Friday, May 5, 2017

Definition of Single Payer


Single Payer: "We're too stupid to figure it out, so if we get sick, just pay the provider whatever they say they want for whatever they say they needed to do to us."


36 comments:

Dan Lynch said...

Single payer = socialized insurance + for-profit providers.

RomneyCare = for-profit insurance + for-profit providers.

Zero payer = socialized insurance + socialized providers.

Medicaid is single payer. It is not a very good program, known for corruption and difficulty finding providers who accept Medicaid.

The VA is zero payer. It has high customer satisfaction and low cost. But as with England's NHS, the politicians are trying their best to drive the VA into the ground by cutting off funding so they can say "see, we told you socialism doesn't work well!"

Penguin pop said...

Dan, I love the idea of zero payer. I'm also familiar with how Medicaid works because I've had it before and I think I still do now and can attest to how difficult it could be to find providers who accept it.

MRW said...

Single Payer: "We're too stupid to figure it out, so if we get sick, just pay the provider whatever they say they want for whatever they say they needed to do to us."

Hunh? This makes no sense.

Ignacio said...

Dan happening all over Europe really, "we are out of money, cut, cut cut; too many elders, not enough young people, system unsustainable, we need more GROOOOOWTH" (growth zombies don't look at productivity growth over the last two decades and poor income distribution, just nominal growth; meanwhile >40% unemployment youth rate LOL)

It's absurd.

Noah Way said...

@MRW, much of what Matt says makes no sense.

Penguin pop said...
This comment has been removed by the author.
Penguin pop said...

Matt's a math guy, not a verbal guy, so it's sometimes harder for him to write things in plain English. I don't even understand what his point is here, and I like when he mentions "USD Zombies."

Matt Franko said...

The providers should have to commit to a fixed monthly amount to provide healthcare in a somewhat competitive environment...

Single payer is a blank check no one should have that other than our elected representatives...

Matt Franko said...

Trump has actual numbers in his legislation to pay both premiums and deductibles that seem to be inadequate under current arrangements based on what we have been seeing ...

meanwhile he is saying that BOTH premiums and deductibles are going to come DOWN maybe to where he has his numbers or pretty close...


Matt Franko said...

So instead of examining this, Democrats say the GOP went out and got beer or wtf...

If he pulls this off a bunch of people are not looking very good AT ALL...

Tom Hickey said...

Trump has actual numbers in his legislation to pay both premiums and deductibles that seem to be inadequate under current arrangements based on what we have been seeing ...

meanwhile he is saying that BOTH premiums and deductibles are going to come DOWN maybe to where he has his numbers or pretty close...


The numbers work by reducing the # of insured through excluding high risk people (preexisting conditions) and "poor people" (Medicaid), or reducing the coverage, e.g., higher deductibles. In the case of the later, the monthly is more affordable because the deductible is higher.

If affordability is the issue, which the GOP has declared it is, then some people are going to have less to bring the cost down unless productivity or efficiency are increased. They are willing to have fewer insured and higher deductibles, lifetime limits, etc., pushing greater risk on individuals.

Tom Hickey said...

If he pulls this off a bunch of people are not looking very good AT ALL..

Premature excitement. The Senate has to weighing and they the House and Senate bills have to go through reconciliation. We still have no idea what the end result will be, if they can actually pass a bill.

But the time this gets through reconciliation and a final vote, the US will be in the throes of the midterm campaign season and the political landscape will look different from now.

Look at this is the initial offer in the negotiation. That is how DJT is viewing it. He knows this is far from a done deal and that the House bill has issues.

Ryan Harris said...

The high-risk people aren't excluded, they are put in high risk pools if they don't already have group insurance. High risk pools are subsidized by the widest possible group: EVERYBODY who has insurance and government. The premiums they pay, are usually capped at twice the median policy price for their demographic or something along those lines and the benefits are usually pretty generous with small deductibles and very little out of pocket.

Matt Franko said...

At some point the providers should be made to write down a number.... everybody else has to they shouldn't be given a pass and a blank check like they have been getting...

Tom Hickey said...

The numbers are already written down. Everything has a code.

Nothing is provided that is not coded and everything is priced on the basis of codes. The discounts are applied afterward.

I get a Medicare statement with the total that provider submits to Medicare and the amount that Medicare paid after the discount, which is usually substantial.

If the provider submits a wrong code, Medicare denies payment for that procedure or device. Then you have to call Medicare to find out why it was denied. In the case of a wrong code, you then call the provider to get the right code submitted, after which Medicare approves.

What providers cannot do is say before a patient is examined what the cost will be. The first step is diagnosis, which determines the appropriate procedures. In most cases this cannot be done prior to individual diagnosis.

The patient also has input. The physician explains the options and the tradeoffs and then answers the patient's questions. Finally, the physician asks for a decision about how the patient wishes to proceed. In such cases it not possible to know beforehand what the cost will be for a particular treatment. One person may opt for an expensive but risky intervention and another may decide to pass.

This is not too different from automotive repair actually and probably a lot of other things that have been digitized and are priced by code. A technician runs a diagnostic and gives an estimate based on the coding, with the proviso that matters may change when after the repair begins owing to discovery.

But in the end it is all in the database using established codes.

Noah Way said...

I need a hernia repair but can't get a price for it. Empire under BO care won't tell providers what they will allow for any procedure. Surgeon, anesthesia, and hospital, nobody has a schedule of fees or allowed costs. I have a big deductible. Fuck me. Maybe I'll just get it done and then offer them all $0.10 on the dollar.

Ryan Harris said...

Before the GOP stonewalled, now the Dems. Everyone loses while the two parties divide the electorate.

Tom Hickey said...

How to Figure Out the Cost of a Medical Procedure Before it Happens

FH Medical Cost Lookup: Get Started

CMS.gov: ICD-9-CM Diagnosis and Procedure Codes: Abbreviated and Full Code TitlesICD-9-CM Diagnosis and Procedure Codes: Abbreviated and Full Code Titles

Noah Way said...

The FH link was the only one that gave me any real info. Only estimated, of course. Interesting how the Medicaid cost is shown as 3X private insurance.

What's up with that - price gouging the poor and the state?

Neil Wilson said...

Time to stop talking about money.

The actual question is whether rich people should be able to reserve scarce medical resources for their own benefit just because they have money - at the expense of poor people.

It is a fundamental political question about whether poor people should die just so rich people don't have to time shift their less urgent medical requirements and wait a bit.

In particular the vanity ones.

Bob said...

Socialized medicine is coming to America, imagine that!

Hell must have frozen over...

Noah Way said...

There is no scarcity of medical resources. This is a huge industry that obstructs delivery of care to increase profits.

Dan Lynch said...

@Neil, why are medical services scarce in the U.S. and U.K. but not in Cuba?

Are the residents of Cuba genetically superior to Anglos such that Cuba has a higher % of citizens intelligent enough to become doctors?

Or is it because Cuba offers free medical school and has no parasitic FIRE sector to compete for talent?

Matt Franko said...

Dan in Cuba the doctors are effectively slaves so the business side of it works down there...

If we had medical slaves in US we wouldn't be having this discussion....

Dan Lynch said...

They are no more slaves than we are, Matt. The market does not set us free, it only sets the rich free.

Matt Franko said...

"ime to stop talking about money."

It's not talking about "money" .... "money" is how we measure price, etc so it is going to be involved in the discussion....

Tom those price schedules are like looking at a room service menu in one of Trumps hotels.... that is not the way HE purchases the things that are on his menu in onesies twosies....

Ignacio said...

"It is a fundamental political question about whether poor people should die just so rich people don't have to time shift"

The first effective principle of conservatism is: conserve myself above everything else, if needed be throw everyone under the bus.

The first principle of "propertarianism" is: everything is property, it can be bough, and exchanged, at convenience by the highest bidder, this includes the so called "healthcare".

The first principle of capitalism is: capital trumps everything, capital is first class citizen, above everything else; you don't have the monies? Sorry pal, get rekt.

We live in a system which is: conservative, propertarian and capitalist. this model is specially liked in the USA and England, in the former they even worship people Ayn Rand (a leading figure of propertarianism and capitalism) So the clear answer to the question is YES, we allow for that behavior to exist, just like we allow welfare healthcare sectors to exist (welfare for healthcare industry, insurance and pharma), etc.

Oh, and it's your fault you are not getting proper healthcare, you are just stupid lazy scum, "something something" freedom!!!, world will be a better place without you. (last part is sarc btw)

Neil Wilson said...

""money" is how we measure price, etc so it is going to be involved in the discussion"

If you do, you divert the issue.

You talk about money after you close the sale. And politics is all about selling.

Neil Wilson said...

"Or is it because Cuba offers free medical school and has no parasitic FIRE sector to compete for talent?"

There are lots of reasons. Is the demand side suppressed? Is the supply side over represented? Do lots of poor people die young? Do lots of people just leave? Are there just no other options? Have you misunderstood the statistics, or fallen for propaganda?

But certainly the use of scarce resources in a pointless financial sector doesn't help. Nor does the restriction on training places (bearing in mind that training also uses up scarce medical resources).

Ryan Harris said...

There are 23 hospitals and 55 medical institutions within 10 miles of my house with more than a million medical professionals work in the area. Scarcity is definitely not a problem. Regional hospitals in the suburbs and other parts of town aren't even included, it's just insane. Here is the skyline for the medical district. That is all medical, nothing else besides a few restaurants and hotels. Money and Finance is the problem not scarcity. The parking garages have sections where the doctors park, impressive. Rolls, Lamborghini, Ferrari, Mercedes, BMW, a few trashy lexus maybe...exotic vehicle competition clearly is clearly an issue for doctors.

Tom Hickey said...

Rolls, Lamborghini, Ferrari, Mercedes, BMW, a few trashy lexus maybe...exotic vehicle competition clearly is clearly an issue for doctors.

This may not be the issue it seems. Physicans have a long and grueling road to hoe before they make it into practice and then about a three decade window to rack up the rewards. During this time, they work long hours and at a furious pace.

The make a lot of $ but don't have much time to spend it so they have fancy well-furnished houses, nice cars, and some exotic vacations now and then.

But they are actually highly productive.

This is not necessarily the case with a lot of other people that are high rewarded and many much more generously reward than physicians.

It's true that physicians in the US have it much better than elsewhere but that is a choice the country has made.

However, the price increases in healthcare are generally owing to other factors than physicians being able to hike their fees.

Dan Lynch said...

@Tom, it's a choice the AMA has made for us. Or in the case of the NHS, the choice was made by corrupt politicians. At no point did we the people vote on how many hours doctors should work or how many med schools or teaching hospitals the government should provide.

There is no long and grueling road to become a physician in Finland. Not only is education free, but they are paid a stipend for attending school (despite that, Finland has a doctor shortage due to the EU's open borders).

Most of the U.S. doctors that I know had their education paid by affluent parents. No hardship was involved.

Doctors don't necessarily work any longer hours than other occupations. At my last engineering job I was on call 24/7, and often had to come in at night in addition to my regular day hours. I have had many construction and maintenance jobs where seven 12's were the norm for part of the year, and those were grueling physical jobs.

Doctors per 1000:
Cuba = 6.7
Greece = 6.2 (it's probably declining due to the Euro-mess)
Russia = 4
US = 2.4

Why so few doctors in the U.S.? Why are American doctors paid so damned much?

"The basic answer is that U.S. doctors operate as a cartel. They artificially limit their own ranks, which drives up their compensation."

In other words, they are rentiers.

Noah Way said...

BS stats. US has more doctors per capita than Sweden and Canada. Shortages are decided by insurance and cost, not availability of service.

Having an unhealthy population can skew the stats.

Dan Lynch said...

@Noah, so the internet is in a giant conspiracy to skew doctor statistics in order to make the U.S. look like a third world country compared to Sweden?

What if the U.S. really is a 3rd world country?

You are correct that Canada has slightly fewer doctors per 1000 (2.3) than the U.S.. Canada's health care cost (the government's cost, not the individual) is relatively expensive, about the same as the per patient cost for the U.S. Veteran's Administration, last I heard. VA able to deliver care for approximately $5,000 per patient. That's 35 percent less than Medicare (2004)

Noah Way said...

@Dan

Stats are silly things. I alluded to such by citing the relativity of a population's general health to the number of doctors per capita.

The US is the world's largest Banana Republic.

http://www.salon.com/2013/09/11/10_ways_america_has_come_to_resemble_a_banana_republic/

Ryan Harris said...

So many small villages in the far reaches of Canadian shield, it MUST be expensive to get care to everyone.