"In other words, the existing American model that you're defending"
Careful, those are fighting words! I am in no way defending the current American model. It sucks. Let's be clear here. I highly, highly doubt that anyone is arguing for status quo in America here.
I'm defending capitalism against single payer and medicare for all proposals that rely on magical thinking and trusting our government (that got us into this terrible status quo). If Japan has a mostly market-based solution then lets hear about that some more.
EDIT: "It's not about whether we can do better. It's about whether we could possibly do any worse, at this point." Yeah, that's the kind of cynicism that I'm also fighting against. "Yep, we are screwed, might as well try socialism" is not an attitude I'm inspired by.
Yes, but. Highly socialist systems are working well in other countries. Interestingly, they seem about as effective as highly capitalist systems in other countries (except, of course, for the American system). So I don't think "socialism" is the problem here, and I worry about the magical thinking of reactionary politics when I see that used as the argument against.
Medicare is, in fact, the largest single payer system in the world, and it's a large chunk of the American system. Criticizing single payer would do well to start by criticizing the current Medicare system. But that means separating it logically from the privatized employer-based insurance model, and that's a very difficult knot.
"Criticizing single payer would do well to start by criticizing the current Medicare system."
Will do.
I have spoken with doctors and they hate medicare. It doesn't pay on time, it pays below market rates, it dictates what they can do with their patients, etc. These doctors still see medicare patients out of compassion, but they are losing money on each one. Think I'm making this up? I just did a quick web search and here's a quote from someone else:
"Yet, thanks to the federal program’s low reimbursement rates, stringent rules and grueling paperwork process, many doctors are refusing to accept Medicare’s payment for services. Case in point: In 2000, nearly 80% of the Texas Medical Association’s doctors were taking new Medicare patients. By 2012, that number dropped to less than 60%.
Why are more and more doctors turning down Medicare? The answer is simple: Medicare typically pays doctors only 80% of what private health insurance pays. While a gap always existed, many physicians feel that in the past several years, Medicare reimbursements haven't kept pace with inflation (especially the costs of running a medical practice), while the rules and regulations keep getting more onerous, as do penalties for not complying with them." --https://www.investopedia.com/articles/personal-finance/10021...
So, if we all go only-medicare, how many doctors decide to retire early? <edit>How many potential doctors will decide to do something else instead?</edit> What quality of doctors and care are we left with?
> Also, criticizing socialism is not magical thinking. It's been a proven failure over and over. Yes, some tiny homogeneous countries have come together and made socialist medicine work, but I'd wager good money that that has more to do with their citizens having a general feeling of all being on the same team, avoiding freeloader problems by discouraging immigration, having larger more prosperous countries in the world to provide innovation and competition, and other factors that America is never going to be able to achieve.
If by that you mean the entire OECD then yes, some tiny homogenous countries have tried it. And it works great. Also, diversity has nothing to do with medicine.
> I have spoken with doctors and they hate medicare. It doesn't pay on time, it pays below market rates, it dictates what they can do with their patients, etc. These doctors still see medicare patients out of compassion, but they are losing money on each one.
Lowering reimbursement rates reduces costs, that's how it's supposed to work. Did you think costs just go down while people get paid the same or more? Where did you think the money was to come from? Sorry, America's costs are 2X Canada's, those doctors do need to be paid less.
> Why are more and more doctors turning down Medicare? The answer is simple: Medicare typically pays doctors only 80% of what private health insurance pays.
Great, now all programs will pay the same, much less than today. You do know doctors in Canada make $200-500K/yr right, they're not exactly starving. They don't need to make more, they're public servants.
In the US the mean salary for a doctor is just shy of $300K (range $200-663K). In Canada the mean salary $225K, ranging from $232 to $676. I think they'll manage with the pay-cut.
> So, if we all go only-medicare, how many doctors decide to retire early?
Those who scrape by on $250-500K/yr and save, then retire, like the rest of the 1%.
"Did you think costs just go down while people get paid the same or more?"
Isn't the whole argument that our system is inefficient and therefore expensive? Get rid of the inefficiency and doctors should still get paid the same, no? Again (I think we are going back and forth in different threads here), free markets are great at doing that. We should try it with health care.
There's a ton of inefficiency in the system: administrative, lack of preventative care, lack of continuity of care, that hospitals are forced to provide critical emergency care to anyone who walks in and can't afford it, cost of drugs, and yes, the amount doctors are paid, and the amount doctors have to pay for malpractice insurance (which is also socialized in Canada dramatically reducing cost).
Doctors become public servants. They should get paid relatively comparably to other first-world countries but the fact is what they're getting paid right now is unsustainable for us as a society if our goal is to cover everyone at a reasonable price -- and it should be. Preserving doctors top-0.5% pay is strictly a non-goal. Building a functioning public health system is a goal.
Yes, pure tyranny. It's not like they can get jobs in other fields. Nobody is entitled to make a certain wage in their field of choice. You're not entitled to a seven-figure salary in janitorial any more than doctors are to mid-six-figure salaries in their jobs.
"Also, criticizing socialism is not magical thinking. It's been a proven failure over and over."
That's just partisan nonsense, platitudes disguised as criticism. You need to do a lot better than that. I could come back with plenty of failure modes for capitalism as well, but I very much doubt you'd call them proof that capitalism is a "proven failure", and I wouldn't make that argument myself. There are many cases where socialism has worked well and continues to work well.
Also, criticizing socialism is not magical thinking. It's been a proven failure over and over. Yes, some tiny homogeneous countries have come together and made socialist medicine work, but I'd wager good money that that has more to do with their citizens having a general feeling of all being on the same team, avoiding freeloader problems by discouraging immigration, having larger more prosperous countries in the world to provide innovation and competition, and other factors that America is never going to be able to achieve.
It's not magical thinking, it's "I've spend too much time watching Fox thinking." Trust me, I watch Fox too. This is just partisan nonsense the rest of the world has disproven if you just took a look outside.
Careful, those are fighting words! I am in no way defending the current American model. It sucks. Let's be clear here. I highly, highly doubt that anyone is arguing for status quo in America here.
I'm defending capitalism against single payer and medicare for all proposals that rely on magical thinking and trusting our government (that got us into this terrible status quo). If Japan has a mostly market-based solution then lets hear about that some more.
EDIT: "It's not about whether we can do better. It's about whether we could possibly do any worse, at this point." Yeah, that's the kind of cynicism that I'm also fighting against. "Yep, we are screwed, might as well try socialism" is not an attitude I'm inspired by.