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Yeah, it sounds pretty brutal, but it was the logical answer given changes in life expectancy. I’m just giving Just Win Baby something to nitpick, as apparently I’m expected to have every detail nailed down before suggesting anything about our system change.
FY19 defense budget:
I'm not sure if you are saying all military jobs (or 25-50% of military jobs) don't provide a meaningful product or service. If so, I could not disagree more.
Life expectancy at age 65 is more relevant to this point than overall life expectancy. Life expectancy at age 65 has only increased by 2.6 years for men and 4.9 years for women since 1940, the year SS benefits went into effect. The normal retirement age has been raised from 65 to 67 for everyone born in 1960 or later, so the deltas aren't very large there.
Medicare for All would add at least $2.5T to the Federal budget. Federal cigarette tax revenue was about $18B last year... about 0.7% of the M4A annual cost. "Sin taxes" aren't going to get it done.
Of course. I don't expect anyone on this message board to have a detailed plan. But I do expect any politician who is going to propose sweeping healthcare change to have one. Bernie Sanders supposedly has a plan to pay for his M4A plan, but the plan on his web site doesn't even cover half of the expected cost. Nor does it address the majority of the issues I mentioned in my earlier post.
So, perhaps I missed it, but what's the complaint? The fact that you're apparently immediately able to get an appointment with triage? That they will have a specialist in the field you need call you, rather than the other way around? That your time to get that answer was only 7 minutes and not over an hour? That you only have to pay a total of $75 to see two doctors, rather than the couple hundred that they'd likely charge you if you didn't have insurance (if you could even get the appointments)? Or that you currently (or may soon) have the ability to talk with, and actually see, a licensed doctor without leaving your house and actually saving $25 in the process?
More the hit with two co pays when the likely outcome from the start was seeing a specialist.
So you're upset with the extra $25 out of your pocket, and a 7 minute appointment? Lots of times, that first visit (and it's $25) can save people the time, hassle, and cost ($50 in your case) of having to see the specialist. I get that in certain situations it's an extra step to a logical and likely conclusion, but often it ends up being what prevents headaches from ever happening.
It’s a minor complaint. Not a big deal.
I'm not saying all military jobs are useless, but I hate the argument that we must sustain a huge military (or any industry, for that matter) purely because of the jobs it provides. As I said, there are a lot of well paying jobs in medical billing/coding/admin and insurance, too, but most should be eliminated when single payor is adopted. Maybe they can go into something that actually meaningfully impacts patient care?
From a provider standpoint, concierge care is great, as is removes as bunch of administrative nonsense and effectively gives insurers the finger. The only problem is, it arguably violates the Hippocratic oath. Also, the more providers who opt out of less desirable insurers/patients, the more other clinicians are overwhelmed with their care - I've seen this repeatedly lead to burn out.
That wasn't my point. I am just saying that anyone who proposes to cut 25-50% of the military budget must understand all of the ramifications and have a plan to deal with them. In my experience, most people who advocate reducing the military budget don't have a complete understanding or a plan for the ramifications. For any politician, that is unacceptable.
You are assuming pay decreases occur in a a vacuum. If the practice of medicine were to become more palatable (getting rid of onerous documentation standards and bickering with insurers, for example), a small drop in pay probably wouldn't mean much.
My point is the size of our military (and the jobs it provides) isn't justifiable. Look at our expenditures compared to the rest of the world.
The truth of the matter is, you likely don't need to see the specialist. But primary care providers are overworked and fearful of missing an obscure diagnosis (and being sued). Plus they cater to the patient's expectations, which more often than not is Do something! (test, refer) rather than watchful waiting and conservative measures.
There are medicolegal concerns with phone/e-consultations, and billing for the service is problematic, too. The doctor needs to justify taking face-to-face time from another patient.
It absolutely will increase the cost for our Federal Government's share of our National Health Expenditures by more than $2.5T.
You are hand waving this as something that will be offset. But how? Details matter.
Define "small drop in pay."
This isn't always true. My wife's neurologist has a concierge-based practice, but he files insurance. My wife started seeing him when he was part of another large practice. That practice got bought out by a large local healthcare provider, and they started limiting the treatments and medications they would allow. He felt that they were compromising the care he needed to provide to his patients and left that practice to start his own.
I understand it isn't explicitly stated, but can be inferred. From the original:
Implies anywhere you'll practice, treating illness (not financial gain) will be the driver. From the modern oath:
If you require a membership fee to enter your practice, you're not really considering the patient's economic stability. From the Declaration of Geneva:
Social standing ~ ability to pay.
Again, concierge care is great for the provider, including the ones who file insurance. Patients like it too. The problem is, not everyone can afford it, and it overwhelms non-concierge physicians with patients who have less financial means and worse insurance.
There is no single answer, as each specialist has different overhead, including malpractice. But there is no good reason dermatologists get paid 1 1/2 to 2 x what primary care physicians earn, for example.
One other thing. The shortage of doctors is multifaceted, but a major part is restriction of medical school and residency spots. In 2018-19, there were over 52,000 applicants for 21K med school positions - the second highest number of applicants ever (2016-27 had a little over 53K).
The key word in your statement here is small. I agree a small decrease won’t make a significant difference. But I posted links yesterday showing the decreases would not be small, which makes this a problem.
I gotta say, you do an outstanding job ignoring anything which invalidates your opinions, while misattributing my position. I never said I advocated Sanders’ M4A, so the estimated payment decreases aren’t applicable.The key word in your statement here is small. I agree a small decrease won’t make a significant difference. But I posted links yesterday showing the decreases would not be small, which makes this a problem.
I’m not attempting to “misattribute” anything. I have posted about Sanders’ M4A because it is the only plan I know of that offers any level of detail
Yes, though I don’t object to supplemental private insurance.Just Win Baby said:
That's kinda chicken and egg - people have figured out the well paying, more lifestyle friendly subspecialties and applied, making them more competitive. It's one of many reasons we have a shortage of primary care providers.
I guess, but the problem of mega-hospitals negotiating excessive reimbursement for services is the result of medicine being run like other businesses. A single payor system with transparent pricing would accomplish the same result, and would potentially allow cost savings by eliminating a lot of hospital/billing/insurance admin, who increase costs by serving as unnecessary middle people.
One option is big, sweeping change that will be so complex and have so many ripple effects that IMO there is no chance our Government can implement it successfully, at least not without decades of painful corrections.Terminalxylem said:
I guess it all depends if you believe the objectives are attainable incrementally, or you think we’re just spinning our wheels until the inevitable occurs.One option is big, sweeping change that will be so complex and have so many ripple effects that IMO there is no chance our Government can implement it successfully, at least not without decades of painful corrections.
An alternative is smaller, incremental changes that focuses on specific issues and stand a much greater chance of achieving their objectives, especially when they are bi-partisan, as is this example.
I favor smaller, focused, incremental change. You obviously favor big, sweeping change. Got it.
Not surprising to me. We’re always behind Scandinavia, Western Europe, Canada, Japan, Australia an New Zealand. I wonder why they omitted numbers 11, 14 and 15?
If he's up for the exercise, you should have him call around to doctor's offices posing as a first time patient wanting to become a client and get him to digest those results
Correct, but only due to the negligence. This practice is apparently very common and will continue to be.
