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

[ccr1138.livejournal.com]

I agree with most of what you'd said, but the caveat is this: with Canada's single-payer system, you'd have to take whatever level of quality and service they offer, with no choice. So would you be better off here under single payer? Only if we somehow make our system accountable to the consumers. Canada's is not. And it's practically impossible to opt out of the system to get private care, faster care, better care, etc., because there are no private providers for basic health care. It's virtually nonexistent because the law makes it virtually impossible. Why do you think people routinely cross the border to get care in the USA? It's not because they have a lot of extra cash lying around. It's because wait times are just that bad. If you were suffering in need of a hip replacement and couldn't walk, faced with a wait time of more than a year, how much would you be willing to pay to speed up the process?

[mijan.livejournal.com]

Canada's system IS accountable to consumers. Do you even understand how their system WORKS?

Hospitals, clinics, and other health care facilities are PRIVATELY run and administrated. Patients are NOT told which hospitals and doctors to go to. Patients CHOOSE THEIR OWN. And then, doctors and hospitals only get paid based on services provided and patients seen. If you don't like your doctor, you find another one. Lousy doctors and hospitals lose patients, and therefore don't make as much money. Competition STILL exists. And unlike the "network provider" plans in the USA, in Canada you can go to ANY doctor without getting "permission" first.

The wait times for non-essential procedures are comparable between the USA and Canada, unless you're RICH or have amazing insurance. Critical care patients are seen just as quickly (if not faster) in Canada as in the USA.

Also, my family is from Canada. My grandmother DID need a hip replacement. The wait time was VERY reasonable... less than two months, and most of that time was because she wanted to wait to get a few things done first. My grandfather had two strokes, and he got immediate critical care, and survived both times. My little cousin had a massive congenital heart defect that they detected before she was born, during the second trimester. Her mother was admitted to the hospital before the third trimester began due to the risk, was given the best care, and when the babies (twins) were born, the girl with the heart defect had a team of the best pediatric cardiologists on hand. Four surgeries later, she's a happy, healthy little girl with a bright future... and her parents (my cousins, both teachers) are not financially ruined.

Oh, and I had to have knee surgery for a nasty injury here in the good ol' USA. The wait was five months.

[ccr1138.livejournal.com]

I do understand how their system works, having lived there the last two years and researched it avidly due to what's happening in the USA. Everything you say is correct. The anecdotal evidence is, well, awesome for you and your family. My experience varied. Earlier I tried to provide actual statistics from the provincial government.

I still say it's not responsive to consumers. The provincial government of Alberta recently closed an imaging center in Cochrane that performed 8000 procedures a year and told all those people to drive to Calgary for service, despite fervent public outcry and already long waits for MRIs, mammograms, etc. Why? Because Stelmach & company are too stupid to charge a proper premium to cover the costs of providing acceptable levels of service.

Do YOU not understand how the laws of supply and demand work? When there's a shortage of something, the price is SUPPOSED to rise, thus encouraging more supply and less demand. When the government artificially suppresses the proper price of something, it results in worse shortages. Why are hospitals at 97% of capacity and yet being cut in Alberta? Why are vital supplies hard to come by? Why are ER waits interminable? Why are 7 million people unable to find a family doctor? Does any of this indicate that the system is responsive to consumers?

In fact, the system is deliberately rigged to discourage consumers. In another link I provided above, it's stated that they deliberately limited the number of medical school graduates in order to keep referrals for expensive procedures down. WTF?

Let me ask you, what incentive does the province have to buy another MRI machine or build more hospital rooms? If they spend more money, can they collect more money? NO. The income side of the equation never changes, because you can't charge more for better service. Therefore, you never get better service. In fact, you can save money by making service worse and worse over time. THIS is what drives single-payer economics.

Not to mention, if you don't like the system, not only is the only alternative leaving the province or the country, but there is practically no accountability through the courts. When you sue for malpractice, etc., you're put through the wringer by the government and spat out the other side. Very few lawsuits are filed because lawyers won't take them due to the dismal win record.

Oh, and you can't go to ANY doctor without permission, as you claim. If you want to go to a specialist, you've got to go through the primary care doctor. And if he/she doesn't refer you, well, I guess you can go to another, and another ... or just come to the USA where, for the moment, we still have true freedom of choice.

[mijan.livejournal.com]

The American system isn't exactly responsive to consumers, either. We also have many people here who are unable to find a family doctor. Something like 57 million Americans have no health insurance, and good luck finding ANY doctor who will take you without insurance unless you can wave a wad of cash under their noses.

I WISH we had more checks and balances in place to prevent frivolous medical lawsuits in the USA. It's gotten out of control. Severely out of control. It's a big part of what drives up our costs.

American ER waits are about the same as Canadian ones. I follow this stuff because I work at a hospital - a recent study found that the average ER wait time in the USA was 4 hours and 27 minutes. No joke. You think that's GOOD?

Also, I understand economics very well. However, standard economics DO NOT APPLY to health care, as any real economist can attest. It's kinda ridiculous to try to drive costs down in health care by raising prices. It's not "can I get the cheaper version of chemo?" or "well, do I REALLY need this appendectomy?" or "can I wait until hip replacement goes on sale?" You either NEED the health care or your don't. And if you can't afford it, you wait until the symptoms become acute. People die in America every day because they're more afraid of being in insurmountable debt than getting their potentially life-threatening ailments treated.

Oh, and if you don't have health insurance, they can turn you away unless you're in emergency-critical condition. I had to wait TWO YEARS after finding a breast lump before I could get someone to remove it... when I FINALLY started working at my current job, which supplies excellent health insurance. My insurance that I had before maxed out almost immediately, and the doctors decided that I was a financial risk, so they wouldn't treat me. TWO YEARS to get a breast lump removed. I'm lucky it was benign.

So, yes, you have freedom of choice in the USA... if you're lucky enough to have an employer who provides an amazing health insurance plan, or you're filthy rich.

[ccr1138.livejournal.com]

I don't want to appear to be defending the status quo. There's a lot that needs to be fixed. The shortage of doctors, for instance, which is actually a result of government interfering in the market and artificially limiting the number of medical school graduates.

You are correct in that an individual will not make decisions based on price in all cases. However, if there is a shortage of MRI machines, for example, the greater price will motivate the purchase of more machines. Once the market is saturated with machines (and they are paid for) the prices come down. This is not a perfect system, but it's better than trying to manage the same thing via government fiat.

Come to think of it, why CAN'T you ask for the cheaper brand of chemo? Or at least a cheaper oncologist? Why can't you shop around? The answer is that you will have a hard time discovering what the actual price of anything is. I have a big problem with the disconnect between consumer and price in our current model. See my blog post here for more: http://ccr1138.livejournal.com/73459.html

[mijan.livejournal.com]

As for why you can't shop around for chemo... I used to work for a big pharmaceutical company. In fact, I worked in Oncology. Funny, huh? I can tell you from the inside that the money is everything. Pharmaceuticals are BIG political business. I can't being to tell you how much money is wasted. It's insane. But it keeps consumers wrapped around their little fingers.

Part of the shortage of doctors is due to the cost of med school. That's half of why I didn't do it. (I was pre-med, majored in Biology, with a 4.0 GPA.) The other half was because I saw what was happening to the system. I'd spend more time fighting with insurance companies than taking care of patients. I wanted no part of that... so I'm "just" a biologist.

I'd write more, but I've actually gotta go. Maybe back later.

[ccr1138.livejournal.com]

My husband is a colon cancer survivor, so you'll understand when I utter the words FOLFOX-4. :-)

Waste? YES. Huge waste. I was looking at the bills from the oncologist. He charged $1300 for a two-minute consult. The insurance said, "Nice try," and gave him $250. If I'd been aware of (and perhaps motivated to save on) the cost of this, I would have refused a few of his brief pep talks. It was the nurses who did all the work. Most of the providers have no reason to want us to know what their rates are, because then we might be able to compare prices, eh?

As for med school, I'm not sure why it has to cost so much, nor why we can't subsidize it to get more doctors, nor why there is a cap on the numbers we allow in. A friend of ours, an extremely bright kid, wanted to be a doctor. He couldn't get accepted to medical school. Not enough slots! And one admissions worker even told him, off the record, that he was the better candidate, but they had to fill the remaining slots with females and minorities. First time I ever felt sorry for a white guy.

So how much sense does it make that a kid who's always dreamed of being a doctor, who has the mental and emotional capacity to be a darn good one, is now selling insurance? That's fucked up.

[dwer.livejournal.com]

Waste? YES. Huge waste. I was looking at the bills from the oncologist. He charged $1300 for a two-minute consult. The insurance said, "Nice try," and gave him $250. If I'd been aware of (and perhaps motivated to save on) the cost of this, I would have refused a few of his brief pep talks. It was the nurses who did all the work.

Clearly, this is somehow Joe Biden's fault. Are you even listening to yourself?

[ccr1138.livejournal.com]

I'm happy to blame Joe Biden for anything you like, but I don't know what you're talking about.

Let's try this. You read the entire thread you're commenting upon and then say something pithy that actually contributes to the discussion. Or just STFU. Your choice.

[dwer.livejournal.com]

self-referential comment is self-referential.

In other words... sochulist physician... heal thyself.

[ccr1138.livejournal.com]

I'm still quite confused. I guess in your attempt to be witty, you've lost me.

[geezer-also.livejournal.com]

The former happens occasionally with him, the latter, well never.
You on the other hand are a pleasure :D

[ccr1138.livejournal.com]

That's a relief. I was beginning to wonder if it was just me.

[mijan.livejournal.com]

It makes as much sense as me not going to med school, either. Granted, I'd feel nauseous if I got a med school slot over a male candidate who was better than me - I've never gotten ANYWHERE on anything but merit, and I wouldn't want to. (Example: when I was in the Army, I made sure I maxed out the MALE fitness standards.) My academic scores were good enough, and I could have gotten into med school purely on merit... but I didn't have the money. Of all the stupid things, right? My mother was a teacher, but my father was a financial idiot, and life has unexpected twists. I made do, but I also could have pushed for it... but I made my decision not to push to get insane loans because of the messed-up health care system.

We do need more doctors, and we need to support EDUCATION if we want to have enough doctors to go around.

Yeah... it's messed up. Just as messed up as the insane prices for basic health care.

[ccr1138.livejournal.com]

I am supporting a friend's kid who's going to med school now, so I understand. The student loan rates are obscene, and that's just the private lenders. (Who apparently aren't going to be allowed to lend students money any more? I don't know ... I haven't read that bit of the bill.) The interest rate on the Sallie Mae student loan was going to be 12.75% *adjustable*. Unbelievable. AND I got turned down as a cosigner by several banks even though my credit score is nearly perfect. Money sure is hard to come by these days.

[allhatnocattle.livejournal.com]

it is amazing to me that medicine is such a revered science, given that such accreditation is fairly recent.

[allhatnocattle.livejournal.com]

Alberta is not Canada, but simply one province within Canada. Your blanket statements simply don't apply throughout.

Alberta healthcare premiums are paid out of oil royalties. The more Americans pay for oil, the better quality care Albertans receive. You want to place blame or want better healthcare in Alberta, drive the price of oil up through consuming more. It's that simple.

There are as many examples of Americans seeking work in Canada as there are of Canadians seeking American medical services. If not more. I don't know of anyone personally who went to USA for medical treatment. I do know a great many Yankees working here in Alberta. You're going to have to figure something out. But if you don't have employment, I don't see American healthcare working out very well.