Single payer debate no so easy

[Slavister]

Nope factually correct. I gave the link that proves it.

Nope. The link you gave proves absolutely nothing. It's an opinion piece looking at just at few recent years. I did not even bother to check its numbers after seeing that. Either way, I think the links I gave are more relevant.

Regarding your increasing demand statement, that does NOT change anything in what I presented. It cost $X in the past for healthcare for an individual. Now it costs $X*Y for SAME set of services (and thus for same-aged) individual and Y is higher than inflation by amounts stated. So, yes, demand increased and so did the prices, but aside from similar demographics applying to other countries, costs are still going up out of control and will for foreseeable future.

No its not the related problem..

Definitely is! Related to how to-high healthcare costs negatively affect patients.

But your graph is largely explained by 1. Not having everyone covered.. 2. American work situations.. like afraid to take off work to go to the doctor to be given a "point" even though by law they are allowed to go.

Wrong. The graph is not explained by being afraid to take off work. Where did you get that from? Imagined it? First sentence in the article: "An 11-country survey finds that adults in the United States are far more likely than those in other countries to go without needed care because of costs and to struggle to afford basic necessities such as housing and healthy food."

Not really.. you said they payed a higher percentage of their budget on medical needs. In any case.. their percentage of out of pocket costs is dropping.

You are confused again. Percentage is NOT dropping. Percentage of budgets and dollar outlay are BOTH increasing. Your only statement MIGHT be that percentage of what patients cover vs what insurance covers is decreasing, which is (a) irrelevant and (b) I did not bother to check because it's irrelevant.

yep. And some do worse.

None do worse on a per DOLLAR SPENT basis.

Yep.. you have made that argument and I have shown over and over again why that's a false argument. One.. we are not "propping up fat".. The rate of increase in healthcare has been because of DEMAND.. large increases in demand.. which you want to ignore. AND you ignore that the government has actually taken large steps to DECREASE reimbursement.. even though DEMAND has been increasing.

I did not ignore it. You did not prove anything. You claimed that increases are purely due to demand increase but you did not show it to be the case. Either way, (a) other countries have similar demographics, and (b) we are still paying more than any other country - i.e. for healthcare dollar spent, we get less than anyone else.

Your argument that there is fat.. is based on the premise.. "Well.. well.. we pay more than other countries"... that's where you claim there is fat. WELL.. we pay a lot of wages more than other countries. IF we followed your argument.. well then.. we should all go lower wages for everyone to say.. a dollar an hour.. because why are we "paying for that fat".. when countries like mexico and china pay less.

You yourself have been pointing out how we spend 18% of our GDP on healthcare, whereas rest of the world is nowhere close. That accounts for all the wage disparities you just wrote about. If we spent same percentage as rest of countries, our wages will still be higher, proportionally.

Yeah and again the lie. YOU cannot get your savings by "cutting inefficiencies".. heck even yourself have indicated that providers are going to either lose jobs or they are going to take pay decreases... that's not "inefficiencies"..

Lies. I never said providers would lose jobs. I said their pay would decrease. And yes, that's FAT. And unnecessary billing personal jobs and private insurance jobs (those are indeed lost) are FAT too. And I also described many substantial inefficiencies. You did not buy them but physicians DO (as I showed with links for administrators related ones) and so does rest of world (related to getting healthcare education faster/cheaper). Again, I know you did not buy it, but at this point we are just going in circles where you keep repeating they are not enough and I keep saying they are a good start and ARE large (per links) and we can do other things too that I mentioned to fill any remaining gap.

You can refer to my list here.

 

[Slavister]

You just stated that employers and employees would be paying the same.. that would mean .. well they would be paying the same.. in other words.. no savings.

They would be paying the same from their at-work environments. For employees, that means paycheck contributions to the healthcare plan. That does not include what people pay when they are patients at provider offices and deductibles. (Sorry if this was not clear, but when I said employer + employee contributions, I meant for what they pay as part of their at-work environment.)

Fantasy.. if you think that cutting provider pay is not going to decrease supply of providers.

Already asked and answered before.

 

[jaeger19]

Well, no, not exactly. Everyone WHO PAYS is sharing the cost of care for those people. KEY words "WHO PAYS". With single payer there would be a large crowd of those NOT PAYING but still eligible for full coverage. The only way to make that work is to make those WHO PAY, pay more. Current Medicare, for example relies on around 150 million workers to finance the benefits for about 60 million recipients. Even at that approximately 2 1/2 to 1 ratio Medicare is running out of cash. Now consider how 150 million workers would pay for 325 million Americans.

No.. because even right now.. you are PAYING for those that don't pay. People in America by law.. get emergency care etc regardless of the ability to pay. Which costs a crapload. So the fellow with uncontrolled diabetes and no insurance comes into the emergency room in a diabetic crisis and ends up in the hospital which costs maybe 100,000 dollars. Which that cost to the hospital gets passed on to you through higher insurance premiums... Or through taxes if the hospital gets indigent support from the government.

Either way you pay. It would be far cheaper if we all simply paid for the persons diabetic medication.

then there are the people that COULD pay.. but choose not to.. and when they get sick.. we end up paying as well.

Current Medicare, for example relies on around 150 million workers to finance the benefits for about 60 million recipients. Even at that approximately 2 1/2 to 1 ratio Medicare is running out of cash. Now consider how 150 million workers would pay for 325 million Americans

this is why medicare for all would not work without serious changes in benefits.. or our taxing structure.

However, until 2006.. medicare DID run a surplus of money for decades.... so the 150 million workers are paying for 60 million recipients.. is a bit of misnomer. The only reason that they are paying is because the government used that money to pay for other things in the general fund and also lowered taxes as well.

 

[jaeger19]

Regarding your increasing demand statement, that does NOT change anything in what I presented. It cost $X in the past for healthcare for an individual. Now it costs $X*Y for SAME set of services (and thus for same-aged) individual and Y is higher than inflation by amounts stated. So, yes, demand increased and so did the prices, but aside from similar demographics applying to other countries, costs are still going up out of control and will for foreseeable future.Lies. I never said providers would lose jobs. I said their pay would decrease. And yes, that's FAT. And unnecessary billing personal jobs and private insurance jobs (those are indeed lost) are FAT too. And I also described many substantial inefficiencies. You did not buy them but physicians DO (as I showed with links for administrators related ones) and so does rest of world (related to getting healthcare education faster/cheaper). Again, I know you did not buy it, but at this point we are just going in circles where you keep repeating they are not enough and I keep saying they are a good start and ARE large (per links) and we can do other things too that I mentioned to fill any remaining ga
URL].

Yeah.. at this point your lack of honesty is just so disturbing.

to get to "what other countries pay".. the FAT as you call it means that we have to cut our GDP by at least 8%. Now.. you want to try and claim that 8% of our GDP is administration costs caused by healthcare billers having to bill multiple insurance companies?. Please.. that's so absurd its not bothering with. that's a big fat lie. (oh but if you can show its 8% of GDP.. you go ahead.. I want to see that its because of billing multiple insurance companies). Yep.. I don't believe you.. because doing so would be against common sense. now.. you say "well its because of inefficiencies.. sure.. PERHAPS getting rid of insurance companies and creating a huge government system to administer medical billing etc.. would be more efficient... but.. I know that right now.. private insurance companies make a profit providing administration to the government in Medicaid and medicare... and you aren;t being honest with yourself or anyone else if you think that's going to go away. And IF you could wave your magic fairie wand.. and get insurance companies to roll over and give up.. You still have the costs of creating a whole healthcare administration in the federal government.. and perhaps in each state as well.
So.. at the end of the day.. there IS NO WAY.. you are getting even close to that 8% of GDP with administration costs.

the place where OTHER COUNTRIES. get their savings? Changes to provider pay and decreasing benefits, controlling expenditures through access changes. THATS REALLY where they get much of their savings. LAbor... in fact.. its probably where they get less of their administration costs.. in wages as well..

Now.. you claim that when you drop a physicians salary by 40K.. that's going to have no impact on supply of physicians.. the same with other providers that may have to take a cut of 30% or more.. Nurses, x ray techs, therapists, PA's NP's.. etc..you think that it won't have any effect on the supply of providers. Based on what pray tell? See.. that's just another lie you are telling yourself and others. You think cutting 8% out of GDP for healthcare spending is not going to have any effect on provider jobs? That's DOUBLE the GDP loss in the great recession. But you? You don't expect any layoffs for providers? Stop lying to yourself and the rest of us.

The problem here is that you don't understand the economics at play here.. its obvious when you say "healthcare IS FAT". Not at all, WHY has healthcare grown faster than inflation. Two major reasons.. the major reason is DEMAND.. demand for services has exploded as the population has aged..(and it increases with the ACA as well)..

Meanwhile.. why doesn't it go up with inflation? BECAUSE ITS DIFFICULT TO OUTSOURCE HEALTHCARE IN THE US. So you can go into the store and buy cheap goods.. that USED to be manufactured in the US.. that are now being made in China.. for dramatically less wages.. And what has that decreased cost meant? Wait.. fewer manufacturing jobs, and stagnant wages in the US.

But with healthcare? Much more difficult to do it. Demand has to be met here in the US with us workers getting paid good wages.... Cripes man.. you say "spending is not sustainable"... HEalthcare spending is SUSTAINING our economy. Where do you think those good wages are going? All those jobs? Healthcare just became the number one source of new jobs in America. Those wages stay right here in the US. AND when you consider the number of NON PROFIT healthcare systems.. that turn around and spend that money back into their communities? Yeah sorry.. but healthcare is SUSTAINING the economy.. not artificially fat.




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[jaeger19]

They would be paying the same from their at-work environments. For employees, that means paycheck contributions to the healthcare plan. That does not include what people pay when they are patients at provider offices and deductibles. (Sorry if this was not clear, but when I said employer + employee contributions, I meant for what they pay as part of their at-work environment.)
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So basically almost no savings. Because most people pay into healthcare.. and don't use it. So for the vast majority of working americans and companies.. the cost would be the same for them.

Already asked and answered before

Oh you have answered.. its just a lie. Its simply not common sense to believe that decreasing salaries by 30% or more.. is not going to have an effect on the supply of providers. You are talking about reducing healthcare spending as a percentage of GDP by 8%. Think of the layoffs that occurred with a drop in 4% during the great recession. but magically.. its not going to affect the supply in providers? Please.

 

[Bullseye]

No.. because even right now.. you are PAYING for those that don't pay. People in America by law.. get emergency care etc regardless of the ability to pay. Which costs a crapload. So the fellow with uncontrolled diabetes and no insurance comes into the emergency room in a diabetic crisis and ends up in the hospital which costs maybe 100,000 dollars. Which that cost to the hospital gets passed on to you through higher insurance premiums... Or through taxes if the hospital gets indigent support from the government.

God, that old "you pay because people go to emergency" mantra is sooooo old. First off a study a few years ago showed almost 80% of people using ER's were insured.

Either way you pay. It would be far cheaper if we all simply paid for the persons diabetic medication.

then there are the people that COULD pay.. but choose not to.. and when they get sick.. we end up paying as well.

this is why medicare for all would not work without serious changes in benefits.. or our taxing structure.

However, until 2006.. medicare DID run a surplus of money for decades.... so the 150 million workers are paying for 60 million recipients.. is a bit of misnomer. The only reason that they are paying is because the government used that money to pay for other things in the general fund and also lowered taxes as well.

Once again, with all due respect I'm going to put my money behind the various studies from institutions across the spectrum that show trillions more in ADDITIONAL COST. You have any data on MC's alleged surplus? Are you talking from FICA?

 

[Slavister]

Yeah.. at this point your lack of honesty is just so disturbing..

Like I said, our discussion here is closing out... You keep misrepresenting my arguments, keep claiming I say things that I don't, keep attributing numbers to me I never talked about.

And then by your logic we should pay everyone awesome income (how about $1million/year?) because it's all going to wages to Americans that will spend it right here. Sure... You clearly understand economics.

I understand your family income depends on the current system. So you might be quite biased to maintain it. (Truth is, so does my family's, but I am still going to vote for the good of the nation instead.)

 

[jaeger19]

God, that old "you pay because people go to emergency" mantra is sooooo old. First off a study a few years ago showed almost 80% of people using ER's were insured.

Old because its true. Dude.. you just pointed out that 80% of the people using ER's were insured... WHO DO YOU THINK PAYS FOR THE 20% that are not?

Once again, with all due respect I'm going to put my money behind the various studies from institutions across the spectrum that show trillions more in ADDITIONAL COST.

Well.. that's because you don't know what you are talking about... you just talked about two different things. Yes. if medicare for all happens.. as I already said.. it won't work without changes in benefits or changing our taxing structure.. "millions".

but.. the idea that you are NOT paying for people that don't have insurance or who have insurance but don't pay in? Yep.. you are paying for those people.

You have any data on MC's alleged surplus? Are you talking from FICA

Social Security tax income exceeds program expenditures, however, the system is
projected to begin running cash flow deficits in 2018. The HI trust fund is projected to
begin running cash flow deficits in 2004, as a result of the Medicare Prescription Drug,
Improvement, and Modernization Act of 2003 and other factors

https://www.everycrsreport.com/files/20040329_95-543_37ddf596e2e7f4a74bc0cb4e8ee19ffb7d6a7012.pdf

Medicare started running a deficit in 2004-2006 depending on how you do the math. Those budget surplus.. and the ones from social security.. where what Bush administration used to justify increased expenditures and tax cuts.

Medicare brings in money mostly from Medicare tax.. (FICA)... , and interest on the funds already deposited it the trust fund. this ran a surplus until 2004-2006.

It also ran a surplus in 2016.

Also in the good-news column: The hospital insurance program ran a $5.4 billion surplus in 2016, and is expected to run modest surpluses every year through 2022. As of the beginning of 2017, the HI trust fund had $199.1 billion in reserves

https://www.fool.com/retirement/2017/07/23/medicare-ran-a-surplus-in-2016-but-is-still-in-tro.aspx

 

[jaeger19]

Like I said, our discussion here is closing out... You keep misrepresenting my arguments, keep claiming I say things that I don't, keep attributing numbers to me I never talked about.

.)

Bull..

And then by your logic we should pay everyone awesome income (how about $1million/year?) because it's all going to wages to Americans that will spend it right here. Sure... You clearly understand economics.

Well.. at some point.. we probably WILL be paying a million a year.. You know what the average wage was in 1900. About 449 dollars.

Lets see. the average wage now is: 44,564,,, so lets see.. that's close to 100 times over in 120 years.

So.. in another 120 years.. that's about 4 million as an average annual salary.

Yep.. I understand the economics.

That result is the result of growth and inflation... due largely to increases in demand, supply of resources etc. Well.. that's why we have the medical expenditures that we have now.. because of demand.. and because we can't outsource that demand. We have to pay good wages in the US. Now.. if you want to argue there is anything artificial about it.. well yes.. we have a minimum wage.. which artificially does push up wages and costs in America for American products and services.

Which you argue we need to get rid of the minimum wage so that we can pay what china pays.. or mexico.

I understand your family income depends on the current system. So you might be quite biased to maintain it. (Truth is, so does my family's, but I am still going to vote for the good of the nation instead.)

Well.. actually no. I actually am rich enough and have enough diversified business that my income doesn;t depend on the current system.. BUT.. my COMMUNITY.. in fact.. much of my state and much of the country.. DEPENDS on those good wages.. My employees are the best in the region.. while other industries have cut back or slowed hiring.. healthcare industry has become the number one employer...

But in the last quarter, for the first time in history, health care has surpassed manufacturing and retail, the most significant job engines of the 20th century, to become the largest source of jobs in the U.S.
In 2000, there were 7 million more workers in manufacturing than in health care. At the beginning of the Great Recession, there were 2.4 million more workers in retail than health care. In 2017, health care surpassed both

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

If you vote to decrease our GDP by 8% by cutting healthcare.. you darn well wont be voting for the good of the nation. You will be voting to hurt the economy more than double of what the great recession did to the country.

Facts are not your friend.

 

[Slavister]

Well.. at some point.. we probably WILL be paying a million a year..

Sure, and as you well know that was not my point. I meant in 2018 dollars. You just deflect.

Which you argue we need to get rid of the minimum wage so that we can pay what china pays.. or mexico.

One of many things you have lately attributed to me which I never said or implied. In fact, I said the opposite.

 

[jaeger19]

Sure, and as you well know that was not my point. I meant in 2018 dollars. You just deflect.
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right.. you were making an absurd argument that I never made. You missed what I was pointing out.. which is that wages often increase because of market forces.. like supply and demand. YOU on the other hand.. assume that because our providers make more.. its "fat".

One of many things you have lately attributed to me which I never said or implied. In fact, I said the opposite.

Stop complaining because I did exactly what you were doing.

I point out that we pay more in wages when it comes to healthcare.. labor, and wages.. and that cutting it will have dire effects to the economy.

And you use a fallacy argument that "well that means we should increase inefficiency and complicate healthcare more".. and ascribe that to me.

Well sir.. what is your complaint about US healthcare? It costs to much because other countries pay less.

Well guess what sir? A lot of other things in America.. cost more too.. because we have a minimum wage in this country.. so we pay more than say a dollar an hour like in mexico.

Because those things cost more.. according to your logic then.. we should lower minimum wage so we can pay what china or mexico pays.

Cuz remember.. according to your logic.. its FAT.. if we pay more than other countries. That sir.. IS your argument.

 

[Slavister]

right.. you were making an absurd argument that I never made. You missed what I was pointing out.. which is that wages often increase because of market forces.. like supply and demand. YOU on the other hand.. assume that because our providers make more.. its "fat".

My argument was with you saying that large wages are no problem because they all go back (i.e. "trickle down") into the economy, so if anything, it's a plus. Here is what you said:

Where do you think those good wages are going? All those jobs? ... Those wages stay right here in the US. AND when you consider the number of NON PROFIT healthcare systems.. that turn around and spend that money back into their communities? Yeah sorry.. but healthcare is SUSTAINING the economy

So yeah, if that's your argument, you'd have no problems with 1M/year average salary either (and yes, in 2018 dollars, so you don't nit pick). After all, economy would benefit so much from it!


Regarding supply and demand, that's a bunch of BS. The system is so distorted, there is NOT much free market in healthcare. It's all building in layers and layers of costs that other countries simply do not bear.

So, yes, compared to other countries, it's clearly "fat". Not only based on wages, but also based on drug costs and a whole layer of costs+profits of insurance companies "built into" the system we pay today. Plus, everything is shielded and obscured to a huge degree from actual consumers that it's anything BUT a free market out there.

It's also fat because even as you point out we spend a lot more of our GDP percentage wise than anyone else.

And you use a fallacy argument that "well that means we should increase inefficiency and complicate healthcare more".. and ascribe that to me.

I am saying it's the same argument. If you claim that high wages and inefficiencies are GOOD because they keep people employed, you cannot complain that I make the logical conclusion that we should increase such GOOD things to make our economy even greater.

Well guess what sir? A lot of other things in America.. cost more too.. because we have a minimum wage in this country.. so we pay more than say a dollar an hour like in mexico. That sir.. IS your argument.

No, it's not my argument. You already tried to claim this minimum wage BS. In case you forgot, I already pointed out that many of the countries we discuss have higher minimum wages than we do. So, this argument holds no water either, let alone being MY argument.

Once again, I said we would pay on the HIGH end of what others are paying. Canada is paying $260k/year on average to it's physicians. That's not that much different from US. Reductions in wages that I suggested would be relatively small. To which you reply that 40k (after tax) would be a huge reduction and we would lose physicians, to which I reply that we won't. Do you think today's physicians are sitting there trying to figure out if they would make that extra 40k or not when they are in med school. Not a single one does. And if in your fairy world we would lose some, as I said, it would still be very lucrative for physicians from other countries to come and take the place of those that decided it;s not worth it. So, no, I do not believe for a second it would cause reduction is healthcare work force.

 

[jaeger19]

So yeah, if that's your argument, you'd have no problems with 1M/year average salary either (and yes, in 2018 dollars, so you don't nit pick). After all, economy would benefit so much from it!

.

Well.. if that's what supply and demand and market forces had done to wages in this country.. yes. If our economy grows that fast, and that well that people are now rich and wages are that good.. sure.

Regarding supply and demand, that's a bunch of BS. The system is so distorted, there is NOT much free market in healthcare. It's all building in layers and layers of costs that other countries simply do not bear.

not at all.. its NOT a bunch of BS. Do you deny that we have a huge population in the baby boomers that's aging. Or do you think that demand is just "made up"? Do you deny that medical technologies and procedures have improved dramatically and that's increased demand as well? Do you deny that we have asthma problems, obesity and more sedentary lifestyles I America? Overuse injuries from repetitive motions? Sorry sir.. but the demand for healthcare HAS been growing by leaps and bounds... and the supply for that healthcare cannot easily be outsourced to other countries or produced in other countries .. while tons of other products and services CAN.

It's all building in layers and layers of costs that other countries simply do not bear.

Wrong.. simply wrong. You need to go study and see where other countries get their savings. Oh.. sure.. some have managed to take insurance companies completely out of the picture. BUT.. others haven't.. like Canada. the fact is.. We do not have "layers and layers" of costs that other countries don't have. that's just an erroneous assumption on your part that's not based on fact.

So, yes, compared to other countries, it's clearly "fat". Not only based on wages, but also based on drug costs and a whole layer of costs+profits of insurance companies "built into" the system we pay today.

Bingo.. wages.. now that.. yes.. we pay a lot more in wages in this country for our providers and their support staff. WE do in large part because of demand and because wages are higher here in many respects. NOW.. you plan to cut wages dramatically to providers in the wake of increasing demand.. and you don't expect any layoffs of providers? you think they are just going to work harder for so much less money? There won't be a decrease in supply of providers? That's absurd.

but also based on drug costs

On drug costs you may have a point because when the federal government expanded medicare to include drugs... it didn;t allow medicare to negotiate prices.. and that has helped increase prices in the US. Other insurance companies negotiate hard when it comes to pharma.. but not the federal government when it comes to medicare. but of course.. we don't need single payer to deal with that.

Plus, everything is shielded and obscured to a huge degree from actual consumers that it's anything BUT a free market out there.

Well.. that's because "actual consumers".. don't actually pay for healthcare. they pay for healthcare insurance. Meanwhile, insurance companies and MEDICARE. and MEDICAID.. and the VA know exactly what things cost because they make the allowables. Single payer is not going to make it MORE of a free market system now is it?

It's also fat because even as you point out we spend a lot more of our GDP percentage wise than anyone else.

In no way does that mean its "fat".. its our economy.. just like other countries get their GDP from a lot of other sources as well. For some its more manufacturing.. for some its natural resources.. etc. I mean its a weird way that you and others look at it. So healthcare is 18% to 20% or more depending on how its calculated).. and you say that's fat.. because other countries "pay" less.
Well. if Manufacturing was 40% of our GDP.. and other countries manufacturing was 20% of GDP.. would you then claim that our manufacturing was "fat".. and that we needed to reduce our manufacturing until it was 20% of GDP?

Please answer that.

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[jaeger19]

I am saying it's the same argument. If you claim that high wages and inefficiencies are GOOD because they keep people employed, you cannot complain that I make the logical conclusion that we should increase such GOOD things to make our economy even greater.

No.. making that argument is like saying that because I can say running 3 days a week is good for your health.. then logically I am saying that running 200 miles a day is even better.

That's the absurd leap that you are making.

Now. if you could argue that our economy was going into recession.. because of what we are spending on healthcare? Okay.. but our economy is growing.
IF you could provide facts that argue that unemployment was increasing because of what we are spending on healthcare ? but.. okay unemployment is low
IF you could provide facts that show anything that our economy is suffering from healthcare to any real extent that money is being drained out of our economy and toward other countries? Maybe you might have point.
but the fact is.. you really don't have a point here when it comes to "Cost".. or "cost per procedure".

That's not that much different from US. Reductions in wages that I suggested would be relatively small. To which you reply that 40k (after tax) would be a huge reduction and we would lose physicians, to which I reply that we won't..

it can't be small and give you the savings your want. Now you mentioned that Canada only pays just a little less.. hmm.. Canada also has a much longer wait time.. in fact on timeliness.. so perhaps.. they are paying their providers similar pay.. but a lot fewer of them..

A new study suggests Canada has just about the lowest number of physicians per capita among dozens of developed countries.

The Fraser Institute claims our country is 29th out of 33 high-income nations, with only 2.7 doctors per thousand people.

That is 20 per cent below the average for countries belonging to the Organization for Economic Cooperation and Development.

https://www.fraserinstitute.org/sites/default/files/supply-of-physicians-in-canada.pdf

Do you think today's physicians are sitting there trying to figure out if they would make that extra 40k or not when they are in med school

Yep.. and so is everyone who is thinking of become a physician in undergraduate school.. and so is every physician who is nearing retirement. WHY do you not think they care about what they get paid.?

And if in your fairy world we would lose some, as I said, it would still be very lucrative for physicians from other countries to come and take the place of those that decided it;s not worth it

Not really because now as you just point out.. you have LOWERED your salary closer to what they are making.. and then.. you have to factor in that while you are artificially losing providers by decreasing wages artificially.. on top of that.. we are already not keeping up with demand and demand is going to INCREASE dramatically as the bulk of the baby boomers age.

So, no, I do not believe for a second it would cause reduction is healthcare work force.

As I have shown.. your believe is not based on anything by feelings... anyone rationale would understand that by cutting healthcare salaries to the point of getting the saving you want.. is going to have negative effects on provider supply

 

[Boo Radley]

You keep chanting that mantra and yet several studies from all points in the spectrum say you're wrong. Right now I'm paying only for my own coverage, under single payer I'd still be paying that PLUS coverage for many others.

No, I don't think they do. I think they look at it in a limited way. But cite your study. I'll gladly examine it.

 

[Boo Radley]

Sure.. hey.. if you want to reduce our GDP by 8% to get there.. awesome.. of course in the great recession.. GDP dropped by 4%.. and we would be doubling that.

this is overblown.. the too many doesn;t come from "too many different means of payment".. it comes from the number of claims.. and outlier insurance that require more hoops.

There is some truth.. getting everyone covered would go a long way to solving that.



The issue here is how. Because we also are pretending that single payer is going to be this simple fix.. and as Greenbeard and I..and even you allude to.. its not.. In fact.. there is a good bet that it will make things worse for the 85% of americans that have health insurance.

Actually we could make things a lot better.. and it would be easier and in a lot smaller steps (easier to take politically).. but that can't get done in an environment in which either side.. (and its mostly liberal lying I will say. sorry but the idea that we can pay what other countries pay.. without a huge hit to our economy is simply a whopper. ).. are willing to not deal with reality.

I'm too tired and have too little time to break your points up. While many like that method, I often find that it just blurs what's actually being said.

I'll save the GDP discussion for later when I'm more awake.

As for the paper work, this is often cited as a major cost. Not to mention how it often hinders care by leading to no answers based on mistakes in paper work.

And no, I'm not pretending single payer would be a simple fix. We'll be terrible in the switch, everyone throwing around misinformation like candy and people will be vile in their comments. It's also not without flaws. No system and I mean no system is perfect. It's all about what you prioritize. For me, more people getting the care they need is the ultimate goal. I'd even pay more for it. But as the OP notes, I believe cost would be a push. We are not the highest in Health care cost due to a single payer system. They cost less. They are also different ways to do it, and we could even explore new ways. But the point is this, how can we explore if we've already bought into sides and won't listen?

 

[jaeger19]

I'm too tired and have too little time to break your points up. While many like that method, I often find that it just blurs what's actually being said.

I'll save the GDP discussion for later when I'm more awake.

As for the paper work, this is often cited as a major cost. Not to mention how it often hinders care by leading to no answers based on mistakes in paper work.
?

Yes.. but here is the thing on that that single payer advocates don't want to listen to. Yep.. it IS a cost. But that cost is usually because of outliers in insurance. In other words.. there are some insurances that are easy to bill. For example.. we submit bills to probably 50 different insurances or more.. probably 40 of them.. maybe more.. follow the same procedures, in fact the same forms.. (electronic).. based on the HCFA form (medicare form). So the costs for the most part are simply the volume of claims. which would likely be the case with a single payer. now.. there is some cost because of the outliers.. those other 10.. that require pre authorization.. or want hard records sent, or require other notes... etcetera... Now THOSE outliers have a definite increase in cost. BUT.. and here is the kicker.. two of those insurances are government insurances VA and Medicaid. So.. when single payer folks state.. "its going to be awesome the savings we have"... I and any other provider that understands billing.. knows better. IT might be a little better.. OR it could and will be dramatically worse.

It's all about what you prioritize

That's exactly right. We have the medical system we have because we in the US prioritize choice and timeliness and quality of healthcare. Now someone will jump up and say "but but.. we don't score number one in those categories"...

and yep.. that's true.. but that's largely because we don't have everyone covered. IF we had universal coverage.. we would score even better on most metrics. and we don't have to have single payer to get universal coverage.

But the point is this, how can we explore if we've already bought into sides and won't listen

And on this I agree totally. that's why its important to have these conversations. You can only explore new ways.. when you actually know what those new ways entail.

 

[Slavister]

Well.. if that's what supply and demand and market forces had done to wages in this country.. yes.

What you wrote is correct about increased demand. I do not deny it. However what I wrote is correct too. We do not have a free market here. It's obscured and even many people in the field do not know how the financial side works. Other countries have exactly the SAME problems we have and same increase in demand. Yet they don't overpay by nearly as much.

Wrong.. simply wrong. You need to go study and see where other countries get their savings. Oh.. sure.. some have managed to take insurance companies completely out of the picture. BUT.. others haven't.. like Canada. the fact is.. We do not have "layers and layers" of costs that other countries don't have. that's just an erroneous assumption on your part that's not based on fact.

Yes we do. Canada has insurance companies for small well-defined areas. For regular care, there is no insurance that's needed. Our drug prices are outrageously expensive too compared to rest of the world.

Well.. that's because "actual consumers".. don't actually pay for healthcare. they pay for healthcare insurance. Meanwhile, insurance companies and MEDICARE. and MEDICAID.. and the VA know exactly what things cost because they make the allowables. Single payer is not going to make it MORE of a free market system now is it?

No it won't but as other countries show, it will keep prices down. We don't have free market either way. I don't think healthcare is a good field / candidate for free market anyway. Those that are ill are not in a good position to negotiate pricing of every little thing when they don't even understand when they are sent for important procedures or not important ones.

In no way does that mean its "fat".. its our economy.. just like other countries get their GDP from a lot of other sources as well. For some its more manufacturing.. for some its natural resources.. etc. I mean its a weird way that you and others look at it. So healthcare is 18% to 20% or more depending on how its calculated).. and you say that's fat.. because other countries "pay" less.
Well. if Manufacturing was 40% of our GDP.. and other countries manufacturing was 20% of GDP.. would you then claim that our manufacturing was "fat".. and that we needed to reduce our manufacturing until it was 20% of GDP?

Please answer that.

At the end of the day, we spend a lot more on healthcare per person than would be spend on same person in any other country. It's MORE than just proportional adjustment you'd make for difference in country currencies. A lot more. Our demographics are similar to many countries. So there is nothing unique here that would justify why we have a lot more demand and why healthcare should be such a big chunk of our GDP. Now, it could be that we don't produce as much as other countries in other areas and that makes the healthcare percentage POP OUT. Yes, that's possible. So I will agree with you that GDP percentage being higher does not imply necessarily it's "fat". However, it's a supporting fact that aligns with rest of the evidence that it IS. It's not the primary or most important piece of evidence however.

 

[Slavister]

No.. making that argument is like saying that because I can say running 3 days a week is good for your health.. then logically I am saying that running 200 miles a day is even better.

That's the absurd leap that you are making.

Not at all. In your case there is no "limit". Your position is that the more the better. We cannot cut the "fat" because that's cutting jobs / GDP output / economy. In this case, you are making the argument that running 200 miles a day IS good.

Now. if you could argue that our economy was going into recession.. because of what we are spending on healthcare? Okay.. but our economy is growing.

Our economy is growing. But what's growing even faster is our National Debt. Because of what we spend on healthcare. And what's shrinking is disposable income for non-healthcare related stuff.

it can't be small and give you the savings your want. Now you mentioned that Canada only pays just a little less.. hmm.. Canada also has a much longer wait time.. in fact on timeliness.. so perhaps.. they are paying their providers similar pay.. but a lot fewer of them..

Or perhaps you should look at the more updated chart to one you had posted. Here. US is LAST on all measures, except for "care process" where it's in the middle of the pack. All of that is BEFORE taking into account the COST that we are overpaying for this subpar result.

Yep.. and so is everyone who is thinking of become a physician in undergraduate school.. and so is every physician who is nearing retirement. WHY do you not think they care about what they get paid.?

That's laughable and completely dishonest if you knew enough docs and medical students. Medical students care about what they get paid but not to the extent of 40k/year. I know that for a fact. Most physicians don't know how much they will be making until after they join a group after they graduate. Even then, if you go to private practice, incomes will vary widely from year to year; in some cases by 100k per year easily. Employees make much more stable income but most medical students still don't have much idea about the numbers. Most medical students just know they will do "well" and that will remain to be the case after the 40k cut.

Not really because now as you just point out.. you have LOWERED your salary closer to what they are making.

Wrong. I explained this many times already. While the salaries are closer to what Canadian docs are making, they are still MUCH MUCH MUCH higher than what most docs are making in some other countries like India.

 

[Aberration]

Single payer means single demand. That’s not a good economic strategy.

 

[jaeger19]

What you wrote is correct about increased demand. I do not deny it. .

Great.. at least we have that.

We do not have a free market here

well of course.. for a lot of reasons.. 1. No one in this country is willing to let a 9 year old die of appendicitis because she doesn;t have the ability to pay.. so. a hospital is forced to provide care.. despite the ability to pay.. and that has a cost.. and thus.. prices/charges.. have to be charged that reflect that cost.

2. There is no way that healthcare would be as advanced without insurance. Which makes it a third party payer system. there is simply no way that you could possibly save enough for a heart surgery.. you need to have an insurance system so that there is money available for that technology for the rare few that need it. And with third party payer.. "insurance".. their are differences in how a "free market system" works.

Other countries have exactly the SAME problems we have and same increase in demand. Yet they don't overpay by nearly as much.

Actually.. most of them have less demand.. because they don't have some of the problems with obesity, sedentary lifestyles, stress, repetitive injuries, etc.. that we have in the states.

In addiction.. they "pay less".. for a variety of reasons... some of it is just cost shifting.. for example shifting education costs.. (that our system bears ) from healthcare to public education. OR for example.. allowing people in physically demanding jobs.. to retire early on the government system... where in the us.. that guy keeps working.. and the result is a total knee later or a back surgery later.

then there are the other reasons for less cost.. for example labor and wages.. we simply pay a lot more and have a lot more jobs. Which of course.. helps our economy. Healthcare is now the single biggest source of new jobs.

Then there is the fact that we have more access in a lot of ways.. particularly to specialists.. (which is why we are often more timely) and also our government insurances and our private insurances also cover a lot more than many of these other countries. then you have things like control of new technologies etc.. which is why that in the US.. we often have access to newer innovations.. where in other countries.. they wait until these innovations are more efficient and thus cheaper..


There are some savings from having everyone covered to some extent.. that definintely saves them money in preventative medicine..

Yes we do. Canada has insurance companies for small well-defined areas

You mean if you define small and well defined as outpatient therapies, pharmaceuticals, home healthcare and durable medical goods. If you don't think getting rehab after your acl surgery is "regular care".. or getting medication for your cancer is "regular care".. I suppose you might be correct. But in the us.. we define that as regular care.. in fact.. it was put in the ACA's essential benefits.

 

[jaeger19]

No it won't but as other countries show, it will keep prices down

Well that depend on what you mean as keep prices down.. YOU just stated how employers and employees were going to have to pay the same..and taxes were likely to rise to pay for it all... So not sure where you think you are going get" keep prices down there"..

Perhaps you can.. but again.. that's largely by decreasing provider pay. Which is going to have negative effects on supply of providers. Your fantasy that decreasing salaries by 30% or more isn;t going to have an effect on labor.. or thinking that we are going to be able to fill needs by recruiting foreign doctors.

Those that are ill are not in a good position to negotiate pricing of every little thing when they don't even understand when they are sent for important procedures or not important ones

. Which is why the federal government, state governments, the VA and private insurance companies all do that negotiation...
F

At the end of the day, we spend a lot more on healthcare per person than would be spend on same person in any other country.

for a lot of reasons.. sure.

It's MORE than just proportional adjustment you'd make for difference in country currencies.

Sure.. again for a number of economic reasons.. like costs are different here.. usually higher.., we don't cost shift as other countries do (like we pay more because education costs are born by healthcare and not by public education).. because our insurances often cover more.. we have timeliness of care.. we have choices of care.. that other countries don't have. Each country is different.. but those are the ways in which they get their savings.. You want to ignore those facts.

Our demographics are similar to many countries. So there is nothing unique here that would justify why we have a lot more demand and why healthcare should be such a big chunk of our GDP

. that's false.

Mirror mirror on the wall, who’s the fattest country in the world? Ouch.

The obesity rate for American adults (aged 15 and over) came in at a whopping 38.2%, which puts the birthplace of the hamburger and the Cronut at the top of the heftiest-nations-in-the-world rankings, according to an updated survey from the Organization for Economic Cooperation and Development.

Running at a not-too-close second is border pal Mexico, with 32.4% of population considered obese, followed by New Zealand, Hungary and Australia (the U.K. comes in at No. 6). The skinniest nations are Japan, with a tiny 3.7% of the population tipping the scales, followed by India, Korea, Indonesia and China. And across much of Europe, less than 20% of the population can be considered obese, according to the survey that was released Thursday.

https://www.marketwatch.com/story/the-us-is-the-most-obese-nation-in-the-world-just-ahead-of-mexico-2017-05-19

Mental health and stress?

Over a 12-month period, 27 percent of adults in the U.S. will experience some sort of mental health disorder, making the U.S. the country with the highest prevalence. Mental health disorders include mood disorders, anxiety disorders, attention deficit/hyperactivity disorder, and substance abuse.

We could continue.. if you wish.. but the US does NOT have the same demographics of other countries.

So I will agree with you that GDP percentage being higher does not imply necessarily it's "fat". However, it's a supporting fact that aligns with rest of the evidence that it IS

No its not. Any more than if more of a countries GDP is in mining would indicate that they are "fat" with mining.

 

[jaeger19]

Not at all. In your case there is no "limit". Your position is that the more the better. .

Now now.. stop lying Again ... That's another bald face lie.. I never ever ever even implied there was no limit. I already stated that if you could show that US expenditure in healthcare.. was causing unemployment to increase.. you would have a point.. but you don't

IF you could show that us expenditure in healthcare was hurting company growth and profit significantly.. you'd have a point.. but companies are making money hand over fist and continue to grow,.

IF you could show that healthcare was sucking money out of the American economy and toward other countries that we were outsourcing to..

but.. none of that is happening.

Our economy is growing. But what's growing even faster is our National Debt. Because of what we spend on healthcare.

Really? You know that medicare ran a surplus right?

According to the recently released 2017 Medicare trustees' report, the Hospital Insurance trust fund, which supports taxpayer-funded Medicare Part A, ran a surplus of more than $5 billion. What's more, surpluses are expected to continue every year through 2022.

https://www.fool.com/retirement/2017/07/23/medicare-ran-a-surplus-in-2016-but-is-still-in-tro.aspx

Sorry man.. The national debt has a lot more due to with deficit spending. with tax cuts that were unnecessary,, with military spending being the worlds policeman.. and a whole host of other things. than it really does with "healthcare spending"..

That's laughable and completely dishonest if you knew enough docs and medical students. Medical students care about what they get paid but not to the extent of 40k/year

BWWWAAAHAHHH... wait a second.. I'll go talk to my employees and see if they mind getting cut 40K a year... ooops.. they do.

Most physicians don't know how much they will be making until after they join a group after they graduate.

Wow is that a lie.. I mean.. man that's a WHOPPER.. Med students are being wooed and looking at salaries before even entering medical school. Its on of the things that gets people even interesting in doing all that schooling. Then.. those med students.. the first years not only are they being wooed by practices and hospitals etc.. all over the country with what they could be making.. and it continues every year they get closer to graduation and past into their residencies.

and so it goes for other providers.

Or perhaps you should look at the more updated chart to one you had posted.

You didn;t post an "updated one" you posted one that had different measures.. which if you had looked at the one I posted.. the us would have scored low on as well. BUT the data I posted... had categories like effective care.. 3.. and timeliness of care 5.. etc..
You have a cherry picked area.. and why do we score lower? not because we don't have single payer.. we get hurt because we don't have universal healthcare. Get everyone insured.. which does not take single payer.. and poof.. we are one of the highest except perhaps administrative efficiency.

Wrong. I explained this many times already. While the salaries are closer to what Canadian docs are making, they are still MUCH MUCH MUCH higher than what most docs are making in some other countries like India.

Right.. we already are facing a shortage of providers.. we have increasing demand.. and you plan on decreasing their salaries by 40k or more.. and then recruiting what we need from india.... Okay... hey.. you might as well say single payer is going to get us world peace too.. :doh

 

[Fearandloathing]

Agreed, it's not as simple an issue as either the "for" or "against" teams want to make it out to be. My oversimplified summation of the good and bad of this approach would be:

Pros

1. Universal coverage. The obvious one: nobody gets left out.
2. Administrative simplicity. Providers would no longer be negotiating fee schedules and contracts with dozens of insurers, no longer going through multiple credentialing processes, etc.
3. Unified policy direction. Much of the current effort to improve our care system is about fixing bad incentives baked into the way care is paid for, which subsequently impedes how it's delivered. But to really address the problem you need all or most boats rowing in the same direction. A dozen payers each trying to fix it independently, each with their customized and branded program, isn't necessarily helpful.
4. Rate-setting. In many markets, high health care prices seem to be at least partially an artifact of health care providers having negotiating clout over insurers. On paper, the ability to set prices and constrain their growth could help to mitigate that issue.

Cons
edited for space[*]Rate-setting. Putting aside the question of how desirable or feasible it is for a single authority to decide pricing levels and the degree to which competing facilities "deserve" to enjoy pricing differentials (Maryland at least seems to have made this work for the past four decades), there are concerns here. Many single-payer advocates view price-setting authority as a silver bullet for addressing high prices--a surefire way to depress prices and suck money out of a bloated health care system.

The problem is, using newfound pricing authority to deliberately take a wrecking ball to our health sector is a potential economic calamity waiting to happen. Health care is increasingly what we as Americans do. It's where the job growth has been, where it's projected to be, and is now the single largest employment sector. It anchors entire communities, not to mention produces some remarkable innovations. Folks in the political sphere would be constrained in how much they could really use this power to push down spending (see previous bullet on politics--they might well use it to push up spending where it benefits their communities)--but the mere fact that this prospect is even on some people's minds is alarming.[/list]

For the most part, I don't think either side is particularly realistic about what single-payer will look like when it comes.

One, I never trust an American's word, and on this file I have never seen one iota of honesty, ever.

Having said that, every news item I have ever seen is an outright lie, like a news clip of a bus load of Canadians arriving to get medical treatment. The clip is 100% bogus, a lie. The reason I know this is I shot the video and it wasn't about medical treatment, but rather 'cross border shopping" where among other things they wanted to buy quantity malitonin.

I find it amusing that the Ametrican right can brag and boast about their super economy and MAGA, but whine they can't afford universal care, can't afford it when others, like little Canada, Cuba, Great Britain, Germany, Italy, Spain, France and even Belize CAN afford it.

The push back against universal care is NOT financial but ideological.
That's why lying is so absolutely necessary on this topic. If Americans knew the real truth they'd be mad as hell.

 

[jaeger19]

One, I never trust an American's word, and on this file I have never seen one iota of honesty, ever.

Having said that, every news item I have ever seen is an outright lie, like a news clip of a bus load of Canadians arriving to get medical treatment. The clip is 100% bogus, a lie. The reason I know this is I shot the video and it wasn't about medical treatment, but rather 'cross border shopping" where among other things they wanted to buy quantity malitonin.

I find it amusing that the Ametrican right can brag and boast about their super economy and MAGA, but whine they can't afford universal care, can't afford it when others, like little Canada, Cuba, Great Britain, Germany, Italy, Spain, France and even Belize CAN afford it.

The push back against universal care is NOT financial but ideological.
That's why lying is so absolutely necessary on this topic. If Americans knew the real truth they'd be mad as hell.

Please detail anything I said that was a lie. I would like to hear it.