A suggestion for single-payer advocates

[ccr1138.livejournal.com]

I have a friend who is a pediatrician and a strong advocate for government-run, single-payer health insurance. To her and all her friends who have formed an organization to fight for socialized medicine, I say this:

If you truly believe in single payer, why not set up your practice now so you ONLY take Medicaid patients? This is a serious suggestion; I’m not trying to be snide. Medicaid patients have an extremely difficult time finding doctors because the government doesn’t pay very much for those services. But if we went to single-payer, EVERYBODY would be like a Medicaid patient. If you truly think that’s best, and you’re willing to take lower compensation for your work for the public good, why not start now? You could significantly reduce your paperwork and staff requirements because you wouldn’t have to hassle with all the different providers. It would be a win/win, and it would be ethically consistent with your stance against private insurance.

My doctor in Canada said he received $8 for a patient visit. That’s Canadian dollars, mind you. Do you think that would work for you?

Comments

[meus-ovatio.livejournal.com]

Sure thing. I'll do that, and you can go ahead and only go to those places that don't provide abortions, and we'll stop bitching, and everything is cool, and we'll just throw "politics" into the dustbin of history! Brilliant!

[ccr1138.livejournal.com]

Don't I wish.

[qnetter]

At an average of eight patient visits an hour, sure.

[xforge.livejournal.com]

What's that like seven and a half minutes per patient? That's more than I saw my doctor last time I went in.

[ccr1138.livejournal.com]

I even offered to pay him cash to let me make an appointment so I wouldn't have to wait 2-5 hours each time, but that's not allowed.

[rosicrucian.livejournal.com]

At my [American] GP's office I make an appointment at least two months in advance (to which is will probably be rescheduled/canceled at least once.) Then when my appointment date arrives I have to go to my GP's office at least an hour before my appointment to verify all my information and wait. Then they send be behind to be seen and verify more information, and am then left to wait for upwards of more than an hour to see my GP. Unless it is highly specific (in which case I am just directed elsewhere), he pops in and looks everything over and is done within five minutes. I will still probably have a referral to go somewhere else.

If I need to see a doctor ASAP because of an infection or a cold, I go to Urgent Care where I sit with other ill people for what could be a few minutes to a few hours to to get a prescription and a few moment's of a doctor's time. And I'm an immunocompromised patient.

Your woe is universal.

[debergerac.livejournal.com]

that wouldn't begin to pay your overhead.

[fizzyland.livejournal.com]

Canadian doctors like Canadian dollars, I heard. Are you intimating that doctors in single-payer systems are some sort of paupers?

[ccr1138.livejournal.com]

I'm saying it would translate to even less in American dollars.

No, I don't think they're paupers. But they don't get paid as much (thus the severe shortages). OTOH, they don't have to pay an extra staff member to deal with insurance claims, and their malpractice insurance is way lower.

I've been trying to find good figures to list here, but they are elusive. Here's some current data on doctor's salaries in Canada. It looks like a family physician gets about $104,000, a plastic surgeon around $120,000 CDN: http://www.payscale.com/research/CA/People_with_Jobs_as_Physicians_%2F_Doctors/Salary - contrast that with $161,490 for family practitioners and $165,000 for surgeons in the USA: http://www.bls.gov/oco/ocos074.htm

Here's an article about the exodus of doctors from Canada to the USA. About 19,000 so far as of 2007. One statistic they list is that specialists in the USA earn 2-3 times as much as their counterparts in Canada. http://www.aafp.org/online/en/home/publications/news/news-now/professional-issues/20070502canadiandocs.html

One in nine doctors trained in Canada works in the USA: http://www.canada.com/nationalpost/news/story.html?id=04c4d089-35f5-4427-b78d-dae67df07bec This article told me something I'd not heard before, and it could explain the current severe shortage: "There was even a conscious decision made in the early 1990s by federal and provincial health ministers to cap enrolments in medical schools in an effort to reduce the amounts their governments were spending on health."

I know in my case, I could not find a doctor who was taking patients, so I had to wait in the walk-in clinic for hours every time I needed anything, even a prescription renewal. Here are some statistics on the shortage of doctors: http://www.cbc.ca/canada/montreal/story/2006/11/02/quebec-familydoctors.html and this one's from my province: http://bruno.penandscale.com/2008/03/shortage-of-family-physicians-haunts.html

And it's already happening in Massachusetts: http://www.slate.com/id/2227082/

[drcruel.livejournal.com]

There's a huge difference. Medicaid pays horribly and has incredibly intrusive and time-consuming paperwork-I don't even accept it. But I do accept Medicare, and in terms of providing good access to service for patients and reasonable compensation for doctors, Medicare beats most private insurance companies. I think single-payor health insurance would look a lot more like Medicare than Medicaid, because it would be for everyone whereas Medicaid is for the poor and, as the recent controversy of healthcare reform has proven, quite a lot of people don't care very much about what kind of healthcare poor people receive.

[ccr1138.livejournal.com]

Well, you can think that, but where's the proof? The truth is, nobody knows quite how it's all going to work, and what the unintended consequences will be. Some people are very optimistic that it will all work out so that 30 million more people can get care while the overall cost of the system decreases. I believe these people have been dipping into the nitrous oxide.

My prediction is that employers will drop insurance ASAP and pay the fines because it will save them significant expense. Individuals will then choose NOT to buy insurance until they need it, because the fines are way cheaper than premiums. Thus only sick people will pay for insurance. This will bankrupt the insurance industry and lead to single-payer. In the mean time, all those folks who can't afford to buy insurance AND can't afford the $750 fine will still go to the ERs like they do now. It's nuts.

[ccr1138.livejournal.com]

BTW, your comments on Medicare give me some hope. If everything devolves into "Medicare for all," perhaps we won't be completely screwed. Well, at least health-wise. Financially? We are already toast.

[tcpip.livejournal.com]

Exactly. When you have a public service that is provided as specialist welfare, the political demand is to punish the recipient - and hence the administrative cost skyrockets.

When the public service is provided universally, as a right, then the administrative cost plummets.

[penguin42.livejournal.com]

Medicaid pays horribly and has incredibly intrusive and time-consuming paperwork-I don't even accept it.

Interesting. I don't know much about Medicaid, but I notice that the health care bill has a whole big chunk of it with sections named things like "Improving the Quality of Medicaid for Patients and Providers." These aspects of the bill have gotten almost no news coverage and I haven't read up on them myself, but I wonder if they might work to improve some of the problems you're referring to.

[mijopo.livejournal.com]

That’s Canadian dollars, mind you

Since the USD and CAD are basically at par, that clarification probably doesn't have quite the deflating effect you seem to be shooting for.

[meus-ovatio.livejournal.com]

Yeah, and now I can't snicker at Canadians every time I buy a book. Bastards.

[ccr1138.livejournal.com]

I still have a lot of funds in Canada I need to transfer back to the USA. Believe me, that 11-cent difference doesn't look so small right now. I'm waiting for true parity!

[sgiffy.livejournal.com]

Because its a sacrifice with no benefit. She would be excluding people and accomplishing nothing.

Single-payer, across the whole system, would, at least in her opinion, create benefits such as greater access to care, lower cost, etc. That would make it, again in her opinion, probably worth the cost of lower compensation.

Libertarians are right when they talk about how people should generally pursue rational self interest. It is the economic equivalent of natural selection. A powerful force for creating efficiency and progress. However they miss that sometimes that rational self interest needs to be directed. Sometimes you have to change the rules of the game so that individual action that betters the common good is encouraged.

[merig00.livejournal.com]

common good sometimes =/= rational self interest

[ccr1138.livejournal.com]

As a quasi-libertarian, I agree with that last bit. I support the free market, but I also want reasonable regulation. I understand why people are against the idea of Medicare and SS, but I see the benefits, too. With universal health care, it's not so much that I am philosophically opposed to it as I have had bad experiences with it AND I think it will bankrupt us. Plus I suspect it's simply a way for Marxists to get their foot even farther in the door of our society.

But "a sacrifice with no benefit"? How so? The Medicaid patients would be immensely helped, while the patients who are dropped can readily find another doctor. And the value of putting her money where her mouth is? Priceless.

[spaz-own-joo.livejournal.com]

This is a bit like asking the proponents of higher taxes to just pony up the extra money themselves. The desired effect is only achieved when *everyone* is compelled to do the same.

[debergerac.livejournal.com]

compelled being the operative word.

[ccr1138.livejournal.com]

No, this is more like saying, "If you think making low-cost abortion available is a great idea, then donate your money to Planned Parenthood. Don't use the law to force me to donate mine."

If a person thinks single-payer is so awesome, they should put their money where their mouth is. It's hypocritical to keep taking private insurance money while bitching about how evil private insurance is, meanwhile turning away Medicaid patients because the system is unwieldy and doesn't pay enough.

The way I see it, most supporters of this sort of thing think that somebody else is going to pay. They think "the rich" should have to fork over some of their ill-gotten gains to provide a better standard of living for those who Nancy Pelosi said, want to quit their day jobs to be artists and writers, etc. without worrying about paying for health care. Well, screw that. Our society doesn't owe free medical care to people whose jobs don't provide tangible value to society. Give people good jobs, make insurance available in a truly competitive marketplace like car insurance and decouple it from employment, and let people choose what coverage they want. Instead we get Big Brother creating hundreds of new bureaucracies and hiring thousands of IRS agents to check us every month to make sure we're buying what they tell us to buy or we're going to be fined? Gosh, people, wake up! This is horrifying! If you take the trillion dollars and just give vouchers to the 30 million who reputedly can't afford insurance so they can buy what they want in the marketplace, that's almost $34,000 each! It's freaking insane. Anyway, we're already broke. Where's the money coming from? And don't point me to the tricked-up CBO numbers. Everybody with two brain cells knows this measure is not going to reduce deficits. What a load of steaming excrement.

[anosognosia.livejournal.com]

"My doctor in Canada said he received $8 for a patient visit."

Your doctor lied. Or you're lying about it.

[ccr1138.livejournal.com]

Perhaps that was his personal share, after paying for the office and staff. I don't know, but it's what he told me. I was complaining about having to make a separate appointment just to receive the results of a test which could have been given to me over the phone, and I joked it must be because he needed to bill Alberta Healthcare for a patient visit. He laughed and said, "Yeah, because I need the eight dollars." Then we got into a discussion about single payer and Obama, etc., and his statement was, "the Canadian system is stupid." He opined that the USA was better, despite the flaws, but that "Obama's going to take care of that for you." With a grim smile.

Believe it or don't. *shrug*