Single payer debate no so easy

jaeger19 · Sep 24, 2018

Slavister said:
Like the opinions of the Physicians that I quoted? Sure...
.

Pretty much yeah.. in fact.. if we went into the specifics of their billing.. and asked them "so.. what if ALL your billing had the hoops of dealing with Medicaid.. do you think your costs would be less"? I bet you would get laughed out of the room..

You are missing the point. This comment was not even about whether the article is RIGHT or WRONG. It's your inability to READ the article

Nope.. clearly able to read the article.. you just seem to want to focus on only ONE PART of that article and not on the other major costs.. which are far and away more than administration.. when it comes to healthcare.

This 10% is what you claim / guesstimate. If however, everything was going through SAME system, and if it were efficient enough

And that sir is a HUGE if. and besides.. we already pretty much established that if we say went to a Canadian type system.. or many others.. it would NOT be going through the same system.. there would be multiple billings to deal with from the federal government.. state insurances and private insurances..

Sure.. if my aunt had testicles.. he would be my uncle. You make it sound like simply going to a single payer will get all these improvements. BUT.. that's a huge IF.. because we have government insurances.. and guess what.. some of them are very costly for the healthcare provider to administer.

jaeger19 · Sep 24, 2018

Slavister said:
Absolutely I did. And even if it did, more foreign docs would happily fill the freed up spots.

What? why would foreign docs want to come here when their systems are so much better.. and they have so little hassles and administration to deal with?

Think about that for just a minute...

Wait, but what happened to that patient only ALWAYS costing you? Did you just say that patient is profitable AFTER ALL? Or did I misunderstand?

They can become profitable through self referral and often through over utilization of services... already explained it to you...

Thanks for the link. It indicates that low compensation is on 1 of 5 concerns for these patients, but we already know it's lower than others. What I did not see is anything there suggesting that it's LOWER than cost and that there is really no profit there.

Really.. so if there is profit there.. why is there restricted access then.. do you claim that physicians don't want profit?

Slavister · Sep 25, 2018

jaeger19 said:
Link please?

Just common sense.

jaeger19 said:
Wait.. so now providers have multiple people to bill again? Oh.. no.. where is the savings? :doh

Lol. Good one

Most providers would still be dealing with 1 payers, EITHER Feds OR State.

jaeger19 said:
Wait.. so now your healthcare is tied to where you live and who your employer is? I thought single payer was going to solve that? :doh

I see how you subtly introduces "employer" here. No, I did not say anything about employer.

As for which state you live - yeah, no biggie. And also we DON'T have to do it like Canada you know. We could make it all covered by Feds.

jaeger19 said:
Wait.. so now we have to pay TWO increased taxes.. one to the state and another to the federal government? Analogous to paying a sales tax? Well so now not only is this going to tax an increase in taxes.. but sales taxes are extremely regressive... so now you are talking about taxing those that can least afford it. Wow.. your plan gets better and better.:roll:

Wow, you are really running out of arguments to start making these dumb ones. Ok, fine, let's take them one by one.

First, you are trying to suggest that increases "TWO" taxes is somehow worse or more than increasing "ONE". No, it's not. Increasing one tax could be by 10%. Increasing two taxes could be 4% and 6% each, so total is still the same. Too complicated for you, Mr. CEO, MD? Seriously?

Second, clearly my analogy to sales tax had nothing to do with whether they are regressive or not. I explained that the purpose of analogy was only to the extent that those paying the tax don't care how much of the funds go to to State vs to Locality. I was not talking about progressive vs regressive nature of the tax or whether medicare tax should be regressive or progressive.

jaeger19 said:
As far as links? You are the one that claims their system is analogous to the US and making comparison with the US...so.. you go ahead and provide links that show the Europeans system of education is exactly similar to the US.

I guess you got no links to support your claims then. I did not see any links suggesting what you said. Noone said the two systems are exactly the same, but your claim that their HS graduates have effectively taken 2 years of USA university, knowledge wise is outlandish enough that you should have no trouble finding links supporting that claim. I am just saying that while European HSs appear to be SOMEWHAT better, that's not enough to cover 2 years of USA univesity. In fact, I said their universities and ours are similar. You can find world rankings of universities in many places to confirm this statement. So, if you were CORRECT in your assertion, their Universities would not need to REPEAT those 2 years AGAIN. There - I just disproved your point.

Let me repeat it again, if European HSs were indeed equivalent of taking 2 first years of universities (which again, are comparable, to US ones), then their BS degrees would have been 2 years instead of 4... but they are not...

Slavister · Sep 25, 2018

jaeger19 said:
The doctor that has an undergraduate degree in Women's Studies... might just be a bit better in the ER and diagnosing women with heart problems.. while her colleagues (including women) are more likely to diagnose a woman with symptoms of heart problems as having psychological problems such as anxiety.. while a man with the same symptoms is more likely to get the required cardiac testing. It makes sense that the physicians with a computer science undergraduate degree might have an advantage with dealing with computer issues and healthcare and might be able to help guide computer programs to be more user friendly and applicable to physicians.

Yes, unrelated degrees may be helpful at the margin. I never denied it. My point all along however has been that those marginal improvements are not worth 2+ years of extra education. And if you are indeed looking for such little edge, like I said then, you should be all for Doctors studying Women Studies AND Computer Science AND others to help them achieve all those little extra advantages and make them for better doctors. For some reason you think they need precisely one unrelated area of specialization (1 four-year degree but not 2 or 3) to give them that extra little edge. How convenient.

jaeger19 said:
And lastly.. you don't consider the down side of an accelerated program:
You have to know right away.. and be sure that you are able and want to be a physician. So.. what happens when 2-3 years into your accelerated program.. you realize or the school realizes.. "this is not for me"? that's a waste.

You learned what you could about an area and now you can switch to something else. Just like if you were doing BS degree and decided you wanted to be an electrician. Yes, you start over and use that knowledge you got at the margin if you want.

jaeger19 said:
And what happens to those that don't know that they want to be a physician? that spend 3 years in their undergraduate degree and find out that "hey, I want to be a physician"... and now they have to finish their undergraduate degree.. and then go back to school for another round of an accelerated program?

Yes, you enter the accelerated program and count any credits that apply (e.g. relevant chemistry / bio) that you happened to have taken.

It's the same thing that happens today if you study 3 years in computer science program and then decide you want to be a plumber instead. Just because you spent your time on stuff that's not going to be relevant to you, does not mean it's a good idea for most people to do so. Yes, people are welcome to change their mind, but it does not mean we should hold most people back to "find" themselves.[/QUOTE]

Slavister · Sep 25, 2018

jaeger19 said:
Wrong.. because it would still have to increase.. because you are talking about more specialists. And from that.. you are going to get more utilization.

Nope. I said cost would not have to increase compared to TODAY. If you shave off 2+ years in education, it would help with keeping the costs down and lifetime income up for those specialists, so despite needing more time to concentrate, the save a chunk of time on NOT getting into less relevant stuff that they forget anyways by the time they graduate.

jaeger19 said:
Except the facts don't support your view. We have had a dramatic increase in medical knowledge over the last 30 years.. and we know have gone to LOWER level providers.. such as nurse practitioners and physician assistants.. providing that care.

I understand your point, but those are different forces in play here. We've gone to lower level providers due to costs only, not to improve care. We've also started seeing more and more sub specializations WITHIN specialties that simply did not exist 30 years ago. The former decreases level of care to save on costs. The latter improves care and is necessary given the knowledge development in the medicine.

jaeger19 said:
Interesting you make that argument. I really think that often an NP can do better in many instances.. but that's because NP's tend to me MORE WELL ROUNDED.. and they have a lot of experience working with patients and have better interview skills etc.

I did not make this argument. I said others do. Maybe NPs have better bedside manner, I don't know. But when I go see a doctor, I much rather go to see a Doctor. An MD. NPs are much more likely to miss a really bad situation, and that's what patients really should care about IMO.

jaeger19 said:
Well.. lets not get too complicated.. here.. lets just start with something general:

https://www.huffingtonpost.com/allen-frances/we-have-too-many-speciali_b_9040898.html

That's just an opinion piece. How about we go to actual studies. Here is one:

Much of the available literature demonstrates that specialist physicians are able to deliver care of higher quality within the narrow, specific areas of their specialty.1-5 Many have relied on this literature to justify preferential resource allocation to specialists when compared with generalists.

Other arguments suggest that relying solely on these types of studies may lead to flawed conclusions about the value of primary care. Some studies have demonstrated that generalists appear to provide care of equal quality to specialists,6-10

So, to summarize, "Much of the available literature" suggests specialists provide better care and "some studies" say they are the same... Meaning none of them claim the obvious nonsense, i.e. that specialists would provide worse care than GP for that given condition.

Clearly though GPs are NEEDED to help TRIAGE and should be good at detecting bad interactions (not in drugs mind you - that's pharmacists' job, but in treatments).

AND... for rural areas, GPs might be the only thing available if there are simply not enough Docs to go around...

Finally, YOUR quoted article states the following:

And most obviously we need to change financial incentives. Primary docs should be paid more, specialists less.

Please DO tell me if you agree with this.

distraff · Sep 25, 2018

Boo Radley said:
Over the years I've seen misrepresentations and down right lies about single payer systems but both advocates and critics. Few discuss the ow they really compare, and it's likely a push concerning costs. And wait times need context. If I can't afford a treatment or not get one, what difference does a slightly longer wait time mean to me? And there are other such questions. But I saw this and thought it might start a conversation that is less convoluted with misinformation. Anyway:

But the bigger problem with Trump’s comparison is that switching to a single-payer system would mean shifting the ultimate payer for health care services from the patient and the employer to the government. Why is that important? Because even as federal expenditures for health care rise under a single-payer system, the expenditures by individuals and companies would fall, potentially canceling each other out.

https://www.politifact.com/truth-o-...1/how-expensive-would-single-payer-system-be/

The US pays 2 1/2 times more for healthcare than any other developed country and actually spends as much in government expenditures to cover 30% of the population under Medicare and Medicaid as all other countries to cover the entire population but we are burdened with heavy premiums and out of pocket expenses for the other 70%. Every other developed country has an efficient universal healthcare system designed to keep costs down and out horrible system is costing us a staggering 3.5 trillion a years which is blowing up our debt and financially ruining millions.

Slavister · Sep 25, 2018

jaeger19 said:
you keep showing me opinions that are clearly not based on a knowledge of the costs of billing and administration of medical claims

Slavister said:
Like the opinions of the Physicians that I quoted? Sure...

jaeger19 said:
Pretty much yeah.

Ok then... Guess we are done with this topic.

jaeger19 said:
you just seem to want to focus on only ONE PART of that article and not on the other major costs.. which are far and away more than administration.. when it comes to healthcare.

The article said X, Y, and Z are all major drivers. You have said that THE ARTICLE CLAIMS that Z is NOT a major driver. Thus, you are having difficulty reading it.

jaeger19 said:
And that sir is a HUGE if. and besides.. we already pretty much established that if we say went to a Canadian type system.. or many others.. it would NOT be going through the same system.. there would be multiple billings to deal with from the federal government.. state insurances and private insurances..

If PT is only covered by State, PT professionals would only deal with State. If all care for GPs is covered by Feds, then GPs only need to deal with Feds. If all care for Dentists is covered by private insurances, then Dentists deal with those. Is it more clear now?

jaeger19 said:
You make it sound like simply going to a single payer will get all these improvements. BUT.. that's a huge IF.. because we have government insurances.. and guess what.. some of them are very costly for the healthcare provider to administer.

Sure, Govt-run programs can be terrible to deal with. I never said there is guaranteed success. However, current system is a guaranteed failure. So we might as well try something that others have done and HAVE BEEN successfully running.

jaeger19 · Sep 25, 2018

Slavister said:
Just common sense.

...

Common sense? You mean where 43% of americans oppose single payer.. yet you claim 99% wouldn;t care?

Lol. Good one

Most providers would still be dealing with 1 payers, EITHER Feds OR State.

citation please. Especially when you consider the low rate you plan on paying those providers.

I see how you subtly introduces "employer" here. No, I did not say anything about employer.

Nope you didn;t.. its just I know that's one of the claims that single payer supporters make..

First, you are trying to suggest that increases "TWO" taxes is somehow worse or more than increasing "ONE". No, it's not. Increasing one tax could be by 10%. Increasing two taxes could be 4% and 6% each, so total is still the same. Too complicated for you, Mr. CEO, MD? Seriously?

Yes.. actually it is worse. First.. I understand what that entails.. You don't seem to... you think its as easy as "payroll taxes".. but then.. we have people that don't get their income from payroll.. so we need another tax.. then what about the people that currently aren;t paying taxes.. now their tax increases.. and then your are talking about having to create.. not just TWO taxes.. but each state.. so each state has to come up with their own tax system.. not to mention their own healthcare system.

You simply don't have a clue do you of what that entails. Its not just a snap of the fingers.. HOLY CRAP BATMAN.. you have states that refused Medicaid expansion.. but now.. you think they are going to suddenly increase their taxes.. and come up with their own healthcare system? What an absolute mess you are talking about. That's right.. I am a CEO.. I understand the logistics that are required here.. not to mention the politics.

Second, clearly my analogy to sales tax had nothing to do with whether they are regressive or not.

I am sure you didn;t... because its obvious you don't think about such things.. you don't think what it means that States might decide to pay for their healthcare systems with a sales tax that hits the poorest the most. Basically you have started with the premise: "Single payer is easy to do,,, other countries do it"... the problem is.. you obviously don't know what those countries ACTUALLY do...

Admit it.. you had no clue how Canadian healthcare works. I had to teach you that. And then.. you don't even think of the ramifications of trying to put such a system on the US.. and what that would entail.

I guess you got no links to support your claims then.

BWWWWAHHHH.. just like you don't have any links to support your claims. Clearly the European system of education in most countries IS different than the US.. particularly in how they track students.. However... you claim that we could go to an education system.. just like they have with their physicians... but didn't realize that their highschool system is not analogous to our system. I point out that fact and you are "but but but"... " you don't have a link"...

You made an assumption.. you got caught.. own up to it.. if you can show that their highschool system is just like ours.. then do so.. otherwise.. my point stands that you cannot make the assumption that their system would work here.

In fact, I said their universities and ours are similar. You can find world rankings of universities in many places to confirm this statement.

Yeah.. the issue isn;t quality. That's what you don't get.. the issue is timing, students, how their system works.

My sons both want to go to med school. Right now.. my oldest is a junior.. he is literally the top of his class. right now.. he is taking classes with kids that don't have anywhere near his intellectual ability and will likely be farm hands when they graduate. that means that right now.. his class cannot go as far or as fast because it can only go at the speed of its slowest student. In Germany? He would be in the class with just the kids that are going on to university. that means their highschool classes can go a lot more advanced.. and cover a lot more.

Now.. my son will begin to catch up.. WHEN HE GETS TO UNVERSITY.. in the US.. because that's where he will be in classes with his peers.. If he was in Germany however, he could go into an accelerated program because he would already have been studying courses at a higher level for the last two years.

Let me repeat it again, if European HSs were indeed equivalent of taking 2 first years of universities (which again, are comparable, to US ones), then their BS degrees would have been 2 years instead of 4... but they are not...

Nope. That's not true.

Sorry sir.. but your assumption that a European style education.. is analogous to the US is simply not true. And thus when you make assumptions based on theme being analogous.. those assumptions are not valid.

Slavister · Sep 25, 2018

jaeger19 said:
What? why would foreign docs want to come here when their systems are so much better.. and they have so little hassles and administration to deal with? Think about that for just a minute...

Yes, you should think about that for a minute before posing dumb questions. Here is one reason for you. Because there are plenty of countries where their lifestyle is still MUCH WORSE than a lifestyle of a middle class here. We are still richer and with better lifestyles than most countries out there. Yes, many docs from other countries would have loved to live in US for 150k+ income doing what they love doing.

jaeger19 said:
They can become profitable through self referral and often through over utilization of services... already explained it to you...

Yes, I saw you made that point, but I gave you another chance to correct yourself without highlighting it. Think about it some more. That does not make any sense. Overutilization does not make them suddenly profitable IF you claim they are UNDER COST. If it COSTS more to provide a service X on a Medicaid patient than what you are going to GET from the Govt, then overutilizing that service is going to get you MORE into RED, not LESS.

Let me break it down. If it takes $100 to provide service X and Medicaid pays you $70. Then for one such instance, you lose $30. If you overutilize that and do it 20 times, you are now losing $600 (20*$30)...

jaeger19 said:
Really.. so if there is profit there.. why is there restricted access then.. do you claim that physicians don't want profit?

I've been giving you benefit of the doubt, but your claims of being MD and CEO are starting to give me pause. Think about what I had said a little more...

... we already know it's lower than others. What I did not see is anything there suggesting that it's LOWER than cost and that there is really no profit there.

See what I just highlighted? If the profit for Medicaid is LOWER than profit from others, then of course physicians would PREFER other patients to Medicaid ones. Duh...

jaeger19 · Sep 25, 2018

Slavister said:
Yes, unrelated degrees may be helpful at the margin. I never denied it. My point all along however has been that those marginal improvements are not worth 2+ years of extra education.

[/QUOTE]

how do you arrive that that? I and just about every medical program... does see a value of that. but you don't... so please provide some evidence other than our opinion.. or that sometimes its done.

You learned what you could about an area and now you can switch to something else

Yeah.. its a bit more complicated than that. first.. the school now has a spot for a person that's now not filled.. because they quit 2 years into the accelerated program. AND that still has a cost.

Just like if you were doing BS degree and decided you wanted to be an electrician

Except you forget that the number of BS degree spots for students.. is far far far more than the number of med school spots... Sure the person starts over.. but then the program now is going to graduate a lot fewer physicians....

Yes, you enter the accelerated program and count any credits that apply (e.g. relevant chemistry / bio) that you happened to have taken.

Accelerated programs don't work that way.

It's the same thing that happens today if you study 3 years in computer science program and then decide you want to be a plumber instead.

you realize that studying to be a computer science fellow and deciding to be a plumber is not analogous to getting a degree in computer science (plus the pre requisites for med school).. and deciding to go med school.

jaeger19 · Sep 25, 2018

Slavister said:
I understand your point, but those are different forces in play here. We've gone to lower level providers due to costs only, not to improve care. .

And you just decreased physician education to do the same thing.

NPs are much more likely to miss a really bad situation, and that's what patients really should care about IMO.

Actually that's probably not true. In fact.. NP's are often in my experience able to catch a bad situation because they are better at listening and have more clinical experience with patients.

That's just an opinion piece. How about we go to actual studies

Sure.. but by the way.. you forgot to read the last part of your quote:

Other arguments suggest that relying solely on these types of studies may lead to flawed conclusions about the value of primary care. Some studies have demonstrated that generalists appear to provide care of equal quality to specialists

See.. you just don't know what you are talking about.. and so cannot understand what these studies are saying.. which is why I gave you a general piece.

I will try to explain it to you. Yep.. there is a REASON for specialists. If you fracture you leg.. you sure as heck want an orthopedic surgeon fixing your leg than your general practitioner... If you have HIV.. you want a specialist that deals with HIV.. no doubt.. especially for that initial care plan.

but say you have COPD, congestive heart failure.. diabetes, and chronic back pain and a hiatal hernia. All stable. Its not best for you to go to your pulmonologist every 3 months, a cardiac specialist every 3 months, An endocrinologist every 3 months, a pain specialist every three months and a gastroenterologist every 3 months!.. what a mess you will be.. (not to mention the expense).

you are much better off.. to have one general practitioner that is assessing and coordinating all that care and seeing the big picture of your medical management. With occasional referrals/consultations to a specialist when needed...

by the way.. one of the reasons for other countries doing better in some categories? Is because they do this with General practitioners and primary care.. where in the states.. we rely more heavily on specialists.

Please DO tell me if you agree with this

Actually there probably is something to this in the US. Mostly the " paid less" really should come from reduction of over utilization, and self referrals and the processes that cause specialists to provide unneeded procedures that could be handled with conservative care.. or better.. preventative medicine.

Slavister · Sep 25, 2018

jaeger19 said:
Common sense? You mean where 43% of americans oppose single payer.. yet you claim 99% wouldn;t care?

Nice try to confuse points. I never said 99% wouldn't care on single-payer vs today's system. I said 99% would not care where their tax payment goes - toward State or Feds.

jaeger19 said:
citation please. Especially when you consider the low rate you plan on paying those providers.

What? Citation for the fact that PTs are generally different than Doctors? We were discussing how PTs get paid by provinces, not Canadian Govt. Then you decided to state this means that under new system healthcare professionals would now be paying to 2 agencies. I pointed out that is a No. Just because PTs are covered by a Province (or a State in our case), it does not mean that Doctors have anything to do with that or that they have to deal with State.

jaeger19 said:
Nope you didn;t.. its just I know that's one of the claims that single payer supporters make..

Don't start bringing up statements of others - we've had enough statements of our own here. So yeah, nice try to distract from topic at hand.

jaeger19 said:
Yes.. actually it is worse. ... you think its as easy as "payroll taxes".. but then.. we have people that don't get their income from payroll.. so we need another tax.. then what about the people that currently aren;t paying taxes.. now their tax increases.. and then your are talking about having to create.. not just TWO taxes.. but each state.. so each state has to come up with their own tax system.. not to mention their own healthcare system.

You simply don't have a clue do you of what that entails. Its not just a snap of the fingers.. HOLY CRAP BATMAN.. you have states that refused Medicaid expansion.. but now.. you think they are going to suddenly increase their taxes.. and come up with their own healthcare system? What an absolute mess you are talking about. That's right.. I am a CEO.. I understand the logistics that are required here.. not to mention the politics.

First, once again, we DO NOT HAVE TO make it like Canada. I have no issues with Feds owning what Provinces own in Canada.

Second, States DO NOT HAVE TO create a separate tax. They could just increase their own tax rates as needed.

Third, we DO NOT HAVE TO charge people that do not pay tax now. So nothing HAS TO change there.

Fourth, people that pay taxes not through payroll would NOT have it any more complicated if all that changes is Medicare tax rate is increased and State tax rate is increased. Nothing would change administratively for them at all.

Fifth, your best point might have been that there are states that don't collect taxes on income at all. And my response to that one would be that those states collect tax revenue via other means. So if they wanted to increase tax revenue to account for PT / whatever coverage, they WOULD BE ALLOWED to increase those taxes accordingly.

Sixth, did I mention that we DO NOT HAVE TO be like Canada and if we want to cover PT, we could do this at the Fed level?

jaeger19 said:
I am sure you didn;t... because its obvious you don't think about such things.. you don't think what it means that States might decide to pay for their healthcare systems with a sales tax that hits the poorest the most.

Once again you misrepresent what I said. I never said states have to collect more sales tax to pay for this. I only brought up sales tax as an example of something that consumers pay and don't care where proceeds go to. I don't know what's unclear about this.

States can decide which taxes they may want to impose and how regressive or progressive they are.

jaeger19 said:
Admit it.. you had no clue how Canadian healthcare works.

Actually, it looks like I had a better clue than you did. (Not to mention I have some personal experience with how that particular system works)

Slavister · Sep 25, 2018

jaeger19 said:
BWWWWAHHHH.. just like you don't have any links to support your claims. Clearly the European system of education in most countries IS different than the US.. particularly in how they track students.. However... you claim that we could go to an education system.. just like they have with their physicians... but didn't realize that their highschool system is not analogous to our system. I point out that fact and you are "but but but"... " you don't have a link"...

You made an assumption.. you got caught.. own up to it.. if you can show that their highschool system is just like ours.. then do so.. otherwise.. my point stands that you cannot make the assumption that their system would work here.

That's a bunch of BS. You made a statement that you cannot support. And I proved to you already that their HS are not as advanced as you make it out to be, simply because they still have to go through same 4 years schooling for their BS degrees like the US. Please go back an reread the details.

jaeger19 said:
Yeah.. the issue isn;t quality. That's what you don't get.. the issue is timing, students, how their system works. ...
Now.. my son will begin to catch up.. WHEN HE GETS TO UNVERSITY.. in the US.. because that's where he will be in classes with his peers.. If he was in Germany however, he could go into an accelerated program because he would already have been studying courses at a higher level for the last two years.

Ever heard of AP classes? Sure students here share some classes with all. But there are plenty they can take with higher level of difficulty. In Germany, the BS degree still takes 4 years. If your statement about HS education was true, then BS degree would have taken 2 years.

Nice try to make things up though...

Slavister · Sep 25, 2018

jaeger19 said:
how do you arrive that that? I and just about every medical program... does see a value of that. but you don't... so please provide some evidence other than our opinion.. or that sometimes its done.

"just about every medical program" just follows the herd. So, no, they don't think (or care) about all those extra classes that you had to take.

I arrive at that by looking at how long it takes to become a physician in other countries and by knowing physicians in this country and talking to them about how much of their schooling is relevant to their jobs.

jaeger19 said:
the school now has a spot for a person that's now not filled.. because they quit 2 years into the accelerated program. AND that still has a cost.

Just like there are costs for resident programs that don't fill - you transfer less desirable students from other programs or free up hours for higher level classes and spend time on other useful stuff (research, etc)

jaeger19 said:
Except you forget that the number of BS degree spots for students.. is far far far more than the number of med school spots... Sure the person starts over.. but then the program now is going to graduate a lot fewer physicians....

Yes, and even less spots for residency programs, yet residency class size can vary a lot from year to year.

jaeger19 said:
Accelerated programs don't work that way.

Does not mean they can't. If you transfer from one university program to another, they will normally count your (relevant) credits that they believe are equivalent. (BTW, even when done from other countries to the US Univesity)

jaeger19 said:
you realize that studying to be a computer science fellow and deciding to be a plumber is not analogous to getting a degree in computer science (plus the pre requisites for med school).. and deciding to go med school.

You were asking what happens if one starts on one track and then decides to switch to another profession entirely. Same as what happens today.

Slavister · Sep 25, 2018

jaeger19 said:
And you just decreased physician education to do the same thing.

Yes, but I did it by eliminating mostly irrelevant waste (yes except for the minor parts - like ability to debug a computer system a bit better if you had 4 years of CS degree).

jaeger19 said:
Actually that's probably not true. In fact.. NP's are often in my experience able to catch a bad situation because they are better at listening and have more clinical experience with patients.

I've seen no studies suggesting NP care is BETTER than MD care. At MOST some studies say they don't see a difference IN CERTAIN areas.

jaeger19 said:
Sure.. but by the way.. you forgot to read the last part of your quote:

No I did not forget. I explicitly talked about it in fact. Read what I said again. Hint: I even bolded related part. I don't want to have to repeat myself YET AGAIN just because you can't seem to read what I said.

jaeger19 said:
See.. you just don't know what you are talking about.. and so cannot understand what these studies are saying.. which is why I gave you a general piece.

I will try to explain it to you. Yep.. there is a REASON for specialists. If you fracture you leg.. you sure as heck want an orthopedic surgeon fixing your leg than your general practitioner... If you have HIV.. you want a specialist that deals with HIV.. no doubt.. especially for that initial care plan.

but say you have COPD, congestive heart failure.. diabetes, and chronic back pain and a hiatal hernia. All stable. Its not best for you to go to your pulmonologist every 3 months, a cardiac specialist every 3 months, An endocrinologist every 3 months, a pain specialist every three months and a gastroenterologist every 3 months!.. what a mess you will be.. (not to mention the expense).

you are much better off.. to have one general practitioner that is assessing and coordinating all that care and seeing the big picture of your medical management. With occasional referrals/consultations to a specialist when needed...

by the way.. one of the reasons for other countries doing better in some categories? Is because they do this with General practitioners and primary care.. where in the states.. we rely more heavily on specialists.

Sure, if you have diabetes with stable A1C. I agree that you don't need to see endocrinologist every 3 months. I never suggested otherwise. However, if it's very unstable and GP can't figure it out in few months what's going on, heck yeah, you are better off seeing an endocrinologist. I don't think I ever contradicted much of what you said in this area. The ONLY thing I said was that we will need MORE specialists simply because we will have MORE sub-specialties to begin with. My main observation has been that more specialists will exist (in absolute number) due to the progress in medicine.

jaeger19 said:
Actually there probably is something to this in the US. Mostly the " paid less" really should come from reduction of over utilization, and self referrals and the processes that cause specialists to provide unneeded procedures that could be handled with conservative care.. or better.. preventative medicine.

Say we did everything you just said. Should GPs be paid more than Specialists?

jaeger19 · Sep 25, 2018

Slavister said:
Ok then... Guess we are done with this topic.
.

Yes.. you are completely wrong. and you don't understand what those quotes really mean. I do.. because I actually understand the system.

The article said X, Y, and Z are all major drivers. You have said that THE ARTICLE CLAIMS that Z is NOT a major driver. Thus, you are having difficulty reading it.

And you.. miss the other two.. which by the way.. are the main drivers.. particularly wages.. You are the one having the difficulty reading it. PLUS I understand where that administration cost comes from.. you don't.. so I understand that its not as easy to get the savings as you claim.

If PT is only covered by State, PT professionals would only deal with State

Accept the billing offices of hospitals, rehab units.. etc.. all bill for multiple services.. so the hospital is still going to be billing multiple places.

If all care for GPs is covered by Feds, then GPs only need to deal with Feds

Except that's not how our medical systems are set up. We have consolidated a lot of facilities into large systems.. so those billing departments are responsible for billing all sorts of providers. And then you have what about people traveling. going across borders.. spending time in NY and then traveling to florida to live for 6 months?

Sure, Govt-run programs can be terrible to deal with. I never said there is guaranteed success. However, current system is a guaranteed failure

Why? Why is it a "guaranteed failure".. you keep saying stuff like this.. and you are not alone... but... here is a fact.. when you look at our outcomes.. things like effective care.. we scored 3. That means that a number of single payer systems... SCORED LESS.

So why exactly are you so sure.. that we will NOT go down hill from there? If these other countries.. can score less than us in things like effective care, timeliness of care etc. .. with their single payer... why are you so sure that WE WON"T score lower when we go to single payer?

There are ONLY two things that single payer does that you could with any assurance say would happen here.. and that is lower costs.. and cover everyone with some type of healthcare. That's all that you can say with any type of confidence (and even that's questionable based on the evidence...

jaeger19 · Sep 25, 2018

Slavister said:
Yes, but I did it by eliminating mostly irrelevant waste (yes except for the minor parts - like ability to debug a computer system a bit better if you had 4 years of CS degree). ?

Well.. that you claim. which is two years of general education.. and the issue would not be "debugging a computer system"... that's not what that 4 year CS degree does. We have computer experts for that. The value of that 4 year degree in computer science and being a physician is that when the hospital or other system.. etc.. is designing a new computer electronic system?.. there is a person who understands the computer end of it... AND understands how it has to work for the providers. understanding the interface between what is capable with a computer system.. and what is necessary for the provider to function in the clinic.. how it has to work to be efficient, what it needs to be able to do to be practical and usefull.. that's whats invaluable.

I've seen no studies suggesting NP care is BETTER than MD care. At MOST some studies say they don't see a difference IN CERTAIN areas.

Bingo.. so the assumption that you are always better with a GP is false. which is the point I am making. There are advantages to both depends on clinician and on setting.

No I did not forget. I explicitly talked about it in fact. Read what I said again. Hint: I even bolded related part. I don't want to have to repeat myself YET AGAIN just because you can't seem to read what I said.

Check your quote from the article.. I see no bolding.. but anyone.. it says that some studies showed no difference in care from specialists to generalists.

Sure, if you have diabetes with stable A1C. I agree that you don't need to see endocrinologist every 3 months. I never suggested otherwise

Of course you did.. you just don't understand how healthcare works. Okay.. so you don't suggest that you need to see that endocrinologist every 3 months. Okay.. then where the heck are all this increase in specialists.. going to get patients then? That's the problem with a lot of your premises.. you don't understand how healthcare and healthcare economics works.

So.. now.. you want to have a system where there is fewer general practitioners.. and more specialists. Well.. those specialists have to have something to do right? they have to have patients... and so.. for the economics to work out.. you are going to have to have more referrals to specialists.. so that instead of one GP seeing them 4 times a year.. to maintain.. they are going to have to see 4 specialist 4 times a year... Its an economic fact.. more specialists..you have to have more patient visits.

Say we did everything you just said. Should GPs be paid more than Specialists?

More than? no... the costs for a specialist preclude that.

jaeger19 · Sep 25, 2018

Slavister said:
Yes, you should think about that for a minute before posing dumb questions. Here is one reason for you. Because there are plenty of countries where their lifestyle is still MUCH WORSE than a lifestyle of a middle class here. We are still richer and with better lifestyles than most countries out there. Yes, many docs from other countries would have loved to live in US for 150k+ income doing what they love doing.
...

You sir are too funny :lamo. So.. you expect to change our system to be like what those doctors are experiencing.. you know.. that lower pay,,government system etc.. but then you expect those very doctors to move to the US.. to experience THE SAME SYSTEM.

You really don't see your intellectual disconnect here. The reason that our physicians experience a much better lifestyle.. is because of that higher pay, autonomy, etc.. that they get in the US.. which you claim is a "bloated system that needs to change" and you want to reduce those salaries TO WHAT OTHER COUNTRIES ARE PAYING.. (and then expecting physicians to move here.. for higher costs.. and the pay they get in their home country!).

Overutilization does not make them suddenly profitable IF you claim they are UNDER COST. If it COSTS more to provide a service X on a Medicaid patient than what you are going to GET from the Govt, then overutilizing that service is going to get you MORE into RED, not LESS

Nope.. I just understand the economic so much better than you. We were discussing access to patients to doctors.. and I pointed out that sometimes government pay is less than cost for those patients. (which it is) .. and you said.. while will they take them then. And I gave a list of reasons.. one of them being they can recoup those costs in overutilization. and that's because not EVERY procedure they order is under cost. So a physician will accept them for an evalution. . getting 100 when it costs him 150.

But he sends them to therapy in his office (attached).. where the patient goes through 12 visits of therapy from a highschool age aide.. at 9.50 an hour.. and he is getting paid 90 dollars for that hour.,,

Or he works in a hospital where he then sends the patient for lab work (they don't need) and the hospital gets reimbursed 200 for lab work that costs them 12 dollars.

Let me break it down. If it takes $100 to provide service X and Medicaid pays you $70. Then for one such instance, you lose $30. If you overutilize that and do it 20 times, you are now losing $600 (20*$30

Yeah.. that's not overutilization... that's not what I am talking about. So it costs the hospital 100 dollars when they see the physician.. and Medicaid pays 70 dollars.. the hospital loses 30.

but the doctor orders test that are not needed.. x rays, MRI, lab work, pharmaceuticals and those are reimbursed more than cost. That's overutilization.. but that only works if you are in a big network.. and... guess what.. that's why you see such large medical networks now... its in response to declining reimbursement.

I've been giving you benefit of the doubt, but your claims of being MD and CEO are starting to give me pause. Think about what I had said a little more...

Yeah.. you should think about what I KNOW and have explained to you.

See what I just highlighted? If the profit for Medicaid is LOWER than profit from others, then of course physicians would PREFER other patients to Medicaid ones. Duh...

Sure.. but why not accept them then? See.. if there is profit in Medicaid.. then the provider should accept them just like they would accept all other insurances.. who also all probably pay differently as well.. if they don't accept them.. then they are turning away profit.. why would they do that?

jaeger19 · Sep 25, 2018

Slavister said:
Nice try to confuse points. I never said 99% wouldn't care on single-payer vs today's system. I said 99% would not care where their tax payment goes - toward State or Feds.
)

Sure they would.. just as they care today where their taxes go.

We were discussing how PTs get paid by provinces, not Canadian Govt. Then you decided to state this means that under new system healthcare professionals would now be paying to 2 agencies. I pointed out that is a No. Just because PTs are covered by a Province (or a State in our case), it does not mean that Doctors have anything to do with that or that they have to deal with State

Except in the US. .you don't realize that providers are often part of a network. Which means that you have physicians, PT's, OT's slp, hospitals, home health, outpatient facilities, cancer centers.. all under one billing system..

First, once again, we DO NOT HAVE TO make it like Canada. I have no issues with Feds owning what Provinces own in Canada.

Sure.. and if my aunt had testicles.. she would be my uncle. We COULD do a lot of things.. but when you start claiming as you do. that single payer is simply better.. well then..you need to actually understand how single payer works in various countries. Its just not as simply as you make it sound.. in fact.. its obvious that you had no idea how Canada works. And I highly doubt you have any understanding how the UK handles medicine.. or France.. or any other of the systems you think we should adopt.

You keep claiming.. but but they do it better. Well no they don't. Even you admitted that say for timeliness we are "middle of the pack".... that's right.. so we are above some single payer systems. SO.. what assurance do you have that what is going to be designed.. is going to be BETTER and not WORSE.. (half are worse remember)...

Tell me.. is it your confidence it Trump. and the Congress? Cripes man.. you didn;t even realize that in US healthcare.. private insurance companies administer and profit greatly from public health like Medicare and Medicaid. You thought "hey we just get rid of all that insurance profit"... really... you think its going to be that easy to simply sidestep insurance companies that have been administering Medicaid, and Medicare.. and develop a whole new government administration to handle not just medicare and Medicaid.. but every sinle persons insurance in the US?

Second, States DO NOT HAVE TO create a separate tax. They could just increase their own tax rates as needed.

See below.

Third, we DO NOT HAVE TO charge people that do not pay tax now. So nothing HAS TO change there.

Well.. we do not charge these people BECAUSE WE DON:T GIVE THEM HEALTHCARE INSURANCE. So you now propose giving millions of americans healthcare.. but not taxing them for it?

Fourth, people that pay taxes not through payroll would NOT have it any more complicated if all that changes is Medicare tax rate is increased and State tax rate is increased. Nothing would change administratively for them at all.

Medicare is basically taxed through payroll taxes. Only a small portion of americans pay an extra medicare tax (threshold is 200,000). The state tax rate may not affect them either very much.. especially if the state gets their income mostly from sales taxes.

Fifth, your best point might have been that there are states that don't collect taxes on income at all.

Nope. . I just know that sales taxes are a substantial part of tax revenue of states.. in some cases as much as 40% of their receipts;... and that these states are more inclined to increase their sales taxes.. than they are their income and corporate taxes (if they even levy them).

Once again you misrepresent what I said. I never said states have to collect more sales tax to pay for this. I only brought up sales tax as an example of something that consumers pay and don't care where proceeds go to. I don't know what's unclear about this

.

Nope.. just you don't have a clue what the ramifications of your policy could be. You haven't even considered what happens if the states.. who now..under your plan have to provide a separate healthcare system to take care of the elderly and youth.. to cover what the federal single payer doesn;t cover.. you have not considered what happens if the states decide to raise sales taxes to cover it.

As the OP stated.. single payer is not as easy as you make out. There are HUGE issues that have to be dealt with..and that WILL lead to all sorts of issues and problems. YOU sir.. have promoted something.. without every considering the ramifications of single payer.

Actually, it looks like I had a better clue than you did. (Not to mention I have some personal experience with how that particular system works

No you obviously didn't.

Slavister · Sep 25, 2018

jaeger19 said:
And you.. miss the other two..

I don't miss the other two. I said this is a major driver. I did not deny other two are also major drivers. You are denying that this is a major driver AND you have denied that THEY said it's a major driver, which is simply ridiculous.

jaeger19 said:
Except that's not how our medical systems are set up. We have consolidated a lot of facilities into large systems.. so those billing departments are responsible for billing all sorts of providers. And then you have what about people traveling. going across borders.. spending time in NY and then traveling to florida to live for 6 months?

I agree. It should all be at Federal level, not at State. But even at State level it would have been better than at dozens and dozens of individual providers.

jaeger19 said:
Why? Why is it a "guaranteed failure".. you keep saying stuff like this.. and you are not alone... but... here is a fact.. when you look at our outcomes.. things like effective care.. we scored 3. That means that a number of single payer systems... SCORED LESS.

It's a failure not because of bad care. I never said we get bad care. In fact it's comparable to others. It's a failure because it COSTS too much WHILE ALSO not covering EVERYONE. I know you like to concentrate on the 85% that are covered but I don't know why you ignore the non-covered people in this country.

Slavister · Sep 25, 2018

jaeger19 said:
Well.. that you claim. which is two years of general education.. and the issue would not be "debugging a computer system"... that's not what that 4 year CS degree does. We have computer experts for that. The value of that 4 year degree in computer science and being a physician is that when the hospital or other system.. etc.. is designing a new computer electronic system?.. there is a person who understands the computer end of it... AND understands how it has to work for the providers. understanding the interface between what is capable with a computer system.. and what is necessary for the provider to function in the clinic.. how it has to work to be efficient, what it needs to be able to do to be practical and usefull.. that's whats invaluable.

Sure, but you don't need 99% of Docs to understand CS for that. Instead, 1% of Docs would more than suffice. Also, it's not like EACH hospital is developing a computer system. You just need a few docs for developing Epic and few other competitors...

jaeger19 said:
Bingo.. so the assumption that you are always better with a GP is false. which is the point I am making. There are advantages to both depends on clinician and on setting.

Nice misrepresentation again. I never made that assumption. I never said you are ALWAYS better with a GP. YOU said that in your experience NPs are generally better that GPs. I said that's wrong and I studies confirm that. So, yes, I would rather go to GP than NP unless I knew the NP is REALLY good and most people would have no idea who is good. It's not like we know any outcomes that Docs have. And it's not like bedside manner has anything to do with being good at diagnosing to coming up with good treatment plan.

jaeger19 said:
Check your quote from the article.. I see no bolding.. but anyone.. it says that some studies showed no difference in care from specialists to generalists.

I said I addressed that, not that I quoted it directly. Here is what I said:

Slavister said:
So, to summarize, "Much of the available literature" suggests specialists provide better care and "some studies" say they are the same... Meaning none of them claim the obvious nonsense, i.e. that specialists would provide worse care than GP for that given condition.

jaeger19 said:
Of course you did.. you want to have a system where there is fewer general practitioners.. and more specialists. Well.. those specialists have to have something to do right? they have to have patients... and so.. for the economics to work out.. you are going to have to have more referrals to specialists.. so that instead of one GP seeing them 4 times a year.. to maintain.. they are going to have to see 4 specialist 4 times a year... Its an economic fact.. more specialists..you have to have more patient visits.

All I am saying is that if yesterday you needed 1 oncologist to understand all lung cancers; tomorrow you may need 3 as we find all the variations and different treatments, etc to get a real specialist. Subspecialties come up all the time because we have to classify diseases into more and more buckets and have to develop treatments for different buckets, etc. I honestly don't know why you are even arguing with this.

jaeger19 said:
More than? no... the costs for a specialist preclude that.

Exactly. Yet that's exactly what the article you quoted proposed.

jaeger19 · Sep 25, 2018

Slavister said:
That's a bunch of BS. You made a statement that you cannot support. And I proved to you already that their HS are not as advanced as you make it out to be, simply because they still have to go through same 4 years schooling for their BS degrees like the US. Please go back an reread the details.
...

No.. you made a statement you can not support. YOU claim that because European schools can accelerate their physician education.. (some do).. that means that the US can do it. Problem is.. the HS systems are different. So therefore your assumption is not valid.

Its as simple as that.

Ever heard of AP classes?

yep.. some schools can offer more than others.. some don't offer them.

Sure students here share some classes with all. But there are plenty they can take with higher level of difficulty

Citation please.. particularly in rural areas and school systems that are already cashed strapped.

In Germany, the BS degree still takes 4 years. If your statement about HS education was true, then BS degree would have taken 2 years.

No.. not at all.. that's you making a leap I never stated.. nor would support. You seem to think that going to med school is basically.. just an amount of years. So.. an average BS student.. just could go a few more years and be a doctor. Nope.. not true. Just not how it works man. If that was the case.. we would have doctors out our Wazoo...

Its takes a weeding out process and rigorousness in selection in order to get to those students that are appropriate to be clinicians. A lot of that is "self weeding".. when students who are undergraduates.. realize.."I am just not cut out to do all this schoolwork"...

I would bet that of the 100 students or so I new that were "pre med" my freshmen year? 10.. maybe 10.. went on in the medical field. Most of those were weeded out before every even applying to med school.. That takes time.

Now.. if that rigorousness starts in highschool.. that process could start earlier..and you might have students prepared for that accelerated program.. and you forget.. that's an accelerated program.. which means its going often going faster than a normal program. I could see that in the European system students could realize whether they were appropriate for that level of training.. and schools could see if these would be appropriate students earlier than American students... based on the differences in education system.

I see it in my own sons.. they both are smart and both plan on med school. They are both number one in their class. they both take what little AP classes are available.. Even in those classes they don't crack a book.. (if they have a book). Its just that easy for them. BUT.. I know what will be expected of them.. and they are not being in any way tested or pushed in their high school.. Nor are the other kids in the state.. .

College is going to be a bit of a shock.. and they will have to learn all sorts of learning habits etc.. that they are not prepared for. In some of the countries in Europe? they would have likely already been a bit more rigorously prepared..

that's perhaps why an accelerate program could work in parts of Europe.

At the end of the day though given the difference in educational systems.. there is no way you can validly state that we could go to a European style accelerated program without possible dire results.

.

jaeger19 · Sep 25, 2018

Slavister said:
I don't miss the other two. I said this is a major driver. I did not deny other two are also major drivers. You are denying that this is a major driver AND you have denied that THEY said it's a major driver, which is simply ridiculous.
y.

Sure you do.. you don't want to discuss that to get those savings.. you are going to have to cut a huge number of providers. by the way.. I DON:T DENY that administration is a driver of costs.. just I understand that its nowhere near what salaries etc are.. .. and I just realize what it is.. and why it is.. and understand that your single payer system is NOT going to get you the savings you think you are. Heck.. as I point out.. IF the single payer system chooses to have the same administration that Medicaid has.. you will INCREASE administration costs for the providers exponentially. But.. you don't consider that possibility. I understand that its a likelihood. Oh and why.. because the reason for all that extra hoops to go through with Medicaid and the VA? The reason given is TOO CONTROL COSTS!!!.. which is one of the things you want to do.!!!

I agree. It should all be at Federal level, not at State. But even at State level it would have been better than at dozens and dozens of individual providers

Individual providers? You mean insurance companies?

It's a failure because it COSTS too much WHILE ALSO not covering EVERYONE

Right.. but the problem is you think you can get that decrease in cost.. with NO consequences to care.. and right now.. you have proven over and over again.. that you have no clue what you are talking about.

By the way.. I DON:T ignore the 15% that are not covered in this country. It would be pretty dang easy to get those 15% covered.. and by the way.. that would improve our metrics substantially.. probably propel us to number 1 or 2 in every category in care.. (since a lot of our metric failures have to do with that 15% not covered).

I just don't believe it makes sense to 1. Make everything worse for the 85% that are covered. to get the 15% covered.

2. Hurt our economy to a tune of 8% of gdp.. particularly when the great recession was only a drop of 4% of gdp. You would basically have to drop GDP by double what happened in the great recession simply to get us on par with the cost of healthcare of other countries.

I know that there is much easier ways than to go to a system that has absolutely no guarantee will be better care.. that will get the savings you think you will without hurting the economy dramatically, or basically will improve anything for anyone.. except. .that 15%.

Slavister · Sep 25, 2018

jaeger19 said:
You sir are too funny :lamo. So.. you expect to change our system to be like what those doctors are experiencing.. you know.. that lower pay,,government system etc.. but then you expect those very doctors to move to the US.. to experience THE SAME SYSTEM.

Are you really that thick or just pretending? It's not about the system. It's about making $50k in country A vs making $150k in country B under THE SAME SYSTEM.

Even if physicians do NOT make exceedingly high salaries in US, it's still a very attractive level of income compared to physician income under same system in other countries.

jaeger19 said:
Nope.. I just understand the economic so much better than you. [...] they can recoup those costs in overutilization. and that's because not EVERY procedure they order is under cost. [...] Or he works in a hospital where he then sends the patient for lab work (they don't need) and the hospital gets reimbursed 200 for lab work that costs them 12 dollars. [...] but the doctor orders test that are not needed.. x rays, MRI, lab work, pharmaceuticals and those are reimbursed more than cost. That's overutilization.. but that only works if you are in a big network.. and... guess what.. that's why you see such large medical networks now... its in response to declining reimbursement.

Exactly, so Medicaid does pay MORE THAN ENOUGH to make a profit, at least in enough cases that Medicaid patients are profitable for a larger organization. This also means that it's possible to redistribute the payments in such a way that the profit is more adequately assigned to the those things that cost more and Medicaid underpays for. So, even according to you, there is no issue with Medicaid paying UNDER COST. The issue is that where they pay ABOVE COST should be moved to codes that pay UNDER COST.

In any case, if you are asking whether single payer should pay enough to Docs to make a reasonable profit, the answer is yes.

jaeger19 said:
Sure.. but why not accept them then? See.. if there is profit in Medicaid.. then the provider should accept them just like they would accept all other insurances.. who also all probably pay differently as well.. if they don't accept them.. then they are turning away profit.. why would they do that?

I'd think a CEO would know these basics. There are limited hours in the day. To maximize profit, you want to spend them on most profitable clients.

Slavister · Sep 25, 2018

... I skipped most of your usual baseless accusations directed at me ...

jaeger19 said:
You keep claiming.. but but they do it better. Well no they don't. Even you admitted that say for timeliness we are "middle of the pack".... that's right.. so we are above some single payer systems. SO.. what assurance do you have that what is going to be designed.. is going to be BETTER and not WORSE.. (half are worse remember)...

You keep missing the simple point... I don't know why, since you claim to be a CEO of some medical company. They do it better because they get roughly SAME results for LESS COST. Got it now?

jaeger19 said:
you didn;t even realize that in US healthcare.. private insurance companies administer and profit greatly from public health like Medicare and Medicaid.

What makes you think I did not realize that private insurance companies profit from Medicare/Medicaid?

jaeger19 said:
You thought "hey we just get rid of all that insurance profit"... really... you think its going to be that easy to simply sidestep insurance companies that have been administering Medicaid, and Medicare.. and develop a whole new government administration to handle not just medicare and Medicaid.. but every sinle persons insurance in the US?

I never said it would be "easy". I said it works most cost-effectively in the rest of the world. And IT DOES.

jaeger19 said:
Well.. we do not charge these people BECAUSE WE DON:T GIVE THEM HEALTHCARE INSURANCE. So you now propose giving millions of americans healthcare.. but not taxing them for it?

I said we don't have to. I am not proposing one way or another. In fact, IMO, we SHOULD charge everyone. But no, we don't have to. This is all about how progressive you want the tax system to be. I personally think it should NOT be as progressive as it is today. But none of that matters. This is all a secondary question.

And on a side note: what you said above is not correct. We DO give them healthcare in many cases (e.g. Medicaid).

jaeger19 said:
Medicare is basically taxed through payroll taxes. Only a small portion of americans pay an extra medicare tax (threshold is 200,000). The state tax rate may not affect them either very much.. especially if the state gets their income mostly from sales taxes.

I thought you were referring to self-employed people. They still pay medicare taxes. My overall point is that administratively, existing taxes may go up if you think adding another tax is so difficult. You could increase income tax rate to pay for it. You don't have to associate it with payroll taxes at all. Here, I just removed a tax for you instead of adding one: get rid of Medicare tax and just increase overall tax rate - done.

Your whole point about increased administrative cost due to adding 1 more line on taxes is nonsense.

jaeger19 said:
you have not considered what happens if the states decide to raise sales taxes to cover it.

Nowhere did I say the states are obligated to cover it like that. Further, as I stated, it would be much simpler and easier if Federal Govt did it all and not involve States all, IMO.