Free-market libertarian think tank concludes single payer healthcare...will save country $2 trillion

[PhitePhan]

Anyone that actually believes Govt would be efficient enough to diminish administrative costs simply because of the shear volume has no idea how Govt is inefficient.

That is what confuses me. Our government has shown itself to be inefficient, and dare I say, obviously corrupt and incompetent in many aspects of functioning, including their role in our current HC problems (such as mandating participation in a obviously flawed healthcare system).

Now we're supposed to buy that they are going to miraculously "fix" HC? What evidence do we have to suggest such an outcome? SS is nearly insolvent, VA healthcare is atrocious and a national embarrassment, various governmental agencies have "lost" billions of dollars without so much as an apology, and the list goes on. Forgive me for being skeptical when others claim single payer is the answer in the US.

 

[PhitePhan]

"and to see our fine nation turn into a third-world zhithole"

Correct me if I'm wrong, but America became a powerhouse well before the government implementing any real of humanitarian programs (SS, Medicare, etc) what makes you think those things are necessary to prevent a decline?

 

[Pseudo Sane]

Canadian here.

I like our single payer system for the most part, but there are practical tradeoffs to it.

Our acute care is pretty good. Treatments deemed non-essential can take a long time to happen. Wait times for ultrasounds or CT scans can take more than 12 months. Knee and hip surgeries are notoriously slow as well.

I think that a lot of Americans who currently have health coverage might have a Brock Lesnar experience if pushed into the Canadian system: https://www.thestar.com/sports/2010...ates_canadian_health_care_as_third_world.html . Our hospitals are smaller, rooms tend to be shared, wait times are longer, medical technology is not cutting edge. We are far from an ideal single-payer system; my understanding is that others, including the UK, tend to have better outcomes, although they have their own problems.

On the other hand,everybody gets a pretty good level of treatment, and those who want cutting edge treatment can go pay for it in America or overseas. Anecdotally, I have been in and out of hospital a few times for various issues and have always received generally appropriate care. The crowding in the hospitals is very noticeable, however.

There is no free lunch with health care. Ultimately, health care is a massive service and it costs a lot of resources. The real question is a matter of how to allocate those resources; who supplies them, who receives them, and why.

As a practical matter, I don't think that the American health care system could switch to a Medicaid-for-all model without the level of care changing. I am not deeply read on this issue, so I am open to correction, but everything I have read suggests that hospitals lose money on every medicaid patient: http://www.modernhealthcare.com/article/20151031/MAGAZINE/310319982. They just don't produce enough money. If they can't make money, the hospital will not stay afloat, so you have to control the cost.

To control this cost, you can do a few things:
1) Reduce the cost (and quality) of healthcare provided;
2) Increase the rates at which the government pays for services (ie, more debt and/or higher taxes); or
3) Cut back on nurses and doctors salaries.

#3 won't happen; nurses and doctors are too powerful and sympathetic as a lobby. Which leaves a combination of 1 + 2, neither of which are something I think people really want.

I think a lot of people are living in a fairy tale if they think that there is a magical solution to health care costs. This is never going to be free, and while Americans might enjoy some increase in efficiencies by simply doing away with a lot of the billing nonsense your current system generates, any transition to single payer would require significant tradeoffs.

 

[Prokofievian]

Canadian here.

I like our single payer system for the most part, but there are practical tradeoffs to it.

Our acute care is pretty good. Treatments deemed non-essential can take a long time to happen. Wait times for ultrasounds or CT scans can take more than 12 months. Knee and hip surgeries are notoriously slow as well.

I think that a lot of Americans who currently have health coverage might have a Brock Lesnar experience if pushed into the Canadian system: https://www.thestar.com/sports/2010...ates_canadian_health_care_as_third_world.html . Our hospitals are smaller, rooms tend to be shared, wait times are longer, medical technology is not cutting edge. We are far from an ideal single-payer system; my understanding is that others, including the UK, tend to have better outcomes, although they have their own problems.

On the other hand,everybody gets a pretty good level of treatment, and those who want cutting edge treatment can go pay for it in America or overseas. Anecdotally, I have been in and out of hospital a few times for various issues and have always received generally appropriate care. The crowding in the hospitals is very noticeable, however.

There is no free lunch with health care. Ultimately, health care is a massive service and it costs a lot of resources. The real question is a matter of how to allocate those resources; who supplies them, who receives them, and why.

As a practical matter, I don't think that the American health care system could switch to a Medicaid-for-all model without the level of care changing. I am not deeply read on this issue, so I am open to correction, but everything I have read suggests that hospitals lose money on every medicaid patient: http://www.modernhealthcare.com/article/20151031/MAGAZINE/310319982. They just don't produce enough money. If they can't make money, the hospital will not stay afloat, so you have to control the cost.

To control this cost, you can do a few things:
1) Reduce the cost (and quality) of healthcare provided;
2) Increase the rates at which the government pays for services (ie, more debt and/or higher taxes); or
3) Cut back on nurses and doctors salaries.

#3 won't happen; nurses and doctors are too powerful and sympathetic as a lobby. Which leaves a combination of 1 + 2, neither of which are something I think people really want.

I think a lot of people are living in a fairy tale if they think that there is a magical solution to health care costs. This is never going to be free, and while Americans might enjoy some increase in efficiencies by simply doing away with a lot of the billing nonsense your current system generates, any transition to single payer would require significant tradeoffs.

About our healthcare system, I think the bolded is a real issue. As I said, I've experienced two single payer systems, and unfortunately the Canadian one was the worse of the two. Doctor supply is artificially restricted in Canada, the only reason that I can see being the protection of Doctor salaries. My former advisor is married to a German medical doctor. She found it absolutely impossible to have her qualifications recognized in Canada, or to find residencies: to be a doctor, essentially. The entrance requirements are just absurd, and too few students are admitted to med school for a country with a doctor shortage for as long as I can remember.

But then, in Canada, we don't really do anything right. Take any example: transportation. We made the decision that our country was going to be a driving country, instead of a country with a robust mass transportation network. One might expect, in that case, that our roads would at least be good. Nope. They're absolutely terrible, antiquated, overcongested and mostly falling apart; and that's even taking our climate into account. We don't have a single program, national or otherwise, that is the envy of the world. To really nail this point home, take the one thing in the world where everyone should be copying us: hockey. We are the only country in the world that doesn't have its own NHL development system beyond U20. Every other country can have their players play at whatever level suits their development, but not us. We can't have our players play in the AHL until their CHL obligations are finished because otherwise, how ever would the Sudbury Wolves survive?

Our bragging rights in so far as health care is concerned is just that we have UHC and the U.S. doesn't: not that our UHC system is particularly well run.

 

[Possum Jenkins]

Wouldn't doctors being able to see more patients as a result of far less paper work result in a pay increase? Or at least offset a cut from Medicare for all.

I've never heard of anything like that.

If there's any paperwork decrease, I don't think it'll be significant enough to add more patients seen. It's not like they're doing hours and hours of paperwork. I don't think, at least.

 

[Possum Jenkins]

Even then doctors make lots of money. In libcvk UK, a GP makes 150k per year, under a single payer system. Specialists make more.

I guess thats not enough for Murkans who become doctors not to help people but because they want to turn into mini-oligarchs.

Yeah, the idea that docs must be outrageously compensated or people will stop studying medicine holds no water when you consider and extreme case like Cuba.

There, doctors literally make less than taxi drivers, bellhops and other people working in the tourism industry. And they have for decades. Yet for decades Cuba produced the best doctors in the entire Latin American/Caribbean region.

 

[surrealworlds]

Yeah, the idea that docs must be outrageously compensated or people will stop studying medicine holds no water when you consider and extreme case like Cuba.

There, doctors literally make less than taxi drivers, bellhops and other people working in the tourism industry. And they have for decades. Yet for decades Cuba produced the best doctors in the entire Latin American/Caribbean region.

How do they compare to American doctors though where 6 figure salaries are not unheard of?

 

[ScottE]

Correct me if I'm wrong, but America became a powerhouse well before the government implementing any real of humanitarian programs (SS, Medicare, etc) what makes you think those things are necessary to prevent a decline?

You realize the world has changed in the past 100 years right?

 

[Possum Jenkins]

How do they compare to American doctors though where 6 figure salaries are not unheard of?

You gotta compare apples to apples. This is why the US is compared to other industrialized countries, not developing ones.

Yet DESPITE the US having 6 times the per capita GDP of Cuba, the difference in health between the two is pretty slim:

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32336-X/fulltext?elsca1=tlpr

Cuba is tied with Costa Rica for tops in Latin America.

 

[surrealworlds]

You gotta compare apples to apples. This is why the US is compared to other industrialized countries, not developing ones.

Yet DESPITE the US having 6 times the per capita GDP of Cuba, the difference in health between the two is pretty slim:

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32336-X/fulltext?elsca1=tlpr

Cuba is tied with Costa Rica for tops in Latin America.

What? I feel like you answered an entirely different statement.
You originally commented that Cuba has great doctors even though they dont get paid shit. My question was, how do they compare to american doctors? Your response is "well america is barely healthier than cuba even though they are richer."
That was not the question. You are implying people will put forth the effort to become extraordinary doctors regardless of profitability. I dont know if that is true or not. I do know America has some of the best doctors in the world and some of the most advanced medical care in the world. We have that because we pay a lot of money for it .
So the question is, if Cuban doctors are great even though they dont get paid shit, are they really as good as the american doctors that get paid a lot?
This is not about comparing the health of the two countries its about the general skill of those countries doctors. The health of america is shit because we live horribly decadent lifestyles and eat horrivly delicious food that kills us. Our doctors are still awesome though. If anything they are better because we give them lots of practice dealing with our fat asses and bad habits.

 

[Possum Jenkins]

What? I feel like you answered an entirely different statement.
You originally commented that Cuba has great doctors even though they dont get paid shit. My question was, how do they compare to american doctors? Your response is "well america is barely healthier than cuba even though they are richer."
That was not the question. You are implying people will put forth the effort to become extraordinary doctors regardless of profitability. I dont know if that is true or not. I do know America has some of the best doctors in the world and some of the most advanced medical care in the world. We have that because we pay a lot of money for it .
So the question is, if Cuban doctors are great even though they dont get paid shit, are they really as good as the american doctors that get paid a lot?
This is not about comparing the health of the two countries its about the general skill of those countries doctors. The health of america is shit because we live horribly decadent lifestyles and eat horrivly delicious food that kills us. Our doctors are still awesome though. If anything they are better because we give them lots of practice dealing with our fat asses and bad habits.

I understood your question, which is why I said that we should compare apples to apples. Comparing the quality of American doctors to Cuban ones is disingenuous.

The US has some of the best doctors and the most advanced medical care because it's by far the richest and most powerful country in the history of the world. It has tremendous resources and infrastructure and has had that for over a century. Cuba is a poor country so it makes sense to compare them to other poor countries in its region.

But even though Cuban doctors make 1/100 the salary of American ones, they still provide enough quality care to have Cuba be close to the US in total health rankings. This suggests that you don't need preposterous salaries in order to produce quality doctors.

 

[AndroidRage]

I've never heard of anything like that.

If there's any paperwork decrease, I don't think it'll be significant enough to add more patients seen. It's not like they're doing hours and hours of paperwork. I don't think, at least.

Its a reason I have seen given as to why more and more doctors are starting to support single payer.

Fifty-six percent of doctors registered either strong support or were somewhat supportive of a single-payer health system, according to the survey by Merritt Hawkins, a physician recruitment firm. In its 2008 survey, opinions ran the opposite way — 58 percent opposed single-payer. What’s changed?

Red tape, doctors tell Merritt Hawkins. Phillip Miller, the firm’s vice president of communications, said that in the thousands of conversations its employees have with doctors each year, physicians often say they are tired of dealing with billing and paperwork, which takes time away from patients.

Also in the article you posted it said some doctors prefer seeing medicare patients because it is a steady income stream.

 

[surrealworlds]

I understood your question, which is why I said that we should compare apples to apples. Comparing the quality of American doctors to Cuban ones is disingenuous.

The US has some of the best doctors and the most advanced medical care because it's by far the richest and most powerful country in the history of the world. It has tremendous resources and infrastructure and has had that for over a century. Cuba is a poor country so it makes sense to compare them to other poor countries in its region.

But even though Cuban doctors make 1/100 the salary of American ones, they still provide enough quality care to have Cuba be close to the US in total health rankings. This suggests that you don't need preposterous salaries in order to produce quality doctors.

Correlation does not equalt causation.
You cant say that American doctors are better because of money and resources and then in the next sentence say you can produce quality doctors without that much money. Its one or the other.
Im sure the doctors in Cuba are very well intentioned and do the best job possible with the equipment and training they have available to them. In no way am i putting them down but its a fact that the more money you spend the better doctors you have available generally speaking.
This is a simple concept. The higher salaries are a huge incentive for doctors to push themselves to be the best. The large amounts of money buys the best equipment and the best training to produce the best doctors(well some of thr best, im not saying we have the absolute best.)
You have provided no proof that less money spent produces better doctors only worse doctors that provide similar healthcare to America but once again you are comparing American Health/healthcare in a conversation about Doctor skills. You seem to have a hardtime staying on track so im done. Have a good day.

 

[Possum Jenkins]

Correlation does not equalt causation.
You cant say that American doctors are better because of money and resources and then in the next sentence say you can produce quality doctors without that much money. Its one or the other.
Im sure the doctors in Cuba are very well intentioned and do the best job possible with the equipment and training they have available to them. In no way am i putting them down but its a fact that the more money you spend the better doctors you have available generally speaking.
This is a simple concept. The higher salaries are a huge incentive for doctors to push themselves to be the best. The large amounts of money buys the best equipment and the best training to produce the best doctors(well some of thr best, im not saying we have the absolute best.)
You have provided no proof that less money spent produces better doctors only worse doctors that provide similar healthcare to America but once again you are comparing American Health/healthcare in a conversation about Doctor skills. You seem to have a hardtime staying on track so im done. Have a good day.

No, it's not one or the other. Both can and do exist together. My point is, of course lots of money and resources help, but doctors' salaries don't necessarily have to be outrageous. The reality of Cuban medicine since the revolution is absolute proof of this. There they actually do get paid like manual workers, yet they're high quality enough to have a poor country like Cuba be somewhat close in rankings to the richest country in history.

Whatever shortcomings Cuban medicine has (and it has very few), it's due to lack of infrastructure and resources in their system, not because doctors aren't motivated enough because they don't get paid enough. If lack of motivation was a problem, you'd have a shortage of doctors and the overall health of the country would be among the lowest in the world.

 

[DespicablePeep]

No, it's not one or the other. Both can and do exist together. My point is, of course lots of money and resources help, but doctors' salaries don't necessarily have to be outrageous. The reality of Cuban medicine since the revolution is absolute proof of this. There they actually do get paid like manual workers, yet they're high quality enough to have a poor country like Cuba be somewhat close in rankings to the richest country in history.

Whatever shortcomings Cuban medicine has (and it has very few), it's due to lack of infrastructure and resources in their system, not because doctors aren't motivated enough because they don't get paid enough. If lack of motivation was a problem, you'd have a shortage of doctors and the overall health of the country would be among the lowest in the world.

Doctors in Cuba are slaves, it only works because they are not allowed to leave Cuba. They have actually been rented out to other countries, some have come to Brasil through OPAS.

Brasil pays OPAS U$2.666,00 per month for each doctor, the doctors get to keep U$800/Month.

There is a lot of myths about Cuban health system most of it its just propaganda.

 

[Possum Jenkins]

Doctors in Cuba are slaves, it only works because they are not allowed to leave Cuba. They have actually been rented out to other countries, some have come to Brasil through OPAS.

Brasil pays OPAS U$2.666,00 per month for each doctor, the doctors get to keep U$800/Month.

There is a lot of myths about Cuban health system most of it its just propaganda.

Yeah, that's how high the quality of their doctors are. They actually go to other countries and do work. Cuba also exchanges their doctors for oil with Venezuela.

I don't know where the myths lie though. It's a fact they're high quality. That they're sent by the Cuban government to other countries isn't a secret. That they don't keep their all their wages isn't a secret either.

When your elementary, high school, college and med school education, as well as your housing, food, transportation, and your own healthcare is subsidized by the state, keeping about 33% of the wages made on an international contract that the same state made possible sounds reasonable.

 

[DespicablePeep]

Yeah, that's how high the quality of their doctors are. They actually go to other countries and do work. Cuba also exchanges their doctors for oil with Venezuela.

They only work in other "socialist" countries, but there are dozens of reports on how most of these doctor have little knowledge of medicine. I like how you also skipped over the fact that these doctors are getting payed very low salaries when most of the money is sent directly to Cuba. And most who were sent to Brasil have already opened law suits demanding they receive the money directly and in full.

Their conditions are analog to slavery can´t understand how someone can claim that is success.

 

[Possum Jenkins]

They only work in other "socialist" countries, but there are dozens of reports on how most of these doctor have little knowledge of medicine. I like how you also skipped over the fact that these doctors are getting payed very low salaries when most of the money is sent directly to Cuba. And most who were sent to Brasil have already opened law suits demanding they receive the money directly and in full.

Their conditions are analog to slavery can´t understand how someone can claim that is success.

If they know little about medicine then the importing of Cuban doctors will stop very quickly. Yet it's been going on for decades. In Brazil, it was wildly popular:

A March nationwide poll showed national approval of the program at 67%. Support is highest in the country’s poor northeast, at 72%, where the most doctors are concentrated. In fact, the program has been so popular there that other states are copying it.

https://qz.com/234561/the-story-behind-cubas-deal-to-send-doctors-to-brazil/


And no, I didn't skip over the salary part. I spelled it out right here:

keeping about 33% of the wages made on an international contract that the same state made possible sounds reasonable.

If they keep about 1/3, that means the state takes about 2/3. This is broadly similar to work requirements in the US where you agree to work for a certain number of years for the VA or something in exchange for your student loans to be forgiven. Again, in Cuba, the state pays for pretty much everything from birth, so taking most of the salary that another country gives you is reasonable.

 

[DespicablePeep]

If they know little about medicine then the importing of Cuban doctors will stop very quickly. Yet it's been going on for decades. In Brazil, it was wildly popular:.

And there are numerous reports how they are inefficient, Brasil only got them because the party in power at the time had close relations with Cuba.

If they keep about 1/3, that means the state takes about 2/3. This is broadly similar to work requirements in the US where you agree to work for a certain number of years for the VA or something in exchange for your student loans to be forgiven. Again, in Cuba, the state pays for pretty much everything from birth, so taking most of the salary that another country gives you is reasonable.

Education in Cuba is "free", they had no loans, they are simply forced to worked for the state and are not free to leave Cuba. That´s slavery

https://www.miamiherald.com/news/nation-world/world/americas/cuba/article129125864.html

Why do you make positive posts to one of the worst regimes in the world? Where people are not free to come and go? Who have to work as slaves to bring the state billions in dollars.

 

[surrealworlds]

No, it's not one or the other. Both can and do exist together. My point is, of course lots of money and resources help, but doctors' salaries don't necessarily have to be outrageous. The reality of Cuban medicine since the revolution is absolute proof of this. There they actually do get paid like manual workers, yet they're high quality enough to have a poor country like Cuba be somewhat close in rankings to the richest country in history.

Whatever shortcomings Cuban medicine has (and it has very few), it's due to lack of infrastructure and resources in their system, not because doctors aren't motivated enough because they don't get paid enough. If lack of motivation was a problem, you'd have a shortage of doctors and the overall health of the country would be among the lowest in the world.

At this point you are either dense or just being argumentative to be argumentative. Maybe your just stubborn?
Either way, its a fact U.S. Doctors are better than Cuban Doctors. Mostly because of money. You can cling to
"But Cuba is ALMOST as good as the U.S. and we dont pay our doctors shit." all you want but almost is not the same and definitely not better.
We have better doctors because we pay them more. They spend more on their education. We spend more on the infrastructure they will use in practice. Every aspect of medicine costs money and money makes our medicine better than Cuba's. You said it yourself. So go ahead, enjoy your almost as good doctors and when a medical procedure goes wrong or they dont have the tools they need due to money you can feel ok about it because the stupid Americans spend way more and barely get better service.