The NY Times weighs in on single payer plans, and why it would still be expensive.


The NY Times weighs in on single payer plans, and why it would still be expensive.

Why is healthcare so expensive in the USA and would single payer solve the problem?    Sure, you would eliminate the cost of administration from large health insurers which can result in reduced costs, and Medicare does have better ability to negotiate both hospital and medical fees, since it is national and has more clout.

There are estimates that a plan like the one suggested by Bernie Sanders would cost double what his presidential campaign proposes, but most other societies seem to have figured out how to deliver great care and half the price we do.

Part of the problem is that in the USA, we pay substantially higher prices than other countries for doctor visits, hospital stays and prescription drugs.  Part of the high cost of visiting physicians has to do with the high amount they need to pay for schooling which can be in excess of $300,000, which is basically a mortgage.  Of course, then they need to live and earn.  Medicare pays less to many hospitals and specialists who in some specialties, are extraordinarily well paid for what they do, yet primary care trails considerably in earnings, for their office visits. Most primary doctors have shortened office visits, and now refer out more and run many more tests as well which raises the cost of care for all of us, and does not assure our needs are met.

We also are paying through the nose for most drugs, and there is no system for evaluating the costs of medicines.  Medicare does not have anything in the law to negotiate drug prices, a huge policy failure which needs to be corrected, unlike the Veterans Administration which does.

It will take more than Medicare for all to solve all the cost problems of insuring American’s, but simplifying the system and improving reimbursements in primary care while broadening who will provide such care is strongly needed.   Deemphasizing overspecialization can help, since often the narrow disease minded scope of practice model is a huge cost driver, and more often than not, does not solve our problems.

Perhaps, a trial roll out of Medicare for those over 50 years of age is needed to see how it works would be a wise approach, nobody is talking about.   If Medicare in its current form works and is cost effective, it is scalable and we may find that a simpler model, that perhaps uses payroll or employer or both to pay for the care as we do now would be a reasonable approach to see how it works.

That model will also force insurers to be more competitive, against a proven model which most seniors are happy with.  It would also be prudent, as “The Donald” has suggested if we allowed insurers to insure others across state lines.  My guess is that most of us would pick the less expensive plan with the most doctors that has a lower deducible whose name is Medicare, and we will eventually move toward a single payer system that has proven itself and worked most of the kinks out over many years.

Insurers I am sure will fight this, but many of them may find themselves having models that look similar to the Medicare model now, which uses private processers to process Medicare claims.

Check out this article

A Single-Payer Plan From Bernie Sanders Would Probably Still Be Expensive

Margot Sanger-Katz  MAY 16, 2016

Bernie Sanders”™s chances at enacting a “œpolitical revolution” are all but gone. But that doesn”™t mean his policy agenda won”™t continue to be felt in this election or future Democratic platforms.

One of his signature proposals is to move the country”™s health care system to a government-run, single-payer system. Last week, Hillary Clinton nodded in that direction, suggesting that she would be open to allowing Americans older than 50 to buy into the government Medicare program that currently covers those 65 and older.

But also last week, a detailed analysis of the Sanders health care plan from researchers at the Urban Institute showed that it would probably cost the government double what the campaign proposed. It is the second credible analysis to suggest that the Sanders plan costs more than advertised. (The other comes from the Emory health policy professor Kenneth Thorpe.)

The Sanders plan is light on some key details, but even in sketch form, it seems clear that it would require even bigger tax increases than the sizable ones the campaign has called for.