But if so, then how would they be able to run a socialized national system?
They would surely contract that out, too.
If they would contract it out, the cost structure would remain the same - expensive. Coding every service, sending out bills for every little thing, dealing with denials and deductibles and audits - is expensive.
If everyone in healthcare, including docs, would be on a government salary - IMO quality would go down, a lot.
I think one under appreciated direction, based on experience with Medicare Advantage, is capitation. Primary Docs could get paid a flat fee per patient per month, plus a reasonable co-payment at the time of service. Specialists would remain on a fee for service system. Patients could freely switch primary care docs - which would introduce a healthy element of competition.
Overall, I think what is killing us is the egalitarian single standard of care. If a person on Medicaid - which is welfare - will receive the same standard of care as a millionaire, that sounds cool and "fair" - but no society on earth can afford it.
Another thing that's breaking us are the unforeseen results of government fee manipulations - the major one seems to be the recent re-orientation of healthcare towards hospital systems. Hospitals already control about 60% of primary care settings -- and anything that hospitals touch becomes crazy expensive. |
