RE: SOCIALIZED HEALTHCARE or welcome to the NATIONAL POTLUCK - Coming from a German tongue
Thank you.
The US system functions a bit differently than how you described. A near or actual majority of the monies spent in healthcare in the United States is public money - Medicare, Medicaid, VA, CHIP, Indian Health Services, etc... To compare the US healthcare system to a functioning market economy is incorrect. I am not defending the US system. Additionally, in the private sector in the US, insurance companies do not reign supreme. Rather, large employers - who may self-insure - have significant leverage in determining what health plans look like.
The premise I was getting at is that there is, especially among certain political circles in the US, raving about single payer healthcare or the NHS system. There are, however, significant trade offs with such a system. For example, if the government only pays for procedure x, there is little incentive to develop a better procedure since there is a significant cost in lobbying in paying off politicians to get the new procedure covered by the public health plan. It is the opportunity cost that I am concerned about. I would also say that such significant opportunity costs exists with education as well. That is why there are a significant number of people who have opted out entirely of the public school system (homeschooling and private schooling) or have partially opted out of the standard system (via charters).
Also, regarding the physician not being employed by the government (therefore it not being actually socialized) - if the physician only has one customer - the government - he is in a effect a sharecropper. It can have more downsides that direct employment by the state since he has to cover his own overhead, but he cannot canvass for other customers that pay more because there is only one (the public insurance plan).
Thank you for comments and post. I think it is unfortunate that people yell at each other rather than genuinely debate these significant issues.
Thanks Edgon for all the time you take to explain some things. I am certainly not an expert, just a citizen who could get sick.
Let me switch to some facts that are pretty clear.
Please read this, would love to hear your opinion. This is a real bill from 2016, this is how health care works today, this is was doctors and hospitals will do if you let them use their "professional judgement":
https://steemit.com/life/@gunternezhoda/my-hospital-bill-6-pints-of-blood-usd24000
Thank you. I do work in healthcare in the US - I've seen this inanity before both at work and in my personal life. This is an effect of using third party payers to cover most healthcare costs (insurance companies). These prices are used to begin negotiating - based on their contracts - with insurance companies on how much they will pay for a service, so the hospital essentially throws out an overpriced pitch first. The problem with this method is patients with high deductible or no insurance get caught in the middle. The Wikipedia article chargemasters has a apt description of the origin of these prices:
"In the United States, the chargemaster, also known as charge master, or charge description master (CDM), is a comprehensive listing of items billable to a hospital patient or a patient's health insurance provider. In practice, it usually contains highly inflated prices at several times that of actual costs to the hospital.[1][2][3] The chargemaster typically serves as the starting point for negotiations with patients and health insurance providers of what amount of money will actually be paid to the hospital. It is described as "the central mechanism of the revenue cycle" of a hospital."
Time magazine in US had a cover story on this a while ago (http://time.com/198/bitter-pill-why-medical-bills-are-killing-us/).
It is a miserable system; poor or inaccurate cost accounting - which this is an example of - is a symptom of a cartelized (which is what healthcare in the US is essentially) or a monopoly. In a freed market, costs would tend to be much more transparent and monstrosities such as this (chargemasters). That is why costs for healthcare procedures in the US that are typically not included in the third party system (cosmetic procedures, lasik eye surgery, some preventative screenings that take a while for insurance companies to cover) tend to go down in price or stabilize in real terms.
I agree - that bill and the millions like them are symptoms of a problem; my theme all along is that public provided insurance is 1.) not the only solution and 2.) not necessarily the best solution (I would claim that it isn't the best solution).
I have spent a lot of time around doctors (I won't speak for hospitals) - I wouldn't blame this on their professional judgement; they are victims of the current system too - they do an overwhelming share of the work and our usually the last ones to get paid.
Hi again,
During my lifetime I developed a sense for facts and learned not to pay to much attention to words only.
To your statement:
"I have spent a lot of time around doctors (I won't speak for hospitals) - I wouldn't blame this on their professional judgement; they are victims of the current system too - they do an overwhelming share of the work and our usually the last ones to get paid."
Let me wipe off my tears and ask:
Just using my common sense and by looking around I see that every doctor I know owns several real estate properties, usually collects gold coins and has 2 $100.000+ cars in his drive way?
The average income of a physician in the US is $200.000
I wish that people that are gifted with intelligence would use it to help others and contribute to a solution, instead of defending the "wrongness" with words, ignoring the actions and facts.
I have no problem with people getting compensated well, but regarding health care, there is a line that needs to be drawn.
Physician salaries vary - some specialists and subspecialists make far more than primary care or general practices. Additionally, I think you are missing that the average doctor in the United States leaves medical school with nearly $200,000.00 in student loans. On top of that, if they are independent - i.e., not employed by an HMO or health system/hospital, they have to cover their own overhead (employee salaries), medical malpractice insurance, corporate insurance, etc... The doctor that takes care of your kids and mine when they have the flu or what-not is not living large as you describe (on average that is); rather, they are comfortably upper middle class. That is a nice place to be, but they are not living the rap music video life as you insinuate in your post.
That some physicians make so much more than others is on account of supply and demand and because of how medical insurers - including the exalted government - compensate for health care. They compensate - more often than - by service rendered, not by meeting some cost threshold of value metric. Additionally, most providers do not work under capitated models where there is a single global payment for a patient. That reality leads to those who provide the most acute and costly services being compensated the most. That is slowly starting to change with value-based payments, but it isn't anywhere near substantially changing the distribution of physician compensation.
One more item - I don't understand the complaints about physician compensation to begin with. It is rather illogical when you look at what percentage of health care spending in United States even goes to physicians (and the overhead described above still needs to be removed from that to discover their profit). I would encourage you to look at some of the links below to see some background on the breakdown on healthcare spending in the US. This is a more complex issue than x makes too much money. Costs in the US have a lot to do with parties (hospitals, testing centers, pharmaceutical companies, etc...), and we simply spend more because we are relatively less healthy than other peer nations. Additionally, we have other social determinants that cause expensive care settings - ERs for example - to become a cross between a primary care practice and a social services agency.
If the government became the only insurer tomorrow and covered everyone at Medicare rates (Bernie's Medicare for all), that would not, in any way, fix this issue. This is more complex than who is the provider of insurance.
Additionally, why shouldn't people who provide objectively valued services (for example neurosurgeons and oncologists) be compensated very well. They have extremely high risk and stressful jobs that require substantial debt and time (in addition to a level of intelligence in at least the top 15 percent or so). Also, they get sued a lot, many have to run or co-manage their business. Their jobs literally extend peoples' lives and fill a valuable need in society. That seems like a good reason to compensated very well. I am not seeing these people are perfect; I am just saying that most of the complaining about their compensation is grounded in less than factual information or anecdotes that irritate people. Important debates ought to be grounded in evidence.
Note: Some information on physician compensation, cost breakdowns for health spending, etc... can be found here:
http://www.commonwealthfund.org/publications/press-releases/2015/oct/us-spends-more-on-health-care-than-other-nations
https://economix.blogs.nytimes.com/2008/11/14/do-doctors-salaries-drive-up-health-care-costs/
https://economix.blogs.nytimes.com/2008/11/14/do-doctors-salaries-drive-up-health-care-costs/
http://www.healthcarefinancenews.com/news/physician-compensation-among-lowest-western-nations
I'll just answer this one:
"Additionally, why shouldn't people who provide objectively valued services (for example neurosurgeons and oncologists) be compensated very well. They have extremely high risk and stressful jobs that require substantial debt and time."
How about the risks a fireman, a cop or a soldier takes.
The fire department is socialized and works exceptionally well. So does the military. Talk about the risks and the stress those people take.
Maybe somebody else wants to chime in.
I think you missed that the number of people with either the skills or desire to go through the time and take on the debt to be a specialized medical professional is smaller - significantly smaller - than the number of people that are willing to enlist, become a fireman, or be a police officer. Also, police officers and firemen are well-compensated when you count in the costs of their public pensions, health benefits, overtime, etc... Those are highly paid working class jobs. I won't speak for the military.
I am honestly confused about the premises that you are using to come up with which professions are worthy of a certain salary. In your ideal world, who ought to be the arbiter of compensation?