Re: Petition to expand Medicare to be the Single Payer Healthcare System for the USA
Originally Posted by
christian
I grew up in a country with single-layer healthcare. It's true that most of the doctors drove Volvos, not Mercedes, but I'm not convinced that the quality of care necessarily is in line with physicians' practices profitability.
8% of the US health care dollar goes to physician salaries. A much more staggering amount of the health care dollar goes towards the overhead of the byzantine reimbursement scheme, inefficient care due to poor IT infrastructure, defensive medicine in a litigious society, and futile end of life care (a complex social problem with lots of blame to spread around among providers, attorneys, the media, and patients/families). I might also throw a dart at Big Pharma and their relentless marketing, but my good friend MarkC might be reading this :)
Your 'Volvos/Mercedes' line completely misses the real problem - US/Canada physician salaries aren't that far apart (if at all) when you compare apples to apples for specialty and hours worked. Also, check the doctor's lot at your local US hospital these days. Not as exciting an automobile selection as you'd like to portray with this trite one-liner. Plus, the subset of physicians who are high earners a) work in difficult specialties with 7-9 years grueling training after medical school and b) work 80 or more hours a week even in middle age due to a shortage of docs willing to do this difficult work. Do you really begrudge the guy who's going to take out your wife's brain tumor his Porsche after he's spent four years in college, four years in medical school, and eight years in residency/fellowship and still works 80 hours a week?
I'm all for single payer and eliminating the middle man and wasteful overhead that he brings. As others have said, reimbursements under a single payer system would have to be sustainable for hospitals and providers. Medicare (and Medicaid) don't even cover cost for many procedures - when you count overhead, there are a number of operations that I do that lose money under Medicare for my hospital. That's on top of caring for 38% uninsured patients in an urban setting. It's only sustainable (but always barely and always threatened) because of a bizarre societal cost-shifting where other services are over-reimbursed. This whole insane system has to go, but I don't see it happening. The real problem with eliminating the middle man is that he (the insurance industry) is a powerful lobby and no way our leaders will have the clout/balls to cut him out of the health care picture and put in an appropriately fair, simple system.
BTW, I don't own a Mercedes but I do have a Spectrum, Sachs, and Parlee. The last two I bought used here on the Salon.
Lou D'Amelio
Bucks County PA
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