Single payer debate no so easy (1 Viewer)

[jaeger19]

Good. Then you can have a single payer system and have a robust economy. I knew we would finally get there. LOL

Well.. you can if you start with an economy that does not have almost 1/3 of its GDP as healthcare.

Which.. wait.. we do.

 

[vegas giants]

Well.. you can if you start with an economy that does not have almost 1/3 of its GDP as healthcare.

Which.. wait.. we do.

Not relevant

 

[jaeger19]

I am an actual expert. Who works in Insurance.

Single payer will magically just cost less, because of how hospitals set their prices.

They use something called a Chargemaster. Expecting to have to negotiate with hundreds of different insurance companies, and medicare. They set their prices about 1000 percent above cost. It's common for a client of mine to receive an out of network bill for double or triple, what it would cost in network. Now here's the thing, that in network cost is still marked up at least 100 percent above cost.

The only reason we even know what things cost is because of VA hospitals by the way, Hospital Cartels do not put those numbers out, and actively derail any attempt to do so. They lobby more than oil. To keep their price fixing game going.

Medicare, pays an average of an areas cost for a procedure. So hospitals jack up price in an area to drive up what medicare pays them.

A single payer system, means one negotiator, instead of thousands. One standardized set of prices. And an end to price fixing from hospitals. Under a single payer system. A broken arm won't cost 6,000 dollars. It will cost 400.

So yes. From an actual expert. Who works in Insurance. Who faces a 10,000 dollar fine and loss of license if knowingly misleads anyone about insurance.

Cost will magically go down under a single payer system.

Edit: and if the one person who works for the hospital disagrees, he is free to post the chargemaster list for his hospital to prove me wrong. Otherwise, let's not do this again.

Oh. it could drastically reduce costs.. absolutely.. one single payer could demand that hospitals drop their costs well below what medicare/Medicaid pays now.

Absolutely positively. ay

But.. here is the economic facts. Medicare/Medicaid are generally the lowest payer.. and often.. hospitals only break even or may EVEN LOSE money on a Medicaid/medicare patient. The difference.. is often made up by private insurance companies that pay more for those procedures. That's where any profit may lie.. and even that's not always true. Hence the Chargemaster.. which of course does exactly what he says it does... and why? Because the hospital really doesn't know what they will get paid from any given insurance.

Insurance companies set their allowables. So.. one company may allow 1000 for a procedure.. that another allows 350 on. thus the chargemaster must be set to capture the maximal reimbursement. IF the charge say was set at 500 dollars for that procedure.. they will still get 350 from the one company.. and only get 500 from the other.. when they would have gotten 1000.

But yep.. we could lower that price right down..

Of course though.. since medicare and Medicaid are pretty close to the costs..

Well then.. hospitals will have to close.. facilities will have to close.. particularly in rural areas. The availability of physicians and providers will have to decline.. and communities will see a dramatic rise in unemployment..

And.. if any experts here disagree.. simply refute all of what Greenbeard posted in the OP.

 

[jaeger19]

Not relevant

Please explain why the state of the US economy and healthcare is not relevant to a discussion of what would happen if you cut healthcare in say half (to be around Canadian levels).

 

[vegas giants]

Please explain why the state of the US economy and healthcare is not relevant to a discussion of what would happen if you cut healthcare in say half (to be around Canadian levels).

Why on earth would we cut healthcare in half when we have many many more people than they do? What utter nonsense?

 

[jaeger19]

Why on earth would we cut healthcare in half when we have many many more people than they do? What utter nonsense?

Oh.. so then we are going to then spend exactly what we are now on healthcare? You don't make sense here.

 

[vegas giants]

Oh.. so then we are going to then spend exactly what we are now on healthcare? You don't make sense here.

If we did and cover everyone without excessive co pays or deductibles and they get services as good as what canadians get who happen to LOVE their system isn't that a great thing?

 

[jaeger19]

If we did and cover everyone without excessive co pays or deductibles and they get services as good as what canadians get who happen to LOVE their system isn't that a great thing?

Sure.. and if we could have wages be doubled in this country.. while the costs of goods and services go down by 90%.. wouldn;t that be a good thing?

What if the North Korea dictator decides to step down and North Korea becomes a free and democratic and pro US state.. wouldn;t that be a good thing?

Wanting stuff is one thing...

Actually getting there is another... and so far.. you haven't provided a lick of evidence that suggest we can without having to make choices... like whether we want rural hospitals or whether we want lower wages and higher unemployment.. or we want longer wait times or loss of pharmaceutical coverage in order to achieve a Canadian style system.

 

[vegas giants]

Sure.. and if we could have wages be doubled in this country.. while the costs of goods and services go down by 90%.. wouldn;t that be a good thing?

What if the North Korea dictator decides to step down and North Korea becomes a free and democratic and pro US state.. wouldn;t that be a good thing?

Wanted stuff is one thing...

Actually getting there is another... and so far.. you haven't provided a lick of evidence that suggest we can without having to make choices... like whether we want rural hospitals or whether we want lower wages and higher unemployment.. or we want longer wait times or loss of pharmaceutical coverage.

Except that Canada did it.....so there's that. I know you hate that but it remains true. LOL

Canada has good wages, low unemployment, rural hopspitals and drug coverage in the Canadian system (public and private) and they LOVE their system

 

[jaeger19]

Except that Canada did it.....so there's that. I know you hate that but it remains true. LOL

Canada has good wages, low unemployment, rural hopspitals and drug coverage in the Canadian system (public and private) and they LOVE their system

Yep Canada did it... can you tell us all what the economic conditions were when Canada did it? Can you compare that to the US and the current US economy? Still waiting for that.

Canada has trouble with rural hospitals.. in fact access to healthcare in rural areas is a problem.. as is the lack of drug coverage in the Canadian government system..

Sure.. they love their system. So?

I know people that LOVE beer.. and I know people that LOVE marijuana..... doesn't mean that I love them.

 

[Slavister]

Here is my take.

Pros

1. Universal coverage...
2. Administrative simplicity ...
3. Unified policy direction ...
4. Rate-setting...

Agreed, and to add

5.Improved health delivery due to no concerns about costs. This is not discussed much for some reason. But when someone gets sick, ADDITIONAL worries about COSTS of treatment add to that person's and their family's concerns at quite the wrong time in their lives. As a result their health suffers as due to this ADDITIONAL layer of stress that other people in the world are simply not familiar with.

Cons

1.Cost. The single-payer wouldn't erase the high costs of the American health system, it would inherit them. Never has anyone tried to install single-payer on top of a system with such a high cost structure and constituting such a large percentage of GDP. The trillion plus dollars in premium revenue flowing through private insurers right now would instead have to flow through the treasury. That's a big tax issue, a tall order and responsibility for the federal government, and a philosophical and political tinderbox.

Significant cost cuts can be immediate due to BOTH effectively CUTTING all existing insurance company profits down to 0 and due to immense price-setting capabilities that you mention in Pro #4.

2.Politics. If part of our predicament has been that we've collectively avoided hard decisions for decades, I don't see much hope that single-payer would solve it. There are many reasons we pay so much for health care: we employ 'too many' people in that industry (including blue and white collar jobs), we pay them wages that are 'too' high, we get 'too many' services and have 'too much' capacity, we use 'too many' medicines, and have access to new drugs and new technologies 'too quickly.' And so on. [Note that it's the promise these "problems" will be fixed that leads to the constant discussion of increasing wait times.]

another reason: ... too costly of an education for the professionals. I think we need more specialized programs for the Docs that don't require BS degree first and much less costly education thereafter.

If we've collectively decided that this isn't worth the cost and we're willing to give it up (and I don't believe that we have agreed this), then we're still going to face individual defections from those conclusions. Maybe we in the U.S. have too many hospitals, but your local Congressman and local politicians certainly aren't going to be in favor of your local hospital closing. The politics of hospital closures and layoffs will be even tougher than the politics of base closures, affecting every single Congressional district in the country. Putting tough decisions about cold, hard realities in the political sphere seems to me less likely to produce needed outcomes, not more.

I don't think this is true in general; i.e. that our medical outcomes or care is that much better or better at all than other countries. For example you mention number of hospitals. I looked up number of hospital beds per 1000 people. US is country #80 on this list. So, I don't think you came up with a good example there as far as having too many hospitals.

Other studies I have seen also do not show US as being ahead in other aspects either.

Here is 1 example: "Inconsistent or unavailable data and imperfect metrics make it difficult to firmly judge system-wide health quality in the U.S., but a review of the data we do have suggests that the system is improving across each of these dimensions, though it continues to lag behind comparably wealthy and sizable countries in many respects."

3.Rate-setting. ...Health care is increasingly what we as Americans do. It's where the job growth has been...

For the most part, I don't think either side is particularly realistic about what single-payer will look like when it comes.

I think it's a flawed argument that we should support a bloated unnecessary system because otherwise it would result in firing of too many people. Many industries have gotten smaller over time. We should NOT be propping up a system for this reason EVER.

If such argument were ever true, then you should go ahead and argue that we should make healthcare MORE COMPLEX to provide more jobs for healthcare professionals. Make taxes MORE COMPLEX to employ more accountants. Make laws MORE COMPLEX to employ more lawyers. Make Government unnecessarily more bloated to provide more jobs.

 

[vegas giants]

Yep Canada did it... can you tell us all what the economic conditions were when Canada did it? Can you compare that to the US and the current US economy? Still waiting for that.

Canada has trouble with rural hospitals.. in fact access to healthcare in rural areas is a problem.. as is the lack of drug coverage in the Canadian government system..

Sure.. they love their system. So?

I know people that LOVE beer.. and I know people that LOVE marijuana..... doesn't mean that I love them.

Canada has a thriving economy and single payer as does other countries. We can too.

The US has trouble with rural hospitals. That is nothing new.

They LOVE their system and could end it at anytime if they wanted but you can't get elected dog catcher if you said you wanted to end it in Canada. LOL

 

[jaeger19]

• Improved health delivery due to no concerns about costs. This is not discussed much for some reason. But when someone gets sick, ADDITIONAL worries about COSTS of treatment add to that person's and their family's concerns at quite the wrong time in their lives. As a result their health suffers as due to this ADDITIONAL layer of stress that other people in the world are not familiar with.

.

Yeah.. that assumes that all costs will be borne by the government. And very few single payers are that comprehensive.

Significant cost cuts can be immediate due to BOTH effectively CUTTING all existing insurance company profits down to 0 and due to immense price-setting capabilities that you mention in Pro #4.

Hmmm.. why do you assume this? Currently private insurance companies are making huge profits administering Medicare and Medicaid. So why do you assume a system will get rid of private insurance companies.

In fact.. Canada has a private healthcare insurance market as well. So does France.. and a number of other single payer countries. So this assumption is based on.....?

another reason: ... too costly of an education for the professionals. I think we need more specialized programs for the Docs that don't require BS degree first and much less costly education thereafter.

Hmmm.. what doctors do you think could do with less education?

I don't think this is true in general; i.e. that our medical outcomes or care is that much better or better at all than other countries

Actually it depends on what you are measuring... we score very well on timeliness of care.. and part of that is because of our availability of physicians, hospitals etc.

I think it's a flawed argument that we should support a bloated unnecessary system because it would result in firing of too many people. Many industries have gotten smaller over time. We should NOT be propping up a system for this reason EVER

.

Fine.. what do you think happens to the economy then when you drastically cut those jobs and salaries?

Yep. many industries have gotten smaller over time.. look at manufacturing..... oh wait.. aren;t we trying to get manufacturing back into the us? Hmmm what did the loss of good manufacturing jobs do to jobs and wages in this country? Do you think that loss of manufacturing jobs might contribute to wage stagnation in the US?

 

[jaeger19]

Canada has a thriving economy and single payer as does other countries. We can too.

LOL

Sure.. but then we won't have the savings that you claim you want.

The US has trouble with rural hospitals. That is nothing new.

So does Canada and that's nothing new.. so why do you think cutting healthcare spending in the US.. won't affect access in rural areas of the US even further? please provide some evidence

They LOVE their system and could end it at anytime if they wanted but you can't get elected dog catcher if you said you wanted to end it in Canada.

Pretty much with the same in the US.

 

[Slavister]

Yeah.. that assumes that all costs will be borne by the government. And very few single payers are that comprehensive.

In most countries all of the necessary treatments are fully covered. Elective or most advanced ones may not be (but those are too out-of-reach cost-wise in US as well for much of population)

Hmmm.. why do you assume this? Currently private insurance companies are making huge profits administering Medicare and Medicaid. So why do you assume a system will get rid of private insurance companies.

In fact.. Canada has a private healthcare insurance market as well. So does France.. and a number of other single payer countries. So this assumption is based on.....?

You are misleading people here. Canada's private health insurance market is NOT for the basic coverage that is the single-payer system. Private insurance companies in Canada are for non-covered services like drugs, dental and optometry.

Hmmm.. what doctors do you think could do with less education?

First 4 years of education where Docs get their Bachelors-of-whatever degrees are mostly a waste and unrelated to practicing Medicine.

Actually it depends on what you are measuring... we score very well on timeliness of care.. and part of that is because of our availability of physicians, hospitals etc.

Links? Proof? I showed you we do NOT score well on availability of hospital beds in fact and there are many other aspects on which we do NOT measure well listed in another link I posted.

Fine.. what do you think happens to the economy then when you drastically cut those jobs and salaries?

Yep. many industries have gotten smaller over time.. look at manufacturing..... oh wait.. aren;t we trying to get manufacturing back into the us? Hmmm what did the loss of good manufacturing jobs do to jobs and wages in this country? Do you think that loss of manufacturing jobs might contribute to wage stagnation in the US?

Yes, holding on to those COAL jobs that we lost is the cure for our problems.. right... How about buggy riders, or all the jobs lost to robots? You think they are coming back? We adopt and move on. Your argument for maintaining an artificially bloated industry is clearly flawed. I repeat, if such argument were ever true, then you should go ahead and argue that we should make healthcare MORE COMPLEX to provide more jobs for healthcare professionals. Make taxes MORE COMPLEX to employ more accountants. Make laws MORE COMPLEX to employ more lawyers. Make Government unnecessarily more bloated to provide more pencil-pusher jobs.

 

[Greenbeard]

I am an actual expert. Who works in Insurance.

Single payer will magically just cost less, because of how hospitals set their prices.

They use something called a Chargemaster. Expecting to have to negotiate with hundreds of different insurance companies, and medicare. They set their prices about 1000 percent above cost. It's common for a client of mine to receive an out of network bill for double or triple, what it would cost in network. Now here's the thing, that in network cost is still marked up at least 100 percent above cost.

Charges are not costs, nor in most cases are they prices. Most hospital reimbursement methodologies aren't based on paying a percentage of billed charges. And even in cases where they are those prices are often protected to prevent hospitals from raising their reimbursements by raising charges.

Fundamentally, costs and reimbursement are not the same thing. From the point of view of a payer they may seem to be, but from a health system view they aren't. I mentioned the case above of a rural hospital closing its doors. Its current reimbursements don't cover its costs, so it's closing. It couldn't just will its costs down to match its reimbursement level, otherwise it would be staying open. Reimbursements can be dialed down through price-setting. Costs, for the most part, cannot.

There are abuses that need to be addressed (e.g., see yesterday's thread, "
Secret Hospital Deals That Squelch Competition"). Single-payer is one option for trying to address those abuses. But it does not magically lower costs. Anyone telling you that is blowing smoke. What it offers is pathways going forward.

The only reason we even know what things cost is because of VA hospitals by the way, Hospital Cartels do not put those numbers out, and actively derail any attempt to do so. They lobby more than oil. To keep their price fixing game going.

Hospitals have to report their costs annually to Medicare.

These days most folks seem to agree that VA hospitals are under-resourced, meaning they ought to cost more than they do.

Medicare, pays an average of an areas cost for a procedure. So hospitals jack up price in an area to drive up what medicare pays them.

A single payer system, means one negotiator, instead of thousands. One standardized set of prices. And an end to price fixing from hospitals. Under a single payer system. A broken arm won't cost 6,000 dollars. It will cost 400.

Again, cost and price aren't the same thing. That's why hospitals have to report their costs in addition to reporting charges.

Anyway, I don't see where you're identifying where the costs of inputs go down. Which I suppose is why you keep using the word "magic."

 

[Greenbeard]

Significant cost cuts can be immediate due to BOTH effectively CUTTING all existing insurance company profits down to 0 and due to immense price-setting capabilities that you mention in Pro #4.

Insurance company profits are not the source of America's higher health care costs. The inputs we use to produce care--people, places, things--cost more here.

I don't think this is true in general; i.e. that our medical outcomes or care is that much better or better at all than other countries.

I wasn't comparing clinical outcomes--trying to do that across nations is really hard ("Challenges in International Comparison of Health Care System "). What's easier to comment on is why other OCED countries spend less, which is what I was talking about.

I think it's a flawed argument that we should support a bloated unnecessary system because otherwise it would result in firing of too many people. Many industries have gotten smaller over time. We should NOT be propping up a system for this reason EVER.

If such argument were ever true, then you should go ahead and argue that we should make healthcare MORE COMPLEX to provide more jobs for healthcare professionals. Make taxes MORE COMPLEX to employ more accountants. Make laws MORE COMPLEX to employ more lawyers. Make Government unnecessarily more bloated to provide more jobs.

I'm not arguing "shoulds," I'm simply pointing out what is. Yes industries shrink and evolve over time. That doesn't change the political challenge of the government affirmatively stepping in to demand that major employers--in some communities, the single largest employer--engage in layoffs. Or even outright closures, if necessary for cost containment reasons. What strikes you as a more likely thing for politicians to do: 1) step in to prop up financially struggling facilities, or 2) step in and scale back or close financially successful ones?

This is a difficult issue to grapple with and it's something that has to be addressed, not swept under the rug. I post about it all the time; see: "A 'mercantilist jobs program for depressed cities'."

 

[jaeger19]

In most countries all of the necessary treatments are fully covered. Elective or most advanced ones may not be (but those are too out-of-reach cost-wise in US as well for much of population)
.

Well a couple of points here. Most Total hips, total knees, most knee arthroscopies, and so on .. are elective surgeries.. Also what is considered "necessary " varies.. for example Frances government insurance will pay for your abdominal surgery.. but may not pay for the anesthesia.

You are misleading people here. Canada's private health insurance market is NOT for the basic coverage that is the single-payer system. Private insurance companies in Canada are for non-covered services like drugs, dental and optometry.

Nope.. you are misleading people here.. remember your point about taking insurance company profit "to zero"... oops.. not so fast there bucko... by the way.. Canada's government insurance ALSO does not pay for outpatient physical therapy, outpatient physical therapy and speech therapy (outpatient).. nor home health services either... while our government insurances here.. do.

First 4 years of education where Docs get their Bachelors-of-whatever degrees are mostly a waste and unrelated to practicing Medicine

Really.. so you don't think chemistry, physics, statistics, cellular biology etc.. are "unrelated to the practicing of medicine?"

Hmmm.. so chemistry is unrelated to say.. prescribing medications? Interesting.. please make your case.

Links? Proof? I showed you we do NOT score well on availability of hospital beds in fact and there are many other aspects on which we do NOT measure well listed in another link I posted.

Sure:



Hmmm.. we score 5 in timeliness.. oh and 3.. in effective care... and what did Canada score? Oh that's right.. 7 in effective care.. and oh wait.. 11 in timeliness of care.

Yes, holding on to those COAL jobs that we lost is the cure for our problems.. right... How about buggy riders, or all the jobs lost to robots? You think they are coming back?

Well first.... how is it "artificially bloated".. please explain how our healthcare system is artificially bloated.

then..

Hmmm So you think buggy riders made up 20-30 % of US GDP.. that's interesting. Nope.. I don't think buggy riders jobs are coming back..

But.. I do see that we have millions of baby boomers that are aging.. and will need healthcare... but hey.. that's just like buggy rider jobs right!!!

I repeat, if such argument were ever true, then you should go ahead and argue that we should make healthcare MORE COMPLEX to provide more jobs for healthcare professionals

Actually more complex tends to decrease the number of professionals working.

taxes MORE COMPLEX to employ more accountants

Actually.. that argument has already been made and has been implemented. In fact.. we have the system we do because of the tax industry which does employee a number of folks and it lobbies like heck/


But.. that aside.. I would argue that we don't need to artificially create more jobs.. nor do we need to artificially DECREASE jobs in a growing industry that's growing not because of complexity.. but because of DEMAND for services from aging baby boomers.

Now.. IF we took your argument.. Since in America.. we pay wages WAY more than say in mexico.. or China.. or many developed countries.. we should purposely artificially lower wages to 1 dollar per hour to be on par with other countries.. Why should I be paying these bloated wages.. when other countries pay so much less???!?!?

 

[Boo Radley]

More would be put in? Even the most conservative estimates say it would that an increase equal to 2/3 to 3/4 of what we're already paying in federal taxes.

Yep, and you wouoldn't be paying premiums. And employers wouldn't be paying. It comes out about a push. Eventually, it might even shrink and on the while have more money in your pocket.

 

[Bullseye]

Yep, and you wouoldn't be paying premiums. And employers wouldn't be paying. It comes out about a push.

Not according to the studies I've seen.

Eventually, it might even shrink and on the while have more money in your pocket.

I don't believe in Santa Claus either.

 

[Boo Radley]

Not according to the studies I've seen.


I don't believe in Santa Claus either.

I don't know what studies you've seen, but I put something in the opening post that supported what I say. And I don't believe in Santa Claus either. As I've said, no system is perfect, but we spend a lot now, more than nearly anyone, and yet, we have many people uninsure and not able to get the care they need. It doesn't have to be that way. It worth an honest look.

 

[Bullseye]

I don't know what studies you've seen, but I put something in the opening post that supported what I say. And I don't believe in Santa Claus either. As I've said, no system is perfect, but we spend a lot now, more than nearly anyone, and yet, we have many people uninsure and not able to get the care they need. It doesn't have to be that way. It worth an honest look.

When everyone from Bernie Sanders to the Urban Institute and Mercatus Institute say federal spending will increase by 1.4 to 2.4 trillion a year I tend to believe them. Your miss that employer and employee costs will balance that out doesn't stand to reason. First off, not everyone HAS employer provide HCI and secondly not everyone is employed. tax will have to cover your insurance cost AND the cost of insurance for unemployed and their families too. Right now approximately 150 million workers are trying to pay Medicare for 60 million MC recipients and not succeeding. Now you want to burden those same workers to shoulder costs for 330 million?

 

[Boo Radley]

When everyone from Bernie Sanders to the Urban Institute and Mercatus Institute say federal spending will increase by 1.4 to 2.4 trillion a year I tend to believe them. Your miss that employer and employee costs will balance that out doesn't stand to reason. First off, not everyone HAS employer provide HCI and secondly not everyone is employed. tax will have to cover your insurance cost AND the cost of insurance for unemployed and their families too. Right now approximately 150 million workers are trying to pay Medicare for 60 million MC recipients and not succeeding. Now you want to burden those same workers to shoulder costs for 330 million?

Yes, it will increase. But again, the individual will not pay premiums, the employer won't be paying premiums, and hospitals won't have to charge $16 dollars for a bandaid because people can't pay. All ways in which the individual pays now. Which makes the increased federal spending and tax increase a push.

the average premium for an individual health insurance plan cost $2,889 per employee in 2001 ($3,886 adjusting for inflation). By 2015, that number had ballooned to $5,963, easily outstripping overall inflation and wage growth.

https://www.forbes.com/sites/willia...-big-problem-for-small-business/#1c03b85425d9

Add to the above what the individual pays.

 

[Slavister]

Insurance company profits are not the source of America's higher health care costs. The inputs we use to produce care--people, places, things--cost more here.

Yes, it's not only profits. It's also all the costs related to running infrastructure that was set up N different times (once for each insurance company), many employees (most of which would be redundant / not necessary under single payer), etc.

I wasn't comparing clinical outcomes--trying to do that across nations is really hard ("Challenges in International Comparison of Health Care System "). What's easier to comment on is why other OCED countries spend less, which is what I was talking about.

Sorry if I misunderstood but I was responding to your point about healthcare costing too much because we provide too much and too good of a service with implication of having better healthcare vs other countries that use single payer, e.g. have too many hospitals or our care is too good. I bolded some parts in your quote that led me to believe this:

There are many reasons we pay so much for health care: we employ 'too many' people in that industry (including blue and white collar jobs), we pay them wages that are 'too' high, we get 'too many' services and have 'too much' capacity, we use 'too many' medicines, and have access to new drugs and new technologies 'too quickly.' And so on. [Note that it's the promise these "problems" will be fixed that leads to the constant discussion of increasing wait times.]
...
If we've collectively decided that this isn't worth the cost and we're willing to give it up (and I don't believe that we have agreed this), then we're still going to face individual defections from those conclusions. Maybe we in the U.S. have too many hospitals, but your local Congressman and local politicians certainly aren't going to be in favor of your local hospital closing. The politics of hospital closures and layoffs will be even tougher than the politics of base closures, affecting every single Congressional district in the country. Putting tough decisions about cold, hard realities in the political sphere seems to me less likely to produce needed outcomes, not more.

I'm not arguing "shoulds," I'm simply pointing out what is. Yes industries shrink and evolve over time. That doesn't change the political challenge of the government affirmatively stepping in to demand that major employers--in some communities, the single largest employer--engage in layoffs. Or even outright closures, if necessary for cost containment reasons. What strikes you as a more likely thing for politicians to do: 1) step in to prop up financially struggling facilities, or 2) step in and scale back or close financially successful ones?

This is a difficult issue to grapple with and it's something that has to be addressed, not swept under the rug. I post about it all the time; see: "A 'mercantilist jobs program for depressed cities'."

Thanks for clarifying. I reread again what you said. I think you point out the reality that it could be painful. (Not only that politicians will have difficulty with it.) My point though is that while this might be painful, it's likely also a necessary and important step to keep healthcare industry costs down for the rest of the population. In many cases, it may not result in closures but in decrease in wages for example and yes, some layoffs. Rest of the world operates this industry more efficiently it seems. It's a far cry from complete dismantling of the industry like some here would have you believe.

 

[Slavister]

Part 1 of 2 reply to jaeger19

Well a couple of points here. Most Total hips, total knees, most knee arthroscopies, and so on .. are elective surgeries.. Also what is considered "necessary " varies.. for example Frances government insurance will pay for your abdominal surgery.. but may not pay for the anesthesia.

Canada single-payer system covers these "elective" join replacement surgeries. So what's your point?

Nope.. you are misleading people here.. remember your point about taking insurance company profit "to zero"... oops.. not so fast there bucko...

My point was that profits go to zero for the services no longer needed, i.e. most of coverages. Yes, clearly with private insurance companies still needed for non-single-payer services, profits would still be made. However, this would be MUCH LESS of an insurance industry vs what it is today.

by the way.. Canada's government insurance ALSO does not pay for outpatient physical therapy, outpatient physical therapy and speech therapy (outpatient).. nor home health services either... while our government insurances here.. do.

You are still misleading people... I randomly decided to fact check you on outpatient physical therapy... Let's see. In US, Medicare covers up to ~$2k in PT expenses, plus it does not pay all but 80% of charges via part B. Canada has its own limits (e.g. if you stayed in hospital for the condition for which you need PT) but it does cover a variety of cases and I don't see a $$ limit: here is one source. Essentially, if it's medically necessary or if you are old or young, you qualify. In fact, it would cover ALL people in US that are on Medicare, since if you are over 65, you are eligible.

Sounds like Canada does better at this coverage than USA. Your claim is that Canada has no coverage at all if false, and you forgot about how our government insurance has quite a few limits in its coverage.

Really.. so you don't think chemistry, physics, statistics, cellular biology etc.. are "unrelated to the practicing of medicine?"

Hmmm.. so chemistry is unrelated to say.. prescribing medications? Interesting.. please make your case.

Yes, some classes are useful and needed indeed. I agree. But my point is that most are NOT relevant. You don't need to waste 4 years on those that are needed. In fact US already has some accelerated programs that skip through crap. More of that should be implemented. Further, medicine is getting more and more specialized. Everyone here goes through med school first and then specializes. Not ALL of that med school training is needed for every specialty. Most Docs forget a lot of the medical school rotations quickly enough. They are simply not relevant to them.