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Taxpayers don't realize how expensive putting someone on Death Row costs. $3 million at least, because once on a Death Row they're allowed 12 appeals which can stretch out for years. Of course, the lawyers handling those appeals will, obviously, be opposed to abolishing the Death Penalty.
I think you are wrong. These lawyers would want to abolish the DP. Lawyers that represent the death row inmates are low paid as far as lawyers go. It's mostly public defenders and/or volunteers and/or panel (i.e. government pay scale) attorneys. It's more of a mission or a love type thing for those lawyers.
The main tenant of the argument is true, but the fundamental problem is hospital billing. They charge an obscene amount for care because insurance companies are paying the bills and passing the costs through the premiums and high deductibles.
You're in the right vicinity... but not quite a bulls-eye.
The $12K number has already eliminated all insurance company interaction.
Quote:
Originally Posted by Dom Cobb
Your right, I’m paying a lot in premiums and not using the care and subsidizing everyone else.
That $12K is everyone - so one payer subsidizing another has already been netted out.
Quote:
Originally Posted by Dom Cobb
However, imagine for a minute that hospitals would no longer be able to charge whatever they wanted, and a single payer system would pre negotiate the costs? Yeah, that 12k per person on average would drop significantly.
Most hospitals are not-for-profit. They don't charge whatever they want. They are charging to cover the costs of delivering the service. Let's say the cost of removing an appendix, all-in, is $X. If a single payer says, "we'll reimburse you for $Y," where $Y is, say, only 60% of X. The hospital will respond by no longer offering the removal of an appendix. This is no different from any other form of a government-imposed price ceiling. For example, if a grocery's price for, say, tomatoes were regulated to be at most $.05 per pound, in short order there would be no tomatoes for sale. Grocery stores would no longer buy tomatoes at wholesale as they could no longer sell them for a profit. Growers, faced with zero demand at wholesale, would stop growing and switch to other crops.
***
But, as I said, I believe you're in the right vicinity. The issue is not the price a hospital charges to remove, for example, an appendix; the issue is the cost -- not the price -- the hospital incurs to offer that service.
The surgeon who performs that hypothetical surgery makes a very good living but is not getting rich (no private Gulfstream jets or mega-yachts). Ditto for the anesthesiologist.
The operating room nurses and support staff make a nice middle-class living but are not getting rich.
Hospital CEOs/COOs/CFOs etc get paid a lot of money, but they are not hedge fund managers by any stretch.
Where does all the money go? The ineluctable conclusion is the costs are in administrative bloat.
Today, that hospital (or doctor's clinic or imaging center or physical therapy clinic, etc etc) employs hundreds of people whose sole job is to bill insurance companies, re-bill insurance companies, deal with patients, etc etc.
Indeed, paid consultants give seminars to the medical billing staff on how to code bills sent to insurance companies so as to maximize reimbursements. Those paid consultants then get on a plane and fly to insurance companies to teach seminars on how to identify excess charges on bills sent by hospitals so they can minimize payments to hospitals.
Under your hypothetical Single Payer system, those hospitals still employ hundreds of medical billing and other administrative staff. Instead of billing the insurance companies, they bill the Single Payer. The same games occur: figuring out how to bill the Single Payer so as to maximize reimbursements, and the Single Payer still trying to figure out how to minimize reimbursements.
That is, it is "game theoretic." Just like the nuclear arms race, each side must employ administrativors & bureaucrats to maximize/minimize revenue precisely because their adversary does. Today, this is hospitals & insurance companies. Under a "single payer" system, it is hospitals & the Single Payer.
That is, Single Payer does not result in lower costs in the system. The only way - the ONLY way - to get lower costs is to fire people. All that administrative bloat of billing people: fire them. All that administrative bloat of computer systems and back-office billing & customer service people: Get rid of them.
Only by actually separating human beings from the payroll do costs go down at the hospital and hence prices could follow going down.
Anything else - everything else - is just rearranging deck chairs on the Titanic. And, as I said, I'm under no illusion that this can occur.
Thus, single payer does not result in lower costs. It does not result in lower prices. Single payer does not solve the problem.
Reminds me of that quote, "no way to prevent this says only nation where this regularly happens". Every other country that implements single payer ultimately has significantly lower costs, period.
Yes there are a variety of ancillary things that need to occur. Administratively it should be easier to administer against contracts, claims, pre-authorizaiton, etc. with a single payer vs who knows how many separate insurers. Costs would be standardized and heavily negotiated. Drug prices need to be negotiated (US needs to stop subsidizing world drug R&D).
The healthcare and insurance lobby has probably at least a trillion reasons to work against it, but ultimately it's where were are going to end up. As healthcare costs continue to exceed inflation rate, we can't afford not to.
Quote:
Originally Posted by RationalExpectations
Thus, single payer does not result in lower costs. It does not result in lower prices. Single payer does not solve the problem.
You're in the right vicinity... but not quite a bulls-eye.
The $12K number has already eliminated all insurance company interaction.
That $12K is everyone - so one payer subsidizing another has already been netted out.
Most hospitals are not-for-profit. They don't charge whatever they want. They are charging to cover the costs of delivering the service. Let's say the cost of removing an appendix, all-in, is $X. If a single payer says, "we'll reimburse you for $Y," where $Y is, say, only 60% of X. The hospital will respond by no longer offering the removal of an appendix. This is no different from any other form of a government-imposed price ceiling. For example, if a grocery's price for, say, tomatoes were regulated to be at most $.05 per pound, in short order there would be no tomatoes for sale. Grocery stores would no longer buy tomatoes at wholesale as they could no longer sell them for a profit. Growers, faced with zero demand at wholesale, would stop growing and switch to other crops.
***
But, as I said, I believe you're in the right vicinity. The issue is not the price a hospital charges to remove, for example, an appendix; the issue is the cost -- not the price -- the hospital incurs to offer that service.
The surgeon who performs that hypothetical surgery makes a very good living but is not getting rich (no private Gulfstream jets or mega-yachts). Ditto for the anesthesiologist.
The operating room nurses and support staff make a nice middle-class living but are not getting rich.
Hospital CEOs/COOs/CFOs etc get paid a lot of money, but they are not hedge fund managers by any stretch.
Where does all the money go? The ineluctable conclusion is the costs are in administrative bloat.
Today, that hospital (or doctor's clinic or imaging center or physical therapy clinic, etc etc) employs hundreds of people whose sole job is to bill insurance companies, re-bill insurance companies, deal with patients, etc etc.
Indeed, paid consultants give seminars to the medical billing staff on how to code bills sent to insurance companies so as to maximize reimbursements. Those paid consultants then get on a plane and fly to insurance companies to teach seminars on how to identify excess charges on bills sent by hospitals so they can minimize payments to hospitals.
Under your hypothetical Single Payer system, those hospitals still employ hundreds of medical billing and other administrative staff. Instead of billing the insurance companies, they bill the Single Payer. The same games occur: figuring out how to bill the Single Payer so as to maximize reimbursements, and the Single Payer still trying to figure out how to minimize reimbursements.
That is, it is "game theoretic." Just like the nuclear arms race, each side must employ administrativors & bureaucrats to maximize/minimize revenue precisely because their adversary does. Today, this is hospitals & insurance companies. Under a "single payer" system, it is hospitals & the Single Payer.
That is, Single Payer does not result in lower costs in the system. The only way - the ONLY way - to get lower costs is to fire people. All that administrative bloat of billing people: fire them. All that administrative bloat of computer systems and back-office billing & customer service people: Get rid of them.
Only by actually separating human beings from the payroll do costs go down at the hospital and hence prices could follow going down.
Anything else - everything else - is just rearranging deck chairs on the Titanic. And, as I said, I'm under no illusion that this can occur.
Thus, single payer does not result in lower costs. It does not result in lower prices. Single payer does not solve the problem.
Your wrong to think that because a hospital is a non profit that they don’t contribute to higher costs. Look at colleges, and their non profit status and it had not caused costs to spiral.
The single payer allows set prices to be negotiated and the nonsense of in network and out of network coverage stops. I know many people (myself included) who went to an in network hospital only to have a doctor that was out of network look at them unbeknownst to them out out of their control bill them at a much higher rate.
Single payer won’t be perfect. But it’s at least more transparent than the madness we are working with now.
So my brother worked for the Obama Administration to change the financial incentive of health care from being profit driven...
There is a common misconception that "Non-Profit" means "Low Cost." It doesn't - at least not by itself. Non-profits have their own administrative bloat.
Take, for example, the non-profit Kaiser Permanente. http://www.kp.org. Kaiser Permanente is a consortium of both for-profit and not-for-profit integrated health insurance & health care entities with over 21,000 physicians and nearly 210,000 total employees.
Looking solely at the non-profit side of the business, Kaiser Foundation Health Plan and Kaiser Foundation Hospitals reported a combined $3.8 billion in net income on $72.7 billion in operating revenues.
The following images contain data from a recent IRS Form 990 - which is public information (again, this is for the NON-PROFIT). I'm showing just top employee compensation as reported by the non-profit entity. I'm just including TITLE, NAME, HOURS PER WEEK WORKED, COMPENSATION and OTHER COMPENSATION.
Clearly, the following non-profit compensation isn't low.
So my brother worked for the Obama Administration to change the financial incentive of health care from being profit driven by keeping people sick to paying doctors to keep people healthy to prevent health care costs from rising similar to the European model. Doctors will get paid for preventative medicine instead...
Our current system is screwed up beyond repair. Such an alternative may be worth trying. I certainly don't have an answer.
Note that in my post above, Kasier Permanente has 21,000 physicians and nearly 210,000 total employees.
Think of the payroll cost for Kaiser Permanente. Does switching to "paying doctors to keep people healthy" reduce their payroll expense? Do they need fewer Doctors? I doubt it. Fewer nurses? I doubt it. Fewer facilities maintenance people? Nope. Fewer supervisors & managers & directors & assistant VPs and VPs and senior VPs and executive VPs? I doubt it; you need a lot of managers for 210,000 employees.
Each of those people in the above paragraph has a mortgage (or rent). They have car payments. Would any of them say, "You know, I'm willing to work for 10% less for the good of the country?" Maybe a few, but I suspect they are outliers.
I don't see how switching to an alternate model ("paying to keep people healthy") will materially change the payroll expense of Kaiser Permanente and hence the reimbursement from a hypothetical "Single Payer."
The slightly better question is, "Under a hypothetical 'Pay to Keep People Healthy' model, how can we shrink the payroll expense?" That is, reduce headcount. Lay off people. People whose lives will be severely altered for the worse. Imagine a 50-something non-clinical employee for Kaiser Permanente who earns, say, $150K/year in the back office doing administration. Imagine she loses her job - she's been "downsized" - because of some substantial change to reimbursement methods. What in the world is she going to do to make her mortgage? Pay for college for her kids? Etc?
It is only be shrinking headcount -- and throwing people out of work -- that we can shrink that $12,000 per person per year, most all of which goes to labor.
I'm not smart enough to know the answer, by the way, and I'm the first to admit it.
ironically, will smith's movie company pulled out of Georgia for filming. Since its rated R, you would need an id to prove your age to see the movie... guess that's ok, but id is not ok for voting...
Apples and oranges. Not everyone going to see the movie would have to provide IDs, just those who appear that they might be underage.
Anyways, all the research shows that switching to Medicare for All would save us enormous amounts of money and people would be healthier.
I'm not sure specifically what research you are citing. I'd love to read it if you can post a link. I'm skeptical, of course. Would we as a nation consume less health care goods and services? Would we as a nation reduce the number of people employed in the industry - that is, lay off hundreds of thousands of people (perhaps millions) to reduce payroll expense? I doubt it.
Quote:
Originally Posted by Merry Lee Gather
This study was actually funded by the Koch brothers in order to disprove that universal health care was beneficial.
Your wrong to think that because a hospital is a non profit that they don’t contribute to higher costs.
I didn't mean to imply that. I guess my writing wasn't clear. Please see post #75 - you and I both agree that "non-profit" does not necessarily mean "low-cost."
I didn't mean to imply that. I guess my writing wasn't clear. Please see post #75 - you and I both agree that "non-profit" does not necessarily mean "low-cost."
I think your making my argument here. If prices were capped or negotiated, I think the hospitals would reduce costs accordingly and possibly layoff or reduce headcount.
Is that a bad thing? Sure, but it’s not unlike any other industry that faces a economic change. Just because it’s health care doesn’t mean they should not streamline and reduce inefficiency. The solution they have been able to get away with for years is passing costs into customers, and not look at the fundamental problem with how healthcare dollars are spent. They look to their shareholders or BOD.
Healthcare is a completely inelastic market. There are no substitutes and you have little negotiating power and price information. How is anyone able to make an informed decision when it comes to healthcare if there is complete non transparency.
I think you are arguing against single payer because you don’t think it’s going to solve the problem? Sure, you could be right but my point is at least try. It can’t get any worse than it is right now.
The biggest opponents of single payer are the insurance companies and hospitals, as they would be forced to change the way they do business. That should tell you what their motivation is.
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