Medicare saves about 20% compared to private insurance

[Recursion]

That is, for a given treatment, Medicare in general delivers at 80% the cost of private insurance (there are fluctuations, of course; that's averaged out, and that includes the fact that Medicare's overhead is half of private insurance).

9% of the country is uninsured

16% of the country "cannot afford to utilize their insurance" (per KFF)

So 25% of the country would have more access to health care services than they do now, and the 50% of the country not on Medicare/Medicaid/CHIP would get their care 20% cheaper.

Can people at least admit it's not immediately obvious that this would save money? Can people admit it's entirely possible that this would end up costing more? And that the big, big variable factor here is how much treatment the uninsured and underinsured are currently not seeking that they would seek if it were free at delivery? And that nobody has ever really come up with a number for that? (Kaiser was the closest, but they couldn't come up with a figure.)

For that matter do we even have the capacity in the current system to treat 80 million more people than we are now? We have much fewer doctors per capita than most OECD countries.

Universal health care is the right thing to do, but that doesn't magically make it save money, nor does it maically produce the personnel to deliver it.

[cantbeserious]

1. The Difference - Most Likely - Being The Profit Pocketed By Oligarchs, Corporations And Banks

eom

[hill2016]

3. what about

lower reimbursement rates by Medicare?

Providers don't have to take Medicare...

[Recursion]

5. A lot of it is pocketed by hospitals, sure

Now, look at the history of the "doctor fix" in Congress. What's the likelihood of Congress fixing providers' overcharging?

Honestly, I think we need to do provider cost controls before we do financing centralization, precisely because cutting provider costs after that would be attacked as "cutting Medicare".

[hill2016]

2. also

the US health care system spends $3 trillion a year.

Of which about $270b is on prescription drugs and $115 b goes to profits and administrative costs of private insurance.

Let's say you cut prescription drug costs by -50% and get rid of the private insurance (you would still need to add back administrative costs). You save < 10% on the entire system.

[Wilms]

4. All reasonable points.

Of course, the 20% will go a long way. So will taxing multi-billionaires.

Not all things needing treatment require an MD, especially when handled early. Physicians Assistants would make a tremendous contribution.

I'll bet the whole transition will be challenging. So?

[Recursion]

6. For once I like something Walmart is doing here

Every Walmart with a pharmacy will have either an LPN or PA on staff by the end of 2016, running a clinic with low and transparent fees for primary care. CVS is rolling out a similar model.

[Cheese Sandwich]

7. We spend much more per person than any country, and with not great results

http://www.theatlantic.com/business/archive/2012/03/10-ways-to-visualize-how-americans-spend-money-on-health-care/254736/


It is immediately obvious we would save a shitload of money by adopting a system similar to the Canadian system, right away.

[Recursion]

8. That's not remotely immediately obvious

It is immediately obvious we would save a shitload of money by adopting a system similar to the Canadian system

Why do you say that?

Their providers make much, much less than US providers make even from Medicare.

Why would that change? The history of the "doctor fix" is not encouraging here, and if we had a Canadian-style system then every single attempt to lower provider prices would be attacked as "cutting Medicare".

[Recursion]

9. 4% of our healthcare expenditures are overhead and profit for insurance companies

Let's be wildly optimistic and say that we can absolutely remove overhead from that situation. Like, 0% overhead.

That cuts our total expenditures by 4%.

But if we're talking about cutting expenditures by 50% to get us in line with OECD countries, that means providers would have to make 46% less than they do now while simultaneously providing health care to 80 million more people than they currently do.

How do you make that happen?

[Cheese Sandwich]

10. My dad pays 400/month for prescriptions that shouldn't cost anything since he worked his whole life

How do you make that happen?

[Recursion]

11. Well, I'd have Congress simply set drug prices

If you're asking what I would do.

Other countries have multiple ways of financing their healthcare systems. The difference is that in all of them, the government sets price limits for drugs and services and devices.

[kristopher]

13. Q: "How do you make that happen?" A: That's why it's called "single payer".

With single payer you can break the back of the medical industry's numerous cartels.

To attempt to control costs the new strategy by insurance companies involves patients "having skin in the game" - a kinder way of saying they are hoping that making patients approach health care as if they are buying a car will result in savings.
They are conceptually correct but the concept for execution is abysmal. It doesn't - it CAN'T - make a meaningful difference because health care is not a car. And frankly, I am sick of having to "shop" to maximize the economics of every health care decision. And the DOCTORS hate having to deal with their patients on those terms. I (and many many physicians) want to hire the government to do the shopping on our behalf.

Dramatically lower costs and better overall outcomes are the result. The largest, by far, group of losers are those who are extracting extortionist's rents for their services and products.

And it lets doctors focus on practicing medicine. They are as sick of the cartels as the patients are.

[Recursion]

17. OK, but look at the history of the doctor fix

Individual doctors may (many of them) be saints, but their trade association has proven itself very good at manipulating Congress to maximize their pay. Would single payer really fix that, or make it worse? What will it look like if every single attempt to lower prices can be attacked as "cutting Medicare"?

[kristopher]

19. They'll have to justify the claim to the public.

Reducing their pay isn't going to equate to a reduction in service as long as the standards for controlling supply of physicians is taken away from the cartels. There are lots of extremely suitable candidates that would embrace the opportunity.

They can spin it, but in the end, the product and the price is going to be far better than now. And I firmly believe this - a large part of the current susceptibility of the people around the world is the fact that mean circumstances make mean-hearted people who become willing to disregard the empathic impulse behind social solidarity. Tie that to the slogan "nothing succeeds like success" to wrap up the audience such complaints by still well compensated physicians would be facing.

FWIW:I've had decades worth of experience, from births to deaths, within both styles of health care systems. I can't think of too many times I'd choose our present profit-driven system over the services that a good national health care system would deliver.

In fact, I can't think of any.

[stillwaiting]

20. This is really such a misleading statement. SHOCKER!

Firstly, there is still a HUGE difference between the overhead incurred by insurance companies and the overhead incurred by medicare and other governmental health care programs around the world. That's a lot of money. That's not to say that other changes won't need to be made. Of course, they will. And, doctors and specialists pay, and hospital executive salaries, and medical technology executive salaries, and many other changes will all need to be adjusted accordingly to support a sane and moral health care industry (such as the rest of the OECD countries are able to provide to its citizens).

And, I unfortunately believe that legislation will be passed that will allow insurance companies to classify overhead costs (very recently insurance companies overhead costs topped 30% and no part of me believes they were all able to slash 10% of their costs as the ACA seems to require) as costs going towards the 80% provision to be classified as "on claims and activities to improve health care quality". That really is a very general statement that can be easily exploited, but they will still claim to only be spending 20% on overhead (which will be a lie one day if it's not already).

Second, health care companies in this country have operated ruthlessly and mercilessly for several decades now. Their actions KILL and bankrupt people needlessly and we're not just talking about a few people. Many of these people would literally still be alive and/or not bankrupt if they lived in one of the other first world countries. This industry has been a blight against our people for a very long time. The effects of our health care system on its people are RADICALLY different from the effects of health care systems on the people of other OECD countries. It's downright immoral and hugely offensive. And, when I read your posts you seem to be fighting for insurance company interests. It's all in how you say things and what you say. You are trying to take the oxygen out of a radical transformation of our health care industry (which is exactly what's needed) so that providing health care in this country can become a much more moral industry that benefits everyone. So often the bulk of your time is spent defending industry status quo in this country when it is very, very, VERY sick. You pooh pooh things, and make things seem impossible. You are fighting against the things that so many of us value.

You have yours, right? And, you don't really care how things are impacting average Americans (you have made this CRYSTAL clear repeatedly). I can't take your observations and discussions seriously for this very important fact.

[Hoyt]

12. Like you say, universal health care is right thing to do. We have to figure out how to make

it work financially, within competing needs like education, infrastructure . . . . . .

[kristopher]

14. Any personnel shortage is almost surely engineered

It isn't difficult at all to streamline the education process and implement programs that make medicine an attractive field.

But first we have to remove control of the process from the hands of the likes of cartels such as the AMA. They engage in restricting supply as energetically as any mafia baron or plumber's union ever hoped to be able to do.

[Recursion]

16. Agreed. Not only does the AMA limit the number of physicians, it limits what non-physicians can do

LPNs, PAs, NPs, etc. could be cleared to do a lot more than they are allowed to do currently.

[leftofcool]

15. Here is my question on single payer?

What percentage of my health costs is it going to pay? 80% like Medicare or 100%. As it stands now, medicare does not pay for prescription drugs unless you have a plan D through a private insurance company. Medicare does not pay for blood tests unless it is diagnostic. Medicare does not pay for vision or dental. How much is single payer going to cost me in taxes? 108 dollars a month like medicare or 500.00 per month or more? How does single payer help or medicare for all help if you have less and less doctors taking any type of insurance at all?

[Recursion]

18. The bills in the House and Senate would have zero premiums and copays

So it wouldn't be "Medicare" in that sense. They're also politically dead letters; and I think the inaccurate phrase "Medicare for all" is a recognition of that. It's possible that with a Democratic House and Senate we could extend the Medicare buy-in to everyone, which as you point out would have a level of copays that wouldn't be affordable for people who don't have insurance today.