However medicare determines prices, they seem to get better results than private insurance, and other countries with single-payer also get much better results than we do. Pricing leverage would seem to be a major factor here. The fact that the drug industry thought it necessary to basically buy off congress to dis-allow medicare from negotiating drug prices in medicare part D should tell you everything you need to know about how the industry views medicare's pricing leverage.

You haven't tried to refute any of this, instead you just keep asking irrelevant questions begging for details on stuff you already feel like an expert about.

You misunderstood my post. The theory is not flawed the implementation under Obamacare is too weak.

Great. You have no idea how Medicare prices are determined yet opine that Medicare would work for the entire population. Just because you think it works in another country doesn't mean it will work here.

Medicare is broken. That is why the government is desperately trying to find a solution. You should read about MACRA. That is what Medicare will be transforming into over the next 10-years. Supposedly. Let's see how many people think Medicare will be working in the year 2026.

Yes because I know how to read a chart. The exact machinations of how medicare determines prices are not important compared to the results.

There's no reason to think medicare for all wouldn't help reduce prices based on empirical evidence, your citation-free handwaving aside. It doesn't just work in another country, it works in all countries. You have absolutely no basis to think it won't work here other than your gut and intuition.

Your side has been claiming medicare is dead, and actively trying to kill it, since it's inception.

Actually I posted an article earlier that showed they were doing exactly that, but you ignored it.

Sick people without insurance should probably just go ahead and join ISIS. It's the easiest way to get conservatives to acknowledge that they exist.

So you're saying even an expensive plan > infinity?

Hmm that's some radical thinking there.

Every time I see these numbers for yearly health care premiums I can't help but shudder, seeing as how I'm living in Canada and paying exactly $0.00 for full coverage with no deductible.

It's really kind of mind-boggling how people are against that idea. Like hey you might have a few less aircraft carriers but if you get meningitis it won't cost you a nickel. Damn people are dumb.

This post proves it.

I just saw that the projected cost of a Silver plan in 2017 is within 1% of what the CBO projected it would be when the law was passed. ~$50 on a $5k annual premium.

Suzzer,

The main advantage that single payer systems have in other countries is that they somehow ration care. Medicare doesn't. If you want a system in the US that is single payer and "medicare for all" then it has to ration care. ($20T, right?)

Its possible that physicians will start self-imposing rationing under MACRA. For example, if they are paying based on outcomes, certain docs might cherry-pick the easiest surgical cases to pad their stats. The hard ones won't get done. They might withhold expensive drugs in certain situations in order to meet "resource measures" etc.



In my experience, Americans want three things with their health care:

1) They want the best health care
2) RIGHT NOW
3) Someone else to pay for it.

Do you have any citation for this crap other than you believe it because some doctor friend told you one time - and being doctors you clearly know more than us mere mortals?

None of what you posted explains why Medicare is better than private insurance at keeping healthcare costs down in the US. The idea of "pricing leverage" has been used 100s of times itt, and ignored every time by the anti-ACA crowd, in place of their own fairy tale about why it will never work in the US.

Are you even able to type the words 'pricing leverage'? If so, maybe take a stab at why medicare might be able to wield it better than other US entities. And why the drug industry was so scared of medicare pricing leverage, that they learned from the healthcare industry's mistake and went balls to the wall to keep it out of play.

America is too unique.

The reason that Medicare appears to work is that doctors are compensated on a fee-for-service mechanism. Meaning that they get paid when a patient is sick. The sicker the patient, the more the doctor (hospital, equipment, facility) will get paid. Therefore, there is an enormous interest to "find" as much "sickness" as possible.

What keeps it sort of in check is jail and fines that are 100x the amount that may be determined not to have been medically necessary. But that is sometimes very hard to prove. How much chemotherapy is medically necessary? Should chiropractic services be covered?

The other way to do it is pay doctors/hospitals a flat fee per patient. Capitated. Hospital gets $1,200 per patient per month regardless if the patient comes in never or every single day. But then you have a perverse incentive to provide as little care as possible.

The more you expand Medicare, the more you expand government auditors which increases costs for everyone. Governmental agencies tend not to be very efficient.

In what way is The US too unique?

The rest of that seems pretty irrelevant to the discussion at hand. I don't see the point going down the rabbit hole with you of dueling speculation as to how we could radically overhaul doctor's fee structure.

I mean, I'm no expert, but it seems pretty simple to me.

Right now the insurance companies have very little pricing leverage. And because of lack of competition, they have no incentive to drive down costs anyway -- they make more money when costs are high.

With single payer you solve both problems. Obviously you would get a dramatic shift in pricing leverage. And since the government isn't concerned with making profit, the incentive would be strictly to lower prices.

But do you know how medicare prices are determined?

LOLGOP has never steered me wrong before.

Hey but thanks MSM for blowing up this story into a ratings bonanza for yourselves. I'm sure right-wing media will return the favor someday and report ACA successes.

I don't know. We just are. We spend more on the military than the next 8 nations combined. We have the highest prison incarceration rate in the world. We spend twice as much on college education per capita than the rest of the world. We are an extremist culture. Good and bad. We couldn't even adopt the metric system.

That sounds like the USSR.

The problem is that doctors, hospitals, pharmaceutical companies, etc. want to make a profit. Or do we just lower the prices to them? Which will lead to fewer quality doctors, hospitals, and less incentive for R&D. And lower quality care. Perhaps.

If someone is that money driven maybe they should choose a field where profits are the top priority, not helping people. If doctors can't handle driving a Ford instead of a Mercedes, living in a great but not exclusive neighborhood or playing golf at a public course they should enter a different field.

Yep. In the past when your insurance went up year after year you had the option of not buying insurance or just going with catastrophic. Don't have that option anymore so they can charge whatever the hell they want.

BREAKING NEWS: Americans want those things for all their goods and services. Like when you get an apple fritter and coffee you'd probably like it to be a) the best and tastiest out there, b) delivered to you quickly and c) free. That's not news.

As for rationing, despite what Sarah Palin told you, it doesn't have to work like that:

http://www.huffingtonpost.com/john-g..._11296230.html

Summary, any 'rationing' of care in the USA similar to that of other nations would probably lead to an increase in access.

Well, if it makes you feel better I'm driving a 12 year old 4-Runner with 200K on it.

I don't quite know how you're going to convince hospitals and health care companies to drive a car at all, never mind a Mercedes, but have at it.

It'll be interesting to see what Clinton does with Obamacare - it's clearly not sustainable (not even close) in anything like its current form, but a lot more people have some sort of coverage which I think is a good thing. Hopefully the Trump disaster will concentrate some minds and things can move forward.

MM MD

To elaborate a little, I may not be following the platform closely enough, but has Clinton said anything specific about her plans for Obamacare, beyond generally being in favor of it? I'm not knocking her if she hasn't, especially at this point in the election process - she probably shouldn't say anything except "I'm not Trump" until election day. I was just wondering if she (or any other dem) has had specific thoughts about the topic.

MM MD

Its not the same because us Canadians spend so little on military.

We are sitting right next to the most powerful army in the world surrounded by 2 oceans. If it was just Canada with Putin to our north we would be spending a lot more on military then we currently are. A lot more, maybe even 1-2% of GDP more. Maybe other Canadians disagree but if there wasn't America having their nukes stationed all across the world and so close to Canada that its practically beneficial for us, many other countries would be spending money on those programs. I would want nukes if America wasn't there and its just Canada a sitting duck near Russia.

If countries like South Korea and Japan didn't have American bases stationed there they would be forced to spend a **** ton more on military spending. Hate to say it, but America bankrolls our social programs.

Ita funny how they call Bernie Sanders a socialist yet Trudeau, maybe even Harper is to the left of Bernie easily.

Lower salaries may lead to lower qualified healthcare professionals. Perhaps. But doctors represent 18% of healthcare costs. What will happen is that there will be a lower incentive for pharmaceutical R&D for example. R&D is big risk, big reward. Some hospitals and surgery centers may not even be able to pay their bills. Some will go bankrupt. Which reduces access. In other industries, the market will work itself out by companies raising prices. In a regulated market with no pricing power, what will occur is delay of treatment and worse health outcomes. The rich will just pay for private care.