Health insurance builds all of those fancy buildings and pays high dollar executive compensation.

It's not where the real savings come from though.

that is a very high cost for them.

You're not going to cut 20% from reimbursements without actually making doctors take home a lot less money.

Big Corporations are not your friend.

Or, if it didn't, it wouldn't actually solve the problem.

Single payer can save a lot in terms of drug costs as well.

That's the main point I've been trying to make for a long time here: Single Payer can save money but it doesn't have to. It all depends on how it's actually done.

is a cultural shift that isn't even on the horizon ... as the OP indicated, Doctors like money, Pharma is in the business to make money, so are healthcare facilities.

While, we, in fact, can legislate out the profit motive; but, with that comes a loss of Doctors, Pharma, and healthcare facilities.

Doctors can make a little less money.

Big Pharma and health insurers are like giant leeches sucking money out of the system. Taking some of the profit motive out of the picture in those areas is a good thing.

Healthcare facilities will have even more customers than they do now, or at least business will be shifted away from their emergency rooms.

Doctors would accept "a little" less money, if student debt wasn't so burdensome,

Student debt is caused by many factors that have nothing to do with education, the explosion in administrative personnel in educational instutions and the enormous salaries paid, often coupled with extravagant spending and insider contracts with kickbacks. This needs to be addressed.


The problem with Big Pharma is that profit reigns supreme.

An easy example is AstraZeneca with Nexium and Prilosec.

When the patent for Prilosec expired they created Nexium, very similar but with 10 times the cost to the system than the now generic form of Prilosec. They spent hundreds of millions promoting the new version as superior. The reality....it wasn't....but they sucked Billions of dollars per year in by misleading everyone. This is not a rare occurrence. 10% of health care costs are the drugs prescribed .

This kind of behavior is mild, though when compared the spin and bribery that accompanies many "products" or when they ignore danger signs and kill you knowingly for profit.

One of the phrases that has become a political joke over the years is the notion of "eliminating waste, fraud and abuse"

Unfortunately it permeates all of our institutions and corporations. Uncoupling ourselves from the corrupt entities that value our money over our health is a good start.

more customers at lower compensation is not a given.....at the level of actual care .

You occasionally scoff at the idea that this is a revolution, but money has corrupted almost every aspect of our society. Without a revolutionary change in our thinking, our society will collapse from the weight of the corruption.

I am for single payer, just not lying to people about how much cheaper it will supposedly be.

drug companies to reduce their pricing to that of what other countries pay. Big Pharma is the driver in the high costs for healthcare, not doctors.

The biggest part of the pie, the orange pac man in those charts downthread, is "services", which is overwhelmingly hospitals and physicians.

We actually spend less per capita than Canada on pharma (though Canada sees that as their biggest cirrent problem) and roughly the same on nursing care. Where we are spending a lot more than them is reimbursements to hospitals and physicians. And if we want to have health care as cheap as Canada's, those reimbursements will have to fall. A lot. While those same hospitals and doctors are treating tens of millions more people than they are now.

but even if we had the overhead of Medicare (3%) vs the overhead of insurance (20%) that is only a 17% savings. Yes, it is a lot of profit for insurance companies (hence the big buildings and compensation) but it is nowhere near the 40+ % savings that our next leading competator gets.

or about 6% of the total spending.

that was a big mistake on my part.

You really think the profits of a few outweigh healthcare for all? That's awful.

You seem to be bemoaning the fact that Single Payer would be cutting payments. So we should not go to Single Payer. The ACA will never cover everybody, premiums and co-pays and out-of-pockets and drugs will just keep going up. That is both unsustainable and not good for people. The logical outcome - profits, for some, are more important than health care.

I can't believe you misinterpreted my post so badly.

it's not a misinterpretation; it's what you literally said.

How you think I agree with that, when I'm the one talking about how to actually lower payments to providers, is beyond me.

that does not address the reality of the OP ... single-payer will not occur without a fundamental cultural shift in the healthcare industry, i.e., accept less (which doesn't appear to be on the horizon without seeing a mass exodus from the field), or, an acknowledgement that single-payer won't be cheaper, which defeats the central single-payer argument.

I both agree and disagree.

I think single payer is doable in increments which require less capital up front as would be required to create it overnight.

I'd say this is how it should be implemented:

Years 26-45 can be given Medicare immediately. this age group generally doesn't require all that health care and adding them to Medicare will not be catastrophic. A subsidy can be provided to health insurance companies to keep premiums low on the rest of the population (because 26-45 subsidize insurance for other groups anyway)

After 3 years, participants can be increased to 26-55 and in another 3-5 years, Medicare for all.

This will be the least disruptive way of doing it. Not Bernie's plan of doing it overnight.

I hope that means you'll vote for him!

How many of the players would remain in the industry knowing that it means a guaranteed 20-40% reduction in revenue?

will result from amortizing up-front costs.

If the up-front costs are kept at a minimum, the fee reductions per patient will be modest and will be made up by increased volume.

Its the American Way.

Poor thing.

and then attribute them to me.

and congrats on starting a nice substantive discussion on the health care issue, aside from the silly folks trying to put words in your mouth.

system. The layers and layers of highly-paid suppliers don't want the gravy train to end, and the complexity of the system we have now makes it very hard to just get rid of it. Most other countries made the change many years ago when systems were much less complex and medicine was not such an enormous cash cow.

I don't know exactly how the govt should go about it, but one idea is to start up a totally parallel system of hospitals, doctors, small clinics, pharmacies, etc., that are geared toward saving on costs. Can the govt buy up a few bankrupt hospitals and staff it with doctors that will take the job to get their med school debts forgiven? Like that.

And most neighborhoods could use a simple clinic with a nurse practitioner for the most common afflictions -- that would keep people from having to go to the emergency rooms all the time.

As far as single-payer skeptics being incredulous that single-payer systems across the world save so much money -- well, if they had looked at actual healthcare systems and not had their minds clouded by 40 years of propaganda against anything govt does, they'd actually be able to evaluate systems instead of just do a knee-jerk reaction toward gubmint.

It doesn't require a single switchover moment; we can ramp it up incrementally.

The move to single payer should include a shift in how we provide healthcare to everyone.
The aca is a very good start in placing the focus to shifting to prevention however the services for providing these services is not there.

There has to be a transition for employees of insurance co"s to new jobs as well. Insurance co's employee a lot of people.

What I took from it is, before there can be any movement towards single-payer, there must be a fundamental cultural shift in the medical industry (from the doctor to hospitals/care facilities to Pharma) away from a money culture to a more altruistic culture.

I wonder if anyone has conducted a "values" survey comparing those of American medical professionals and "foreign" professionals?

To not even mention the role of private for-profit insurance companies is strange.

Frankly, I think that omission rather undercuts the entire piece.

Profit for insurance companies is 4% of our national healthcare spending (it was 7% before ACA).

It could be improved, but it's just not the big problem. The big problem is that US providers (physicians, hospitals, and drug and device manufacturers) make a lot more than their counterparts in foreign countries, even from Medicare.

Here is a portion of a rebuttal to the OP's article written by 'Physicians For A National Health Program' (PNHP)

The highest overhead part of our health care spending is, oddly enough, workers' compensation, but Medicare and Medicaid overhead are fairly significant, viz:



That's services, overhead, and stuff (ie, pharma and devices, mostly) as percent of US healthcare spending



And that's the public-private breakdown of the overhead

And here's the public breakdown:



Here's the spending by source:





(For the curious, here is a breakdown of "stuff&quot



(And here is "services&quot



So, if we can replace the 1/3rd of our health care spending that is private insurance with public insurance, at the overhead public insurance currently has, we would cut the private overhead rate in half, which would save about 4% of our annual spending. We'd save an additional 2% if that same process reimbursed providers at the same rate Medicare does. But the point is, we're not talking about "removing 31% of spending".

And, as Yglesias points out, that Medicare rate has been inflated by 20% for two decades now, and Congress proved itself absolutely incapable of actually holding doctors to the legal limits set. This is probably why providers like the idea of single payer so much: they know that they can attack any attempt to lower their reimbursements as "cutting Medicare".

-let alone no explanation (that I can find at these sites) of how you arrived at your conclusion/opinion?


Can you at least show what part of these sites provide the info you used? TIA

I linked them to you.

https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/NHE2013.zip

There, you don't even have to use CMS's menu now.

Read them. This isn't something that can be answered by a meme; you have to actually look at the data I linked you.

Even if I had the time or inclination to read that, (there are no pie-charts there btw) it still does not answer my question. How did you arrive at your conclusion/opinion?

In any event, none of this is germane to the article I posted from The Physicians For A National Health Program in rebuttal to the misinformation in your OP article.

But you know, at this point... just never mind. I'm sick of the shifts and evasions.

You're joking!

Yes, it's an absolute shit ton of numbers, and if you aren't inclined to go through them then why do you care about the issue?

And it absolutely answered your question; I got the numbers from those spreadsheets.

The google search for the top image is hilarious, I choose to not try it on the others.


Here is an example of the kind of numbers I am used to seeing for Medicare. Keep in mind that Medicare Advantage has been eliminated under the ACA.



http://www.pnhp.org/news/2013/february/setting-the-record-straight-on-medicare%E2%80%99s-overhead-costs

^snip^

The traditional Medicare program allocates only 1 percent of total spending to overhead compared with 6 percent when the privatized portion of Medicare, known as Medicare Advantage, is included, according to a study in the June 2013 issue of the Journal of Health Politics, Policy and Law.

The 1 percent figure includes all types of non-medical spending by the Centers for Medicare and Medicaid Services plus other federal agencies, such as the IRS, that support the Medicare program, and is based on data contained in the latest report of the Medicare trustees. The 6 percent figure, on the other hand, is based on data contained in the latest National Health Expenditure Accounts (NHEA) report.

Can you please link Directly to where you are getting those numbers?

As the legacy of the doctor fix shows



Can you please provide numbers which prove that "Single-payer systems save money by squeezing health care providers"?


Umm... you're honestly unaware that the US pays nearly twice as much for health care as the rest of the world? If you really need that proven to you, I can find a definitive statement of it.

Last edited Sat Jan 16, 2016, 10:17 PM - Edit history (1)

comprehensive public systems that deliver superior results at lower per capita costs. I guess, in the final analysis, we are just too stupid to get it right, and we are better off just sticking with our crappy ass expensive corrupt system.

They have the political will to pay their providers less, and we so far don't. These countries have a wide array of health care financing structures (some of which are remarkably similar to ACA); that's not our problem. Switzerland's private insurance companies pay hospitals significantly less than Medicare does.