Thus the situation in Italy as compared with the situation in South Korea or Singapore or Iran has no simple explanation.
True, because oftentimes the explanation lies OUTSIDE the health care system itself.
Singapore is a dictatorship; South Korea is a liberal democracy, but they do have strict martial law provisions which they invoked in this case. Suffice to say that in both countries, you can get into deep, deep, shit (legally) if you don’t follow government “requests” under these circumstances.
OTOH, there are some posts from some medical professionals in Italy that have sheepishly admitted that they did this to themselves, by not following government instructions when they were first issued.
The question is how they interact, e.g. whether instituting M4A in the US would expand or contract the medical infrastructure. Would M4A mean more doctors, nurses, hospitals, ERs clinics, medical labs, drugs, bedpans, etc. or fewer of them?
Can’t tell. But what you know is that regardless of if the insurer is the government or Humana, the administrators are under pressure to come in at budget. The only difference is who gets pissed off if you fail to meet budget. If the insurer is the government, it’s the taxpayer, because they have to make up the difference out of their wallets (theoretically speaking); if the insurer is Humana, it’s the shareholder.
But the pressure to make ends meet is the same.
My own opinion is that M4A would tend to shrink and consolidate the US healthcare infrastructure — mainly through price fixing, the sine qua non of a single-payer system.
Well, it would probably shrink, but not for that reason. Sanders himself (not sure why we’re talking about him anymore, since he’s a Dead Man Walking) admits that medical professionals will not earn what they do today. His acolytes, reading that, think to themselves “Yea, well, doctors make enough already”, but they forget that it’s ALL medical professionals……and when you’re in the hospital, the last thing you want is an overworked, underpaid, pissed off nurse. :-)
So, shrinkage happens, because you are no longer attracting the same quality and quantity of medical professional; hospitals which today might be barely solvent (and there are many operating on the edge — — these are pricey operations to run) go into the red; the government, pressured by budget reality, closes money losing operations.
There are better ways to do a universal care system.
Only large medical conglomerates, capable of leveraging economies of scale, could survive in such an environment. That is to say, the government will pay and big corporations will cash the checks. Doctors and other medical professionals will become corporate employees, a business model not exactly compatible with Comrade Sanders’ stick-figure democratic socialism. But what else can you expect from a guy for whom Cuban healthcare is the standard of the industry?
And interestingly (and alarmingly) if you dig into the books of some of those large medical conglomerates…..the most profitable part of their business is the Medicare part, because they can cost-shift. The private insurance, which they cost-shift into, operates break even.
But, if there are no private plans to cost-shift to……… :-)