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Unlike the AMA, the Physicians for Single Payer have done the research and have a plan.......
Single-Payer Primer for the Press | Physicians for a National Health Program
It might be useful to understand who actually funds and runs the AMA and read alternative voices to get a more complete picture of what medical providers think about this issue.
Historically and philosophically, however, AMA's opposition is hardly newsworthy. Despite a lofty reputation and purported commitment to universal coverage, AMA has fought almost every major effort at health care reform of the past 70 years. The group's reputation on this matter is so notorious that historians pinpoint it with creating the ominous sounding phrase "socialized medicine" in the early decades of the 1900s.
"The AMA used it to mean any kind of proposal that involved an increased role for the government in the health care system," Jonathan Oberlander, a professor of health policy at the University of North Carolina, told NPR in a 2007 interview. "They also used it to mean things in the private system that they didn't like. So, at one point, HMOs were a form of socialized medicine."
Indeed, the role played by AMA throughout health care reform battles past has often been primarily as the defender of the status quo. In 1935, fears of an AMA backlash helped persuade Franklin Roosevelt's advisers to drop a health care article from the Social Security package -- fearful that the opposition would sink the legislation altogether.
Concerned about government restriction on and oversight over surgical activities -- not to mention the loss of physician income -- the group deployed the "socialized medicine" argument to undermine Harry Truman's effort at a national health care system years later.
In 1961, AMA organized a campaign to block Medicare. Titled "Operation Coffeecup," the effort insisted that the government-sponsored system would lead to a varying form of totalitarianism.
There are other voices out there besides the one behemoth obstructionist group opposed to any kind of change. I expected their response and knew it would be similar to their last response and the one before that. They're predictable.
What I wanted to know and understand is the entire debate. I never hinted that anyone was ignorant, but offered another view from another group of physicians.
This is too important for your partisan bull****.
You specifically stated that the AMA hasn't done their research, but then you point us to a group called Physicians for Single Payer, whose very name suggests they have a biased agenda of their own. Why should we believe your group is anymore credible than the AMA?
It won't happen in a million years, well maybe a hundred years.Eliminate the current health insurance monstrosity across the board.
Eliminate the current health insurance monstrosity across the board.
The only viable "reform" is to eliminate the current health insurance monstrosity across the board.
The only credible alternative is to eliminate the current health insurance monstrosity across the board.
The health insurance system in this country is geared towards price maximization. In every respect, it operates to inflate prices. Until that beast is killed outright, there will be no effective cost containment in healthcare.
Government plans merely substitute cost maximization for price maximization--until the government runs out of money, as is happening with Britain's National Health Service right now.
The only rational economic structure is one where the consumer of healthcare (i.e., the patient), is 100% burdened with the the costs of his/her own care. The idea of "sharing risk" sounds all cute and warm and fuzzy and fully of compassion and preserving of life and so on, but it is bad economics and has produced artificial and irrational price inflation in healthcare.
Do away with health insurance. That is the beast that drives up costs; kill that beast and costs come crashing back down to earth.
This scares the bejeezus out of me. This is the thing that Obama wants most, and it is the one thing that will be impossible to undo later on. Once you've got it, you're stuck with it. Just ask the Canadians and British.
BINGO!
Name the only insurance that covers anything and everything?
Health insurance. Insurance is there for catastrophic incidents, not routine stuff, except for health insurance that is.
When was the last time you claimed an oil change on car insurance?
When was the last time you claimed an AC filter on homeowners insurance?
Routine stuff that dont need 2 other groups paying for them should not be insured by either of the 2 groups.
We just had a clinic open up here in town that is not taking insurance. It has set prices on all procedures. It was started by a group of doctors who got fed up with Medicare and Medicaid not paying up (same government that now wants to include everybody on these programs with ObamaCare) and having to deal with intermediate groups instead of just the doctor patient relationship. You can go there for all the routine tests, procedures, shots, etc, etc. They can refer you to a hospital for major medical care, but everything else is paid out of pocket.
I can agree with cutting out routine "maintenance" medical procedures, like physicals, eye exams, dental exams, etc on principle.
But it gets a bit more difficult when you start getting into just what is a "catastrophic" medical event, and what is not. Who is going to make that determination? If its the private market, then in order to compete and offer a better product, they will eventually reach the point where we are today. And do you trust the government to make a determination as to what is or is not a catastrophic medical event?
I suspect that if you structured it more like car insurance or homeowners insurance (or any type of liability insurance), your concern could be addressed better.
Do away with health insurance. That is the beast that drives up costs; kill that beast and costs come crashing back down to earth.
The only rational economic structure is one where the consumer of healthcare (i.e., the patient), is 100% burdened with the the costs of his/her own care. The idea of "sharing risk" sounds all cute and warm and fuzzy and fully of compassion and preserving of life and so on, but it is bad economics and has produced artificial and irrational price inflation in healthcare.
You are assuming that incentives to the patient are identical with or without insurance. However, a very brief analysis demonstrates that this could never be the case.I disagree with this. The problem is health care is a product for which there is little demand until it is too late. If people paid for their own care, many maybe even most, would not go routinuely and thus allow many diseases to escalate treatment costs exponentially, often beyond what even the wealthy would have the ability to afford, much less anyone else.
You are assuming that incentives to the patient are identical with or without insurance. However, a very brief analysis demonstrates that this could never be the case..
With health insurance, for any doctor's visit, hospital stay, medical procedure, or prescription, the patient pays either a small portion of the price directly out of pocket or pays nothing out of pocket. Depending on the source of their insurance benefits, they may not even pay for the insurance premiums out of pocket, instead having them via their employer. Thus, it is impossible for the patient to ever know and accurately assess the price of healthcare and its impact on his or her finances. When the pricing does intrude on the patient's perception of healthcare consumption, it does so as the presentation that healthcare costs are so great as to be beyond the patient's capacity to pay.
The end result is the patient does not consider healthcare costs in managing their finances or their lives.
Without health insurance, the patient would be compelled to pay directly any and all healthcare costs. They would have, by virtue of the checks they write to doctors, perfect information about the impact of healthcare costs on their finances. It is impossible for a patient not to include healthcare costs in managing their finances or their lives.
How can we be certain of this? Easily--look at automobiles. Most car owners get their oil changed semi-regularly; they are not told to do this, but the cost savings from proper preventative care is a powerful incentive, and even when people are imperfect in maintaining their vehicles, overall they are willing to trade the inconveniences of preventative care for the cost savings of preventative care. Similarly, when one rents a vehicle, one does not worry about the oil, or the transmission fluid; there is no incentive to do so, as one does not directly bear the costs of vehicle maintenance in that circumstance..
Change the payment model from third party payor (insurance company) to direct payment by the patient and the incentives have to change. As incentives change, the attractiveness of preventative care will change.
Unlike the AMA, the Physicians for Single Payer have done the research and have a plan.......
There's a point that everyone's missing. Read between the lines, and you'll get it. I work in the health care industry as a provider and I can tell you what the AMA's position is really about...what it's always about: MONEY. A public health care plan, to work effectively, will, undoubtedly necessitate that physicians start charging less for procedures. The doctors of the AMA don't want their salaries cut. I'm not saying that this is good or bad, but let's call it what it is. The AMA is not interested in you or me...if they were, as don said, they would have proposed an alternative. The AMA is interested in the AMA.
Don't jump to the conclusion that the AMA opposes this legislation for some noble, Hippocratic reason. Doctors get rich prescribing procedures and medications that cost a fortune, and they get a piece of it. Of course they would object to anything that makes them less money.
Your first sentence is patently false. There are clear economic incentives in preventative care when the patient pays the full cost of care that do not exist in the current health insurance model. Yes, people are reluctant to go to the doctor--and when there is no incentive to do so, that reluctance is not countered and thus predominates in the choices patients make.You are right, there is in fact less incentive for patients to go routinely if there is no insurance. It is a well-known phenomena among people in the health profession. It has to do with the fact there is no natural demand for health care, it is a learned response. Worse, many people harbor an unconscious fear of it, which makes demand not only a matter of indifference, but avoidance. But such a distinction was irrelevant in my original post since either eventuality would have substantiated the point I was making.
Some people would make that choice. However, others do not. I know people who go to the doctor at the first sneeze.So your point is? You must agree with my original assessment then. Being able to visibly see those costs would scare patients off, justifying a delay of health care. Patients, I can attest, claim to be scared off just with token co-pays. Mostly that is probably an excuse, since they often will have just finished telling you they are about to go on a trip to Tahiti. Medicine is a service they need, not want.
Actually, perfect knowledge of the costs of care would only be scary in a "sticker shock" manner. Fear is primarily a response to an unknown/unknowable phenomenon. Very little that is well known is much feared.Having perfect knowledge of the cost would be doubly scary, even at half the current cost. Many co-pays for basic procedures are fairly small, less than someone would spend in on an impulse buy at the department store, so you have no basis to extrapolate that knowing the full, exact amount would somehow induce greater compliance, when compliance with much lower bugetable amounts is resisted.
Again, you are presuming incentives do not change. That is an irrational and unsupportable position to take. Incentives most assuredly would change.Bad example. People are often more abusive to their bodies, although not necessarily consciously so, than they are of their cars. Also, the life-span of cars is more visibly limited, and the cost to replace it visibly high, so there is greater incentive for an oil change. That is not to say no one learns and applies a similar concern toward health care, however even then, most have no clue what the consequences of a lack of treatment would be, or even what the symptoms of something serious may be. The medical consequences of lifestyle, and therefore the true cost of medicine, will always be a nebulous, if not invisible threat to most of the population ... a threat most will not fully understand until it is too late.
Those factors do not invalidate my hypothesis. I am not claiming people will be perfect in pursuing preventative care, merely that they will be incented to do so, and that the incentives will have significant impact on their consumption patterns regarding healthcare.A real world example: in the 60's Congress acted on the information that only about 50% of the population went to see a dentist routinely. They funded dental schools and helped push out a ton of dentists to serve the unserved. Forty years later, there still is only a 50% compliance rate. That suggests that the problem is not in the supply, but the demand. There are many well-known irrational factors in the human psyche that invalidate your hypothesis, not to mention the rational ones I have presented.
True enough, but you are talking about a small sliver of overall healthcare cost and consumption. Also, given the problematic nature of serious disease, it is a markedly different economic discussion. Cost of cancer treatment is not what drives the cost of "normal" healthcare through the roof.More significantly, not all serious disease is preventable. People can lower their risk, but not eliminate it. Treatment of many serious diseases is completely unaffordable already by the majority of the population. There is zero chance most could ever budget for such contingencies, ever.
Moreover, you still haven't answered the most important issue, how would prices actually fall without competition from a public system? I have never seen much price competition in any branch of medicine except in the more commodity-like cosmetic services. No one feels right about shopping around for bargain heart surgery, believe me*. The medical industry has no incentive to rebate any savings that may fall into their hands, and most doctors in the US expect to be in the upper quintile of earners. Given that the recession is pinching everyone, most doctors would seen any improvement in income as something they wholly deserve, however I suspect even in good times, many would find a way to justify keeping the extra as well.
I don't see the economic benefit or welfare to consumers from AETNA, Blue Cross-Blue Shield et. al. at present.donsutherland1 said:While advocates of single payer coverage typically tout the benefits of such an approach, from an economic perspective very real adverse issues associated with monopolies that typically harm consumer welfare arise ie.,
I know you're talking about single payer and single payer only, but the proposals that I have seen offer at the very least, one more choice.reduced consumer choice,
Who is advocating the elimination of specialized coverage (cancer insurance, long term care etc.) if people so choose to pay for it?reduced customization of specialized products/services,
Costs over the long run is what is trying to be curbed right nowlong-run costs,
I keep hearing that and don't see it, how many study grants do university hospitals receive each year?lack of innovation,
What other interest would a government payer plan have other than to provide a vehicle to help pay medical costs. We already know that private insurers interest is to make as much money as possible for themselves and that is not to the consumers benefit.divergence of a monopoly's interests from those of its consumers, etc.
1. Persistent high incidence of uninsured persons. This situation imposes costs on the nation's economy.
2. Persistent situation where costs are rising faster than nominal economic growth, an unsustainable situation in the long-term.
3. Procyclicality of a largely employer-based private system.
Doctors are not economists. But we shall note their objection and continue on with the debate.
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