Single payer healthcare system discussion

infinitenexus said:

because tricare can suck sometimes.

As short as I can make it- due to cancer I had a 9 inch incision. Didn't heal up right. It's called a weeping wound. I was sitting at home stuffing a bandage 5 inches down into my abdomen because Tricare doesn't approve home healthcare nurses. (The University of Kansas Medical Center told Tricare I needed one, the wound needed professional care) 

I finally got an appointment when I told Tricare I had video of me drugged up for the pain jabbing the sterile packing in with a stick and mentioning YouTube.

Tricare is a single payer system or government run healthcare. 

I was just told my doctor doesn't see patients anymore unless it's very limited circumstances.

The VA? I have been tortured, during a blood draw the "person" pulled the vein up a 1/4 inch with the needle causing extreme pain. I saw the "person" smile. At that time getting someone fired was impossible.

The VA also let a student X ray my knee at full power, twice, like when the actual tech came in she panicked. I thought the machine was going to vibrate off the wall. I now have more trouble with that knee years later.

Don't ask me if I think a single payer / government run healthcare is a good idea. You will get my opinion and I'm tired of this crap how it's better.

Bent-Valve said

The VA also let a student X ray my knee at full power, twice, like when the actual tech came in she panicked. I thought the machine was going to vibrate off the wall. I now have more trouble with that knee years later.

2019 "private" HC story: 

I live in GA. Wife is in healthcare. She had a mammogram this week. She was told during the procedure that in Georgia you don't have to be a trained radiology tech to be a radiology tech. 

Evidently anyone with an eight hour "training" session can shoot x-rays... so one health system whose name rhymes with Bellstar recently got rid of all radiology techs.

One of the recently fired radiology techs (doing her scan and telling the story) said his replacement performed TWELVE chest x-rays on a patient. 

tester said:

In reply to The0retical :

You just destroyed some huge % of the economy that pay taxes to support Medicare, VA benefits.... Funny isn’t it. Unintended consequences are a tough cookie. 

Do you?  The people who provide actual care will have jobs, as will their managers.  The people who process the payments will still have jobs, as will their management (if they so wish to do it).  

The ones who will have severely cut back salaries are the super top management and the shareholders of the company.  And it remains an honest question whether it's morally correct to profit from finding excess money that is intended to help a person's health- which does actually restrict the amount of money that people can actually use for their health.

Given that much of the population will have increased health outcomes, which actually will help the consumer base of the country- it seems like a fair trade off.

In reply to Bent-Valve :

While I totally see your point that your ACA assigned health care didn't actually cover your needs- and it was a horrible situation (which I would openly ask was that legal or not...)....  (on a personal note, I had a very close relative that had the same situation, not as painful, but the repair was covered- but a year later)

When there are no more choices for doctors to get payments for, the ONE choice left will be how they get paid.  So by that rule, unless doctors go out of business, they will have to take money from the single payer, otherwise they will not get paid by anyone- except for direct payments.  

One of the core problems with the system is that doctors can choose who they get paid by- as there are many multiple sources of payment right now.  When you narrow that to one, then they don't really have a choice to deny someone's coverage.

At this point, I totally agree that payment levels do need to stay competitive so that docotrs are encourage to do the best of the best work.  But at the same time, we should not be paying for procedures (so that doctors blanket people with procedures that they don't need)- but we should be paying for healthy outcomes.

Just some disorganized ideas on the subject. Feel free to poke holes:

Instead of focusing on who pays for coverage, how about focusing on reducing the costs of medical care to start? If medical care prices go down, then medical insurance costs should follow. How do we do that? I'd put my energy into increasing oversight, increasing competition, and leveling the playing field.

I think it's worth considering regulating the medical industry the same way we regulate utilities now. It's important to note that increased regulation does not equal government run. They're often privately owned, and allowed to make a profit, but any price changes have to be justified and approved by a government board. This keeps prices affordable for everyone for what is a basic need in modern society. This seems like it could greatly reduce any price gouging, profit padding, etc.

Next, lets increase competition within the medical industry. Go to a hospital and ask how much a procedure costs beforehand and after the giggles are replaced by dumbfounded looks, eventually when they realize you're serious you get a bunch of "I don't know" responses. And the price can be very different for different people. I can't think of another business that could function in this way. Make them post prices for procedures or care for all to see. They already have that data somewhere, it's just not made available. That way, the prices are the same for everybody, and when they're out in the open, consumers can make more informed choices about their care.

Then, I'd really dive into the tax breaks that many non-profit hospitals receive while raking in massive profits and sitting on enormous war chests that earn billions per year in interest alone. That puts other hospitals at a disadvantage and reduces tax revenue that could go towards something more useful. So it's a double whammy for consumers. They get less competition in the market and less money in the coffers for useful gov programs. That tax money could even fund the regulation I mentioned in the first suggestion above, or go towards covering some of the free ER visits that get racked up every year.

In reply to STM317 :

Everything you say is valid, but stopping it doesn’t work. That was the initial goal of insurance.  Then HMO’s and finally commercialization of health care ( where non profit hospitals  were bought and combined to make greater profit). 

The health care industry is so big that only something really big will work at making it affordable for all. 

America simply has to follow the rest of the world and take ownership of health care.  Once it’s owned by the people, for the people. We will have the power to control it.  

alfadriver said:

In reply to Bent-Valve :

While I totally see your point that your ACA assigned health care didn't actually cover your needs- and it was a horrible situation (which I would openly ask was that legal or not...)....  (on a personal note, I had a very close relative that had the same situation, not as painful, but the repair was covered- but a year later)

When there are no more choices for doctors to get payments for, the ONE choice left will be how they get paid.  So by that rule, unless doctors go out of business, they will have to take money from the single payer, otherwise they will not get paid by anyone- except for direct payments.  

One of the core problems with the system is that doctors can choose who they get paid by- as there are many multiple sources of payment right now.  When you narrow that to one, then they don't really have a choice to deny someone's coverage.

At this point, I totally agree that payment levels do need to stay competitive so that docotrs are encourage to do the best of the best work.  But at the same time, we should not be paying for procedures (so that doctors blanket people with procedures that they don't need)- but we should be paying for healthy outcomes.

You make a point I hadn’t thought of regarding the payment stream. 

My understanding is that most national health care systems do have a private  health care component.  I’m not sure about France though. There the government health care is pretty marvelous. Doctors and nurses come to you. Not only do you not have to get out of your sick bed to receive help. But if you remain bed ridden your house is cleaned.  Dishes and clothes washed. Shopping is done. 

Ambulances ( or taxi’s ) take you in for XRays and procedures.  ( and return you home.)  it’s just cheaper that way. Plus there are some diagnostic benefits. 

Although I've stated I'm lucky and have a good job and insurance covered by my company.  I was unemployed for nearly six months this year and experienced the other side.  COBRA is terrifyingly expensive so we looked outside of that.  We got coverage, but both of us being over 50 what was affordable is what I call catastrophic insurance, really there to cover a car accident or similar.  It was a backstop against bankruptcy, not real coverage.  We had to take a calculated risk that it was worth it for an undetermined period of time.  We never went to any regular visits and had one urgent care visit which we had to cover 100% as the deductible was so high.  It worked for us with savings, but it's the sort of coverage many low income people have, and they simply can't afford regular doctor visits or prescriptions on that type of coverage.   To me, many of the people who do have coverage don't have any meaningful coverage.  Even if we can't go to a true one payer system, we really need to do something to make it more affordable. 

People keep saying 'if the US system is so bad, why do people come here for it'  Simple, the health system here is great if you can afford it.  The people who come here from overseas are either paying out of pocket or being covered by some kind of charity organization.  They are getting the best service, but it's service that simply isn't accessible to tens of millions of people.  This is what needs to get fixed.

frenchyd said:

In reply to STM317 :

Everything you say is valid, but stopping it doesn’t work. That was the initial goal of insurance.  Then HMO’s and finally commercialization of health care ( where non profit hospitals  were bought and combined to make greater profit). 

The health care industry is so big that only something really big will work at making it affordable for all. 

America simply has to follow the rest of the world and take ownership of health care.  Once it’s owned by the people, for the people. We will have the power to control it.  

I feel like this argument has been made before and I'm struggling to come up with a decent example of when it's actually been true that government providing funding mostly cart blanche for something has decreased costs to the consumer.

They did it with student loans, and college tuition has skyrocketed.

The ACA took effect in 2014, and has had no real impact on the rate of increase of health insurance premiums:

 

 

 

Government providing a massive pool of funds, without doing anything to control industry costs only increases demand for a service, which drives prices up. They're trying to treat a symptom rather than the root cause of the problem. I think they could tackle the problem more efficiently (greater gain per $ spent) by simply regulating the industry and letting market forces drive prices down.

STM317 said:.....I'm struggling to come up with a decent example of when it's actually been true that government providing funding mostly cart blanche for something has decreased costs to the consumer........

See Exhibit A.  The rest of the First world democratic societies and healthcare!!!

In reply to Adrian_Thompson :

They might have lower costs relative to the US, but what did implementing these systems do to prices within the country? Britain's NHS was formed in the 1940s, so data to really understand what it did to healthcare costs within the country is probably slim. How likely is it that a similar system could be implemented in the modern American environment, where every company involved is trying to profit? Costs already go wildly unchecked.

It looks to me like the rate of increase in healthcare costs among first world countries is pretty similar across the board, it's just that pricing in the US is higher. I think there are more efficient ways to directly attack the issue of high healthcare costs than simply changing who pays for it:

OHSCrifle said:

Bent-Valve said

The VA also let a student X ray my knee at full power, twice, like when the actual tech came in she panicked. I thought the machine was going to vibrate off the wall. I now have more trouble with that knee years later.

2019 "private" HC story: 

I live in GA. Wife is in healthcare. She had a mammogram this week. She was told during the procedure that in Georgia you don't have to be a trained radiology tech to be a radiology tech. 

Evidently anyone with an eight hour "training" session can shoot x-rays... so one health system whose name rhymes with Bellstar recently got rid of all radiology techs.

One of the recently fired radiology techs (doing her scan and telling the story) said his replacement performed TWELVE chest x-rays on a patient. 

I hope they get sued BEFORE they really mess someone up.

My point is a Single Payer System allows care to be dictated by a bureaucracy, when your a number and not a person seen by a doctor the bottom line becomes easier to justify.  

Recently Tricare had to send me to a Hospital in North KC. Excellent care, can't say enough good about the staff. The co pays sucked, but you get what you pay for.

UKMC who took care of my cancer were also outstanding, they fought a losing battle with Tricare to get me what I needed at home. To take care of the wound I drove to Western Missouri Medical Center, sat in the parking lot and took drugs for the pain, then the outstanding and caring lady took care of the wound. Three days a week for, I forget, several weeks. I walked back to the car and waited for the pain medicine to wear off and drove home. (car note, did this in a 1988 Olds Stationwagon, Sam, my 120lb Blue Tic hound was in the back watching over me) Four months to heal up before I could work again.

In reply to Bent-Valve :

Hey, I'm in the same area and have dealt with the same VA.

I've been on hold with the KC VA for a couple hours at one point, prior to getting my own insurance and vowed to never use them again.

Thankfully they opened up a small clinic not in the heart of the ghetto in Shawnee and I've used that a couple of times now for the yearly physical and shots. Not bad and much better than KC.

For everything else? I strictly use Olathe Health

In reply to STM317 :

The difference between student loans and healthcare is the ability to negotiate or set rates. There are no controls on money issued for student loans, so free money it is. That's why there's been an explosion in cost for post-secondary education.

For healthcare other countries very much learned that they need to negotiate and regulate rates. There's no reason doctors, medical billers, staff, and paperwork handlers shouldn't be well compensated. But there's no reason for companies to make money carte blanche on something their customers are required to have in order to continue living a decent life.

In general what a single payer system would do is greatly expand the risk pool. That's in pretty stark contrast to companies diving up the customers (thus reducing the pools into tons of smaller ones) then generating value for shareholders on top of that which drives up the cost. Socializing the risk provides better access, through everyone belonging to the same network, and a lot more clout for negotiation of rates by the regulating entity.

As it stands now medical billing is basically throwing E36 M3 at the wall and seeing what sticks. There's no consistency to it, so why not toss out prices like $50k for an MRI or $10k a night for a room? It's like dealing with Craigslist car sellers where they start at $4k for their rusted POS Miata expecting to be talked down to $1k.

Except you don't need to buy the Miata, but you might need to be admitted for 4 days to the hospital in order to continue living. ACA was a step in the right direction but the controls aren't or weren't strong enough on it.

As for a Canadian/UK style system vs a Public/Private system like the rest of Europe, I'm basically indifferent to which we choose until I see some details on how they would work.

FuzzWuzzy said:

In reply to Bent-Valve :

Hey, I'm in the same area and have dealt with the same VA.

I've been on hold with the KC VA for a couple hours at one point, prior to getting my own insurance and vowed to never use them again.

Thankfully they opened up a small clinic not in the heart of the ghetto in Shawnee and I've used that a couple of times now for the yearly physical and shots. Not bad and much better than KC.

For everything else? I strictly use Olathe Health

As a fellow Vet I’ve never used the VA. Apparently if your income is over a certain amount you aren’t eligible? 

STM317 said:

In reply to Adrian_Thompson :

They might have lower costs relative to the US, but what did implementing these systems do to prices within the country? Britain's NHS was formed in the 1940s, so data to really understand what it did to healthcare costs within the country is probably slim. How likely is it that a similar system could be implemented in the modern American environment, where every company involved is trying to profit? Costs already go wildly unchecked.

It looks to me like the rate of increase in healthcare costs among first world countries is pretty similar across the board, it's just that pricing in the US is higher. I think there are more efficient ways to directly attack the issue of high healthcare costs than simply changing who pays for it:

That is a cost of being late to implement.  A cost that potentially is getting higher by the year.  It's not a disincentive to doing it, it should be a hurry up.  

Bent-Valve said:

OHSCrifle said:

Bent-Valve said

The VA also let a student X ray my knee at full power, twice, like when the actual tech came in she panicked. I thought the machine was going to vibrate off the wall. I now have more trouble with that knee years later.

2019 "private" HC story: 

I live in GA. Wife is in healthcare. She had a mammogram this week. She was told during the procedure that in Georgia you don't have to be a trained radiology tech to be a radiology tech. 

Evidently anyone with an eight hour "training" session can shoot x-rays... so one health system whose name rhymes with Bellstar recently got rid of all radiology techs.

One of the recently fired radiology techs (doing her scan and telling the story) said his replacement performed TWELVE chest x-rays on a patient. 

I hope they get sued BEFORE they really mess someone up.

My point is a Single Payer System allows care to be dictated by a bureaucracy, when your a number and not a person seen by a doctor the bottom line becomes easier to justify.  

Recently Tricare had to send me to a Hospital in North KC. Excellent care, can't say enough good about the staff. The co pays sucked, but you get what you pay for.

UKMC who took care of my cancer were also outstanding, they fought a losing battle with Tricare to get me what I needed at home. To take care of the wound I drove to Western Missouri Medical Center, sat in the parking lot and took drugs for the pain, then the outstanding and caring lady took care of the wound. Three days a week for, I forget, several weeks. I walked back to the car and waited for the pain medicine to wear off and drove home. (car note, did this in a 1988 Olds Stationwagon, Sam, my 120lb Blue Tic hound was in the back watching over me) Four months to heal up before I could work again.

 

As far as single payer systems requiring bureaucracy to determine when you get seen.  

You must not have been to a hospital lately.  Or a health clinic.

That’s how medicine is done here in America for the past few decades.  You walk in and someone has you fill out forms then she gives them to a nurse who decides who has priority, heart attacks apparently have priority over bleeding, stroke over broken bones, and lowest on the list is discretionary issues like is this a mole or cancer.  

Works the same pretty much all over the world.  I’ve waited in waiting rooms for hours. I’ve even been told to come back tomorrrow or after the weekend, with one broken bone they couldn’t do anything until the following Thursday.  

By the way, some insurance plans now encourage what’s called medical tourism.  If your procedure isn’t life threatening they will give you plane tickets, motel rooms, ground transportation, meals etc to fly to Say India  or wherever they have a great reputation and low costs.  As a reward you get a cash incentive.  

It makes sense, a procedure here in America could cost  more than a $100,000 US dollars. But be performed in France for say $21,000.  Add a few thousand for transportation and lodging plus a cash bonus to the patient  and the insurance company saved themselves a big pile of money.    

There is some disagreement about the best way to move forward, but most of the people who have commented in the thread seem to agree that there are areas of the current US healthcare system that could be improved greatly.

Adrian_Thompson said:

STM317 said:

In reply to Adrian_Thompson :

They might have lower costs relative to the US, but what did implementing these systems do to prices within the country? Britain's NHS was formed in the 1940s, so data to really understand what it did to healthcare costs within the country is probably slim. How likely is it that a similar system could be implemented in the modern American environment, where every company involved is trying to profit? Costs already go wildly unchecked.

It looks to me like the rate of increase in healthcare costs among first world countries is pretty similar across the board, it's just that pricing in the US is higher. I think there are more efficient ways to directly attack the issue of high healthcare costs than simply changing who pays for it:

That is a cost of being late to implement.  A cost that potentially is getting higher by the year.  It's not a disincentive to doing it, it should be a hurry up.  

Nice graph and a very clear case for national health care.  

Incidently, My brother is a doctor, he compared his income with most European doctors income.  While he made more once he deducted his mandated liability insurance the differences were insignificant.  More a reflection of that days exchange rate than real. 

In reply to The0retical :

I understand how insurance spreads cost around. I guess what I'm suggesting is that instead of simply sharing the cost after the fact, we should try to reduce or control those costs upfront.

I also get how a larger entity should be able to use scale to negotiate lower prices. Medicare is a decent example of this already, and they seem to do a decent job of it compared ot private insurers. But I think it's likely that hospitals, etc take less from Medicare because they know they can overcharge other places to make up the difference. So I kind of expect adopting a "medicare for all" type of model might result in prices higher than current Medicare prices, even with a much larger pool. I would hope they'd be lower than current private costs however.

Completely agree with your point about medical billing being a case of seeing what sticks. Believe it or not, the current Administration has already laid some groundwork for more clarity with regards to pricing and quality. I see no downsides here. This act alone could increase competition and allow consumers to make informed choices about their medical care (when they have a choice). And when an X-Ray is cheaper for elective stuff, then it should become cheaper for emergency situations too.

I know that in emergency cases, there is little or no choice about where you seek treatment or if you seek treatment. But there's a ton of medical stuff that takes place that does involve some choice from consumers. I'd guess that elective stuff makes up a larger percentage of most people's spending on healthcare. Things like dental appointments, knee replacements, cosmetic surgery, annual checkups, etc all let consumers pick where/when/if they want medical care and having clear pricing upfront should allow consumers direct control of their care. So it's not always like buying a Miata, but sometimes it is.

Adrian_Thompson said:

That is a cost of being late to implement.  A cost that potentially is getting higher by the year.  It's not a disincentive to doing it, it should be a hurry up.  

At any cost? If it's been studied thoroughly by much smarter people than me, and determined that it's the most efficient path forward, then I could be on board. But I do think it's worth considering other options and studying them to see how the cost might compare.If treating the medical field like a utility gets us to a similar result, through means of oversight influencing market forces rather than direct government involvement, that would be my preference.

STM317 said:

Adrian_Thompson said:

That is a cost of being late to implement.  A cost that potentially is getting higher by the year.  It's not a disincentive to doing it, it should be a hurry up.  

At any cost? If it's been studied thoroughly by much smarter people than me, and determined that it's the most efficient path forward, then I could be on board. But I do think it's worth considering other options and studying them to see how the cost might compare.If treating the medical field like a utility gets us to a similar result, through means of oversight influencing market forces rather than direct government involvement, that would be my preference.

The fundamental truth is the people are the government and we get no better or worse than a well informed electorate demands. 

Private industry needs controls and guidelines  to flourish. Unregulated banking is the prime example. Depressions and recessions occur when rules are relaxed. Long term stability occurs when rules are enforced.  

Market forces are not the solution. Unregulated markets would be selling drugs on our playgrounds.  Cigarettes to minors.  

Big powerful  governments  are required to control big powerful companies.  

We are a complex society filled with divergent interests and  ambitions.  That forces any government to be complex to represent the variety of interests.  

People that attempt to distill it down to a simple message are not being honest. People that accept a simple solution  are asking to be fooled.  

In reply to frenchyd :

Perhaps you misunderstood? I'm not suggesting less regulation. I'm calling for increased regulation by treating healthcare as a utility. But once you protect consumers from price gouging, and take away any unfair business advantage (like non-profit hospitals getting tax breaks) I think government has done enough, and market forces would provide the rest of the improvement. And if the costs of medical devices, treatment, medicines, etc is better controlled, then insurance costs will go down too.

Closing tax loopholes are a one time cost. Having a regulatory board place reasonable limits on the cost of medical devices and services is likely to be much cheaper than flat out paying $3 Trillion/year for everything, indefinitely. I think you could get serious cost reductions with far lower cost to the tax payer through a method like that.

STM317 said:

Adrian_Thompson said:

That is a cost of being late to implement.  A cost that potentially is getting higher by the year.  It's not a disincentive to doing it, it should be a hurry up.  

At any cost? If it's been studied thoroughly by much smarter people than me, and determined that it's the most efficient path forward, then I could be on board. But I do think it's worth considering other options and studying them to see how the cost might compare.If treating the medical field like a utility gets us to a similar result, through means of oversight influencing market forces rather than direct government involvement, that would be my preference.

And to add onto this- we also have to consider the cultural aspect as well. Europe *still* remembers- in a subconscious, zeitgeist sense- World War 2 and how they had to band together to fight against Fascism, and has been argued that it's the major reason why they have a more "collectivist" mindset. Meanwhile, Americans have such  a deeply ingrained Cowboy mentality that asking for help can be a massive hit to their pride (we nickname them 'John Wayne' types in the Midwest, guys that'll have heart attacks and will refuse care for hours).

It is not enough to say that massive changes need to be made- This thread shows that despite anyone's political leanings- but we also have to ask what culturally will work here when we still shame people for taking unemployment benefits. We have a massive pool of systems to look at, what works, and what doesn't- we are in the worst situation for costs, but funny enough we are in the best scenario in finding and building something that will work as we need it to.

I don't know if necessarily need "universal healthcare" so much as a "universal insurance" option. 

Unfortunately, it seems the insurance system is where many of the inefficiencies happen. 

Working in the pharma industry, I have seen a staggering amount of waste, but these companies also take on huge risks. And sometimes those risks bite them.  For example, I worked for a client that spent about $1B (yes - Billion) on a production facility for a new drug. At the 11th hour, the drug failed trials and never went to market. The facility sat idle for years as they looked for a replacement use for it before the building was finally torn down for tax and upkeep reasons. Part of the problem is a drug is patented many years before it is finally developed and approved for market, so the company often only has a few years to actually make money off the sales of the drug.  I have worked on other projects with similar, although usually less drastic, outcomes.  There are also to dozens to hundreds of drugs a company will spend money working on, but ultimately never make money from. The sales of the drugs that do make it have to pay for all of the ones that don't, as well as provide returns to shareholders.