A question for those that support single payer health insurance

[taught_me_patience]

and work in the private sector:

How comfortable would you be if the government essentially regulated how much money you can make? For those those that own their own business: How comfortable would you be if you had the option of only one client and you had to take whatever price they offered? Would you make long term investments into your business knowing that at some point republicans will have the power and would love nothing more than to "starve the beast"?

Personally, as someone who works in the private sector, I'm not comfortable at all with the government determining my pay. I can't think of a single private sector industry where this is the paradigm. For this reason, I'm against single payer but I'm for a universal health care similar to the Swiss system:

https://en.wikipedia.org/wiki/Healthcare_in_Switzerland

[shraby]

1. What does the government regulating how much you can make have to do with

single payer health insurance?

I would think businesses would welcome it because they don't have to pay to insure their employees. That's overhead they can use to expand their business.

[WillowTree]

2. I think the OP is referring to medical providers.

[elleng]

53. Maybe, but the OP should say so, imo.

Let's not add hidden burdens to an already burdened issue.

[DemocratSinceBirth]

3. I favor a public option alongside a private insurance system.

Most folks get their insurance from their employers and are satisfied with it. We only create problems for us ourselves by tinkering with it; if you like your insurance you can keep it.

[unblock]

4. much of the defense industry is single-payer

not putting it out there as an ideal market, just saying it's another example of a single-payer market.

[taught_me_patience]

11. As an industry, kind of...

but the government contracts do not effectively determine how much engineers at Raytheon make, for example. By having a single entity reimbursing doctors directly for services performed, it is essentially determining the pay for that individual.

[unblock]

18. only because there are more, smaller suppliers in the health care industry.

in any event, there are experiments of other ways to pay than fee-for-service. this doesn't have much to do with single-payer.

[Hoyt]

31. Not really. Some doctors might choose to work 4 days a week, or 6 hours a day. Others might choose

to work longer hours, see more patients, provide more services, hire physician assistants, invest in their own surgical center, one can choose a specialty that is in high demand, etc. Doctors can supplement their income in research, teaching, etc.

All the government does under Medicare is say, we are going to pay a doctor $250 for a colonoscopy, and another $450 if the doctor owns the facility. A doctor can probably perform 10 - 12 or so from 8:00 am to Noon. Some might do 20. Innovation might increase the number one can do. In any event, a doc can do that once a week and see other patients in the office on other days, or he can do it several days a week. Of course, there are expenses those payments have to cover.

Now, you do have to depend on politics to determine how much you get paid for each specific procedure since they can change the rates, how many people have insurance, etc. That is a risk, one a lot of people are willing to take for the chance to earn $200K, $300K, or more per year.

And doctors can always decide to work outside the single payer system and cater to the well-to-do who don't want sit in a waiting room with the rest of us (if they can find enough well-to-do as they compete among each other). If not, they are glad to get the $250 per procedure. Some doctors -- like dermatologists -- can add cosmetic procedures and products (that are not covered by the program) to increase their income.

And, don't forget that under the ACA, a lot of insurers offered payment rates less than Medicare.

Finally, there are a lot of docs who would be fine with getting a salary of $200K or so, and having to work no more than 40 hours a week.

[haele]

32. Actually, government contracts do effectively determine how much engineers make...

I work government contracts. I've been "topped out" at a position for several years at a time because the government has determined that my position on that contract only is worth "X" amount of dollars to the prime - even if I had been getting more work and responsibility thrown at me. The pass-through money is a killer.
So, while they'll contract to pay a max of $150K a year for 5 years in task allotments to the prime for my position, I'd be lucky to see $70K in my pocket at the end of the contract - and that's at the top of the pay scale for someone working that position, even if the company pay scale for the worker's actual position might go up into 6 figures.
I'm most likely to begin that type of contract position at $55K to $60K, and hope they increase any follow-on task dollars so that maybe I can see an occasional pay raise.
Over the years, I've been lucky that I'm also somewhat able to work my ass off - in my own time - to qualify for both an accretion in position or to get a higher position, but I've seen way too many engineers have to "start over" at another task (or company) - actually getting less pay on that task - just to be able to maintain work continuity.

The nasty secret of government work is that there's only so many senior or management positions around; usually at a 10 - 1 ratio. So if you're one of the 10 who isn't politically savvy enough to get into a management position, you're SOL when you've topped out.

This typically happens around age 50 - 55. I think because of Ms. Clinton's tenure in the State Department, that was one of the reasons she was talking about dropping Medicaid entry and flirted with Social Security entry down to 55; there's a lot of topped-out mid-level State Department workforce (federal employee and contractor) that really needed to either retire or be able to get into management, and they could do neither.

As for Single Payer health care...

Yes, single payer payments to doctors will probably work in a similar manner. There will be a range payment based on several factors - most likely location costs, affiliation to specialties, costs associated with maintaining the practice and accreditation, hours practice is open to general public, amount of other similar practices in the area - that sort of thing, and doctors can always set aside hours for specialty patients who are paying for voluntary/cosmetic procedures and care that is not typically covered under insurance anyway. Just as insurance companies do now. Doctors get paid in accordance to what the insurance companies think they should be paid - which is varied and cut-throat.
Just try to get your preferred doctor if s/he won't take your insurance because they'll only pay $50 a visit (plus your $40 co-pay), and the actual break-even profit-neutral payment for that doctor is $120 an hour. And that was happening before the ACA was enacted. The ACA actually helped some of those doctors.

In effect, what single payer will do will normalize the typical pay of doctors that take insurance across the board. There will be no "out of network" doctors or specialists that need to be paid more; every doctor knows how much they can expect to get paid, which will cut down on a lot of extraneous paperwork costs - which often acts to drive up the price almost double in the first place.

There is one real major problem with going single payer. There also has to be a mechanism in place to cut down the cost of training and credentialing of doctors, PAs, nurses, and other medical positions that require 4 years or more of college. $200K in student loans to get a Master's in Medicine, then add on the $25K - $50K -or more - every couple of years that most doctors and nurses need to come up with to maintain their board certification, and you can see why doctors and other medical staff are so expensive.

Haele

[okieinpain]

38. yeah sounds great but will they be able

to afford Porsche, Mercedes, and Lamborghini's, will they become disgruntle workers and join isis.

[Laffy Kat]

79. The Danish exchange student was the daughter of a physician.

They had two houses, several cars, went on many vacations every year. Of course, their healthcare is paid for, their universities free. She was really surprised when I had to take my son of school to see the orthodontist because their school has located at the school, free of course, so students don't miss their classes.

[stopbush]

5. You don't understand what single payer means.

Do some research. You'll be embarrassed by this post you just composed.

[taught_me_patience]

10. Please enlighten me

Single-payer healthcare is a system in which all residents pay the state – via taxes in amounts determined by the state – to cover core healthcare costs for all residents regardless of income, occupation, or health status – rather than select individuals buying from private insurers with varying health care coverage dependent upon their specific wealth.[1][2][3] Single-payer systems may contract for healthcare services from private organizations (as is the case in Canada) or may own and employ healthcare resources and personnel (as is the case in the United Kingdom).

The term "single-payer" thus describes the funding mechanism, referring to healthcare financed by a single public body from a single fund, not the type of delivery or for whom physicians work.

https://en.wikipedia.org/wiki/Single-payer_healthcare

[LanternWaste]

25. single payer also allows for a two-tier system rendering your reponse irrelevant.

All things being equal, single payer also allows for a two-tier system rendering your reponse irrelevant.

[still_one]

59. Single Payer, like Medicare, is less prone to rationing of services, which Universal Health is

very vulnerable to

I would also say that Medicare as an example, allows for those who cannot afford the Medicare premiums, to be covered under Medicaid.

but you are right, single payer allows for a two-tier system. Private insurance or Single Payer.

In the case of Medicare, for items not covered, that is where private insurance takes over through a Supplemental or Medicare advantage plan, it isn't required though.

[stopbush]

64. Your OP implies that you would have only one choice

when it comes to your healthcare provider. That is not true.

[LonePirate]

6. To me this is a values question. Should health care decisions be influenced by profit?

We have a public education system that is supposed to be non-profit and we also have a smaller private education that is undeniably a for profit system. Should the health care system become a mostly non-profit system?

[tazkcmo]

14. Bingo.

It indeed is a values question.

[KG]

7. I lulz'd

[NRaleighLiberal]

8. is health care a right, or a privilege?

[unblock]

20. apparently profiteering is a right.

[Grins]

21. A great an enduring question

Other nations have asked that question and the answer is, pretty much - it's a right.

There are arguments! And some are pretty good. But Americans have never asked that question so there is no answer, and until we do, there will never be single payer or universal health care in this country.

[Bettie]

37. It is not only a right, it is

a public good.

If people have access to healthcare, especially preventative care and regular check ups, serious illnesses are caught before they become catastrophic, minor illnesses can be treated before they turn into something serious.

I don't see why people don't get that it is better for all of us to have everyone covered and no one going bankrupt because they got sick and it cost too much.

[LeftInTX]

9. We have an escalating health care cost problem.

I think you are implying the health care workers be fairly compensated. I don't dispute that. Doctors were rich in the 1960s when health care costs were reasonable. Nurses were paid decent wages too.

We now have pharmaceutical execs, insurance execs etc. who are getting all the money.

[taught_me_patience]

15. I'm asking a philisophical question

A "medicare for all" or universal single payer system would effectively mean that the government directly controls the pay of a private sector worker. Even if that pay was phenomenal, as a private sector worker, I'm uncomfortable with that because I would hate for the government to determine MY pay with an effective monopoly of the market.

[Trial_By_Fire]

28. Addressing your primary concern regarding 'controlling pay'...

First of all, it already happens with Medicare.

My first reaction is, if a doctor doesn't like what 'pay' is offered by Medicare for All, well,
the doctor does not have to accept Medicare for ALL patients. I bet many other Docs would.

I don't hear any problems with pay in advance countries that offer single payer...

(And, it's "philosophical" - I had to look it up because the spelling looked funny!).

[tazkcmo]

12. Not insurance, care.

I am not a proponent of single payer health insurance. I am a proponent of single payer health care. I would prefer a government ran health care system that directly employs medical staff much like our military hires, trains and pays our armies. There would remain room for private health care providers to continue to treat medical care as a commodity to be sold to the highest bidder or what the "market" will bear and there will no doubt be a portion of our society that can afford to pay those costs.


As for the government deciding what you make, that's not happening and as long as we treat health care like it's a luxury that you can either afford or not and just tough shit if you can't, then you'll be o.k.

[davsand]

13. I support Medicare for all. Less bullshit attached to that description.

Medicare works. We know it. I hear an awful lot of Seniors saying they are grateful for it. Docs can choose to accept it or not, and if they choose to accept Medicare patients they are choosing to accept chargemaster payments for services. Billing issues in medical offices decrease, and fewer clerical people are required to deal with billing.

Lotta crap flying around when you use the terms "single payer" or "Universal". Avoid that entire trap by talking about Medicare for all.


YMMV.


Laura

[taught_me_patience]

19. Then there really is no choice to accept it or not

if the government has a monopoly over the market, you have to accept it or have no business. Are you in the private sector? If so, would you be comfortable with the government determining your pay?

[bresue]

30. ACTUALLY, PAYMENTS FROM FEDERAL WOULD BE HIGHER THAN PRIVATE SECTOR.

I know several lab techs, nurses, x-ray techs who work at a VA hospital and their pay is above the market rates. I may be wrong, but most generally working for federal is higher than most market rates, regardless of industry.

[phylny]

74. Right now, some private insurers reimburse $7 for a speech therapy session.

Not only does that not nearly cover the hourly cost for salary, it does not cover any of the associated costs for running a business. My boss has to eat the other $33 for my pay. I'll take my chances with the government determining pay, since private insurers aren't very reliable.

Edited to add: Most private insurers don't pay for therapy services for children, but Medicaid does. When I think of all the kids who would come to therapy if insurance paid for it, the resulting revenue would be phenomenal.

[davsand]

75. I am self employed. I earn what the market will pay for my services.

I could charge more, but probably would not have the volume of business I do. I could provide lesser quality service, but I'd probably lose clients. If I had the option of taking on the business model of rape and pillage the way some of the medical billing is handled I'd be loath to give it up too. Oddly enough, I am in a market driven business and my fees have to stay competitive--you know--that fair market system that the GOP loves to hold up to everyone...

Let me ask you, if Medicare is such a horrible burden for Docs and hospitals, why do they opt to accept it? They could easily go the route of the docs and clinics that don't accept Medicaid patients. They could just say no, but they don't. WHY is that the case if the idea of market oversight on prices is so very appalling?

[Voltaire2]

83. Why are you comfortable with some for-profit insurance company determining what health care you get

and what health care service providers should be paid?

That is our current situation. Health care service providers are compensated by insurance companies. Those companies pay out as little as they possibly can in order to maximize their profits and they do that by limiting access to healthcare and compensation to health care service providers.

[treestar]

16. The government provides the

Funding for what it costs. No part of single payer means restricting charges.

This would be good for providers in that the government would pay per the law. No uninsured people who can't pay so there is more business. No insurance companies to deny claims.

There were wage and price controls
Once. That was what led to the model where health insurance comes with a job. We make the assumption that all jobs are permanent which is not true.

[Phoenix61]

17. Even in a single payer system, there will be private care

Plastic surgery won't be covered. I can see luxury type hospitals popping up. The care will be the same but the amenities will be really nice. Electric companies have been regulated for ages and they make good money as do the people who work for them.

[politicaljunkie41910]

22. Where does your link say that the Swiss regulate how much you can make?

The Swiss have one of the highest standards of living and always rank up near the top in reported high personal satisfaction with their jobs, healthcare and standard of living in the world. People are well educated, tend to have higher job satisfaction, and seem to like their healthcare. I think plenty of people would trade their lives in the US for the standard of living of the Swiss. My husband and I made a very comfortable living but we also paid a whole lot for private education for our 3 kids. We were blessed with a good employer provided healthcare system for which we contributed to. I would have been willing to give up part of that income for my husband working less hours and our peach of mind that our savings would not be wiped out due to a medical illness.

What is your point in all of this? Plenty of people make lots of money, but that doesn't necessarily equate to a high quality of life. Usually with making a lot of money comes a lot of job related stress. Most of those European countries with single payer healthcare are happy and healthy. They may pay a higher income tax rate or a VAT (Value Added Tax) on all purchases to cover costs such as healthcare, education, etc) but it's a tradeoff that they are willing to make. Is the European system perfect? Probably not, and the biggest problems come with the European system has come about because of declining population growth due to lower birthrates, increased lifespans, and an aging society. But these are common problems of advanced societies. No reason to throw the baby out with the bath water.

[taught_me_patience]

26. My point is that the Swiss system is not single payer

which is why I support it. I have a strong philosophical issue with a "medicare for all" system because the government will have a monopoly over the health insurance market which will effectively determine wages for doctors. I don't want the government determining MY wages and therefore don't support a "medicare for all" system.

Medicare for all is bandied about quite a bit here on DU. I want to see of those that support it would be comfortable with the government determining their wages too. So far, nobody has answered my question.

[rgbecker]

46. There are thousands of teachers across America that have their wages determined by the "Government".

Doesn't seem to be a problem.


If you think the current system of healthcare being provided as if there were some invisible hand market place determining access and cost is a good way to distribute the care is fine, I'm guessing you are in good health. For the rest of the population, choices are very few or non existent. With money as the determinate factor, cosmetic surgeons are advertising for more business, while people are unable to pay for a simple blood test, check up or essential medicine.

[wasupaloopa]

50. Your question is a talking point. It shouldn't be answered.

That goes on a lot with the right. They put a bull shit talking point out there and you are supposed to defend against it.

You have gotten a lot of response to your OP you should pay a attention and lesrn something and quit with the talking points.

[genxlib]

23. Who said they don't regulate how much I make

I am in the Engineering Consulting industry and work on government projects. They determine how much each hour of time is worth. If I don't like, they will find someone else to do it. There is some variability in the system but they ultimately decide.

I could eschew government work and do only projects in the private sector. However, the metrics are so cooked into the system that the economics generally are the same. 95% of the time, private work is the same or worse. In rare events, you can find someone willing to pay for premiere service or reputation but it is rare.

Most of the time private work is worse because of what I call the OPM principal. Working for a government institution, you have clients that are working with Other Peoples Money (OPM). It gives them an emotional distance from the money that allows them to think about quality of work, life cycle cost, maintenance expense, etc. I have found that private owners and developers often lack that big picture and are focused on the short term expenditures to the detriment of the project.

Which brings me to my other point; someone will be responsible for determining your pay. It isn't a "free" market no matter how you look at it. I get why you may not want it to be the government. But is it preferable for it to be a private insurance company with a focus on bottom line profitability?

As a related aside, I think any medical industry reform should address the cost of Medical School. It is ridiculous to ask people to invest in a six figure education and not expect them to cash in. Any controls on the back end should come with cost controls and loan forgiveness on the front end.

[taught_me_patience]

29. Thanks for the answer.

I disagree because you're always free to move to another company.. but thanks for the answer and the thoughtful post.

[genxlib]

36. You are correct

But all of the companies work under the same economics for the same variety of clients. There is some movement in the industry but the salary increases are generally small.

Almost every case I can think of where someone got a big bump by moving to another company did not end well. The underlying economics simply don't support it. Either the employer lost too much money or the employee was unable to meet the expectations that came with the salary bump.

[Blue_true]

48. The cost of medical school should be addressed.

Doctors that sign a contract to work for a public health system for x years should have their medical school expenses paid for, up to total payment of the expenses of people that stay in Public Health Service.

I don't see single payer restricting Doctor's salaries any more than insurance companies restrict them today. Insurance companies are about maximizing profit, if they can get away with paying Doctors nothing, they would. My Doctor runs an office that has him and three Nurse Practitioners, he gets a small cut of the NP fee and all of his fee for seeing a patient. All people turn around routine appointments in 10-15 minutes max and work about 7 hours, not counting lunch.

[Blue Meany]

24. I don't think that single-payer determines anyone's pay anymore than insurance companies

do. Socialized medicine, which I favor, would do this. And, while I have no interest in controlling salaries of medical professionals, I do have an interest in minimizing profiteering, which is evident particularly in the pharmaceutical and for-profit hospital industries; and I would like to eliminate the enormous wastage that is generated by insurance companies, which requires additional staff through the medical system to navigate the byzantine rules they create to minimize what they pay in support of healthcare.

The result is that healthcare, like the finance industry, has become an enormous drag on our economy. And, in my view, no industry should be allowed to drag down the entire economy.

[Grins]

27. If a government can set a minimum wage why can't it set a maximum wage...?

Well that should get the discussion going.

I read T.R.Reid's "The Healing of America" some time ago. (A really good book!) One of the things that struck me was - your question never came up among the medical community! It wasn't extensively address, either, probably because when you eliminate a world of overhead from admin people doing the back-and-forth dance with insurance companies which they no longer have to do, you don't have to charge as much. That, and European universities do not turn out graduates burdened with hundreds of thousands in debt. There is some debt but governments find ways to greatly ease that burden. We could, too.

[DemocraticWing]

33. I am in favor of a maximum wage and wealth caps.

People in the medical field in single payer countries aren't hurting anyway. Maybe doctors don't need the second house and the luxury cars and all that crap?

[moondust]

55. +1

[wasupaloopa]

34. I was a controller at a medical clinic for a number of years

We had 21 doctors who negotiated with the clinic concerning the amount of revenue that they generated and how much they would keep. Usually it was around 40 to 60 percent.

Reimbursement for a procedure was determined by insurance companies or Medicare or Medicaid.

So someone always tells doctors how much they make.

It seemed that many of the doctors had an income level that they were comfortable with.

When they reached that amount each week they did not work the rest of the week. They would schedule patients for part of the week,

The point is that it is not as cut and dry as you make it out to be.

What you have is more of a talking point used to win over someone.

The thing we should be concerned with is medical care for all

[taught_me_patience]

47. The difference is that the doctors have choice

as does anyone in the private sector. The are free to move to another clinic that only serves high reimbursing insurance so they can generate more revenue and either make more money or work less for the same pay. They are free to open their own practice and accept what insurance groups they want to participate in. That's not possible under universal single payer. You, as a controller, are free to move to any company you want for more pay or better lifestyle.

[wasupaloopa]

54. The only difference is who reimburses. Instead of insurance companies

who need profits, single payer is non profit.

You OP is not relavant. Reimbursement is based on transaction codes either way.

Doctors will not be salaried employees.

What they make is determined a lot by how hard they work.

[Phentex]

62. This is not how it works. You do not understand

how providers apply to be in an insurance company's network. This is but one problem that exists right now. The insurance company can drop coverage to an area, a hospital, a practice whenever they feel like it (they also drop off the exchange.)

[DanTex]

35. I'm not sold on single payer in the US, but I still disagree with your criticism.

First of all, I'm not in the healthcare industry, so it wouldn't affect how much I make. But even for healthcare providers, single payer doesn't mean that doctors become government employees, it just means that the insurance and reimbursement is done by the government. Doctors would still be free to set up private practices, just that instead of dealing with private insurers over rates, they would be dealing with the government (and possibly with supplemental private plans).

The only people who would actually become government employees with pay rates set by the government would be insurance administrators. Instead of working for, say, Humana, they would work for the government. So, yeah, if I worked for Humana, I might have a problem with that. Especially since, if single payer does save as much on administrative costs as its proponents say, then there will be many people who currently work for health insurance companies that end up losing their jobs, or else making less money administrating the single payer.

But that's more of a transition issue than an inherent problem with single payer. That doesn't mean it's not a big deal: the transition to single payer would be very difficult, and that's one of the big reasons I'm not sold on it.

But, in general, I don't see a philosophical problem with more government involvement in the healthcare system. I think the amount of government involvement in any sector of the economy should be determined by what yields the best outcomes -- by pragmatism rather then either pro-market or anti-market ideology. In healthcare, the free market just doesn't work very well for numerous reasons that have been discussed extensively by economists. In places with single payer, the fact that the government has a stronger hand in setting rates doesn't seem to have the deleterious effects on healthcare workers that you suggest.

You are right to point out that there are alternatives to single payer that achieve universal coverage, such as Switzerland, Germany, Holland, and many others. And I agree with you that those are probably better models for the US than single payer. But in those places, the government still has a much bigger role than in the US in setting rates.

[Trial_By_Fire]

39. To address your perceived issues with Medicare for All...

Regarding "the transition to single payer would be very difficult, and that's one of the big reasons I'm not sold on it.":

One solution is to lower the eligibility age gradually, say 60 and older, then 50 and older, etc...

And, I think that as Americans, we can come up with a transition. We already did it with the ACA. Yes,
there are always problems - that's why we need a Congress who would actively fix issues as they arise. Doctors
already have to deal with the insurance industry, so it could not be a huge problem at all.

[DanTex]

51. Yes, gradual lowering of the eligibility age is a possible way forward.

The transition problems with Medicare-for-All would be a lot more problematic than with ACA, though.

ACA had a big effect, obviously, on the insurance industry, but it didn't have huge transitional impacts on the actual healthcare industry. But single payer would have to. And even though you're right that doctors, clinics, and hospitals currently deal with the insurance industry, with single payer they would suddenly be getting almost all their reimbursements from Medicare.

Which would be very disruptive. In fact, there are clinics and hospitals that would have to either go out of business or drastically reorganize because they currently rely on the rates they get from private insurers to stay in business.


Another big difference is on the patient side. ACA didn't have very much effect on people who were already covered, particularly people who had employer coverage. Obama said that if you liked the insurance you had, you could keep it, and for the most part, that turned out to be true. The exceptions were a small number of people who had plans that didn't satisfy the ACA regulations (basically people with very bad insurance).

With Medicare-for-All, nobody would get to keep the insurance they had (unless they were already on Medicare), including people who have good plans and are happy with them. This would, first of all, become a political nightmare. Sure, polls show people support single payer (depending on how the question is asked), but polls also show that most Americans are happy with their own healthcare coverage. If single payer gets close to actually happening, people are going to wake up to the fact that it means their own healthcare coverage is going to be changed in a rather unpredictable way, which I think will make it politically untenable.

And aside from the politics, it would be very disruptive to the lives of many people. And some people will end up worse off under Medicare, or require a supplemental plan, or whatever.

[Adrahil]

40. The thing that concerns me about single-payer....

Is that it puts most people at the mercy of whatever the party currently in control wants.

Wanna see what can happen to a health care system in such a position? Take a look what happened to the British NHS when Thatcher and the Tories began cutting funding for it.

I do support the idea of universal health care, but would have to see the specifics of any single payer plan before I supported it.

[taught_me_patience]

44. thanks for the answer.

[hunter]

41. Yeah, I'd rather the income and practices of medical professionals...

...be regulated by the insurance companies, to the point that people with no medical training are micro-managing doctors and other medical professionals, telling them what they can and cannot do.



The problem with medical insurance in the U.S.A. is that the people at top don't seem give a shit about anything but the size of the revenue streams they control. The bigger the revenue stream, the more money they can siphon off for obscene salaries for their officers, private jets, and political lobbying.

The government has of course been determining what many people make for a long time now, for example minimum wages. If it was up to me there would be a maximum income too, set somewhere below 20 times the minimum wage. Any income above that would be taxed at 100%. That would be a great incentive for very high income people to support higher minimum wages, maybe even to the point that minimum wages were comfortable living wages.

Yes, the sorts of people who can buy politicians and regulators, the uber-wealthy, ought to be taxed out of existence. I believe the health insurance companies ought to be nationalized, but that's not going to happen in the U.S.A. because all the deplorables believe they are going to be millionaires someday, or believe that they'll get ahead kissing up to billionaires who despise them, or would rather suffer in toothless ignorance than see a single dime of "their" taxes benefiting any of the people they hate.

But aside from that, I'm fairly certain the Swiss model is not applicable to any other nation but Switzerland. Their health insurance industry is heavily regulated, to such an extent that the line between public and private blurs. Most U.S. citizens would find the Swiss bureaucracy suffocating. Doctors in Switzerland face pretty much the same constraints as they do in the United Kingdom, which has a socialist health care system. Both nations have less expensive medicine with better outcomes than the U.S.A. because regulators there pay more attention to the scientific evidence and less attention to lobbyists of the pharmaceutical, hospital, and insurance industries.

I think the U.S.A. would do well to model our healthcare system after Canada, but it's possible our government here is too corrupt. The U.S.A. has never been a true "first world" nation, rather it's the top dog of the "developing" nations, and it's getting worse as the middle class bleeds away and income disparities between the uber-wealthy and everyone else increase.

[Blue_true]

42. You are trying to pass off an incorrect image as fact.

Nowhere in the world where Single Payer exists does the government restrict how much a person or business can earn. Your argument is a Cad.

[taught_me_patience]

43. So if you're practically only allowed to bill one client

and that one client has a charge master for everything you did, how is that not restricting how much a person can make? A doctor can only see x number of patients/day...

[Blue_true]

52. My Doctor works for a clinic.

He has him and three Nurse Practioners that report to him. He gets 100% of theDoctor cut for the patients that he sees and a portion of each patient each NP sees. I have been in when he was on vacation and was seen by an NP. I had late appointments for physicals when the office was near the end of it's day, the staff all drove expensive luxury cars as best I could tell. I never felt that I was rushed, my routine visits required 10-15 minutes of the staff time, less in some cases. Three times, I was referred to Soecialists Doctors, who also had Nurses or NPs seeing patients.

I didn't mean to rough you up. I am a professional person who does fee work and have never felt that I faced caps, even when working for government, as a matter of fact, if one knows regulations, government is better because I know what I am getting into.

[crazycatlady]

45. I used to work for a bank

We had several medical office accounts. Their deposits were a combination of personal checks, insurance company checks, and government checks. IT's been 10 years, but I don't remember the insurance checks being substantially bigger than the government checks.

[WinkyDink]

49. I find your alleged analogy, not.

[FiveGoodMen]

56. Funny, it works all over the place

But not here, huh?

[still_one]

57. Universal health care does NOT mean coverage for all people for everything.

While its primary goal is for citizens to access health services without incurring financial hardships, it determines who is covered, and what services are covered, and rationing does occur in such systems.

Medicare is Single Payer, and that is an extremely successful program.

[Trial_By_Fire]

67. Doesn't it depend on how it is implemented?

Yes, it does depend on how the law is written...

[still_one]

68. of course

[grantcart]

58. your simply don't understand the economics of the industry

Currently the ACA limits the Medical Loss Ratio (The insurance part of the pie) at 20%, in Europe and Canada it is around 12% regardless of whether it is public or private.

Rather than being worried about how much the government is limiting insurers income you should be worried about how much the government is limiting the medical professions ability to earn.

A single payer system, like Canada is MORE market oriented NOT LESS.

We do not have a market based capitalist health care model, we have a mercantile one.

In a market based capital model there is no barrier between the producer (the health care professional) and the consumer (the patient). In the US Doctors and patients don't meet in the market as the insurance industry is an outside force that interrupts market liquidity (like mercantilism does).

In Canada where the insurance part of the equation is socialized and minimized any patient can go to any doctor. That means that doctors that do a really good job get more patients and the market rewards quality.

It is very similar to the US airline industry where the government provides control of the airports, control over safety, etc. but any passenger can go to any airliner and as a result we have a very (and perhaps overly) competitive market in the airline industry.

The insurance industry adds nothing to the health care product and in many ways. A single payer system minimizes the insurance industry and, if done correctly, actually increases the liquidity of the health care market and improves care, lowers costs and gets better outcomes.

The proof of this is that countries like Canada have a lower patient cost and get better longevity and healthier patients. That's because insurance is minimized and there is no obstacle between patient and doctor, which is the way that capitalism is supposed to work.

[brooklynite]

60. I don't believe that Single Payer stops you from buying supplemental medical services...

For example, I have employee-based health care, but I pay $200 a year for a medical service where I can always make a same-day appointment and won't be rushed at the examination.

[taught_me_patience]

61. Your wife is a lawyer

The government doesn't set the reimbursement rates that lawyers receive. She's free to charge what she wants and accept who she wants as clients.

[ProfessorGAC]

63. An Argument Intended To Support An Existing Bias

And, flawed at that. Strawman nonsense

[DefenseLawyer]

65. Public Defenders haven't driven me out of business. n/t

[hunter]

66. You'll walk away from this post?

Ping. I hope not.

You won't agree public_sector/private_sector is somewhat blurred in Switzerland, where they don't even allow power line poles to lean too much, and you must not walk on the grass?

Ping.

No apologies, I have some funny, and a few disturbing stories about Swiss sensibilities.

[taught_me_patience]

69. Almost nobody has answered my question... Including you

And I have no idea what the hell you're talking about

[hunter]

70. Of course you don't.

Binary thinking.

Public Sector/Private Sector

Ones and zeros. That's not the real world. The real world is all gray.

Switzerland isn't actually binary like that; to me they seem very similar to Iceland.

Costumes.

I'm not kidding about slumping power line poles, or weedy flower boxes. Leaning is bad in Switzerland.

If you lean too much you might have to run away to France.

[leftstreet]

72. snarf

In Switzerland, zip lining is preferable to walking on the sacred grass

[erinlough]

71. A thought provoking question.

I googled and this is what I found.

http://www.motherjones.com/kevin-drum/2013/02/charts-day-doctor-pay-america-and-other-countries

Simply put American doctors now make the most of any country. I will not make a judgement because I'm not a doctor and I have a whole different perspective because my earnings are not in question. As a teacher though I made a decision to work in a small, less well paid school over urban schools because of the quality of life. That is the only way I can relate.

[hunter]

73. Except for the front line primary care physicians and other front line medical professionals.

It's a bad place.

Altruistic professionals, teachers to nurses to doctors, are punished in the U.S.A..

Bob Dylan's Maggie's Farm

She gives you a nickel, she gives you a dime....

[Warpy]

76. I'm a lot less comfortable with health insurance in the private sector

because for decades they've played every filthy trick they have been able to devise to delay or even deny health care until people have died, often from something that could have been fixed rather easily had they not been stonewalled or had the care challenged as part of some "preexisting condition," probably the cruelest two words some executive bucking for promotion ever came up with. They have been killing us for decades, all the name of maximizing profit.

So spare me your false tears and hand wringing about the private sector. Some things are so important they can't be trusted with them, like the military, the police, education, the fire department, and health care.

Sorry, buddy, but this isn't Switzerland, it's a country where so many regulatory laws have been weakened that the private sector has begun to act like racketeering organizations, especially when they've intruded into areas where they don't belong.

[gtar100]

77. I feel so much better having private individuals

determine my pay and health insurance. And it's good to know they can let me go if it suits their needs. I don't need no stinkin' government telling these guys what to do. The invisible hand of the marketplace is so much more comforting than a government.

Kidding aside, I have no doubt that the lobbying will continue even with single payer and that doctors and other health care workers will have a voice. But then so will the consumer and I think that's what worries all those gaming the system as it is now. Such is the need to sow doubt about what just might be the best option out there - single payer.

And for all those doctors who became doctors to make a boat load of money... all those pharma execs seeking the big $Millions and maybe even the big $Billions... and all the investors who are seeking to make a killing on the backs of our loved ones who suffer with diseases and addictions....they can all go fuck off.

[kristopher]

78. +1

You speak for me.

[Ilsa]

80. You don't think insurance companies do this?

Only the uninsured pay the going rate, if they can ever pay it off.

[Spider Jerusalem]

81. I'm sorry, but this is a frankly moronic comment

the UK has a single payer healthcare system (the NHS); the government does not "regulate how much money you can make" (unless you're talking about the insurance industry and healthcare industry, in which case, fuck them because healthcare in the USA is the most expensive in the world in part because of added costs due to private insurance and private healthcare companies).

The UK spends less than half as much per capita on healthcare, compared to the US, and has a longer life expectancy. Oh, and Switzerland? Second behind the USA among OECD countries in healthcare expenditure per capita.

[area51]

82. I think quite a few questions

may be answered at this site.

[PdxSean]

84. You can charge $600 for an aspirin . . .

. . . to anyone willing to pay it, but single-payer would limit what the plans are willing to pay. The OP seems to offer a false equivalency between limiting what a healthcare provider can charge vs limiting what a person or entity is willing to pay.

Single-payer would not enslave doctors and force them to provide services within the system. They are welcome to see only private patients who are willing to pay whatever the doctor wants to charge.