Are claims that single payer health care systems are inferior to the current US hodgepodge true?

[craig]

There are many well informed Canadians on this forum and some have experience with health care in both countries. Please let us know what you think?

I think Medicare has proven that single payer can be very efficient with low overhead costs. Of course private insurance is now doing its best to ruin it.

 

[Greenbeard]

A thought:

Challenges in International Comparison of Health Care System

An interesting recent JAMA perspective piece from a pair of researchers: Challenges in International Comparison of Health Care Systems Their argument boils down to: "There are at least 3 key challenges of conducting international comparisons: drawing the boundaries of the health system...

debatepolitics.com

 

[Razoo]

There are many well informed Canadians on this forum and some have experience with health care in both countries. Please let us know what you think?

I think Medicare has proven that single payer can be very efficient with low overhead costs. Of course private insurance is now doing its best to ruin it.

Single Payer will be insurance only. The health care will provided by the private health care industry just as it is today. Single Payer is not government heath care no way jose'.

Government health care is what active duty military receive through dispensaries and military hospitals. Health care in the USA would be wonderful if the care one receives was never based on how much insurance one could afford to purchase. Yes the insurance industry does intervene as many doctors have mentioned to me. UNDER INSURED should not be available.

THE insurance industry wants to own Medicare across the board because of guaranteed profits however there is no need to allow such BS. Medicare is not free, never has been free and is deducted from SSI every month. Never stop paying in .....it pays 80% but will one day pay 100%.

Remember folks while the insurance industry whines and lies they pay only 60% of invoice. They need to drop CEO's , golden parachutes and political campaign donations all of which is reckless spending of health care dollars.

 

[craig]

Single Payer will be insurance only. The health care will provided by the private health care industry just as it is today. Single Payer is not government heath care no way jose'.

Government health care is what active duty military receive through dispensaries and military hospitals. Health care in the USA would be wonderful if the care one receives was never based on how much insurance one could afford to purchase. Yes the insurance industry does intervene as many doctors have mentioned to me. UNDER INSURED should not be available.

THE insurance industry wants to own Medicare across the board because of guaranteed profits however there is no need to allow such BS. Medicare is not free, never has been free and is deducted from SSI every month. Never stop paying in .....it pays 80% but will one day pay 100%.

Remember folks while the insurance industry whines and lies they pay only 60% of invoice. They need to drop CEO's , golden parachutes and political campaign donations all of which is reckless spending of health care dollars.

A single payer system allows more free market competition among healthcare providers because it eliminates insurance and middle men that try to integrate vertically with healthcare providers and stifle competition.

 

[Deuce]

A single payer system allows more free market competition among healthcare providers because it eliminates insurance and middle men that try to integrate vertically with healthcare providers and stifle competition.

It also allows greater freedom of choice in who your doctor is.

 

[Neomalthusian]

A single payer system allows more free market competition among healthcare providers because it eliminates insurance and middle men that try to integrate vertically with healthcare providers and stifle competition.

That makes very little sense. The mechanisms of single payer cost control are the service fee setting by DHHS for fees for service (to non-hospital/health system providers) and global budgeting for hospitals/health systems. These pricing and budgeting mechanisms work in the opposite direction of free market competition. Free market competition controls cost by competing for customers who discern on price. Single payer does not achieve that or even attempt to, either by design or indirectly.

It also allows greater freedom of choice in who your doctor is.

Even if true this would be a pretty minor footnote in the grand scheme of things, and mostly a response to the holes skeptics and old conservatives were trying to poke in Obamacare back in 2009-10.

 

[craig]

That makes very little sense. The mechanisms of single payer cost control are the service fee setting by DHHS for fees for service (to non-hospital/health system providers) and global budgeting for hospitals/health systems. These pricing and budgeting mechanisms work in the opposite direction of free market competition. Free market competition controls cost by competing for customers who discern on price. Single payer does not achieve that or even attempt to, either by design or indirectly.



Even if true this would be a pretty minor footnote in the grand scheme of things, and mostly a response to the holes skeptics and old conservatives were trying to poke in Obamacare back in 2009-10.

The health care providers compete with each other on cost and quality to get the single payer business. Much simple mechanism than the employee, business, insurance provider, health care provider chain.
Medicaid’s costs per beneficiary are substantially lower than for private insurance and have been growing more slowly than per-beneficiary costs under private employer coverage.

Medicaid provides more comprehensive benefits than private insurance at significantly lower out-of-pocket cost to beneficiaries, but its lower payment rates to health care providers and lower administrative costs make the program very efficient. It costs Medicaid much less than private insurance to cover people of similar health status. For example, adults on Medicaid cost about 22 percent less than if they were covered by private insurance, Urban Institute research shows.[2]

Frequently Asked Questions About Medicaid | Center on Budget and Policy Priorities

Recent proposals at the federal and state levels to radically restructure Medicaid raise questions about how the program works and its current role for states, beneficiaries, and health care...

www.cbpp.org

Medicare, Medicaid contain costs better than private insurers, study says

While Republican lawmakers insist trimming Medicare and Medicaid is the only way to rein in federal spending, researchers have found the programs have done a better job at controlling spending than private payers.

www.modernhealthcare.com

 

[Napoleon]

A single payer system allows more free market competition among healthcare providers because it eliminates insurance and middle men that try to integrate vertically with healthcare providers and stifle competition.

No one has done that.

 

[craig]

No one has done that.

In the United States, the health care pricing problem is largely a provider market power problem." Within the same geographic area, there can be a 60% difference between the highest- and lowest-priced hospitals for the same inpatient service, and a twofold difference in prices for outpatient services. " A substantial body of research demonstrates that market power drives these unwarranted variations in price between providers, not differences in quality, payer mix, demographics, or health of the patient population. 20 In other words, when we pay more at a high-price provider, we rarely receive more or better care; we simply pay more for its market leverage. 2 1 Unfortunately, the vertical integration used to target overutilization may also increase provider market leverage. 22 The primary vehicle for achieving vertical integration in the ACA is the Accountable Care Organization (ACO), a group of affiliated doctors, hospitals, and other health care providers that cooperate to provide high-quality, coordinated care to a specific patient population. 23 To form an ACO, provider organizations can integrate clinically, structurally, and/or financially. However, obtaining the desired clinical and financial integration can also open the door for health care provider organizations to vertically integrate in ways that further consolidate health care markets, increase provider market leverage, and raise prices

https://repository.uchastings.edu/cgi/viewcontent.cgi?article=2552&context=faculty_scholarship

 

[Napoleon]

In the United States, the health care pricing problem is largely a provider market power problem." Within the same geographic area, there can be a 60% difference between the highest- and lowest-priced hospitals for the same inpatient service, and a twofold difference in prices for outpatient services. " A substantial body of research demonstrates that market power drives these unwarranted variations in price between providers, not differences in quality, payer mix, demographics, or health of the patient population. 20 In other words, when we pay more at a high-price provider, we rarely receive more or better care; we simply pay more for its market leverage. 2 1 Unfortunately, the vertical integration used to target overutilization may also increase provider market leverage. 22 The primary vehicle for achieving vertical integration in the ACA is the Accountable Care Organization (ACO), a group of affiliated doctors, hospitals, and other health care providers that cooperate to provide high-quality, coordinated care to a specific patient population. 23 To form an ACO, provider organizations can integrate clinically, structurally, and/or financially. However, obtaining the desired clinical and financial integration can also open the door for health care provider organizations to vertically integrate in ways that further consolidate health care markets, increase provider market leverage, and raise prices

https://repository.uchastings.edu/cgi/viewcontent.cgi?article=2552&context=faculty_scholarship

None of which changes what I said.

 

[craig]

None of which changes what I said.

You haven't said anything.

 

[Napoleon]

You haven't said anything.

Sure I did. I pointed out that no one has eliminated insurance.

 

[Neomalthusian]

The health care providers compete with each other on cost

No they don't. Under single payer (imagined by proponents/sponsors in this country thus far), the patients don't see a cost because they don't pay a cost, and services provided by hospitals and large health systems don't charge a cost per service, their services are covered by a global budget. Non-health system providers will still receive fees for service but that fee is set by DHHS. There is no real competition on cost. Single payer is not a free market competition promoter, so don't obfuscate.

Medicaid provides more comprehensive benefits than private insurance at significantly lower out-of-pocket cost to beneficiaries, but its lower payment rates to health care providers and lower administrative costs make the program very efficient. It costs Medicaid much less than private insurance to cover people of similar health status. For example, adults on Medicaid cost about 22 percent less than if they were covered by private insurance, Urban Institute research shows.[2]

This comment doesn't actually support your argument, but it does reveal a different possible challenge with single payer, which is that it could affect access if fee-for-service providers who already operate on thin margins can't absorb the significant revenue cuts that adopting the existing prevailing Medicare rates would cause.

 

[craig]

Sure I did. I pointed out that no one has eliminated insurance.

I don't have insurance and I get health care.

 

[craig]

No they don't. Under single payer (imagined by proponents/sponsors in this country thus far), the patients don't see a cost because they don't pay a cost, and services provided by hospitals and large health systems don't charge a cost per service, their services are covered by a global budget. Non-health system providers will still receive fees for service but that fee is set by DHHS. There is no real competition on cost. Single payer is not a free market competition promoter, so don't obfuscate.



This comment doesn't actually support your argument, but it does reveal a different possible challenge with single payer, which is that it could affect access if fee-for-service providers who already operate on thin margins can't absorb the significant revenue cuts that adopting the existing prevailing Medicare rates would cause.

That is how the market works. They will be forced to become more efficient or lose to those who can.

 

[Greenbeard]

In the United States, the health care pricing problem is largely a provider market power problem." Within the same geographic area, there can be a 60% difference between the highest- and lowest-priced hospitals for the same inpatient service, and a twofold difference in prices for outpatient services. " A substantial body of research demonstrates that market power drives these unwarranted variations in price between providers, not differences in quality, payer mix, demographics, or health of the patient population. 20 In other words, when we pay more at a high-price provider, we rarely receive more or better care; we simply pay more for its market leverage. 2 1 Unfortunately, the vertical integration used to target overutilization may also increase provider market leverage. 22 The primary vehicle for achieving vertical integration in the ACA is the Accountable Care Organization (ACO), a group of affiliated doctors, hospitals, and other health care providers that cooperate to provide high-quality, coordinated care to a specific patient population. 23 To form an ACO, provider organizations can integrate clinically, structurally, and/or financially. However, obtaining the desired clinical and financial integration can also open the door for health care provider organizations to vertically integrate in ways that further consolidate health care markets, increase provider market leverage, and raise prices

https://repository.uchastings.edu/cgi/viewcontent.cgi?article=2552&context=faculty_scholarship

If we imagine that there are policy solutions to the pricing problem available right now (e.g., anti-trust interventions, price caps or even more deliberate price-setting, etc) and those haven't been implemented, then to some degree we must have a political problem, too, don't we? What happens if single-payer isn't the solution to that problem? Then we consolidate health care pricing authority into a single public entity that's been captured by the entities it's funneling public money to.

 

[bave]

There are many well informed Canadians on this forum and some have experience with health care in both countries. Please let us know what you think?

I think Medicare has proven that single payer can be very efficient with low overhead costs. Of course private insurance is now doing its best to ruin it.

If you want to be taken seriously in a real conversation, then I would recommend not starting with a blatantly biased opening.

To address your basic statement, Medicare does run very efficiently with low overhead, but how does it do that? Well, a few big reasons...

1) They pay below the cost to provide care. A number of studies have shown that medicare pays between 88-93% of the actual *cost* of care. Let's just use 90% for simplicity. Imagine running a business where every customer you saw you lost 10% of the bill on. Never mind turning a profit, you are losing money for every customer you see. The government has a great solution though, they tie your licensing and permitting to your acceptance of medicare. It is effective blackmail, if you want to be in the healthcare delivery business in the US then the regulating agencies are going to tell you that you have to treat ~a third of the patients that walk through your door at a loss. That pricing power/government fiat really lets you run efficiently.

2) Their efficiency ratio is helped by the fact that Medicare doesn't do authorization or audits. They simply pay the charges as they come thru the door and then randomly audit those bills retroactively and claw back whatever they feel was too high. It is relatively much simpler to take 3 years worth of billings at once and review them and correct them and turn around and just take the money out of the providers bank account without their knowledge or approval.

3) Circling back to #1, Medicare has a big cost advantage as outlined, but they also hamstring their private insurance counterparts at the same time. Because Medicare knowingly and intentionally underpays for services the providers who are forced to eat those Medicare losses are forced to recoup the lost money the only place they can, private insurance. So if you imagine you have a hospital that has 1/3rd medicare patients, 1/3rd medicaid patients, and 1/3rd privately insured patients you are losing money on 2/3rds of your patient encounters. You have to literally cram all those losses as well as a profit margin onto the remaining third. You then have the government talk about how much better they are than the privates from a cost structure. No shit, they created the cost imbalance in the first place.

 

[craig]

If you want to be taken seriously in a real conversation, then I would recommend not starting with a blatantly biased opening.

To address your basic statement, Medicare does run very efficiently with low overhead, but how does it do that? Well, a few big reasons...

1) They pay below the cost to provide care. A number of studies have shown that medicare pays between 88-93% of the actual *cost* of care. Let's just use 90% for simplicity. Imagine running a business where every customer you saw you lost 10% of the bill on. Never mind turning a profit, you are losing money for every customer you see. The government has a great solution though, they tie your licensing and permitting to your acceptance of medicare. It is effective blackmail, if you want to be in the healthcare delivery business in the US then the regulating agencies are going to tell you that you have to treat ~a third of the patients that walk through your door at a loss. That pricing power/government fiat really lets you run efficiently.

2) Their efficiency ratio is helped by the fact that Medicare doesn't do authorization or audits. They simply pay the charges as they come thru the door and then randomly audit those bills retroactively and claw back whatever they feel was too high. It is relatively much simpler to take 3 years worth of billings at once and review them and correct them and turn around and just take the money out of the providers bank account without their knowledge or approval.

3) Circling back to #1, Medicare has a big cost advantage as outlined, but they also hamstring their private insurance counterparts at the same time. Because Medicare knowingly and intentionally underpays for services the providers who are forced to eat those Medicare losses are forced to recoup the lost money the only place they can, private insurance. So if you imagine you have a hospital that has 1/3rd medicare patients, 1/3rd medicaid patients, and 1/3rd privately insured patients you are losing money on 2/3rds of your patient encounters. You have to literally cram all those losses as well as a profit margin onto the remaining third. You then have the government talk about how much better they are than the privates from a cost structure. No shit, they created the cost imbalance in the first place.

Health insurers' profits topped $35B last year. Medicare Advantage is the common thread

Big-name health insurers raked in $8.2 billion in profit for the fourth quarter of 2019 and $35.7 billion over the course of the year. | Big-name health insurers raked in $35.7 billion in profit over the course of the year. Check out the comparisons of how they performed.

www.fiercehealthcare.com

Health Insurance Premiums More than Double as Insurers Report Billions in Profit

/PRNewswire/ -- QuoteWizard®, a LendingTree company, and one of the nation's leading online insurance marketplaces released a report on how top health insurers...

www.prnewswire.com

 

[bave]

I am not sure what you are trying to point out with the articles you link.

More and more people are shifting from traditional medicare to medicare advantage, why do you think that is? Why do you think CMS is happy to have that happen? Answer: Win.Win.Win. The consumer wins through better coverage and a lower cost share, electively at that. The insurance company wins because they have figured out how to profit from it and it gains them negotiating leverage. CMS wins because they pay the insurance company to take the patient, less than it would cost CMS to keep the patient. I don't see how you can be pissed off at that?

Health insurers profited during COVID? Again, what exactly is your point? Premiums for health insurance, all insurance actually, are determined through actuarial assumptions from previous years and then submitted to state regulators who must approve them. As a result of COVID almost all insurance estimates were off, and favorable to the insurer, because risk assumptions were too high. Think about it this way, if you paid $1000/yr for auto insurance and you drove 10k/miles a year, you were effectively paying $.10/mi for insurance. Suddenly, due to COVID you drove 1000 miles, but you still paid the same premium. Of course your auto insurance carrier made money. The same way health insurers came off way better as elective surgeries for ~half the year were curtailed and many hospitals/physicians reduced workloads due to COVID.

Any other insights?

 

[craig]

I am not sure what you are trying to point out with the articles you link.

More and more people are shifting from traditional medicare to medicare advantage, why do you think that is? Why do you think CMS is happy to have that happen? Answer: Win.Win.Win. The consumer wins through better coverage and a lower cost share, electively at that. The insurance company wins because they have figured out how to profit from it and it gains them negotiating leverage. CMS wins because they pay the insurance company to take the patient, less than it would cost CMS to keep the patient. I don't see how you can be pissed off at that?

Health insurers profited during COVID? Again, what exactly is your point? Premiums for health insurance, all insurance actually, are determined through actuarial assumptions from previous years and then submitted to state regulators who must approve them. As a result of COVID almost all insurance estimates were off, and favorable to the insurer, because risk assumptions were too high. Think about it this way, if you paid $1000/yr for auto insurance and you drove 10k/miles a year, you were effectively paying $.10/mi for insurance. Suddenly, due to COVID you drove 1000 miles, but you still paid the same premium. Of course your auto insurance carrier made money. The same way health insurers came off way better as elective surgeries for ~half the year were curtailed and many hospitals/physicians reduced workloads due to COVID.

Any other insights?

Big health insurance has got its fingers into Medicare. They plan to take it over or ruin it. They have already begun to ruin it. Just the co-pay on medications through the advantage plans is 3X higher than buying it straight out.

 

[bave]

Big health insurance has got its fingers into Medicare. They plan to take it over or ruin it. They have already begun to ruin it. Just the co-pay on medications through the advantage plans is 3X higher than buying it straight out.

Your point is absurd. People are buying more and more advantage plans every year, the government isn't forcing them to, or hell, they aren't even enticing them. The advantage plans offer a better value, period. Otherwise people wouldn't buy them. Some plans might have different advantages and disadvantages, but as a whole there is a damned good reason why people want them.

 

[craig]

Your point is absurd. People are buying more and more advantage plans every year, the government isn't forcing them to, or hell, they aren't even enticing them. The advantage plans offer a better value, period. Otherwise people wouldn't buy them. Some plans might have different advantages and disadvantages, but as a whole there is a damned good reason why people want them.

Why Medicare Advantage Plans Are Bad

Why are Medicare Advantage plans bad? The truth is that Medicare Advantage plans are not bad, just not right for everyone. Find out why here!

www.medicarefaq.com

 

[bave]

Why Medicare Advantage Plans Are Bad

Why are Medicare Advantage plans bad? The truth is that Medicare Advantage plans are not bad, just not right for everyone. Find out why here!

www.medicarefaq.com

Look, you can have an opinion about something, but how about you come up with some of your own opinions and statements to back them up rather than just linking obscure websites for opinion pieces?

For instance, from your link:

Why are Medicare Advantage Plans Bad?​

There are many reasons why some beneficiaries feel Medicare Advantage plans are bad. Some individuals may say it’s due to their smaller networks, others may say they are not a fan of the annual changes. It really depends on who you ask.
If you ask a doctor, they may tell you they don’t accept Medicare Advantage because the carriers make it a hassle to get paid. If you ask your neighbor why Medicare Advantage plans are bad, they may say they were unhappy with how much they had to pay out of pocket when using the benefits. If you ask your friend why they felt Medicare Advantage plans were bad, they might say it’s because the plan wouldn’t travel with them. A common answer is “because I thought the plan was free.”





First off, your site is actually a place that sells medicare advantage plans, lol. Secondly, look at the listed reasons why "some" beneficaries "feel" they are bad. Smaller networks. Yes, that's true, you accept an insurance carriers network as part of the deal. You know this in advance, there is no surprise there, and the networks tend to be extremely broad. Second, the annual changes, like every other insurance policy of any sort in the world? No shit sherlock.

Look at the other side of the coin. Stick with traditional Medicare bud and just pay 20% of *all medical bills*. Which would you do as a senior citizen? Have an unlimited network with little to no annual change, but pay 20% of all your medical charges, or accept a network that has a small copay and deductible and a limited financial risk to you.

That's the reason why so many people buy advantage plans, stop being either ignorant or intentionally obtuse.

 

[craig]

Look, you can have an opinion about something, but how about you come up with some of your own opinions and statements to back them up rather than just linking obscure websites for opinion pieces?

For instance, from your link:

Why are Medicare Advantage Plans Bad?​

There are many reasons why some beneficiaries feel Medicare Advantage plans are bad. Some individuals may say it’s due to their smaller networks, others may say they are not a fan of the annual changes. It really depends on who you ask.
If you ask a doctor, they may tell you they don’t accept Medicare Advantage because the carriers make it a hassle to get paid. If you ask your neighbor why Medicare Advantage plans are bad, they may say they were unhappy with how much they had to pay out of pocket when using the benefits. If you ask your friend why they felt Medicare Advantage plans were bad, they might say it’s because the plan wouldn’t travel with them. A common answer is “because I thought the plan was free.”





First off, your site is actually a place that sells medicare advantage plans, lol. Secondly, look at the listed reasons why "some" beneficaries "feel" they are bad. Smaller networks. Yes, that's true, you accept an insurance carriers network as part of the deal. You know this in advance, there is no surprise there, and the networks tend to be extremely broad. Second, the annual changes, like every other insurance policy of any sort in the world? No shit sherlock.

Look at the other side of the coin. Stick with traditional Medicare bud and just pay 20% of *all medical bills*. Which would you do as a senior citizen? Have an unlimited network with little to no annual change, but pay 20% of all your medical charges, or accept a network that has a small copay and deductible and a limited financial risk to you.

That's the reason why so many people buy advantage plans, stop being either ignorant or intentionally obtuse.

The reason I shared the link is because it is from the insurance industry. They are spending many millions of dollars advertising and will use their monopolistic power to integrate health care into vertical slices that prevents free market competition across the actual health care providers. And billion of dollars will flow into big health insurance and their middle men and not go to providing actual health care services. This is how they will destroy Medicare.

- PROHIBITING PRICE FIXING AND OTHER ANTICOMPETITIVE CONDUCT IN THE HEALTH INSURANCE INDUSTRY

www.govinfo.gov

Health Insurance & Monopoly — Open Markets Institute

The Open Markets Institute uses journalism to promote greater awareness of the political and economic dangers of monopolization.

www.openmarketsinstitute.org

 

[bave]

The reason I shared the link is because it is from the insurance industry. They are spending many millions of dollars advertising and will use their monopolistic power to integrate health care into vertical slices that prevents free market competition across the actual health care providers. And billion of dollars will flow into big health insurance and their middle men and not go to providing actual health care services. This is how they will destroy Medicare.

Millions of dollars in advertising for a sector that represents ~18% of the US economy? That's nothing. Monopoly? Really? How many insurers are there nationwide? Dozens? That's the worst monopoly I have ever heard of. Hell, they don't even get to set their own prices, they have to be approved by the each state's insurance commission. Who is forcing you to participate with these evil middle men? No one. You don't have to use medicare. You don't have to have insurance at all. Just negotiate with providers and pay cash, they will all be happy to do so. I assume you are doing just that given your ideological position, yes?