@Shahryar

The greater number of health care providers are not on the higher end of the scale. Hospice workers, home health aides, volunteers, everyday techs & etc. are the muscle behind assisting the ill. Nurses are striking for better working conditions. Perhaps, thinking macro economics, spending is important.
The bigger issue, to me at least, the industry being controlled by profiteers. Buying health care is a poor example of what most healers and helpers provide.

there's a guy I come in contact with on the internet whose job is basically handing out pills to patients. He often writes things like "thinking about buying a lake house" or "thinking about buying a boat for my lake house" or "should I hold the door open for the person behind me?"

Anyway...some people in the profession might have problem if their salaries go down. Others make way too much money with the extortionary "you like your health, don't you? now pay up!"

People smirk at stories of how doctors used to practice, coming to your house when you were sick, charging $50 for the visit. As if that's so naive and impractical. But what if grocery stores charged like doctors? What if milk was $7000 a carton? Or eggs? And why not? What about water? Nestle would like to control water and charge whatever they want.

Well that's what's happened in the US health care system.

Oh, and by the way (as Bernie might say), if there was less money involved the lower paid workers would not get 50% less while the top earners also get 50% less. In fact it would weed out the top earners because the assistants are more important to delivering health care.

@Azazello
it's not "million-dollar CEOs" it's BILLION dollar CEOs.

It's the reason we need M4A.
That's the whole point of a single-payer system!
Yes, we spend more than the rest of the civilized world, and get less.

Did you know that under Medicare Part D the government is prohibited from using its bargaining power to negotiate lower prices ?

The federal government is not permitted to negotiate Part D drug prices with drug companies, as federal agencies do in other programs. The Department of Veterans Affairs, which is allowed to negotiate drug prices and establish a formulary, has been estimated to pay between 40%[29] and 58%[30] less for drugs, on average, than Part D. On the other hand, the VA only covers about half the brands that a typical Part D plan covers.

Getting rid of for-profit insurance companies and their million-dollar CEOs is just the first step. Under a single-payer system we will be able negotiate lower prices, and therefore less spending, in every part of our current obscenely expensive system.
We need to change from delivering profits to delivering healthcare.

@wouldsman

you're basically describing the funding mechanisms of a typical 'managed care' system.

If you're not referring to managed care, would you please clarify. (Especially, since you mention other countries, which might mean that you have in mind something else.)

My problem with the type of funding you describe is that, for the most part, health care providers stay within their lump sum budgets by mostly employing "utilization management." IOW, so-called 'managed care.'

It's my experience that a lot of folks (Mr M and I, included) prefer the autonomy of making their own medical decisions--including, getting second opinions, seeing specialists--without having to obtain a bureaucrats 'approval,' or jumping through a bunch hoops, etc.

IOW, we wouldn't be too keen on the idea of having medical services denied, due to budgeting considerations. So, we'd much rather stay with the FFS-model of provider reimbursement--like our current 1965 Traditional Medicare--not a capitated system.

IMO, vigilant and thorough auditing, along with the imposition of sanctions/penalties on practitioners who abuse the system, should eliminate the misuse of testing, rendering of unnecessary services and procedures, etc. Certainly, we're not in favor of so-called 'gaming the system.'

Thanks.

Mollie

I think dogs are the most amazing creatures; they give unconditional love. For me they are the role model for being alive.
~~Gilda Radner, Comedienne

Gratitude is not only the greatest of virtues, but the parent of all others.
~~Cicero

The obstacle is the path.
~~Zen Proverb

that other countries will do is to pay health care providers in a "block grant" or "lump sum" style. As an example- say there is a small town clinic with two part time doctors, 5 nurses and three treatment rooms. A healthcare administrator can calculate that this size facility can see X amount of patients and provide Y amount of services. The administrator makes a simple calculation as to the value of X and Y and cuts them an annual check. The clinic provides services and does not waste any time on itemized billing. They just serve the clients needs as best as they can. They do the diagnostics that they feel necessary and don't do them if not necessary.
It turns out that there can be huge savings by switching to this payment style. Think about this- why do diagnostics cost so much? Often the machine is just sitting there waiting to be used. Whether it be an Xray machine or whatever, the cost of the machine sitting there is the real cost. It doesn't cost much more to use it or to not use it. So clinics wouldn't do diagnostics to just pad their bills. But there would be no reason to not do them if they thought it necessary.
So, if your question is really serious, then know that there are many many ways that other nations use to keep their costs down. The real question that we are faced with right now is why do we choose to use the most innefficient and costly system imaginable? Why? Thats the real question.

@Not Henry Kissinger
situation has deteriorated into the "very expensive to treat" category is well-understood, well-documented, and well-ignored.

there are, amongst the worst of the worst, a subset of individuals whose devotion to a weird and ugly concept of virtue is such that they would rather that 100 people go without valid and deserved care, than that one hypochondriac go to the doctor when it isn't necessary. introducing this sort of calvinist moral blather to the formula for deciding how to provide our citizens with decent healthcare is insane.

against MfA miss a much larger reason that costs are so high: for-profit health systems promote expensive treatment over inexpensive prevention.

In a for-profit system, nobody makes money until somebody gets sick, so preventing illnesses before they develop into full blown medical problems is not good for the bottom line. In order to maximize profits, the system wants people to be more sick, more often. Simply put, all those extra 'costs' of a for-profit system are a feature, not a bug.

Instead of looking for reasons to increase costs, non-profit systems seek to reduce costs by emphasizing illness prevention, which is far less expensive than treatment and includes the added bonus of creating a much healthier populace over time.

@Not Henry Kissinger  
when I received a stern lecture from the doctor about the importance of listening to what my body was telling me and how failing to take good care of myself drags down society in general.

That was the same incident where, when it came time to hand me the hospital bill, the staff had to ask around to find someone who had ever prepared a bill. They finally found an improvised form in a drawer, a photocopy of a photocopy. It took only a minute to type up a one-line invoice for one lump sum covering everything, to be sent to my German health insurer. If I had been Norwegian, no billing procedure would have been necessary at all.

against MfA miss a much larger reason that costs are so high: for-profit health systems promote expensive treatment over inexpensive prevention.

In a for-profit system, nobody makes money until somebody gets sick, so preventing illnesses before they develop into full blown medical problems is not good for the bottom line. In order to maximize profits, the system wants people to be more sick, more often. Simply put, all those extra 'costs' of a for-profit system are a feature, not a bug.

Instead of looking for reasons to increase costs, non-profit systems seek to reduce costs by emphasizing illness prevention, which is far less expensive than treatment and includes the added bonus of creating a much healthier populace over time.

@UntimelyRippd

..this is the money quote:

when every medical procedure or process must return a profit to somebody; while at the same time it must impinge on the profits of somebody else; then the system is just one gigantic tug-of-war to provide the least care for the most money.

the inefficiencies of our "system" of healthcare are well-documented. we spend a half-trillion a year on billing; and that doesn't include the time that doctors spend on the phone "negotiating" with insurance company stooges to win approval for treating their patients according to their medical expertise. I've seen MDs who talk about spending 2 to 4 hours PER DAY on the phone with hacks whose job is to make sure that their own customers -- the policy-holders -- do not get the care that they were supposedly paying for.

your concern for those at the bottom rungs of providing healthcare is well-meant, but irrelevant. we aren't going to cut the cost of healthcare in half by cutting the wages of orderlies and nurses in half, we're going to do it by cutting the bonuses of pharmaceutical marketing douches 100%. and cutting the salaries of health insurance executives 100%. and yes, eliminating the clerical position in every MD's office that is devoted to nothing but navigating the insurance/billing minefield.

look: the bottom line is that we will spend, as a nation, whatever we're going to spend; whether it's the government spending it is immaterial. what is indisputable is that whatever amount we choose to spend, will be better spent -- more efficiently, more effectively, and across a larger swath of the population -- in a single-payer situation, with the government as the single-payer. every alternative -- which is to say, every system in which the people are paid to do absolutely nothing that has anything to do with actually delivering healthcare, while some capitalists somewhere profit, handsomely or otherwise, must be less efficient and less effective. when every medical procedure or process must return a profit to somebody; while at the same time it must impinge on the profits of somebody else; then the system is just one gigantic tug-of-war to provide the least care for the most money.

so i'm not going to get into an exhaustive list of inefficiencies. suffice to say that i'm not the least bit concerned about our national healthcare budget ballooning to 18 trillion dollars ($50k per capita), unless we leave it in the hands of the profiteers, the marketing douchebags, and miscellaneous other useless eaters sucking on the teat of our dire necessity.

@snoopydawg is something that Bernie has talked about. He would enforce the federal antitrust laws, to prevent the kind of unfair market rigging that we see Big Pharma, Big Insurance, and to some extent Big Healthcare, doing today.

This includes price-fixing and the creation of de facto monopolies that deprive the public of true choices. As I've mentioned before, Big Insurance is doing it right now with original Medicare. They're attempting to manipulate the healthcare "marketplace" in many geographic areas, to effectively shut out original Medicare so that people have no real choice except to buy their private Medicare Advantage plans.

As Bernie points out, these things are illegal. He says he would use his DoJ to enforce the existing laws. Of course, it would be good to do this along with enacting tough laws specifically dealing with the "healthcare" industry.

I just don't see it happening with our current out-of-control medical costs.

Congress could insist that insurance companies aren't gouging us by raising premiums so that CEOs can get huge bonuses just for denying people care which they do. They can also negotiate for drug prices. There is no way insulin should cost $300 here when it sells for $30 in Canada. There are numerous other drugs that have seen their prices skyrocket for no reason other than drug companies can do so. Epi pens also went sky high for no other reason than a different company bought it.

UR is spot on this.

I've seen MDs who talk about spending 2 to 4 hours PER DAY on the phone with hacks whose job is to make sure that their own customers -- the policy-holders -- do not get the care that they were supposedly paying for.

I worked in ophthalmology and when patients had urgent retinal emergencies first the front desk person had to punch countless buttons to get to the right person who would then ask questions that they had no idea what the answer meant. After being denied the doctor would then have to take over and describe to a lay person what the disease was and why it needed treatment now. One doctor said it's like having a third grader checking a college professors exam. Time away from patients that made the whole day behind therefore running into after hours and paying overtime... and that was in just one office. Multiply that by every specialist in the country... let's do away with all of that..

@Anja Geitz
Just like sports teams are always losing money, yet they're worth hundreds of millions of dollars.

Many believe insurance companies and the pharmaceutical industry are the ones cashing in on all the money Americans spend on health care. But is this true? In 2008, before the Affordable Care Act was passed, health insurance companies' profit margins averaged a narrow 3.4 percent, ranking the 87th- most-profitable industry out of 215. Its ranking placed it a bit ahead of the median profitability of 2.2 percent. Beverages was the most profitable business back then; that industry had a 25.9 percent profit margin. Oil and gas also fared reasonably well, at 10.2 percent [source: Newman].

https://people.howstuffworks.com/10-questions-in-u-s-health-care-cost-de...

Uh....okay. So you are telling us that big pharma and insurance companies are pouring millions of dollars into lobbying D.C. for a profit margin of 3%? That simply invites more questions than answers. Isolating numbers like this makes me very inquisitive.

@travelerxxx

My own endocrinologist completely gave up on the paperwork and insurance haggling and now pays a third-party company to manage it. That company is in Maine; we're in Texas.

The number of companies that spend hours each day dealing with the billing has increased big time as have the companies that go after people who owe on their medical bills. The debt collectors can be downright ruthless going after people who can't pay their medical bills. Imagine dealing with a serious health issue and being hounded to death for something you can't do. 500,000 medical bankruptcies in this country each year. Then of course there are the millions of Americans who don't even have access to insurance. Some disorders are very painful and yet those people have to suffer through it just cuz congress gets to decide that no we shouldn't have affordable health care. Less than 600 people keeping us from having what should be rightfully ours.

None of this means anything. Or maybe it does...

Back in my grade school days (late 1950's to early 1960's) one of my classmate-friends was the son of the local surgeon. We used to play in their yard. Their home was in a decent, but far from new, section of our midwestern town. Next door to the doctor lived a bulldozer operator. I can no longer remember who lived on the other side of the doctor's house, but as I recall it was the home of a shoe salesman or hardware buyer ... or something similar.

***

I was born in a frat house. Yes, really. Well, okay ... at the time it was a hospital and later the building was used as a fraternity house. Years ago, my parents showed me the hospital bill they had to pay after my birth. Frankly, I don't remember the exact amount, but it was something on the order of $26.82. Yes, that decimal point is in the right place. To get me born-ed, the hospital, doctor, everything, cost less than thirty bucks.

***

These days, I have to frequent doctor's offices more than I would like. With not so much better to do, I often arrive early. So, I observe. One thing that I see constantly, without fail, is certain well-dressed people - men and women - coming up to the front desk and speaking to the receptionist as they hand them a business card. Usually with no wait, that person is buzzed quickly behind the locked entry to the doctors offices and exam rooms. These folks are always carrying rather bulky bags, larger than briefcases; sometimes they have small wheeled luggage thingys they drag along. These peeps are drug sales men and women. While the rest of us wait and wait for our few minutes with a doctor, these stalwarts of the medical industry have the keys to the kingdom. Evidently.

(By the way, there is a website where you can look up what monies have been fronted to your doctor by the various pharmaceutical companies simply for prescribing their drugs. Check it out.)

***

My wife's brother is a very successful (and wealthy) personal injury attorney. Occasionally, he'll talk shop with my wife and myself. Usually just general talk, no names of course. Around two years ago, he mentioned that the doctors he knows have all had to increase their staff to do paperwork and deal with insurance claims since the Affordable Care Act came into existence. They didn't just double the staff. Generally, they quadrupled the staff ... or more. A close doctor friend of his went from four people doing insurance work to nearly 20. My own endocrinologist completely gave up on the paperwork and insurance haggling and now pays a third-party company to manage it. That company is in Maine; we're in Texas.

@janis b

Wow,

If that doesn’t draw an image of how drastically (for the worse) things (you name it) have changed, I don’t know what could.

Speechless. Shameful.