Single-payer: A test-case study (salaries, attorneys, compared, education)

[OhioRules]

Originally Posted by BoomBen

Except many people do not have the cash to pay for those visits. Then they go to the ER where by law they must be seen by a Doctor.

In a free market system you eliminate the government. That automatically reduces costs.

You also streamline the insurance paperwork and forcing people to insure things they don't want insured. That also reduces costs.

And the governmen doesn't suppress the number of doctors. Which reduces costs.

Then people would be able to pay. And the ones that can't will work out a payment system to the doctor.

Just like anything else.

[OhioRules]

Here's another link to how the free market works efficiently, cheaply and safely in providing health care.

Better than any government run system.

EconomicPolicyJournal.com: What Free Market Health Care Looks Like

[kidkaos2]

Originally Posted by squarian

PA Medicaid Expansion Debate Isn't About Costs - Keystone Politics

The full MIT study is available by link in the Keystone article above.

Obviously, PA isn't about to try the experiment anytime soon: its governor, Tom Corbett, is a Republican who has just recently declined to participate in the ACA Medicaid expansion or state-run insurance exchange, and both chambers of the state legislature have GOP majorities who will (probably) back him on both decisions.

Nonetheless, as a theoretical example of a large state's implementation of a single-payer system, equivalent to the Canadian model in being state-based, it provides some interesting policy-wonk fodder.

In practice, single-payer state plans are more likely to tried first in smaller states: in Oregon, where the governor John Kitzhaber has been a national leader in health-provision reform and innovation, there is a significant and growing movement for a single-payer system. Vermont, led by Gov. Peter Shumlin, may well be the first state to implement such a plan.

The role of the states is often described as "laboratories of democracy", and in the area of health-insurance reform, that appears to be exactly correct. A key, however, will be the willingness of the federal government to issue waivers to the ACA to allow such experiments to take place - and that of course depends on who controls the federal government.

It does? Funny how the very same Republican politician who started mandates in his own state and conservative think tank who proposed mandate ideas both opposed them being enacted at the federal level then. Sorry but your partisanship here isn't supported by facts. The constitution allows the states to do things which are forbidden to the federal government. Opposing something at the nation level does not equal opposing it at the state level.

[Katarina Witt]

Originally Posted by lycos679

Medicare is also going to go broke.


"Last July, I wrote about a landmark study conducted at the University of Virginia that found that surgical patients on Medicaid are 13 percent more likely to die than those without insurance of any kind. The study evaluated 893,658 major surgical operations from around the country from 2003 to 2007, and normalized the results for age, gender, income, geographic region, operation, and 30 background diseases.

Patients on Medicare were 45% more likely to die than those with private insurance; the uninsured were 74% more likely; and Medicaid patients 93% more likely. That is to say, despite the fact that we will soon spend more than $500 billion a year on Medicaid, Medicaid beneficiaries, on average, fared worse than those with no insurance at all."

Why Medicaid is a Humanitarian Catastrophe - Forbes

Overuse of Preoperative Cardiac Stress Testing in Medicare Patients Undergoing Elective Noncardiac Surgery

Mortality in Medicare Patients Undergoing Surgery in July in Teaching Hospitals

Complications, Failure to Rescue, and Mortality With Major Inpatient Surgery in Medicare Patients

The Effect of the CMS National Coverage Decision on the Performance and Outcomes of Bariatric Surgery for Medicare Recipients in the U.S


Health Status, Health Care and Inequality: Canada vs. the U.S.

"Does Canada's publicly funded, single payer health care system deliver better health outcomes and distribute health resources more equitably than the multi-payer heavily private U.S. system? We show that the efficacy of health care systems cannot be usefully evaluated by comparisons of infant mortality and life expectancy. We analyze several alternative measures of health status using JCUSH (The Joint Canada/U.S. Survey of Health) and other surveys. We find a somewhat higher incidence of chronic health conditions in the U.S. than in Canada but somewhat greater U.S. access to treatment for these conditions. Moreover, a significantly higher percentage of U.S. women and men are screened for major forms of cancer. Although health status, measured in various ways is similar in both countries, mortality/incidence ratios for various cancers tend to be higher in Canada. The need to ration resources in Canada, where care is delivered "free", ultimately leads to long waits. In the U.S., costs are more often a source of unmet needs. We also find that Canada has no more abolished the tendency for health status to improve with income than have other countries. Indeed, the health-income gradient is slightly steeper in Canada than it is in the U.S."


"However, only 37% of the procedures overall were completed within the requested waiting time.
Patients awaiting cardiac catheterization may experience major adverse events, such as death, myocardial infarction and congestive heart failure, which may be preventable. Our findings provide a benchmark by which to measure the effect of increased capacity and prioritization schemes that allow earlier access for patients at higher risk, such as those with aortic stenosis and reduced left ventricular function."

The risks of waiting for cardiac catheterization: a prospective study

Originally Posted by Mircea

Pathetic doesn't even begin to describe that.



In other words, that poster doesn't know and doesn't have an answer (which is something we've come to expect).

I will be more than happy to give you --- and anyone else who is interested in empowering themselves through knowledge so that they can make the best possible informed choices --- the globally accepted definitions of health care rationing, including the sources for them.

Rationing exists when...

1] Scarcity of physical resources and a perceived need for their allocation
2] Waiting lists and long waiting times
3] Denial of treatment based on funding limitations
4] Discrimination between patients regardless of need

Those definitions stem from....

Allocating resources when their supply is limited (EIU Healthcare International)

The displacement of the interests of one group of patients by another (Spiers, J., The Realities of Rationing: ‘Priority Setting’ in the NHS, London)

How many of a given intervention will be provided, to whom, at what cost, and under what circumstances (Rationing Health Care, British Medical Bulletin No 51)

Die kuenstliche Verknappung eines durchaus vorhandenen Angebots --- The artificial curtailment of supply when it is actually available (Cueni, T., Rationalisieren oder Rationieren?)


The point is that we don't make up definitions to suit ourselves, like the OP does.

I will try to explain each of the above using real world examples where possible.

Scarcity of physical resources and a perceived need for their allocation.

That takes place in all countries that have so-called single-payer or national health care systems. For your real world example, I give you the Heilmittel

In order not to trigger penalty payments, the KBV devised an Emergency Programme which would, in effect, ration drug prescribing for the rest of the year.

The Emergency Programme proposed five steps:
1. Waiting lists for prescription drugs and other prescription treatments (Heilmittel, which include physiotherapy, acupuncture etc.) except in life threatening or medically essential circumstances
2. Postponement of innovative therapy to the following budget year
3. Radical switching of prescriptions from brand to the cheapest generic
4. Prior authorisation of expensive therapies
5. In the event of budget being exceeded, ‘emergency prescriptions’ to be issued temporarily, for which patients would have to pay out-of pocket and personally claim reimbursement (in Germany, unlike France, patients pay only user charges out of pocket)

Source: Why Ration Healthcare? Page 86

Waiting lists and long waiting times

Someone already posted an article from a Canadian medical journal showing that Canadians die waiting for cardio-catheterization.

I will tell the story of Diane Gorsuch.

Diane had an heart condition that would cause her to die.

Diane had open-heart surgery scheduled......then cancelled because there were no hospital beds available, nor was there any money to perform the surgery that fiscal quarter.

Diane had open-heart surgery scheduled....a second time...months later ..and that surgery too was cancelled for nearly the same reasons.

Diane had open-heart surgery scheduled....for a third time....months later...

...she died while waiting months for surgery she would have gotten in a matter of days in the US.

Manitoba kills cardiac care unit, consolidates services at single site

However, attitudes changed when people on the waiting list started dying — there have been 11 deaths since 1999 — and both the Liberals and Conservatives demanded Chomiak's resignation. The last straw appears to have been the death of Diane Gorsuch, 58, who died in February after spending more than 2 years awaiting surgery. Thirteen days after she died, the review was announced.

Manitoba kills cardiac care unit, consolidates services at single site

That's from the Canadian Medical Association.

So a review was announced.......yeah....after 11 freaking people already died waiting for surgery they could have gotten in a few days in the US.

See, one of the differences between Capitalist Property Theory and Socialist Property Theory, is that in Capitalism, Capitalists react an helluva lot faster to the needs and wants of people than the government does.

Denial of treatment based on funding limitations

Diane's case qualifies that. So do the many British and Swedish people (and others) who die because there isn't enough money.

What people refuse to understand, is that health care costs the same all over the world. Health care in Canada, Britain, Germany, Scandinavia, Italy, France etc is not cheaper than in the US...

...but those governments do spend less......and that makes it appear to be cheaper, when in fact it is not.

Delay, Denial and Dilution: The Impact of NHS Rationing on Heart Disease and Cancer
IEA Health and Welfare Unit (London)

12% of kidney specialists in the UK said they had refused to treat patients due to limited resources (same source).

......and then this......

65 patients per million population UK
98 patients per million population in Canada
212 patients per million population in the US

If health care in the US costs twice as much as other countries......then why can't Britain or Canada afford to pay for kidney dialysis?

Discrimination between patients regardless of need

The elderly, those with chronic conditions, and those with costly conditions are often discriminated against in Canada and Euro-States that have single-payer or national health care.

RATIONING HEALTH CARE IN EUROPE – FRANCE D. Benamouzig & R. Launois
In J. Matthias Graf von der Schulenburg and Michael Blanke (Eds.) RATIONING OF MEDICAL SERVICES IN EUROPE: AN EMPIRICAL STUDY
IOS Press Amsterdam 2004: p. 27-60

I hope that helps with respect to the concept and definition of rationing.

Defining....

Mircea




That is not rationing. That is part and parcel of a contractual obligation.

This person....



...got it right.

Perhaps you can see your way to taking off the blinders just long enough to actually learn something.



Uh, insurance should not cover it. That is something for which you should pay.

On this thread you claimed.....



...and you have now demolished your own thesis with your own comment.

Congratulating....

Mircea

First of all, Mr. Self-Congratultions:

Why should someone pay for insurance, and then have to pay out of pocket for health care, too?

Secondly,

My insurance will pay for the shingles shot at the Dr's office, just not at Walgreen's. Since you know EVERYTHING and I do mean EVERYTHING about health care, explain that!

[lycos679]

Originally Posted by BoomBen

You have some good points but is the system we have now working well?
Is the system we have now not burdening millions of middle class Americans?

Healthcare costs are astronomical and are a hinderence to economic growth. They must be reduced.

The capitalist healthcare system is not reducing costs as in theory it should be.

The problem is that the USA healthcare market is not a free market. The American Hospital Association has been working to eliminate competition for decades. Over time the healthcare system has become more and more monopolistic. Monopolies are not competitive.

[Katarina Witt]

Originally Posted by lycos679

Patients on Medicare were 45% more likely to die than those with private insurance; the uninsured were 74% more likely; and Medicaid patients 93% more likely. That is to say, despite the fact that we will soon spend more than $500 billion a year on Medicaid, Medicaid beneficiaries, on average, fared worse than those with no insurance at all."

Medicare patients are older than patients with private ins., no wonder they are 45% more likely to die. The uninsured don't get to the dr until they are very sick, ditto Medicaid patients.

[Tilt11]

Sigh. So it appears we already have proof of the failure that is Obamacare. Rather, we already have proof of its purpose. They know it will damage the country even more. Obamacare wasnt designed to make health care better or more affordable. It was designed to make it all more of a burden on society so they can say "looks like we have to try single payer".

Liberals are despicable beings. Ends justify the means jerks.

We do not want single payer any more than we wanted Obamacare and you know it. But im sure that wont stop you from trying to shove it down America's throat like you did Obamacare.

[lycos679]

Originally Posted by Katiana

Medicare patients are older than patients with private ins., no wonder they are 45% more likely to die. The uninsured don't get to the dr until they are very sick, ditto Medicaid patients.

Ahem, statistical analysis controls for all factors including age, illness, and income. Medicaid patients are usually poor women that have kids. Why would they be more likely to die than privately insured or medicare patients that are older?

ASA: ASA 130th Annual Meeting Abstracts - Primary Payer Status Affects Mortality For Major Surgical Operations

"Moreover, mortality was lowest for Private Insurance patients independent of operation. Importantly, after controlling for age, gender, income, geographic region, operation, and 30 comorbid conditions, Medicaid payer status was associated with the longest length of stay and highest total costs (p<0.001). In addition, Medicaid (p<0.001) and Uninsured (p<0.001) payer status independently conferred the highest adjusted risks of mortality (Table 1)."

"Conclusions: Medicaid and Uninsured payer status confers increased risk of adjusted mortality. Medicaid was further associated with the greatest adjusted length of stay and total costs despite risk factors or operation. Possible explanations include delays in access to care or disparate differences in health maintenance."

[Katarina Witt]

Originally Posted by lycos679

Ahem, statistical analysis controls for all factors including age, illness, and income. Medicaid patients are usually poor women that have kids. Why would they be more likely to die than privately insured or medicare patients that are older?

ASA: ASA 130th Annual Meeting Abstracts - Primary Payer Status Affects Mortality For Major Surgical Operations

"Moreover, mortality was lowest for Private Insurance patients independent of operation. Importantly, after controlling for age, gender, income, geographic region, operation, and 30 comorbid conditions, Medicaid payer status was associated with the longest length of stay and highest total costs (p<0.001). In addition, Medicaid (p<0.001) and Uninsured (p<0.001) payer status independently conferred the highest adjusted risks of mortality (Table 1)."

"Conclusions: Medicaid and Uninsured payer status confers increased risk of adjusted mortality. Medicaid was further associated with the greatest adjusted length of stay and total costs despite risk factors or operation. Possible explanations include delays in access to care or disparate differences in health maintenance."

I don't know how they controlled for age when Medicare is ONLY for people 65+ plus a few special situations. For the most part, if you qualify for Medicare, you can't get other ins. One exception is if you are over 65, working and covered under a group insurance plan. But there aren't a lot of people out there in that situation.
Medicare

The elderly and disabled account for the majority of Medicaid spending.
http://www.kff.org/medicaid/upload/8139-02.pdf
**The elderly and disabled account for the majority of Medicaid spending. While children and parents make up about 75% of Medicaid enrollees, they account about a third of the spending. In contrast, the elderly and individuals with disabilities make up about 25% of enrollees but about two-thirds of spending.
. . .
The elderly and disabled have higher utilization and intensity of use for acute care services and the elderly and disabled are more likely to use long-term care services.

The link seems like an example of "how to lie with statistics".

[Mircea]

Originally Posted by Mr. Mon

Actually, no, it isn't. Medical care does not function in a free market. You are forced to pay what the provider says you will pay in order to receive whatever life saving treatment they are offering. Shopping for emergency care is not the same as shopping for the best price on braces for your kid or lipo for your wife.

Originally Posted by Jaggy001

Market-based system cannot work for healthcare.

For example .... you are having a heart attack or laying on the ground with a broken leg. What do you do? Call 911 or start calling around hospitals or other health care providers to see who can get you the best deal?

UHC does not have to be government run. But because free market cannot work (see above example), you do need government regulation to protect the consumer. In that respect it is not all that different to private utilities in the USA.

Originally Posted by Katiana

What, people don't have heart attacks in a free market system? Coulda fooled me!

The Argument for Free Market Health Care is very, very simple....it means repealing or vacating all of the Soviet-style Command Economics-based judicial and special interest legislation enacted through the lobbying efforts of the American Hospital Association, since 1933....

1] The repeal of Paragraph 23(a) of the Internal Revenue Code enacted in 1954, which states....

Premiums paid by an employer on policies of group life insurance without cash surrender value covering the lives of his employees, or on policies of group health or accident insurance... do not constitute salary if such premiums are deductible by the employer under Section 23(a) of the Code.

For those who don't understand (or refuse to understand), one of the first and best documented pre-paid hospitalization plans provided 21 Days of Hospitalization for $6.

The American Hospital Association's lobbying efforts before Congress and the IRS change the IRS Tax Code in 1954 to this...

An Unspecified/Unknown/Undetermined Number of Day of Hospitalization for $6....and no, that is not insurance....that is fee-for-service.

2] The repeal of applicable sections of Obamacare™ written by the American Hospital Association that ban both annual limits and life-time limits. We have gone from this...

21 Days of Hospitalization for $6

...to this....

An Unspecified/Unknown/Undetermined Number of Day of Hospitalization for $6

...and now this (thanks to the American Hospital Association and Obamacare™)....

An Infinite Number of Days of Hospitalization for $6

...we want to go back to this....

21 Days of Hospitalization for $6

3] The repeal of all "enabling laws" and "enabling legislation" enacted during the period 1933 to 1948 through the lobbying efforts of the American Hospital Association.

4] The reversal or vacation of the US Supreme Court's decision for In Re: Inland Steel (1949) which gave unions the right to negotiate health care benefits for employees.

5] The reversal or vacation of the National War Labor Board's ruling in 1942 declaring health care plans to be "fringe benefits."

Now that we have open competition between health plan providers, we need to create competition for health care givers....

6] Enforce the Sherman Anti-Trust Laws and enact other anti-trust laws that bar hospitals from forming and operating as Cartels to illegally collude and illegally fix prices. That would also include certain doctors' group practices.

7] Enact legislation similar to the Sports Franchise Rule, or the old AM/FM Radio Rule which would bar ownership of more than one hospital (or certain group physician practices) in each Metropolitan Statistical Area.

Ever wonder why someone has to be airlifted for a 20 minute flight to a Level I Trauma Center, instead driving 10 minutes by ambulance to a Level I Trauma Center?

Now you know why...you don't have a competitive hospital system in the US...and you can thank the American Hospital Association for that, and for the fun time you'll have flying like a bat out of hell to get to a trauma center to save your life.

Do all 7 of the above, and you'll have affordable health care for everyone, for which everyone has access...for those who actually want access.

You will be able to shop for insurance anywhere.

You will be able to cover anyone with your policy -- although it might cost you a little extra -- meaning you can cover your next-door-neighbor, family members who live in other cities/States, just like you do with auto insurance.

You will be able to tailor your plan to your own needs and wants. If you would prefer to pay for a visit to the doctor's office out of pocket, instead of being "covered" for it, then you can do that....and you'll pay less money for your premium.

You'll be able to use your insurance anywhere at any medical facility or doctor's office....no such thing as "Out-of-Network" fees or charges or denial of services --- which I would point out was invented by the American Hospital Association in 1939 and then solidified as a permanent fixture in 1946.

Even though your employer no longer crow-bars you into an health plan that you neither want nor need, and doesn't work (for you), you can still negotiate health plan benefits as part of your employment package to cover part or all of your monthly health care premiums.

Burning down Straw Men...

Mircea

Originally Posted by BoomBen

I consider myself to be Libertarian (not Sarah Palin's definition) and believe we absolutely need a system similar to Canada's.

I'm guessing you've never read the Chaoulli Decision.

In order not to end up like Diane Gorsuch and die waiting for medical treatment in Canada, Chaoulli obtained private health care insurance to pay for the necessary medical procedure.

The provincial government of Quebec cried, "Foul! No Fair! You must die waiting your turn just like the thousands who have died before you."

The Canadian Supreme Court’s decision in Chaoulli found a regulation banning private health insurance for medically necessary care to be unconstitutional.

That's the kind of health care system you want?

You want to die waiting for treatment? Do you want to have to get private insurance to get medical care promptly so you don't die waiting for treatment?

Originally Posted by BoomBen

I generally endorse the free market but for Healthcare it does not work.

And how could you possibly know, since you've haven't had Free Market health care in the US since 1933?

Originally Posted by BoomBen

There is no way any free market enterprise puts health above profit. It just cannot be done.

That is an emotional argument, not based on facts or reality, and certainly not based on Economics.

The Market allocates or distributes resources via the Laws of Economics. If you interfere, then you will suffer financially (if not physically in the case of health care as the facts repeatedly prove).

No person or group, living or dead, or who will ever live can alter the Laws of Economics. Like it or not, accept it or not, you have a limited amount of resources for health care...

limited cash Capital
limited credit Capital
limited labor Capital (whether it is doctors, nurses, hospital orderlies or Candy Stripers)
limited space Capital (for medical facilities)
limited manufacturing Capital (for medical devices of all types, supplies, pharmaceuticals etc)
limited other Capital

From the standpoint of Economics, health care produces absolutely nothing. It's actually drain on the State economy. Health care is no different that Education or Government.....increased inputs do not result in higher yields, greater efficiency, better service or a better product, and the outcome always remains unchanged.

I spend $800 per child and this child ends up as a 'C' student. If I increase spending to $8,000 per child, this student ends up as a 'C' student. If I increase spending to $80,000 per child, I still end up with a 'C' student.

What happened? A lot of money was wasted creating a drag on the economy that ultimately harmed everyone.

Originally Posted by BoomBen

And by the way -currently we do not actually have a free market- we have a bunch oligopolies controlling the business cycle.

And one of those oligarchies ruining your health care system is the American Hospital Association.

Here's a bright idea...let's let the American Hospital Association write some health care legislation....oh, wait...you already did...they gave you Obamacare™.

Originally Posted by Katiana

It's so frustrating to try to discuss this issue with people who will not open their minds to something other than "unfettered free market system".

And it's equally frustrating to try to discuss this issue with people who have never experienced a Free Market system and will not open their minds to anything except a system that will need rationing.

I can only hope such people experience the effects of rationing up close and personal.

Originally Posted by squarian

And - it's the usual suspects bleating the usual noises about the virtues of the Hallowed Free Market Amen.

Perhaps when you indicate you have some understanding, they'll stop.

Originally Posted by TriMT7

5 Myths about Canadian Single Payer Healthcare:

1) Myth #1: Canadians are flocking to the United States to get medical care.

2) Myth #2: Doctors in Canada are flocking to the United States to practice.

3) Myth #3: Canada rations health care; that’s why hip replacements and cataract surgeries happen faster in the United States.

4) Myth #4: Canada has long wait times because it has a single-payer system.

5) Myth #5: Canada rations health care; the United States doesn’t.

5 Myths About Canada

All of those, um, you know, "myths" have been debunked by the Canadian Supreme Court in the Chaoulli Decision, and by the Canadian Medial Association, and the Canadian Journal of Medicine.

Originally Posted by jmking

The delivery of heath care in the US is not a bazaar quite yet, but maybe heading that way.

Originally Posted by squarian

Bizarre, but not a bazaar.

It's "bazaar."

Ce faci Mircea, umbli?

Ma-duc in bazaar la Nyiregyhaza (Hungaria)

It's a Turkish word.

It's in the vocabularies of Balkan languages --- like Romanian --- since they were under the suzerainty of the Ottoman Empire.

A "bazaar" is a Market Place.

The bazaar at Nyiregyhaza (in northeastern Hungaria near the borders of Slovakia and Romania) happens to be an huge open air Market where people from Cheha, Slovakia, Romanian, Hungaria, Ukraine and the Vojvodina (from Serbia) come to buy, sell or trade goods. Lots of tigani go there too (I think you call them "gypsies").

Repealing the "enabling laws" and "enabling legislation" enacted through the lobbying efforts of the American Hospital Association would -- among things -- eliminate the silly "Out-of-Network" nonsense and make health care like a bazaar, where you have no restrictions on where you can use your health plan coverage.

You stand corrected.

Correcting...

Mircea