Survey of intergenerational opinions on socialized medicine/single payer/'medicare for all'

[907914]

After being on here for a while, talking with fellow applicants at interviews, and speaking with med students, residents, and attendings I have discovered that there is a wide margin of opinions on the matter of socialized medicine/single payer/'medicare for all.' However, I have noticed a trend in that opinions appear to be generationally/status-based clustered. I wanted to do conduct an informal survey to see if it has just been confirmation bias of what I have observed or if these trends really exist.

When I say "socialized medicine" in the questions, it refers to tax-payer funded healthcare for all in whatever form that may take. It could be like what the UK has, where private insurance is still a thing, it could be like what bernie proposes with 'medicare for all.' However you envision it.

Edit: yes, I know socialized medicine =/= socialized insurance but this took too much effort to make to start over...just...taxpayer funded healthcare

I have split this up into two categories:

Status and opinion (select one):
I am a pre-med and <26 years old and would like to see socialized medicine
I am a pre-med and <26 years old and would NOT like to see socialized medicine
I am a pre-med and >26 years old and would like to see socialized medicine
I am a pre-med and >26 years old and would NOT like to see socialized medicine
I am a medical student/resident <32 years old and would like to see socialized medicine
I am a medical student/resident <32 years old and would NOT like to see socialized medicine
I am a medical student/resident >32 years old and would like to see socialized medicine
I am a medical student/resident >32 years old and would NOT like to see socialized medicine
I am an attending physician/faculty and I would like to see socialized medicine
I am an attending physician/faculty and I would NOT like to see socialized medicine

Why I have this opinion (select all that apply):
I support socialized medicine because people should not need to go in to debt to be healthy
I support socialized medicine because healthcare is a right
I support socialized medicine because it reduces overall costs to healthcare through increased preventative care
I DO NOT support socialized medicine because it removes individual responsibility
I DO NOT support socialized medicine because it will reduce physician salaries
I DO NOT support socialized medicine because it will reduce standard of care
I DO NOT support socialized medicine because it treats physicians as 'providers' instead of the academics we are

Please select one of the "status and opinion" and as many of the "why" as you would like. Please feel free to discuss the subject below and ask me if I should add any more'why' options. These were the most common things that I have come across.

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[peanuttbuttah]

some men just want to watch the world burn

 

[allantois]

I don’t like the term socialized medicine as it implies something socialist and consequentially has a bad connotation to it. I do believe we ought to do a better job ensuring everyone has access to affordable healthcare.

 

[907914]

I don’t like the term socialized medicine as it implies something socialist and consequentially has a bad connotation to it. I do believe we ought to do a better job ensuring everyone has access to affordable healthcare.

I can dig that. Our word choice when speaking on issues very much affects how people perceive it. I agree with your statement/what we should be doing and that was/is the intent.

 

[ciestar]

Medicare for all might not be the answer but something has to give... something is very wrong in the US.

 

[dr_kateb]

Gotta protect my paycheck

 

[Med Ed]

After being on here for a while, talking with fellow applicants at interviews, and speaking with med students, residents, and attendings I have discovered that there is a wide margin of opinions on the matter of socialized medicine/single payer/'medicare for all.' However, I have noticed a trend in that opinions appear to be generationally/status-based clustered. I wanted to do conduct an informal survey to see if it has just been confirmation bias of what I have observed or if these trends really exist.

Socialized medicine (e.g. the NHS or VA system) is quite distinct from socialized insurance (e.g. Medicare, single payer, etc.). You should delete this thread and start over.

 

[907914]

Socialized medicine (e.g. the NHS or VA system) is quite distinct from socialized insurance (e.g. Medicare, single payer, etc.). You should delete this thread and start over.

“Taxpayer funded healthcare”

 

[907914]

Socialized medicine (e.g. the NHS or VA system) is quite distinct from socialized insurance (e.g. Medicare, single payer, etc.). You should delete this thread and start over.

It took too much time to create and there are too many votes already, lemme make an edit.

 

[Jappa]

Is there any place I can read up on all of this? Get more informed about it all?

 

[lull]

Should public health insurance be offered? yes. Should public health insurance be obligatory? no.

 

[907914]

Is there any place I can read up on all of this? Get more informed about it all?

This is an OK place to start:

What Is Universal Health Care?

Universal health care is a system in which the government provides health care to all citizens regardless of their ability to pay. Learn the pros and cons, and how it works.

www.thebalance.com

Exploring actual literature from there will be more specific towards further questions.

 

[u_raptor]

Interesting split among us <26'ers. I agree something must be done, but don't agree with socialization of med due to worries of reduced standard of care (longer waits, govt inefficiency, potential loss of elective procedures, etc). While govt provided sounds nice, I worry what gets lost in the process of producing that...

Would love to read more literature on it and discuss however. Always open to listening!

 

[Cornfed101]

Interesting split among us <26'ers. I agree something must be done, but don't agree with socialization of med due to worries of reduced standard of care (longer waits, govt inefficiency, potential loss of elective procedures, etc). While govt provided sounds nice, I worry what gets lost in the process of producing that...

Would love to read more literature on it and discuss however. Always open to listening!

This is similar to my opinion. I think everyone needs affordable healthcare, but I've also been to the DMV and been on Medicaid. As a side note, the president of the United States is Donald Trump... I just really don't know if the government is terribly capable right now (FYI, I am neither Republican nor Democrat, so I can effectively bash whomever we have for president).

 

[deleted972488]

The current system (i.e. private health insurance) of paying for healthcare is about as ineffective and expensive as it gets, especially when compared to the systems of other countries. That being said, we have high quality care for those who can afford it.

The Healing of America is a good read, for those interested in learning more.

 

[Cornfed101]

The current system (i.e. private health insurance) of paying for healthcare is about as ineffective and expensive as it gets, especially when compared to the systems of other countries. That being said, we have high quality care for those who can afford it.

The Healing of America is a good read, for those interested in learning more.

It's tough because most countries where universal healthcare works have much less social and economic stratification than we do here. I really don't know if there is a great answer. Hopefully, somebody much smarter than me figures it out soon though.

We do a lot of special testing in this country and that becomes expensive quickly. In the book When the Air Hits Your Brain, Dr. Vertosick talks about doing a residency rotation in England and how they rarely order X-rays and CT scans, which was shocking to him as a neurosurgeon. They were able to come to the same conclusions using more old school methods, but it often took quite a bit longer. He found that physicians here often default to radiological tests because they are readily available, but they sure do drive up costs.

 

[Angus Avagadro]

It's tough because most countries where universal healthcare works have much less social and economic stratification than we do here. I really don't know if there is a great answer. Hopefully, somebody much smarter than me figures it out soon though.

We do a lot of special testing in this country and that becomes expensive quickly. In the book When the Air Hits Your Brain, Dr. Vertosick talks about doing a residency rotation in England and how they rarely order X-rays and CT scans, which was shocking to him as a neurosurgeon. They were able to come to the same conclusions using more old school methods, but it often took quite a bit longer. He found that physicians here often default to radiological tests because they are readily available, but they sure do drive up costs.

Hard cheese those Aneurysms......great book! When the Air Hits Your Brain

 

[907914]

Interesting split among us <26'ers. I agree something must be done, but don't agree with socialization of med due to worries of reduced standard of care (longer waits, govt inefficiency, potential loss of elective procedures, etc). While govt provided sounds nice, I worry what gets lost in the process of producing that...

Would love to read more literature on it and discuss however. Always open to listening!

Maybe in a week or so I will make a follow up poll - What matters more, a high standard of care for a few or an adequate standard of care for all? Would “adequate for all and speedy care for those who can afford it” be a fair compromise? But then doesn’t that lead credence to a larger gap for standard of care? Is that large gap tolerable as those who previously were not receiving care now are?

I personally would like to see a system where people can walk in to their primary care provider and walk out with either a care/treatment plan or a referral and not have to worry about a bill. And if they get a referral, not have to worry about a bill from that referral. If people want to pay for earlier appointments, earlier surgeries, whatever then that should be allowed.

Additionally, I would like to see a separate branch of the department of health split off for research funding. Just because healthcare is provided doesn’t mean research and innovation needs to be stifled.

 

[u_raptor]

Maybe in a week or so I will make a follow up poll - What matters more, a high standard of care for a few or an adequate standard of care for all? Would “adequate for all and speedy care for those who can afford it” be a fair compromise? But then doesn’t that lead credence to a larger gap for standard of care? Is that large gap tolerable as those who previously were not receiving care now are?

I personally would like to see a system where people can walk in to their primary care provider and walk out with either a care/treatment plan or a referral and not have to worry about a bill. And if they get a referral, not have to worry about a bill from that referral. If people want to pay for earlier appointments, earlier surgeries, whatever then that should be allowed.

Additionally, I would like to see a separate branch of the department of health split off for research funding. Just because healthcare is provided doesn’t mean research and innovation needs to be stifled.

Yeah, I could see a compromise being made where it is provided "standard" healthcare, with the option to pay for "speedier" or "special" care. At the very least it would bring care to the disadvantaged that currently have none, while ensuring that those worried about time or elective surgeries, etc, still have those options. But A) how viable would that model be ultimately? I honestly have not read up much on other countries' models, does any other have one like how you describe? B) I worry that it would lead to a larger gap as the "standard care" would just become the lowest denominator, or least amount of procedures etc. If govt provided/standard care is the one everyone gets with certain procedures being in the extra $ option, the standard of the free care might be lowered to extremely basic procedures to allow for financial viability of the model and make more advanced procedures in the $ option. I imagine the govt would try to look for the cheapest model, similar to how an insurance company might. Or no? Although I guess like you said, is that dip in quality of the "standard" care justifiable to allow more access?


If what I just said makes no sense please let me know

 

[u_raptor]

Maybe in a week or so I will make a follow up poll - What matters more, a high standard of care for a few or an adequate standard of care for all? Would “adequate for all and speedy care for those who can afford it” be a fair compromise? But then doesn’t that lead credence to a larger gap for standard of care? Is that large gap tolerable as those who previously were not receiving care now are?

I personally would like to see a system where people can walk in to their primary care provider and walk out with either a care/treatment plan or a referral and not have to worry about a bill. And if they get a referral, not have to worry about a bill from that referral. If people want to pay for earlier appointments, earlier surgeries, whatever then that should be allowed.

Additionally, I would like to see a separate branch of the department of health split off for research funding. Just because healthcare is provided doesn’t mean research and innovation needs to be stifled.

Definitely agree with the distinct branch for research funding however.

 

[Corali]

Another thing to consider is that most countries with socialized medicine (most European nations) have better patient-to-doctor ratios than the US...and they still have problems with long waits for procedures. I am totally for socialized medicine in principle, but I'm unsure of how well such a system would work in America as things currently stand.

 

[Med Ed]

I personally would like to see a system where people can walk in to their primary care provider and walk out with either a care/treatment plan or a referral and not have to worry about a bill. And if they get a referral, not have to worry about a bill from that referral. If people want to pay for earlier appointments, earlier surgeries, whatever then that should be allowed.

You've just described the essence of a two-tier model. The best example of this in the world right now is probably Australia.

 

[907914]

You've just described the essence of a two-tier model. The best example of this in the world right now is probably Australia.

Then let’s do this

 

[dr_kateb]

Then let’s do this

Yeah it's that simple. And it's not like half the country disagrees.

 

[907914]

Yeah it's that simple. And it's not like half the country disagrees.

I’m a liberal, we don’t care about opinions that disagree with ours.

Edit: This is a self mocking joke

 

[Med Ed]

Then let’s do this

It took 40 years to go Swiss. You think we’re just going to waltz into Australian?

 

[ThetisAntithesis]

The Healing of America is a good read, for those interested in learning more.

Amazing book. The only book recommended in NP school that I actually read.

Sounds simplistic but I just want everyone to have healthcare and not have to pay a dime for it.
I had a patient that crashed her car bc she was in DKA - A1c of 17% (still debating if this was a typo on her discharge summary as its the highest I've ever seen after 14%) - apparently, she had come to see me for routine care but had a bill she couldn't afford it so she went on with her life until her BG skyrocketed, she crashed her car, lost her job and then was able to get medicaid.
Or when little old 72yr olds can't afford their BP mds bc of the donut hole or their insurance doesn't cover hearing aides (like WTF?!).

I think America is too far gone though. The private insurance companies won't give up their profits, etc.

 

[Dr. Faust]

Just a grain of salt here....but many <26 do not pay for their own health insurance nor do they pay for deductibles, procedures, medications, etc. Once you realize the donations you make to private insurance companies, around the ball park of $400 per month for just you, not your family, and have a $5,000 deductible and an albuterol inhaler that lasts one month costs $102.00, you might think a little differently. I am for more options other than "private insurance or nothing" for regular working adults.

 

[Dr. Faust]

Another thing to consider is that most countries with socialized medicine (most European nations) have better patient-to-doctor ratios than the US...and they still have problems with long waits for procedures. I am totally for socialized medicine in principle, but I'm unsure of how well such a system would work in America as things currently stand.

What about Canada? Can we get some stats?

 

[907914]

Just a grain of salt here....but many <26 do not pay for their own health insurance nor do they pay for deductibles, procedures, medications, etc. Once you realize the donations you make to private insurance companies, around the ball park of $400 per month for just you, not your family, and have a $5,000 deductible and an albuterol inhaler that lasts one month costs $102.00, you might think a little differently. I am for more options other than "private insurance or nothing" for regular working adults.

True...didn’t consider that when I made this. I have personally either had military health insurance (covered basically everything for my entire family with no deductible for around $200 a month) or Medicare (covers everything and I don’t pay anything)

 

[ciestar]

Just a grain of salt here....but many <26 do not pay for their own health insurance nor do they pay for deductibles, procedures, medications, etc. Once you realize the donations you make to private insurance companies, around the ball park of $400 per month for just you, not your family, and have a $5,000 deductible and an albuterol inhaler that lasts one month costs $102.00, you might think a little differently. I am for more options other than "private insurance or nothing" for regular working adults.

Very true. Yet the people who are under 26 and want to the ACA to go away neglect to realize this.

I went without insurance for three years after I turned 21. I was denied medicaid multiple times and couldn’t afford my university insurance. I then graduated and still had nothing. A lot of people never go through this but people in lower income brackets know how bad it can be. I cannot help that my parents didn’t have insurance. I cannot help I was denied medicaid multiple times. I cannot help that I didn’t have a job that didn’t give me insurance either. This perspective is why I hate the current system. It is broken. The ACA and my low-paying job let me get insurance for the first time in years. It has is flaws but it helped people like me. I love it when people tell me with a straight face I didn’t deserve to have it and Obama had no right to implement the ACA.

Funny story: I was actually told by my county’s assistance office that if I got pregnant I would get insurance. Great advice. My state didn’t expand medicaid until we got a democratic governor.

 

[dr_kateb]

Just a grain of salt here....but many <26 do not pay for their own health insurance nor do they pay for deductibles, procedures, medications, etc. Once you realize the donations you make to private insurance companies, around the ball park of $400 per month for just you, not your family, and have a $5,000 deductible and an albuterol inhaler that lasts one month costs $102.00, you might think a little differently. I am for more options other than "private insurance or nothing" for regular working adults.

How’s that different than paying more taxes or taking a 40% pay cut (for doctors)?

 

[907914]

How’s that different than paying more taxes or taking a 40% pay cut (for doctors)?

Let’s roll with that: let’s say it is no different. Either way you are shafted with the cost. But the only difference is 1 million doctors now make 20% less and 26 million people have health insurance that they didn’t have. Is that worth it to you?

 

[Cornfed101]

Let’s roll with that: let’s say it is no different. Either way you are shafted with the cost. But the only difference is 1 million doctors now make 20% less and 26 million people have health insurance that they didn’t have. Is that worth it to you?

I think that’s really the difficulty with socialized medicine. Would a 20% pay cut for every doctor be enough to provide 26 million people with health insurance?

Doing some quick numbers:

• Medscape states 2018 average physician salary is ~$300000
• 20% is $60k
• $6*10^10 total if we say there are 1 million physicians
• That leaves $2300 per year for each of those 26 million people
• Less than $200 a month for health insurance

Outside of the military, you would be hard pressed to find insurance for $200 a month. My insurance is more like $400 and includes a $4000 deductible. It wouldn’t be enough to cut physicians salaries by 20%.

Why just cut physician salaries to make this happen? We should really be capping hospital administrator salaries so that the top hospital admin makes, at most, what the top doctor on staff makes.

 

[Med Ed]

I think that’s really the difficulty with socialized medicine. Would a 20% pay cut for every doctor be enough to provide 26 million people with health insurance?

You have to understand how fee-for-service payment models relate to physician income before you attempt this calculation. Say you're an orthopedic surgeon who does nothing but hip replacements. Global reimbursement for hip replacements is cut by 10%, so you decide to increase your volume to maintain your level of take-home pay. Here's the rub: a surgeon doing 10% more work incurs far more expenditure than just his/her salary. The tail wags the dog.

The same relationship works in reverse. To actually force a 20% pay cut for physicians would require cutting reimbursement beyond the point where it can be mitigated by increasing volume of work. That would amount to a lot more than $2,300 for each of 26 million.

Here's a more useful way of looking at it: Canada spends 11.3% of its GDP on healthcare, the US spends 17.9%. The US's GDP is currently around $21 trillion. Hypothetical adoption of a healthcare system that runs on 11.3% GDP would therefore "save" $1.386 trillion, or $4,183 for every person in the country. This basic calculation is what the folks at the PNHP point to when saying we can provide Cadillac care to the entire nation if we reduce administrative costs.

 

[electropartyogram]

You have to understand how fee-for-service payment models relate to physician income before you attempt this calculation. Say you're an orthopedic surgeon who does nothing but hip replacements. Global reimbursement for hip replacements is cut by 10%, so you decide to increase your volume to maintain your level of take-home pay. Here's the rub: a surgeon doing 10% more work incurs far more expenditure than just his/her salary. The tail wags the dog.

The same relationship works in reverse. To actually force a 20% pay cut for physicians would require cutting reimbursement beyond the point where it can be mitigated by increasing volume of work. That would amount to a lot more than $2,300 for each of 26 million.

Here's a more useful way of looking at it: Canada spends 11.3% of its GDP on healthcare, the US spends 17.9%. The US's GDP is currently around $21 trillion. Hypothetical adoption of a healthcare system that runs on 11.3% GDP would therefore "save" $1.386 trillion, or $4,183 for every person in the country. This basic calculation is what the folks at the PNHP point to when saying we can provide Cadillac care to the entire nation if we reduce administrative costs.

So the problem is not how the government implements health care, obviously, I support some basic services at an extremely subsidized rate based off of income. However, insurance companies and pharmaceutical companies are the primary culprits behind rising health care costs. Why should I, as the taxpayer, subsidize these companies? Remove them? The federal government cannot and will not offer quality, and accessible health care to all people. The blended system is superior. If I can afford it, I should not have to wait (with the exception of list procedures, like organ transplants).

On the other hand, considering, what was the statistic, 5% of the population consumes 50% of health care costs? People just need to get healthier. People being able to have ready access to medicines and treatments just prolong their unhealthy lives. Why do we encourage people to be unhealthy? Because they pay for it, and thus the cycle continues.

 

[deleted972488]

People just need to get healthier. People being able to have ready access to medicines and treatments just prolong their unhealthy lives. Why do we encourage people to be unhealthy? Because they pay for it, and thus the cycle continues.

Not all health problems are caused by “being unhealthy.”

 

[Cornfed101]

This basic calculation is what the folks at the PNHP point to when saying we can provide Cadillac care to the entire nation if we reduce administrative costs.

I think this is really where the system is broken and how it ultimately will need to be fixed. When you are sometimes spending over 20% on administrative costs (primarily billing) that is out of control IMO. If we can simplify billing to avoid the need for huge hospital billing teams that quickly cuts costs while reducing physician burnout. I'm sure insurance companies wouldn't really be interested in making things more simple though. This is possibly an argument for universal health care, but I worry that billing wouldn't really be simplified if that were implemented in this country.

 

[Cornfed101]

Not all health problems are caused by “being unhealthy.”

True, but it is a fact that end of life care in the United States is a huge portion of our healthcare costs. We just really don't like the idea of not helping our old folks... it puts us between a rock and a hard place

 

[electropartyogram]

Not all health problems are caused by “being unhealthy.”

The majority of treatable illnesses are preventable and are caused by "being unhealthy", mainly due to obesity. One-third of the population is obese. Obesity increases the risk and is the primary contributor to diseases such as diabetes, heart disease, stroke, cancer.

Yes, there are social determinants of obesity, enhanced by food deserts and such. But anyone can lose weight for free, it is a matter of taking responsibility for your own health. "If people don't make time for their health, they will be forced to waste time and money on it later." (paraphrase)

 

[deleted972488]

The majority of treatable illnesses are preventable and are caused by "being unhealthy", mainly due to obesity. One-third of the population is obese. Obesity increases the risk and is the primary contributor to diseases such as diabetes, heart disease, stroke, cancer.

Yes, there are social determinants of obesity, enhanced by food deserts and such. But anyone can lose weight for free, it is a matter of taking responsibility for your own health. "If people don't make time for their health, they will be forced to waste time and money on it later." (paraphrase)

OK, but I was diagnosed with cancer at 25 and I am the furthest thing from obese. Not everything is caused by being unhealthy. Sometimes it's just bad luck. And this caused me to go broke even with "good" insurance.

 

[electropartyogram]

OK, but I was diagnosed with cancer at 25 and I am the furthest thing from obese. Not everything is caused by being unhealthy. Sometimes it's just bad luck.

I am sorry for your diagnosis and I hope you are doing well. And yes, that is correct, but obesity is still a huge risk factor for many. many other illnesses. If no one was obese, there would still be sick people, but there would be a lot less sick people.

 

[Angus Avagadro]

Canadian Health system works great for young couples with children. If child has an ear infection, access is quick. If you need a hip replacement, not so much. Canada buys a fixed number of total hip replacement implants in just a few basic sizes. Once they are all implanted, you must wait until next fiscal year to resume the process and your place in line. This as told to me by a Canadian orthopedist. I was in maine a few years back and the wait for an MRI in Canada was 3 months. Most back problems would be resolved by then. Brain tumors, ..well no. The NHS in England has a fixed amount they will spend on you. Used to be around 250k per year. If your breast cancer chemo costs above that number, you got the cheaper less effective therapy. Centralized healthcare, either private or governmental ends with the same outcome. A generic version for those who cant afford it, and a better version with faster access for those who can pay. Canadians come to the US frequently for treatment when they are unwilling to wait. Why did Mick Jagger come to the US for his aortic valve replacement?

 

[Angus Avagadro]

I think this is really where the system is broken and how it ultimately will need to be fixed. When you are sometimes spending over 20% on administrative costs (primarily billing) that is out of control IMO. If we can simplify billing to avoid the need for huge hospital billing teams that quickly cuts costs while reducing physician burnout. I'm sure insurance companies wouldn't really be interested in making things more simple though. This is possibly an argument for universal health care, but I worry that billing wouldn't really be simplified if that were implemented in this country.

You would be correct that administrative costs are a huge drain on healthcare. Look at the number of administrators and lawyers employed by hospitals. Why are they required? To keep the hospital in compliance with....wait for it....government regulations. Medicare, the govt, denies more claims than any private ins. The govt sets the regulations and the insurers must be in compliance to avoid fines and penalties. This creates mountains of paperwork. All govt beauracricies have survival instincts and will never downsize. This is why many fear single payer govt healthcare.

 

[tri99]

A large portion of unnecessary administrative costs stem from the current model of mostly private healthcare insurance. At the family practice I work at, each physician has two assistants. One assists with providing care, the other spends the entire day dealing with private insurance authorizations.

 

[tri99]

While I understand there are downfalls to "socialized medicine" and there must be some form of checks and balances, at the end of the day I cannot in good conscious support the current model because healthcare will never act as a free market economy. People do not have the freedom to participate in healthcare, so demand is not dictated by the supply and benefit of the services supplied. As I once heard it put, imagine if your house caught on fire and the fire department showed up, just to tell you they would have to start fighting it with a super soaker due to your insurance.

 

[907914]

You would be correct that administrative costs are a huge drain on healthcare. Look at the number of administrators and lawyers employed by hospitals. Why are they required? To keep the hospital in compliance with....wait for it....government regulations. Medicare, the govt, denies more claims than any private ins. The govt sets the regulations and the insurers must be in compliance to avoid fines and penalties. This creates mountains of paperwork. All govt beauracricies have survival instincts and will never downsize. This is why many fear single payer govt healthcare.

Let’s roll with that: assuming the bureaucracy doesn’t shrink on its own to accommodate a universal coverage system. Would it still not eventually shrink administrative costs and healthcare costs at the level of the hospital once patients stop using the ER as their primary care, or stop waiting until the pain is too bad or what have you, and they start actually getting preventative care?

 

[Cornfed101]

Let’s roll with that: assuming the bureaucracy doesn’t shrink on its own to accommodate a universal coverage system. Would it still not eventually shrink administrative costs and healthcare costs at the level of the hospital once patients stop using the ER as their primary care, or stop waiting until the pain is too bad or what have you, and they start actually getting preventative care?

I feel like the biggest problem with primary care from the patient perspective is not the cost, but the wait time. I can only imagine this getting worse, not better, if more people are insured. My children routinely get ear infections and it is always a 2 to 3-week wait to see the pediatrician... I don't think she will have an ear infection anymore at that point!

 

[907914]

I feel like the biggest problem with primary care is not the cost, but the wait time. I can only imagine this getting worse, not better, if more people are insured. My children routinely get ear infections and it is always a 2 to 3-week wait to see the pediatrician... I don't think she will have an ear infection anymore at that point!

This is where either incentivizing primary care or (gonna get some flack for this, it is NOT a preferred option) increasing PA and NP presence and scope of practice in a primary care environment specifically for algorithms-based care.

 

[Angus Avagadro]

Let’s roll with that: assuming the bureaucracy doesn’t shrink on its own to accommodate a universal coverage system. Would it still not eventually shrink administrative costs and healthcare costs at the level of the hospital once patients stop using the ER as their primary care, or stop waiting until the pain is too bad or what have you, and they start actually getting preventative care?

It's an interesting theory. I have little faith in the govt making anything more efficient or cheaper. Obamacare the most recent example. Although recent improvements at the VA are encouraging. No one ever mentions tort reform either.