Comment by TuringNYC
15 hours ago
>> Medicare pays 50% less than private insurance. So doing this would require either layoffs, cutting salaries for doctors/nurses/etc, or both. This may well be the right decision for society as a whole--that's a big part of the debate here--but there's no free lunch.
You arent considering
1. Hospitals eating the cost of the uninsured, which this would solve
2. Hospital spending tons on administrative duties fighting with insurers on coverage, which this would reduce
> Hospital spending tons on administrative duties fighting with insurers on coverage, which this would reduce
Would this go away, though? Instead of fighting with insurers they would be fighting with the government insurer?
I am very pro universal healthcare, I just don’t want to pretend there aren’t still going to be fights over what should be paid for.
No matter what, there are going to be disagreements on what medical procedures should be paid for and who needs them, as well as how much they should be billed for.
The way a lot of other countries deal with this is that the government calculates out a benefit vs cost assessment for every new treatment and only covers ones that come out ahead. But, that ends up with things like new targeted chemotherapies being unavailable for years after their initial release, vs in the US where they are available to much of the population once the right prior auth is filed. There is also more top down management of costs, such as long term life support for people in vegetative states.
All of this was branded as "death boards" in the American healthcare debate.
People hate it when faceless bureaucrats decide that some health care expense is too expensive for the large faceless bureaucracy to cover, when they have a medical issue that they would like the large faceless bureaucracy to spend money on. Perhaps in that world, some insane guy with a back injury who's unhappy about the quality of his care assassinates the Secretary of Health and Human Services, rather than the CEO of a medical insurance corporation (and hey, a lot of people hate RFK Jr. anyway, so maybe that assassin still becomes a folk hero for doing it).
> Instead of fighting with insurers they would be fighting with the government insurer?
1. I'd rather fight the non profit-motivated entity 2. We can probably compare to VA and Medicare and even other countries to see what the fight will be like. I'm willing to bet it will be a big improvement.
> No matter what, there are going to be disagreements on what medical procedures should be paid for and who needs them, as well as how much they should be billed for.
Government insurance has a service motive. Private insurance has a profit motive.
Those are two real effects, but together they wouldn't compensate for the rate cuts.
About 8% of the population is uninsured. The uninsured population skews younger, with less healthcare utilization (Medicare already covers everyone 65 and older).
Another comment in this thread estimated billing overhead at 8.5%. Medicare for All would eliminate some, but not all of this, since Medicare is still a claims-based system. You would remove a lot of overhead around prior auths, which I agree is a good thing, but could be achieved with more focused legislation.
> .. 8% of the population is uninsured. .. this is Bogus, one of the first argument hospitals make for inflated pricing is that they have to cover the cost of uninsured. if the uninsured doesnt exist then the whole line of BS argument falls.
> 2. Hospital spending tons on administrative duties fighting with insurers on coverage, which this would reduce
This layer won't go without a fight. Maybe it _is_ the layer we're fighting against. The owners will still make profit, the providers still have jobs.. but the middle layers are useless bloat. They don't have skills to provide care, they don't operate at the capitalist layer. They are useless today, and even more useless tomorrow.
And that is likely useless layer is millions? of jobs.
What hospitals makes has nothing to do with physician pay - those are separate categories. Hospitals aren’t going to magically start giving some of their profit to doctors to help cover their lower fees.
OP makes a good point. The studies assumes two diametrically opposed things will happen - doctors will take a 50% pay cut but access to primary care physicians will increase.
Why would we solve the primary care physician shortage by cutting their pay?
Allow/force medical schools to grow, increasing the provider pool, thereby reducing their pay?
How would this change solve: "Hospitals eating the cost of the uninsured..."?
Wouldn't it just transfer the cost from the hospitals to the universal coverage agency? This would make the financial picture even worse for the proposed system.
>>> Hospitals have an operating margin of 2-5%. Medicare pays 50% less than private insurance.
The hospital can be paid less without reducing their margin if they can remove a cost from their balance sheet. It does not make the system cheaper overall, but it means the hospital does not have to bear those costs directly. They may not have to bear them at all, because hospitals are not the only things in the system.
No, because that cost is included in the $300 billion increase in spending that is part of the calculation they do.
Think about corps merging to save cost on back office. Here is the same idea. With AI, it would even cut additional order of magnitude of cost.