Article: Would ‘Medicare for All’ really save money?

[Doctor_Strange]

Interesting article in Politico about the M4A debate -- commentators include both liberal and conservative thinkers. Regardless, the below stuck out to me, and wanted to know what others think of this line of thinking? I've already rotated with an anesthesiology group, where CRNAs are working independently on many cases, but the author (and did some background research on him) seems to advocate for expanding the role of many allied health professionals (eg. NPs, PAs) to offset the lack of supply. Is this something those who are interested in anesthesiology consider when making a decision, or not really? Looking any insight -- pretty ignorant on this topic!

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[deleted480308]

No one wants to admit that "top of the license" just might mean being supervised by a doctor and not actual independent practice

 

[Planktonmd]

They somehow forget the simple well known fact that the cause of the astronomically expensive health care in this country is not physicians' pay, which does not exceed 20% of the total cost.
80% of the cost goes to all the others: Insurance companies, pharmaceutical companies, medical devices manufacturers, hospital administrators, management companies, lobbyists employed by all these entities, and last but not least the politicians bought by these lobbyists to keep the money coming to all these blood suckers.

 

[ambiturner]

They somehow forget the simple well known fact that the cause of the astronomically expensive health care in this country is not physicians' pay, which does not exceed 20% of the total cost.
80% of the cost goes to all the others: Insurance companies, pharmaceutical companies, medical devices manufacturers, hospital administrators, management companies, lobbyists employed by all these entities, and last but not least the politicians bought by these lobbyists to keep the money coming to all these blood suckers.

Don’t forget device reps! Lord knows we wouldn’t be able to take metal knees out of a box without them taking a 300-700k/yr cut.

The problem with all these midlevels ideas is that they pretend the hospital is going to charge less if a midlevel does the procedure/anesthetic/clinic visit when we all know that’s not the case. They will bill the same and just pocket the difference to buy more billboards and TV ads.

 

[bronx43]

Someone needs to show the data that utilization of midlevels actually leads to decreased cost, because we all know that’s total bs.

 

[ChiDO]

It's not like the 250k savings of a mid-level is given back to the patients. It's given to the ceo or other admin as a bonus. It's just redistribution of $$ within the system.

 

[BLADEMDA]

Would Medicare for all save the USA money? Yes. But, would the middle class or upper middle class see any of that savings? No. The rich would still pay cash or have private insurance while the poor get an upgrade to Medicaid. Overall, healthcare expenditures go down as does GDP.

Physicians get slashed and some specialties get crushed. Innovation gets obliterated and many hospitals go out of business. I do think the system would adjust back to the middle and politicians along with the public would come to accept a two tier healthcare system. The best I could hope for is that my future Medicare card would pay for 1/2 of my healthcare expenses when I am admitted to a private hospital. The public system would be a disaster with long wait times and heavily rationed care.

Rather than opine on "right vs wrong" the fact remains the elderly would no longer get their current version of medicare. Their care would be heavily rationed and those on demand knee/hip replacements vastly reduced annually. This would occur across the board as society no longer has the money or sees the need to pay for retirees to ski in Vail or play pickle ball at the taxpayer's expense. Retirees would be seen as the expendable citizens they are to the overall country.

 

[Planktonmd]

Rather than opine on "right vs wrong" the fact remains the elderly would no longer get their current version of medicare. Their care would be heavily rationed and those on demand knee/hip replacements vastly reduced annually. This would occur across the board as society no longer has the money or sees the need to pay for retirees to ski in Vail or play pickle ball at the taxpayer's expense. Retirees would be seen as the expendable citizens they are to the overall country.

In many European countries with single payer systems the elderly do not get their health care rationed or slashed, they just get the care they need, not the unnecessary and expensive procedures they are made to believe they need under our system.
Also under these single payer systems no one is trying to convince the patients that they should get their health care by nurses to save money.
If the retirees were seen as "expendable citizens" the life expectancy wouldn't be higher than what we have here (80 years in the UK Vs. 78 years in the US).

 

[deleted480308]

In many European countries with single payer systems the elderly do not get their health care rationed or slashed, they just get the care they need, not the unnecessary and expensive procedures they are made to believe they need under our system.
Also under these single payer systems no one is trying to convince the patients that they should get their health care by nurses to save money.
If the retirees were seen as "expendable citizens" the life expectancy wouldn't be higher than what we have here (80 years in the UK Vs. 78 years in the US).

now you're just talking semantics as the person getting denied something (and everyone in gramma's family) would just say the evil rich aren't wanting to buy "x" for gramma because they hate gramma and want her to die. Whether it was a legitimate need or just a want doesn't change that

 

[Planktonmd]

now you're just talking semantics as the person getting denied something (and everyone in gramma's family) would just say the evil rich aren't wanting to buy "x" for gramma because they hate gramma and want her to die. Whether it was a legitimate need or just a want doesn't change that

If you "want" a procedure and your physician does not think you need it then you should pay for it out of your pocket, this will only work when your physician does not make more money by offering you unnecessary procedures.

 

[VA Hopeful Dr]

In many European countries with single payer systems the elderly do not get their health care rationed or slashed, they just get the care they need, not the unnecessary and expensive procedures they are made to believe they need under our system.
Also under these single payer systems no one is trying to convince the patients that they should get their health care by nurses to save money.
If the retirees were seen as "expendable citizens" the life expectancy wouldn't be higher than what we have here (80 years in the UK Vs. 78 years in the US).

The life expectancy thing isn't actually true.

The Myth of Americans' Poor Life Expectancy

It’s one of the most oft-repeated justifications for socialized medicine: Americans spend more money than other developed countries on health care, but don’t live as long. If we would just hop on the European health-care bandwagon, we’d live longer and healthier lives. The only problem is it’s...

www.forbes.com

 

[Planktonmd]

The life expectancy thing isn't actually true.

The Myth of Americans' Poor Life Expectancy

It’s one of the most oft-repeated justifications for socialized medicine: Americans spend more money than other developed countries on health care, but don’t live as long. If we would just hop on the European health-care bandwagon, we’d live longer and healthier lives. The only problem is it’s...

www.forbes.com

This article is basically saying: let's wait until you get sick and see if we spend a fortune on fixing you, we can make you live longer compared to others with a similar illness, who are not lucky enough to live here and enjoy our wonderful health care system.
In a health care system that is not focused on profit and lucrative procedures, we would try to prevent the illness rather than wait for it to happen.
It's preventive medicine that makes the difference in life expectancy, it improves your health from infancy to the end of your life and makes you less likely to need expensive procedures.

 

[BLADEMDA]

"Unnecessary procedures." That is another way of saying your knee pain "in my opinion" doesn't warrant a replacement or that A. Fib doesn't "need" an ablation or watchman. In fact, you don't need Xarelto or Eliquis because the much cheaper Coumadin is more than adequate.

Almost every decision for someone else's quality of life will be made by a govt. panel or official. No longer will you or even your doctor have the "right" to decide on what type of care you wish to receive unless you have the $$ to pay for it. The care will be rationed as that is the only way to truly save money in the system. The budget breaking Medicare for all policy will eventually lead to severe restriction in elective surgery because the "panels" will determine they are "unnecessary" surgeries.

I prefer a system when i get to decide for myself what type of care I prefer. This means I can get Proton Beam therapy for Prostate cancer, Treatment for my arthritis as I see fit which includes elective total joint replacement, the option for a lumbar fusion down the road and not just a heating pad, a coronary stent for asymptomatic CAD and not just medical management at age 80, etc etc,

The government isn't the solution to healthcare crisis it is the problem.

 

[deleted480308]

If you "want" a procedure and your physician does not think you need it then you should pay for it out of your pocket, this will only work when your physician does not make more money by offering you unnecessary procedures.

"you" should always pay for it either way...or pay the market rate premium for insurance that offers it as coverage

It should never be your neighbor forced to buy you things

 

[Planktonmd]

"Unnecessary procedures." That is another way of saying your knee pain "in my opinion" doesn't warrant a replacement or that A. Fib doesn't "need" an ablation or watchman. In fact, you don't need Xarelto or Eliquis because the much cheaper Coumadin is more than adequate.

Almost every decision for someone else's quality of life will be made by a govt. panel or official. No longer will you or even your doctor have the "right" to decide on what type of care you wish to receive unless you have the $$ to pay for it. The care will be rationed as that is the only way to truly save money in the system. The budget breaking Medicare for all policy will eventually lead to severe restriction in elective surgery because the "panels" will determine they are "unnecessary" surgeries.

I prefer a system when i get to decide for myself what type of care I prefer. This means I can get Proton Beam therapy for Prostate cancer, Treatment for my arthritis as I see fit which includes elective total joint replacement, the option for a lumbar fusion down the road and not just a heating pad, a coronary stent for asymptomatic CAD and not just medical management at age 80, etc etc,

The government isn't the solution to healthcare crisis it is the problem.

Your doctor should decide what you need not the insurance company or your personal frequently ill informed opinion.
What percentage of the population in your opinion is actually capable of understanding medicine and make therapeutic decisions on their own?

 

[Planktonmd]

"you" should always pay for it either way...or pay the market rate premium for insurance that offers it as coverage

It should never be your neighbor forced to buy you things

So, why have insurance then? I mean insurance companies are able to survive by insuring people who don't need too much care and using their money to pay for others who need the most care, that is a form of socialism too. You should pay cash for all your health care needs.

 

[deleted480308]

Your doctor should decide what you need not the insurance company or your personal frequently ill informed opinion.
What percentage of the population in your opinion is actually capable of understanding medicine and make therapeutic decisions on their own?

if you take the notion of patient autonomy seriously? almost all of them

It's not my job to decide what they need for them. It's my job to provide the information about relevant risks/benefits/costs/nuisances of treatments and see what fits their values

 

[deleted480308]

So, why have insurance then? I mean insurance companies are able to survive by insuring people who don't need too much care and using their money to pay for others who need the most care, that is a form of socialism too. You should pay cash for all your health care needs.

insurance, being voluntary, is not socialism.
insurance, charging appropriate actuarial rates to each person based off risk, is not socialism

 

[vector2]

I prefer a system when i get to decide for myself what type of care I prefer. This means I can get Proton Beam therapy for Prostate cancer, Treatment for my arthritis as I see fit which includes elective total joint replacement, the option for a lumbar fusion down the road and not just a heating pad, a coronary stent for asymptomatic CAD and not just medical management at age 80, etc etc,

if you take the notion of patient autonomy seriously? almost all of them

It's not my job to decide what they need for them. It's my job to provide the information about relevant risks/benefits/costs/nuisances of treatments and see what fits their values

Do you let your patients request MD-only care, preop aprepitant, intubation with a cobalt glidescope, high-flow desflurane, remifentanil and precedex infusions, and reversal with suggamadex even if none of those things is warranted or indicated?

 

[BLADEMDA]

The left will try to make private insurance illegal. There will be court challenges to these laws based on the constitution. I don't see how the govt. can forbid a private citizen from buying a product or service which clearly benefits that individual. Our entire Constitution is based on our "rights" as individuals.

Eventually, healthcare becomes a 2 tiered system where those with money or private insurance seek out the Mayo Clinics of the world while the majority are stuck with the public healthcare system with rationed care.

 

[Planktonmd]

if you take the notion of patient autonomy seriously? almost all of them

It's not my job to decide what they need for them. It's my job to provide the information about relevant risks/benefits/costs/nuisances of treatments and see what fits their values

It is your role as a physician to determine what the patient truly needs to get better or to not get sick, if the patient disagrees with your expert opinion then they have the right to "want" whatever they think is better for them but the system does not have the obligation to pay for their desires.
When the system pays the bill then the system has the right to play a paternal role over your autonomy. It's like when your adult child lives under your roof and you pay his bills, you have the right to tell him how to spend your money.
This is by the way what insurance company physicians do now when they deny your claims.

 

[VA Hopeful Dr]

This article is basically saying: let's wait until you get sick and see if we spend a fortune on fixing you, we can make you live longer compared to others with a similar illness, who are not lucky enough to live here and enjoy our wonderful health care system.
In a health care system that is not focused on profit and lucrative procedures, we would try to prevent the illness rather than wait for it to happen.
It's preventive medicine that makes the difference in life expectancy, it improves your health from infancy to the end of your life and makes you less likely to need expensive procedures.

Yes. But, more importantly for this discussion, its also saying that if you ignore violent deaths, our life expectancy is higher than literally everyone elses. I mean, car accident deaths alone we're 2X the rest of OECD.

Beyond that, we actually do quite well on lots of preventative measures: Mirror, Mirror 2017: International Comparison

Go to the appendices.

We are #1 in "talked with provider about healthy diet/exercise" yet are still way above the other OECD nations in obesity rates (as a PCP, there are limits as to what I can accomplish in fixing obesity).

We're also number 1 in talking about smoking cessation. And alcohol use. And screening mammograms. And flu vaccination. And in doing regular med recs.

Our preventative care isn't the problem. Our unhealthy lifestyles are.

 

[BLADEMDA]

Do you let your patients request MD-only care, preop aprepitant, intubation with a cobalt glidescope, high-flow desflurane, remifentanil and precedex infusions, and reversal with suggamadex even if none of those things is warranted or indicated?

Your post is not relevant. Because I want a total knee replacement doesn't mean i get the $10,000 prosthesis vs the $4,000 prosthesis. My cost will likely increase the more I "demand" the fancy/upgraded service.

The fact is my Ortho surgeon will discuss with me my options and the cost. Basic total knee vs upgraded total knee. When I do the GA vs SAB that too may be limited due to cost in the future. As long as my outcome to the individual ( no N/V, no weakness postop, etc) is the same then I would recommend the cost effective anesthetic.

I do NOT want the govt. to dictate the anesthetic and limit my ability to decide along with the patient the best plan of action.

 

[VA Hopeful Dr]

It is your role as a physician to determine what the patient truly needs to get better or to not get sick, if the patient disagrees with your expert opinion then they have the right to "want" whatever ever they think is better for them but the system does not have the obligation to pay for their desires.
When the system pays the bill then the system has the right to play a paternal role over your autonomy. It's like when your adult child lives under your roof and you pay his bills, you have the right to tell him how to spend your money.
This is by the way what insurance company physicians do now when they deny your claims.

That is extremely paternalistic. It may work that way for anesthesia, but not for everyone else.

Metformin is the best diabetes drug we have, hands down. If a diabetic patient doesn't want to take it for who-cares-why, I'm not just going to wash my hands of that patient. I'm going to offer alternatives. Those alternatives won't be as good at treating diabetes and preventing complications, but we'll talk about the options and find the best fit between what I think they should do and what they are willing to do.

I have lots of patients I inherited who are on atenolol for HTN. We have lots of evidence that says it is inferior to ACE/ARB, diuretics, CCBs so I always try to get them to change to something else. If they refuse, I will continue the atenolol because its better than nothing. I won't just refuse to write the inferior medicine.

 

[BLADEMDA]

Vector, I am not saying regulation of insurance companies is a bad idea. These companies need regulations to make sure they do what the person paying for the policy expects them to do: cover their healthcare costs. Regulations keep the companies from hurting the consumer and making sure the playing field is level.

But, the current ACA is excessive and forces the consumer to purchase products he/she doesn't need or want. Insurance should be tailored to the individual and sold nationally across state lines.

Govt. Insurance like Medicaid and Medicare should be limited to those in need. Medicare should be folded into a voucher system to purchase private insurance. This is similar to the Advantage Plans many seniors now buy anyway.

 

[deleted480308]

It is your role as a physician to determine what the patient truly needs to get better or to not get sick, if the patient disagrees with your expert opinion then they have the right to "want" whatever ever they think is better for them but the system does not have the obligation to pay for their desires.
When the system pays the bill then the system has the right to play a paternal role over your autonomy. It's like when your adult child lives under your roof and you pay his bills, you have the right to tell him how to spend your money.
This is by the way what insurance company physicians do now when they deny your claims.

You are making one of the best arguments against even having a "system" here. Even better than I often do

 

[vector2]

Your post is not relevant. Because I want a total knee replacement doesn't mean i get the $10,000 prosthesis vs the $4,000 prosthesis. My cost will likely increase the more I "demand" the fancy/upgraded service.

The fact is my Ortho surgeon will discuss with me my options and the cost. Basic total knee vs upgraded total knee. When I do the GA vs SAB that too may be limited due to cost in the future. As long as my outcome to the individual ( no N/V, no weakness postop, etc) is the same then I would recommend the cost effective anesthetic.

I do NOT want the govt. to dictate the anesthetic and limit my ability to decide along with the patient the best plan of action.

The key point being your "Ortho" is going to discuss the options and the cost. Your original post was essentially saying that the patient gets to decide on their own whether they want a knee or a stent.

 

[VA Hopeful Dr]

Do you let your patients request MD-only care

You absolutely should be able to barring emergent cases.

 

[vector2]

Vector, I am not saying regulation of insurance companies is a bad idea. These companies need regulations to make sure they do what the person paying for the policy expects them to do: cover their healthcare costs. Regulations keep the companies from hurting the consumer and making sure the playing field is level.

But, the current ACA is excessive and forces the consumer to purchase products he/she doesn't need or want. Insurance should be tailored to the individual and sold nationally across state lines.

Govt. Insurance like Medicaid and Medicare should be limited to those in need. Medicare should be folded into a voucher system to purchase private insurance. This is similar to the Advantage Plans many seniors now buy anyway.

You won't get an argument for me that health insurance (misnomer anyway since everyone needs healthcare at some point) needs to be regulated, or that it should be available across state lines with full transparency about costs.

Medicare folded into a voucher system is a terrible idea. Private insurance already takes a 20% cut for administration fees. Medicare benefits would get even worse under a fully private system since administration costs would double.

I honestly don't see the problem with a two-tiered system like Australia. Everyone gets a basic health plan, and if you want more and can afford it you can buy supplemental insurance on top.

 

[vector2]

You absolutely should be able to barring emergent cases.

Unfortunately, just like blade's dream of having every 80 year old get a knee or a lumbar fusion or a stent with the snap of a finger, MD-only anesthesia is essentially an impossibility in many if not most ACT practices, even with advance notice.

 

[BLADEMDA]

The key point being your "Ortho" is going to discuss the options and the cost. Your original post was essentially saying that the patient gets to decide on their own whether they want a knee or a stent.

Insurance companies are heavily regulated and can be sued for not paying for healthcare services as agreed to in the contract. Medicare is a national, govt. run system when unelected officials have immunity to lawsuits. These people will decide whether you are allowed to receive that "elective" treatment. The idea that Medicare will take the place of private insurance in terms of "on demand" services is foolish. National healthcare systems have a budget and that means rationing of care to some degree.

I simply don't trust govt. to run my life. Medicare works today because the private health insurance absorbs the impact. Medicare doesn't reimburse enough or pay well enough to sustain the current system.

 

[BLADEMDA]

Unfortunately, just like blade's dream of having every 80 year old get a knee or a lumbar fusion or a stent with the snap of a finger, MD-only anesthesia is essentially an impossibility in many if not most ACT practices, even with advance notice.

In my neck of the woods every 80 year does get on demand services at the snap of a finger. I see it daily. If the 80 year old wants it there is a physician/hospital out there willing to provide it.

 

[BLADEMDA]

You won't get an argument for me that health insurance (misnomer anyway since everyone needs healthcare at some point) needs to be regulated, or that it should be available across state lines with full transparency about costs.

Medicare folded into a voucher system is a terrible idea. Private insurance already takes a 20% cut for administration fees. Medicare benefits would get even worse under a fully private system since administration costs would double.

I honestly don't see the problem with a two-tiered system like Australia. Everyone gets a basic health plan, and if you want more and can afford it you can buy supplemental insurance on top.

I was just pointing out the popularity of Advantage plans in my state. The elderly like the plans as they pay for co-insurance in addition to the Medicare policy. This is private insurance on top of Medicare.

We agree that a 2 tier system is the likely solution but not everyone currently on the left feels that way.

 

[Planktonmd]

In my neck of the woods every 80 year does get on demand services at the snap of a finger. I see it daily. If the 80 year old wants it there is a physician/hospital out there willing to provide it.

The question is not if it happens , the question is if it's the right thing for patients and for tax payers.
The hospital or doctor will do a procedure as long as they know medicare will pay for it, but that does not make it right.

 

[vector2]

Insurance companies are heavily regulated and can be sued for not paying for healthcare services as agreed to in the contract. Medicare is a national, govt. run system when unelected officials have immunity to lawsuits. These people will decide whether you are allowed to receive that "elective" treatment. THe idea that Medicare will take the place of private insurance in terms of "on demand" services is foolish. National healthcare systems have a budget and that means rationing of care to some degree.

I simply don't trust govt. to run my life. Medicare works today because the private health insurance absorbs the impact. Medicare doesn't reimburse enough or pay well enough to sustain the current system.

Firstly, the largest set of regulations aimed at the insurance companies in the last 3 decades was part of a bill that you and many other Americans opposed until they realized how much they liked certain aspects of it. That an individual (not a class action) can successfully sue a multibillion insurance company is about the same odds of that individual launching a manned mission to Mars. Conversely, insurance companies are notoriously successful at sicc'ing debt collectors on people and forcing them into medical bankruptcy.

As many people have pointed out already, we already live in a rationed system. Things would start going a whole lot better if we could all just admit that the rationing today is people who get cadillac care vs people who aren't getting any care (or getting EMTALA/charity care at a tremendous cost to someone else).

Any major overhaul of healthcare in which Medicare plays a bigger role would require Medicare to reimburse professional fees at a higher rate. No doubt about that. If Canada and Australia can figure out a way to pay anesthesiologists reasonably then so can we.

 

[BLADEMDA]

 

[BLADEMDA]

Firstly, the largest set of regulations aimed at the insurance companies in the last 3 decades was part of a bill that you and many other Americans opposed until they realized how much they liked certain aspects of it. That an individual (not a class action) can successfully sue a multibillion insurance company is about the same odds of that individual launching a manned mission to Mars. Conversely, insurance companies are notoriously successful at sicc'ing debt collectors on people and forcing them into medical bankruptcy.

As many people have pointed out already, we already live in a rationed system. Things would start going a whole lot better if we could all just admit that the rationing today is people who get cadillac care vs people who aren't getting any care (or getting EMTALA/charity care at a tremendous cost to someone else).

Any major overhaul of healthcare in which Medicare plays a bigger role would require Medicare to reimburse professional fees at a higher rate. No doubt about that. If Canada and Australia can figure out a way to pay anesthesiologists reasonably then so can we.

I hate the ACA. For those of us who do not get free money from the taxpayer the plans are ridiculously expensive with massive deductibles. I can purchase a non ACA compliant plan for 30% less which meets all my needs. The average American doesn't buy such a plan because the govt. mandates that all plans receiving a govt. subsidy are ACA compliant.

This is an example of a massive waste of money by our govt. and why I think govt. is not the solution to our healthcare crisis.

 

[BLADEMDA]

The question is not if it happens , the question is if it's the right thing for patients and for tax payers.
The hospital or doctor will do a procedure as long as they know medicare will pay for it, but that does not make it right.

Who decides what is right? You? Me? Of course, unelected lifetime govt. officials in Washington get to decide what healthcare people are allowed to receive. No thanks.

Even with all its flaws the current system is better than a govt. run healthcare plan where panels will make all the decisions.

 

[vector2]

I hate the ACA. For those of us who do not get free money from the taxpayer the plans are ridiculously expensive with massive deductibles. I can purchase a non ACA compliant plan for 30% less which meets all my needs. The average American doesn't buy such a plan because the govt. mandates that all plans receiving a govt. subsidy are ACA compliant.

This is an example of a massive waste of money by our govt. and why I think govt. is not the solution to our healthcare crisis.

The bill is not aimed at you so I'm not surprised that your choices are different. However, in places where it has appeared to "fail," this is an effect from the bill being fought tooth and nail instead of seeing if it could actually work. All the red state governors whose people needed the medicaid expansion more than anyone else turned down the federal money. Many of these same states also declined to start their own exchanges.

However, in states like Kentucky where their Kynect program is pretty popular, so much so that Bevin essentially lost the election over wanting to repeal ACA:

 

[Planktonmd]

Who decides what is right? You? Me? Of course, unelected lifetime govt. officials in Washington get to decide what healthcare people are allowed to receive. No thanks.

Even with all its flaws the current system is better than a govt. run healthcare plan where panels will make all the decisions.

The one who decides if it's right is again the physician, provided that the physician is not motivated by profit from doing more procedures.
No system is perfect but the current system is certainly failing, and all that fear from government dysfunction is partially justified but there is no alternative to government increased oversight and enforcement to create a stable patient focused system.

 

[deleted480308]

The bill is not aimed at you so I'm not surprised that your choices are different. However, in places where it has appeared to "fail," this is an effect from the bill being fought tooth and nail instead of seeing if it could actually work. All the red state governors whose people needed the medicaid expansion more than anyone else turned down the federal money. Many of these same states also declined to start their own exchanges.

However, in states like Kentucky where their Kynect program is pretty popular, so much so that Bevin essentially lost the election over wanting to repeal ACA:

so for a bill that both mandates having coverage and makes your neighbor buy it for you, you use "do more people have coverage" as the marker of it being a good idea?

 

[deleted480308]

The one who decides if it's right is again the physician, provided that the physician is not motivated by profit from doing more procedures.
No system is perfect but the current system is certainly failing, and all that fear from government dysfunction is partially justified but there is no alternative to government increased oversight and enforcement to create a stable patient focused system.

there is an alternative. Make the patient's buy the stuff they want, then the doctor and the patient decide together what is important to them. You don't need the govt to discuss anything

 

[DirtDocMD]

Firstly, the largest set of regulations aimed at the insurance companies in the last 3 decades was part of a bill that you and many other Americans opposed until they realized how much they liked certain aspects of it. That an individual (not a class action) can successfully sue a multibillion insurance company is about the same odds of that individual launching a manned mission to Mars. Conversely, insurance companies are notoriously successful at sicc'ing debt collectors on people and forcing them into medical bankruptcy.

As many people have pointed out already, we already live in a rationed system. Things would start going a whole lot better if we could all just admit that the rationing today is people who get cadillac care vs people who aren't getting any care (or getting EMTALA/charity care at a tremendous cost to someone else).

Any major overhaul of healthcare in which Medicare plays a bigger role would require Medicare to reimburse professional fees at a higher rate. No doubt about that. If Canada and Australia can figure out a way to pay anesthesiologists reasonably then so can we.

Canada is almost as large (geographically) as the USA, has just about as many natural resources, yet only has 1/10th our population. Providing healthcare for 30 million is somewhat easier than 300 million (and likely 20-30 million illegals)..

Multiply 300 million x $100k (which is still less than one hip surgery plus a CABG/stenting for every man/woman/child in the USA)....

 

[Planktonmd]

there is an alternative. Make the patient's buy the stuff they want, then the doctor and the patient decide together what is important to them. You don't need the govt to discuss anything

That would work if you truly pay for the service and nothing more, unfortunately you pay for the service, the inflated hospital charges, the CEO's bonus, the medical devices and pharmaceutical mafia tributes, the administrators, the politicians and the lobbyists.
This is why under your suggested model more than 90% of Americans won't be able to get any health care.

 

[deleted480308]

That would work if you truly pay for the service and nothing more, unfortunately you pay for the service, the inflated hospital charges, the CEO's bonus, the medical devices and pharmaceutical mafia tributes, the administrators, the politicians and the lobbyists.
This is why under you suggested model more than 90% of American won't be able to get any health care.

that's not true, because if everyone went private insurance or cash, the sudden drop in guaranteed govt money would make the hospitals/docs/pharmacy re-evaluate their pricing and we'd have to demonstrate value to the customer who now actually writes a check. Prices drop enough to bring more people into the "now I can afford this" realm.

But yeah, there would absolutely be some people who would need to make judgement calls on care based on pricing....which is how that should work

 

[BLADEMDA]

so for a bill that both mandates having coverage and makes your neighbor buy it for you, you use "do more people have coverage" as the marker of it being a good idea?

Did you notice Vector failed to respond to my point that a non ACA compliant healthcare policy is significantly cheaper than an ACA policy? This is massive waste by our govt. to spend taxpayer money on insurance policies that families/people do not want or need. That's billions of dollars of taxpayer money being wasted each year being given to insurance companies.

I am all for Medicaid expansion to the help the poor among us. I am not for a mandatory govt. run ACA law which dictates what the consumer must buy in terms of coverage. Yes, the "pre-existing condition" clause is worth keeping from the ACA but everything else about the law is a failure.

 

[Planktonmd]

that's not true, because if everyone went private insurance or cash, the sudden drop in guaranteed govt money would make the hospitals/docs/pharmacy re-evaluate their pricing and we'd have to demonstrate value to the customer who now actually writes a check. Prices drop enough to bring more people into the "now I can afford this" realm.

But yeah, there would absolutely be some people who would need to make judgement calls on care based on pricing....which is how that should work

Under your system medicare and the VA should not exist which means all these retirees and veterans will be out of luck.

 

[deleted480308]

Under your system medicare and the VA should not exist which means all these retirees and veterans will be out of luck.

medicare really shouldn't exist, we should stop taking new enrollees and phase it out as those on the books now age out

The VA system shouldn't really exist in it's current form, providing long term care coverage for vets as an employment benefit makes more sense than creating a completely secondary govt employed health system.

 

[vector2]

so for a bill that both mandates having coverage and makes your neighbor buy it for you, you use "do more people have coverage" as the marker of it being a good idea?

You're already paying for someone else's healthcare. Regardless, yes, sometimes you have to pay for other people. That's the cost of living in a society. If you don't like it, feel free to move into a cave.

Did you notice Vector failed to respond to my point that a non ACA compliant healthcare policy is significantly cheaper than an ACA policy? This is massive waste by our govt. to spend taxpayer money on insurance policies that families/people do not want or need. That's billions of dollars of taxpayer money being wasted each year being given to insurance companies.

I am all for Medicaid expansion to the help the poor among us. I am not for a mandatory govt. run ACA law which dictates what the consumer must buy in terms of coverage. Yes, the "pre-existing condition" clause is worth keeping from the ACA but everything else about the law is a failure.

The bill was not aimed at people like you who can afford cadillac plans. The bill is aimed at people who make less than 400% of the FPL (equal to $48,560 for an individual and $100,400 for a family of four in 2019), for whom the ACA-compliant plan is affordable since they receive the subsidy.

Furthermore, this cost discrepancy is directly due to the fact that this tangled mess was the best that Congress could do at a time. Federal subsidies for privately administered plans will always be more expensive than a federally administered plan, but unfortunately enough *****s were shouting DEATH PANELS at the time to make a two-tiered single payer plan untenable.

 

[BLADEMDA]

Under your system medicare and the VA should not exist which means all these retirees and veterans will be out of luck.

We all now that politics will prevent any real changes to the VA. Medicare should become Medicare Advantage where seniors pick their private plan with copays combined with govt. subsidized medicare payments. These policies would create a private/public partnership with competition among all the players. Seniors get good insurance and can pick from a basic plan all the way up to a Gold/premium plan.