A Peek Into How Obamacare Would Play Out
Alan B. Miller's company ran a hospital in London, and from that experience, he says we don't want to go the public health care route. He writes in the WSJ:
Medicare works because hospitals subsidize the care they provide with revenue received from patients who have commercial insurance. Without that revenue, hospitals could not afford to care for those covered by Medicare. In effect, everyone with insurance is subsidizing the Medicare shortfall, which is growing larger every year.If hospitals had to rely solely on Medicare reimbursements for operating revenue, as would occur under a single-payer system, many hospitals would be forced to eliminate services, cut investments in advanced medical technology, reduce the number of nurses and other employees, and provide less care for the patients they serve. And with the government in control, Americans eventually will see rationing, the denial of high-priced drugs and sophisticated procedures, and long waits for care.
My company's experience with health care in the United Kingdom illustrates the point. In the 1980s, we opened The London Independent Hospital to serve the private medical market in the U.K. The hospital had not been open long when representatives of a 1,000-bed government-run hospital located a short distance away approached us to borrow high-tech equipment and instruments. Because people were ill and needed procedures the government hospital could not provide, we provided that hospital with the help it needed. But that experience convinced me that under a single-payer system hospitals do not receive the money required to purchase advanced technology or provide quality care.
Advocates of a single-payer system say that hospitals would survive if they learned to operate more efficiently. While we are always looking for ways to improve efficiency, the economic conditions of the past few years have already forced most institutions to reduce expenses and increase efficiency as much as possible.
The reality is that Americans have come to expect the best health care in the world, and to provide that, hospitals must continue to invest in advanced medical technology, salaries for well-trained nurses and technicians, and state-of-the-art facilities. If hospitals were required to operate solely on revenue from a single-payer system, they could no longer afford to provide the care that Americans deserve.
Single-payer systems have proven to be wholly inadequate in Canada and the U.K. Most people in America are satisfied with the care they receive, so it is important that we take the time to fix only the parts of our system that need repair. Let's not destroy a system that works well for most Americans. Let's judiciously change only the areas in need.
This article is 100% correct.
All roads in this "healthcare reform" lead to lower reimbursement rates for providers.
Does it really take a PHD in economics to figure out what will happen when Hospitals start getting paid less for the work they do?
Just like any business, when revenue decreases they will cut expenses. Layoff staff, eliminate capital projects, reduce spending all across the board.
But The Messiah will still say with a straight face that no reduction in the quality of care will occur.
And the MSM will let him get awy with it.
sean at August 13, 2009 5:22 AM
"Most people in America are satisfied with the care they receive" If this were true, the discussion wouldn't even be being had.
"Americans eventually will see rationing, the denial of high-priced drugs and sophisticated procedures, and long waits for care" As opposed to the profit motivated insurers already doing this?
muggle at August 13, 2009 5:30 AM
No, if it were true, we wouldn't be getting fed a constant stream of lies by the Democratic party.
If it were true, there would not be so much resistance to so-called "reform".
What you have here is a dedicated bunch of socialist cockholsters who think that the world would be just peachy if all you morons would just shut up and let them run your lives.
When the insurance company denies a procedure, you have recourse. You can sue, complain, pay for the procedure yourself, rely upon private charity.
Once the government gets through (and make no mistake, the goal is single-payer like Canada, even Obama himself has said so) you won't have any of those options.
See, in order for a government-run system to work, it has to undercut all the insurance companies first. Then, once they are gone, it has the ability to control costs by setting payments by fiat. Which means doctors opt out.
And the only way to prevent the collapse of a price-controlled system is to make it illegal to opt out.
Of course, those provisions being in Hillarycare from day one is what killed that plan dead. As soon as people read that doctors would be put in jail if they did fee for service, it was over.
But as sure as the Sun rises in the east, that is coming. It might not be for another 2,5 or 10 years, but it's coming.
You are free to delude yourself of course. Just don't ask me to commit suicide with you.
brian at August 13, 2009 6:28 AM
"Most people in America are satisfied with the care they receive" If this were true, the discussion wouldn't even be being had.
Muggle, that is crap. Many many surveys have been done on this. This is from one article about it:
A survey conducted jointly by the Kaiser Family Foundation, ABC News and USA Today, released in October 2006, found that 89 percent of Americans were satisfied with their own personal medical care
...
Those with recent serious health problems, possibly the people with the best knowledge of how health care is working, were generally the most satisfied. Ninety-three percent of insured Americans who had recently suffered a serious illness were satisfied with their health care. So were 95 percent of those who suffered from chronic illness.
The reason we're having this "discussion" is because we have a Socialist living in the White House.
sean at August 13, 2009 7:03 AM
Want to know what happens if all healthcare is paid for by the government? Healthcare providers go out of business.
My employers own a private ambulance company based in Laredo, TX. People who require private ambulances are usually completely immobile (can't even sit up) and either on chemo or dialysis. They need to be transported from the nursing home to the hospital or dialysis center. On the border, the majority of the patients are on medicare or medicaid. So, my boss's business is largely dependent on government reimbursement.
Medicare will deny any claim they can, for any reason they can find. The doctor authorizing the trip to the hospital signed on the wrong line. Our paramedic used the wrong word to describe the position the patient was in when the ambulance arrived. A four-paragraph description of the situation wasn't detailed enough. The trip to the dialysis center was authorized, but the return trip to the patient's home wasn't. The person reviewing the claim isn't convinced that the patient is completely immobile. Etc, etc. And, when a claim is denied, the company can't really go after the patient for the money. We have to write if off. There is no recourse.
So... if we are on a single-payer system, and the government is that single payer, and the government will find any way it can to avoid paying for services, and there's no recourse, where is the incentive to provide the service? Yeah, helping people is great, but fluffy feelings don't keep companies from going bankrupt.
As an aside, I wonder what the incentives to become a doctor will be if the Gov takes over healthcare. Why would one go through years of school, and take out extensive loans, only to have one's income capped by Big Brother? I suppose that everyone graduating from Med school will be trying to get into either plastic surgery or dematology... And I expect that the medical tourism industry will become even more lucrative.
ahw at August 13, 2009 8:45 AM
Healthcare under NHS in the UK sucks.
It would never care for someone like Stephen Hawking, whose ALS is progressed to the point where it requires experimental treatment to be able to communicate with the outside world. Think of a governmental health care body denying the world his genius just because he contracted a progressive disease that would leave him paralyzed long before he made his great scientific achievements.
It would certainly deny expensive experimental care to a brain-damaged newborn because he would never be a productive member of society.
And 8/10 people in the UK are certainly NOT PROUD of their health care system.
Whatever at August 13, 2009 9:13 AM
Actually, Hawking lives in the UK and credits the NHS with keeping him alive.
But for every success story like Hawking, there's about 10 people who get mediocre care, and another one who dies from negligence or malpractice.
And that's the problem with government systems. There's no recourse, there's nowhere else to go. You go to the hospital that they tell you to go to. You go to the doctor they tell you to go to. Or you die.
And sometimes, you die anyway.
My father didn't like his oncologist, he told the guy to stuff it and found one with a better attitude. Under any government care system, that simply isn't going to happen.
brian at August 13, 2009 9:23 AM
Brian, I know Hawking has lived his life in the UK and credits NHS with keeping him alive. The idiots on the editorial board of Investors Business Daily didn't, at least not when they published that lie recently.
All the pieces evidence I asserted above were false.
BTW, choice at NHS looks a lot like choice at Kaiser. You can choose from any doctor in your area.
http://www.nhs.uk/Pages/HomePage.aspx
Whatever at August 13, 2009 9:55 AM
Hawking does credit the NHS with keeping him alive. He also credits the work of several foundations that pay for his 24 hour care. Would NHS pay for his 24 hour care? Not the same kind of care, that's for sure, and not for everybody who has his condition but isn't a world class scientist and celebrity.
Pseudonym at August 13, 2009 10:12 AM
Pseudonym, follow my link above to read about how NHS treated one random brain-damaged infant.
No "death panels" like Palin's baby would have to face!
Whatever at August 13, 2009 10:16 AM
As an aside, I wonder what the incentives to become a doctor will be if the Gov takes over healthcare. Why would one go through years of school, and take out extensive loans, only to have one's income capped by Big Brother?
Teachers do
lujlp at August 13, 2009 10:28 AM
I'm gonna get hammered for this, because I know a few teachers, and they aren't all dimwits, but it's pretty safe to assume that the bulk of your primary and secondary education teachers aren't exactly top quintile stuff.
Vox had a link to something that showed that the typical education major was actually bottom quintile as far as intelligence goes.
In other words, as the old saying goes:
Those who can do. Those who cannot, manage. Those who cannot manage, teach.
brian at August 13, 2009 11:02 AM
"Teachers do"
Oh Brother.
You know a lot of teachers that you'd trust with your life?
Not me.
I prefer someone who takes their job more seriously than taking the summers off and getting off work at 2:00 when they do work. And then gets a pension at 55.
All while screaming about being "underpaid". So underpaid that they never go out and get another job.
Oh, right. They "correct papers". And don't forget the "lesson plans". Wow, how do they manage under all that stress.
Look to the great socialist republic of Canada. There are towns that hold lotteries for Doctors appointments because there is such a shortage.
Plenty of teachers suckling on the public teat though.
sean at August 13, 2009 11:05 AM
Hey! Brian has some ideas about insurance to share!
Did you finally buy some insurance, Brian? Are you protecting your family and your community from the expense of sudden illness?
Crid [CridComment @ gmail] at August 13, 2009 11:42 AM
If I did, you're the last person I'd tell. Just because you're a douchebag about it.
brian at August 13, 2009 11:48 AM
That would be "no".
Good to know!
Crid [CridComment @ gmail] at August 13, 2009 12:14 PM
Have any of the proposed bills or plans called for a single-payer system?
I'm not sure why everyone assumes that the existence of a public option would drive the private insurers out of business, when the public option will probably not offer the same benefits as a private plan.
Gastric bypass, for instance, is covered under many private plans, but it's *really* hard to get Medicaid to pay for it.
jen at August 14, 2009 12:21 PM
Are you really that dense?
The "public option" is going to offer coverage that's not significantly worse for a lower premium.
Combine this with the fact that the "penalty" that a company pays for not providing insurance to their employees is 8% of payroll -- which is less than they're paying for insurance -- and you end up with companies dropping their insurance plans left and right and forcing their employees into the public option.
The estimates I read said anywhere from 80 to 100 million people would be pushed off of private insurance for that reason alone.
Why do you think the unions and big businesses are all behind this monstrosity? Because they know it leads to taxpayer-funded single-payer, and they don't have to pay for health insurance any more.
Nobody plays chess. Nobody thinks farther ahead than the current move.
brian at August 14, 2009 4:46 PM
The "public option" is going to offer coverage that's not significantly worse for a lower premium.
And this is supposed to be bad, why?
Whatever at August 14, 2009 9:22 PM
Plenty of teachers suckling on the public teat though
Yeah, cause working with asshole kids, grading papers at night, and being paid a pittance is just like nursing at mom's breast. Douche.
Whatever at August 14, 2009 9:24 PM
"Yeah, cause working with asshole kids, grading papers at night, and being paid a pittance is just like nursing at mom's breast. Douche."
Why wait until night to grade those papers? Do it when you get off work at 2:15 while the rest of us have 3-4 hours left in our work day.
And let me know when there's a shortage of teachers because of the pittance you get paid. Obviously you are getting paid enough or you'd quit.
But thanks for taking the time to share your opinion. It must have been a lousy beach day where you are.
sean at August 14, 2009 9:48 PM
Whatever:
For the same reason that DMV, USPS, and every other government endeavor are bad.
When there's no competition (and with Government Health Services, there won't be -- they'll make sure of that), there's no incentive to not suck.
So it'll start out as mediocre care for cheap. It'll turn into lousy care for a shitload.
Kinda like Canada, only without the safety valve. Unless you really like Mexican hospitals, anyhow.
Now I see how Obama got elected. The 52% who voted for him are ALL marginal thinkers just like he is. Nobody goes beyond zeroth-order effects of policy when determining what to do.
Mike Judge is a prophet!
brian at August 15, 2009 8:02 AM
Leave a comment