
Medicare for All – The Bernie Sanders and Elizabeth Warren Health Care Plans - jumbopapa
http://healthpolicyandmarket.blogspot.com/2019/10/medicare-for-allthe-bernie-sanders-and.html
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devinl
I agree that short term providers will likely take in less money with a
"Medicare for all" solution, but I think the problem presented by this blog
post is overstated/misrepresented: 1) The "Over 65" demographic visits the
hospital more than other demographics so comparing raw number of people is an
apples to oranges comparison (65+ somewhere between 3-10x more likely to
utilize an inpatient stay, [https://www.hcup-
us.ahrq.gov/reports/statbriefs/sb235-Inpati...](https://www.hcup-
us.ahrq.gov/reports/statbriefs/sb235-Inpatient-Stays-Age-Payer-Trends.jsp)) 2)
Roughly half of all administrative costs in US hospitals are associated with
billing. Administrative costs are lower in single payer systems because
hospitals don't need to bargain and coordinate billing with multiple parties.
Doctors will still be needed by hospitals, but hospital workers/sales
people/VPs who bargain with insurance companies will be less necessary. This
is a significant percentage of hospital expenditures
[[https://www.americanprogress.org/issues/healthcare/reports/2...](https://www.americanprogress.org/issues/healthcare/reports/2019/04/08/468302/excess-
administrative-costs-burden-u-s-health-care-system/)] Administrative staff
seem much more likely to see paycuts or staffing cuts rather than necessary
staff like doctors/nurse.

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pwinnski
The reason candidates feel a need to propose anything related to health care
is that the costs are too high. Anybody expecting lower costs without cutting,
you know, costs isn't engaging reality.

So yes, any serious proposal to address the cost of health care in America
will include cuts to the costs of health care in America, which includes
hospitals, doctors, and so on. This seems blindingly obvious.

The linked blog post seems to want the current system to be preserved as-is,
with no cuts to anything. Which is a viewpoint, but not a very popular one.

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jumbopapa
I think the enlightening thing is that higher costs have been driven by
government funded programs. I have to pay taxes for Medicare directly and
there is a hidden tax in the form of higher healthcare costs in the private
market.

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Ancalagon
Yes. The plan is to cut payments to providers. This includes doctors. I'm
sorry.

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oflannabhra
Healthcare has become a huge portion of our economy, in fact the largest at
18%. Doctors account for about 750k jobs in the US, compared to 16 million in
the segment total: they account for only 4.5% of healthcare jobs.

Healthcare is also the fastest growing employment sector.

There are huge inefficiencies in the US healthcare system. We pay more to
provide equivalent service as other first world countries.

However, switching to a single-payer system with a snap of one's fingers will
not solve those inefficiencies, and will create massive upheaval in just about
every Americans life, and our economy in general.

The article is pointing out that if the government sets prices _at which all
companies decide they cannot profitably render services_ , 20% of our economy
and 16 million jobs just vanished. No candidate has addressed this issue.

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pwinnski
I find it hard to believe that someone who has spent a large chunk of their
life in the field of medicine is going to choose unemployment over continuing
to practice with less remuneration.

If the jobs you describe are necessary, then they will continue. If they are
not, they might go away. That's how things work.

We've had a long time to find these inefficiencies you describe, and yet all
they've done is multiply. Cutting rates means leaving less room for
inefficiencies, and is the most certain precursor to eliminating them that I
know of.

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oflannabhra
Those conclusions are taking the available detail of the current proposals to
conclusion.

I seriously doubt that any proposal would pass that results in such a
conclusion. The point the article is making is that the proposals need to
consider the facts that result in that conclusion (ie, _current Medicare /aid
rates cannot support the current industy_), and need to offer proposals to
counter act such a conclusion. Any proposal that doesn't is not a proposal,
but a platitude.

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pwinnski
Supporting the current industry is not the goal. The current industry is
failing too many people.

Proposing too many details before a candidate is even elected would be
foolish. Any particular detail can be distracting from the overall goal.

