My personal opinion, is that the biggest mistake was passing the healthcare act congress did in 2009 instead of national single payer Medicare/Medicaid for all.
Socialize it all; call in the military doctors to provide care that's missing. Train up more. Break the education cartel and '(evil/dark) company' style hazing of new grads in grueling 12-36 hour deathmarch shifts. Train enough doctors to fulfill society's needs.
We need to move to a capitated payment system. The current fee for service system incentivizes everyone to consume more than necessary. Doctors prescribe more because they get paid more, insurance gets a fixed percentage of revenue as profit so they want to spend more too. The systems has evolved into tons of make work bs because as the amount of money sloshing around grows so does profit for everyone. Capitated payment encourages everyone to save money as profit is just the left overs after everyone is treated. If you spend less than the provider next door without outcomes suffering you make more money, so innovation is encouraged and waste eliminated. Also fixes the "insurance denying coverage" issue as all prescription decisions are made by the provider.
Socialized healthcare is also failing all around the world. Have you seen the situation in the UK recently? Or Canada?
The cause of the malaise seems to be the same everywhere. See the biggest shift in the US healthcare system over the last 50 years for example:
There was a 3,200 percent increase in the number of healthcare administrators between 1975 and 2010, compared to a 150% increase in physicians, due to an increasing number of regulations:
>Supporters say the growing number of administrators is needed to keep pace with the drastic changes in healthcare delivery during that timeframe, particularly change driven by technology and by ever-more-complex regulations. (To cite just a few industry-disrupting regulations, consider the Prospective Payment System of 1983 [1]; the Health Insurance Portability & Accountability Act of 1996 [2]; and the Health Information Technology for Economic and Clinical Act of 2009.) [3]
In contrast, the fields of medicine in the US less affected by this surge in government intervention; cosmetic and laser eye surgery, have seen prices increase at below the rate of inflation. [4]
A significant fraction of healthcare administrators are there to deal with insurers, both to negotiate pre-approval and then to get paid afterward.
That's what happens when you have thousands of insurance companies, each negotiating their own individual prices for everything. On top of that, you have to deal with insurers that will deny pre-approvals for medically necessary treatments on first request as a matter of course, then deny the first claim afterwards despite acquiescing to the pre-approval. And finally, patients may have primary, secondary, tertiary, and even quaternary insurers to ensure they're fully covered, so you have to figure out which fraction of the procedure each will pay.
Rather than doctors spending their entire days haggling with insurers, they've hired administrators to offload the work so they can get back to being doctors. Unfortunately, the byzantine structure which is privatized health insurance has only continued to grow in size and complexity, necessitating a growing number of administrators to handle the interface between the two.
A point, part of the reason insurance companies deny claims isn't because they think they can get out of paying. It's because doctors don't get paid for dealing with insurance. So they tie doctors up so doctors can't see more patients and generate billing.
The current share of healthcare spending that occurs through government and private insurers is due to government intervention. Out of pocket spending constituted the vast majority of spending in the 1950s before these government interventions were enacted.
In contrast, cosmetic and laser eye surgery have mostly escaped the effects of these interventions, and are consequently the only fields of medicine where 1. most spending is out of pocket, and 2. prices have increased at below the rate of inflation.
As for the socialized health care panacea, if you look at the health care systems of other countries where they have fully socialized expenses, you see huge problems, not exactly the same as the U.S.'s, but absolute disasters nonetheless. Health care as a centralized institution doesn't work.
I'm a pretty conservative person, and this is the one view I break with hardliners completely with - I agree completely.
The funny thing is, most people you talk to on either side of the aisle are for it. The healthcare lobby is so large as to buy politicians to make it seem like a wedge issue, but even a ton of conservatives agree with single payer in principle.
I'd wager if you put it to a national vote, it'd break something like 80-20 for.
I think the core ideas of the ACA with the public option was originally Gingrich, in response to Hillary Clinton’s much more aggressive proposal for single payer, right? And then before the federal ACA, “Romneycare” was implemented in Massachusetts (without a public option, but with preexisting condition protection and not allowing separate high risk pools) by Republican Governor Mitt Romney. I think the discourse ended up polarized because Obama presented it that it seemed really partisan but the person that killed the public option in a Herculean commitment to insurance company profiteering was none other than liberal centrist Senator Joe Lieberman. This is not a partisan issue. There are obviously going to be ideological pockets in the extremes but outside of that, for the most part, the only people that are stepping up to defend the insurance companies are in their goddamned pockets.
You're right, but there are people on both sides who toe the party line blindly(and stupidly, if I might add).
I'll never forget Trump being cornered, and him saying he's not going to let people die in the streets, and his audience booing. He claimed they were all donors and lobbyists taking the audience seats, and despite his typical theatrics, I now believe that to be the truth.
Either way, today it is a leftist idea I think, so there will exist some people who oppose it out of spite.
I don't know a single person happy with the system today, which is damning. Just look at the reaction from recent events...
Fair enough. It is rather telling and should be extremely concerning to the insurance industry that in our extremely polarized political culture of late, this has been a the largest patch of common-ground many of us have stood on in a long time. Obviously not a total common ground issue, but I can’t think of anything bigger recently.
I disagree with Medicare for all and single payer.
The role of govt is a catch 22 - it is by design a monopoly, and monopolies are usually inefficient, so too much govt power gets monopoly capture but too little means govt can’t break the monopolies.
The largest issue with US healthcare is lack of price-quality transparency and competition.
This means tons of middle player monopolies e.g PBMs.
I can’t go shop around for a procedure on a marketplace and pay out of pocket, the same rates an insurer would.
I can’t deal directly with service provider or the labs. It has to be intermediaries.
The # of medical licenses are capped, they’re not growing in proportion to population.
Demand-supply dynamics, the basis of capitalism is wildly inefficient in US.
Get rid of employer given insurers, make a law that insurers cannot negotiate a lower price than out of pocket price. Every procedure price should be openly put on an easily searchable marketplace.
Make it easy to start new practices, more doctors and nurses and hospitals.
The prices will come down.
Single payer is a bandaid fix. It does nothing to fix the supply problem.
this argument comes up every time and it always ignores a critical aspect of medicine: not all procedures can be “shopped for”.
If I have cancer and I need to start treatment as soon as possible I’m not going to waste precious time comparing rates of infusion centers, especially given that one may be able to take me in for treatments 2 weeks sooner. That two weeks could make all the difference
If I have a heart attack, stroke, car accident, etc, that incapacitates me, I am simply incapable of shopping around for the best price. I am going to be taken in for emergency care and treated to the point of stabilization (or better, depending on whether I have a guardian who can approve more. Said guardian could theoretically shop around at this point but it is difficult given the potential emotionality involved and danger in moving someone who is critically injured)
Increasing provider supply is certainly a huge part of fixing things, if it’s done correctly. If you merely lower standards you just increase supply with substandard practitioners that overall worsen outcomes
What percentage of the money spent on healthcare is the type of emergency you're talking about?
5%? 10%?
I'm not saying stuff like that doesn't happen but insurance for healthcare in this country is totally insane. If car insurance worked the same way Geico would be paying for my gas and oil changes. Heck they'd be paying to have the car cleaned once a month.
well my insurance company just doubled the rate on my 2009 clunker because i had the audacity to move to a low-income neighborhood, so i find these terms acceptable.
most people spend a lot of money on healthcare as they age. Many times this is emergency stuff that’s unplanned and not possible to shop for, or it’s just flat out expensive to care for. Stuff like falling at home and breaking a hip, cancer, heart attack, dementia care, etc. Once you’re admitted into the hospital it’s game over. You think someone is going to shop around while in a hospital bed connected to IV’s? That’s crazy talk.
A little boo boo or an urgent care visit can be shopped for, sure, but that’s all cheap stuff compared to emergency or end of life care! That’s the stuff people actually stress about in my opinion. So why not fix that?
Another example: a mother “shops around” to find a cheap place to deliver her baby. Great! But maybe she’s unlucky and needs emergency C-section or another emergency intervention. What good is shopping around if it’s not actually practical?
People expecting children are exactly the type of people who should be able to shop around. Even in the case of an emergency delivery it's an event that you have what, 6 months to plan for?
I see you conveniently ignored the fact that any emergency before age 65 is hard to shop around for. From a hospital bed and all that…
Anyway i simply think the idea of “shopping around” for medical care is barbaric. As a concept. We’re talking about peoples lives here. I think as a country we should have some actual pride and treat our citizens well. Not like an inconvenience.
just my opinion, as a lucky person with great health insurance.
As somebody having once "shopped for healthcare" in the US: It's pretty high on my list of all-time most frustrating and stressful situations, and that was for a relatively minor dental issue. I can't begin to imagine how it must be for somebody facing a major life-threatening (but not urgent in the emergency room sense) condition.
I'd gladly "overpay" a few (or even many) percent if that's what it takes to get systematic protection from being a pawn in a game of 10d chess between doctors needing to overtreat to recoup their enormous investments, insurers pushing back by possibly declining to pay for what I actually need to get done, and medical administration and billing companies, and industry for the size of which I have yet to hear a compelling economic argument.
It's actually easier to shop for medical care than dental. Health plans are now required to give members an online price comparison tool. You can just log on to your insurance company's member portal and search for the care you need to see prices for network providers in your area. Unfortunately, the same rule doesn't apply to dental insurance.
Still, a problem at least as big as finding various options and their prices seems to be finding somebody incentivized to give an honest evaluation of whether a given treatment is medically necessary at all.
Sometimes I wonder if it wouldn't make sense to have a doctor "on a retainer" that just gets a fixed yearly compensation for advising what to do, and what to better decline, but there's probably tons of ways this could go wrong in either direction (overtreatment vs. missing important issues) as well.
You are essentially describing "concierge medicine". This can be a good option for affluent patients who can afford the monthly fee but it's not a scalable solution for the systemic problems in the US healthcare system. A lot of the people who take advantage of it are what is known in the industry as the "worried well" — rich hypochondriacs willing to pay for personal reassurance whenever they have a tummy ache.
The public option in 2009 would have helped, let the profit-skimmers compete with the government program and prove that they really can deliver better service while taking their 20-30% cut. But the "free market" captains of industry are liars, they say that they want competition but they don't, they want market manipulation and safe cozy profit margins.
It's funny (not funny haha) how Democrats always seem to have a few undercover sabotagers in their ranks that get elected having lied to voters and then undermine Democrat's agenda, Lieberman, Manchin, Sinema, now Fetterman.
> national single payer Medicare/Medicaid for all.
Barack Obama himself said in an interview that this option wouldn't be on the table, because it would kill millions of jobs. When there is great inefficiency in a system, remember that the "wasted" money is going to someone. Some voting districts in the eastern USA rely heavily on jobs in medical payment administration.
I don’t follow. What happens when they need care themselves? I read about layoffs in American auto manufacturers all the time. How does the value added by this paper-pushing bloc outweigh our collective health?
Socialize it all; call in the military doctors to provide care that's missing. Train up more. Break the education cartel and '(evil/dark) company' style hazing of new grads in grueling 12-36 hour deathmarch shifts. Train enough doctors to fulfill society's needs.