This is the core problem.
I'm all for Medicare for all, but what to do with the many physician assistants, nurses, billing specialists that the US is employing and promoting as a middle class career as we speak.
These people will not just stay silent when they become unemployed because practitioners can't afford to keep them.
You need retraining programs (in what? Beats me ...), fund unemployment insurance ...
The point is that things don't happen in a vacuum.
Anecdotally, I see the situation in France (I'm from there). Unemployment is always high.
People have great healthcare, but they are still struggling with mininum income service jobs. They won't be ruined by a cancer diagnosis though.
I don't think any western countries has figured out how to expand the middle class in recent
times without heavy subsidies (in the US, we are effectively subsidizing those jobs with our high costs)
Keep the PAs and nurses, lose the billing specialists. Seems like a really clear cut call to me.
I know they're people, maybe we could have retraining programs, but it's not like private capital says "what about the people?" when trimming the redundant.
Hmm. I have assumed that there would be large efficiencies available here, because (while there would still be paperwork) you wouldn't have the insurance company employing people to find ways to avoid paying the doctor, which leads to the doctor having to hire people to find ways to get the insurance company to pay like they're supposed to. (I literally had an insurance company that denied something like 2% of all claims every month, because many patients would just pay the doctor themselves rather than question the insurance company's rejection.) With Medicare, you shouldn't have that going on...
... until Medicare is underfunded. And, if funding comes from Congress and is therefore a political football, do you really think that it will be adequately funded?
Wayyyy simpler, and it's only one system instead of many conflicting ones.
It seems like the real problem is that "insurance" has something to do with <$1000 bills to begin with. The overhead is negligible if the bill is going to be large enough to actually require being insured against, but then we use "insurance" for routine care that wouldn't otherwise be expensive enough to justify it and then no surprise there is unnecessary overhead.
Medicare and SS move money around much more efficiently than any private system in terms of overhead.
They make the same argument about the IRS. Look how much money it "brings in" compared to the number of people it employees. Very "efficient" -- except that the money they take in was already the taxpayer's to begin with, so moving it around is net of zero and the only thing there is cost. And they don't count the overhead on the taxpayer's side of doing the paperwork either.
It's the same here. Most of the insurance paperwork is to prevent insurance fraud and determine coverage and prevent unnecessary procedures. It's not more efficient to pay for more unnecessary procedures and lose more money to fraud.
And you're still not going to beat the overhead of the patient going in for a $100 procedure, paying $100 for it, and never involving a third party to the transaction at all.
Dude, look at the topline numbers. They are completely fucked.
Of course they are. Healthcare costs in the US are completely out of control. But if you want a better system you need to understand what causes it to be the way it is. Keeping every expensive thing about the existing system and just changing how the money is transferred is not going to fix it.
Meanwhile, 10/10 developed nation socialist healthcare systems are comparatively cheaper and better.
They are cheaper because of specific flaws in the US system that cause costs to be high, which are real and need to be fixed but are independent of socialization. Low deductible insurance that encourages unnecessary tests and involves "insurance" in low cost routine transactions (currently caused by tax laws encouraging employer-provided insurance, but Medicare doesn't make it better), liability rules that encourage doctors to do the same unnecessary tests, certificate of need laws and other limits on the supply of doctors, the high cost of getting FDA approvals, lack of price transparency etc.
And the patient outcomes in the US system are better for anyone who has health insurance. The net outcomes are worse only because the outcomes for people without health insurance are very bad, because the independent flaws cause routine care to be prohibitively expensive and people without insurance often go untreated, which brings down the average dramatically.
That is completely broken and we need to fix it, but how about we do that without throwing away the part where the patient outcomes are better for the majority of people who are actually participating in the healthcare system?
Comments
Health insurance takings don't have to be 'profits' to be waste.
How much unnecessary work happens around crazy billing systems and arguing over who pays what? Those people all draw salaries.
This is the core problem. I'm all for Medicare for all, but what to do with the many physician assistants, nurses, billing specialists that the US is employing and promoting as a middle class career as we speak.
These people will not just stay silent when they become unemployed because practitioners can't afford to keep them. You need retraining programs (in what? Beats me ...), fund unemployment insurance ...
The point is that things don't happen in a vacuum.
You're looking at it backwards. We, as a society, can stop wasting people on this nonsense, and find something worthwhile for them to do.
(Yes, and we have some responsibility to make it possible for them to find a new way to earn a living, training them if needed.)
Anecdotally, I see the situation in France (I'm from there). Unemployment is always high.
People have great healthcare, but they are still struggling with mininum income service jobs. They won't be ruined by a cancer diagnosis though.
I don't think any western countries has figured out how to expand the middle class in recent times without heavy subsidies (in the US, we are effectively subsidizing those jobs with our high costs)
Keep the PAs and nurses, lose the billing specialists. Seems like a really clear cut call to me.
I know they're people, maybe we could have retraining programs, but it's not like private capital says "what about the people?" when trimming the redundant.
Except that Medicare is "insurance" and correspondingly still has insurance paperwork.
Hmm. I have assumed that there would be large efficiencies available here, because (while there would still be paperwork) you wouldn't have the insurance company employing people to find ways to avoid paying the doctor, which leads to the doctor having to hire people to find ways to get the insurance company to pay like they're supposed to. (I literally had an insurance company that denied something like 2% of all claims every month, because many patients would just pay the doctor themselves rather than question the insurance company's rejection.) With Medicare, you shouldn't have that going on...
... until Medicare is underfunded. And, if funding comes from Congress and is therefore a political football, do you really think that it will be adequately funded?
Wayyyy simpler, and it's only one system instead of many conflicting ones.
Medicare and SS move money around much more efficiently than any private system in terms of overhead. Sometimes innovation is a downside.
It seems like the real problem is that "insurance" has something to do with <$1000 bills to begin with. The overhead is negligible if the bill is going to be large enough to actually require being insured against, but then we use "insurance" for routine care that wouldn't otherwise be expensive enough to justify it and then no surprise there is unnecessary overhead.
They make the same argument about the IRS. Look how much money it "brings in" compared to the number of people it employees. Very "efficient" -- except that the money they take in was already the taxpayer's to begin with, so moving it around is net of zero and the only thing there is cost. And they don't count the overhead on the taxpayer's side of doing the paperwork either.
It's the same here. Most of the insurance paperwork is to prevent insurance fraud and determine coverage and prevent unnecessary procedures. It's not more efficient to pay for more unnecessary procedures and lose more money to fraud.
And you're still not going to beat the overhead of the patient going in for a $100 procedure, paying $100 for it, and never involving a third party to the transaction at all.
Dude, look at the topline numbers. They are completely fucked.
Meanwhile, 10/10 developed nation socialist healthcare systems are comparatively cheaper and better.
I'm not super impressed by well-written rationalizations in light of those facts.
Of course they are. Healthcare costs in the US are completely out of control. But if you want a better system you need to understand what causes it to be the way it is. Keeping every expensive thing about the existing system and just changing how the money is transferred is not going to fix it.
They are cheaper because of specific flaws in the US system that cause costs to be high, which are real and need to be fixed but are independent of socialization. Low deductible insurance that encourages unnecessary tests and involves "insurance" in low cost routine transactions (currently caused by tax laws encouraging employer-provided insurance, but Medicare doesn't make it better), liability rules that encourage doctors to do the same unnecessary tests, certificate of need laws and other limits on the supply of doctors, the high cost of getting FDA approvals, lack of price transparency etc.
And the patient outcomes in the US system are better for anyone who has health insurance. The net outcomes are worse only because the outcomes for people without health insurance are very bad, because the independent flaws cause routine care to be prohibitively expensive and people without insurance often go untreated, which brings down the average dramatically.
That is completely broken and we need to fix it, but how about we do that without throwing away the part where the patient outcomes are better for the majority of people who are actually participating in the healthcare system?