And your doctor:
Doctors will consolidate into larger practices to spread overhead costs, and they’ll cram more patients into tight schedules to make up in volume what’s lost in margin. Visits will be shortened and new appointments harder to secure. It already takes on average 18 days to get an initial appointment with an internist, according to the American Medical Association, and as many as 30 days for specialists like obstetricians and neurologists.
Right or wrong, more doctors will close their practices to new patients, especially patients carrying lower paying insurance such as Medicaid. Some doctors will opt out of the system entirely, going “cash only.” If too many doctors take this route the government could step in — as in Canada, for example — to effectively outlaw private-only medical practice.
These changes are superimposed on a payment system where compensation often bears no connection to clinical outcomes. Medicare provides all the wrong incentives. Its charge-based system pays doctors more for delivering more care, meaning incomes rise as medical problems persist and decline when illness resolves.
So let’s expand Medicare to everybody. Great.
Medicare overheads are very low for providers compared to
Private Insurance overheads. The problem is as the WSJ points out
that Medicare poorly reimburses for primary care. The big dollars
in a medicare payment is for procedures, but a 25% increase in
payments for basic diagnostic visit would go a long way to fixing that.
Aetna and UH provide much more imposed costs then Medicare.
Docs consolidating their practices have been going on for a long time. My primary doc joined a group practice 4 or 5 years ago. This was driven in part by the logistics of the current billing system, and in part because now, when he refers me to a specialist in-group, he gets a cut.
Don’t get me wrong – Medicare is not a perfect solution. That’s why Obama had his health care summit. He’s trying to avoid the Hillary-care solution developed in secret problem.
I’m living in italy where the healthcare is “free”. the pediatrician has 1400 patients, so getting an appointment is difficult, but doable. for a GP it’s not so bad either, a doctor is assigned when you move to an area and become a resident, and after clearing a huge number of bureaucratic hurdles to prove you are entitled to health care you are in and your troubles just begin.
To see a specialist requires a note from the GP, then a trip to the medical bureau, where they assign a specialist who is generally just an intern.
Going to the hospital gives fast care for sick children, and an effective triage system, but the treatment rooms look just like the new orleans public health hospital in 1980.
so it’s free, but worth every penny. unfortunately I’m paying around 54% tax, so it’s not very free.
I used to have health insurance through Parkland Hospital. They have a primary care group in the hospital that has rather attractive rates. However, when I tried to book an appt. I was put on a new patient list and was told the earliest opening was in 2 1/2 weeks, on a Friday, a 3:30 pm.
I had a sinus infection right then and hoped it wouldn’t be around for another 2 weeks. I went to a private doctor down the street.
Oh, and I asked what the earliest opening was if I wasn’t a new patient and they said 3 days which was still crazy to me.
Finally to jack and chris, don’t yall have some hairshirts to go wash or something. ‘Cause yall’s rhetoric is really startin’ to stink.
Oh yea, I forgot about my Mom’s primary care group that she tried for a while. She would have to book appointment several days out, waiting room would take 3 hours, and another hour or 2 sitting in the exam room. Then, the Dr. would come in, flip through some papers in the chart, ask a question and cut her off halfway through the answer, then prescribe this and that, and walk out the door to never be seen again. All that for 10 minutes of interaction, tops.
But I feel so much better knowing my health care decisions are being made for me by Obama out in the open instead of being kept hideously secret.
“Aetna and UH provide much more imposed costs then Medicare.”
Single-payer health care proponents claim that there would be huge cost savings through having a huge government program in charge. The reasoning, as far as I understand it, is that there is a great deal of duplication of effort with multiple insurance companies, that the current health care system spends an inordinate percentage of health care money on paperwork and administration, and that there are too many bureaucrats and not enough health care providers.
There are lots of counter-arguments to this claim. Medicare is fraud-ridden and does insufficient paperwork, administration, and anti-fraud work. A big government single payer system would result in greater and less efficient bureaucracy than even the current system (see your motor vehicle department and the VA). The incentives would be all wrong for a single payer system and the result would be less health care, worse health care, and poorly distributed health care. Many of the current problems are caused by government regulations, such as coverage mandates, tax laws which tie your insurance to your job, and Medicare/Medicaid rules which encourage health care pricing to be very strange and opaque.
However, the most obvious argument is the historic one. There is convincing historic evidence that centralized government control of anything is ultimately less efficient and effective. Trying to centralize the huge number of health-related decisions for a huge number of people is ultimately disastrous. I don’t think we can point to any industry that has become more productive and efficient in the years following a government takeover of that industry, at least in the long term. It may be true that particular instances of waste in the current health care system might be eliminated in a single payer system. But there is the law of unintended consequences. You might get the intended consequence of eliminating some particular waste, but you will get many other problems and likely even more waste. And neither I nor you can foresee those problems or those sources of waste because we cannot foresee everything.
I am not impressed with other countries’ nationalized health care systems. In Cuba, from what I can tell, they have lots of doctors but very insufficient facilities and available technology. In Canada there are ridiculous waits for health care, and you can’t pay for private health care so many patients come to the U.S. The people I’ve met from England pay for their own private insurance because the public health care isn’t good enough, and they are paying the taxes for the public health system too–and the public health system there, from what I can tell, also has long waits and mostly old technology. Medical advances mostly come from the U.S. because there is actually incentive to make medical advances here. Centralizing our health care system will ultimately stop those medical advances.
Most Americans (I think I saw 80% plus in a poll) think their health care is okay. The uninsured numbers are misleading because of the number of healthy people choosing not to pay for insurance. I think Most Americans are convinced that the health care system is awful for everyone else, not realizing that huge changes in the system will ultimately be detrimental for their own personal health care experience. And, like so many other things, it wouldn’t look bad at first. Two years in we’d hear glowing reports about how now nobody was uninsured, and how much better things are. But seven years from now, you’ll either have expensive private health care costs (on top of the taxes you are now paying to subsidize the government-available insurance)–if such things are legal–or you’ll have really long waits for care no better or worse than it is now (i.e. no major health care improvements in seven years). And we’ll have lots and lots of news reports about how bad things are in the government run health care system and lots of suggestions on how we can “reform” (not eliminate) the giant government program.
If we go to a single payer system (and I think Obamacare is just a way to get us there incrementally by making the government health care option the only real option), I sure hope we never get to the point of the Canadians and can’t pay for the help we really need when we really need it.
Josh – well, I’m sorry, but I’ve not had any problems with my doctors. Maybe you should get a new one?
Jeff – I hear lots of reports about foreigners not liking their health care system. But I am not aware of any major political party in any of these countries saying that they should get rid of their existing system.
So, questions:
1) Are their political parties advocating abolishing “socialized medicine” in countries that have it?
2) If not, why? Are all foreigners too stupid to see how much better we do it in America? Or is there another explanation?
Are all foreigners too stupid to see how much better we do it in America? Or is there another explanation?
How would most foreigners have any idea of how we do it here, other than what they get from their own biased press? The Canadians seem to know how we do it here, at least the ones who come here for treatment, but they’re not enough of a majority to get a significant overhaul.
How would most foreigners have any idea of how we do it here
The Internet? Talking to expats who’ve lived in America? Maybe even making a visit?
You mean that there’s discontent with the current system in, say Canada or Great Britain, but no political party there thought to do some investigation and see what the alternatives are? Despite all the curious Americans who come to their countries, research their system, and writing articles in our blogs and papers, nobody thought to say “let’s do it like Americans?”
“How would most foreigners have any idea of how we do it here?”
I don’t know, Millions of tourists come to Florida every year. A few hundred thousand of them have some brush with our health care system.
Mr Simberg, why don’t you go down to a resort at the beach and ask the europeans how they like capitalist medicine.
Jeff Maudlin writes
“A long string of suppositions and claims”.
I suggest you read the data. Medicare has 15 times less overhead then United Health. VA has significantly less overhead then Aetna.
The single best Medical system in the US is VA.
Okay, I’m now convinced “jack lee” is someone’s sock puppet. No one could have written that line in complete seriousness.
Jack Lee, if the VA is your example of good care, I think I’ll opt out.
Business Week says VA is the best medical system in the US.
http://www.businessweek.com/magazine/content/06_29/b3993061.htm
“The Best Medical Care In The U.S.
How Veterans Affairs transformed itself — and what it means for the rest of us ”
I agree VA has had a bad rep, and certainly, I saw some of the degenerated system in the 1970’s, but, I had a good buddy have nuerosurgery there, and they did an amazing job on him. He swears by them.
Business Week says VA is the best medical system in the US.
And we should care what the socialists at Business Week think why…?
“reality has a well-known liberal bias.” Stephen Colbert.
The reality is that the VA is a socialist system. It’s created as a social
contract between this nation and her veterans. Every Veteran gets Lifetime
medical care for no fee, and that is socialism.
And VA is a governmental entity, which makes it socialist, and VA is able to exploit sovereign immunity so it can have doctors apologize for errors and not be sued for malpractice.
And VA is Socialist because it uses a single national Electronic Patient Record, so that a patient can travel from state to state and still get continuity of care.
And that Socialist system is better then the average private hospital.
” reality has a well-known liberal bias.”
Why do you imagine that quoting Stephen Colbert as some kind of sage makes you look like a non-idiot?
Oh. That’s right. Because you’re an idiot.
The VA. The same guys who run Walter Reed, who had all kinds of investigations into their malfeasance in 2006 throughout 2007 and early 2008, which the Democrats tried to use as a blunt object to beat Bush and Cheney over the head with during their primaries?
That VA?
Pull the other one, Jack. I tell you with total honesty and a straight face – it’s got bells on it.
“he VA. The same guys who run Walter Reed,”
http://www.wramc.amedd.army.mil Note the army.mil?
http://www.va.gov
Walter Reed is an army Hospital, under the Army Chief of Staff and Army Secretary.
VA is under the secretary for Veterans Affairs. An independent cabinet agency.
Confusing VA and DoD medical is like confusing the DOE Labs and the AFRL.
If it makes you feel any better, none of the Bush White House staff could tell the difference between Medicare and Medicaid.
Most of the arguments for socialized medicine are based on theory. Most of the arguments against it are based on experience.
What those promoting low overhead for government insurance are missing are administrative costs not included in their budgets but provided by other government departments.
The same VA that over five years has infected potentially thousands of vets with AIDS or hepB?
I’ve got a great idea: those who favor SocialistCare can go onto it, on a pilot program, without bothering the rest of us- with the proviso that they and their progeny have to STAY on it for at least a full 25 years, with no escape hatch.
If, after having bueraucrats make ‘cost-effectiveness’ decisions about their lives and the lives of their families with no choices and no alternatives, for a full generation, they still can say they prefer that way to free-market… maybe they can tell the rest of the nation what to do.
Of course, I’ll bet that after being denied treatment for heart disease due to a Federally-defined “unhealthy lifestyle” or being told that their daughter is 5,028th in line for her braces appointment, the might change their tune…
…but maybe not. Anyway, it’ll cause a bunch of stupid people to suffer, which will be fun for me to watch.
I note that govt pays for about half the healthcare today in the US and covers about half of the folks who have “coverage”. Oops – so much for cost savings.
Let’s give the “universal healthcare” advocates free reign with folks whose coverage is provided by govt today. When they’re producing significantly better results for the same money or the same results for less money, private party payers will demand to get into the system.
I do look forward to Jack Lee telling federal employees that they’re going to be covered by Medicare instead of Blue Cross et al.
“Walter Reed is an army Hospital, under the Army Chief of Staff and Army Secretary.
VA is under the secretary for Veterans Affairs. An independent cabinet agency.”
Yup. I had no idea that Walter Reed was not run by the VA. And I shouldn’t have to become an expert in the ins and outs of all the government run health care facilities in this country to get the government to LEAVE us ALONE! I shouldn’t have to come to my congressmen with my hat in hand begging to please not change things so I eventually get pushed into a government health insurance program I don’t want to be in.
If you want to propose and debate a program to help the poverty stricken have access to medical care, okay, we can have that debate. It’s not my objective in life to make sure poor people don’t get medical care (although I wouldn’t mind if they eschewed cable to help with copayments). I thought that’s what medicaid was, and I’m sure that could be reformed. But for the rest of us I want less government interference, not more.
“1) Are their political parties advocating abolishing “socialized medicine” in countries that have it?”
It’s extremely hard to abolish once entrenched. It’s better not to go there in the first place. It’s politically difficult to suggest abolishing a socialized medical system–you are open to easy demagoguery by your opposition. That’s one of my biggest complaints about government programs–they never seem get killed no matter how bad they are.
I also believe citizens don’t usually think in those terms. In a socialized medical system they see a problem, such as “I have to wait 10 months to see a specialist about hip replacement,” and think “the government should hire more hip replacement specialists,” or possibly “I’ll go to the US,” not “we should get rid of socialized medicine so I can hire a doctor when I need one.” People aren’t spending their time thinking about the overarching issue. They’re thinking about getting to work, going to soccer practice with the kids, and wishing they could see their doctor sooner. They’re not thinking about socialized medicine vs. private medicine. And they shouldn’t have to.
How might we count, for example, the collapse of the Soviet Union or the Ukrainian change of government? I’m not sure what their health care systems were like before their governments fell, but the people were definitely expressing a “not this way” opinion about the way the government was running things, and health care would have been at least a piece of that. I doubt health care in Russia is better than in 1985 (although the reduced life expectancy there might have more to do with criminal activity than failed health care), but that doesn’t mean unhappiness with health care in 1985 didn’t contribute to the Soviet downfall. Sometimes things get so bad you’re willing to risk worse in the hope of something better.
“2) If not, why? Are all foreigners too stupid to see how much better we do it in America? Or is there another explanation?”
All the Canadians who come to the US for health care seem quite intelligent and capable of seeing how we do it. For that matter, the Americans who (somewhat riskily in my opinion) go to Mexico and pay cash for Dental and Medical procedures are expressing an opinion as well.
I’m not saying we do it great here. It’s crazy that we have medical insurance at all for routine medical stuff. That’s a craziness brought on by the government’s tax policies about medical benefits, started (I think) in WWII as a relief to another government thing about wage controls. It’s a shame when families are financially ruined by medical expenses. It might be good if we had some better way to deal with catastrophic health care issues. But to give government control of such a huge portion of our economy–and such an important aspect of our lives–is the wrong way to go.
“f you want to propose and debate a program to help the poverty stricken have access to medical care, okay, we can have that debate. It’s not my objective in life to make sure poor people don’t get medical care (although I wouldn’t mind if they eschewed cable to help with copayments). I thought that’s what medicaid was, and I’m sure that could be reformed”
The problem isn’t the impoverished who do get medicaid, it’s the working poor. All those folks working at Wal-Mart, or convenience stores, or
cleaning houses and hotel rooms.
The lady who cleaned my house made $15/hour, a decent wage for a high school drop out, but, she couldn’t get health insurance. Too expensive and she had various pre-existing conditions. 30% of all americans who have jobs don’t have health insurance, that’s nuts.