Friday, January 29, 2016

The Washington Post Spins Fantasy About Bernie

The Washington Post decries Bernie as just another politician spinning fantasy.
To wit, the editors of the Post believe to advocate a single payer system for medical insurance, or even the option for a government Medicare-for-anyone who wants it, is sheer fantasy in the America of 2016.  Sanders's argument:  "It works in Sweden and every other major industrialized country, why would it not work here?"  is met with the argument of American exceptionalism by the Post

The editors argue that Medicare for all would not save all that much money and would result in diminished earnings for doctors and hospitals. 
This, actually, is the real  fantasy. 

 I once tried to calculate what the administrative costs mean for the American health care system. It's a tough estimate,  because nobody really seems to know how many hangers on there are in the system, between the insurance agents who sell health insurance, the Human Resources people at every company,  who spend most of their time negotiating with health insurance companies for good prices, the teams of "billers" in every doctor's office whose job is to spend all day every day fighting claims through insurance companies, the clerks on the other end, in the insurance companies who are busy denying claims, the marketing people for the insurance companies, but a conservative estimate of all these people involved in the financial and commercial side of American medicine is likely between 5 and 10 million people. If the average salary of all those hangers on is $50,000 (an estimate, I am told is very conservative) then there is $500 billion dollars in "waste" in our current system--"waste" in the sense of money spent which does not go to treating patients but only to financing the system. If you divided this by the 500,000 physicians in the country that comes to about a million dollars per doctor, which would not represent a loss of income for most of them, for 99% of them. 
Of course, not all of that would go to physicians, but the point is, there is way more money going to the financial part of our health care system than goes to the providers of health care, which is why our spending on "healthcare" dwarfs that of any other "advanced" country.  We spend it on middlemen. They spend on the folks who actually provide the services.

Cutting out the middlemen  would mean displacement and unemployment for a lot of middelmen who currently are employed to do work which is superfluous and unnecessary to the real  mission of the enterprise of American health care, which is, as I understand it, to provide health care for patients as opposed to salaries for clerks and salespeople.

It would also mean that patients would likely be seen by physicians as opposed to nurse practitioners much more often, because the main reason nurse practitioners are seeing so many patients now is that it cost corporations and insurance companies about a quarter as much for a NP as for a MD.

The Post says Americans would never stand for the "rationing" of medical care which the Brits and the Canadians and the Swedes all tolerate without a peep of protest. Of course, as anyone who watches Prime Minister's Questions knows, the Brits do no tolerate inadequacies in their health care system. But in Britain, if you have a beef with your provider, you can take it to the House of Commons where you will get a more sympathetic hearing than you are likely to ever get from Blue Cross. The fact is, the private insurance companies have been rationing care for years in the United States.  We'll accept rationing from private commercial concerns but we go ballistic when it's the government saying no. 

This is the reality. What the Post endorses is the fantasy.

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