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We Need to Design Health Care Reform That Puts Patients Before Profits

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Re: We Need to Design Health Care Reform That Puts Patients Before Profits

#191

Post by tptacek »

claudeganon wrote: post #189
tptacek wrote: post #156

Earlier quoted context omitted.

What does universality have to do with it? They already cover virtually everyone in the most expensive segments of the market. They're not controlling costs for those patients; Medicare overpays, hugely, both compared to other countries and in historical terms (costs have skyrocketed over the last 20 years). I think the burden of proof is on you for this argument. "Excluding drug costs" can't be the problem, because…

What does being the sole payer for services give you, besides a monopoly on payments and all the leverage that comes with it? It should be self-evident, but the ability to negotiate far better prices from healthcare suppliers. Medicare for All’s (not Medicare’s) “unique ability” is this ability to say do these things or you won’t get paid or paid as much. It’s a big part of what single payer systems do around the wor…

Are we talking about the same Medicare? Because Medicare today absolutely does have the ability to say "do these things or you won't get paid".

Re: We Need to Design Health Care Reform That Puts Patients Before Profits

#192

Post by tptacek »

CharlesColeman wrote: post #188
tptacek wrote: post #181

Earlier quoted context omitted.

That's a dodge. How does it get us any closer to solver provider costs, when the evidence available suggests it has never done so before despite having enormous authority to do so in the existing system? Remember that the argument isn't that single-payer is bad. It's that it's not actually relevant to the current problem. There may be a variety of reasons why single-payer is better than private; "will automatically s…

It isn't a dodge, and I'm not claiming a single-payer system "will automatically solve provider-side costs" (which is an odd thing for you to put in quotes, since I said no such thing). What I am saying is that such a system opens up avenues to pressure providers that aren't available in other systems (or are more easy for providers to escape [1]), and that potential gets us closer to solving those problems. After th…

Sorry, I didn't mean to attribute those words to you, but I could have been clearer.

What I'm saying is that there's no evidence that an M4A system would have any more ability to push back on provider costs than new federal regulations that didn't switch to a single payer model wouldn't be able to do, and further, no evidence that any of the existing M4A plans really target costs at all.

Re: We Need to Design Health Care Reform That Puts Patients Before Profits

#193

Post by lotsofpulp »

kerkeslager wrote: post #162
shsjxjbsbs wrote: post #128

Earlier quoted context omitted.

There are way more doctors than CEOs. If you’re gonna claim that CEO pay is a more significant factor than doctor pay you should do the math on that.

I'm saying that a doctor's contribution to society is a lot more than a health insurance CEO's and yet that is not reflected in their salary. It wouldn't surprise me if doctor pay was a larger factor in healthcare costs. But doctor salaries are an inherent cost of healthcare, and while we can certainly lower their salaries, it's not entirely clear to me what a fair salary would be. Health insurance CEOs, and indeed m…

You are welcome to figure out a way to allocate society’s resources in a way that results in everyone having access to healthcare without the use insurance companies and actuaries.

As far as I can tell, there does not exist a sufficient quantity of healthcare supply to meet the demand, hence the high prices. Without increasing the supply of healthcare, the conversation is moot.

Re: We Need to Design Health Care Reform That Puts Patients Before Profits

#194

Post by claudeganon »

tptacek wrote: post #191
claudeganon wrote: post #189

Earlier quoted context omitted.

What does being the sole payer for services give you, besides a monopoly on payments and all the leverage that comes with it? It should be self-evident, but the ability to negotiate far better prices from healthcare suppliers. Medicare for All’s (not Medicare’s) “unique ability” is this ability to say do these things or you won’t get paid or paid as much. It’s a big part of what single payer systems do around the wor…

Are we talking about the same Medicare? Because Medicare today absolutely does have the ability to say "do these things or you won't get paid".

Yes, and as I already mentioned, the existing leverage Medicare has in this regard already puts downward pressure on costs. But it’s insufficient relative to how costs are being driven up further down in the system and quite obviously an orders of magnitude smaller amount of leverage than a universal system and a monopoly on payments.

Re: We Need to Design Health Care Reform That Puts Patients Before Profits

#195

Post by tptacek »

claudeganon wrote: post #194
tptacek wrote: post #191

Earlier quoted context omitted.

Are we talking about the same Medicare? Because Medicare today absolutely does have the ability to say "do these things or you won't get paid".

Yes, and as I already mentioned, the existing leverage Medicare has in this regard already puts downward pressure on costs. But it’s insufficient relative to how costs are being driven up further down in the system and quite obviously an orders of magnitude smaller amount of leverage than a universal system and a monopoly on payments.

Medicare is the near-exclusive provider of medical services to the most lucrative and demanding segment of the market. You're going to need to explain, with specifics, why they've had such a limited ability to hold down costs. Adding a bunch of 30 year olds who see a doctor once every 3 years isn't going to do that automatically.

Re: We Need to Design Health Care Reform That Puts Patients Before Profits

#196

Post by pcwalton »

tptacek wrote: post #176
pcwalton wrote: post #171

Earlier quoted context omitted.

Doesn't your argument suggest that a functional national health care policy should focus on both controlling payer-side costs and provider-side costs? Like the Swiss system does—payer-side costs are capped as a fraction of household income, and provider-side costs are tightly managed so that the total economic burden remains reasonable. To me it seems that both sides are presenting a false dichotomy where none need e…

I'm receptive to all reforms! Reforming health care administration is worth doing; even if it doesn't make health care "affordable", these are big numbers we're talking about, and percentage-point changes in administration costs still generate money we can use on other things. Where we get into trouble is when we start contemplating radical reorganizations of the existing system without a clear goal or path to achiev…

I think most Americans who say they're in support of M4A would be perfectly fine with the Swiss system, or really any health care system that is universal. The differences between single-payer and private subsidized insurance with automatic enrollment are fairly wonkish to ordinary folks. Most people just want to feel assured they'll have insurance when they go to the doctor and are less interested in the details of how that works. I suspect that polls of M4A are really measuring that instead of support for single payer per se.

(My personal feelings are along these lines; I think a Swiss-style private universal system is more likely to work than single-payer in the US, so I favor a private system, but I wouldn't describe myself as an opponent of M4A.)

Re: We Need to Design Health Care Reform That Puts Patients Before Profits

#197

Post by 4ntonius8lock »

dsfyu404ed wrote: post #187
Balgair wrote: post #160

Earlier quoted context omitted.

The poster you are replying to is a troll, likely. I'd disengage with the poster and not continue the conversation, as they do not tend to comment 'in good faith'. Their HN profile bio as of 8pm GMT states: "When you read a HN article about some despot in a foreign land having the intellectuals lined up and shot it seems irrational. When you read the comments and you realize the despot might be on to something." 'Iro…

I understand you're going to use the least charitable reading because you disagree with me but it was supposed to be a comment about the quality of discourse in internet comments.

Have you thought of the irony between the quote, your explanation and the comments you post?

I looked at the last 5-10 comments in your history. Two comments were for articles you clearly didn't read. Others are quick sound bytes thrown at people digging at the truth. It's like your trying to be cool.

I think HN is loved because here there is a higher percentage of people making long, well thought out comments AFTER reading the article. And the comments are generally aimed at furthering understanding, not people's individual ego. Doesn't always happen, but I find it happens here more than anywhere else I've found.

I invite you to contribute in the same line, that's what makes this place special for me.

Re: We Need to Design Health Care Reform That Puts Patients Before Profits

#198

Post by claudeganon »

tptacek wrote: post #195
claudeganon wrote: post #194

Earlier quoted context omitted.

Yes, and as I already mentioned, the existing leverage Medicare has in this regard already puts downward pressure on costs. But it’s insufficient relative to how costs are being driven up further down in the system and quite obviously an orders of magnitude smaller amount of leverage than a universal system and a monopoly on payments.

Medicare is the near-exclusive provider of medical services to the most lucrative and demanding segment of the market. You're going to need to explain, with specifics, why they've had such a limited ability to hold down costs. Adding a bunch of 30 year olds who see a doctor once every 3 years isn't going to do that automatically.

They can’t hold down costs because they’re just a competing payer in a large, dysfunctional system whose overall costs are determined by the sum total of this dysfunction and the general trajectory of healthcare outcomes it produces.

I’m sure you’re quite aware of this, as well as the difference between having a monopoly on payments, continuity of care, and “adding a bunch of 30 year olds” to the system, but feel free to waste more time with these obfuscations. A defense of the status quo isn’t really helped by them.

Re: We Need to Design Health Care Reform That Puts Patients Before Profits

#199

Post by tptacek »

claudeganon wrote: post #198
tptacek wrote: post #195

Earlier quoted context omitted.

Medicare is the near-exclusive provider of medical services to the most lucrative and demanding segment of the market. You're going to need to explain, with specifics, why they've had such a limited ability to hold down costs. Adding a bunch of 30 year olds who see a doctor once every 3 years isn't going to do that automatically.

They can’t hold down costs because they’re just a competing payer in a large, dysfunctional system whose overall costs are determined by the sum total of this dysfunction and the general trajectory of healthcare outcomes it produces. I’m sure you’re quite aware of this, as well as the difference between having a monopoly on payments, continuity of care, and “adding a bunch of 30 year olds” to the system, but feel fre…

No. Medicare does not in fact meaningfully compete with private insurance in the markets it serves. It is a universal entitlement for US senior citizens.

Re: We Need to Design Health Care Reform That Puts Patients Before Profits

#200

Post by claudeganon »

tptacek wrote: post #199
claudeganon wrote: post #198

Earlier quoted context omitted.

They can’t hold down costs because they’re just a competing payer in a large, dysfunctional system whose overall costs are determined by the sum total of this dysfunction and the general trajectory of healthcare outcomes it produces. I’m sure you’re quite aware of this, as well as the difference between having a monopoly on payments, continuity of care, and “adding a bunch of 30 year olds” to the system, but feel fre…

No. Medicare does not in fact meaningfully compete with private insurance in the markets it serves. It is a universal entitlement for US senior citizens.

Yes, I should’ve been more precise in saying they are one payer in a system of many payers vying for lower prices from healthcare suppliers.

But as I’ve stated multiple times and what you seem to be purposefully ignoring to defend your position, the overall costs of these services are determined not only by how they’re consumed by Medicare beneficiaries, but by overall functioning of the healthcare system and continuity of care throughout its beneficiaries’ lifetimes.

You can very clearly understand that the price of any given procedure is not determined by how it is consumed and paid for by one segment of the market, but by all of its consumption and the interactions around it. A given surgery or hospital stay is is not something consumed exclusively by Medicare beneficiaries so they are not the sole determinants of its price.

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