I’m not overly impressed with the quality of most doctors I’ve currently seen in the U.S., and that’s because all their incentives are screwed up by the system.
Those are two different things; I’ll take the other side of the trade. Doctors, nurses, and med tech wages insure we get the best and brightest in all those respective groups into the profession. Lower the wage, you’ll lower the quality.
I’d rather have people drawn into the medical profession because they actually want to be there and not because they’re so motivated by the vast amount of money they can earn
That’s your view, not mine. I’ll take the really really smart guy who was lured by the money over the average intellect who really wants to be a doctor any day of the week. Money motivation does not imply a lower work ethic, aptitude, or talent level.
I’m reminded of an anecdote from G. Gordon Liddy some years back, in reverse from this disussion. The Army was lowering their physical fitness standards so they could get more recruits; seems the Army was having to choose between fit individuals who couldn’t pass the written test and smarter people who couldn’t pass the physical standards. Liddy was displeased.
A caller who supported the lower standards proposed this hypothetical to Liddy: “Who would you rather be under fire in a fox hole with; a smart guy who might be able to reason his way out but has a fitness problem, or a dumb fit guy who couldn’t think his way out of the house.”
Liddy didn’t miss a beat. “I’ll take the dumb fit guy. I’ll tell him what to do.”
They’re motivated to authorize unnecessary procedures and over-prescribe medications…
Yes, the incentives are all screwed up. You can fix the incentive problem without breaking the system. Ask Kaiser or the Cleveland Clinic how they do it.
My point is that if private insurance goes away — either as a result of a single-payer system or as the result of a pure out-of-pocket market system — the actual cost of medical care is going to drop precipitously, because what’s keeping it artificially high is adverse selection and the unnecessary drugs and services.
That’s only true in the latter case. In the single payer scenario, you drive practitioners out of the system, and when good practitioners are in short supply, supply and demand: prices go up, not down. In the latter case, you’re right, prices would drop like a rock…….but not far enough to cover the lowest income quintile. They’d still need insurance, and you’re right back where you started from.
If we have the whole country paying into one public insurance system through taxation, then we don’t have this issue you identified of doctors being able to shift their losses on medicare/aid to patients with private insurance. Same if we don’t have insurance at all.
California modeled it.
A legislative analysis found that California’s single-payer plan would cost $400 billion to implement, $200 billion of which would be new spending. Critics were quick to point out that this “hefty” price tag is twice the state budget. Furthermore, the bill did not include a funding plan (although the bill’s language ensured that Healthy California would not launch unless it was funded).
And it’s important to note that that’s not a universal single payer system; it just covers (a) the portion of the population that’s not covered under Medicare, Medicaid, Medi-Cal, and (b) CA is already home to the most efficient provider organization in the country, Kaiser.
No thanks. There’s a reason why most developed nations have stayed away from the single payer system in favor of the dual payer model.