Single-payer: an honest debate?

[Guinevere]

Just make sure you buy a good supplemental plan to go with that Medicare. Because, you know even socialized medicine requires that the insurance companies get a piece of the pie if you want decent coverage (and anyone who has the medical conditions you have wants decent coverage).

[Long Run]

That's a good point, Guin. Even with Medicare's low reimbursement rates, the other way the govt. holds costs down is to leave a lot for the covered to pay. Typical Medicare supplemental policies run $200-$400 per month. So, even if there were a government health coverage program for all, there would still be at least two separate markets: 1) for the top 10% of so, there would be a completely separate market that completely opts out of the govt. program; and 2) the supplemental market that can vary greatly depending on price.

[Scooter]

Or you could go with the model that does not allow providers to charge more than the government approved rate for any insured service, eliminating the need for those two markets.

[Bicycle Bill]

I spent three days in a local hospital last August. I have read the $158,000 itemized bill and I've seen the multiple charges of $34 each for a prescription pill that I pay 60¢ each for. That made the $1.34 each for the ibuprofen seem reasonable.

Well, in their defense, they *DO* have to pay for those little paper cups they use when they bring the pills to you.

-"BB"-

[Scooter]

Eliminating the need for all the bureaucratic bloat required for such billing would in itself probably reduce health care costs by 15-20% right off the bat.

[MajGenl.Meade]

Just make sure you buy a good supplemental plan to go with that Medicare. Because, you know even socialized medicine requires that the insurance companies get a piece of the pie if you want decent coverage (and anyone who has the medical conditions you have wants decent coverage).

Endorsed. I've got a $99/month supplemental but given that both knees are supposed to be chopped up this year, it's my best bet. After the max out of pocket 3500 (which will be hit in the next week or two!), the per diem hospital cost is zero. After they are done, I can drop back to a supplemental for less than half that amount and there's even one that's $zero.

Price controls are certainly one legislative option that removes the need for the fully socialized medical care option - but even with price controls, what to do about those people who cannot afford to pay (either for insurance or treatment)?

[Sue U]

The OP is a bit disingenuous in characterizing the "trade-offs" and cost-shifting in implementing a single-payer or public-option healthcare system. Per capita healthcare expenditures in every other industrialized country -- all of which provide universal healthcare -- are roughly half that of the US, so there's obviously plenty we could do in terms of cost containment. "Squeezing" doctors to accept "lower reimbursement rates" is only a thing in a system where providers are paid on a per-service basis -- which itself starts with an economic incentive to perform as many services and "up-code" wherever possible to maximize reimbursements. It also fails to account for the practice of referring patients to physician-owned diagnostic and ambulatory surgery centers regardless of need or cost efficiency.

Another major driver of healthcare costs is technology: Every podunk facility feels the need to immediately stock up on the newest and best of every technological advancement in an effort to attract medical staff and compete with other regional medical centers. It is simply unnecesary for every hospital to buy every new piece of equipment so as to offer every medical service. A rational plan for regional allocation of resources, with "specialty hospitals" for certain types of care, would both cut costs and improve the overall quality of care.

One of the cheapest fixes that can be made is in preventative care and education to avoid or curtail the severity of diseases that result in hospitalization. Reducing the rate of Type 2 diabetes and keeping those with the condition otherwise healthy, for example, can avoid a lot of expensive complications, including blindness, heart disease and lower limb amputations. Reductions in smoking will avoid COPD, heart disease, stroke and oral/respiratory cancers. Routine detection and treatment of hypertension and atherosclerosis can avoid or lower the incidence of heart attack and stroke. Likewise, improvement of hospital patient care -- avoiding nosocomial infection and iatrogenic injury -- would reduce the treatment needed and shorten the length of stay.

The fact is, there is enough money in the U.S. healthcare system as it stands now to cover all the same costs and continue paying at current rates without any change in the effective economic burden on taxpayers. There isn't even a need to wipe out private health insurance companies or mandate that everyone enroll in governmental coverage (although I would prefer both of those, personally). As I have been pointing out for more than seven years, we could even start with the dopey premise of employment-based health insurance that we currently have and implement the following reforms:

1. Consolidate Medicare and Medicaid into a single public program that provides a uniform package of basic benefits to anyone not otherwise covered by private insurance. Provide for additional benefits upon enrollment and payment for supplemental coverage.

2. Require all employers of 20 or more to offer a private health plan to employees that includes as a minimum the same basic benefits offered by the public program. Private plans can compete with the public program by offering additional services and/or lower costs

3. For each employee not enrolled in the employer's private plan and not covered by other insurance (e.g., a spouse's health plan), the employer would pay into the public plan. For each employee that is enrolled in the employer's private plan, the employer would receive a tax credit. Each employee who enrolls his/her family members in the employer's private plan would receive a tax credit in respect of premium contributions.

4. Require that private health insurers be organized as mutual insurance companies or not-for-profits (this alone would put nearly $20 billion back into the system).

The major reasons single-payer/public option proposals went nowhere in the healthcare reform legislation were a failure of leadership in the White House and Republican hysterics in Congress. What we got is better than what was, bit it's still a long way from the healthcare that citizens in every other industrial nation can count on.

[wesw]

nice post.

I would add that I believe that all doctors should see a percentage of the public system patients, no matter what we ultimately adopt.

we should all be in this together to some degree.