Congressman Admits ObamaCare a Platform for Single Payer

[blu]

single payer would be the best thing to happen to this country in a long time

Yes, people absolving themselves of responsibility is always a great idea.

I would love to see you explain this ...

 

[RDD_1210]

I like parts of it too. The problem is they can't afford it.

What country has a quality health care system and can afford it?

But I thought affordability was the issue we were trying to address. Now your're basically admitting that you've given up on that and are really only interested in allowing people to pay as little as possible and if we can do that by going into debt, so be it?

Affordability AND quality. We suck at both...for the average person. It's only quality if you can afford it, which many can not. This issue is much more the basic economics. I've given up on nothing, my position is the same as its always been. We have a severely broken system that is failing for many people, both in terms of access to care and cost of care. There is no magic bullet fix and this legislation is severely flawed, but it does get the ball rolling by making some immediate improvements in the system we are stuck with.

 

[Bern80]

single payer would be the best thing to happen to this country in a long time

Yes, people absolving themselves of responsibility is always a great idea.

I would love to see you explain this ...

By going to a single payer system, what you are basically saying is;

"I would rather not have to deal with hassle of managing health care finances. Please, government, just take some extra money out of my paycheck, let my insurance company bill you and you deal with it."

Clear enough?

 

[3DG4life]

I hope so.

Me too. For profit health care is one of the worst things to ever happen in this country. 45,000 die a year. Yes, that number will be lowered thanks to the Affordable Care Act, but more needs to be done. A little government competition for the private companies wouldn't hurt, would it? I think it would drastically drive down costs across the board, and we could easily just open up existing programs to every one.

 

[asterism]

I hope so.

Me too. For profit health care is one of the worst things to ever happen in this country. 45,000 die a year. Yes, that number will be lowered thanks to the Affordable Care Act, but more needs to be done. A little government competition for the private companies wouldn't hurt, would it? I think it would drastically drive down costs across the board, and we could easily just open up existing programs to every one.

How has removing the profit from Amtrak helped? Did the quality of service go up? Did the cost go down?

 

[Immanuel]

I hope so.

Me too. For profit health care is one of the worst things to ever happen in this country. 45,000 die a year. Yes, that number will be lowered thanks to the Affordable Care Act, but more needs to be done. A little government competition for the private companies wouldn't hurt, would it? I think it would drastically drive down costs across the board, and we could easily just open up existing programs to every one.

A little government competition? Do you realize that there would be no competition within five years? The public option was written to eliminate competition for the government. That was why the insurance companies fought so hard to get it removed from the reform.

A Single Payer would also eliminate the competition completely. Anyone have any idea how many people work in the Health Insurance Industry? Everyone of them would end up on the unemployment line! When that happens we will all be begging for 10% unemployment figures again.

Immie

 

[Procrustes Stretched]

Not like we didn't already know that, but finally one of the socialists admits it.

Eyeblast.tv

D'Oh!!!!

still running behind?

 

[Bern80]

What country has a quality health care system and can afford it?

But I thought affordability was the issue we were trying to address. Now your're basically admitting that you've given up on that and are really only interested in allowing people to pay as little as possible and if we can do that by going into debt, so be it?

Affordability AND quality. We suck at both...for the average person. It's only quality if you can afford it, which many can not. This issue is much more the basic economics. I've given up on nothing, my position is the same as its always been. We have a severely broken system that is failing for many people, both in terms of access to care and cost of care. There is no magic bullet fix and this legislation is severely flawed, but it does get the ball rolling by making some immediate improvements in the system we are stuck with.

If those are the two issues you see you need to take a hard look at whether you are sacrificing quality for affordability. It goes both ways you know. You're right quality is irrelevent if it isn't affordable. But affordability is also irrelevent if the quality sucks.

It is as you say simple economics. If understand single payer right, supposedly we would still have private plans through private companies, but instead of doctors submitting claims and being reimbursed by insurance companies, claims would be submitted to government and hospitals and insurance companies would be reimbursed by government. That about right?

 

[jillian]

Not like we didn't already know that, but finally one of the socialists admits it.

Eyeblast.tv

conyers is a bit out there. i suspect that's wishful thinking on his part.

 

[Flopper]

Single payer can mean a lot of things. It can be run as a huge insurance company with premiums determined by costs. The government would subsidize premiums for low income earners similar to Medicaid. For those that elect not to join, they would be allowed to joint later but at higher premiums similar to what Medicare does.

Insurance companies now contract with providers to form networks. Members of the network accept significantly lower fees in order to be a part of the network. In this way insurance companies attempt to control costs. If government replaced the insurance companies, the government would do the same thing that insurance companies are doing now set the amount it will pay for a given service.

Currently there are a number organizations where all the providers work for the insurance company such as Group Health and Kaiser Medical. Under a single payer system, these organization would collect the standard fees from the government for services provided for it's members. Additional services not normally paid for by the government could be offered, similar to the Medicare MedAdvantage plans.

Do not assume a single payer system would look like the UK or France. Single payer just means the government pays for medical costs.

 

[Bern80]

Single payer can mean a lot of things. It can be run as a huge insurance company with premiums determined by costs. The government would subsidize premiums for low income earners similar to Medicaid. For those that elect not to join, they would be allowed to joint later but at higher premiums similar to what Medicare does.

Insurance companies now contract with providers to form networks. Members of the network accept significantly lower fees in order to be a part of the network. In this way insurance companies attempt to control costs. If government replaced the insurance companies, the government would do the same thing that insurance companies are doing now set the amount it will pay for a given service.

Currently there are a number organizations where all the providers work for the insurance company such as Group Health and Kaiser Medical. Under a single payer system, these organization would collect the standard fees from the government for services provided for it's members. Additional services not normally paid for by the government could be offered, similar to the Medicare MedAdvantage plans.

This last one, are you saying the hospital is also basically the insurance company? That might have some possibilities.

Do not assume a single payer system would look like the UK or France. Single payer just means the government pays for medical costs.

The questions I have about that would be:

How is it funded?

Does it not basically render insurance companies irrelevant?

If I require a service, an MRI for example, what role does government, as the single player, play in the transaction process?

 

[Flopper]

Single payer can mean a lot of things. It can be run as a huge insurance company with premiums determined by costs. The government would subsidize premiums for low income earners similar to Medicaid. For those that elect not to join, they would be allowed to joint later but at higher premiums similar to what Medicare does.

Insurance companies now contract with providers to form networks. Members of the network accept significantly lower fees in order to be a part of the network. In this way insurance companies attempt to control costs. If government replaced the insurance companies, the government would do the same thing that insurance companies are doing now set the amount it will pay for a given service.

Currently there are a number organizations where all the providers work for the insurance company such as Group Health and Kaiser Medical. Under a single payer system, these organization would collect the standard fees from the government for services provided for it's members. Additional services not normally paid for by the government could be offered, similar to the Medicare MedAdvantage plans.

This last one, are you saying the hospital is also basically the insurance company? That might have some possibilities.

Do not assume a single payer system would look like the UK or France. Single payer just means the government pays for medical costs.

The questions I have about that would be:

How is it funded?

Does it not basically render insurance companies irrelevant?

If I require a service, an MRI for example, what role does government, as the single player, play in the transaction process?

Yes, the insurance company, the hospitals, the doctors, and all the providers are part of the same company. There are a number of these in the country. I am familiar with Group Health, which covers several states in the Northwest. Group Health has nearly 700,000 members with 41 hospitals and thousands of employees. My son and his family are members and have nothing but good to say about them. I have a close friend who has been a member for 45 years.

Every medical record is online. When you visit any provider in the system, they have every test at their fingertips. If you are in the hospital, your primary care doctor can monitor your care without leaving the office. They answer email as well phone calls. The doctor doesn’t give you a prescription; he just puts it in the computer and you pick it up at one the pharmacies.

You would think they would skimp on services to maximize profits but that doesn't seem to be the case. If I lived in the area now, I would certainly be a member.

In this single payer system, just like an insurance company, you pay premiums based on total cost. For those who meet the low-income requirements, the government pays the premium in lieu of Medicaid.

Insurance companies could be irrelevant. Possibly, they would play some role, but nothing like the current system.

If you needed an MRI, the government would play a role similar to the insurance company. Your doctor orders the MRI. The MRI provider either bills the doctor or the government direct. The government pays according to a schedule based on the procedure code and geographic location.

The government does not own or operate any medical facility. It’s not really socialized medicine, but some would claim it was because it controls price. However, the system would socialize the health insurance industry.

Actually, I don’t know why I’m wasting time discussing this. The insurance companies would never let it happen. The resulting system would be a bastardize version of what we currently have.

 

[Bern80]

Single payer can mean a lot of things. It can be run as a huge insurance company with premiums determined by costs. The government would subsidize premiums for low income earners similar to Medicaid. For those that elect not to join, they would be allowed to joint later but at higher premiums similar to what Medicare does.

Insurance companies now contract with providers to form networks. Members of the network accept significantly lower fees in order to be a part of the network. In this way insurance companies attempt to control costs. If government replaced the insurance companies, the government would do the same thing that insurance companies are doing now set the amount it will pay for a given service.

Currently there are a number organizations where all the providers work for the insurance company such as Group Health and Kaiser Medical. Under a single payer system, these organization would collect the standard fees from the government for services provided for it's members. Additional services not normally paid for by the government could be offered, similar to the Medicare MedAdvantage plans.

This last one, are you saying the hospital is also basically the insurance company? That might have some possibilities.

Do not assume a single payer system would look like the UK or France. Single payer just means the government pays for medical costs.

The questions I have about that would be:

How is it funded?

Does it not basically render insurance companies irrelevant?

If I require a service, an MRI for example, what role does government, as the single player, play in the transaction process?

Yes, the insurance company, the hospitals, the doctors, and all the providers are part of the same company. There are a number of these in the country. I am familiar with Group Health, which covers several states in the Northwest. Group Health has nearly 700,000 members with 41 hospitals and thousands of employees. My son and his family are members and have nothing but good to say about them. I have a close friend who has been a member for 45 years.

Every medical record is online. When you visit any provider in the system, they have every test at their fingertips. If you are in the hospital, your primary care doctor can monitor your care without leaving the office. They answer email as well phone calls. The doctor doesn’t give you a prescription; he just puts it in the computer and you pick it up at one the pharmacies.

You would think they would skimp on services to maximize profits but that doesn't seem to be the case. If I lived in the area now, I would certainly be a member.

In this single payer system, just like an insurance company, you pay premiums based on total cost. For those who meet the low-income requirements, the government pays the premium in lieu of Medicaid.

Insurance companies could be irrelevant. Possibly, they would play some role, but nothing like the current system.

If you needed an MRI, the government would play a role similar to the insurance company. Your doctor orders the MRI. The MRI provider either bills the doctor or the government direct. The government pays according to a schedule based on the procedure code and geographic location.

The government does not own or operate any medical facility. It’s not really socialized medicine, but some would claim it was because it controls price. However, the system would socialize the health insurance industry.

Actually, I don’t know why I’m wasting time discussing this. The insurance companies would never let it happen. The resulting system would be a bastardize version of what we currently have.

So the government would offer a variety of plans? It seems to me you're just trading a private insurance company for a public one. To me there still only seems to be one benefit to single payer in that case. That hospitals only have to deal with one reimburser. I just don't see how that will fix the problems in our health care industry. That singular benefit would have to yield some pretty significant savings to be worth dealing with the government beauracracy and inefficencies. Say what you want about the evils of the profit motive, but one thing it does is keep a business running efficiently. Government won't have that incentive so you have to take as a given that there will be more money going to excess waste in this public insurance company than in private ones.

Now I believe the goal is for the financial scales to be tilted in the cosumer's favor. So another thing that has to happen is these public premiums have to be less than what one would pay for the same coverage privately, otherwise what's the point? If that happens, something has to give somewhere else. I would have to guess it would mean an across the board decrease in revenue for providers. Less for doctors, less for nurses, less for investment in new technology, etc. I have a hard time believing that isn't going to negatively effect provider quality.......or consumer premiums go down, providers get reimbursed at the same rate and government has to subsidze the difference. Subsidies usually artificially inflate the price goods and services and it woud likely require adding to the debt. Also not a good option.......or government will have to start slowly cutting back on what it will reimburse for meaning these public plans people are purchasing will cover less and less. If government will reimburse for fewer services the providers are going to want to charge more for the services they will still get reimbursed for to make up the difference. Either a vicsious cycle of declining reimbursements and escalating costs ensues or government, with the power of the law behind it says "tough shit providers, this what you're getting and you'll like it." That would again have an effect on quality because now the provider has no incentive to do anything well. They are gonna get reimbursed at a less than market value if government deems it so regardless of how well they do their job.

Those are some of the pragmatic issues I see with single payer. But there are some benefits of the free market that would taken away too. As mentioned above and as you admitted, the government is going to have the bulk of the power in negotiating reimbursement for services and in single payer they would be the only source of reimbursement. Government is the only customer available per se. So if providers are gonna make anything at all it will have to except whatever decides it want's to pay. Since the reimbursement will be what it is and there are no other sources of reimbursement, you have removed the free market incentive for a service provider to provide a quality service. You can't expect quality while taking away the incentive to provide quality. The other free market issue is fairness. Negotiations for service won't be fair. Government will have all the power so there will never really know the true value of the service. Another is loss of coverage choices. With only one insurance company (government) choices for coverage will be rather limited. Economics says when the fewer choices there are for a demanded good or service, the higher the cost of that good or service will be. Granted because it's government they are somewhat insulated from those forces unlike a private business, meaning maybe they could keep prices down anyway, but again that will have a negative impact other places. Yet another issue is absolvng people of the financial responsibility of taking care of themselves. The less your choices financially impact you the less likely you are to make good choices. And at some point people have to acknowledge a good chunk of our health care costs in this country are the result of the poor deitary and health choices people make. That won't get better by making peope less respsonsible for the choices they make.

Because of some of these issues I'm wondering if you're going to push for single payer and that single payer would be government if you might as will not go full on socialized medicine where government runs the hospitals as well. Government can keep it cheap by subsidizing things, sacraficing quality, or going into debt which will have some pretty negative long term consequences but it would be cheaper for the consumer.

 

[Flopper]

This last one, are you saying the hospital is also basically the insurance company? That might have some possibilities.



The questions I have about that would be:

How is it funded?

Does it not basically render insurance companies irrelevant?

If I require a service, an MRI for example, what role does government, as the single player, play in the transaction process?

Yes, the insurance company, the hospitals, the doctors, and all the providers are part of the same company. There are a number of these in the country. I am familiar with Group Health, which covers several states in the Northwest. Group Health has nearly 700,000 members with 41 hospitals and thousands of employees. My son and his family are members and have nothing but good to say about them. I have a close friend who has been a member for 45 years.

Every medical record is online. When you visit any provider in the system, they have every test at their fingertips. If you are in the hospital, your primary care doctor can monitor your care without leaving the office. They answer email as well phone calls. The doctor doesn’t give you a prescription; he just puts it in the computer and you pick it up at one the pharmacies.

You would think they would skimp on services to maximize profits but that doesn't seem to be the case. If I lived in the area now, I would certainly be a member.

In this single payer system, just like an insurance company, you pay premiums based on total cost. For those who meet the low-income requirements, the government pays the premium in lieu of Medicaid.

Insurance companies could be irrelevant. Possibly, they would play some role, but nothing like the current system.

If you needed an MRI, the government would play a role similar to the insurance company. Your doctor orders the MRI. The MRI provider either bills the doctor or the government direct. The government pays according to a schedule based on the procedure code and geographic location.

The government does not own or operate any medical facility. It’s not really socialized medicine, but some would claim it was because it controls price. However, the system would socialize the health insurance industry.

Actually, I don’t know why I’m wasting time discussing this. The insurance companies would never let it happen. The resulting system would be a bastardize version of what we currently have.

So the government would offer a variety of plans? It seems to me you're just trading a private insurance company for a public one. To me there still only seems to be one benefit to single payer in that case. That hospitals only have to deal with one reimburser. I just don't see how that will fix the problems in our health care industry. That singular benefit would have to yield some pretty significant savings to be worth dealing with the government beauracracy and inefficencies. Say what you want about the evils of the profit motive, but one thing it does is keep a business running efficiently. Government won't have that incentive so you have to take as a given that there will be more money going to excess waste in this public insurance company than in private ones.

Now I believe the goal is for the financial scales to be tilted in the cosumer's favor. So another thing that has to happen is these public premiums have to be less than what one would pay for the same coverage privately, otherwise what's the point? If that happens, something has to give somewhere else. I would have to guess it would mean an across the board decrease in revenue for providers. Less for doctors, less for nurses, less for investment in new technology, etc. I have a hard time believing that isn't going to negatively effect provider quality.......or consumer premiums go down, providers get reimbursed at the same rate and government has to subsidze the difference. Subsidies usually artificially inflate the price goods and services and it woud likely require adding to the debt. Also not a good option.......or government will have to start slowly cutting back on what it will reimburse for meaning these public plans people are purchasing will cover less and less. If government will reimburse for fewer services the providers are going to want to charge more for the services they will still get reimbursed for to make up the difference. Either a vicsious cycle of declining reimbursements and escalating costs ensues or government, with the power of the law behind it says "tough shit providers, this what you're getting and you'll like it." That would again have an effect on quality because now the provider has no incentive to do anything well. They are gonna get reimbursed at a less than market value if government deems it so regardless of how well they do their job.

Those are some of the pragmatic issues I see with single payer. But there are some benefits of the free market that would taken away too. As mentioned above and as you admitted, the government is going to have the bulk of the power in negotiating reimbursement for services and in single payer they would be the only source of reimbursement. Government is the only customer available per se. So if providers are gonna make anything at all it will have to except whatever decides it want's to pay. Since the reimbursement will be what it is and there are no other sources of reimbursement, you have removed the free market incentive for a service provider to provide a quality service. You can't expect quality while taking away the incentive to provide quality. The other free market issue is fairness. Negotiations for service won't be fair. Government will have all the power so there will never really know the true value of the service. Another is loss of coverage choices. With only one insurance company (government) choices for coverage will be rather limited. Economics says when the fewer choices there are for a demanded good or service, the higher the cost of that good or service will be. Granted because it's government they are somewhat insulated from those forces unlike a private business, meaning maybe they could keep prices down anyway, but again that will have a negative impact other places. Yet another issue is absolvng people of the financial responsibility of taking care of themselves. The less your choices financially impact you the less likely you are to make good choices. And at some point people have to acknowledge a good chunk of our health care costs in this country are the result of the poor deitary and health choices people make. That won't get better by making peope less respsonsible for the choices they make.

Because of some of these issues I'm wondering if you're going to push for single payer and that single payer would be government if you might as will not go full on socialized medicine where government runs the hospitals as well. Government can keep it cheap by subsidizing things, sacraficing quality, or going into debt which will have some pretty negative long term consequences but it would be cheaper for the consumer.

A major cost saving benefit of a single payer system is as you said, a single reimburser. However, this is not a minor cost advantage. The reduction in back office claim filing could reduce the total costs by 4%. Write offs of bad debt by health care providers is over 5%. This can be drastically reduced because the healthcare provider and the patient knows exactly what the reimbursement will be for any service. The provider can collect from patient up front. In case of private insurance, the provider has no idea what the insurance company will pay because there are so many companies with so many different plans. I have seen estimate that provider saving in loss due to bad debt and claim processing would reduce cost by 7%.

A single payer system would run very much like CMS, Center for Medicare Services, which serves about 50 million people. The overhead of CMS is 2%. The average health insurance company has overhead rate of 10%. Unlike a single payer system, insurance companies have the cost of marketing their product and the high cost of continually enrolling and unenrolling members. Insurance companies profits have in the past run 15%. More recently over the last decade they run about 10%.

Considering all of the above, it would seem likely that a single payer system would reduce the cost of healthcare at least 20%.

I don’t think a single payer system would be a lot better at controlling cost increases than the current system. Currently the only real cost control comes from insurance companies who contract with providers, Medicare and Medicaid who have fixed reimbursement rates. The consumer is not really a factor at controlling cost because patients do not cost shop for medical care. There are lots of ways of reducing the cost of care, but they have little to do with single payer versus multipayer.

In a single payer system, the government would ultimately fix the all fees. The profits would be determined by cost reduction, which is what we want, and the provider’s ability to bring in new patients. Currently, providers are limited by their membership to the various insurance networks. With a single payer system, every patient is potential new patient.

The question about quality of care is very subjective. If you use objective measures of quality such as successful outcomes, then statistics of single payer systems in other countries show that quality remains high and costs are lower. Unlike our current system, where millions of patients are limited as to what providers they can use by their insurance company, a single payer system would allow the use of all providers, so the patient could really shop for providers based on service.

I am not in favor of government ownership of healthcare providers because it eliminates patients choice in providers. Once the government owns the providers, the patient doesn't really have a choice. In addition, there would little incentive for the healthcare provider to control cost.

 

[Bern80]

A major cost saving benefit of a single payer system is as you said, a single reimburser. However, this is not a minor cost advantage. The reduction in back office claim filing could reduce the total costs by 4%. Write offs of bad debt by health care providers is over 5%. This can be drastically reduced because the healthcare provider and the patient knows exactly what the reimbursement will be for any service. The provider can collect from patient up front. In case of private insurance, the provider has no idea what the insurance company will pay because there are so many companies with so many different plans. I have seen estimate that provider saving in loss due to bad debt and claim processing would reduce cost by 7%.

A single payer system would run very much like CMS, Center for Medicare Services, which serves about 50 million people. The overhead of CMS is 2%. The average health insurance company has overhead rate of 10%. Unlike a single payer system, insurance companies have the cost of marketing their product and the high cost of continually enrolling and unenrolling members. Insurance companies profits have in the past run 15%. More recently over the last decade they run about 10%.

Considering all of the above, it would seem likely that a single payer system would reduce the cost of healthcare at least 20%.

I don’t think a single payer system would be a lot better at controlling cost increases than the current system. Currently the only real cost control comes from insurance companies who contract with providers, Medicare and Medicaid who have fixed reimbursement rates. The consumer is not really a factor at controlling cost because patients do not cost shop for medical care. There are lots of ways of reducing the cost of care, but they have little to do with single payer versus multipayer.

In a single payer system, the government would ultimately fix the all fees. The profits would be determined by cost reduction, which is what we want, and the provider’s ability to bring in new patients. Currently, providers are limited by their membership to the various insurance networks. With a single payer system, every patient is potential new patient.

The question about quality of care is very subjective. If you use objective measures of quality such as successful outcomes, then statistics of single payer systems in other countries show that quality remains high and costs are lower. Unlike our current system, where millions of patients are limited as to what providers they can use by their insurance company, a single payer system would allow the use of all providers, so the patient could really shop for providers based on service.

I am not in favor of government ownership of healthcare providers because it eliminates patients choice in providers. Once the government owns the providers, the patient doesn't really have a choice. In addition, there would little incentive for the healthcare provider to control cost.

But they don't have a choice with single payer either. Government is the only place anyone will be able to 'shop' for a plan. And I honestly think you are predicting savings that simply aren't there. It just isn't realistic to believe the providers don't know how much insurance companies will reimburse them for. There aren't that many insurance companies for providers to deal with. And there won't be any savings to claim filing. People aren't going to not get sick just because we go to single payer. There is no reason to believe the number of claims that need to be filed will go down

 

[blu]

can't wait for single payer and the death of insurance companies... hopefully all of their executives get fed to sharks and their blood money gets distributed to people who need it

 

[Bern80]

can't wait for single payer and the death of insurance companies... hopefully all of their executives get fed to sharks and their blood money gets distributed to people who need it

You must have quite the hard on for washington beauracracy and it's politicians.

 

[Immanuel]

can't wait for single payer and the death of insurance companies... hopefully all of their executives get fed to sharks and their blood money gets distributed to people who need it

can't wait for single payer and the death of insurance companies... hopefully all of their executives get fed to sharks and their blood money gets distributed to people who need it

You must have quite the hard on for washington beauracracy and it's politicians.

The sad thing is that what he is hoping for will do a lot more harm to good hard-working folk than it will to the Executives of the insurance companies. The bastards that run the companies can retire today and never have to worry about a thing, whereas, the people that actually work for those companies will all be joining the unemployment lines in their cities.

Immie

 

[Polk]

Congressman Admits ObamaCare a Platform for Single Payer

One can only hope but I highly doubt that's happening.

And your link is bunk.

Yes, one can only hope for higher costs of procedures, fewer resources, and fewer coverage options.

You realize that makes no sense, right? The United States has the most free-market healthcare system in the world and it also has the highest costs. That's not by chance.

 

[Flopper]

A major cost saving benefit of a single payer system is as you said, a single reimburser. However, this is not a minor cost advantage. The reduction in back office claim filing could reduce the total costs by 4%. Write offs of bad debt by health care providers is over 5%. This can be drastically reduced because the healthcare provider and the patient knows exactly what the reimbursement will be for any service. The provider can collect from patient up front. In case of private insurance, the provider has no idea what the insurance company will pay because there are so many companies with so many different plans. I have seen estimate that provider saving in loss due to bad debt and claim processing would reduce cost by 7%.

A single payer system would run very much like CMS, Center for Medicare Services, which serves about 50 million people. The overhead of CMS is 2%. The average health insurance company has overhead rate of 10%. Unlike a single payer system, insurance companies have the cost of marketing their product and the high cost of continually enrolling and unenrolling members. Insurance companies profits have in the past run 15%. More recently over the last decade they run about 10%.

Considering all of the above, it would seem likely that a single payer system would reduce the cost of healthcare at least 20%.

I don’t think a single payer system would be a lot better at controlling cost increases than the current system. Currently the only real cost control comes from insurance companies who contract with providers, Medicare and Medicaid who have fixed reimbursement rates. The consumer is not really a factor at controlling cost because patients do not cost shop for medical care. There are lots of ways of reducing the cost of care, but they have little to do with single payer versus multipayer.

In a single payer system, the government would ultimately fix the all fees. The profits would be determined by cost reduction, which is what we want, and the provider’s ability to bring in new patients. Currently, providers are limited by their membership to the various insurance networks. With a single payer system, every patient is potential new patient.

The question about quality of care is very subjective. If you use objective measures of quality such as successful outcomes, then statistics of single payer systems in other countries show that quality remains high and costs are lower. Unlike our current system, where millions of patients are limited as to what providers they can use by their insurance company, a single payer system would allow the use of all providers, so the patient could really shop for providers based on service.

I am not in favor of government ownership of healthcare providers because it eliminates patients choice in providers. Once the government owns the providers, the patient doesn't really have a choice. In addition, there would little incentive for the healthcare provider to control cost.

But they don't have a choice with single payer either. Government is the only place anyone will be able to 'shop' for a plan. And I honestly think you are predicting savings that simply aren't there. It just isn't realistic to believe the providers don't know how much insurance companies will reimburse them for. There aren't that many insurance companies for providers to deal with. And there won't be any savings to claim filing. People aren't going to not get sick just because we go to single payer. There is no reason to believe the number of claims that need to be filed will go down

I think there should be only one plan, similar to Medicare. You would not shop for health insurance but you would shop healthcare providers. The savings are there. With single payer, your premiums do not include the insurance company profits, which has averaged nearly 10%. Unlike a single payer system, the insurance companies offer a variety of plans, PPO, HMO, EPO, POS, PPS, etc. These plans are then modified with riders tailored to the group policy holder. The cost of claim processing and customer support is very high at 10% compared to CMS at 2%. Single payer also has no marketing costs, CEO bonuses, or reserve requirements. Unlike insurance companies, the big cost of handling enrollment and unenrollment of members is not there. Once you enroll for single payer, it’s for life. Also, healthcare is no longer a cost to businesses. I think there is easily a 20% reduction in premium plus savings for businesses and healthcare providers.

The reason why providers don’t know the amount of insurance reimbursement at time of service is there are so many different policies with different deductibles, different co-insurance, and different exclusions plus many patients have multiple policies. To determine reimbursement, a claim(s) has to be submitted. That’s why providers bill the patient after the service is rendered unless you have an HMO type policy. The patient typically pays only after they receive their explanation of benefits, which can take months. The whole process leads to slow pays and no pays, which drives up the providers cost. With a single payer system, the benefits are the same for everyone and everyone knows what those benefits are. The provider can collect the charges that are the patient responsible at the time of service.