #2 in any single category measured!

Again.. how you do claim that is "artificially bloated".. Greenbeard has already supplied the evidence on why we pay more. A lot has to do with costs.. costs in paying nurses, and doctors and therapists and so on.. cost in having lots of medical equipment and lots in costs when it comes to having things like rural access hospitals. I would add that it also has to do with our demographics.. that americans often have more comorbidities like obesity and stress that raise costs... not to mention that our insurances also tend to pay for more in other countries.

Please explain how all of that is artificially bloated.

First, from what I found it's 18%. Not 20-30%.

Depends on how its calculated.. and whats included.. that's why the range was presented... Its still a VERY significant portion of GDP.. and will likely grow.

Buggy riders were basically totally eliminated

Because demand fell. Meanwhile demand for healthcare is increasing. But hey.. lets ignore that fact shall we?

You make it sound like single payer is going to destroy 18% of GDP. Noone is saying that. While there would be some layoffs (mostly in insurance industry), healthcare professionals will mostly be still employed, even if they make less money. So no, the damage will not be anywhere close to 18%.

Wow.. okay lets use your numbers. Now.. according to the big thing here is that we should go to single payer to get the savings other countries get... okay.. Canada spends about 10% of the GDP is healthcare. So lets simply drop our GDP by 8%.
Some layoffs?

The wholesale price index declined 33 percent (such declines in the price level are referred to as deflation). Although there is some debate about the reliability of the statistics, it is widely agreed that the unemployment rate exceeded 20 percent at its highest point. The severity of the Great Depression in the United States becomes especially clear when it is compared with America’s next worst recession, the Great Recession of 2007–09, during which the country’s real GDP declined just 4.3 percent and the unemployment rate peaked at less than 10 percent.

the Great recession.. which we just went through.. was just a drop of 4.3% of GDP.. and to get to Canada level of healthcare.. using your very conservative numbers.. You would cut GDP by DOUBLE that.

Meanwhile.. you would be doing that while DEMAND for that very healthcare is growing. AND as Greenbeard points out.. you know where our growth in employment has been..

Due to the inexorable aging of the country—and equally unstoppable growth in medical spending—it was long obvious that health-care jobs would slowly take up more and more of the economy. But in the last quarter, for the first time in history, health care has surpassed manufacturing and retail, the most significant job engines of the 20th century, to become the largest source of jobs in the U.S.
In 2000, there were 7 million more workers in manufacturing than in health care. At the beginning of the Great Recession, there were 2.4 million more workers in retail than health care. In 2017, health care surpassed both.

https://www.theatlantic.com/business/archive/2018/01/health-care-america-jobs/550079/

Oh... but you say.. "well there will just be some layoffs"?

Sorry sir.. but you cannot get the savings you claim... without dramatically hurting our economy.

jaeger19 · Sep 20, 2018

Boo Radley said:
I don't know what studies you've seen, but I put something in the opening post that supported what I say. And I don't believe in Santa Claus either. As I've said, no system is perfect, but we spend a lot now, more than nearly anyone, and yet, we have many people uninsure and not able to get the care they need. It doesn't have to be that way. It worth an honest look.

Yes... and HONEST look.

so how about you address and refute all the points that Greenbeard has made on his original post?

Slavister · Sep 20, 2018

Part 1 of 2 reply ...

jaeger19 said:
IF the government thinks is necessary.

... which is based on whether your Doctor thinks it's necessary. Even in US, not many people would be replacing their knee if their Doctor did not advise it or was not on board with it.

jaeger19 said:
Private insurance companies already make a ton of money off of public plans... and in all likelihood.. that will continue. So we will end up with a system where high cost, high risk folks who are middle class or poorer..and the poor.. will end up with a crappy government system that is administered by the private insurance companies...

You can claim this, but I see no proof of any of it. And again, there is no need for private insurance companies for things covered by single-payers. Just because we have it now, does not mean we need to going forward.

Further, part of the issue with Medicaid is that few doctors take it. If we go to single payer, many more Docs would have to accept it in order to have enough business.

jaeger19 said:
...to get the savings that you believe you are going to get.. something has to give. OUR government insurances like Medicaid and medicare cover far more and are way more generous than just about any single payer system out there..

I already said what's going to give. Savings will come from
- Private insurance infrastructure costs + profits.
- Administrative overhead for health facilities related to dealing with multiple insurance companies
- Overhead dealing with different billing systems
- Lower (perhaps not by much) compensation
- Lower drug costs
- I am sure I am forgetting other things too.

Many other countries have done it and despite your claims on how bad their healthcare is, that's NOT what the comparative studies show. US is not a leader in healthcare. Look at your own chart, like my prior reply said.

jaeger19 said:
Nope.. you are misleading people. First of all Medicare covers far more than 2k in PT expense in outpatient therapy. Because there is an exemption process where patients can get far more than that first 2k.

Got recent link to that?

Do you know for sure that Canada does not have an exemption process too?

Slavister · Sep 20, 2018

Part 2 of 2 reply ...

jaeger19 said:
Secondly.. based on medicare allowables.. that means that a patient with a total knee.. will pay about 20 dollars for an hour of therapy.. IF they don't have Medicaid or some other co insurance.. which most folks have. Oh and based on the allowables on medicare? That's about 20 visits of therapy for an hour each time.
Just to get to that 2000 dollars. (depends on your area fee schedule.. but that's close)

Lots of claims here. Yet no proof. Why don't you show me some medicare links describing what you just said?

You might instead find something like this: "Original Medicare covers outpatient therapy at 80% of the Medicare-approved amount. When you receive services from a participating provider, you pay a 20% coinsurance after you meet your Part B deductible ($183 in 2018)." So, AFTER deductible, you are paying 20%, not $20...

jaeger19 said:
Canada? their Government insurance does not pay at all for outpatient therapy.

Did you miss the link I provided where they DO cover outpatient therapy?

jaeger19 said:
Oh.. so now we are walking it backwards.

I agreed that some classes are useful indeed. You have an issue with that?

jaeger19 said:
Well accept that its not a waste. In fact.. in many ways its essential to get better more well rounded students into medical fields.

Clearly, I disagree. You can tack on many years for the purpose of "well-roundness" but it does not make any difference as far as practicing medicine. I don't believe cutting 2-3 years from the 4 BS + 8 Med school years would not affect well-roundness all that much but would be of great help to doctors, career and finances wise. That would allow us to pay doctors less due to more productive years in their careers and less loans needed before starting.

jaeger19 said:
there is the irony here. First.. the reason that everyone specializes is because there is better reimbursement for specialties. They make more money and thus more people go into these specialties. Secondly.. this specialization is what INCREASES THE MEDICAL COST.

More specialists.. mean more costs to as its less efficient..

When you can concentrate on a specialty, it's MORE efficient. There is TOO MUCH to know in medicine. You can't be good at everything. You have to specialize, just because we know so much more now and depth of our understanding of each little area is increasing. Yes, specializing increases costs (it takes extra time to learn the specialty), but you can start saving time by not doing a deep dive into unrelated specialties along the way. Docs from different specialties are already so much removed from the other areas that they are quite useless in them.

jaeger19 said:
In addition.. the more you specialize physician training.. then you have high cost specialists.. treating things that before.. were more economically handled by general practitioners. We are seeing that now.. which is what has added to the cost. The less trained and knowledgeable a "gate keeper" or initial provider is..often the more likely they are to refer to a specialist (not to mention more likely to order unneeded tests)..

I agree with what you said above. I am saying we can reduce costs while retaining specialization by starting to eliminate some things that are less relevant to each specialty.

Slavister · Sep 20, 2018

jaeger19 said:
Right.. and did you notice that Canada and many other countries did not score very well either? Wait.. but we scored better when it came to quality care and effective care.. than.. who? Oh yeah Canada. Oh and timeliness of care as well. so its not as clear cut as you want to make it out.

What's clear cut is that US is NOT better than others. It's somewhere in the middle of the pack. At much higher costs!

jaeger19 said:
Again.. how you do claim that is "artificially bloated".. Greenbeard has already supplied the evidence on why we pay more. A lot has to do with costs.. costs in paying nurses, and doctors and therapists and so on.. cost in having lots of medical equipment and lots in costs when it comes to having things like rural access hospitals. I would add that it also has to do with our demographics.. that americans often have more comorbidities like obesity and stress that raise costs... not to mention that our insurances also tend to pay for more in other countries.

Easy. Many (all?) other countries provide health care for cheaper. US health care is NOT better. Overheads are clear and I listed them in earlier reply.

jaeger19 said:
Because demand fell. Meanwhile demand for healthcare is increasing. But hey.. lets ignore that fact shall we?

I never said healthcare should disappear. I've been saying the opposite.

jaeger19 said:
Wow.. okay lets use your numbers. Now.. according to the big thing here is that we should go to single payer to get the savings other countries get... okay.. Canada spends about 10% of the GDP is healthcare. So lets simply drop our GDP by 8%. Some layoffs?

If we have 8% of overhead and fat, then yes, SOME layoffs in HEALTHCARE field, MANY layoffs in INSURANCE field and medical BILLING staff, SOME paycuts, LESS profits for insurance company owners.

jaeger19 said:
Meanwhile.. you would be doing that while DEMAND for that very healthcare is growing. AND as Greenbeard points out.. you know where our growth in employment has been..

Killing off insurance companies and billing services does not affect how we service increased demand for healthcare.

jaeger19 said:
Sorry sir.. but you cannot get the savings you claim... without dramatically hurting our economy.

So, once again, then let's have more complex and inefficient healthcare to help our economy! Let's have more complex taxes for sake of hiring more accountants! Let's have more complex laws for sake of supporting more lawyer jobs! Let's have more bloated Government too - it provides all those jobs, you know...! Oh wait.. you are a conservative?

Ridiculous

Bullseye · Sep 20, 2018

Boo Radley said:
Yes, it will increase. But again, the individual will not pay premiums, the employer won't be paying premiums, and hospitals won't have to charge $16 dollars for a bandaid because people can't pay. All ways in which the individual pays now. Which makes the increased federal spending and tax increase a push.

the average premium for an individual health insurance plan cost $2,889 per employee in 2001 ($3,886 adjusting for inflation). By 2015, that number had ballooned to $5,963, easily outstripping overall inflation and wage growth.

https://www.forbes.com/sites/willia...-big-problem-for-small-business/#1c03b85425d9

Add to the above what the individual pays.

Once again, individuals, particularly people who pay tax will be paying those premiums THROUGH THEIR TAXES and also be paying the premiums of families of those that don't pay tax. The cost of bandaids in hospitals isn't high insurance premiums, or because they treat people unable to pay by the way. Our current tax system is taking in almost a trillion less that what it's paying out. Where do you think the money is going to come from to take on another $1.5-2.5 TRILLION to fund M4A? NO, it's not because we won't be paying premiums - that's private money you've earned NOT government revenue.

jaeger19 · Sep 20, 2018

Slavister said:
... which is based on whether your Doctor thinks it's necessary. .

If it fits the government criteria.. there generally is no free lunch here. One way in which single payer countries get their savings is by reducing what they consider "unnecessary" surgeries.. so a patient here in the US that would get a total knee.. because of their level of pain and their desire to see it go.. that same patient may NOT qualify in other countries with single payer. They may instead.. have to do injections and wait until it gets so dysfunctional that they qualify..

Now.. sometimes.. that is appropriate.. in the US.. yes..we have people that run to surgery. (for a number or reasons).. when its unnecessary. However, when the government looks at cost containment.. the flip side is that patients that need it.. sometimes don't get it.. or have to wait a long time.

You can claim this, but I see no proof of any of it

Oh.. you mean except for the fact that RIGHT NOW.. Medicaid and medicare is being administered by private insurance companies for a large profit. SO.. your assumption is that the federal government is going to suddenly.. abandon decades of using private insurance companies for managing public plans... and take over all that administration themselves.. BUT then add the rest of the population in that administration as well.

Okay...:roll:

Further, part of the issue with Medicaid is that few doctors take it. If we go to single payer, many more Docs would have to accept it in order to have enough business.

And the reason they don't accept it is because the reimbursement is too low.. and the admin costs of it are too high (hoops to jump through)... if we go to single payer.. you may simply see a decrease in the number of physicians.. We will retire early and get out.. and there will be fewer that want to take our place. Particularly in general practice

Private insurance infrastructure costs + profits.

AS greenbeard points out.. that's not why our system costs so much. but.. you seem to forget.. that private insurance is going to be handling that public plan.. like they do now.. OR you are going to have to create a whole new government administration to handle it. the savings here is going to be negligible.. and it may even cost more because of having to create new infrastructure.

Administrative overhead for health facilities related to dealing with multiple insurance companies

Or not.. when you consider that one of the biggest insurance headaches is often dealing with public insurances.. like Medicaid. or the VA. And sometimes medicare. In any case. the savings is going to be negligible here as well.

not to mention.,, you just pointed out that there would still be private insurances to deal with.

Lower (perhaps not by much) compensation

Bingo.. and its going to have to be a HUGE cut to get the savings you want.. as Greenbeards numbers show. Because this is one of the largest costs.

Lower drug costs

Assuming that the government does a 180 degree turn on their policy.

Many other countries have done it and despite your claims on how bad their healthcare is, that's NOT what the comparative studies show

Nice try. I have simply provided more than just claims. There IS a tradeoff and you don't want to be honest about it. YOU want to say how terrible America has.. and how we have terrible outcomes... but oops.. we score 3 on quality of care. Canada.. not so high.. as well as host of other countries. Where we fall down. is things like efficiency and equity because we don't have universal coverage.

But there are tradeoffs.

Do you know for sure that Canada does not have an exemption process too?

on medicare: .

The legislation enacted today provides a fix for the therapy cap by permanently extending the current exceptions process, eliminating the need to address this issue from year to year. Among the provisions included in the new policy:
•Claims that go above $2,010 (adjusted annually) still will require the use of the KX modifier for attestation that services are medically necessary.
•The threshold for targeted medical review will be lowered from the current $3,700 to $3,000 through 2027; however, CMS will not receive any increased funding to pursue expanded medical review, and the overall number of targeted medical reviews is not expected to increase.
•Claims that go above $3,000 will not automatically be subject to targeted medical review. Instead, only a percentage of providers who meet certain criteria will be targeted, such as those who have had a high claims denial percentage or have aberrant billing patterns compared with their peers.

A Permanent Fix to the Therapy Cap: Improved Access for Medicare Patients Comes With Pending APTA-Opposed Cut to PTA Payment

jaeger19 · Sep 20, 2018

Slavister said:
Part 2 of 2 reply ...
Lots of claims here. Yet no proof. Why don't you show me some medicare links describing what you just said?

You might instead find something like this: "Original Medicare covers outpatient therapy at 80% of the Medicare-approved amount. When you receive services from a participating provider, you pay a 20% coinsurance after you meet your Part B deductible ($183 in 2018)." So, AFTER deductible, you are paying 20%, not $20...

Actually see below.. but.. Actually I provided correct information. you pay 20% after your deductible is met.. (most peoples coinsurance pays their deductible. but the medicare deductible is 183)

And yep. you pay about 20 bucks for therapy for an hour. that's because the allowable ranges from 25 to about 35 per 15 minute charge of CPT 97110 which is for an hour about 100 to 140.. that puts 20%.. at about 20 bucks to 28 bucks an hour.

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched/PFS-Federal-Regulation-Notices-Items/CMS-1676-F.html

Did you miss the link I provided where they DO cover outpatient therapy?

You need to look at that again. When. and if they pay. its not the basic government single payer.. its often addition coverage depending on your Territory or province.. and when you are either older than 65 or a child.

Meanwhile.. all those working class adults on Medicaid in the US.. get it.

I agreed that some classes are useful indeed. You have an issue with that?

Yeah.. when you start with "well the undergraduate degree is unnecessary".. and then you now walk back.. well "some classes are necessary".. face it.. you don't know what you are talking about.

Clearly, I disagree. You can tack on many years for the purpose of "well-roundness" but it does not make any difference as far as practicing medicine

It actually makes a lot of difference. Especially when it comes to the art of practicing medicine. Look.. maybe you don't think taking some educational classes on effective education in your undergraduate will help a physician... but it actually does when the doctor is trying to explain a procedure to you.. or what is going on with you. Maybe you don't think the language classes I took help.. but they definitely do when I can speak in a patients native language.. just trying.. helps reassure them and reduces anxiety and that leads to better outcomes. And so on.
The fact is.. you would have worse doctors..

When you can concentrate on a specialty, it's MORE efficient

Missing the point.

Say I have a general practitioner that's well trained and well rounded. A fellow walks in with pain in his knee after falling. That practioner knows enough orthopedics that he can do a varus. valgus stress test, a lachmans test, posterior draw and meniscus compression test. All test are negative. for laxity or severe issue. That GP gives the patient an anti inflammatory.. tells them about icing resting and compression and elevation. and then says if it doesn;t get better in 10 days see me and we will go from there.. (perhaps PT).

YOU have one of your not so trained GP's. They see that same patient.. which generates a cost.. they order an x ray that's not needed.. and they send a referral to a specialist orthopedic.. which generates another cost.. and that specialist.. to justify their position orders an MRI.. and maybe PT..

A LOT more hassle and expense. which is in one way more specialists are inefficient.. and they add to the cost in the US.

Docs from different specialties are already so much removed from the other areas that they are quite useless in them.

To some degree yes.. which means that it is more inefficient. Now a patient that could be well managed by one practitioner.. now has a pulmonologist, a pain specialist, a neurologist, and a cardiologist, and a urologist. None of whom are coordinating well with each other and understand little of what the other is doing.

When before a regular GP could handle all of their chronic conditions well.. and frankly manage them better because the care was under one GP.

I agree with what you said above. I am saying we can reduce costs while retaining specialization by starting to eliminate some things that are less relevant to each specialty.

YEah.. explain exactly how you plan to do it. Especially when you consider.. that physicians generally decide on a specialty after having seen more of the gamut of medicine. Many of the lesser known but vital specialties only get recruits because of that very education that introduces them to that specialty.

Slavister · Sep 20, 2018

Part 1 of 2 reply to jaeger19

jaeger19 said:
there generally is no free lunch here.

Yes, there is free lunch. I already described all the free lunch you get with single payer. All those cuts to insurance industry and admin overheads are free lunch.

jaeger19 said:
Now.. sometimes.. that is appropriate.. in the US.. yes..we have people that run to surgery. (for a number or reasons).. when its unnecessary. However, when the government looks at cost containment.. the flip side is that patients that need it.. sometimes don't get it.. or have to wait a long time.

Yes, just like other countries, we'd need to balance having healthcare affordable and attending to health needs of the population. Now, do I think we should PREVENT doctors from doing elective surgeries on people that really want them and are willing to pay for them? Of course not. I am not saying the two cannot coexist. However 95% of care would be done via single payer and EVERYONE would be covered and would not have to worry about how to pay for it at the time of need.

jaeger19 said:
Oh.. you mean except for the fact that RIGHT NOW.. Medicaid and medicare is being administered by private insurance companies for a large profit.

Well, guess what. That large profit by insurance companies - let's instead get rid of them and use that large profit to help pay for the single payer WITHOUT the insurance companies. That's how others do this. USA can do it too. There is nothing inherently wrong with that.

jaeger19 said:
SO.. your assumption is that the federal government is going to suddenly.. abandon decades of using private insurance companies for managing public plans...

That's not my assumption. I don't know how "sudden" is has to be. But that's the desired outcome for most people in the country, IMHO.

jaeger19 said:
And the reason they don't accept it is because the reimbursement is too low.. and the admin costs of it are too high (hoops to jump through)...

Yes, reimbursement is too low COMPARED to their other options. If they don't have other options, it won't be considered too low. And yes, costs are too high because of all the hoops to jump though - the hoops of dealing with 20 insurance companies. If you only deal with 1 system, there is much less overhead. And guess what, after eliminating that large overhead, perhaps that "low" reimbursement won't be so low anymore, huh?

jaeger19 said:
if we go to single payer.. you may simply see a decrease in the number of physicians..

May or may not. Are you saying other countries have less physicians per capita? Also, I am not sure physician pay would have to go down a lot. Look at all the other reductions in costs I had mentioned earlier.

jaeger19 said:
We will retire early and get out.. and there will be fewer that want to take our place. Particularly in general practice

We? Are you claiming to be a physician?

Slavister · Sep 20, 2018

Part 2 of 2 reply to jaeger19

jaeger19 said:
you seem to forget.. that private insurance is going to be handling that public plan.. like they do now.. OR you are going to have to create a whole new government administration to handle it. the savings here is going to be negligible.. and it may even cost more because of having to create new infrastructure.

You have MANY insurance companies, EACH with their own infrastructure. Having a SINGLE on of them (and NON-PROFIT at that) would be (should be) CHEAPER.

jaeger19 said:
one of the biggest insurance headaches is often dealing with public insurances.. like Medicaid. or the VA. And sometimes medicare.

Says you. I've read opinion pieces to the contrary. One thing to note is that EVEN IF gov't insurances were the hardest to deal with (again, I heard the opposite), the BIGGER problems for the Docs is dealing with 20 of them, even if each one is easier. Why? Because they are all different in their own way.

jaeger19 said:
not to mention.,, you just pointed out that there would still be private insurances to deal with.

They won't HAVE TO. Right now, they have to deal with many insurances because they can't be picky and just choose one. With Single-Payer, most docs could choose to deal with just 1. Plus they can offer extra stuff for cash (like those not-needed knee surgeries). Insurance companies might be needed for OTHER docs, e.g. if dental / optometry is not covered by single-payer. Or even if some Docs provide EXTRA services (not covered by single payer) and via private insurance (and not cash), then yes, they would be OPTING IN to deal with them.

jaeger19 said:
Bingo.. and its going to have to be a HUGE cut to get the savings you want.. as Greenbeards numbers show. Because this is one of the largest costs.

I don't see numbers in Greenbeards post that I originally replied to. So I don't know which numbers you refer to. I think there is plenty of savings to be had in other areas.

And here is another thing: all the savings companies will have from NOT having to provide the insurance for their employees - all that could also help pay for and go toward paying the expenses and minimize the pay cuts to Docs and Medical staff.

jaeger19 said:
Assuming that the government does a 180 degree turn on their policy.

Huh? 180 degree turn on which specific policy? Single payer would have a larger negotiating power.

jaeger19 said:
Nice try. I have simply provided more than just claims. There IS a tradeoff and you don't want to be honest about it. YOU want to say how terrible America has.. and how we have terrible outcomes... but oops.. we score 3 on quality of care. Canada.. not so high.. as well as host of other countries. Where we fall down. is things like efficiency and equity because we don't have universal coverage.

I never said we have terrible outcomes. We are terrible at costs and not covering people and requiring health care to be related to work. As far as health outcomes, I said we are not that much better than others. We are not #1. We are not #2. And that is one study. I had linked another one showing various issues with our quality of care vs other countries. To summarize it again

"Inconsistent or unavailable data and imperfect metrics make it difficult to firmly judge system-wide health quality in the U.S., but a review of the data we do have suggests that the system is improving across each of these dimensions, though it continues to lag behind comparably wealthy and sizable countries in many respects.".

Some things are better in US. Some things are better elsewhere. Examples of those that are WORSE in US include:
- The U.S. has the highest rate of deaths amenable to health care among comparable countries
- Disease burden (years of life lost due to premature death as well as years of productive life lost to poor health or disability) is higher in the U.S. than in comparable countries
- Hospital admissions for preventable diseases are more frequent in the U.S. than in comparable countries
- The U.S. has higher rates of medical, medication, and lab errors than comparable countries
- Post-op suture ruptures are worse in the U.S. than in comparable countries
- The mortality rate for respiratory diseases is higher in the U.S. than in comparably wealthy countries
- etc. did not bother to scan it all

jaeger19 said:
A Permanent Fix to the Therapy Cap: Improved Access for Medicare Patients Comes With Pending APTA-Opposed Cut to PTA Payment

You did not answer about Canada. And regarding Medicare, you still did not prove as far as costs. As I said, you pay 20%, not $20 as you claimed. Yes, I saw that cap was being lifted thanks to Obama; but I did not see existence of a cap in Canada to begin with.

Slavister · Sep 20, 2018

jaeger19 said:
You need to look at that again. When. and if they pay. its not the basic government single payer.. its often addition coverage depending on your Territory or province.. and when you are either older than 65 or a child.

Meanwhile.. all those working class adults on Medicaid in the US.. get it.

In Canada, everyone over 65 and under 19 gets it no matter what. Everyone in between gets it when a Doctor says they need it.

In USA, people over 65 get it (used to be with cap, not maybe won't be with cap). People under 65 only get it if they have no assets and have to be on Medicaid.

Either way, your original assertion was Canada does not cover PT and it's wrong.

jaeger19 said:
Yeah.. when you start with "well the undergraduate degree is unnecessary".. and then you now walk back.. well "some classes are necessary".. face it.. you don't know what you are talking about.

Yes, undergraduate degree is unnecessary. You don't need ALL 4 years of irrelevant classes. You just take what you need from those 4 years and roll it into Medical school as necessary. There is no reason to have a BS in chem or bio. Just take the subset of classes you needed for medicine. Get it?

jaeger19 said:
It actually makes a lot of difference. Especially when it comes to the art of practicing medicine. Look.. maybe you don't think taking some educational classes on effective education in your undergraduate will help a physician... but it actually does when the doctor is trying to explain a procedure to you.. or what is going on with you. Maybe you don't think the language classes I took help.. but they definitely do when I can speak in a patients native language.. just trying.. helps reassure them and reduces anxiety and that leads to better outcomes. And so on.
The fact is.. you would have worse doctors..

You can also add a lot of years of education as well. Just go to school until you are 50 and then start practicing. That would make you an even BETTER doctor. So what? The marginal improvement in the Doc skills from that German-language class are negligible compare to the time and effort and costs invested in it.

jaeger19 said:
Missing the point...

Your example is just that better GP will have less steps to go through. Yes, sure. That does not contradict what I said. What I said is that the specialist, like a cardiologist, does not need to know much about urology or say spend as much time on that rotation vs cardiology rotation in med school. They would have all but forgotten much of what they learned on those many other rotations they go through by the time they start practicing. They only need small relevant pieces... relevant to THEIR area of specialization.

jaeger19 said:
To some degree yes.. which means that it is more inefficient. Now a patient that could be well managed by one practitioner.. now has a pulmonologist, a pain specialist, a neurologist, and a cardiologist, and a urologist. None of whom are coordinating well with each other and understand little of what the other is doing.

Yes, a good GP is still needed. But to really to take care of many conditions, you now need a specialist who knows a lot of SUBAREAS of that general area.

jaeger19 said:
YEah.. explain exactly how you plan to do it. Especially when you consider.. that physicians generally decide on a specialty after having seen more of the gamut of medicine. Many of the lesser known but vital specialties only get recruits because of that very education that introduces them to that specialty.

Ok, you have a point here that in some cases people don't know yet. But in others, they DO. And even if they are going through their rotations and decided to set their heart on a specialty after being exposed to it, I don't see why they need to finish the rest and not start concentrating as soon as they are ready. This way, by the time someone goes through ALL rotations, perhaps they may decide to stay as GP.

jaeger19 · Sep 20, 2018

Slavister said:
What's clear cut is that US is NOT better than others. It's somewhere in the middle of the pack. At much higher costs!

s

Actually it depends on what those things are.. AND you need to understand why we do poorly in certain categories. And by the way. its NOT due to "not having single payer".. if you will note.. there are plenty of single payer systems out there.. ALL with widely varying costs and varying outcomes. Which is something that you folks that love single payer and claim its going to be a panacea.. can't seem to explain. IF the issue is single payer.. why is it that so many countries with the similar system.. have widely varying costs and outcomes?

I can answer that.. and that's because of differences in economies, in demographics etc which are far and away a bigger issue than whether its single payer or not.

Easy. Many (all?) other countries provide health care for cheaper. US health care is NOT better. Overheads are clear and I listed them in earlier reply.

And many countries with the same system have varying costs.. is that do to "being bloated" or are those differences due to things like Greenbeard.. pointed out.. wages and demand?

So the reality is that you ASSUME that we are "artificially bloated".. but only because other countries pay less. Well.. other countries pay less in wages and have lower minimum wages.. I guess that means our current minimum wage is bloated right?

I never said healthcare should disappear. I've been saying the opposite.

Right.. you mean when you gave the examples of buggy drivers? You mean that example? But.. you just again.. went on a diatribe about how much we pay.. and you want to reduce that amount.. dramatically (if you want other countries levels of cost).. but for some reason.. you don't think that reducing what we pay in healthcare in half.. is going to have any negative effects on the amount of healthcare available? Hmm.. please explain that.

If we have 8% of overhead and fat, then yes, SOME layoffs in HEALTHCARE field, MANY layoffs in INSURANCE field and medical BILLING staff, SOME paycuts, LESS profits for insurance company owners.

Well.. that's your assumption that 8% of our GDP is simply "fat" in the healthcare system. BUT that 8% is actually healthcare costs.. not "insurance field and profits for insurance".. that's direct hospitals, doctors and medical equipment and so forth. And you are talking about reducing our GDP by 8%.. which is DOUBLE the amount our GDP dropped in the GREAT recession. and you claim its going to cause" some layoffs? SOME layoffs?

You really don't understand the economics here do you. Its not just going to cause layoffs in healthcare.. that dramatic decrease in GDP is going to cause ripples in all sorts of industries that rely on the good wages that healthcare worker make.. its going to have effects on suppliers of healthcare facilities.. its going to have effects on contractors.. its going to have effects on all sorts of folks.. dramatic negative effects. AND unlike the great recession.. there is not going to be an easy correction.. .because you just artificially reduced your GDP by cutting a major employer.. if that THE employer in the US.

Killing off insurance companies and billing services does not affect how we service increased demand for healthcare.

One.. that's not going to happen as I explained since you still have to process all those claims. and you may find your government system is not as efficient.. and in all likelihood it will be private insurance companies still administering it.
.. and its not going to get you that 8% of gdp out of healthcare because as Greenbeard points out.. not where the cost difference is.

So, once again, then let's have more complex and inefficient healthcare to help our economy!

Nice try. You have talking about reducing our GDP by 8%.. while.. that industry is facing increasing demand!.. 8% is double.. what the GDP dropped in the last recession.

So bloated.. not bloated or any of the rest of your BS.. the economics are clear.

then let's have more complex and inefficient healthcare to help our economy

Problem is.. as Greenbeard pointed out with his links.. our costs are not due to "complexity and inefficiency"..

Its things like the fact that we pay a lot more in wages... that we have a lot more access than needed.. because the public demands more when it comes to healthcare.. that's what pushes our costs up (among other things like demographics etc).

So.. when you make the cuts you make.. you are going to hurt wages and jobs of healthcare workers and all those that support them.. because frankly.. that's where the cost is

jaeger19 · Sep 20, 2018

Slavister said:
Yes, there is free lunch. I already described all the free lunch you get with single payer. All those cuts to insurance industry and admin overheads are free lunch.

?

Nope.. there is no free lunch.. you overblow costs that aren;t there.. and underestimate where the real costs are.. Just go and look at Greenbeards posts.

Yes, just like other countries, we'd need to balance having healthcare affordable and attending to health needs of the population.

Right.. which is a big deal. Which you make it sound like..no problem... when in reality to get the savings you plan.. it means.. closing hospitals, losing specialists, greater wait times for everything but seeing your general practitioner.. (which is ironic because you want to go toward more specialists).. etc.

However 95% of care would be done via single payer and EVERYONE would be covered and would not have to worry about how to pay for it at the time of need.

well basically what you are describing is that for 85% of americans that have healthcare insurance.. their insurance would now be WORSE.

Well, guess what. That large profit by insurance companies - let's instead get rid of them and use that large profit to help pay for the single payer WITHOUT the insurance companies. That's how others do this. USA can do it too. There is nothing inherently wrong with that.

Yeah.. you need to think about that. First.. many insurance companies are non profit.

I believe some 61% of the private health insurance plans with more than 100,000 people are non profit. then you have Medicare/ Medicaid and VA.. which are all "non profit" .. You are not going to get the savings you think you are. As greenbeard points out.

That's not my assumption. I don't know how "sudden" is has to be. But that's the desired outcome for most people in the country, IMHO.

Yeah.. you might want to rethink that when people find out about the massive increase in government to take care of healthcare.

Yes, reimbursement is too low COMPARED to their other options.

No.. the reimbursement is too low to make a profit or even to break even at times. Its simply not worth the hassle.

And yes, costs are too high because of all the hoops to jump though - the hoops of dealing with 20 insurance companies.

Yeah not really. I mean.. have you ever owned healthcare facilities? Doesn;t sound like you do... I do.. and most insurances use a standard billing form based on the HCFA billing form. so its pretty standard. In fact.. a lot of places.. which is what we do.. is use a clearinghouse. So there is not this massive extra cost in having "20 insurance companies"... the cost is in dealing with 1 insurance company like Medicaid.. or the VA.. (both government programs).. that make you jump through multiple hoops to get paid.. AND THEN their reimbursement is the lowest. (which is why places don't like taking these insurances).

There simply is NOT this massive savings that's going to be made by billing one insurance. In fact. its very well could be worse.. if the government insurance has more hoops.. like MEDICAID. Where you will get your savings.. is because with one insurance.. the government has a monopoly and can force reimbursement way down.. which ends up getting rid of small hospitals, etc.

May or may not. Are you saying other countries have less physicians per capita?

Actually you can't compare because the economics are vastly different. Many other countries.. shift their healthcare costs (we haven't even gotten into that.. but its another reason that they have lower healthcare bills.. but in reality.. don't) from healthcare to education. for example.. a country spends a ton on educating their physicians.. and thus can reimburse their physicians less.. (because they have less debt).

In America.. that debt gets folded into the cost of healthcare.. in what the physician has to get. the cost is still there.. except its tacked onto healthcare.. in America.. and in Europe.. its tacked onto government education. (just a cost shift).

jaeger19 · Sep 20, 2018

Slavister said:
You have MANY insurance companies, EACH with their own infrastructure. Having a SINGLE on of them (and NON-PROFIT at that) would be (should be) CHEAPER.
QUOTE] Well... that's 1. A huge assumption that the government will set up its own separate insurance company to manage them the single payer. Especially when you consider that private insurance companies right now.. administer medicare and Medicaid.
2. Its a huge assumption that a government entity will necessarily..be more efficient when there is no reward for efficiency ( in other words.. no profit motive to be more efficient).

One thing to note is that EVEN IF gov't insurances were the hardest to deal with (again, I heard the opposite),

Click to expand...

Yeah..no.. that's pretty unlikely... just go do a search on dealing with Medicaid.. or the VA. Even medicare can be a hassle (but generally not that bad anymore).

the BIGGER problems for the Docs is dealing with 20 of them, even if each one is easier. Why? Because they are all different in their own way

Click to expand...

. Actually that's not true.. generally that's not true at all. In fact. .most insurance companies standardize their billing and procedures with medicare.. .. In fact the billing forms etc... that they all use tend to be rather standardized. The hassles are really the one or two.. that require some extra hoops.. like workers comp.. or VA or Medicaid

They won't HAVE TO. Right now, they have to deal with many insurances because they can't be picky and just choose one. With Single-Payer, most docs could choose to deal with just 1

Click to expand...

That's a pretty big assumption when you just said how you were going to cut reimbursement.. etc..

In all likelihood.. providers are going to have to have use private insurance to bolster the declining reimbursement.. oh.. like they do now. You don't get that. I could just decide to take medicare.. that's it.. I could just decide to take Medicaid.. just that. There is nothing that says I have to take a particular insurance. In fact.. we don't accept a number in some areas. But guess what.. If we only accepted medicare.. we would go out of business.. because we would have the volume but reimbursement is too low.

jaeger19 · Sep 20, 2018

And here is another thing: all the savings companies will have from NOT having to provide the insurance for their employees - all that could also help pay for and go toward paying the expenses and minimize the pay cuts to Docs and Medical staff.

Well.. that's not really a savings.. because its going to be made up in higher taxes.. maybe higher payroll taxes.. which really suck.. and many companies are STILL going to have supplemental insurance policies like in Canada.

I never said we have terrible outcomes. We are terrible at costs and not covering people and requiring health care to be related to work.

Which we can easily solve without a single payer system.

Inconsistent or unavailable data and imperfect metrics make it difficult to firmly judge system-wide health quality in the U.S., but a review of the data we do have suggests that the system is improving across each of these dimensions, though it continues to lag behind comparably wealthy and sizable countries in many respects.".

Yep.. and we are ahead of many comparable wealthy and sizable countries on many metrics... its about what you value to some degree. There is no free lunch here.

The U.S. has the highest rate of deaths amenable to health care among comparable countries

Because we don't have everyone on insurance.. and some of that is because of culture.. of being rugged and not going to the doctor.

Disease burden (years of life lost due to premature death as well as years of productive life lost to poor health or disability) is higher in the U.S. than in comparable countries

THAT is not due to our healthcare system.. that is due to our demographics.. the number of immigrants we take in from other countries, our obesity rate, our stress levels.. lack of vacation and downtime.. work related stress, sedentary rates of living.. working hours.. etc.

The U.S. has higher rates of medical, medication, and lab errors than comparable countries

A variety of reasons for this.. but its not due to single payer.

Post-op suture ruptures are worse in the U.S. than in comparable countries

this is most likely due to obesity. return to work.. etc.

The mortality rate for respiratory diseases is higher in the U.S. than in comparably wealthy countries

Obesity, smoking, sedentary lifestyles and environmental factors.. like smog.

And regarding Medicare, you still did not prove as far as costs. As I said, you pay 20%, not $20 as you claimed

Yep I did. I provided the physician fee schedule and the code 97110 which is probably the most used therapy code..it runs about 25 to 35 per 15 minutes.. so for 1 hour.. that translates to 80% of the allowable.. 20 bucks to 28 dollars.

that's what 20% of the allowable is. Oh.. and guess what.. you were WRONG about the cap.. so maybe you just need to take a breather..

Canada does not have a cap.. because Canadian government insurance does not cover outpatient therapy. For certain groups.. like elderly and the youth.. its covered by a mishmash of territorial and provincial programs. In fact.. that creates it own hassles because often provincial and territorial plans don't cross provincial lines well.

jaeger19 · Sep 20, 2018

Slavister said:
In Canada, everyone over 65 and under 19 gets it no matter what. Everyone in between gets it when a Doctor says they need it.
.

Not true. especially the "everyone gets it when a doctor says they need it"..

In USA, people over 65 get it (used to be with cap, not maybe won't be with cap). People under 65 only get it if they have no assets and have to be on Medicaid.

Actually everyone with insurance gets it.. its part of the essential benefits.

Either way, your original assertion was Canada does not cover PT and it's wrong.

Nope I was right. My assertion was that Canadian government insurance.. their "single payer" does not pay for outpatient therapy.. nor homeheath, or pharma etc.

Now.. provinces and territories have their own plans.. that will cover the elderly and those who are children for some of those things.. not its not universal.

That's WHY by the way that Canadians have to get supplemental coverage for those things. IF what you contend is everyone gets it especially if a doctor needs it...Well then.. why the need for supplemental coverage insurance?

Yes, undergraduate degree is unnecessary. You don't need ALL 4 years of irrelevant classes

Again.. you are making a giant assumption that there is the massive number of irrelevant classes. Your opinion is noted and rejected as false. There is no reason to have a BS in chem or bio? So you don't think a physician having a background in chemistry or biology.. is an asset? What classes do you think are irrelevant? botany? Oh wait.. people take all sorts of supplements now.. you now.. cause its "natural". Maybe if you knew some botany.. you would know that the patient eating certain greens or supplements is actually making his blood to thin in addition to the blood thinner you are giving him.. or maybe if you understand botany.. you are understanding why this child developed an unknown rash.. because he was around a certain ornamental shrub.
Sir.. honestly.. you don't have a clue what you are talking about when you suggest what you are suggesting.

You can also add a lot of years of education as well. Just go to school until you are 50 and then start practicing. That would make you an even BETTER doctor

YEp.. so whats your point? You just pointed out that more education was good for a doctor.

The marginal improvement in the Doc skills from that German-language class are negligible compare to the time and effort and costs invested in it.

Actually the HUGE improvement in interview skills, rapport etc.. from taking Spanish.. is huge.

German and French I already spoke (to a degree.. )..

Your example is just that better GP will have less steps to go through.

WHICH IS A HUGE COST SAVINGS AND IS VASTLY MORE EFFICIENT. You seem to gloss over that fact.

Yes, a good GP is still needed. But to really to take care of many conditions, you now need a specialist who knows a lot of SUBAREAS of that general area.

That's kind of ironic when you consider your premise. The reality is that WE DO NOT "now need a specialist".. why would you suddenly "now need" a specialist? The reason specialists are now more prevalent is because.. 1. More docs specialize because there is yore money in it. and more docs specializing means that they have to fill those spots.. so now there is more marketing that Americans need a specialist.. when the reality is that they don't. but the expectation now is that they get a referral for a specialist.. and that they continue when a GP could assess and maintain their chronic conditions just as well. Its interesting that you have bought into that belief because it IS one of the reasons that American healthcare is more expensive. AND by the way.. most other countries.. REDUCE their number of specialists to control those costs.

And even if they are going through their rotations and decided to set their heart on a specialty after being exposed to it, I don't see why they need to finish the rest and not start concentrating as soon as they are ready

.

Okay.. Remember all those medical mistakes and so forth? You are just pointing out one reason for it in the US. And that's the proliferation of specialists and specialist care. All the specialists.. that aren;t coordinated or know to consider what other issues the patients are having.. and what other physicians may be doing leads to polypharmacia.. it leads to drug interactions.. it leads to all sorts of mistakes because you have too many cooks.. rummaging about.

Slavister · Sep 20, 2018

jaeger19 said:
IF the issue is single payer.. why is it that so many countries with the similar system.. have widely varying costs and outcomes?

I can answer that.. and that's because of differences in economies, in demographics etc which are far and away a bigger issue than whether its single payer or not.

And many countries with the same system have varying costs.. is that do to "being bloated" or are those differences due to things like Greenbeard.. pointed out.. wages and demand?

Yes, there is a lot of variety out there. Different single-payer systems cover different things. Different countries indeed have different wages and demand as you state which affects how much of GDP is needed to support the system. HOWEVER, US is more expensive then ALL of them. And it's not because Demographics (demand) and costs are THAT much different inherently. The reason costs are high in US is BECAUSE of the bloated non-single-payer system we have.

jaeger19 said:
Well.. other countries pay less in wages and have lower minimum wages.. I guess that means our current minimum wage is bloated right?

You keep making authoritative statements that are easily disprovable. Why is that? I just looked up Canadian min wage. After converting to US$, Canada has higher min wage that USA, in not just 1 province, not just 2, but in ALL of its provinces. German min wage is almost twice the US min wage.

jaeger19 said:
Right.. you mean when you gave the examples of buggy drivers? You mean that example?

That example was not meant to imply that healthcare as an industry should disappear in the USA. I clearly never suggested that. Consider rereading what I had said.

I did say though that large parts of healthcare insurance companies could disappear and give us quite a chunk of change...

jaeger19 said:
But.. you just again.. went on a diatribe about how much we pay.. and you want to reduce that amount.. dramatically (if you want other countries levels of cost).. but for some reason.. you don't think that reducing what we pay in healthcare in half.. is going to have any negative effects on the amount of healthcare available? Hmm.. please explain that.

Already explained earlier the sources of cost savings. From more efficient administrative and billing to not having expenses or profits related to a whole bunch of private insurance companies. Some reductions in pay too will not limit healthcare as much as you think either. Lower drug costs will not limit it either. There is no reason US needs to subsidize low drug prices for the rest of the world.

jaeger19 said:
Well.. that's your assumption that 8% of our GDP is simply "fat" in the healthcare system.

8% came up as your comparison with other nations. It's not just an assumption. If anything, it's YOUR assumption that there is more to it than just fat.

jaeger19 said:
BUT that 8% is actually healthcare costs.. not "insurance field and profits for insurance".. that's direct hospitals, doctors and medical equipment and so forth.

No, it includes spending related to private insurance companies.

Slavister · Sep 20, 2018

jaeger19 said:
And you are talking about reducing our GDP by 8%.. which is DOUBLE the amount our GDP dropped in the GREAT recession. and you claim its going to cause" some layoffs? SOME layoffs?

Actually, you came up with that figure of 8% by comparing percent of US GDP vs another country. I did not say we need to drop it by that much and in fact suggested that companies COULD START PAYING so as not to decrease GDP by THAT much. And I don't mean ADDITIONAL tax on companies, but redirecting their healthcare costs of today toward the new system, since now they would not have any healthcare costs. Consumers would also pay into the system of course - and again, instead of consumer payments being directed at private insurance market via paycheck deductions of today, they would be directed toward the single payer system.

So, I am not sure we'd actually need to reduce spending by the 8% you came up with.

jaeger19 said:
You really don't understand the economics here do you. Its not just going to cause layoffs in healthcare.. that dramatic decrease in GDP is going to cause ripples in all sorts of industries

You are going back to your nonsense argument that we should be paying for fat because cutting it will cause all kinds of ill effects. Already answered this before. If you believe it, you should ask for more bloated Government so that the same ripple effects give us wonderful economy for many years to come. This is one of the most anti-Conservative arguments, if I ever heard one. But I see you keep trying to hold on to it.

jaeger19 said:
One.. that's not going to happen as I explained since you still have to process all those claims. and you may find your government system is not as efficient.. and in all likelihood it will be private insurance companies still administering it.

That's not what happens in the rest of the world with single payers. Of course it's more efficient for the Docs to deal with 1 administrator. Not 20.

jaeger19 said:
Its things like the fact that we pay a lot more in wages...

... BECAUSE we don't have Single Payer.

jaeger19 said:
that we have a lot more access than needed

Good. Cut the fat.

jaeger19 said:
because the public demands more when it comes to healthcare

Really? Public demands? Hmm.. I never heard anyone saying they moved to another city because it had extra beds in the hospital.

Slavister · Sep 20, 2018

jaeger19 said:
Nope.. there is no free lunch.. you overblow costs that aren;t there.. and underestimate where the real costs are..

There are plenty of sources confirming that administrative costs are just too big in US.

Here is one. Admin costs eat up to 30% of the bill!
Here is one where doctors indicate 25% goes to waste.
Here is another example.
And here is another.

You start with basic assumption that USA runs very efficiently and any "savings" mean "less" care. You start with basic assumption that single-payer cannot change this equation. And then you arrive at conclusion that there is some valuable service that will get CUT if we switch to single payer.

Simply stated, your assumptions (that you seem to WANT to believe) are wrong.

The rest of your responses are all suffering from this same circular reasoning, no matter how many times I try to point out WHERE the "free lunch" comes from.

And again, it's not just the cost savings from the various overheads of NON-SINGLE-PAYER.

It's also ripple effects of not having crowded ERs by the 15% that don't have insurance and not spending as much money on THEIR health.

It's also redirecting money corporations currently spend (and employees via healthcare deductions) toward the single payer system. So the reduction is not nearly as drastic as you'd have us believe.

jaeger19 said:
No.. the reimbursement is too low to make a profit or even to break even at times. Its simply not worth the hassle.

Yet plenty of docs find it worth the hassle... Hmm... Yet rest of the world can afford it, but not USA? Hmm.. Sounds about right.

jaeger19 said:
Where you will get your savings.. is because with one insurance.. the government has a monopoly and can force reimbursement way down.. which ends up getting rid of small hospitals, etc.

Are you claiming that US has better access to hospitals than other nations?

jaeger19 said:
Actually you can't compare because the economics are vastly different. Many other countries.. shift their healthcare costs (we haven't even gotten into that.. but its another reason that they have lower healthcare bills.. but in reality.. don't) from healthcare to education. for example.. a country spends a ton on educating their physicians.. and thus can reimburse their physicians less.. (because they have less debt).

Yes, in fact, I had implied US should do the same.

Slavister · Sep 20, 2018

jaeger19 said:
1. A huge assumption that the government will set up its own separate insurance company to manage them the single payer. Especially when you consider that private insurance companies right now.. administer medicare and Medicaid.
2. Its a huge assumption that a government entity will necessarily..be more efficient when there is no reward for efficiency ( in other words.. no profit motive to be more efficient).

Yeah..no.. that's pretty unlikely... just go do a search on dealing with Medicaid.. or the VA. Even medicare can be a hassle (but generally not that bad anymore).

Yes, maybe USA is worse than rest of the world in setting up a system that works well. I don't know. I'd like to think we can be comparable.

jaeger19 said:
That's a pretty big assumption when you just said how you were going to cut reimbursement.. etc..

Again, I am going by experience of rest of the world. It's not an unknown that I am guessing about. Doctors offices elsewhere don't normally deal with a bunch of insurance companies.

jaeger19 said:
In all likelihood.. providers are going to have to have use private insurance to bolster the declining reimbursement.. oh.. like they do now. You don't get that. I could just decide to take medicare.. that's it.. I could just decide to take Medicaid.. just that. There is nothing that says I have to take a particular insurance. In fact.. we don't accept a number in some areas. But guess what.. If we only accepted medicare.. we would go out of business.. because we would have the volume but reimbursement is too low.

If medicare/medicaid were indeed so under-the-cost as your describe, why would ANYONE take them at all?

Perhaps your facilities run with too much fat that you are underwater so much with medicare/medicaid...

Slavister · Sep 20, 2018

jaeger19 said:
Nope I was right. My assertion was that Canadian government insurance.. their "single payer" does not pay for outpatient therapy.. nor homeheath, or pharma etc.

Now.. provinces and territories have their own plans.. that will cover the elderly and those who are children for some of those things.. not its not universal.

So, you found a province that does not cover PT?

jaeger19 said:
IF what you contend is everyone gets it especially if a doctor needs it...Well then.. why the need for supplemental coverage insurance?

Mostly for drugs, dental and optometry services. And I guess for PT cases when doctor does not recommend it? Or maybe it's needed in that province you found that does not cover it sufficiently well.

jaeger19 said:
Again.. you are making a giant assumption that there is the massive number of irrelevant classes. Your opinion is noted and rejected as false.

US already has accelerated programs skipping unnecessary classes. In Europe takes 6 years instead of 8 to get MD. Your opinion is rejected as false.

jaeger19 said:
YEp.. so whats your point? You just pointed out that more education was good for a doctor. Actually the HUGE improvement in interview skills, rapport etc.. from taking Spanish.. is huge.

My point is that your logic leads to ridiculous conclusions. You need to look at marginal effect of those classes, not whether it makes for a better doctors in absolute terms. And yes, in some parts of the country Spanish may help with potential patient population. In others, it's a waste.

jaeger19 said:
WHICH IS A HUGE COST SAVINGS AND IS VASTLY MORE EFFICIENT. You seem to gloss over that fact.

I don't think I contradicted this at all.

jaeger19 said:
That's kind of ironic when you consider your premise. The reality is that WE DO NOT "now need a specialist".. why would you suddenly "now need" a specialist?

I already answered that question. Medicine is evolving quite fast actually. Every few years you get a lot more distinct diseases identified / classified and specialized treatments created. In many areas of medicine one can no longer keep up with wealth of knowledge needed. Specialization is required to get better outcomes.

jaeger19 said:
Okay.. Remember all those medical mistakes and so forth? You are just pointing out one reason for it in the US. And that's the proliferation of specialists and specialist care. All the specialists.. that aren;t coordinated or know to consider what other issues the patients are having.. and what other physicians may be doing leads to polypharmacia.. it leads to drug interactions.. it leads to all sorts of mistakes because you have too many cooks.. rummaging about.

I won't disagree with this one.

Nickyjo · Sep 21, 2018

Sorry if this has already been covered, but dont Medicare, Medicaid and the VA, plus the various plans that governmental employees get qualify as single payer systems? If so, isn’t a significant portion of the US population already covered by single payer? I can’t imagine the math, but couldn’t Medicare be phased in gradually, that is, first covering 60 and older, then 50, etc.? Or start with the young.

marke · Sep 21, 2018

Nickyjo said:
Sorry if this has already been covered, but dont Medicare, Medicaid and the VA, plus the various plans that governmental employees get qualify as single payer systems? If so, isn’t a significant portion of the US population already covered by single payer? I can’t imagine the math, but couldn’t Medicare be phased in gradually, that is, first covering 60 and older, then 50, etc.? Or start with the young.

The Obamacare tax plan was intended to raise large sums of money from young healthy working Americans for the purpose of bailing the US government out of deep fiscal debt due to its Medicare costs.

Single payer debate no so easy

All Lives Matter or No Lives Matter