There is an instinct among political pundits to confuse caution for practicality — an assumption that those who advocate for incremental change are being reasonable, while those pushing for bold reforms aren’t. This is seen most starkly in the debate around health care reform, despite the fact that the “practical” pushers of limited reform fail to address the real problems in our health care system.
We all recognize that the status quo isn’t working. We spend more per person than any other country on health care, but we aren’t getting any bang for our buck. We have lower life expectancy, higher infant mortality rates and more preventable deaths, and too many personal bankruptcies are due at least in part to medical bills.
[...]Time to get real. As an economist who has spent decades studying our health care system, I can tell you that Medicare for All advocates are the only ones who are being reasonable, because theirs is the only plan that will control health care costs while finally achieving universal coverage.
The problem with incremental plans, whether they are public options, buy-ins to Medicare or Medicaid, or pumping more money into subsidies in the Affordable Care Act's individual marketplace, is that they preserve the private health insurance system weighing down our health care. [...]they are leaving the main reason for our system’s dysfunction in place: the multipayer, for-profit financing model.
Commercial insurance companies are nothing more than middle men. They add no value to our system, but they do drive up costs with their bloated claims departments, marketing and advertising budgets and executive salaries. We pay for all of these things before a single dollar is spent on the delivery of care.
They also create extra costs for providers who need large administrative staffs to deal with billing systems, accounting for as much as $100,000 per physician.
Any plans short of Medicare for All leaves these costs in place. In other words, they leave hundreds of billions of dollars a year in savings on the table.
[...]Gerald Friedman, a health care and labor economist, is an economics professor at University of Massachusetts Amherst and the director of The Hopbrook Institute.
[Related]:
Democrats' promise of Medicare for All is remarkably misguided and unrealistic
Trump wants to drop a neutron bomb on Obamacare. Over to you, 2020 voters.
Take it from me, tweaks won't fix health care. Dems should focus on Medicare for All.
(Score: 3, Insightful) by sjames on Tuesday April 09 2019, @08:03PM (3 children)
There are always dangers of administrative bloat whenever you have a bureaucracy. It can be pruned, but too often isn't.
But as for rationing, that is already a feature of our healthcare system, we just call it something else. Most call it "I can't afford to go to the doctor" or "these prescription co-pays are killing me!". Unfortunately, those statements are too often followed by "Call 911!" and often eventually "does anyone know a good funeral home?" or "how do you file for bankruptcy?". Make no mistake, that *IS* rationing. In fact it is rationing with a particularly poor criterion.
Have plenty of money, get cutting edge antibiotics for a cold, no money, wait for the STEMI rather than treating 98% coronary blockage.
The current insurance scheme is just an expensive way to push responsibility for the poor rationing decision to nameless and faceless administrators who are exceedingly unlikely to ever face any consequences.
Don't fool yourself into thinking we can EVER have a free-market system. In order to actually achieve that, we would have to eliminate prescription laws entirely, do away with patents, and make both FDA approval and medical licensing advisory at most.
As for any sort of ideological purity, it is primarily the "free market advocates" that have forbidden medicare from negotiating drug prices on the free market and even disallowed individuals from buying drugs on the free market from other countries or suppliers that might be violating a dubious patent. That would have to go too.
(Score: 3, Insightful) by slinches on Tuesday April 09 2019, @08:34PM (2 children)
You're confusing an unregulated market with a free one. Free markets require some regulation to ensure that information asymmetry is minimized and to allow investment in new technology to be profitable. The problem with health care currently is that there is no price competition. We need to make prices transparent and the same no matter who is paying. That way we can regulate the price when there is a monopoly (e.g. patented drugs/tech and emergency medicine) relative to the market prices for non-emergency procedures and generic prescriptions. That would allow us to set a fair price to ensure maximum affordability while still rewarding research and development investments.
(Score: 3, Insightful) by sjames on Tuesday April 09 2019, @09:51PM (1 child)
These days, "free market" is generally code for "unregulated market". What you're talking about is just called a market.
Many aspects of healthcare will never have price competition. Can you even imagine someone having a heart attack doing a quick price check for ambulance service and trying to decide if the extra 15 minutes to get to hospital B will be too long (and of course, the ambulance will take you to the closet, no choice offered)? Too many drugs have one and only one supplier due to patents and FDA grants. Even many generics have only one source due to FDA approvals and companies being paid NOT to sell a drug.
(Score: 2) by slinches on Tuesday April 09 2019, @10:45PM
I won't argue semantics about how free a free market must be to really be free. That's just talking in circles. I think everyone recognizes that natural monopolies exist and artificial ones are created for a purpose, and these need regulations to keep things in check and create a fair market.
It's true health care has many monopolies, but why not let the market work to minimize cost when choosing providers is an option. The complete lack of pricing transparency makes that impossible in the current system. If we can fix that, then we can use the market price as a basis to regulate the cost of similar services in emergencies and patented vs. generic drugs.