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A Health Care Overhaul Could Kill 2 Million Jobs, And That’s OK

nekrodev said:
I don't understand what this guy is getting at, like at all. I feel that he doesn't understand the issue, and that's why it's so confusing.

There is no reason why people working in the pharmaceutical industry or hospitals would have to lose their jobs, aside from corporate BS. The only people who are really at risk of losing their jobs due to Medicare For All is the health insurance industry - which is all just administrative work, something that's easily transferable.

As others have already mentioned, the problem with our current healthcare system involves pricing being insane because of the for-profit system. People will still need healthcare, and the amount of people actually using hospitals or needing prescription medications is likely to increase, so I don't see why it would be a good idea to even think about getting rid of people in those areas. If this is actually an issue, and we're going to say that corporations being dicks is going to result in the loss of 2 million jobs, then we can just make it a fully nationalized system and take the profit motive out entirely.
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It hinges on the assumption that single-payer would be used to spend less on health care (i.e., save money). If less revenue flows to providers, then they need to do something about the costs that revenue is intended to cover. For hospitals, something like 2/3 of their underlying costs are labor-related. For settings like a physician practice, it's somewhere north of that.

In other words, much of health spending is somebody's paycheck. The health sector is, after all, labor-intensive and now the largest employment sector in the country. Finding substantial savings without hitting those paychecks isn't doable, which is why finding big savings over a relatively short period is extremely disruptive.

E.g., here's a thread about one hospital's efforts to find barely two percent in savings: An inside look at a top hospital’s struggle to cut costs . They ended up buying out over 800 employees.
 
Deuce said:
:

Adorable Econ 101 there. ‘Everyone has access to healthcare’ somehow ended up with fewer people getting healthcare.

And it didn’t occur to you at all that maybe you are looking at this in an outrageously oversimplified fashion.

lets ask this: whats the demand for continuing to be alive?
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Facts are facts. Just because the government says everyone gets health care, if it isn't available (supply) people just can't have it.
 
Greenbeard said:
Baicker's great, but that's not a great analogy. If policymakers had said "we eat too much, let's burn 22% of the farms down" it would be more comparable to this situation. Working to expose the industry to the sorts of economic winds of change that would lead to the sort of organic restructuring over time she's referencing is exactly the approach we ought to be taking (and to some degree have started taking over the past decade). Intervening directly to put people out of work because we've decided they ought to do something we deem more productive is a very different beast.
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I would think the world prior to ACA was the "organic" world, while higher government intervention / ACA of the past decade is the "intervention" part. But if I understood you, you are implying the ACA intervention was "organic", while M4A is not.

And how about Medicare-for-all-over-65 program? Would you consider that the "bad intervention" one or the "good organic" one?

Greenbeard said:
It hinges on the assumption that single-payer would be used to spend less on health care (i.e., save money).
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I am not sure that's a valid assumption. And even with that, it does not mean that healthcare professionals *must* have much lower pay, if at all. I think M4A would save money to the extent of
- much less expensive insurance - we go from dozen(s) of insurance companies to 1
- much less administrative overhead - providers deal with 1 system, not dozen(s)
- time savings due to efficiencies
- insurance company profits erased
- drug company profits lessened
- medical device company profits lessened
All these are cost savings. As for the rest, we'd have higher taxes for example; or combination of higher taxes and maybe *small* cuts in reimbursements.
 
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Greenbeard said:
It hinges on the assumption that single-payer would be used to spend less on health care (i.e., save money). If less revenue flows to providers, then they need to do something about the costs that revenue is intended to cover. For hospitals, something like 2/3 of their underlying costs are labor-related. For settings like a physician practice, it's somewhere north of that.

In other words, much of health spending is somebody's paycheck. The health sector is, after all, labor-intensive and now the largest employment sector in the country. Finding substantial savings without hitting those paychecks isn't doable, which is why finding big savings over a relatively short period is extremely disruptive.

E.g., here's a thread about one hospital's efforts to find barely two percent in savings: An inside look at a top hospital’s struggle to cut costs . They ended up buying out over 800 employees.
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Maybe this is just the leftist part of me, but this all seems like someone searching for a problem where there shouldn't be one. Currently, insurance companies, pharma companies, and many hospitals are for-profit businesses, this means that they're charging as much as they can and spending as little as possible in order to make the most profit. If you eliminate the for-profit nature of any of those industries, cost will fall for the consumer and overall revenue will likely decline, but that doesn't mean they still won't be profitable, or couldn't afford to keep the same staff levels at the same salaries. It just means someone / some people at the top are getting smaller bonuses at the end of the year.
 
nekrodev said:
Maybe this is just the leftist part of me, but this all seems like someone searching for a problem where there shouldn't be one. Currently, insurance companies, pharma companies, and many hospitals are for-profit businesses, this means that they're charging as much as they can and spending as little as possible in order to make the most profit. If you eliminate the for-profit nature of any of those industries, cost will fall for the consumer and overall revenue will likely decline, but that doesn't mean they still won't be profitable, or couldn't afford to keep the same staff levels at the same salaries. It just means someone / some people at the top are getting smaller bonuses at the end of the year.
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Which government run enterprises are more efficient than their private sector competitors? Profit and competition in the private sector forces enterprises to deliver quality and a competitive price. Since government wouldn't HAVE an competition and would be staffed by Civil Service protected employees what could possibly go wrong?
 
Slavister said:
I would think the world prior to ACA was the "organic" world, while higher government intervention / ACA of the past decade is the "intervention" part.
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"Organic" here doesn't mean "unconnected to government policy." I like health policy! It means manageable change rooted in the actual possibilities of the market, not artificial shocks whose impacts are unknown. If I tell you that you need to run your hospital at 75% of last year's budget, you may not actually be able to do that. If I offer you a business model whereby revenue and service volume/widgets begin to disentangle and give you room to get creative about rethinking or revamping your cost structure, well, we'll see what you can do.

What the ACA has done is start to reshape the playing field. What was a rather static, insulated industry is becoming increasingly exposed to exactly the sorts of economic winds of change I'm talking about. And it's been experimenting and evolving in response. There was an article in the Economist, a few years old now and parts of it are a bit dated, but I've liked the way it captured the changing dynamic of the last decade.

Shock treatment: A wasteful and inefficient industry is in the throes of great disruption
One of the biggest shifts under way is to phase out the “fee for service” model, in which hospitals and doctors’ surgeries are reimbursed for each test or treatment with no regard for the outcome, encouraging them to put patients through unnecessary and expensive procedures. Since Obamacare they are increasingly being paid by results—a flat fee for each successful hip replacement, say. There are also incentives for providers which meet cost or performance targets, and new requirements for hospitals to disclose their prices, which can vary drastically for no clear reason.
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The upshot is that there are growing numbers of consumers seeking better treatment for less money. Existing health-care providers will have to adapt, or lose business. All sorts of other businesses, old and new, are seeking either to take market share from the conventional providers, or to provide the software and other tools that help hospitals, doctors, insurers and patients make the most of this new world.
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Hospital operators are now facing a classic “innovator’s dilemma”, as described by Clay Christensen, a Harvard business professor. If they persist with their high-cost business model even as their customers discover that cheaper alternatives are good enough, they will be in trouble. According to Strata Decision Technology, an analytics firm, many hospital groups saw what was coming and started to cut their costs well before the provisions of Obamacare started to bite. One of the fastest movers is Advocate Health Care, a hospital operator from Illinois, which says it now earns two-thirds of its revenues from value-based payments.
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Obamacare is also encouraging the creation of all sorts of health-related advisory and intermediary companies that help care providers, insurers and patients save money. A company called Vitals approaches employees on behalf of their company’s health plan, and offers them cash rewards, and a taxi, if they agree to be treated at a cheaper provider. The sums to be saved can be astonishing: a new cost-comparison tool created by Blue Cross Blue Shield, a big alliance of private health insurers, has found that a colonoscopy with a biopsy costs $8,489 at one clinic in Chapel Hill, North Carolina, but just $928 at another provider in Greensboro, only 50 miles (80km) or so away.

Cohealo offers a “sharing economy” solution for hospitals and clinics wanting to make the best use of expensive equipment, in much the same way as Airbnb helps people with spare rooms fill them with paying guests. Doximity is trying to be a Facebook for doctors, letting them refer patients and discuss treatments securely without the blizzard of faxes they rely on today. Grand Rounds is a sort of medical Match.com: an online matchmaker that pairs patients with specialists. As in other industries, administrators are being tempted to switch to renting software and data storage in the online “cloud”: Athenahealth, a seller of medical back-office software, is trying to get doctors and hospitals to move patients’ health records onto its cloud-based service.
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That's organic change. Those providers that find efficiencies and savings and better service delivery will win and those that don't will lose. Those startups and other third parties that can help them do that stand to benefit from a major business opportunity. Health care is a very big ship to turn and nobody knows how fast it can turn or how much it can turn. Realistic policy will focus on finding ways to push it and help it to turn faster, not capsize it by demanding it do things it cannot.
 
nekrodev said:
Maybe this is just the leftist part of me, but this all seems like someone searching for a problem where there shouldn't be one. Currently, insurance companies, pharma companies, and many hospitals are for-profit businesses, this means that they're charging as much as they can and spending as little as possible in order to make the most profit. If you eliminate the for-profit nature of any of those industries, cost will fall for the consumer and overall revenue will likely decline, but that doesn't mean they still won't be profitable, or couldn't afford to keep the same staff levels at the same salaries. It just means someone / some people at the top are getting smaller bonuses at the end of the year.
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Do you mean literally they're publicly traded for-profits, or do you mean more generally they're economic entities that need to bring in revenue to cover their costs and make some sort of margin?

Most hospitals in the United States are not for-profits, only about 25% are for-profit. But even the 75% of hospitals that aren't for-profit are still businesses. Zuckerberg San Francisco General took a lot of heat late last year for its ER billing practices (which frankly did seem abusive) which were very much about squeezing out every last dollar it could and that's a public hospital, owned and operated by the city. There are differences by ownership type, sure, (not-for-profit hospitals in particular, which dominate the landscape, tend to be most apt to let their cost structures expand) but the same forces are operating on all of them.

Look at Boston: it's dominated by not-for-profit hospitals and not-for-profit health insurers. That doesn't make it low cost, it just means shareholders aren't cashing in. That money largely flows back into those institution, not least of which by providing jobs (the largest private employer in Massachusetts is in fact a Boston-based hospital system).
 
Mycroft said:
Facts are facts. Just because the government says everyone gets health care, if it isn't available (supply) people just can't have it.
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Don't call your hypothetical scenario based on laughably simple economic principles a fact.
 
Deuce said:
Don't call your hypothetical scenario based on laughably simple economic principles a fact.
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You can easily badmouth facts. Disproving them is harder. Perhaps that's why you are limiting yourself to the badmouthing.
 
Greenbeard said:
Do you mean literally they're publicly traded for-profits, or do you mean more generally they're economic entities that need to bring in revenue to cover their costs and make some sort of margin?

Most hospitals in the United States are not for-profits, only about 25% are for-profit. But even the 75% of hospitals that aren't for-profit are still businesses. Zuckerberg San Francisco General took a lot of heat late last year for its ER billing practices (which frankly did seem abusive) which were very much about squeezing out every last dollar it could and that's a public hospital, owned and operated by the city. There are differences by ownership type, sure, (not-for-profit hospitals in particular, which dominate the landscape, tend to be most apt to let their cost structures expand) but the same forces are operating on all of them.

Look at Boston: it's dominated by not-for-profit hospitals and not-for-profit health insurers. That doesn't make it low cost, it just means shareholders aren't cashing in. That money largely flows back into those institution, not least of which by providing jobs (the largest private employer in Massachusetts is in fact a Boston-based hospital system).
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I mean that they're seeking as much profit as possible by overcharging and being dicks, people's lives be damned. You'll also note that I never claimed "most" hospitals were for-profit, just many - and any at all is too many, imo.

I tried fact-checking some of your claims here, but there's a massive amount of conflicting information from what I've found. I certainly did not find anything that supported your claim that public hospitals are more expensive than private, for-profit hospitals, though, and the claim itself just seems completely ignorant of how reality works. When you have people at the top who want to make money, of course you're going to charge more and cut out things that would dig into your profit.
 
Mycroft said:
You can easily badmouth facts. Disproving them is harder. Perhaps that's why you are limiting yourself to the badmouthing.
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None of what you talked about is a fact. You made up a hypothetical and used.... not even Econ 101. Like the first day of Econ 101.
 
Greenbeard said:
"Organic" here doesn't mean "unconnected to government policy." I like health policy! It means manageable change rooted in the actual possibilities of the market, not artificial shocks whose impacts are unknown. If I tell you that you need to run your hospital at 75% of last year's budget, you may not actually be able to do that. If I offer you a business model whereby revenue and service volume/widgets begin to disentangle and give you room to get creative about rethinking or revamping your cost structure, well, we'll see what you can do.

...and new requirements for hospitals to disclose their prices, which can vary drastically for no clear reason...The upshot is that there are growing numbers of consumers seeking better treatment for less money. ...
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I get your overall point and maybe would even agree if I believed it, but so far, despite what the article says, I see healthcare bills as mysterious as ever, and customer reps at both hospital billing and insurance declining to provide even the CPT codes they used to arrive at the amounts they charge. As usual, they point fingers and each other and me, the patient, is stuck in the middle with some large bill. Noone wants to go anywhere below the surface on a bill when I try to question what this was really for. The system is as messed up as ever and no good "shopping around" can happen with current system IMO, based on attempts to do so a few times recently.

Sometimes it's best to start from scratch and redesign the whole thing than to keep patching the monstrosity that we call healthcare costs and coverages.
 
Deuce said:
And? We gonna fight to maintain whaling jobs and swordsmiths?
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We would if there was a great demand for swordsmiths and whalers.

With an aging baby boomer population.. demand for healthcare is increasing exponentially.
 
Deuce said:
"Saving money is bad because it hurts the economy" certainly is a new hot take.

If those jobs only exist because of inefficiency in the system, then they're jobs that never deserved to exist in the first place.
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They aren't jobs because of inefficiency.. they are jobs because of the demand of an aging population and because of the US demand for timeliness in being seen.
 
Deuce said:
Medicare for all will increase the demand for health care services. So you tell me, where are these million jobs being lost from?
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There is no free lunch here. If you want to get the savings that Medicare for all proponents say they will.. they will have to cut reimbursement.. which means cutting jobs. Its just that simple.
 
Slavister said:
I get your overall point and maybe would even agree if I believed it, but so far, despite what the article says, I see healthcare bills as mysterious as ever, and customer reps at both hospital billing and insurance declining to provide even the CPT codes they used to arrive at the amounts they charge. As usual, they point fingers and each other and me, the patient, is stuck in the middle with some large bill. Noone wants to go anywhere below the surface on a bill when I try to question what this was really for. The system is as messed up as ever and no good "shopping around" can happen with current system IMO, based on attempts to do so a few times recently.

Sometimes it's best to start from scratch and redesign the whole thing than to keep patching the monstrosity that we call healthcare costs and coverages.
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Healthcare bills will still be mysterious billing system... and that's because you have a third party payer. Its going to be the same whether you have medicare, Medicaid or private insurance.

then there is the need for cost shifting. Cost have to be shifted or.. there is no way having rare but needed technology can exist.
 
nekrodev said:
I tried fact-checking some of your claims here, but there's a massive amount of conflicting information from what I've found.
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What are you looking for/at? Happy to help if you want to know where to look and what to look for.

I certainly did not find anything that supported your claim that public hospitals are more expensive than private, for-profit hospitals, though, and the claim itself just seems completely ignorant of how reality works. When you have people at the top who want to make money, of course you're going to charge more and cut out things that would dig into your profit.
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I didn't make that claim, I brought up a recent prominent example of behavior from a public hospital that one might naively associate with a for-profit hospital.

That said, for-profits on the whole tend to have leaner cost structures. I.e., their inpatient expenses per day tend to be lower than those of public or not-for-profit hospitals and they are more likely to break even or come out in the black on their Medicare business. Whether or not that means they're 'less expensive' depends on what that phrase means. Usually when the costliness of a provider is being discussed we're talking about what that provider is being reimbursed, not what that provider's underlying costs are; these are different questions. The former depends on a lot of things, not least of which is relative market power in their service area, so that's a tougher question to tease out. But I haven't claimed for-profits are getting paid more or less than comparator hospitals of the other ownership types.

Slavister said:
I get your overall point and maybe would even agree if I believed it, but so far, despite what the article says, I see healthcare bills as mysterious as ever, and customer reps at both hospital billing and insurance declining to provide even the CPT codes they used to arrive at the amounts they charge. As usual, they point fingers and each other and me, the patient, is stuck in the middle with some large bill. Noone wants to go anywhere below the surface on a bill when I try to question what this was really for. The system is as messed up as ever and no good "shopping around" can happen with current system IMO, based on attempts to do so a few times recently.

Sometimes it's best to start from scratch and redesign the whole thing than to keep patching the monstrosity that we call healthcare costs and coverages.
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The question of whether competitive forces can be at play and the question of whether an underlying bill is comprehensible aren't necessarily the same thing. If the goal is competition via a direct consumer market for provider services, then they are. But there are different ways to approach and think about it.

If we were to rebuild from scratch--which we can't realistically do--I assume we would still want to design in some room for competitive pressure.
 
jaeger19 said:
Healthcare bills will still be mysterious billing system... and that's because you have a third party payer. Its going to be the same whether you have medicare, Medicaid or private insurance.

then there is the need for cost shifting. Cost have to be shifted or.. there is no way having rare but needed technology can exist.
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No, under medicare for all, there will be NO mysterious billing system as far as general population is concerned. In the countries with universal health care, there are no bills to pay when you used the healthcare - you just waive your cards and that's it.

I am NOT saying of course it's "free" - clearly, taxes on employers and employed would pay for it. But there will be no bills to deal with or pay separately when using healthcare system.

Greenbeard said:
The question of whether competitive forces can be at play and the question of whether an underlying bill is comprehensible aren't necessarily the same thing. If the goal is competition via a direct consumer market for provider services, then they are.
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Your article to which I was replying seemed to imply direct consumer market and how people would shop around for hip replacements. That's why I quoted "the upshot is that there are growing numbers of consumers seeking better treatment for less money" part of it.

Of course when you are being rushed in an ambulance somewhere, you don't have much time to shop around. More generally, people feeling ill don't normally have a good state of mind for shopping around.

Greenbeard said:
If we were to rebuild from scratch--which we can't realistically do--I assume we would still want to design in some room for competitive pressure.
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What does the rest of the world do as far as building competitive pressure into the system?
 
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Slavister said:
Your article to which I was replying seemed to imply direct consumer market and how people would shop around for hip replacements. That's why I quoted "the upshot is that there are growing numbers of consumers seeking better treatment for less money" part of it.
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That bit of the article was mostly a preface to the part about the rise of retail and urgent care clinics as alternatives to emergency departments, etc.

But hip replacements are something you can shop around for. California's public employees' health plan famously saved millions on hip and knee replacements and certain other services by exposing consumers to relative prices for those procedures at different hospitals (through a benefit design called reference pricing). Consumers voted with their feet and uncompetitive hospitals responded with price reductions.

Under this approach, CalPERS set a maximum contribution it would make for the cost of knee and hip replacement surgeries, colonoscopies, cataract removal and a handful of other elective procedures, according to the report. Patients who decided to get a procedure at a hospital with higher prices paid the difference out of pocket.

According to a series of studies, health economists found under the reference pricing system, patients largely sought care a lower-priced hospitals and outpatient centers. As a result, prices and total spending on the procedures fell dramatically.

Lower-priced hospitals saw their market share grow by 28 percent for hip and knee replacements, prompting many higher-priced hospitals to lower their prices. Overall, the cost of the surgery fell by an average of more than 20 percent, saving CalPERS and its patients $6 million in the first two years. Reference pricing had similar effects for the other designated procedures, according to the report.
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These concepts don't work in all situations (~43% of health spending is on shoppable services) but there certainly are situations in which they can work.

Of course when you are being rushed in an ambulance somewhere, you don't have much time to shop around. More generally, people feeling ill don't normally have a good state of mind for shopping around.
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There are indeed many factors that make consumer choice difficult.
 
Greenbeard said:
~43% of health spending is on shoppable services
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Do you happen to have a link? Curious what this number includes. For example, my close relative had a terminal cancer diagnosis. She had less than a year left. And yes, we could / had to shop around for the chemo, etc, despite no clear pricing exposed to us of course by different options. Does that count as part of that 43%? In the rest of the world, families do not spend their precious remaining time with loved ones weighing the costs of treatments, trying to get the best deal, putting a price tag on one facility over another, one treatment over another, one manufacturer discount over another. The disease itself is more than stressful enough. Adding the affordability stress is the crazy that only this country "enjoys".
 
Slavister said:
No, under medicare for all, there will be NO mysterious billing system as far as general population is concerned. In the countries with universal health care, there are no bills to pay when you used the healthcare - you just waive your cards and that's it.

?
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And the above is not true. In countries with universal healthcare.. there are definitely bills when you use healthcare. In Canada.. the government single payer does not pay for pharmaceuticals outside the hospital.. it does not pay for home health or outpatient therapy. To cover that.. people either have to PAY PRIVATELY..or have other supplemental insurance.. from their employer mostly.

In other countries.. the single payer only pays for certain things.. like in France the single payer will pay for your laparoscopic surgery.. but NOT pay for the anesthetic, so if you want surgery with anesthetic.. you have to either pay privately or have a separate private insurance... Called a mutuelle

What is a mutuelle?
As the state only pays for around 70% of the majority of healthcare costs, many of those living in France choose to purchase a top-up health insurance, called a mutuelle, to cover the rest of the cost.
There are numerous insurers to choose from and, as with all types of insurance, a wide range of policies with varying degrees of cover and premiums. Basic packages tend to cover hospital costs and medicine, but you can choose to add things like dental costs. It is worth shopping around and seeking advice to ensure you choose the best policy for your needs and budget. If you’re an employee of a company, you will most likely be able to join the company’s policy as part of your benefits package.
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Healthcare in France: What is a mutuelle? | Healthcare | Complete France

And you say.. but but MEDICARE... okay..well Medicare.. PArt B (if the medicare for all proposal actually includes a part B).. only covers 80% of costs... so patients will still receive a bill or have private insurance.

AND even when medicare pays 100%... there is still that confusing bill. And that's because Medicare requires hospitals to outline their charges etc for say a surgery in the hospital and the hospital stay.. EVEN THOUGH.. the hospital is currently reimbursed by a DRG or diagnostic related group reimbursement. In other words.. we send a bill to medicare.. which outlines a whole host of charges.. and it really doesn't matter because Medicare is basically going to give us a lump sump based on the diagnosis.

Sorry man.. but you are just plain wrong. You need to realize that the Medicare for all proponents are not being truthful..or they are being ignorant.
 
Greenbeard said:
There was an op-ed that ran in the NYT a couple weeks ago arguing the merits of creative destruction in the context of a move to some sort of single-payer system. The underlying assumption, of course, is that SP would be designed in such a way that it pushes down health spending, which isn't really a given (for exactly this reason!).

The argument is essentially that if we push money and jobs out of the health sector, they'll be freed up to flow to other sectors and theoretically perhaps put to more productive use. This is similar to the popular of concept of "bending the cost curve" in heath care, except that the point there is to stop jobs and dollars from disproportionately flowing into health care and re-balance the economy on a prospective, go-forward basis.

Analysis: A Health Care Overhaul Could Kill 2 Million Jobs, And That’s OK



Baicker's great, but that's not a great analogy. If policymakers had said "we eat too much, let's burn 22% of the farms down" it would be more comparable to this situation. Working to expose the industry to the sorts of economic winds of change that would lead to the sort of organic restructuring over time she's referencing is exactly the approach we ought to be taking (and to some degree have started taking over the past decade). Intervening directly to put people out of work because we've decided they ought to do something we deem more productive is a very different beast.

Anyway, this reality is shaping some of the politics of the Medicare for All debate.

'Medicare for All' backers find biggest foe in their own backyard



The political danger of dropping a NAFTA-esque job shuffling on every region of the country, with white collar health sector jobs playing the role blue collar industrial jobs played in the Rust Belt 25 years ago, seems to me to be to be significant, even if one firmly believes that the pieces will eventually be put back together as something superior.
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I can't believe we are all paying for 2 million wasteful jobs. No wonder my healthcare bill is so outrageous. We are literally paying millions of people to do healthcare paperwork. Our cost savings on healthcare will allow us to spend our money elsewhere and create jobs there.
 
jaeger19 said:
And the above is not true. In countries with universal healthcare.. there are definitely bills when you use healthcare. In Canada.. the government single payer does not pay for pharmaceuticals outside the hospital.. it does not pay for home health or outpatient therapy. To cover that.. people either have to PAY PRIVATELY..or have other supplemental insurance.. from their employer mostly.

In other countries.. the single payer only pays for certain things.. like in France the single payer will pay for your laparoscopic surgery.. but NOT pay for the anesthetic, so if you want surgery with anesthetic.. you have to either pay privately or have a separate private insurance...
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You are trying to use examples of small exceptions to pretend like it applies to overall healthcare. That's misleading.

What I said applies to 90% of the care. Sure, some parts of healthcare are not covered in some countries and the same issues come into play then. Say, dentists in some countries, eyecare in some countries, drugs outside of hospitals or home health therapy in your examples. But those are SMALL subareas of overall healthcare. What I said is absolutely the case of most of the care that people receive.

jaeger19 said:
AND even when medicare pays 100%... there is still that confusing bill.
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Nope. Not to the patient. It's between the providers and the Medicare and patient never has to see the bill. That's the beauty of it.

And even when Medicare does not pay 100%, which I am fine with it not doing so, the bill is no more complex than a well-known reasonably small copay and/or deductible; normally collected at the point-of-service, so there is not even a bill needed.
 
Greenbeard said:
There was an op-ed that ran in the NYT a couple weeks ago arguing the merits of creative destruction in the context of a move to some sort of single-payer system. The underlying assumption, of course, is that SP would be designed in such a way that it pushes down health spending, which isn't really a given (for exactly this reason!).

The argument is essentially that if we push money and jobs out of the health sector, they'll be freed up to flow to other sectors and theoretically perhaps put to more productive use. This is similar to the popular of concept of "bending the cost curve" in heath care, except that the point there is to stop jobs and dollars from disproportionately flowing into health care and re-balance the economy on a prospective, go-forward basis.

Analysis: A Health Care Overhaul Could Kill 2 Million Jobs, And That’s OK



Baicker's great, but that's not a great analogy. If policymakers had said "we eat too much, let's burn 22% of the farms down" it would be more comparable to this situation. Working to expose the industry to the sorts of economic winds of change that would lead to the sort of organic restructuring over time she's referencing is exactly the approach we ought to be taking (and to some degree have started taking over the past decade). Intervening directly to put people out of work because we've decided they ought to do something we deem more productive is a very different beast.

Anyway, this reality is shaping some of the politics of the Medicare for All debate.

'Medicare for All' backers find biggest foe in their own backyard

The political danger of dropping a NAFTA-esque job shuffling on every region of the country, with white collar health sector jobs playing the role blue collar industrial jobs played in the Rust Belt 25 years ago, seems to me to be to be significant, even if one firmly believes that the pieces will eventually be put back together as something superior.
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I don't really understand the mechanics of replacing the entire insurance industry as well as most of the provider billing and documentation-related staff under a theorized single payer overhaul. What takes the place of all that? Nothing, magically? I mean literally how would the nation's health care claims be submitted and processed? The idea that all our savings will come from "cutting out the middle man" really blinks reality to me. Government programs tend not to streamline and simplify anything, in my experience. And if a single payer plan proposes to reduce overall health spending and control provider costs, how does it do that and process the nation's health claims without simply replicating the same bureaucracy?

I just don't get what people are actually imagining with these proposals that would result in mass layoffs of the insurance and provider billing industries.
 
distraff said:
I can't believe we are all paying for 2 million wasteful jobs.
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If they were that inherently wasteful, then it should be easy for one insurance company to undercut another by running a bare bones simple and straightforward insurance plan, as well as easy for one provider/clinic/facility to undercut another, by running very efficiently and eliminating their wasteful billing staff, and then everyone would favor those insurance companies and/or providers because of their superior prices and efficiency thanks to their choice not to employ all those "wasteful" staff.

No wonder my healthcare bill is so outrageous. We are literally paying millions of people to do healthcare paperwork. Our cost savings on healthcare will allow us to spend our money elsewhere and create jobs there.
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How would any single payer overhaul save on healthcare costs and process the entire nation's health care claims and reimbursement without requiring healthcare paperwork?

Would it be because fee-for-service would be eradicated, to be replaced by some sort of federal "global budgeting" system? If so, how do you imagine the nation's providers, clinics, hospitals, et al. will line up with their hands out awaiting their federal annual budget appropriation without being required to complete all sorts of healthcare paperwork?

The notion that the federal government can comprehensively take over this gigantic sprawling industry while maintaining quality and access while reducing costs while eliminating the insurance industry and millions of billing related jobs while reducing paperwork and bureaucracy? Seems a bit like a fantasy to me.
 
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