Medicare-for-All

[sparky]

ask the Doc's about that.....>

EHR to become Mandatory

 

[Greenbeard]

Now - preventive care, healthier lifestyles, using low-value services, sounds great but I don't see why these ideas will change things in a any appreciable way from the way they are now. I'm not seeing any savings happening here.

"Value" here has a particular meaning, namely health outcomes achieved per dollar spent. Increasing the value of the services we're getting translates into getting equivalent or even better health outcomes for less money. There are plenty of things you'd need to do that but many of them can be traced in whole or in part to payment policy. And that's where single payer could be very useful.

At present, we spend large amounts of money on things that don't make us appreciably healthier. We use information poorly (this is where EHRs and health information exchange more generally can make an impact), we tolerate systems that produce disturbing numbers of medical errors and conditions acquired from health care facilities, we're rarely good enough at identifying and measuring quality, we have a long way to go toward determining the relative effectiveness of different treatment options, our systems of service delivery are often uncoordinated, wasteful, and duplicative, and so on. Each of these deficiencies suggests there's substantial room for improvement that would allow us to achieve equivalent or better health outcomes and spend less money doing it. That is, there's a lot of room to build a higher value health system.

The health system is just that: a system. But at present it's a very fragmented system, rife with inefficiencies that raise the costs of that system and potentially negatively impact health outcomes. Buying health outcomes in a haphazard, à la carte fashion from different providers who may not communicate with each other and may operate with imperfect information isn't a recipe for success (on the flip side, you see more coordinated models of care delivery, like the patient-centered medical home, that seem to be experiencing success). The question is how do you effectively overcome that fragmentation and stitch together a high-value, learning system that delivers better care at a better price. A single-payer system isn't a panacea and it's not the only way to do it, but it is potentially a very potent tool for doing that stitching together, if used correctly.

 

[Douger]

Sanders is a self-proclaimed communist. He will get little support. If the public option couldn't get through with a strong Democratic majority in both house and senate, why would anyone thing UHC could get through with a Republican House majority and slight majority in Senate?

Hey S(shit)Hook. You do understand the difference between communism and socialism , don't you ?
Bernie is a socialist and, to be more specific, a social democrat.
I understand. It's a Chicago thing.

 

[Dont Taz Me Bro]

Isn't MA going broke under the single payer system?

No, Massachusetts does not have a single payer system.

 

[Dont Taz Me Bro]

Can somebody explain to me how we can implement a single payer system and keep the costs down? Provide care for many millions more people who can't pay for it, and have no incentive to not seek free treatment? We don't have enough doctors as it is, so aren't most people going to show up at emergency rooms for a common cold? Better than waiting 6 months to see a provider,right? How could we avoid the so-called death panels where a group of bureaucrats decide the criteria for who gets treatment and who doesn't? How many doctors and providers are gong to opt out of Medicare or retire altogether if this happens?

Stop being logical. That isn't appreciated by the ideologues here.

 

[Publius1787]

http://sanders.senate.gov/newsroom/news/?id=47d632b8-4a43-4d2b-b500-cb2c105e93ef

WASHINGTON, May 10 -- Sen. Bernie Sanders (I-Vt.) announced today that he introduced legislation to provide health care for every American through a Medicare-for-all type single-payer system.

Rep. Jim McDermott (D-Wash.) filed a companion bill in the House to provide better care for more patients at less cost by eliminating the middle-man role played by private insurance companies that rake off billions of dollars in profits.

The twin measures, both called the American Health Security Act of 2011, would provide federal guidelines and strong minimum standards for states to administer single-payer health care programs.

Burnie Sanders is an economic idiot and a self avowed socialist. Any time he tells you that he has a plan to nationalize something and make it cheaper just ignore him. If Medicare and medicaid are any indicaters of how the government runs healthcare you should know how bogus of a statement your making.

 

[sparky]

If Medicare and medicaid are any indicaters of how the government runs healthcare you should know how bogus of a statement your making

riiiiggghhhhhhhtttttttttooooooooo.............

Medicare overhead is 4% compared to 12% for private insurers

With private insurance, 30 cents of every dollar pays for nonmedical costs: marketing, billing, denying coverage, hassling patients and doctors, profits and astronomical CEO salaries. Medicare overhead, on the other hand, costs just 3 cents on the dollar.

 

[JBeukema]

medicare overhead is 4%

... Medicare overhead, on the other hand, costs just 3 cents on the dollar.

3/100 = 3%, not 4%

Which is it, 3 or 4?

 

[California Girl]

Are we honestly that stupid that we think that we can succeed where every other country that operates something similar has failed?

Really?

Are we somehow immune to the catastrophes that happen elsewhere?

 

[JBeukema]

Are we honestly that stupid that we think that we can succeed where every other country that operates something similar has failed?

Really?

Are we somehow immune to the catastrophes that happen elsewhere?

Are you saying you don' believe in American exceptionalism?

Are we just another country like any other?

 

[California Girl]

Are we honestly that stupid that we think that we can succeed where every other country that operates something similar has failed?

Really?

Are we somehow immune to the catastrophes that happen elsewhere?

Are you saying you don' believe in American exceptionalism?

Are we just another country like any other?

Oh, we are exceptional. I am just hoping that we aren't stupid. It would be stupid to follow others into the clusterfuck that most other countries "free" health care is.

 

[JBeukema]

Why are we exceptional, if not because we can do things others can't?

 

[AVG-JOE]

The twin measures, both called the American Health Security Act of 2011, would provide federal guidelines and strong minimum standards for states to administer single-payer health care programs.

I was skimming through the bill a bit last night. It's a very interesting contrast with the perennial single-payer bill, H.R. 676, which really is Medicare-for-all--that is, a single federal program that operates very much like Medicare. Sanders and McDermott, on the the other hand, are proposing this state-administered variant, so there would actually be (presumably) 51 single-payer programs, though I believe states do have the option of joining together to form multi-state systems if they wish.

So it really raises the question of, if you were going to have a single-payer system, would you want it administered at the federal level largely without state involvement, or would you want individual states to administer their own single-payer program? That is, it's the Medicare structure vs. Medicaid structure question.

Seems like it's usually taken for granted that it would just be a Medicare expansion and thus entirely federal. Very interesting that Sanders and McDermott have gone the other route and put states in charge in their proposal.

I like the state administration option. If the Federal Government sets it up and runs it, we have only 1 program going forward to learn from. If the states are free to see what works for each particular region, we can study 40 to 51 programs at once to find out what works and what's wasteful.

 

[AVG-JOE]

I keep hearing that people want 'choices'. Usually in the context of choices in coverage. I think people want choices in providers and when it comes to coverage, they want a clear understanding of what they have to pay for themselves and a minimum of paperwork.

The folks using Medicare today are very frustrated with the blending of public and private bureaucracies and the hassles and paperwork required to see a doctor and get a 'scrip filled.

Medicare part D is a pharmaceutical and insurance industry wet dream of confusion, paperwork and profits.

 

[AVG-JOE]

Can somebody explain to me how we can implement a single payer system and keep the costs down? Provide care for many millions more people who can't pay for it, and have no incentive to not seek free treatment? We don't have enough doctors as it is, so aren't most people going to show up at emergency rooms for a common cold? Better than waiting 6 months to see a provider,right? How could we avoid the so-called death panels where a group of bureaucrats decide the criteria for who gets treatment and who doesn't? How many doctors and providers are gong to opt out of Medicare or retire altogether if this happens?

Step one is to understand how clever the medical industry was in designing the health care payment system.

If we paid teachers that receive public funds for services the same way we pay doctors that receive public funds for services, we'd look twice as stupid from space.

Instead of paying teachers 'per pupil, per test' we put them on a salary, give 'em a bunch of kids and say "Get 'er done".

One way of controlling costs is to pay doctors a salary for taking care of folks instead of padding their paychecks for every pointless test and procedure they do.

 

[editec]

http://sanders.senate.gov/newsroom/news/?id=47d632b8-4a43-4d2b-b500-cb2c105e93ef

WASHINGTON, May 10 -- Sen. Bernie Sanders (I-Vt.) announced today that he introduced legislation to provide health care for every American through a Medicare-for-all type single-payer system.

Rep. Jim McDermott (D-Wash.) filed a companion bill in the House to provide better care for more patients at less cost by eliminating the middle-man role played by private insurance companies that rake off billions of dollars in profits.

The twin measures, both called the American Health Security Act of 2011, would provide federal guidelines and strong minimum standards for states to administer single-payer health care programs.

There is no solution to this problem that mere market forces or changes in WHO PAYS that are going to solve this entirely organic problem.


As long as HC is actually working better, more people live still longer and therfore need still more HC.


Add to that trend, that better HC reasonable DOES cost more and we have a macro-economics problem that is insoluable.


Bottom line?


This society will either accept the fact that HC consumes more and more of its GDP, OR we start RATIONING HC -- either by allowing supply/demand to ration it invisibly, or by creating DEATH PANELS to ration it socially.


The HC market is a BLACK HOLE of demand

 

[AVG-JOE]

I'm still drawn to 'medicare plus'- revamping Medicare and opening it to all American adults who choose to enroll. Allowing younger, healthier individuals in would better spread risk and should bring down costs. Also, we need to ensure that various providers must compete for contracts and health care providers are able to purchase medications from the least expensive (verified) source

At this moment in time, AVG-WIFE and I are spending $620 per MONTH on "health care" in the form of insurance premiums, which include the portion paid by my employer.

AVG-WIFE has seen a doctor ONCE since we signed up for this insurance 2 years ago, and she had to pay much of the cost for that visit 'out-of-pocket' - I have yet to meet a physician for professional services.

Since we are both fairly healthy and not real fond of doctors, the odds are that neither of us will use our insurance until we get closer to retirement, say around age 65. At that moment in time some insurance executive will take all the money we've paid out in "health-care" costs over the last 17 years and buy a corporate jet to fly to Cancun on for a marketing meeting, confident that the money is theirs to spend because they've successfully dumped us on to the taxpayers via Medicare.

I just wish I could 'buy into' Medicare for it's 80% coverage now so I'm insured against tragedy and, ass-u-me-ing I make it to age 65 and need to start seeing a doctor, I won't feel so guilty tapping Medicare for the bill because I will have paid all the premiums of my youth into the system I'm getting ready to start using.

 

[CrusaderFrank]

Human nature Pop Question. Pick the one correct answer.

When people don't have to pay for stuff, they want (more/less) of it.

 

[Cuyo]

Can somebody explain to me how we can implement a single payer system and keep the costs down? Provide care for many millions more people who can't pay for it, and have no incentive to not seek free treatment? We don't have enough doctors as it is, so aren't most people going to show up at emergency rooms for a common cold? Better than waiting 6 months to see a provider,right? How could we avoid the so-called death panels where a group of bureaucrats decide the criteria for who gets treatment and who doesn't? How many doctors and providers are gong to opt out of Medicare or retire altogether if this happens?

We already provide care for millions who can't pay for it, we just do so in a ridiculously expensive way. The hope is that when people aren't terrified to get problems checked out (due to costs), problems can be caught earlier when they're cheaper to fix.

 

[Cuyo]

Are we honestly that stupid that we think that we can succeed where every other country that operates something similar has failed?

Really?

Are we somehow immune to the catastrophes that happen elsewhere?

Do you classify our current system as "Success?"