Single payer healthcare

The high overhead and profits of the private, investor-owned insurance industry would be eliminated, along with the burdensome paperwork imposed on physicians and other providers. As a result, the plan would save at least $400 billion annually – enough money to provide comprehensive, quality care to all.

If it works I'm all for it, just hope there is still an option for someone to still go private if they can afford it.

I'd have to read more into it, but I like it so far.

Can you elaborate on what you mean by "the deficit issue"?

What about the impact to the economy when you lay off tends of thousands of employees at Aetna, CIGNA, BCBS, etc.? The private insurance industry is a multi-billion dollar industry that employs thousands upon thousands. Including the thousands of smaller firms that work with the big firms.

Not gonna happen. The only solution in the US is a plan that is in addition to the current private insurance, nothing that destorys it.

This issue right here is what scares me the most, and it's not just the baby boomers that will bankrupt healthcare; it's also the rising numbers of uninsured/underinsured (mainly immigrants) that are starting to severely tax the current system. My wife works for a major health care provider, and she has seen firsthand how the costs are skyrocketing. The money has to come from somewhere, and that tap is running dry.

Not true. The statistics on voluntary health checkups by insured individuals is ridiculously low. Many companies that provide insurance today even offer credits or bonuses of some kind if their employees will get annual checkups or physicals and they still have abhorrent participation rates. While I agree that people w/o insurance do forego doctor visits until its too late, don't think giving people coverage will see a jump in preventative care. It won't. People are fat, lazy and stupid and giving them coverage won't change that.

Agreed. The prices are ridiculous. The non-insurance rates that hospitals charge are astronomical. Unless you're a millionare no one can afford surgery at a hospital without insurance.

I don't see how universal insurance could allow individuals to keep or choose their own doctors. There is no way. I know personally of some doctors who are in such demand in their fields they already charge massive premiums to be seen even by those with insurance. The govt couldn't cover that.

You are wrong on so many issues with regard to this it is amazing you even deign to speak up about it.

This is the most egregious example though so I shall chime in.

My commodity as a physician is my knowledge and time. I only have a limited amount of time in my day to offer for sale. Supply of time is finite. So there your entire assumption is already shot down without much effort.

When people have insurance that covers even the slightest boo-boo they run to their doctor because there is no punishment for spending other people's money. When my waiting room is filled with people and 60% of those people are there because they have no out of pocket expense and they can just ride for free looks at every little ache and pain they are using up time I could be spending on people who actually have a superceding need.

Therefore, my supply of time is dwindled. As I look at the amount of people taking up my time I see that I am in demand. I then raise my prices in order to match what is the perceived demand on my limited supply of the commodity I am trading.

Therefore it logically follows that a single payor system will drive many more people into the office because they have no punishment, i.e. out of pocket expense. This over utilization will cause the administration of the single payor system to artificially drive down prices in order to cut costs. This will drive many physicians either out of business entirely or will force them into private care only practices, which incidentally would have be a criminal act(as would be paying a private doctor for the consumer) under Hillarycare.

Allowing insurance companies to write policies only for the specific needs of the purchaser, i.e. a 60 year old couple does not need maternity care riders on their health insurance, expanding and teaching people about MSA and HSA options and putting the cost on them while allowing deductions for private insurance policies is the better option.

The U.S. auto industry is going to collapse because of government interference and you are advocating the Nationalization of 20% of the U.S. economy by instituting a single payor system? This brand of socialism is extremely dangerous and will serve only to cripple this country even further.

Even if it's slightly off-topic, I'd also be interested to hear how the U.S. auto industry would be faring without government intervention.

So glad to know that you are "in demand," and can therefore charge whatever you chose. Case in point, I just had an abscess drained. Total time spent with the doctor and triage? 15 minutes. Amount billed? $1,500.00. Ridiculous.

Aren't you a chiropractor?

Thanks for your response. I mistakenly assumed TzuDoNihm was referring to recent attempts to hold GM accountable and that s/he was saying they were better run when left alone.

Nhim is a medical professional? The fuck is he doing here?

Low standards?

Why would it matter? I think CHUD is pretty widely represented by different fields of work.

Personally, I want to know whether he is subsidizing his CHUD time by charging higher rates seeing that he is in such demand.

Those physicians I know practicing in Canada, Italy, Germany and OZ are not happy by any means with their systems. They have to do 2 and 3 times the work I have to do to earn the same kind of living. Continuing to work under the system and being happy with the system are entirely different things.

Two colleagues I know in Britain are fully privatised because they could no longer earn a living they were comfortable with under the NHS regulations.

Hopefully all but Ford would have gone under by now.

The biggest hurdle to reigning in balance sheets would be the wages paid to US auto plant workers that nearly double the wages earned by workers in US based foreign automakers plants.

Whatever I choose isn't the issue. The issue is artificial demand created by insurance copays that are too low which drive up costs.

Now you say amount billed, I would like further clarification on that. Is that to an insurance company? If so the fee is artificially high to account for contracted rates which will automatically lower the bill. Contracted rates are determined by the prevailing rate being charge in a geographic area. If the rate drops, the contracted rate will drop, if it goes higher then the insurance company nudges their payable rate higher each year.

It is quite similar to how union contract rates are tied to the minimum wage. MW goes up, union pay goes up which is why unions are such big supporters of the minimum wage. None of them are making it but their contracts usually are based on a multiplier of it and so their pay goes up concomitantly.

Most physicians will be happy to lower your bill to even Medicare allowables if you will pay the entire bill at once. I routinely have patients with no insurance negotiate MRI's down to these prices.

I am indeed sir and while I may have been a bit harsh throwing the socialism word around with yt I would expect you to not be asking that in order to make some sort of ad hoc attack on me for the profession I am in.

I am not your run of the mill D.C. I will go ahead and tell you that.

I just asked a simple question out of genuine curiosity. Unclench.

Amount billed to me. Amount paid by me. As I said, ridiculous.

Side note, there are plenty of people who don't go to the doctor because they don't want their hard earned money going to a profession that charges astronomical fees. Myself, included. There is such a thing as making a profit, and there is also such a thing has robbing. The medical field, in my opinion, are just legal thieves.

I figured, just being preemptive. We cool, bro.

If you are a cash paying, non-insured patient, NEVER pay the full price. I guess I could start a banking advice type thread on health care. Trust me that if you speak to the office manager and are a cash patient they will be more than happy to accept a full payment on a bill that is lower than charged and inline with a contracted insurance rate.

Please do. I know that I would read it.

I shouldn't ever have to negotiate my bill. I should be charged a fair price. Hence, doctors are thieves. I, for one, relish the government getting involved in a field that steals from it's customers.

You don't understand, the prevalence of "contracted rates" reducing prices to an artificially low rate necessitate the need to have, in many cases, "exorbitant" cash prices to make up the difference.

Take for example the estimated cost analysis to perform one adjustment in my office, approximately $50.

Location overhead plus equipment overhead plus labor cost to have someone file the claim plus the fact I have to wait a week at best sometimes months at worst to receive my compensation plus the labor involved in checking on claims status' plus labor and fixed costs of sending out paperwork copies and letters justifying care all equal to that $50.

The prevailing contracted rate in my area for an adjustment is $32. $18 below what it actually costs me to run my business per person I treat.

If the paperwork regulations, waiting periods and delaying tactics imposed on me by insurance companies didn't necessitate the need for a full time person just to deal with these people I could charge significantly lower rates.

There are two ways to go to combat this. I can perform unnecessary procedures to pad your bill which many of my colleagues do or I can raise my cash prices to a level that the percentage of cash paying patients offsets this.

This isn't thievery.

A number which is skewed by the many people who choose to be uninsured. I myself fall into that number as well as probably a good percentage of people who choose to pay for health care out of their own pocket.

Don't talk to me about uninsured people when the government regulations that mandate full coverage policies for people who do not need certain aspects of health care coverage price many health plans out of the reach of most so called uninsured people.

If insurers were allowed to write buffet policies then prices would come down and numbers of insured people would go up. No need to have the government nationalize 20% of the U.S. economy.

You should start that thread, Tzu.

(And you're doing a good job in this one.)

I see both sides of this issue here in Canada: friends are medical GPs but my family is in the private side of medicine: dentistry.

The medical GPs certainly work really hard and churn through a lot of patients (and paperwork) in a day. However, compared to dentistry, their staffing costs are much lower, office expenses are miniscule and, due to patient demand for family doctors, marketing and promotional costs are nothing at all.

In dentistry, we charge what we like (though most adhere to the dental college fee guides) and certainly take home more than a family doctor. But, staffing costs are sky high, supplies and lab fees are a constant worry and given how much competition is out there (there are five clinics within easy senior walking distance to us and there's a downtown Vancouver medical building with over a dozen clinics alone), advertising and promotional costs take a nice bite out of the bottom line. Don't get me started on the pain of dealing with insurance companies (and how little patients understand their coverage).

In both systems, however, the common thread is that the patient is at a huge disadvantage as a consumer of medical services. The average person just isn't qualified to judge the care they receive from a doctor/dentist. On the dental/private side, they can only measure cost, degree of pain and degree of soft customer care. None of these factors can be used to form a decisive judgement on the actual health outcome, e.g., a root canal can remove pain but is unnecessary if it was a misaligned bite or a simple cavity.

Bullshit. I'm an accountant by trade. Specifically cost accounting. Every other industry handles its overhead costs in a logical manner. Plenty of other industries deal with "contracts." Hell, I don't know of many companies that don't have full-time billing and collection agents. Oh, but poor little medical industry and extra costs. Bullshit. Thieves.

Keep in mind that the rules on collections (at least here in Canada) are different than other industries because we are in healthcare.

In many places it is illegal to perform immediate balance billing, i.e., ask the patient to pay what their insurance does not at the time of care.

Other places do not allow the direct billing to an insurance plan and so the practice must wait for the insurance company's payable cycle to find out how much was covered.

Finally, insurance billing is often a two-step procedure for major work: get pre-authorisation from the insurance company and then submit after the work is done (and then wait for the money with any unforseen adjustments). Note that the pre-auth is not binding on either party.

It would give more options to lots of people and it would take options away from no one. Could you go further as to the negative effects you see?

You sneaky minx. Don't deny your politics and your biases here. Leave your original words intact.

Define greed.

I'd wager something along the lines of $1500 for 15 minutes of work. I'd call it thievery though.

What extra costs are you talking about? The cost to run my business is X. Insurance companies pay less than what it costs to operate, X-18 in the case I made above. Precisely because of governmental regulations on full service policies driving up the costs of insurance to the average person is what drives up the costs needed to operate a business properly.

I am having a hard time coming up with another industry that is expected to perform a service and then wait weeks and months to actually receive payment for said service.

And as sunwukong has already beaten me to the punch I can only reiterate that collections are a whole nother ballgame in the healthcare industry.

I remember listening to an interview with a doctor regarding bills. If I remember correctly, he stated that half of the people who seek medical treatment don't pay their bills at all, so the rest of us that DO pay our bills have to make up for the lost revenue by paying higher fees. If they didn't charge those fees, the doctors wouldn't be able to maintain their practices.

This sounds like a death spiral if true.

Really? I can name dozens. Try again. Some of the biggest companies in the US pay their vendors in 90-120 day terms. Increasingly, in this global economy, global terms are net 90.

Boo fucking hoo to the medical industry. Join the rest of us.

This is the reason most hospital charges are so high. Federal law forces ER's to treat uninsured people. I'd wager that your average independent physician office isn't dealing with this that much.

This is an incorrect statement. Many people attend ER's for their bumps and bruises and their regular check-ups precisely because they know federal laws state that ER's cannot turn them away for treatment. They then skip out on the bill. This does in turn drive up costs for everyone else.

There are a multitude of factors and many can be pin pointed right back to when the government got involved.

I have often wanted to write a book on this. Any Chewers want to write something with my ideas?

*EDIT* Honestly, go sit in an ER sometime and look at the people waiting for care. Go to an Urgent Care in your town affiliated with the local hospital. On average 20-50% of those people do not even need to be visiting a doctor. Many are there for common cold-type ailments.

I'm sorry sir, you are dealing with company to company interactions. I am speaking of consumer level interactions.

So? Companies are still having to wait weeks and months for payments. Isn't that what you were decrying?

Fair question and one to which I think there are many answers other than just profit. For example, say what you want about the uninsured and that is a horrible problem, but the advanced level of medical coverage available in the US is amazing. I may be wrong and I'd love to hear it (happened once in '93 if I recall) but I do think that the majority of advanced mecial breakthroughs are in the US and more importantly are available in the US. While they are only available to some, not making that argument here, just saying that they do exist here and not elsewhere.

Also, Americans with coverage are not prepared to accept decreased coverage levels. All we hear about is the anecdotal stories about heart patients in Canada driving to the US to see a private doctor or the English who have to wait a year for a chest x-ray. Americans with coverage shit their pants thinking about that.

I would wager to say that Americans with coverage vote more than those without and thus they wouldn't support a national plan if it reduced their coverage levels. Americans in general also distrust their government when it comes to large spending plans. People bitch and moan nonstop about Medicare, Social Security, etc. Just imagine a new program 10x bigger. Shit, personally I don't trust the government to wipe my ass let alone run major programs.

Lastly, while you wouldn't know it by watching the news and the recent decisions by the current administration but America runs on capitalism aka profit motive. There may be a valid arguement than in health care profit doesn't belong but thats currently not the case in the good ol US of A.

The plans would be smaller than the cheapest current ones, of course. Maybe somebody would like those, though. I probably would. Doesn't mean everybody would, and doesn't mean everybody who does would be correct. But if you can only afford the cheapest buffet items, and they're not worth it, then your worst case scenario is to buy nothing... which is your only option now. So it's not great, but it might help some people. I wasn't trying to say that the buffet-style options are the solution, just that they're not evil.

As for the administration costs, I'm no expert, but again: this would only be an option. The insurance companies could offer more compartmentalized choices if they wanted, but if it'd be too expensive, then that's fine. They're not being forced to join in.

Yeah, that person would be in the same spot in that situation as he/she would be now. I'm not saying the buffet plans would solve everything for everyone. They're just a small thing, which I happen to think would be a small positive thing.

Do you still go to that doctor or have you switched?

So, you don't believe in loss leaders, services with different margins, services with high fixed costs or pricing according to boutique demand?

Should any of these things should exist in healthcare?

Keep in mind that I pointed out that pricing is one of the transparent measures patients do have access to in private care.

Finally, as an accountant, what is the average write off of bad debt (receivables) each year for the industries you work with?