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Single Payer Health Care


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2009 Apr 28, 4:21am   39,757 views  115 comments

by Patrick   ➕follow (55)   💰tip   ignore  

cost distribution

Single-payer health care rarely makes it into any serious discussions in Congress, as it's so easy to shoot down with cries of "socialism". The main complaints are that:

  • A government bureaucracy will get to decide on your coverage.
  • Taxes will go up.

What is not mentioned is that:

  • Currently the insurance bureaucracy already gets to decide on your coverage, and they give employees bonuses for how much coverage they deny to you.
  • Taxes will go up, but insurance premiums will go away. Probably a net win. Works pretty well in Canada, Europe, Japan.
  • Employees will be more independent of employers, since insurance will no longer be tightly linked to a specific job.

This means there are two huge and powerful lobbying groups with vast amounts of money that will oppose single-payer health care:

  1. Medical insurance companies, since this would put them out of business.
  2. All employers who relish the control they have over employees via health care.

That second one is not to be underestimated. The power of employers rests first on wages, but a close second is on control over medical insurance. No Republican boss would ever voluntarily give up that employee whip.

Here's a good site that goes over a lot of the issues.
http://www.healthcare-now.org/

Maybe I spoke too soon. Here's a Republican group that does support single-payer health care:
http://republicansforsinglepayer.com/

Patrick

#politics

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1   justme   2009 Apr 28, 4:59am  

Patrick, how about adding another Adversary:

3. The medical establishments, who relish that at least in theory they can charge whatever they want, although in reality the insurance companies negotiate the billable rates with them.

2   Patrick   2009 Apr 28, 5:06am  

I'm not sure whether the medical establishment would be for or against single-payer. Seems about the same for them, having to argue with either an insurance company or with some government insurance department. Equally bureaucratic.

I knew a doctor who said the main function of the AMA was to deliberately limit the number of doctors, to keep doctors' wages high.

3   DinOR   2009 Apr 28, 5:39am  

Whatever the system, it needs to be less cryptic. It's unbelievable to me that someone gets paid a 'bonus' for denying you coverage?

When I got into it w/ my wife's insurer, they said "Before you were even admitted, you signed a form that clearly states... YOU are liable for any medical procedures that are 'not' covered by YOUR insurance!"

On it's surface that "sounds" reasonable enough, until you apply it to practically any other service? So... basically whatever we quoted you was at best, an estimate and likely we'll be billing you more and whatcha' gonna' do about it?!

For example they said that the "surgical facility" was not covered in full? I said what do you mean the "surgical facility"? Oh, that's the Operating Room! I said, "Well where did you 'think' they'd be doing the procedure, in the f@cking parking lot!?" So... if that's a given, why wasn't I made aware of that prior to doing this? Please tell me you've done this before?

Again, here we are w/ the REIC correlations. Everyone in the HCIC is indoctrinated in deceptive practices and how to live with it.

4   sa   2009 Apr 28, 5:48am  

I knew a doctor who said the main function of the AMA was to deliberately limit the number of doctors, to keep doctors’ wages high.

Remove the limit or open up to some doctors from outside. Open up competition.

No Health Insurance needed. You would only need some form of insurance in case of unforeseen complications or accidental injury. That should probably be 1/10th of what we pay for insurance.

When patients start paying for care, doctors wouldn’t be charging exorbitantly and competition would limit their leverage.

You don’t need a MD to look at patients having a common cold or infection.

A family of 4 would probably save around $10,000 from insurance, if they are health conscious. People who don’t care would end up paying lot more. There is an incentive to take care of yourself.

When you let more doctors into system, a lot of them can get to team up and open smaller hospitals and make the system more competitive.

A major portion of the money is spent on last year of a persons life and major chunk of it in last month. People could make a better decision on this.

That's the free market solution.

5   sa   2009 Apr 28, 5:52am  

“Well where did you ‘think’ they’d be doing the procedure, in the f@cking parking lot!?”

LOL!! That about sums it up on the games played on you. There are so many players who keep moving the target, that you want to give up.

6   justme   2009 Apr 28, 6:02am  

>> Again, here we are w/ the REIC correlations. Everyone in the HCIC is indoctrinated in deceptive practices and how to live with it.

This is a key point. All institutions and professions, if left unchecked and unregulated, will descend into abusive practices.

7   patb   2009 Apr 28, 6:17am  

sa:

medicine fails the classical tests for free markets.

1) Players lack perfect information, i know very little about drugs, and
less about medicine and I'm a smart guy. I can't debate with my doctor over
the average prescription, unless i'm on it for months i can't bother getting smart
and, despite google, i can't match 4 years of med school.

2) players lack substitution. When i wheel in the ER, i don't have crap for time,
i need stitches then, figure all out later. Who bargains in an ER?

3) people don't downgrade. i won't go to a discount nuerosurgeon.

and if you look 31% goes to insurance overhead thats where the savings are

8   Patrick   2009 Apr 28, 6:36am  

I've always thought the worst franchise name in the world would be "Budget Surgeon", though it has a nice ring to it.

9   sa   2009 Apr 28, 6:44am  

Patb,

for 1)
I am not sure why you need drugs, you would need them when you are ill. I don't want to debate average prescription either, just want to take it and get over with it. If you are talking about drugs like cholesterol reducing statins, you are missing my point or having a easy life.

for 2)
No Health Insurance needed. You would only need some form of insurance in case of unforeseen complications or accidental injury. That should probably be 1/10th of what we pay for insurance.

That should cover it.

for 3)
By all means, cover your insurance by paying higher premiums. Don't generalize all people needing all kinds of complicated procedures and hence have to be insured against it. The beauty of the plan is, you pay for insurance and you might be covered. Again, more competition would bring down the costs.

I am no rich guy, i am open to the idea that i could have some complicated disease or needing a complicated procedure and may not be able to afford it. Existing insurance doesn't cover complicated cases for more than a few days. So, we are not far off from no coverage.

10   DinOR   2009 Apr 28, 7:25am  

sa,

I don't bring up my personal experience as a means to solicit empathy or anything of the sort. I only share that w/ people to expose just how hysterical the whole game is.

It illustrates that you don't have to be broke, bleeding or oblivious to be taken advantage of? I kept hammering on "How could I -possibly- have been more thorough going into this! What more could -possibly- be reasonably expected!?"

And they had/have no perfectly good answer for that. Just sheepishly shrug their shoulders in coy fashion and say "C'mon, you know the drill, hike 'em sweetheart". And you're absolutely right, after little more than a few days, your policy turns back into a pumpkin anyway.

11   MST   2009 Apr 28, 7:46am  

Again, we see why this is very germane to a Housing Bubble blog. What we are talking about is the Socialization of Risk. The entire point of (any) insurance is to A) Make the insurance companies money, through B) statiscally normalizing risk by selecting a *pre-qualified* pool of the least risky, then C) Collectively charging them (much) more than the stats say you'll pay out, and using the float meantime. Works a trick for Life Insurance (very large pool, *very* selected, very reliable statistical performance. Oh. And only you and the insurance company as interested parties. Good point.) Like a casino, the house aways wins statistically, though you may hear of big payouts.

Starting with FDR we started socializing Mortgage risk, and it worked well enough: Lenders selected their clients with care (Qualified them because the banks had skin in the game) who then performed well (or you lose your house), and the insurer (Fannie Mae, Freddie Mac, FHA, FMHA) had a large (nationwide) pool of these good applicants to draw from. But the third party system has latent problems. [And I would add that the casino-wins aspects were not lost on the New Deal gang. C.f. Social Security, payroll taxes, etc.]

We're seeing those problems now: whatever the genesis, lending standards were lowered at the same time the risk was shifted from the person/bank making the loan to some "insuring" third (or fourth, or fifth) party who then has no idea what risk they are facing (but pretended to so they could off-load the risk to sixth, seventh, eighth parties) you begin to see why things blow up. Bailouts merely exacerbate the problem by truly removing the risk to the entire society.

At least for health insurance risks, people die. Finis. The debts generated by the socialization of Mortgage risks, and the subsequent increase in risks taken because they *were* socialized, and *those* subsequent debts, all now guaranteed by the governments of the world, will be a noose our *world* will have its collective neck in for generations.

12   cranker   2009 Apr 28, 8:03am  

I knew a doctor who said the main function of the AMA was to deliberately limit the number of doctors, to keep doctors’ wages high.

Not doctors. Specialists. The number of residencies in any specialty is tightly controlled by the AMA.

No joke, but read here the proposal to do so.
http://content.nejm.org/cgi/content/extract/333/7/454

It is estimated that there will be an excess of approximately 165,000 specialist physicians in the United States in the year 2000.1,2 Consistent with these projections are anecdotal reports that physicians completing residency training in some specialties are having difficulty finding suitable professional opportunities and that the growth of managed care is adversely affecting established specialty practices in some regions.

The doctors think they are not making enough, because there is too many of them.

13   Different Sean   2009 Apr 28, 9:15am  

I'm not sure that the AMA can control numbers of graduates, specialisation college places, etc -- I think the AMA, BMA and Oz AMA are really just a union for doctors -- who admittedly have some clout and influence in the medical sphere. They may do some background research on numbers and influence the colleges of specialisation, etc, but not sure that they set the numbers.

The Oz AMA is really on the nose with the current govt here now, especially as the new head is a known conservative supporter. they have cut the AMA out in talks in preference for dealing with more progressive medical reform groups in order to try to boost nurse practitioner places, allow non-doctor referrals to be made, etc.

the interesting thing about single payer 100% tax subsidy is that I could walk into a 'bulk-billing' medical practice every single day and see a doc for free with no appointment, and get loads of free tests done, x-rays, scans, ultrasounds, blood and urine, etc etc, forever (when indicated by actual medical symptoms), or until they told me to stop coming back as a hypochondriac. of course, real hypochondriacs are the bane of the medical world, but they have ways of dealing with that which mitigates expense.

the interesting thing about free healthcare is that it takes the monetary sordidness out of medical practice and makes it more altruistic again -- speaking of how the profession is meant to be 'noble' -- as there is little hip pocket pain or even consideration of how expensive a procedure or investigation is -- treatment is the first priority, whereas in the states people are often dying of ailments or leaving them untreated because of the expense or coverage. and when you go to the docs, there's no real billing, you just sign a standard carbonised form and walk away -- it's all over in a sec, and it's an extremely efficient system for the govt to pay the dr in bulk based on coded items submitted to them by the practice -- the dr is really acting as the gatekeeper for approving services rather than an insurance clerk.

however, the system is not perfect, especially when it comes to waiting lists for various types of surgery in the hospital system -- you might be waiting a long time for non-elective surgery, whereas if you're insured or willing to pay you can get private treatment almost immediately.

Orthodontics - much more teasing if you have braces as a kid in the UK and lots of people think you don’t really need them - just cosmetic.

Also, dentists in the UK have a bad reputation for painful injections etc - so many people avoid them until it’s absolutely necessary.

Which is probably why people in the UK are regarded as having such bad teeth -- crooked, holey and grey! :P Ruins your chances of getting into a boy band...

14   patb   2009 Apr 28, 9:21am  

Sa

The market has failed miserably in providing decent health care for americans.
You can blat on about the market but in the end, we are paying 18% of GDP into Health care and getting coverage to only 60% of all americans.

The other G-8 countries pay 12% of GDP and provide health care to 100%.

The system is Systemically busted.

Why do antibiotics cost me $300/Month at CVS when i buy off the regular schedule and $15 when i have health insurance? Defend that?

Why is physician income falling for 15 years?

The deal is we need god basic coverage, let insurance provide bonus coverage.

if I had medicare and it gave me Generic drugs, Basic service from my Internist at $15/Visit and accident coverage at the ER i'd be fine. If i stay in the hospital, then let me share a war with 4 or 8 patients. If i want a private room I can pay for that.

15   Different Sean   2009 Apr 28, 9:28am  

So I can say socialism now? Socialism, socialism, socialism. I'd stopped posting because of that ;)

16   Different Sean   2009 Apr 28, 9:35am  

danville woman Says:
April 26th, 2009 at 11:33 pm
I am a nurse practitioner and a good percentage of my patients are on mood altering meds due to nonspecific fears, and depression, anorexia, etc

Only certain fields of endeavor require mind numbing memorization, regurgitation, and competition. Medicine is one of them, however, I would say that many of the docs I work with, really regret their career choice. Their life can be hell.

DW, can I get in touch and get some more info on NPs in the US? There's only a handful of NPs in Oz, the British Commonwealth systems have really marginalised alternative providers like NPs, PAs, etc, they don't really exist as yet except as an experiment in rural/remote areas -- it's like a 100 year old system of entrenched privilege for MDs. It's one of the major areas for reform the govt is looking at. Just curious to know about the training time and limits on ability to diagnose, prescribe and order tests etc. my email is housingaffordability at gmail.com. I know there's probably resources on the net about this, just interested to ask a couple of questions comparing and constrasting the role of NPs with primary care MDs, relative salaries, etc from the figurative horse's mouth...

17   DennisN   2009 Apr 28, 9:40am  

SA in a previous thread opined " people look at healthcare costs and believe insurance is the solution and fail to see insurance is one of the biggest problem."

This may be true. I think there's a lot of agreement here that student loans are a cause of high tuition, not a solution thereof.

Costs can only go up if there's an easy path for the average bloke to temporarily come up with the funds. I think there's a great similarity in the bubbles and their causes: housing and cheap no-doc mortgages; tuition and easy to get student loans; and medical costs and comprehensive medical insurance for 70% of the population.

18   Different Sean   2009 Apr 28, 9:48am  

oh, did I mention university education tuition fees are free too... well, they charge a % now, it used to be free. same in UK -- new £3,000 fees per annum as the welfare state tires of footing the bill... primary care MDs here (GPs) only get paid about $70-90K per annum though, possibly because they don't have to pay huge tuition fees to get trained, and consequently don't have to claw back the money from their patients over a few years. the only reason a student generally needs to get loans in Oz is for lifestyle reasons, although the relatively new fee regime is gradually changing that...

19   EBGuy   2009 Apr 28, 10:15am  

I’m not sure that the AMA can control numbers of graduates, specialisation college places, etc
Why don't come over here and try to practice, DS. An extremely onerous process to become licensed (to protect the patient, of course, not to "limit competition").

20   DinOR   2009 Apr 28, 10:18am  

"the house always wins statistically, but you may hear of big payouts"

Hey, and that's what keeps me coming back! Hell I figure if I allow myself to slide into a total state of disrepair, I TOO can cash in on one of those big paydays!

( You just have to hope you don't "cash in" altogether? )

21   OO   2009 Apr 28, 1:10pm  

Honestly, it is very easy to bring down the medical cost without even changing over to mandated national coverage.

1) Only cover major illness, because that is the part that we cannot afford and people go broke over. When you are slightly ill, you can bargain and shop around. There are lots of illness that won't kill you overnight, and some don't even need treatment.

Americans are spoilt to the point that those that are covered go to doctors for every single little thing (including me of course). Why not? The co-pay is only $10, might as well get the most out of it. Instead, we should all have to pay for medical cost for the first, say, $2500pp each year. Then people will learn to take care of themselves.

2) Let old people die a natural death. The US is the only country in the world with national coverage ONLY for the elderly, and we spare no cost to keep them alive, particularly towards the end of their lives. Americans spend about 40%-60% of lifetime medical cost in the last 6 months of our lives, is that ridiculous or what? Because at that stage of life, no matter how much you spend, you are gonna die, it is just a matter of dying a fast and natural death or dying an agonizing prolonged death.

We should really have a lifetime cap for every single person, and that is just fair. If someone just blows all his lifetime cap at 50, tough luck, or he can spend his own money for the extra years he wants to live. But I am sick of hearing those Medicare dollars spent on installing defibrillator on a 90-year old, or prescribing $100/day pills for an 85-year old cancer patient so that he can live on another 3 months on taxpayer dollars.

22   OO   2009 Apr 28, 1:20pm  

Also, why do American doctors have to go through the medical school system beyond college to rack up an average of $200K debt?

Why can't we be like other countries so our doctor can start studying medicine at college level? I know we have pre-meds but the seats are so limited.

For most illness, American doctors are over-trained, and as a result, they usually are stuck in this laser-focus ONLY in the area they know, sometimes losing sight of a big picture. They also see far fewer patients than their counterparts in other countries, which makes them far less intuitive in making diagnosis, because tests only reveal part of the story.

23   OO   2009 Apr 28, 1:30pm  

I guess not a lot of people are aware how bad the tiered insurance system is, particularly for the self-employed.

I have both individual and group, so when I use the medical service, my provider sends bill to both policies, all by the same insurance company. For example, I recently did a blood test that cost ~$460 , but my individual allowed them to bill $160, paying for 70% of that leaving me ~$50 bill.

Now, my group only allowed them to bill $80 (!!), and I pay 10%, so my share of the same service is $8.

Got the picture? The uninsured in this case will have to pay $460, or just ignore. Those on individual insurance pay $50, so the self-employed need to pay $50. Then the group insured only need to pay $8. All for the same darn blood test. It is a wonder indeed how the lab could inflate a service that they happily settled for at $80 to $460.

Those who are not in perfect health should really not become self-employed just because of the very discriminating medical policy alone.

24   desertnomad   2009 Apr 28, 3:04pm  

I am American but left the USA after my employer went out of business in 2002. I was denied insurance by every company licensed in my state. So I sold most everything, put the rest in storage and left on a one-way ticket. I now have insurance for my wife and I for $200/mo valid everywhere in the world except the USA.

I have hired foreigners and run my business from the UAE and other places. I'd like to live in my own country again, but I don't think I'll ever be able to go home now.

25   B.A.C.A.H.   2009 Apr 28, 3:39pm  

When I was in college during the Cold War, I met two medical students who the Navy was putting through medical school.
Both of them were not in the Navy nor in the reserves when they were premed majors. They both applied and got accepted to medical schools, one was somewhere in the midwest, I forgot whether the other one was going to med school. Then they signed some kind of contract that made them reserve officers, their job being to go to med school, Navy picking up the expense and paying them living expenses as officers or reservists or some such. Then they were going to owe the Navy 5 or 7 years or something like that.

Well looking bad it seemed like a way to get started with some hands on clinical practice and no worries for beginning doctor about malpractice insurance nor student loans.

I wonder if the Navy still has that kind of a program.

26   imperturbable_homeshopper   2009 Apr 28, 4:23pm  

I have a feeling the government would screw this up. Look at social security, our education system, the inabiltiy to count votes in FL and MN...

"Insurance invites waste. That's a reason health care costs so much, and is often so consumer-unfriendly. In the few areas where there are free markets in health care -- such as cosmetic medicine and Lasik eye surgery -- customer service is great, and prices continue to drop."

"Suppose you had grocery insurance. With your employer paying 80 percent of the bill, you would fill the cart with lobster and filet mignon. Everything would cost more because supermarkets would stop running sales. Why should they, when their customers barely care about the price? "

John Stossel

http://abcnews.go.com/print?id=2574980

27   justme   2009 Apr 28, 4:41pm  

>> Americans spend about 40%-60% of lifetime medical cost in the last 6 months of our lives

I was looking for a source for that number, and came upon the number for Canada, which In Canada, the number is 30-50%., per the following article.

http://findarticles.com/p/articles/mi_m0LVZ/is_8_17/ai_84895863/

28   justme   2009 Apr 28, 4:47pm  

OO,

>>Why can’t we be like other countries so our doctor can start studying medicine at college level?

Indeed. This works well in other countries, and saves cost both for society and for medical students. The MDs are done at a young age and do not need a gigantic initial salary to pay off student loans. They can more ease into their career, as it were.

One problem seems to be that US teenagers at least appear to be more irresponsible and less "mature" (I hate that word, sensibility and morals really have nothing to do with age).

29   justme   2009 Apr 28, 4:49pm  

I hate it when I start rewriting a sentence, and then do not quite finish. It makes for odd sentences.

30   Different Sean   2009 Apr 28, 5:18pm  

EBGuy Says:
April 28th, 2009 at 5:15 pm
I’m not sure that the AMA can control numbers of graduates, specialisation college places, etc
Why don’t come over here and try to practice, DS. An extremely onerous process to become licensed (to protect the patient, of course, not to “limit competition”).

Does the AMA set those conditions? Or another licensing body? I thought there was one licensing body per state. One Dr Patel aka 'Dr Death' was barred from practising in NY and Oregon (only) recently after killing a few patients in Oz...

Apparently Oz graduates 2,000 drs a year, and has to import another 4,000 from overseas! Every year. Go figure...

31   Different Sean   2009 Apr 28, 5:22pm  

sybrib Says:
April 28th, 2009 at 10:39 pm
When I was in college during the Cold War, I met two medical students who the Navy was putting through medical school.

I wonder if the Navy still has that kind of a program.

The Australian Defence Force has a tri-service scholarship scheme like this, where they will pay for n-1 years of an undergrad med course or all 4 years of a graduate one -- salary, textbooks, fees, and maybe a few other perks. Nice gig to get. Your ROSO is n+1 years of their assistance, plus 2 years internship in the civilian system as an officer after graduation. So can vary from 7-13 years all up depending. Army, Navy or Air Force.

32   Different Sean   2009 Apr 28, 5:30pm  

About the Medical Board of California

The mission of the Medical Board of California is to protect health care consumers through the proper licensing and regulation of physicians and surgeons and certain allied health care professions and through the vigorous, objective enforcement of the Medical Practice Act, and, to promote access to quality medical care through the Board's licensing and regulatory functions.

http://www.medbd.ca.gov/board/Index.html

Just sos youse all know - yes, I'm looking at you, EBGuy.

33   DesertDoc   2009 Apr 28, 5:49pm  

I am a doctor, and I don't play one on TV.

American medicine has become schizophrenic. It is a rigidly controlled and regulated and yet no one can truly regulate or control it. Cash "customers" pay the highest rates(!) Insurance adjusters with a high-school education (or less) determine medical care using a preprinted algorithm. I could go on and on.

Doctors don't like it. Patients don't like it. So why not change? Because I think we all fear that if the government took over health care there'd be a trail of dead bodies in the streets. Let's face it, do you really want your health care totally controlled by the same people who run the Post Office?

Let me correct some prior postings. The AMA does not determine how many doctors are graduated. (I'm not and never have been a member of the AMA.) And that New England Journal of Communism (I meant Medicine) article -- pure left-wing BS from a once honored journal. Fact is, their 1995 projection of a surplus of specialists has become, in the real world of 2009, a worsening deficit of specialists. A deficit of doctors all around. So the force that actually DOES controls the number of doctors, the funding of the Federal Government, is now markedly increasing the number of medical students.

The forces that actually DO control the number of specialists, the specialty Boards, probably do limit their numbers to keep reimbursements high -- but who knows, since they are all self-selected and secretive.

One huge misuse of medical spending is on defensive medicine. Of course, all the lawyers are saying: "What? Outrageous! Take that back or I'll sue you. We have studies that show only 1 or 2% of medical spending goes towards defensive medicine." BS. I have ownership in an MRI unit. Probably 40% of the tests ordered are done "just to make sure we don't find anything dangerous". Notice I did not say the tests were "unnecessary". They are very necessary under our present laws -- to protect the doctor. If the doctor didn't do the test, he vastly increases his likelihood of being sued. The entire system is rife with these expenses for defensive tests and procedures. I should know, and I do.

Some of the posters have correctly pointed out that a large portion of expenses are incurred in the last 6 months of life. Then there are posters questioning pacemakers for 90 year olds, and expensive chemotherapy for terminal cancer patients. OK -- so the solution is to have a Federal bureaucracy with an algorithm telling doctors who should live and who should die? I think we've already seen this: was it Nazi Germany or the Soviet Union? I forget. But not places I'd want to live (or die!). When you walk down this road of "economic credentialing" you better watch out for the land mines.

You really want to save money fast? Then change the malpractice laws, stop giving free ER care to anyone who shows up, get rid of Medicare and Medicaid (and let doctors deduct discounted or free care from their taxes -- they'd line up to do it), allow cross-border medication purchases by pharmacies, and (just once in a while) thank your doctor for putting up with all this nonsense.

Wow -- I feel better already.

34   Different Sean   2009 Apr 28, 10:33pm  

DesertDoc Says:
April 29th, 2009 at 12:49 am
You really want to save money fast? Then change the malpractice laws, stop giving free ER care to anyone who shows up, get rid of Medicare and Medicaid (and let doctors deduct discounted or free care from their taxes — they’d line up to do it), allow cross-border medication purchases by pharmacies, and (just once in a while) thank your doctor for putting up with all this nonsense.

All the other countries just socialised their medicine at half the cost per capita of the current US system and provide a universal healthcare guarantee to boot... effectively they've extended Medicare and Medicaid to the entire population.

Doctors' salaries in Oz are lower than US, but I believe UK salaries are comparable -- although with an NHS and socialised medicine.

Single payer has much lower admin costs per item and is more efficient.

Cross-border purchases are required simply because big pharma has the US citizenry by the proverbials. Oz manages to negotiate even cheaper drug prices than Canada through the PBS, somehow. They require that a new drug is proven to be more effective than an existing drug to pay any more than the old price. If big pharma want to sell any product into Oz, they have to play by the rules and adjust their prices. Canada also negotiates tougher prices (obviously). The culprits re US pharma pricing are prolly corrupt Congressmen passing laws favouring big pharma with either personal kickbacks or political donations, from what I've heard -- bit hard to address this problem with the current setup...

35   DinOR   2009 Apr 29, 12:53am  

OO,

Well said across the board. Most doctors -are- over trained! Their reliance on 'tests' borders on maniacal. Dude, make the call, o.k?

Actually one of our long time posters ( SFWoman ) shared that the "end of life" expenditures are even -more- dramatic. I believe those costs are actually compressed into the last 90 days of one's life?

NOW... if they could give us that 90 days at an -earlier- time of our lives, well... then it might be worth it? But when the nurse comes by twice a day to wheel you into the sun like a potted plant..? No f@cking thanks!

36   moonmac   2009 Apr 29, 1:47am  

If we let the 90 yr olds die, can we also let the 30 yr old lazy, uninsured, good for nothing couch potato's die along with them please???

37   shordov   2009 Apr 29, 1:55am  

A note from an Israeli here:

The Israeli system is halfway between the Canadian and the US (not sure how it compares to the UK or Oz):

There is good universal healthcare that covers mostly everything, which is paid for by a 5% income tax (unlike general income tax, which is progressive, "medical insurance tax" is a constant at 5%, and it does cover the unemployed as well even though they don't pay it). Copay toggles between $2 /quarter and nothing depending on a random dice roll made by the minister of health. (that is, if you used services this quarter, you pay $2, otherwise you don't)

The system is NOT single player -- there are 3 big players and possibly one or two smaller ones I'm not aware of. There is active competition between the players, to everyone's benefit. Everyone must register with a player, and they get their money from the state accordingly. (The bureaucracy behind this is surprisingly efficient).

A government committee comprised of 2 politicians and something like 8 doctors (some affiliated, but most unaffiliated with any player) determines what the players MUST cover freely, what they can charge more money for and how much money. Furthermore, this committee determines which non essential treatments and medicine are subsidized (basically, all life saving is subsidized).

The players make their money by offering additional services. E.g., I pay $20/month more to my HMO to get coverage that includes any non-referral 3 specialist visits I choose every year (That is, if my primary care physician doesn't think I should see a specialist but I want to, that's 75% covered up to 3 times a year; Specialists can charge $200/hour). They offer many other additional services.

All emergency room visits with referral are covered. All emergency room visits without referral that were justified in retrospect are covered.

Private medicine is alive and well -- if you want to see a specialist and willing to pay for it, they will be happy to accept you. But everyone gets a good level of medicine for free (as much as you can call 5% tax "free").

I've heard people in the US saying "Oh, I'll only see a doctor if this gets worse because the cost is prohibitive". I've never heard an Israeli say that. Furthermore, when I need to, I prefer to go the $15/visit copay and come at the time I want to (usually 10pm, no waiting lines whatsoever) because I can afford to and waiting an hour in the middle of the day costs me more than that -- but most people use the $2/quarter copay.

Drug companies in Israel do not have the political power they have in the US, and neither do the HMOs; In fact, as far as I know, Teva -- the largest Israeli drug company, and the worlds largest generic drug manufacturer -- has more influence on US policy than it does on Israeli policy.

State managed does not necessarily mean single player, and there are numerous examples around the world in which it actually works.

38   sa   2009 Apr 29, 2:06am  

There could be lot of instances where single payer or some other version of it could work provided the people managing would look out for the little guy and keep the system efficient. I am not that optimistic about it working here, the lobbies are way too powerful and they always get it their way.

39   badpaper   2009 Apr 29, 2:25am  

"[the insurance bureaucracy] give employees bonuses for how much coverage they [sic] deny to you."

Citation, please. This is the stupidest thing I've read on your blog yet.

40   Patrick   2009 Apr 29, 2:53am  

For an interview with insurance company employees who get bonuses depending on how much coverage they deny, see the movie "Sicko" by Michael Moore.

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