If you have "no place to go," come here!

If "patients are not consumers" then why in the name of sweet suffering Jeebus is neoliberal, market-based HCR "on the table"?

Why not single payer? Heck, why not the National Health Service? Professor? One despairs.

And, oh yeah, this increasingly elderly person takes great exception to the idea -- especially when 'splained by very well-insured pundits who will get the health care they need no matter what -- that it's greedy oldsters who are running up the costs, even if that's now become the conventional wisdom in Versailles, happily shared by conservatives and liberals of conscience alike. How about we cut out the $350 billion a year that the insurance parasites are sucking out of the system as a first step, and go from there, Paper Boy?

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jumpjet's picture
Submitted by jumpjet on

It's my favorite method of health care delivery- based on what I've seen, it's got comparable health care outcomes to single-payer, and it saves even more money. There might be some issues with performance, but overall, it seems to work extremely well. Hell, Great Britain doesn't even save as much money as they could be saving with the NHS, because of 'market reforms' introduced by Thatcher and the Tories in the 80's. Italy and Spain, which have purer socialized medicine systems, save more money, and their quality of care is excellent.

The issue I see is that a U.S. state that wanted to implement socialized medicine would have to have a decent tax base to start with, because the up-front costs of socialized medicine are higher. I'll assume no state has the money to buy out both the private health insurance industry and the private hospital industry in their borders, and that Eminent Domain can't be used to simply take them. In which case, the state would have to construct its own hospital system.

It would take a big, populous, wealthy state, like California or Texas or Florida. Perhaps a medium-sized state like North Carolina could do it if it were scaled back a little.

letsgetitdone's picture
Submitted by letsgetitdone on

And doing our damnedest to sell it. Then, after scaring the living shit out of them, we could at least compromise on Medicare for All!

Bryan's picture
Submitted by Bryan on

Single payer will save so much money for providers that you get into diminishing returns when you get into a NHS situation.

I have worked on medical billing software and it is obscenely expensive and requires constant upgrading to deal with the games of the insurance companies. Doctors who want to continue in private practice are pretty much forced to decline all insurance, and can make a good living charging remarkably cheap fees. It is the cost of billing that is really driving up the price of health care. It is normal for hospitals to have more billing personnel than medical personnel.

If you have one standard claim form, with one set of procedure codes, you will see a lot more doctors in private practice because they won't need the billing infrastructure now required.

The insurance companies add nothing of value to the health care system, but they soak up a major portion of the money.

Submitted by Fran on

that they are not heavy 'consumers' of educational services. It is all a divide and conquer tactic. Turn different groups against each other. Seniors get hit with school taxes they cannot afford when they have no children in school. We should be looking at society overall.

In any case, as you point out, it is not the Seniors who are driving up the costs anyway. They have old people (older even!) in other countries, don't they?!

I favor Single Payer. Then you still have a choice of provider. It is only about how it is funded. In fact, people with Medicare often have more choices than people with private plans. I saw a candidate on TV (in passing) saying that Single Payer would be a monopoly. It is not. A monopoly is about the supply, not about how something is paid for.

The idea of competing for patients came into vogue in the eighties. Hospitals started advertising to compete for patients. This only caused costs to rise! (At the time I worked for a SW company that provided planning - and then marketing, ugh - SW to hospitals.) The hospitals and health care systems were now spending money on marketing and redundant expensive equipment for a limited number of 'customers'. You don't suddenly have more people deciding to be patients - it is not really an elastic demand.

I see them doing to medical care what has happened to education. Instead of providing solid care (or education) to everyone, it varies depending on your situation. Some people end up with more than they need and some with not enough. (In some schools around here, every student is given a laptop; in others there are not even enough books or paper. Some people have access to good medical care and some do not.)

I also think we would need less of the expensive care if our environment were not so toxic. This is another social cost imposed by corporations. It could also be improved by not subsidizing the worst kinds of foods, etc.

It probably costs more to leave so many people out of the equation because then you have other social costs incurred.

just some random thoughts......

Submitted by Hugh on

Divide and conquer, setting us against each other is more class warfare.

Krugman has made a career out of looking at bits and pieces of our economics and politics and acting like he's presenting the Big Picture. It's why he castigates Republicans but only admonishes mildly the Democrats although both parties are equally corporatist, warmongering, kleptocratic, and Constitution hating. He will criticize some aspects of the Establishment but never the Establishment itself. He will say patients aren't consumers and then champion a market-based system for healthcare.

He really is nothing more than a shill for those who are looting us.