NeSailor,
You are spot on for many of the items you described in your last two posts. Just a few items that CMS (Medicare/Medicaid) have control over. The documentary and regulatory burdens hospitals, doctors, and offices have to deal with to just even be allowed to bill CMS for the services provided is very time consuming and very expensive. The amount of people that are hired to keep up with all this costs a significant amount. That doesn't even include the equipment and technology required to keep up with these ever changing regulations. For example CMS has pulled out a new payment scheme called MACRA. Providers who do not comply 100% with MACRA will have a 9% cut in reimbursement by 2020 while those who do will get a 9% increase. Despite the 9% on each side of the equation the total will be a cut in reimbursement across the board (A method to control cost.) The people who will be hit the hardest are the small practices 1-9 providers who will be unable to easily fund the technology needed to meet MACRA's demands. This 9% cut could be the difference between staying in business or being forced to close the doors. Also, our government has had plenty of opportunity to prove that it can do a good job on paying for healthcare. The VA is 1 example of the government doing a half ass job. Although the VA is able to control cost the care is extremely delayed, and most VA patients I work with prefer to never have to go back to the VA hospital. The other example is CMS which has done a piss poor job of controlling costs. Because of this I am just skeptical that our government, is physically able to do a good job with the 1 payer model. I would be thrilled to be proven wrong if California could pull it off, but again I'm very skeptical and glad I do not live in California.
Just wanted to point out. Medicare pays hospitals decently. Not great, but definitely enough to make some profit on the transaction. That is not the case for physicians. For example Medicare will pay a surgeon $667 to remove an appendix. Although this may seam like a terrific deal, let me elaborate. The $667 covers the pre-op, surgery, as well as post op in the hospital followed by an office visit. About 2% of appendix surgeries can have complications but that $667 is included. Also the surgeon has overhead. They must pay the coder, the biller, the IT guy, the nurse and secretary in his/her office, also keep the lights on and the rent the surgeon must pay. For a cumulative of about 4 hours of work the surgeon might get to keep $200-$250 pre-tax. I'm sorry but all that education including 5 years of residency plus accrued debt should pay a little more that $50-$65/hr. Also, the average salary for physicians is about $250k/yr not $500k as you specified.
Jrr85,
I think you are 100% correct. As long as the US population continues to expect everything regardless of cost or necessity while the actual cost is hidden through the veil of insurance, there is no hope in controlling how much we spend on healthcare. It can only go up just like higher education.
Nereo,
You are correct I pointed out how medicaid pays very little. You must understand that if a physician or hospital does not make even some profit they might as well close the shop and find something else to do. Currently Medicaid pays about 80% of the cost of providing the care which means everyone involved loses money on the transaction. For everyone to have Medicaid either the cost pf providing care must go down by 25-30% or reimbursement must go up by 30%-35% or some combination of both. You can't expect people to work for free can you? Another interesting fact for you. Since ACA has come out, more people have health insurance, but more people with insurance don't bother to pay their deductibles and therefor hospitals are either much less profitable or even loosing money. Around the country hospitals are cutting costs and laying off people. Again, you can't expect a hospital to keep its doors open and loose money every year.