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I agree with you that Medicare for all would be better than what we have now...better than Trumpcare or Obamacare certainly.
All you have to do is pay for it.
There is no law that MDs accept Medicare patients. When Medicare is stingy with MD reimbursements, fewer MDs accept Medicare or limit the number of Medicare payments. When Medicare increases MD reimbursements, more MDs accept more Medicare patients.
Medicare reimburses hospitals at an average rate within a Geo Rates area. That rate includes the hospital's overhead.
Medicare could negotiate/ regulate the price of prescription medications if Congress authorized them to do so.
Medicare, as is, is unsustainable from a financial standpoint. 11,000 people are turning 65 every day. Nonetheless, the oldest of the old is the fastest growing segment of the Medicare population. So much of what used to kill people just 50 years ago is now curable or treatable. And this costs serious money.
Politicians do not want to increase premiums ( Payroll taxes) and the enrollee and near enrollees do not want change. This voucher concept assumes the Federal Government would mandate health insurers insure the exposures of the elderly. Gawd only knows what premiums would cost given most Medicare enrollees have one or more chronic conditions.
The original framework of the ACA compelled healthcare providers to do end of life counseling. Opponents to the ACA got a lot of political mileage out of deeming such counseling to be death panels and it was removed from the legislation. And so people with end stage Cancer continue to recieve Cancer Treatment despite that there is no evidence that supports doing so. MDs recieve a percentage of the cost of drugs administered in their facility. And some ( certainly not most ) healthcare providers abuse/ game the system.
So long as healthcare remains a political football, this there is no hope for reform.
There is no sucessful model of free market healthcare anywhere in the world.
In every society, there has been a priestly class who has placed itself above the society they are a part of, and acquired special and unearned privileges for themselves. American society, for better or worse, does not have a priest class sanctioned by the state, as the First Amendment and custom mandates the separation of church and state. But old habits die hard, and where a priestly class does not exist, I argue that other social groups take on the functions of priests.
In Catholic Europe, individuals went to priests to confess their sins, and the priests would, using his powers, adopt the pretense of healing the confessor and absolving him of his sins, thus curing his soul. Whether or not a soul exists, it is obvious that the priests in the days of Europe before the Protestant Reformation had acquired an undue amount of influence in society and were abusing their privileges. Martin Luther, when he boldly denounced the Catholic Church and called for systemic reforms, was in fact a traitor to the class to which he belonged. He saw that the average churchgoer was being given a raw deal, and sacrificed his social position, his livelihood, and risked his life to fight for a noble cause.
Doctors in our society are, in all sense, the new priestly class. Just as churchgoers in the medieval era went to their priests to confess their sins, without the priests actually solving their problems, patients today visit their doctors at an exorbitant hourly rate, but the doctors don't have to actually cure the patient to get paid. So many doctors just tell their patients the mantra of "diet and exercise," or "it's just anxiety," when the patient complains about pain, just as the priests of old would tell their confessors "say the Lord's prayer and end it with Amen" or whatever. How many people have you heard of who were told by their doctors that their cancers were nothing to worry about, and ended up dying prematurely?
So much blame for the high cost of healthcare is directed at the insurance companies, but who are the insurance companies really working for? Who are the insurance companies paying? It's the doctors. The insurance companies are just a convenient front organization for the doctors. If the doctor directly billed the patient for the exorbitant cost of a procedure, they know they would never get paid. So they and the insurance companies have set up a payment system that squeezes every last dollar out of the patient, the government, and businesses, and the insurance companies have agreed to take the heat of the public anger at the rising cost of healthcare. But in reality, who's raking in the big bucks? It's the doctors who are pulling in multi-six figure salaries, much more than in any other country of comparable wealth as the US.
The priests had an exploitative and underhanded way of extracting revenues from their believers as well. It was called indulgences, and Martin Luther exposed it for the dirty practice that it was. In my opinion, we should just ban health insurance altogether. If a person needs treatment for an illness, that person should be able to get it at an affordable price without paying for a policy beforehand. And the hospitals and physicians should be required to charge an affordable price for it even without insurance. Instead of Obamacare, which mandated that everyone needed to purchase health insurance, I would support a law that bans health insurance. Health insurance is the equivalent of papal indulgences, a practice that has through time and habit become so ingrained into our everyday lives that we have almost stopped questioning how terrible the system is, just as the medieval Europeans for so long accepted the practice of indulgences. But why do we have to pay for healthcare through insurance? There's no real answer. It's just how it's come to be. And we shouldn't just blindly accept an industry standard as some law of nature, as we seem to be doing.
Trump, Obama, and both parties seem to believe that health care reform can be achieved by tinkering, without changing things at a fundamental level. But I argue that the true cause of the healthcare problem lies in the irrational and unstated respect that we give to physicians, believing them to be entirely innocent, just as the Russian peasants believed in the myth of the "good Tsar," with all of their problems and poverty being blamed on the Tsar's advisers or the nobles (i.e. analogous to the health insurance corporations and drug companies). Some brave soul, preferably within the ranks of the medical profession itself, needs to call out the exploitative and underhanded practices of the medical profession, and call for a complete overhaul. Just as people in the early 16th century rose up and took religious matters into their own hands, and discarded a priesthood that had become irrelevant, patients and average citizens today should take their healthcare into their own hands, and imagine a bold new future where doctors simply aren't necessary, or act as consultants in which patients direct the course of their own care.
Also, the hospitals have become the new churches, owners of vast amounts of wealth, land, and resources, while the sick go bankrupt, just as the churches owned vast estates and properties at a time when there were food shortages and the peasants were barely scraping by. Science has replaced religion, and the doctors have become the new priesthood of this new science. But just as the new boss is the same as the old boss, the new priests are really the same as the old priests.
If you want real change, speak up for it. Don't accept the two-party system's talking points on healthcare. Go to your congressman and ask him difficult questions like,
"Why do we even need health insurance to be able to afford healthcare? Why can't it be like other goods and services that we buy when we need it? If obtaining healthcare through insurance has become the industry standard, why are you, as politicians, just accepting it as a fact of life? Why aren't you discussing alternatives to the insurance-based healthcare delivery model?"
"Why can't the government impose price controls on health insurance premiums so that they cannot exceed the Consumer Price Index as a temporary measure?"
"Why can't the government fund the creation of medical schools or expanding enrollment to increase the supply of doctors as a measure to control costs?"
"Why do I have to get permission from my doctor to get an MRI or some non-invasive medical procedure? Why do I not have the right to know about my own body and my own health? Doesn't the individual have absolute sovereignty over his own body? If so, why do I need another person's permission to learn about it?"
The powers that be want you to meekly accept the status quo. They want you to accept insurance as the only alternative to delivering healthcare. They want you to believe that the pre-Obamacare health insurance sector was a "free market," when in reality it was a controlled, highly regulated market. They want you think of temporary price controls as outside the Overton Window and not really acceptable. Don't let them.
There is a simple solution OP. Become a doctor. Open your own hospital. Run it the way you think it should be run.
But the insurance companies exist because healthcare is so expensive. You don't need insurance to pay your plumber when a pipe leaks. You don't need insurance to pay for an electrician when the lights go out. We need insurance FOR healthcare because healthcare is expensive. Insurance companies want to offer their customers the lowest price possible. They're competing against each other for customers. But because the underlying product/service that is being insured against is so expensive, they can't effectively compete!! The AMA has created a monopoly in training doctors, and in an economic sector in which demand is inelastic (price increases not reducing demand by much), that's a recipe for huge price hikes! Profit margins for insurance companies are almost invariably under 10%.
Big pharma is a problem, but drug costs contribute less to the total cost of healthcare than labor.
No! I think they should make what other skilled workers make like engineers, on par with other industrialized countries with similar GDP per capitas as the US. Doctors in the US aren't really any better than those in Europe, but they make almost twice as much.
Right now, doctors in the US make so much money that everyone wants to become one. It's sucking away an entire generation's talent pool. Think about all of the great scientists, engineers, inventors, etc that we are missing out on because everyone wants to become a doctor. There's a massive misallocation of resources right now.
Trump doesn't get it. He's always been a rich guy so he can't imagine that a guy making $300,000/year is somehow squeezing the system. But they are. Making $300,000/year without really taking on any risk or working insane hours is making a killing. And if you can't see that their huge salaries are the principal cause of the sky-high healthcare costs, well, you're one of those people who've been stupefied by the new priesthood.
I take it you've never heard of homeowner's insurance...which does exactly as you describe?
I've worked in medicine for years. It's not the doctors squeezing the system for the most part. It's the insurance companies, big pharma, and the for-profit, non-research hospital corporations.
You know what all three of those have in common? They are very profitable, and traded on Wall Street.
As for the doctors, what, you think they should work 12 hour days for 50k a year or something?
True story: my knee started acting up. I went schedule an appointment telling them I'd like to do an MRI. They set me up to see a Sports Medicine Doc. I get there, pay my $50 copay because it's a specialist. Meet the doc. Seems like a nice lady, we talk about running and stuff. She agrees I need an MRI. Sends me on my way... I tell her I scheduled this visit to have the MRI done. She says she needed to meet me and validate the need. I leave, but now I'm annoyed because I wasted $50 of my flex spending account, and my insurance company will probably be charged several hundred dollars for a 10 minute conversation with a specialist.
If it were a car, I wouldn't have gone to Discount tire to get a tire replace, spent hundreds for the first appointment to meet the tech, shaken his hand, and then had to schedule a second appointment just to do what I already knew needed to be done.
Don't tell me it's not the Doctors squeezing the system. They are just as complicit in the blatant ripping off of America as everyone else.
There is no law that MDs accept Medicare patients. When Medicare is stingy with MD reimbursements, fewer MDs accept Medicare or limit the number of Medicare payments. When Medicare increases MD reimbursements, more MDs accept more Medicare patients.
Medicare reimburses hospitals at an average rate within a Geo Rates area. That rate includes the hospital's overhead.
Medicare could negotiate/ regulate the price of prescription medications if Congress authorized them to do so.
Medicare, as is, is unsustainable from a financial standpoint. 11,000 people are turning 65 every day. Nonetheless, the oldest of the old is the fastest growing segment of the Medicare population. So much of what used to kill people just 50 years ago is now curable or treatable. And this costs serious money.
Politicians do not want to increase premiums ( Payroll taxes) and the enrollee and near enrollees do not want change. This voucher concept assumes the Federal Government would mandate health insurers insure the exposures of the elderly. Gawd only knows what premiums would cost given most Medicare enrollees have one or more chronic conditions.
The original framework of the ACA compelled healthcare providers to do end of life counseling. Opponents to the ACA got a lot of political mileage out of deeming such counseling to be death panels and it was removed from the legislation. And so people with end stage Cancer continue to recieve Cancer Treatment despite that there is no evidence that supports doing so. MDs recieve a percentage of the cost of drugs administered in their facility. And some ( certainly not most ) healthcare providers abuse/ game the system.
So long as healthcare remains a political football, this there is no hope for reform.
There is no sucessful model of free market healthcare anywhere in the world.
THANK YOU! This is totally spot on! The economic model we're on is fundamentally broken, and so ripe for abuse it's not surprise that our medical expenditures continuously rise at a rate that far exceeds inflation.
True story: my knee started acting up. I went schedule an appointment telling them I'd like to do an MRI. They set me up to see a Sports Medicine Doc. I get there, pay my $50 copay because it's a specialist. Meet the doc. Seems like a nice lady, we talk about running and stuff. She agrees I need an MRI. Sends me on my way... I tell her I scheduled this visit to have the MRI done. She says she needed to meet me and validate the need. I leave, but now I'm annoyed because I wasted $50 of my flex spending account, and my insurance company will probably be charged several hundred dollars for a 10 minute conversation with a specialist.
If it were a car, I wouldn't have gone to Discount tire to get a tire replace, spent hundreds for the first appointment to meet the tech, shaken his hand, and then had to schedule a second appointment just to do what I already knew needed to be done.
Don't tell me it's not the Doctors squeezing the system. They are just as complicit in the blatant ripping off of America as everyone else.
Absolutely. Quite a few doctors are scoundrels. (Not being facetious). Just look at the fraud, illegal prescribing of prescription drugs, etc. that takes place.
Most doctors care mostly about money and getting rich.
But again, don't blame them: blame society for being so afraid of dying. That's what makes all of this possible.
True story: my knee started acting up. I went schedule an appointment telling them I'd like to do an MRI. They set me up to see a Sports Medicine Doc. I get there, pay my $50 copay because it's a specialist. Meet the doc. Seems like a nice lady, we talk about running and stuff. She agrees I need an MRI. Sends me on my way... I tell her I scheduled this visit to have the MRI done. She says she needed to meet me and validate the need. I leave, but now I'm annoyed because I wasted $50 of my flex spending account, and my insurance company will probably be charged several hundred dollars for a 10 minute conversation with a specialist.
If it were a car, I wouldn't have gone to Discount tire to get a tire replace, spent hundreds for the first appointment to meet the tech, shaken his hand, and then had to schedule a second appointment just to do what I already knew needed to be done.
Don't tell me it's not the Doctors squeezing the system. They are just as complicit in the blatant ripping off of America as everyone else.
Why didn't you just go see your primary care doctor and let HIM decide if you needed to see a specialist and have an expensive MRI or if some other study would be appropriate and skip the specialist?? You have no one to be mad at but yourself.
There is no sucessful model of free market healthcare anywhere in the world.
The reason why is human compassion. In order for a free market to work, there has to be an equilibrium point between the price customers are willing to pay and the provider is willing to sell. That means some customers are willing (or forced) to go without the service because they cannot pay for it. When too many customers are lost due to that, the provider will lower the cost.
In healthcare, that means we have to be willing to let people suffer and possibly die in order to find the equilibrium (lowest) price point. But our humanity won't allow us to do that - we make sure that people who cannot afford care are covered in some way. The market is not floating and will not equilibriate at the lowest possible price as it does with everything else.
So while I pretty much believe in single-payer, the truth is any insurance system - private or medicare - that tries to cover everyone will never allow a true free market situation. The price of healthcare cannot come down and will probably just continue to rise. At some point price controls will have to be implemented which I think will be detrimental to the quality of care. But we cannot have it both ways - take care of all Americans AND have affordable care.
The reason why is human compassion. In order for a free market to work, there has to be an equilibrium point between the price customers are willing to pay and the provider is willing to sell. That means some customers are willing (or forced) to go without the service because they cannot pay for it. When too many customers are lost due to that, the provider will lower the cost.
In healthcare, that means we have to be willing to let people suffer and possibly die in order to find the equilibrium (lowest) price point. But our humanity won't allow us to do that - we make sure that people who cannot afford care are covered in some way. The market is not floating and will not equilibriate at the lowest possible price as it does with everything else.
So while I pretty much believe in single-payer, the truth is any insurance system - private or medicare - that tries to cover everyone will never allow a true free market situation. The price of healthcare cannot come down and will probably just continue to rise. At some point price controls will have to be implemented which I think will be detrimental to the quality of care. But we cannot have it both ways - take care of all Americans AND have affordable care.
Our (free market) health system DID have quite a bit of that "human compassion" you talk about.........50-100 years ago. Partly because of that, it worked quite well.
But hey, whoever said that the massive intrusion of The State into a social system ever had any negative, unintended consequences......right??
(Guess what started to happen with American healthcare around 50 years ago......hint hint.....)
Our (free market) health system DID have quite a bit of that "human compassion" you talk about.........50-100 years ago. Partly because of that, it worked quite well.
But hey, whoever said that the massive intrusion of The State into a social system ever had any negative, unintended consequences......right??
(Guess what started to happen with American healthcare around 50 years ago......hint hint.....)
Rising healthcare costs have more to do with the advancement of technology ( no MRIs back then), for-profit insurance companies, and big hospital chains than the creation of Medicare.
I swear. Some people want to blame the government for everything.
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