One thing that is often missed in this whole debate of "private" versus "universal" health care is that we already have a socialized program. The essential idea is deciding whether or not we want to cover everyone and if we want it to cost us less. I've worked my entire adult life in health-care administration and financials, so I do know a thing or two about how it works.
Example;
I had surgery on my nose and sinuses to correct an old injury and also do something called a "turbanite reduction". I'm covered through my employer with Aetna HMO. My PCP referred me to an ENT who did all my treatments and surgery. By the way... this ENT was very good at his job, exceptionally well trained, and was very personable.
But here's the deal. Everything about my treatment was done exactly as it would be in a socialized program. My physician charged just over $11,000 for the surgery. It probably took him an hour and a half to perform it, and say another 2 hours for prep work and such. You might think "holy crap, that's $3,142 an hour!", but because I'm with an HMO and he's a participating physician, he's agreed to accept payment at the negotiated rate. Aetna paid him a bit over $2,000, which is still quite a lot but considering all the doctor's training, insurance, office costs and so on, it's quite fair. My out of pocket cost for the surgery was $183. The facility that runs the operating room also charged over 10 grand, but accepted the negotiated rate from Aetna. Same with the anesthesiologist.
The point is, the doctor could have charged a million dollars and it wouldn't have made any difference at all. He was contractually bound to accept the fee (plus my co-payment) as payment in full. When people bitch about the cost of an aspirin at a hospital, it's a meaningless gripe. They can charge a billion dollars for it. They're not going to get paid. Now - the people who DO get screwed are the people without insurance, or who are on insurance plans that only cover a percentage of the costs and not negotiated rates.
This, boys and girls, is exactly the same as what we could have in a socialized system. The difference is, it wouldn't cost us as much and it would cover far more people. What we're talking about is changing the model of how the insurance is administered, NOT how doctors are paid.
I want to make this really clear for the bat-shit crazy wingers who have trouble comprehending. They like to bitch and moan about how socialized medicine will "ruin" health care in the US. They are concerned that if doctors don't make a bunch of money, the quality of health care will decline.
What we're talking about is NOT changing how, or how much, doctors and health care facilities get paid. They are already overwhelmingly contractually bound anyway. What we're talking about is changing how the insurance is administered. Okay? Got that?
My health insurance company, Aetna, is a for-profit company. Their financial incentive is to pay health care providers as little as possible, and charge my company as much as possible in order to maximize their profits. What happens if we fire Aetna and have a company with no profit motive administer the program? You save asstons of money! With that cost savings, you can cover more people (everyone!), and reduce co-insurance amounts, while at the same time making sure you're paying the providers fairly. Everyone wins - except the insurance companies who were making a fuckload of money at our expense.
The ONLY - and I mean ONLY - reason a rational person could be opposed is because of sympathy towards the insurance companies. I say that health care is far too important to give a shit about their profit margins. Covering everyone is far more important than their shareholders. Socialized medicine would be a huge benefit to society as a whole, and too bad for the insurance companies.
And guess what... Medicaid goes away completely. When everyone has the same insurance, there is no longer a lower standard of care for poor people. No more horrors of the county hospitals.
Just think about what that would mean for small business. Can you imagine trying to run a business with 5 employees? Trying to give them health insurance would bankrupt you. What if you're self employed? The cost of buying your own policy is astronomical, and what you get for it is really horrible. A socialized program would be a huge boon to free-market capitalism in that people will no longer be bound to their corporate employers solely for the huge health insurance benefit.
Regardless of the arguments in favor of socialized medicine, the nay-sayers will claim that putting the administration in the hands of the government will wreck health-care. They will reference what they claim is the shitty care in countries like England, Canada and Australia. I say that's a defeatist attitude, and without even arguing if they are right in their claims about those other nations, I say we can do it better. Heck, we already have socialized programs in Medi-Care and Medi-Caid. Lets dump those costly programs and rebuild it under one quality program for all.
The bottom line is, when you remove the huge waste that is the administrative costs, you can cover everyone and you can pay the providers very well. Everyone wins. Whether you like it or not, our system is already socialized. Lets just make it better and more cost effective.
13 comments:
Medicaid and Medicare are both examples of when the government tried to make socialized medicine work. It looks great, and it makes people feel good, but the government is incapable of making it work. It's far too much beauracracy to deal with anything efficiently.
Genious Tom, pure genious.
Don't listen to Dan, you're plan sounds pretty solid to me, and I'd love to see that get implemented.
Steve.
Social Security is a huge beauracracy and everyone gets their checks like clock-work. Just saying that it wouldn't work doesn't mean it wouldn't work.
In fact, most of the administration would be done automatically by computers. You get treated, it gets coded (all proceedures have a corresponding "CPT" code), the provider electronicly submits the claim, the gov computer adds the proceedure to the provider record and every other week one check gets cut to the provider for all the services rendered. There is no human intervention in that process. You gain an enourmous economy of scale by centralizing the administrative activities.
The only thing that would have to be looked at closely is how to prevent fraudulent claims by providers.. but that's already an issue.
Imagine.. we'd have essentially "free" health care for everyone at a much cheaper cost then we do now, with no change to the level of service we are used to. You schedule your appointment, you give them your ID card.. and all services are performed and you walk out the door without ever having to think about a bill.
In fact, the govt could set up a giant provider web site, where you could rate your provider.. and when you're looking for a new provider you could check their scores. There are already web sites like that, but imagine it done on a national scale. That gives providers even more incentive to do a good job.
This plan rocks, pure and simple. Oh.. and guess what happens when your company no longer has to pay the super high cost of health insurance premiums for you? Maybe you get a raise? Maybe they hire more people?
There are no downsides.
I really hate when people talk about free stuff provided by the government. It's not free.
It either entails extreme defficit spending or huge tax increases, both of which will hurt the economy. Nothing is free. Ever.
Then again, you also run into that whole capitalist thing you were promoting in the illegal alien discussion. If you have no competition for business, service quality and speed of service go down the tubes. Why work harder for the same amount of money?
It's getting to point where I'm not even going to bother responding to you. Your sole purpose seems to be to irritate by misunderstanding what you're reading.
I said "Imagine.. we'd have essentially "free" health care for everyone at a much cheaper cost then we do now,"
Notice the quotes around "free", and the words "much cheaper cost"? It is "free" in the sense, as I described, that you get your service and don't have to think about the bill. It's much cheaper in that removing the profit motive and using economies of scale greatly reduces administrative costs.
I never said it was "free". Of course things have to be paid for, that's obvious.. but you're totally missing the point that the greatly reduced cost of administration vastly more than compensates for any increase in taxation required to pay for it.
You also missed the point where I described the motive for providing quality service. You missed the point that I already told you that it's ALREADY FUCKING SOCIALIZED. Every fucking ENT gets paid exactly the same fucking amount from an HMO for the same fucking proceedure. Every fucking chest x-ray at every fucking radiology department in any fucking city in this fucking country gets paid the same god damn amount of money from an HMO for the fucking x-ray.
Jesus fucking christ.
I also fucking explained WHY I think "capitalism" should be suspended for health care. It's far too important. It's a basic service to our population exactly the same way law enforcement, or fire fighting is. We don't have "for-profit" police departments for a reason, and in my view health care is just as vital.
Again, and maybe I should write really slowly for you.. Nothing will change from the providers viewpoint. As I said, they will be paid the same as they have been.. There is no reason why quality of health care would be impacted when NOTHING FUCKING CHANGES FROM THE POINT OF VIEW OF THE PROVIDER.
It's really interesting that you do exactly what you accuse Doug of...making baseless claims and not supporting them. Do you have any evidence that 90% of MDs/RNs/PNCs/ENTs/ets...are paid the same amount for each procedure? I highly doubt it as differnt insurance providers provide different amounts of coverage. It also depends on whether or not the doctor works for a public or private hospital. So, you claim that without any actual data/study/relevant logic in order to back it up. I really don't bother reading things that have no basis in reality. I stopped reading Dougs blog a long time ago...
Oh, and then we get on to the free arguement and how somehow creating a giant beauracracy is going to somehow eliminate cost and actually save the government money? Really? You really think that all of this will be done on computers? Please, Tom, you have to have some understanding of reality. The government doesn't work that way. You know that, I know that, and anyone with any sort of critical thinking skills knows that. We can't provide basic food/water/medicine to millions of survivors of a hurricane with any real efficiency and without millions of dollars in fraud and you expect me to beleive we can provide hundreds of millions of people with thousands of different kinds of healthcare all without some giant oversight mechanism? Are you functionally retarded? Or is this some exercise in idealistic futility?
Oh, and then capitalism shouldn't apply because that means that some people can't afford healthcare. So why not give money to them so they can, instead of making everyone use one system? Does that make any sense? Of course it doesn't, but it makes people like you feel good that you are helping the guy mowing your lawn because that's "capitalism." You justify holding down their wages so they can't afford healthcare, and then want some giant government program to help them, when, instead, you could just let their wages increase so they wouldn't need it. But then they could all afford big houses and nice cars, and you wouldn't feel special anymore right? The irony is shocking. And in any case, you don't even address the fact that the quality and speed of service will go down without competition, so I guess you agree with me on that. You just want them to technically have healthcare...voodoo style!
And then, in the end paragraph, you still make absolutely baseless claims with no evidence. Way to be, Julius.
PS: Typing slower doesn't mean anything. I guess I probably would've ommited that rather than make a contradictory sarcastic comment that just makes you look like a tool. Maybe that's just me.
PSS: There was actually a study done a while back, I'll see if I can find it, asking about this very same question. 75% of Americans think their insurance currently is fine. In another question, 60% of them think the government would do a worse job than they currently have, and out of those 60, 25% thought we should still have government run health care EVEN THOUGH IT WOULD BE WORSE. They study should've been titled "25% of Americans need to be hit in the head with a shovel."
Hey, you know what? I'll even bring facts into this lunacy? Ready...close your eyes!
http://www.balancedpolitics.org/universal_health_care.htm
An interesting addition that begs a question is this. If the US Healthcare system is the most expensive in the world, can your claim be correct that all doctors get paid the exact same per similar procedure?
http://allnurses.com/forums/f100/debate-pros-cons-universal-health-care-8387.html
I would point out the article posted in the top 4-5 posts.
http://www.amatecon.com/etext/dosm/dosm-toc.html
http://www.cato.org/healthcare/index.html
One more thing, and then I'll get back to watching TV. If you really want to do something about the cost of healthcare in this country, a plan for comprehensive tort reform would do wonders. One of the biggest factors in medical costs in this country is the exhorbitant rates for medical malpractice surgery due to the rediculous amount of cases. Do you know a lot of doctors refuse to give mamagrams anymore? The breast has no defineable anatomy and, therefore, is hard to detect abnormalities aka:tumors. If they fail to detect one, they can be sued for hundreds of thousands of dollars. As a result, they either pass that on to the consumer, or they just don't perform them.
And here, again I know crazy, are some facts.
http://scholar.google.com/scholar?q=medical+malpractice+effects+on+costs&hl=en&safe=off&rlz=1T4ADBR_enUS214US215&um=1&oi=scholart
Uh.. I checked a couple of those links but read nothing specificly interesting to what I described as a useful program.
Medical malpractice wasn't something that I talked about because it's irrelevant to my suggested changes for insuring more Americans.
As I said, providers negotiate rates with HMO's, and there is a bit of wiggle room. Some rates can be adjusted by geography, but essentially it all comes out the same in terms of real dollars.
As I said, medical "costs" are really irrelevant unless you are uninsured. Providers get paid their contracted amounts.
John is self employed and he pays something like $600 a month for a really shitty policy that doesn't pay benefits anywhere near the quality of my HMO. Changing to the socilized program I described would be a massive improvement for him - again while having no effect on the way that providers are paid.
And you still give no evidence? It's mindboggling! How can yu say that "most" doctors get payed a contracted amount? Are you a hospital administrator? A doctor? or even a medical financier? You cite no evidence but expect us to beleive it on your word.
Now, as for the particular points of said articles I thought you should take away...
from http://www.balancedpolitics.org/universal_health_care.htm
Profit motives, competition, and individual ingenuity have always led to greater cost control and effectiveness.
Patients aren't likely to curb their drug costs and doctor visits if health care is free; thus, total costs will be several times what they are now.
Government-controlled health care would lead to a decrease in patient flexibility
Healthy people who take care of themselves will have to pay for the burden of those who smoke, are obese, etc
Loss of private practice options and possible reduced pay may dissuade many would-be doctors from pursuing the profession
From http://allnurses.com/forums/f100/debate-pros-cons-universal-health-care-8387.html
One of the most dangerous health care reform proposals
currently being considered is the call for a single-payer,
government-operated, tax-funded system--the type of system,
generally referred to as national health care, currently
operated in Canada, Europe, Australia, New Zealand, and else-
where
A single-payer national health care system would come
at enormous cost to American taxpayers. For example, Russo-
Wellstone would require employers and the self-employed to
pay a tax equal to 7.5 percent of wages. The top individual
tax rate would rise from 31 to 38 percent. Corporate income
taxes would increase from 34 to 38 percent. Social Security
benefits would be taxed at 85 percent rather than the cur-
rent 50 percent. And the elderly would be assessed a $55
per month fee for long-term care.(2) Even those levies may
not be enough to pay for national health care. Some econo-
mists put the cost as high as $339 billion per year in addi-
tional taxes.(3)
For all that tax money, we would buy surprisingly lit-
tle health care. The one common characteristic of all na-
tional health care systems is a shortage of services. For
example, in Great Britain, a country with a population of
only 55 million, more than 800,000 patients are waiting for
surgery.(4) In New Zealand, a country with a population of
just 3 million, the surgery waiting list now exceeds
50,000.(5)
Shall I continue? I think the evidence is damning enough.
So, you see, the real way to give everyone health care is to make healthcare affordable to everyone by reducing it's cost and using a program similar to school vouchers in order to bring people who still can't afford it up to the point where they can. You do that with medical tort reform and, really, tort reform in general.
And you still give no evidence? It's mindboggling! How can yu say that "most" doctors get payed a contracted amount? Are you a hospital administrator? A doctor? or even a medical financier?
I've worked for 20 years in healthcare receivables. I started out as an insurance biller for providers (hospitals and doctors). I'm currently a software engineer supporting the Veterans Health Administration. I'm quite familiar with all forms of "payers" and very familiar with HMO's, PPO's, Medi-Caid, Medi-Care, DoD, and VA.
I completed a half-billion dollar project for the VA to transform their billing system to completely electronic and automated. Essentially, the VA treats a patient, records the data.. then our software transforms that into an electronic UB92 (claim form), uses HL7 interfacing to move the claim to a COTS (commercial off-the-shelf) billing platform called FlowCast from IDX systems, which then moves the claim to an electronic clearinghouse that works much like a mail room. It moves the claim to the correct payer electronically. The payer, processes the claim electronicly by applying the insureds policy, then electronicly remits the payment back to the VA account.
Nobody is involved in that process except the clinicians unless there is an anomoly. This is how the single payer government system will function. It will massively reduce the administrative costs and will in-turn, cost average Americans and their employers much less than the current model.
Providers do not get paid what they charge in any of the current insurance systems. However, they CAN and do charge their usual rates to uninsured, or under-insured (those on say 80/20 non-contracted plans). Those uninsured and underinsured are major benficiaries of this system.
The vast majority of provider income is via contracts. I suppose I could dig around the internet to find a statistic.
Some insurance plans also use "capitation". That's even more socialist, and fairly common in Medi-Caid programs.. less so in private insurance. In a capitated plan, an insurance company pays a provider a set amount of money every month depending on how many patients the doctors is the PCP. There is no billing involved, and they don't even keep track of the number of patients seen or their treatments. They just pay the flat amount every month via the number of people on the roster. Capitated plans go away in my system.
Profit motives, competition, and individual ingenuity have always led to greater cost control and effectiveness.
I don't know how many different ways I can say this. Under the "Single Payer" plan, the effect to the providers is transparent. They'll continue to get paid the way they currently do. I can't imagine why you think my plan would effect competition, when the only thing that changes is the the name of the paying company on the check the doctor receives. It's pretty simple.
Patients aren't likely to curb their drug costs and doctor visits if health care is free; thus, total costs will be several times what they are now.
That's a subjective point. Most providers think the "cost" will go down if people get better "routine" health care instead of waiting for the problem to become severe. For instance, if a patient gets screened for cholestol and treated if it's high, that costs a shitload less than paying for heart attack treatment later. In the health care field, that's 'conventional wisdom'.
Healthy people who take care of themselves will have to pay for the burden of those who smoke, are obese, etc
Wow.. that is THE definition of insurance, and is exactly how the system is now. Good drivers are insured and are "paying" for those that have accidents. I mean - it's hard to debate when you don't even understand what "insurance" is.
Loss of private practice options and possible reduced pay may dissuade many would-be doctors from pursuing the profession
Again, that is not a factor because providers are unaffected, as I've said like 5 million times.
There are ALWAYS private practice options. I could have had my sinus surgery done by an ENT that was not a participating provider in my HMO. It would have cost me a shitload more money.. about $22,000 to be exact. I can scan the EOB's (explanation of benefits) and show you if you like. Have you ever seen an EOB?
You really are just arguing to contradict my point of view. Most of what I'm talking about isn't even a point of view, it just is.
I suppose if you wanted to write about how to make a pizza, I could tell you that you're completely wrong, just to tell you that you have no idea what you're talking about. Well, for the analogy to work, you'd have had to be making pizzas for 20 years before I tell you you're wrong.
But you are doing exactly what you berate Doug for doing, and that is making claims with no evidence. If indeed this is true, couldn't you find some evidence? Cause I've been googling everytime I post and I can't find any. If what you are saying IS true, then a lot of my points are invalid, I admit. But I still don't see where you can make that assumption as you work for the VA which is, actually, very well run socialized medicine. How much experience have you had with private insurance billing.
I would take issue with this...
Wow.. that is THE definition of insurance, and is exactly how the system is now. Good drivers are insured and are "paying" for those that have accidents. I mean - it's hard to debate when you don't even understand what "insurance" is.
The thing is, actuaries raise and lower insurance rates depending on your lifestyle and riskfactors. Increasing taxes doesn't do that. It treats everyone equally. Unless, of course, you plan to perform said analysis on everyone in the US, but then that gets rid of your administrative overhead arguement.
And for the record, I have had this arguement before a few times with an uncle of mine who works as an actuary in Seattle.
In conclusion, I think your plan COULD work, but I think it depends on weather or not all doctors get paid the same (which I find hard to beleive. We had the #2 heart surgeon in the country working at Deaconess here for a while who commuted to work from NY, NY. I don't think all doctors can do that. Also, if what you say is true, why is Americas health care system the most expensive in the world? I don't see how these things rationalize with your statement.) and whether or not you could really undertake national socialized medicine without some giant beauracratic oversite. There is not one government program that runs efficiently. Why not just use a voucher system or improve tort reform?
Just an interesting tally of figures here....
According to Health Affairs, a health policy journal,
U.S. citizens spent $5,267 per capita for health care in 2002—53 percent more than any other country.
And the population of the US being 301,139,947, that means that this will end up costing the government ~1,586,104,100,849. That's before ANY administrative cost. Now, that is the cost incured by the person before insurance, so that may be a bit smaller than the actual bill for the insurance company. Looking at this, I don't know how anyone expects to fund socialized medicine.
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