I didn't say doctors were responsible for all understaffed roles in the country. But they are partly responsible for understaffed physician roles. :) The payer aspect I mentioned is relevant for the nurses.
In America we pay on average ~$3000 per day of stay in the hospital. How much extra do we have to pay to have enough nurses so that we don't work them to death?
Why British hospitals have a fraction of that cost (1/10th)? Oh yes, it is because they decided that it is not a moneymaking business.
Overworked employees should not blame themselves for not being able to keep up with unreasonable hours. They should blame the real responsible for their misery. Their employer.
Hospital profits are part of the costs, but doctors and nurses here are also paid more than elsewhere. Doctors in the US are paid multiple times as much as doctors in the UK, and supply restriction is a big part of why that is possible.
There are also administrative costs, drug costs, and insurance overheads to deal with.
It's not that complicated. When we setup competition for infrastructure, we needlessly duplicate management, marketing, accounting, and everything else that does not directly result in the service being provided. The US is doubly idiotic by creating huge financial barriers for anyone who wants to enter healthcare. We make the problem even worse with a system that encourages people to delay treatment for problems that get more expensive to treat over time. The less money you have the more you delay, so the entire system eventually ends up overpaying for a worse outcome.
This doesn't factor in all the time spent dealing with inscrutable billing practices for fully insured people having routine medical procedures, or the tens of thousands who are bankrupted every year by the same practices. We recently took our daughter to the ER, which is supposed to be a $400 copay. We now have three separate bills from that visit totaling $1100, and I have no idea how many hours it will take to sort out. The same billing department sent us a $380 invoice six months after her birth because (in their description) they forgot she was there.
Just out of curiosity, what’s your proposed solution?
There's been decades of very smart people working on this problem and its still a problem largely because of its complexity. If there was a simple solution, I have a feeling it would have been implemented already.
The irony of your post that starts with "its not that complicated" ends with an anecdote about just how complicated the system is.
It was an anecdote about how complicated the US system is. Other countries figured out decades ago that adding competition to healthcare does not bring down the price or lead to better life expectancy.
But you’re missing a crucial point: The US is not starting from a blank slate.
President Obama acknowledged this much when he proposed the Affordable Care Act. He said that he’d prefer a single payer system like other countries use, but that it’s not feasible in the US because we can’t just completely uproot the current system without a ton of unintended consequences.
“Just do it like other countries” isn’t a real plan.
So given the current state of the healthcare system, how do you propose it gets modified to mirror those other countries? Do you have a good handle on how those proposed steps (like drastic reductions in R&D spending) will affect the overall system?
When people naively think there are simple solutions to extremely complex systems, it reminds me of the quote “For every problem there is a solution that is simple, straightforward, and wrong.”
Obama has also been endorsing Medicare For All since 2018. From an article about that subject:
"The facts are undeniable. Citizens of developed countries with variations of single-payer systems — Britain, Germany, France, etc. — pay roughly half what Americans pay for health coverage and have better results to show for it (longer life spans, lower infant mortality).
They accomplish this not through some exotic, foreign magic but by exploiting the economic benefits of large insurance pools that represent the entire population. This allows comprehensive coverage to be offered at affordable rates because everyone shares in the risks and rewards of the system.
Let’s be real clear: This isn’t socialism. This isn’t communism. It’s simple risk management — the same economic principle that underlies all forms of insurance."[1]
The bottom line is that nearly a third of America (over 100 million people) are already on Medicare or Medicaid. That is enough data to forecast any outcome there is. Billing, coding, everything is already at a federal standard. Hospitals, doctors, and clinics love Medicare/Medicaid because they know what they are going to be paid and they are paid. Anyone who claims that it can't work here is either unaware of these facts, or purposefully pretending they don't exist.
I'm not arguing whether single payer is a good idea. I'm not arguing that it's tantamount to communism. I'm not arguing that there are many politicians (Obama, included) who are in favor of it. I'm arguing about the feasibility of it in light of naive statements.
It's easy for a politician to endorse a policy, particularly a populist one like Medicare for All. It's entirely different to craft a policy, within the current system, that pragmatically implements it.
My claim is that Obama endorsed the idea because he both thought it was good policy and populist idea that worked in the favor of his politics. But that's entirely different from crafting a pragmatic policy that actually can get passed into law.
I think he's been on the record stating that he didn't like the ACA, but the goal was to pass something, even if it's broken, to try to force it into policy so that it would eventually be fixed into something better. So with so much support, why can't the U.S. implement it? That's central to my point.
"President Obama was clear that – while he would have preferred single payer if we were starting from a clean slate – it would be too disruptive given our current system."[1]
Point being, in many ways it is against the current system. So while you haven't directly addressed my questions, I get the impression you think "Just expand Medicare" is the answer. My point is that it's a bit naive because it really doesn't address the systemic effects that have kept single payer policy from already being implemented.
Medicare/Medicaid is on track to be the largest proportion of the entitlement budget, before expanding it and it doesn't count the Dept. of Veterans Affairs budget (I don't think healthcare is a bad way to spend the budget btw). I know many people will say the Defense budget can be cut to pay for it. But how do you plan on getting that passed when nearly every senator wants to protect the DoD jobs in their state? I'm not even against that idea, I'm just not seeing you advocate a real strategy to implement it. The U.S. is perpetually running against the debt ceiling and your proposal will exacerbate that. This is just the beginning; how do you address the medical insurance industry, particularly when they are heavily lobbying Congress?
If the answer was "Just expand Medicare", it probably would have been implemented already but the fact that it's not should tell you something: maybe it's not that easy. So my question is not whether or not you think it's a good idea, my question is how do you get from the current state to your goal of a single payer system?
> I'm arguing about the feasibility of it in light of naive statements.
I have directly addressed your question with the fact that already a third of Americans are in a single payer system, and most of the world has a single payer or hybrid system.[1] It's naive to think we don't know how to do it, and that we can't learn something from other nations when we expand it.
If you don't think we're capable of achieving the same results as a bloc of nations that has twice our population and many more cultural differences between them, why? Low confidence in America as a whole? Math and science fundamentally change in different time zones? Nobody in America knows how to read German, Spanish, French, Japanese, Korean, Italian, Swedish, Norwegian, Dutch, Belgian, or English?
> If the answer was "Just expand Medicare", it probably would have been implemented already but the fact that it's not should tell you something: maybe it's not that easy.
There's an even simpler explanation: S.1129 was not passed.[2]
> So my question is not whether or not you think it's a good idea, my question is how do you get from the current state to your goal of a single payer system?
No, your question is, "How can I keep the conversation going pretending that I'll accept an answer?" So let's nip that, and you can answer the following question: what evidence would convince you it is feasible?
Yes, the bill was not passed. Neither were any of the proposals for the last 3 decades. Why do you think that is??
I mean, it’s “obviously” just so easy. Do you have better answers than President Obama? Or President Clinton before him? Or Bob Dole? Or John McCain? Yet with all their knowledge and connections, they couldn’t get it accomplished. Note that in nearly 20 years, Medicare for All bills only made it out of committee once. Why do you think that is?
Perhaps because it’s an enormously complex problem with lots of stakeholders and lots of competing interests. One that doesn’t get fixed by just copying a different model that operates outside of the U.S. constraints.
You still never addressed why those bills don’t pass. It’s like your answer is the trivial (and useless) one that “it’s because not enough people voted for it.”
Saying “we already cover 100MM” doesn’t explain how it can be more than tripled. I didn’t claim it can’t be done, I’m asking why none of the proposals have worked out so far. I’ve never claimed the US “doesn’t know how”, I’m saying they haven’t shown political will to implement it. I’m asking for a pragmatic answer that shows why it hasn’t worked despite previous efforts.
I’m asking for your opinion why that’s the case that nothings has been passed in the last 30 years despite the desire among many, many people to do so. I’ve already outlined a few examples that you just blow past for the naively simple answer. That’s not helpful nor does it demonstrate anything beyond a simplistic understanding of the problem.
I have no problem accepting an answer that actually shows an understanding of the complexity of the problem, even if I don’t agree. I’ll help you: I think the very first problem needs to campaign finance reform. Because without that, any proposed bill that goes against the monied interest is dead in the water. But that’s just the first of many things that has to happen before the bills you’re talking about have any chance.
Again, I’m not arguing whether it’s technically feasible. I’m saying the US has not yet shown its politically feasible. I think you’re conflating my position on these.
That latter part is a much tougher and complex problem but every bit a necessary part of the solution. So take just a very small subset of that problem: how do you plan on mitigating the insurance industry’s influence in preventing the passage of a bill that goes against their interests?
Once you figure that out, you’ll have dozens of other political concerns to solve before you ever get to consider implementing the technical solution.
There’s a saying that your can choose between access, quality, and low cost but you can only choose two. The US system has chosen quality and access at the expense of cost.
Other countries benefit largely from the US healthcare R&D machine. The US funds over 40% of the world medical R&D. While other countries put price controls on their medicine, this arrangement won’t work with the current system if the US does the same. To a certain extent, US high prices partly subsidized the rest of the world.
