Universal / National Health Care Insurance

Who said anything about being "beneath" anyone?

If, on the other hand, our primitive ancestors had never looked at the world around them and wondered how to make it better "productive" would still mean catching a parasite ridden buffalo once in a while to get the tribe some protein to go with their berries.

In their cold, wet, caves.

Listening to cassettes.

Doctors ordering unnecessary MRI scans is also a shady cash grab in and of itself. America has 4x the number of MRI machines per capita as Canada (only Japan has more), but Canadians still have longer life expectancies.

There should never be a financial incentive to carrying out an unnecessary procedure or course of treatment, ever.

If you imagine all that money only goes toward those things you've listed, you are engaging in fantasy. Other industrialized nations manage to do the same thing for a fraction of the cost. Hospitals make a shit ton of money by overcharging for aspirin, let alone an MRI.

Unnecessary is relative. MRIs are the best tool for many imaging jobs, even if they're not the best value imager for the money. Having the government come in and take over insurance is either going involve a loss of services that people expect -- which at this point includes lots of MRIs -- (unpopular, so unlikely), or no cost reductions. And we have shorter life expectancies because we're fat fucks who vastly out-consume everyone else. Other high per-capita consumption countries (similar medians) have similar lifespan decreases (Luxembourg, for instance, IIRC). Government taking over health insurance is not going to change that either.

I mean... If they're already installed, I wouldn't insist they be ripped out. But I wonder how much of it is a chicken and egg thing, with doctors under a private system being encouraged to upsell by ordering scans they otherwise wouldn't?

Either way, a single payer system could set reimbursement rates so that ordering an MRI only nets the hospital as much profit as ordering an x-ray or a CT scan. Take away the profit motive and let the chips fall where they may.

Except in that there is an incentive to be more pro active about health education, obesity reduction programs, so on and so forth when the financial burden of procedures isn't offset by a potential profit.

That's not to say there's no debate about the efficacy of such schemes, but nationalising healthcare more broadly shifts the focus on preventative measures rather than the most costly available reactive approach.

Ninja'd

Before UA starts shitting blood, spot is talking about doctors suggesting less invasive treatments like lifestyle changes before jumping right into the expensive and invasive stuff, not any sort of mandatory cheeseburger restrictions or limits on your 128oz Dr. Pepper refills or government agents forcing you to jog every morning at gunpoint.

Should have made that explicit probably....

I can think of another reason why a doctor would order an MRI that might not really be necessary: Insurance purposes. The patient's insurance company might demand an MRI before they agree to surgery. Why? Because if a $2K MRI procedure saves them from having to spend $36K on an operation, they consider that a win. They don't think about the fact that if the patient really does need the surgery, it now costs them $38K, instead of $36K.

I think you're assuming this system is more for-profit right now than it actually is. The vast bulk of hospital care in the US is already non-profit or government. Something like 15% is for-profit. Insurance is a more profit-driven: only ~60% (ca. 2010) of large insurance plans (I couldn't quickly find data on small ones) are non-profit. But either way, insurers lose money when unnecessary tests are run, so they have a direct motive to stop unnecessary tests. Why should we expect a nationalized insurance regime to be any more effective than one with a profit motive?

They certainly think about that. But if just 1 in 18 MRIs reveals that the planned operation is unnecessary, or the wrong operation, that's a win. They'll only demand an MRI between diagnosis and operation if the conversion rate from pre-MRI treatment plan to something else is greater than 1 in 18. They don't really care about paying more in any individual case as long as the statistics show it's cheaper on average.

ETA: and there's no reason to think that would change under a nationalized insurance regime.

But do they? Corporations tend to only think short-term, not long-term. In the 90s, I can remember reading an article about the shitty practices of HMOs, where they were more than happy to put a patient's life at greater risk, simply to shorten the hospital stay the doctors recommended.

For tax purposes only. They inflate paying patient bills to cover non paying.

And doctors are all for profit. Few work as hospital employees.

A national insurance would have huge bargaining power.

Why would they be effective at all, especially in a world without copays? Need either more a virtuous people (not a thing nationalized health insurance or care is going to bring about) or lower consumption to actually improve preventive health outcomes (and tell anyone you're going to deliberately lower their standard of living for their health and watch the riots). Basic preventive care has been required to be covered for everyone with insurance for a decade, and our life expectancy numbers are still going down.

What's that you say? Can this be reduced to free will vs. optimal collective outcome?

I'll grant that there can be institutional inertia (and I mean that in both ways: they can do nothing when they should do something, or start doing a lot and not stop when they should), but there's no reason to believe that the government would do better on that front. It took 20 years for the UK to stop explicit (and another 5 implicit) rationing, the last 10 of which was under Labor governments (this is just an example; I'm NOT saying the US under eg Medicare for All would ration, just that any changes in policy, no matter how good for long-term outlook, would come slowly).

I said non-profit, not a charity. They've still got to pay the bills and salaries or the hospitals will close. Hospital C-level compensation does appear to be out of control though, in some places. Still, add up all the excessive hospital C-suite compensation nationwide, and you might find a billion dollars. Drop in the bucket compared to the $1.6 trillion people think we're overpaying for health care (based on GDP)

Yeah but their share of national health expenditures, on a per-doctor basis as measured in multiples of the median wage, has been steady over the decades (small decreases for all salaried doctors, steady for non-salaried GPs, slightly up for non-salaried specialists). Like, really steady. They're basically not a component of the increases in NHE over the years. What has increased a lot, personnel-wise, is sheer quantity. The increase in nurses, technicians, support staff and administrators has outpaced population growth (something like 1/11th, or maybe it was 11%, I forget, of the workforce works in health care now), while doctors (especially specialists, NPs and PAs) have ~kept up (MD GPs have not, but a lot of their former work is going to NPs and PAs now).

Plus, Medicare for All explicitly doesn't do anything to control costs other than for prescriptions, so as to not shit all over anyone except insurance companies, in order to garner support.

You're talking about the country which has ads telling people to suggest medication to their doctors.

How then would you explain the odd coincidence that of all developed nations the one most ideologically tied to a privatised system also fares so badly in terms of health choices?

Requiring basic preventative healthcare of a private provider whose profits lie in having an insurer pay out for their clients is by no means the same as having a system which is motivated by minimising the scale and cost of intervention.

One is realistically tokenistic, the other an existential necessity.

There's nothing wrong with that. Doctors are not omniscient, after all, and it's entirely possible that someone might have seen some information about a new drug or treatment that their doctor has not.

Of course, it's much more likely that that person has either (A) seen some bullshit on teh intarwebz and believed it, or (2) seen a commercial on that there tee vee and, lacking the ability to think critically, believes whatever outlandish claim is being made.

Better yet, require doctors to “re-certify” every year to ensure they are on top of the latest treatments and drugs available.

So schools should be giving the exact same resources towards all students regardless of their personal situation except for the ones who should receive special attention and extra resources because of their personal situation?

If you got that from what I posted, you are a truly imaginative person.

I'm happy to be corrected if so:

I understand this as meaning that the kids with different needs (ie the ones who need different resources and/or teaching methods) to best have a chance of reaching their full potential should receive those.

Whereas this complains that we shouldn't be looking at different needs to reach the best outcomes, but should be giving them the same opportunities to sink or swim.

How have I misinterpreted?

Such teachers are expensive. It's cheaper just to dump all the kids in the same classroom and hope for the best.

It's also the case that lumping them all together as an "other" can easily lead to them being with a teacher who equally isn't able to meet their needs because there are many different students needs to consider.

In many cases those students being in the same classroom as the other students can be beneficial, where they aren't left behind simply because of an expectation that they can't handle the work rather than actually having that inability.

Support can come in the form of a support person who works with them for some of the week to give extra assistance, the degree of this support customised to their particular needs (my mother has done this job).
Some students have needs that are best served in a dedicated classroom, however it's not something where any blanket statement can hold true.