CBO: Key Design Components and Considerations for Establishing a Single-Payer Health Care System

[David]

I came across this document from the Congressional Budget Office regarding Establishing a Single-Payer Health Care System. The CBO in my experience provides excellent non-partisan analysis of issues.

https://www.cbo.gov/system/files/2019-05/55150-singlepayer.pdf

I thought this one paragraph was especially important, regarding possible consequences:

An expansion of insurance coverage under a single-payer system would increase the demand for care and put pressure on the available supply of care. People who are currently uninsured would receive coverage, and some people who are currently insured could receive additional benefits under the single-payer system, depending on its design. Whether the supply of providers would be adequate to meet the greater demand would depend on various components of the system, such as provider payment rates. If the number of providers was not sufficient to meet demand, patients might face increased wait times and reduced access to care. In the longer run, the government could implement policies to increase the supply of providers.

The #1 problem I see with the health care "system" today is the scarcity of service providers (lack of competition) results in high prices, especially when many providers have a charge as much as the market will bear mentality. Case in point from own experience: 6-8 weeks to see a doctor as a new patient. 2 or more weeks to see an existing doctor. One urologist in all of St. Mary's Co.

My Solutions:

1) We need more doctors (and why are so many of our doctors from other nations?)

One of the most critical supply side issues in health care is the supply of qualified doctors. The Wall Street Journal has reported that the number of doctors per capita is in decline for the first time in two generations, and the American Association of Medical Colleges has predicted a shortage of 45,000 primary care physicians and 46,000 specialists by 2020.

https://mises.org/library/how-government-helped-create-coming-doctor-shortage

--- We need a STEM-like program in schools for the medical career?
--- After entering the medical field, allow doctors and nurses to get 100% of their college tuition back in the form of tax credits (10% per year over a 10 year period for as long as they work in the field)
--- Do away with the AMA's ability to restrict the flow of doctors into the workforce

Every student wishing to practice medicine must pass the United States Medical License Examination, and all states impose additional requirements from state licensing boards. These are frequently lengthy and expensive procedures. Medical organizations such as the AMA have an incentive to limit the number of licensed doctors practicing in the marketplace, in order to protect high wages for established incumbents.

https://mises.org/library/how-government-helped-create-coming-doctor-shortage

2) Stop the Raping of the Large Pharmaceutical Companies

While many would argue that profit is absolutely necessary to foster the incentive to develop these drugs:

--- When you look at prices these companies charge for the same drugs in other countries, it pretty much tells me that they have a charge what the market will bear policy for the USA. Insurance pays the bill, the premiums to the patient go up, and of course patients have no control over that what-so-ever.
--- I've read from many credible sources that taxpayer funded research for many drugs pays the vast amount of development cost; the drug companies pick up the ball at the 5 yard line and run it into the end zone.

3) Get the Government the Hell out of the Way

I'm not an expert in this area, but the above referenced MISES article details many of the areas where government gets in the way.

Midwives, physicians’ assistants, and other alternative practitioners also have a key role to play in medical care, and should be permitted to practice without physician supervision. Midwifery in particular was once a vibrant industry, that has since been crippled by costly regulations.

I'm a long time contributor to Remote Area Medical (RAM). Doctors who volunteer to provide services often have to jump through hoops to have their medical credentials recognized in the other states where the volunteer services are to be provided.

4) Allow people to have a Health Savings Account (HSA) with no other requirements.

An HSA is basically an IRA for medical expenses. Right now, you need to have an ObamaScam policy in order to be allowed to have an HSA. So, if you can't afford insurance, or elect not to get it, the government does not allow you to help pay for your out-of-pocket medical expenses tax free.

5) We need some industry-disrupting force to allow people to shop for the best prices for medical procedures.

For people who have insurance that is largely paid for by employers and low to no out-of-pocket costs, why would they care about how much things cost? They probably don't. What happens when customers have no skin in the game? Gluttony!

Even if you want to shop for prices, it is nearly impossible. Hospitals are required to publish prices starting this year. I've read that many simply post an Excel spreadsheet with procedure codes and costs. Good luck figuring that out.

Here's a good illustration in why this is important:

A Long Beach hospital charged Jo Ann Snyder $6,707 for a CT scan of her abdomen and pelvis after colon surgery. But because she had health insurance with Blue Shield of California, her share was much less: $2,336.

Then Snyder tripped across one of the little-known secrets of healthcare: If she hadn't used her insurance, her bill would have been even lower, just $1,054.

"I couldn't believe it," said Snyder, a 57-year-old hair salon manager. "I was really upset that I got charged so much and Blue Shield allowed that. You expect them to work harder for you and negotiate a better deal."

Unknown to most consumers, many hospitals and physicians offer steep discounts for cash-paying patients regardless of income. But there's a catch: Typically you can get the lowest price only if you don't use your health insurance.

https://www.latimes.com/business/la-xpm-2012-may-27-la-fi-medical-prices-20120527-story.html

Just as a side note, based on personal experience, St. Mary's and Calvert hospitals offer no discount and couldn't give a crap about cash discount for self-pay customers. However, most of the doctors are pretty good about it.