The never-ending POTUS Election Tracker....

[boozeman]

Closer by the minute...

Idiocracy is a very underappreciated movie.

Funny as shit, but it was because it was so true.

We are coming closer and closer to that dystopia than we want to admit.

 

[VTA]

Idiocracy is a very underappreciated movie.

Funny as shit, but it was because it was so true.

We are coming closer and closer to that dystopia than we want to admit.

True on all accounts. I think I remember Judge said something fairly recently (too lazy to look right now) concerning his feelings about how accurately his comedy was playing out.

 

[Hoofbite]

I think the single payer bullshit is from an interview about 20 years ago where he said "it works in Canada and other places."

I watched all the debates up until the last two I think, I never heard him say he is in favor of single payer.

I could be wrong, but I don't think he said that.

He said it last September in an interview he did with 60 Minutes.

[video=youtube;6inQmf96SYQ]https://www.youtube.com/watch?v=6inQmf96SYQ[/video]

Everyone is going to be covered. The government is going to pay for it.

On the list of prerequisites for a single payer healthcare system, this pretty much hits them all.

 

[Hoofbite]

I guess the US Attorney General who is being called in to assist with the Hillary email debacle also played a part in extraditing the guy who hacked Hillary's server.

I don't think she'll ever be convicted of a crime but she could take a big enough hit to preclude her from being elected, and if the investigation concludes soon it could prevent her from being the nominee. She secures the nomination and I think this will be a huge attacking point.

 

[Hoofbite]

This might be semantic. Whether or not he meant to say Single Payer - he didn't deny it in the debate, he is talking about Socialized Healthcare


http://www.forbes.com/sites/theapothecary/2015/08/07/no-donald-trump-single-payer-health-care-doesnt-work-incredibly-well-in-canada-scotland/#1ddaec153056


http://www.forbes.com/sites/theapothecary/2015/09/28/donald-trump-on-obamacare-on-60-minutes-everybodys-got-to-be-covered-and-the-governments-gonna-pay-for-it/#5c7da9433862

The government doesn't pay for anything, tax payers do. He can word play and dance, he's far too inconsistent to even approach being believable in any context.

I'd like to read those articles, but Forbes won't let you view their site with an ad blocker enabled. It looks like they now want you to sign up for something if you us an ad blocker. I have no interest in disabling my ad blocker or signing up for anything. 2 things that cause me to close a webpage I just opened.

1. You require ad blockers to be disabled.

2. You split a list of items into multiple web pages.

Fuck both types of websites that do this.

As for his comments, he's absolutely right that the money saved on the backend would be huge and would reduce the cost significantly.

The government doesn't pay for anything, tax payers do. He can word play and dance, he's far too inconsistent to even approach being believable in any context.

Obviously, but he's absolutely right. It would reduce costs monumentally. Beyond that, everyone is already paying taxes for healthcare, it's just not healthcare the majority of these people use. 1.45% of your paycheck goes to Medicare. 1.45% of everyone's paycheck goes to Medicare. In addition to that, a portion of your federal and state taxes then goes to Medicaid. Same with everyone else.

Essentially, everyone who pays taxes pays for 1/3rd of the country to have healthcare, and then the vast majority of those people get to have the pleasure of going out and paying for part of, or all of, their own healthcare.

The kicker here is that the population covered by taxpayers is far and away the portion of the population that uses the most resources, and it's not even close. The elderly, sick, and disabled are funded by taxpayers.

 

[dbair1967]

The elderly, sick, and disabled, lazy & unmotivated are funded by taxpayers.

fify

 

[VTA]

I'd like to read those articles, but Forbes won't let you view their site with an ad blocker enabled. It looks like they now want you to sign up for something if you us an ad blocker. I have no interest in disabling my ad blocker or signing up for anything. 2 things that cause me to close a webpage I just opened.

Last night in Cleveland, the 17 declared Republican presidential candidates participated in the first official debates of the 2016 election season. Health care policy was a bone of contention. “How can you run for the Republican nomination and be for single-payer health care?” asked former Texas Gov. Rick Perry of Trump. When Fox anchor Bret Baier later asked Trump to defend his position, Trump responded: “As far as single payer, it works in Canada, it works incredibly well in Scotland.” Here’s why Trump is wrong.

(DISCLOSURE: I am an adviser to former Texas Gov. Rick Perry, but the opinions in this post are mine, and do not necessarily correspond to those of Gov. Perry.)

Trump praises socialized medicine
First, some terminology. Single-payer health care describes any country in which the government is effectively the sole insurance company: the “single payer” of health insurance claims. Socialized health care describes a country in which the government owns the entire health care system—not just the insurance companies, but also the hospitals, the nursing homes, and the doctors’ offices.

Canada is single-payer because while Canada’s insurance system is controlled by the government, there are private hospitals and doctors. Scotland’s system, like the rest of Great Britain, is socialized, because the British National Health Service runs everything.

So, back to Donald Trump. His argument last night was that single-payer health care in Canada “works,” and that fully socialized medicine in Scotland “works incredibly well.” Let’s start with Canada.

Canadian health care model: Send tough cases to America
Canadian health care is popular with healthy Canadians who never really have to use it. But if you’re sick, look out. A 2014 study by the Fraser Institute found that wait times for medically necessary treatment in Canada have increased from 9.3 weeks in 1993—not great—to 18.2 weeks. Wait times were especially bad if you needed hip, knee or back surgery (42.2 weeks) or neurosurgery (31.2 weeks).

As we know from the scandal involving the U.S. Veterans Health Administration, health care delayed is health care denied. The people who suffer the most under the Canadian system are those who can’t afford to hop on a plane or pull strings to get treated in the United States.

Martin Samuels, the founder of the neurology department at Harvard’s Brigham and Women’s Hospital, found this out when he worked as a visiting professor in Canada. “The reason the Canadian health care system works as well as it does (and that is not by any means optimal) is because 90% of the population is within driving distance of the United States where the privately insured can be Seattled, Minneapolised, Mayoed, Detroited, Chicagoed, Clevelanded and Buffaloed,” Samuels wrote recently in Forbes. “In the United States, there is no analogous safety valve.”

Scotland: Nearly the worst health outcomes in Europe
The sick in Scotland, unfortunately, have no such safety valve. They are forced to wait, and wait, and wait. In 2008, a group of investigators conducted a worldwide study of cancer survival rates, called CONCORD. The investigators asked the question: if you get diagnosed in your country with breast cancer, or colon cancer, or prostate cancer, how long are you likely to live?
In that study, the U.S. performed better than every country in western Europe. The United Kingdom came out second-to-last. The researchers broke out the data for Scotland, and the results are revealing. If you’re diagnosed with breast cancer in the U.S., you have an 84 percent chance of living for five years. In Scotland, it’s 71 percent. If you have colon cancer in the U.S., you have about a 60 percent chance of surviving five years. In Scotland, it’s 46 percent. If you have prostate cancer in the U.S., you have a 92 percent chance of living five years; in Scotland, it’s 48 percent.

This is the system that, according to Donald Trump, “works incredibly well.”

Trump’s dishonest defense
Trump attempted to justify his support for single payer health care this way: “It could have worked [here] in a different age, which is the age you’re talking about here.” Implied in this statement is that Trump somehow believes that single payer could have worked in America in some different, far-away time, but that America has changed too much since that far-away time.
But the “different age” Trump is referring to here is the year 2000. What, exactly, is it that makes single-payer great for America in 2000, that isn’t true today?
“What I’d like to see,” Trump continued, “is a private system without the artificial lines around every state. I have a big company with thousands and thousands of employees. And if I’m negotiating in New York or in New Jersey or in California, I have like one bidder. Nobody can bid.” (Emphasis added.)

Trump’s policy pronouncements are rarely coherent. But what he appears to be saying here is that he supports a privatized version of single-payer health care, in which perhaps a single private company has a monopoly with which to negotiate contracts with hospitals and doctors. Gone would be companies like Aetna, Anthem, UnitedHealth, and Blue Cross—or perhaps they would be merged into a single entity.

This is hardly a superior outcome to single-payer health care: an unaccountable, trillion-dollar private insurance monopoly.
Some of Trump’s aides attempt to backfill the Donald’s ideas by claiming he really wants to “repeal and replace Obamacare” with something more consistent with conservative principles. But Trump himself has never backed off from his support for government-run health care. Indeed, Trump*believes that the problem with Obamacare is that it doesn’t go far enough.

I'll do the second one later...

 

[VTA]

Fuck both types of websites that do this.

As for his comments, he's absolutely right that the money saved on the backend would be huge and would reduce the cost significantly.



Obviously, but he's absolutely right. It would reduce costs monumentally. Beyond that, everyone is already paying taxes for healthcare, it's just not healthcare the majority of these people use. 1.45% of your paycheck goes to Medicare. 1.45% of everyone's paycheck goes to Medicare. In addition to that, a portion of your federal and state taxes then goes to Medicaid. Same with everyone else.

Essentially, everyone who pays taxes pays for 1/3rd of the country to have healthcare, and then the vast majority of those people get to have the pleasure of going out and paying for part of, or all of, their own healthcare.

The kicker here is that the population covered by taxpayers is far and away the portion of the population that uses the most resources, and it's not even close. The elderly, sick, and disabled are funded by taxpayers.

I’m not sure what’s being focused on here. Is it a single payer/government program that will somehow save money? How and by what precedent? Who’s money is being saved and on the back end of what?

I’ll be the first to admit my knowledge of exactly how the single-payer program really works is lacking, but as it stands, my costs as a covered employee have gone no where but up. I’ve paid more on medical the first 4 months of this year than I have in the last seven of my employment with this company. Insurers are raising deductibles. At least mine is and the EOY policy changes pointed specifically to the ACA as the reason.

Medicare is ‘for us, by us’. Not an allowance or benefit, but something we’ve paid into all of our working lives, not to be mixed-up with welfare. I pay Medicare tax in the (vain at this point) hope there all be a fund for when I retire. I’m not sure how adding yet another healthcare fund for those who can’t afford it will work it’s way toward saving anyone money.

 

[ThoughtExperiment]

Good posts, vta. I don't know how the hell my stupid phone managed to bowtie that first one. (Wish we could undo mistakes like that.)

 

[Hoofbite]

I’m not sure what’s being focused on here. Is it a single payer/government program that will somehow save money? How and by what precedent? Who’s money is being saved and on the back end of what?

Absolutely it would. Here's a study of 13 comparable counties. US is the only private health insurance system on the list.

U.S. Health Care from a Global Perspective - The Commonwealth Fund

Nearly every other country pays less. I think only two of them have higher spending per capita but they cover the entirety of their population. The only outcomes the US has any sort of advantage is in the field of oncology. Deaths from ischemic heart disease, infant mortality rates, life expectancy, obesity rates, and just about everything else the US is not getting it's money's worth. Shit, we have more people lose their limbs from diabetes than most of those other countries.

Look at the number of people compared to the number of MRI, CT, and PET machines those countries have. Somehow these countries can also afford to have greater access to the top medical technology?

The cost saving comes from a number of places.

• Cutting out insurance companies is a good start. If there is room for insurance companies to profit then there's room for taxpayers to save.
  
• Simplifying and ensuring (to a much greater extent than now) reimbursement. Insurance companies dictate reimbursement, which is why you see hospitals charge an arm and a leg for fucking everything. They're playing a numbers game where they know a lot of shit will be rejected so they charge for everything so they can avoid providing care at a cost to themselves.
  
• Greater bargaining power when it comes to pharmaceuticals. I'm all for rewarding advancements in medicine but the vast majority of products on the market cannot make such a claim. These companies still charge a fucking arm and a leg for drugs that they did very little to research and simply altered the core structure of someone else's work. There are countless classes of drugs where this applies. Furthermore, these companies also extract billions of dollars from the system with shit that doesn't work. Go check out how much money Vytorin made for the company that developed it, and by "developed", I just mean they combo'd a previously patented product with a drug for which the evidence now says is worthless.
  
• You'd also have about 12% of the population who would start paying into the system when they currently have no insurance.
  
• Providing access to healthcare before a readily treatable skin infection, UTI, or whatever else develops into sepsis and requires admittance to the ICU.

I’ll be the first to admit my knowledge of exactly how the single-payer program really works is lacking, but as it stands, my costs as a covered employee have gone no where but up. I’ve paid more on medical the first 4 months of this year than I have in the last seven of my employment with this company. Insurers are raising deductibles. At least mine is and the EOY policy changes pointed specifically to the ACA as the reason.

And part of the reason you paid more is because insurance companies were forbidden from rejecting coverage to people with preexisting conditions. Their risk goes up, their reimbursement payments to providers goes up, they just subsidize the cost with higher premiums for everyone.

Medicare is ‘for us, by us’. Not an allowance or benefit, but something we’ve paid into all of our working lives, not to be mixed-up with welfare. I pay Medicare tax in the (vain at this point) hope there all be a fund for when I retire. I’m not sure how adding yet another healthcare fund for those who can’t afford it will work it’s way toward saving anyone money.

There already is a healthcare fund for those who cannot afford it. Medicaid.

 

[VTA]

Absolutely it would. Here's a study of 13 comparable counties. US is the only private health insurance system on the list.

U.S. Health Care from a Global Perspective - The Commonwealth Fund

Nearly every other country pays less. I think only two of them have higher spending per capita but they cover the entirety of their population. The only outcomes the US has any sort of advantage is in the field of oncology. Deaths from ischemic heart disease, infant mortality rates, life expectancy, obesity rates, and just about everything else the US is not getting it's money's worth. Shit, we have more people lose their limbs from diabetes than most of those other countries.

What doesn’t seem to be accounted for in these kind of data sheets are the population disparities among these nations. Cultural differences, historical data and migration rates aren’t factored in either. Though the current ‘migrant crisis’ in Europe is going to fully expose the un-sustainability of government health care. It’s already being reported that more migrants are on government welfare than natives in some of these countries.

When France, the UK and everybody else have their populations swollen with non-working, non-contributing patients they’re going to fold. The European model is nothing to follow, because no part of life is one-size-fits-all and the freedom of the rest of the world having the U.S. provide the brunt of world security is quickly fading. They’ve been benefitting greatly from not having their economies stunted with security costs. That is soon going to end.

But these are aspects that are never brought up in these discussions. Politicians rely on emotional black-mail, and proponents cite data sheets with very shallow observances of the actual conditions these individual countries function under. Facts are cited only as a means of drawing a singular contrast to the numeric differences, but not at all highlighting the individual conditions of each country.

The U.S. has 330 million people. - (with a history of not receiving aid, unlike the nations we trashed and those we helped in WWII through the Cold War, a long history of spending millions per day to keep our Naval force afloat) - That’s more than all listed nations, omitting Japan, combined. What do you suppose the administrative costs alone would be for such a population?

The nations that have a fraction of the population can more efficiently manage their systems and handle fraud.

Look at the number of people compared to the number of MRI, CT, and PET machines those countries have. Somehow these countries can also afford to have greater access to the top medical technology?

Your link seems to contradict this, citing a reason Americans pay more is it’s greater use of such technologies…

Americans have relatively few hospital admissions and physician visits, but are greater users of expensive technologies like magnetic resonance imaging (MRI) machines.

—

Americans appear to be greater consumers of medical technology, including diagnostic imaging and pharmaceuticals. [Exhibit 5, 6]

The U.S. stood out as a top consumer of sophisticated diagnostic imaging technology. Americans had the highest per capita rates of MRI, computed tomography (CT), and positron emission tomography (PET) exams among the countries where data were available. The U.S. and Japan were among the countries with the highest number of these imaging machines.

The cost saving comes from a number of places.
◦ Cutting out insurance companies is a good start. If there is room for insurance companies to profit then there's room for taxpayers to save.
◦ Simplifying and ensuring (to a much greater extent than now) reimbursement. Insurance companies dictate reimbursement, which is why you see hospitals charge an arm and a leg for fucking everything. They're playing a numbers game where they know a lot of shit will be rejected so they charge for everything so they can avoid providing care at a cost to themselves.
◦ Greater bargaining power when it comes to pharmaceuticals. I'm all for rewarding advancements in medicine but the vast majority of products on the market cannot make such a claim. These companies still charge a fucking arm and a leg for drugs that they did very little to research and simply altered the core structure of someone else's work. There are countless classes of drugs where this applies. Furthermore, these companies also extract billions of dollars from the system with shit that doesn't work. Go check out how much money Vytorin made for the company that developed it, and by "developed", I just mean they combo'd a previously patented product with a drug for which the evidence now says is worthless.
◦ You'd also have about 12% of the population who would start paying into the system when they currently have no insurance.
◦ Providing access to healthcare before a readily treatable skin infection, UTI, or whatever else develops into sepsis and requires admittance to the ICU.

Point 1. If you’re cutting out insurance companies, how is there room for them to profit?
Point 2. Sounds fine, but how? Remember that magic number 330 million, which does not include illegal immigrants and as of yet, refugees. The states can’t simplify the DMV, I have no faith they can simplify giving citizens their money back. They don’t hire Ivy League’ers to handle administration.

Point 3. I’ve heard this before and while it doesn’t sound right, I’m not inclined to look into how taking away marketing competition will ensure lower drug costs.
Point 4. How?
Point 5. —

And part of the reason you paid more is because insurance companies were forbidden from rejecting coverage to people with preexisting conditions. Their risk goes up, their reimbursement payments to providers goes up, they just subsidize the cost with higher premiums for everyone.

Ok, and that’s fine and no one really minds regulation to level the playing field for customers. But that's only part of the reason.

And what does all of this remind you of? Remember a certain President signed into law that banks were suddenly forbidden to deny credit to high-risk borrowers? Remember the emotional appeals of how everybody deserves heal- I mean a house? That effects of course were not fully realized until sometime later, but the cause was just the same. The government once again claiming the authority to institutionalize a commodity as a right.

Expect the quality of care to fall exponentially in the very foreseeable future.

As for Medicaid, if it worked we wouldn’t be having this discussion. I don’t see how more agencies, which require more funding and more bodies to run somehow saves us money in the long or short of issue.

Think about this: We’re having a disagreement based on social outlook. Think about how these social disagreements also effect the outcome of these ideas. If enough people don’t sign on, then the idea has to be shelved. Politicizing and cramming ideas down a segment of society’s throat is never going produce success. Never.

But those are the other things that are never inserted into the discussion. Implementation, lack of unity, etc, etc, etc

 

[VTA]

Good posts, vta. I don't know how the hell my stupid phone managed to bowtie that first one. (Wish we could undo mistakes like that.)

I thought you were schizo...

 

[SixisBetter]

1. You require ad blockers to be disabled.

2. You split a list of items into multiple web pages.

Fuck both types of websites that do this.

Fuck those click bait motherfuckers.
Carry on everyone.

 

[VTA]

Forbes works fine for me. I'm using OS X with pop-ups blocked and wasn't asked to sign in.
Weird shit.

 

[dbair1967]

I would hope anyone making the argument that "single payer" or "national healthcare" type systems are "saving money" would also understand that they "save money" by rationing/severely limiting access to care, and by paying physicians considerably less in many cases.

Its why sick people or people needing certain procedures from all over the world come here to get their care, if able. Its also why in many of those countries where they have single payer or true government run healthcare that there are private, for profit companies that help arrange healthcare for their citizens here in the US.

Its also why doctors from all over the world come here to work, so they can make more money.

If the US ever goes to a true single payer/national healthcare system, many of the most talented & brightest individuals in our country will lose the desire to become doctors, and instead pursue other careers. So we'd be likely to end up with a substantially less qualified physician base (especially specialists)

 

[Hoofbite]

What doesn’t seem to be accounted for in these kind of data sheets are the population disparities among these nations. Cultural differences, historical data and migration rates aren’t factored in either. Though the current ‘migrant crisis’ in Europe is going to fully expose the un-sustainability of government health care. It’s already being reported that more migrants are on government welfare than natives in some of these countries.

When France, the UK and everybody else have their populations swollen with non-working, non-contributing patients they’re going to fold. The European model is nothing to follow, because no part of life is one-size-fits-all and the freedom of the rest of the world having the U.S. provide the brunt of world security is quickly fading. They’ve been benefitting greatly from not having their economies stunted with security costs. That is soon going to end.

So let them take some of that weight of providing security. That still doesn't address the fact that they pay less for healthcare. They wouldn't pay any more if they had to divert funds to national defense.

But these are aspects that are never brought up in these discussions. Politicians rely on emotional black-mail, and proponents cite data sheets with very shallow observances of the actual conditions these individual countries function under. Facts are cited only as a means of drawing a singular contrast to the numeric differences, but not at all highlighting the individual conditions of each country.

A private healthcare system doesn't mean that non-contributing members actually contribute or are excluded if they don't. You have non-contributing members either way and under both circumstances they receive healthcare. Either through Medicaid or through a Universal System, you have not done anything to satisfy whatever desire there might be to arrive at the point where people have "earned" their healthcare.

The U.S. has 330 million people. - (with a history of not receiving aid, unlike the nations we trashed and those we helped in WWII through the Cold War, a long history of spending millions per day to keep our Naval force afloat) - That’s more than all listed nations, omitting Japan, combined. What do you suppose the administrative costs alone would be for such a population?

The nations that have a fraction of the population can more efficiently manage their systems and handle fraud.

How so? They have less people so they probably have less people working in this area to manage their system. They also have smaller economies. The UK has about 1/6th the population of the US. Their GDP is right along the same ratio.

Your link seems to contradict this, citing a reason Americans pay more is it’s greater use of such technologies…

It does, you're right. Read the chart incorrectly. My bad.

Point 1. If you’re cutting out insurance companies, how is there room for them to profit?

Insurance companies currently profit, which means they could charge less in premiums to break even. Without them, those profits would become taxpayer savings.

Point 3. I’ve heard this before and while it doesn’t sound right, I’m not inclined to look into how taking away marketing competition will ensure lower drug costs.
Point 4. How?
Point 5. —

You get lower drug costs because the entire population of the US would be up for grabs. There are countless alternatives to nearly every medication, both within a single class of drugs and when considering moving to another class of drugs. Hospitals do not carry every medication, they have a formulary. You might take drug X but the hospital only has drug Y from that particular drug class. They automatically substitute it to the drug they have because they are almost exactly the same in terms of efficacy.

Rather than having 5 groups of 60 million all coming to separate agreements for drug pricing (that's what the major insurance companies do), you would have 1 large group 300+ million people. There isn't a drug company in the world that wants to lose access to the one of the wealthiest and largest populations. They'll either compete to gain these contracts, or the healthcare system will simply use another product from the same class.

Ok, and that’s fine and no one really minds regulation to level the playing field for customers. But that's only part of the reason.

And what does all of this remind you of? Remember a certain President signed into law that banks were suddenly forbidden to deny credit to high-risk borrowers? Remember the emotional appeals of how everybody deserves heal- I mean a house? That effects of course were not fully realized until sometime later, but the cause was just the same. The government once again claiming the authority to institutionalize a commodity as a right.

Healthcare shouldn't be viewed as a commodity. If you're willing to grant that people have a right to life, then it shouldn't be a big leap to say that people have a right to immunizations and antibiotics because they unquestionably add decades to a person's life.

Expect the quality of care to fall exponentially in the very foreseeable future.

That's not backed up by the outcomes across the world.

As for Medicaid, if it worked we wouldn’t be having this discussion. I don’t see how more agencies, which require more funding and more bodies to run somehow saves us money in the long or short of issue.

Think about this: We’re having a disagreement based on social outlook. Think about how these social disagreements also effect the outcome of these ideas. If enough people don’t sign on, then the idea has to be shelved. Politicizing and cramming ideas down a segment of society’s throat is never going produce success. Never.

But those are the other things that are never inserted into the discussion. Implementation, lack of unity, etc, etc, etc

Medicaid works. In my state, it's a $0 copay on all medications. Medicaid isn't the problem. The problem is that we still have a large number of people who are uninsured and even for those who are insured, the costs are still obscene. The entire system is set up in such a way where prices and reimbursements are entirely independent of each other, nobody actually knows what a particular procedure or service should cost, and ultimately the people of this country are getting fucked over.

More agencies may be required, but when we aren't funneling 1 trillion dollars through insurance companies, that's not really a problem. Insurance companies are simply a middleman who also acts as a gatekeeper on both ends. They make the system less efficient and there isn't even a question about this aspect. Every pharmacy in America would be significantly more productive if they didn't have to deal with the minefield of 3rd party reimbursement. That's a fucking fact.

 

[Hoofbite]

I would hope anyone making the argument that "single payer" or "national healthcare" type systems are "saving money" would also understand that they "save money" by rationing/severely limiting access to care, and by paying physicians considerably less in many cases.

Its why sick people or people needing certain procedures from all over the world come here to get their care, if able. Its also why in many of those countries where they have single payer or true government run healthcare that there are private, for profit companies that help arrange healthcare for their citizens here in the US.

Its also why doctors from all over the world come here to work, so they can make more money.

If the US ever goes to a true single payer/national healthcare system, many of the most talented & brightest individuals in our country will lose the desire to become doctors, and instead pursue other careers. So we'd be likely to end up with a substantially less qualified physician base (especially specialists)

Physician costs are but a fraction of the overall cost of healthcare. Administration takes up a much bigger percentage of the pie. I even went through the trouble of turning off Adblocker so you better read this shit.

Moreover, doctors’ net take-home pay amounts to only about 10 percent of overall healthcare spending. Which if cut by 10 percent would save about $24 billion – a considerably modest savings when compared to the $360 billion spent annually for administrative costs as estimated by the Centers for Medicare & Medicaid Services (CMS), and the fact that 85 percent of excess administrative overhead can be attributed to the insurance system. Administrative costs for physicians are in the range of 25-30 percent of practice revenues and insurance-related costs are 15 percent of revenues, according to a National Academy of Social Insurance report for The Robert Wood Johnson Foundation.

http://www.forbes.com/sites/physici...for-our-rising-healthcare-costs/#4009742d5671

There are counties that pay physicians more.

Physician Compensation Worldwide

It would be entirely possible to pay physicians exactly what they are paid now or more. Even if every doctor (1 million or so) in the US was paid the specialist average, that equals $260B. That's roughly 9% of total healthcare expenditures at this very moment. 3 Trillion in US spending on healthcare for 2014.

There is very little money to be saved by doing anything with physician salaries.

 

[dbair1967]

There is very little money to be saved by doing anything with physician salaries.

The money part I only mentioned as motivation for why some of the brightest people become doctors, not all but a significant portion. If that isn't there, they'll look towards different career options.

Most doctors are paid fee for service. When there is less competition, fees for those services are reduced. More and more physicians everyday refuse to accept Medicare and Medicaid because government reimbursements are too low and admin costs are too high. In areas of the country where there is one dominant carrier (think Anthem/BCBS in many states) the carrier greatly slashes fees paid to providers, but providers don't have much choice to accept or not because if they drop out of that network thy lose access to market share. This is why government run healthcare/single payer systems suck. Once they are implemented, fees will go down. All the while physician costs (especially for things like medical malpractice coverage) have gone through the roof.

 

[SixisBetter]

the carrier greatly slashes fees paid to providers

This is true with almost every insurance company but still I get your point.
The guy who did my knee replacement in January told me he just does more surgeries.This is not exactly comforting.He's the head of a clinic that has four other full time surgeons.They take over the ORs in their hospital Monday and Wednesday every week except Thanksgiving and the two weeks at the end of the year.
My doc did over 250 surgeries last year,that's how he makes up for cut fees.
Think how many the whole team knocked out.
He's doing my other knee in August lol

 

[Hoofbite]

The money part I only mentioned as motivation for why some of the brightest people become doctors, not all but a significant portion. If that isn't there, they'll look towards different career options.

Most doctors are paid fee for service. When there is less competition, fees for those services are reduced. More and more physicians everyday refuse to accept Medicare and Medicaid because government reimbursements are too low and admin costs are too high. In areas of the country where there is one dominant carrier (think Anthem/BCBS in many states) the carrier greatly slashes fees paid to providers, but providers don't have much choice to accept or not because if they drop out of that network thy lose access to market share. This is why government run healthcare/single payer systems suck. Once they are implemented, fees will go down. All the while physician costs (especially for things like medical malpractice coverage) have gone through the roof.

Fee for service is a shitty model that won't last regardless of whether or not the United States goes to a single payer system. It's largely part of the problem with runaway costs. It incentives volume rather than outcomes, which means that malpractice is a product of FFS by pushing people out the door sooner than necessary and subjecting them to unnecessary testing and procedures.

FFS isn't going to last. If single payer would give the system a kick in the ass towards finding a better pay model then single payer is absolutely needed.