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Current government programs don't cover all of peoples' costs: medicare for example only covers about half. A single-payer plan would have to pay the other half plus the costs of people who either have private coverage or no coverage.
Further the claim that "All the redundant work, bureaucracy and payments run by Medicare, Medicaid, Veterans, Childrens, Indians etc cost more in total than single payer would" is just flat out wrong. Which you would have known if you had done some basic research and arithmetic. Medicare advantage programs average better than 83% of dollars spent on medical care and direct medicare does even better; there is no reason why other existing programs should do worse. The massive administrative savings you think there are from consolidating programs are simply in your imagination - the simple, numerical fact of the matter (I am using wikipedia to source my numbers btw, incase anyone is wondering; they tend to be pretty accurate in these things) is that most dollars are spent on care.
Let's say you have an absolute best-case (in the sense that it would be "best" at supporting your claims) scenario where 15% of costs are administrative and you can get that down to about 5% with single payer AND you don't have any increase in utilization from increased access (neither of these assumptions is realistic, but, I'm constructing the best possible case for your argument even if it stretches a little). You're still looking for about 950 billion dollars in additional annual revenue to pay for it. Which is still several hundred billion bigger than the annual cost of the peacetime US military.
edit:
Public sector overhead is some number I don't exactly know below 17%.
Private sector overhead was limited by law in the ACA to 15% for most insurance plans and 20% for a handful of smaller ones. There is also overhead at the actual hospital/doctors office/etc., but, this is unavoidable.
No system will have zero overhead. Realistically you're not going much below 5% regardless of what you do.
So let's say that overall private/public payer-side overhead is 17% (this is probably an overestimate, but, when one makes assumptions best to lean against one's own case, which I am doing here) and we get that down to 5% with no losses to more use of care, less efficient use of care, etc. That is a savings of about .12 * .16 * $15 trillion = ~288 billion, and represents an unrealistically high best case. That isn't chump change, but, it doesn't get you anywhere close to paying for single payer. In fact, it doesn't even fill the gap between the cost of single payer and the savings from, say yet again, dismantling the entire peacetime US military.
"Medicare advantage programs average better than 83% of dollars spent on medical care and direct medicare does even better;"
And why do they do better? By strangling doctors and limiting the choices for their members. If doctors don't succumb to the insurance companies demands the companies will steal their business and force members to go to other doctors that will slave to their demands. One of the most HILARIOUS arguments from the right against a universal form of healthcare is that they think the government will be telling them which doctors they can and cannot go to. What the HELL do you think your insurance companies are doing to you?! You go out of network and you will pay out the ass for it. My grandmother has to drive to another county for gods sake to be in network with her advantage program. If there is anything strangling the freedom that Americans have with their healthcare it is these programs and the insurance companies. Certainly not the government.
I have no ideas about healthcare reform. It is an appallingly sticky subject in which I claim no expertise.
My job requires review of thousands of medical files each year. I have noticed several things over the decades:
1. Private health insurance companies will try their best to avoid paying for diagnostic tests. It is common to see in my files letters from medical doctors to the insurance carriers, arguing that their patient needs such and such test to discover the source of pain, etc. Since private health insurance companies are in business to maximize shareholder return, this is not too surprising. But, it is wrong. Unless, of course, you own stock in the company.
2. People with no insurance will go to the local county hospital emergency room for the most minor of ailments. They do not pay anything. I, a real property owner, pay for their health care through my property taxes. I would like that to stop.
3. Related to No. 2 (for I got off on a tangent): when an uninsured person goes to the emergency room complaining of a headache, he or she will often be told to take aspirin. If that person returns a second time, for headache, they will probably start ordering tests (MRI scans of the brain, and so on), which, of course, costs quite a bit of money, but the physician does not want to be held liable if the 'headache' turns out to be due to a brain tumor.
4. The number of visits to the county emergency room increases ten-fold after a person files for federal disability benefits. Indeed, in many cases, they will have virtually no medical records when they file, but by the time they get to the hearing (six months later, if lucky) they will have generated hundreds of pages of emergency records.
5. The VA medical centers are worse than county emergency rooms in ordering tests. If a Vet walks in and says "I was exposed to Agent Orange" they will run thousand of dollars worth of tests, before discovering that the veteran was never in Vietnam, but served all his time stateside working on jeeps (true story).
6. Finally, I have seen numerous instances where uninsured people improve in their health after they become insured (through being found disabled, and thus getting on either Medicaid or Medicare). I see these cases when we review people to see if they continue to meet the definition of disability (cessation cases).
"Medicare advantage programs average better than 83% of dollars spent on medical care and direct medicare does even better;"
And why do they do better? By strangling doctors and limiting the choices for their members. If doctors don't succumb to the insurance companies demands the companies will steal their business and force members to go to other doctors that will slave to their demands. One of the most HILARIOUS arguments from the right against a universal form of healthcare is that they think the government will be telling them which doctors they can and cannot go to. What the HELL do you think your insurance companies are doing to you?! You go out of network and you will pay out the ass for it. My grandmother has to drive to another county for gods sake to be in network with her advantage program. If there is anything strangling the freedom that Americans have with their healthcare it is these programs and the insurance companies. Certainly not the government.
Sorry if I was being insufficiently precise: "direct medicare does even better" was meaning that direct (i.e. government-as-payer traditional medicare) spends less than ~17% on overhead and more than ~83% but medical care (although the wiki didn't give exact numbers, hence the assumptions above).
I have never argued that insurance companies don't restrict care. Just that people who want single payer almost never run the numbers on how much it would cost, and that neither cutting other parts of government or raising taxes enough to afford it are politically or economically feasible, even after accounting for the maximum possible reduction in administrative costs (oh, and FYI in all my numbers I have included corporate profit in administrative costs).
Dismantling the current system and instituting a system similar to say, Canada's, would drastically lower this number by getting rid of the immense amount of overhead and administrative costs of our current healthcare system. Of the remaining cost, about 50% of it is already covered by taxes through medicaid and medicare. The remaining costs can be covered through taxes and spending cuts.
not quite
admin costs are small
the fact is you cant REGULATE the costs of everything
is the US government going to mandate what the xray machines MADE IN DENMARK are going to cost the us doctors
I think not
Last edited by workingclasshero; 06-26-2012 at 08:37 PM..
Should we FORCE doctors and nurses to work for minimum wage. and have offices in huts
when your doctor charges you $100...its not $100 going into his pocket
he/she still has to pay rent/lease/mortgage
still has to pay an electric bill
still has to pay for supplies
still has to pay THE NURSE/RECEPTIONIST/RECORDS KEEPER
still has to pay ofr that mri/xray machine (equipment) etc
and you are not going to lower THOSE costs by the government or insuance
.
how are you going to control the cost of medical equipment(mri or xray machines, etc)??????most xray machine are made in denmark(((((((why does that PROCEEDURE of getting an MRI cost 4k???.......because the MACHINE itself cost 1.4 million dollars.......and the tech that runs it has to make ATLEAST minimum wage......and then the DOCTOR/SPECIALIST has to READ(analyze) the MRI
it can take YEARS before that machine has even paid for itself..and you have the cost of the personnel and the electric to run it, on top of that)))))))
how are you going to control the cost of the rising electric bills the doctors/hospitals are facing????
(((((you understand the AVERAGE hospital spends 430,000 dollars a MONTH on ELECTRICITY ALONE...that's 5,160,000 (5.1 million) a year just in electric costs...not to mention custodial costs, food costs, laundry costs, sanitation costs, staff costs, etc)))))))....you realize how many hospitals have GONE OUT OF BUSINESS because they cant make a profit enough to stay afloat...and the government is a good part of the problem
how are you going to control the rising property tax/rent/mortgage that doctors face?????
how are you going to control the cost of supplies(gauze, plaster, silk, rubber, polystirene( a oil product)?????especially some supplies that arent even american
how are you going to control the cost of people salaries???? a maximum wage???
how they are going to control the employment costs for Doctors, nurses, technicians, hospital food operators, hospital linnon cleaning service, custodial services, medical transcribers........are you going to 'nationalize' every profession that is even remotely connected to medicine????
how are they going to control malpractice INSURANCE COSTS?????the biggest expense for Dr's today. MALPRACTRICE INSURANCE This cost drives many Dr's out of practice and shoves them into working in Labs or other institutions that cover their insurance if the screw up.
dont you get it... medicine (like anyother SERVICE) costs money,,(,money that our government doesnt have)
want to know why its lower in those other countries...a nurse in france(actually most of europe) makes about 1500-1800 a month(in us dollars)..that's 18-20000 a year.....meanwhile according to payscale.com the average Rn makes 40-78,000 in the usa
is that what you want??? do you want to be forced to work for nearly minimum wage
^^Do doctors in Canada, Europe, Japan, Australia and New Zealand and others operate out of mud huts? Do they work for minimum wage? Do they not have electric and other utility bills? Etc???
I agree with the others, but would prefer a differnt tweak for the above. Adopt McCain's 2008 idea, tax employer Health Care as employee income, and give them a tax credit. He liked $7,500 single, $15k family. I'd prefer $5k and $10k, respectfully. Get employees to want to control policy costs via healthier lifestyle choices.
The average the governamnt released on employer contribtuion this is year was alittle over 13K per insured. But I agree the only fair way to do it is allow all compensatio to be counted as income. I know of some who actually get over 20K in employer compensation thru healthcare payment by employer now. That is a hewck of a free compensation income not taxed as income.
the fact is you cant REGULATE the costs of everything
is the US government going to mandate what the xray machines MADE IN DENMARK are going to cost the us doctors
I think not
Administration cost of US healthcare is not small...It is huge....More than three times greater than Canada's...
The United States, which has the most privatized health care system of any OECD country, spends 14% of its GNP on health care, compared to 9% for Canada.
The U.S. pays $911 per person per year in administrative costs. Canada by contrast pays $270 per person.
The disproportion in insurance overhead costs is even more marked: insurance overhead per capita comes to $212 in the U.S., $34 in Canada. Blue Cross/Blue Shield of Massachusetts, a typical major insurer, employs 6680 people to administer insurance for 2 1/2 million customers, more than are employed to administer public health insurance for all 28 million Canadians. 10 Health Care Myths: Understanding Canada's Medicare Debate
Administration cost of US healthcare is not small...It is huge....More than three times greater than Canada's...
The United States, which has the most privatized health care system of any OECD country, spends 14% of its GNP on health care, compared to 9% for Canada.
The U.S. pays $911 per person per year in administrative costs. Canada by contrast pays $270 per person.
The disproportion in insurance overhead costs is even more marked: insurance overhead per capita comes to $212 in the U.S., $34 in Canada. Blue Cross/Blue Shield of Massachusetts, a typical major insurer, employs 6680 people to administer insurance for 2 1/2 million customers, more than are employed to administer public health insurance for all 28 million Canadians. 10 Health Care Myths: Understanding Canada's Medicare Debate
US healthcare was at 17.6% of GDP in 2010 and is projected to hit 19.8% by 2020. Health care costs are expected to grow at 5.6% annually over the next eight years.
Now we can all tout this solution or that solution. But a smart person would look at the numbers and ask why every other developed country can provide good health care a lot cheaper than we can. And I mean a lot!!!
Now they might be a bunch of 'pinko-commie socialists' but they are clearly doing something right and we are clearly doing something wrong. So maybe we should be learning a few lessons from their experience before trying out solutions that are wholly unproven even if they are ideologically 'purer' for some.
Because I really don't care who is running health care if it is providing the same quality care for a lower price. And that is what other countries seem to achieve.
1. Lower the cost of healthcare. Most people only need catastrophic health insurance. Regular checkups should cost less and be paid for out of pocket. Routine tests should also cost much less. Medicine should cost less too.
2. Hospitals should also run 24 hour health clinics adjacent to the ER entrance. That way, people with minor medical issues can see a basic and less expensive clinician for their problems. No need to tie up expensive trauma staff for just a bad cold or fever.
3. Put a cap on malpractice suit claims and limit how much a lawyer can charge for a settlement.
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