If the greater savings is positive, then yes it is worth it. Is this something you deny?
I don’t deny it. The math does.
While Sanders argues that single-payer will make the health system more efficient, “we have seen no evidence of this from the Medicare program, whose cost has grown substantially faster than the economy for most of the last 50 years,” Antos said.
Second, reduced costs could also create issues with access. Lower drug prices limit funding for research and development, lower physicians’ salaries disincentivize people going into medicine, lower fees could bankrupt hospitals, and people would have less choice in health plans, listed Hussey.
And finally, experts expressed skepticism that lawmakers would ever pass Sanders’ single-payer system, which would require a tax increase of hundreds of billions.
No proof? Something I found with a cursory glance. Standing as an apparent paradox to this zero-sum equation are countries such as Canada that ensure access to all at a cost 40% per capita less, with satisfaction and outcomes as good as or better than those in the United States.3, 4
The full article. A Better-Quality Alternative: Single-Payer National Health System Reform | Physicians for a National Health Program
It is about the evidence not me winning, unlike your side that cherry-picks evidence most likely funded by the very industry in question. All of this to declare that “I’m right”!
Even on the most infinitesimally small chance that you were right in some parallel universe- you would still be wrong, and here’s why-
Because I will gladly give $20.00 for something I want, but not a penny for something I don’t want.
Its the concept of fair exchange.
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As sweeping generalizations go, this one is very misleading. It fails to take into account the fact that the sophistication of HC (and therefore its cost) has increased massively over the past 50 years. The number of drugs; the sophistication of imaging systems; the introduction and proliferation of specialized intensive care units; the explosion in transplant capabilities; etc, have all contributed to the fact that the cost of Medicare has outpaced the rest of the economy. In short, because HC is vastly expanded now compared to how it was 50 years ago, it is not surprising that it has outpaced the rate of increase in cost of other aspects of the economy.
A non-Medicare example: 50 years ago, acute lymphoblastic leukemia (ALL), the most common form of pediatric cancer, was a death sentence for children. Now, essentially all treated cases go into remission, and over 90% are cured. But this success has come at significant cost–the cancer must be genotyped; the meds needed (and the means by which they are delivered) are expensive; once remission is achieved, the child needs a bone-marrow transplant of normal progenitor cells; etc. None of this is can be done on the cheap.
We could turn the ‘treatment clock’ back 50 years, and would save an enormous amount of money on HC. We would also have to watch a great many people suffer and die unnecessarily. Pick your poison.
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Duly noted.
If you read the article there are detractors and proponents giving advice. The most interesting detractor was:
“Most employer-based health insurance policies currently have more comprehensive coverage than traditional Medicare, pointed out William Hsiao, a leading health economist at Harvard University who designed universal coverage systems for Vermont, China, Sweden, and South Africa, to name a few.”
A guy who literally designs universal healthcare systems is saying that we would have to accept less benefits for it to work. He’s quoted in the below Forbes article about why the Vermont try at single payer failed dismally.
Links to Physicians for a National Health Program then says this.
Fucking priceless.
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As you know, I am not a proponent of single-payer, so I won’t try to defend it.
But from the Forbes article:
“The market-oriented way to bring prices down is to give consumers more control of their own health care dollars, like they have in every other aspect of the economy. If you as an individual control the money, you’re going to shop around for the best combination of quality and price.”
IMO, this is nonsense. As I have argued before, HC is not a market amenable to the constraints that control costs for other services, and it never will be.
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We have argued this before and not agreed. I believe that given the choice consumers can make informed decisions about many things in healthcare (drugs/procedures/providers). Not all things, but many things.
I can buy a car without knowing exactly what makes each make/model better or worse for my needs. There are many manufacturers of cars and very few people with the mechanical engineering chops to discern between their differences.
I can type this response to you without being able to engineer a smartphone. I barely remember ohm’s law.
Can an unonscious ER patient make choices? No. Can nearly everyone else? Yes. I can choose between two types of chemo without knowing how they work. The doctor gives me the probabilities of survival and side effects and cost them bam. Choice made.
I would expect independent rating agencies to pop up as well. A Consumer Reports of HC so to speak.
As it stands now you have these choices. They are made by people everyday, limited only by the restrictions within a specific policy.
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I think half of the problem with these discussions is that healthcare and healthcare insurance are treated as the same thing when they are not.
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If you have insurance, then it dictates the providers, services, and price you are going to pay for healthcare. I’m old enough to remember a time before co-pays & networks, and I always negotiated directly with the provider on pricing. FTR…I preferred it that way.
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Apples and oranges. Presumably, prior to buying a car, what you would do is look online for trusted sources of info (eg, Consumer Reports), and base your decision in part on what they say. There can be no such source of comparable info for most healthcare decisions–far too many variables, some of which are unique to the individual ‘consumer.’ Further, when car shopping, you have the luxury of no time-related pressures, whereas some HC-related decisions must be made now. Finally, buying a car is not a life-and-death decision, unlike many HC decisions.
No, they really can’t. This is a classic case of ‘you don’t know what you don’t know.’ An informed decision requires just that–information.
That is what happens. And since there’s no way to truly appreciate and weigh things one has never experienced–in the present case, things like just how bad a given side effect is; death–most pts resort to ‘Whatever you say, doc.’
Not practical, for the reasons alluded to above.
My hospital system already puts all of my vitals and diagnostic information in an idiot-proff format I can pull up on a phone. Why not have an app where I can pay $5 to have 20 cardiologists vote on my treatment options?
Should I take the statins and beta blockers? If so which ones? Lifestyle interventions? I could easily have 400 years of cardiologists’ experience at my beck and call. This is the information age, these problems can be solved.
Well, for one thing, because unless they’ve examined you, offering medical advice is inappropriate and unethical.
If your course of care could be appropriately determined solely by the diagnostic info in your chart, your ins co would simply pay IBM’s Watson to be your doctor.
400 years worth of cardiologists’ experience–none of whom who has examined you; none of whom has a personal relationship with you; none of whom is personally accountable for your care; all of whom are being paid a pittance for their medical opinion; and some of whom may have an undisclosed fiduciary relationship with the beta blocker and/or statin manufacturer.
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All fair points. But what is the value of a personal relationship or an in person examination? Here’s the MRI, symptoms, charts etc… hell you could record the exam and post that up.
For instance I’d like to ask you about drusen. I know you wouldn’t give medical advice to a stranger on the internet. Is there anything to the AREDS studies and formulas? Taking a multi can’t hurt, but is it snake oil?
Indeed. Take the numbers Tha usmc posted on population in 2015–the USA has a little more than 5x the population of the UK. So, let’s say we can magic a system into place-- based on the UK’s budget numbers times our population difference, since that’s what is being held up here, that means we would spend $815 Billion every year.
Yeah…no. Not happening.
I’d actually love it you ever posted real evidence.
While difficult to quantify, I think there is significant value to be had in having a personal relationship with one’s physician. For example, that individual is able to develop a sense of your personal physical characteristics (eg, your heart sounds) that might allow him/her to detect a change that would be impossible for someone not familiar with you to notice.
An in-person examination is vital in that certain aspects of one’s physical state are not (as yet) readily quantifiable by available tests. Further, I would point out that over-reliance on unmotivated (or ‘shotgun’) testing may actually increase the cost of healthcare, along with morbidity/mortality. For example, a ‘screening’ MRI may well turn up a finding (we call it an ‘incidentaloma’) that begets further imaging–or worse yet, invasive testing that carries a risk of injury or even death.
We have a saying in medicine: ‘When all else fails, examine the pt.’ It’s a good saying.
The Age Related Eye Disease Studies 1 and 2 (AREDS1; AREDS2) provided strong evidence that a particular combo of ‘supps’ can reduce the risk of developing wet (=bleeding under or in the retina) macular degeneration, but only in individuals who have moderate or advanced dry AMD (which is characterized by the presence of drusen, along with degeneration of the retinal pigment epithelium, or RPE). In other words, for pts with moderate to severe dry macular degeneration, the AREDS combo has been demonstrated to reduce (but not eliminate) the risk of progression to wet dz. For anyone other than this population, no benefit has been demonstrated.
Note that the presence of drusen, in and of themselves, do not constitute macular degeneration; they have to be of a particular sort, size, location and density to do so.
As an aside, the AREDS2 formula is considered superior to the one employed in the original AREDS. It (the AREDS2 formula) has several advantages, so for my pts that can afford it (naturally, it’s more expensive), it’s the one I recommend.
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