If something more than 15% of the economy is health-care involved, and if the excess money we spend on health care is at least partially for the bloated bureaucracies needed to administer it, what is the effect on employment of switching to Medicare?
If current compensation rates from Medicare applied across the board, would we see a (perhaps temporary) loss of doctors and clinics?
Medicare is low-cost to customers because it has both low overhead and low payouts. Providers service Medicare patients because they also have other patients that help the bottom line. It is true that Florida, with its large cohort of Medicare clients, also has lots of hospitals and doctors, but I would think many of those older folks have supplemental insurance, which pays out for plenty of clinics and rehab facilities.
If there is some concern over how to help out unneeded coal miners and factory workers, should we consider that about half a million people work in the health-insurance industry? Is there any chance of actually passing legislation that would be so disruptive to the labor force?
There are reasonable questions over how to fund a single-payer system, and reasonable answers to those questions (although they mostly go unasked or answered by proponents). But I wonder at the way people in the business, the vast majority of whom don’t own stock in Humana or Pfizer, will feel about being made obsolete?
Sanders’ current offering proposes a 4-year transition, which seems pretty fast, a 5-Year Plan without believable details. A suggestion I ike is to not ask for single-payer, which is not the sole answer to the issue, but to ask for Universal Health Care. Germany and the Netherlands have this without a single-payer system. The question is the two forms of cost—that paid by the patient and that paid by the insurer. The premium variability is what looks and feels unfair, that some people can skate with little outlay and others are bankrupted. But the charges by providers are high, here, too. That second issue is more easily addressed, as it benefits the few that are significant owners of companies or stock, which includes doctors in business partnerships with clinics. (It also probably includes various pension funds that invest in profitable stocks.)
To smooth the range of premium costs a large pot of cash is needed to give to the insurers, or a large pot of cash is needed to pay from to the providers. This is going to be tax revenue, of course, but the selling point to taxpayers will be it will save them money (unless they are young and healthy, of course). But what to tell the people who will be laid off from large private insurers? If there is less cash flowing through Blue Cross or Aetna, they will not need the same number of workers. And if the profits are capped more stringently, they will feel pressure to cut hours and wages. And if the single-payer system is popular enough, do the big insurers go out of business?
I want to see more discussion of the real picture of the future and how we get there from here, “here” meaning a huge economic presence by the health business. That presence will not go quietly.