Comment by tptacek
3 days ago
This is my issue with M4A: it seems clear from the numbers that the problems in our system --- and I think they're grave --- are almost entirely on the provider-side, and Medicare has, if anything, locked us into those cost structures. If anyone's curious why there's a scarcity in physician care hours in the US: Medicare rate limits the number of new doctors allowed into the system every year, through the residency funding system.
Agree that it's not perfect, but I do feel that we could take 60-80% of the money we're currently spending and fix this and any other issues that come up and get in the way of improved outcomes like the rest of the world does.
I don't know why what you're describing happens, but my money would be on some triage that needs to happen due to limited funding since so much of our spending goes into private healthcare solutions.
I really just have two things to say on this subthread:
* Medicare would not have 2% overhead if it served 30-year-olds.
* Medicare is in fact the primary constraint on the supply of doctors in the US system.
Fair, don't think I disagree with you on these points. I just believe we can do significantly better. In a similar vein, I believe:
* For profit motives get in the way of cheap, effective healthcare. Maximizing shareholder value leads to higher prices, overutilization of expensive proceedures and prioritization of profit generating services vs. preventive care or basic health care needs and improved outcomes.
* Incentives are currently heavily skewed to the point that providers and insurers are more likely to treat symptoms rather than address root causes or preventive measures leading to a cycle of chronic illness and higher long term costs.
* Access to healthcare should not be tied to socioeconomic status. Employer sponsored insurance and high out of pocket costs create significant barriers for lower income individuals and families, dragging the average down (i.e. the system is fine if you can afford it).
* Administrative complexity in the current system massively inflates cost. The fragmented nature of private insurers, billing systems and out of network shenanigans results in massive inefficiencies and expenses that contribute nothing to patient outcomes. I am confident this comes out to more in savings than the %age profit that is referenced in other places in this thread.
Swing and a miss. Medicare does cover 30 year olds, you just have to be sick enough to qualify. So in fact Medicare covers the least profitable young folks.
Edit since responding to your prolific bad faith arguments got me throttled:
Your argument is that younger people would magically add to the overhead incurred by Medicare. My point is that Medicare's low overhead already includes younger people who are more likely to use expensive modes health care more frequently than the typical younger person. And even then Medicare denies claims at a much lower rate than for-profit insurance companies.
But somehow, adding more, healthier younger folks to Medicare would add to the overhead?
Nah.
Edit since I might as well address another bad faith argument:
Congress controls that funding. Medicare is the administrator. At best your phrasing is disingenuous.
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