Somebody will be paying, and will want adequate and auditable documentation about what they are paying for. The potential for fraud is too great. Medicare and states all have to watch for fraud in their claim payments.
What fraud? Going to the doctor is literally useless unless you're ill.
They will literally send you away home if they find you to be fine. The doctors and nurses and personnel and what have you will also get mad at you for wasting their time unjustifiably (and I've done this myself and oh boy they left an impression on me).
If you mean Government fraud, from the ones planning the system yes, indeed, all documentation about how much a healthcare center "costs", how their location and capacity is decided, and etc... should be open and easily accessible to the public.
Medication is partially subsidized and never given for free at a medical center or hospital unless it's an emergency, older than 65+, disabled, etc...
You're right that "patient"-doctor fraud is unlikely, but receiving unnecessary medication (addictive/fun/valuable drugs) or medical people overcharging or charging for unperformed or unnecessary procedures is a possibility for fraud.
Most hospitals have on-call work, overtime, outsourced work, consumables that can be billed for etc.
Pay cheques vary a huge amount depending on work done, and as a radiographer in a regional hospital my yearly wage was more than half made up by penal rates and overtime.
Sure, but adequate and auditable documentation need not involve the patient nor money. Just a "here is the medical care we dispersed, on this date, to this person, it took these resources, these people administered the care." No following up every record for payments, no arguing with insurance companies over the price.
And also, what abuse? If medical care is free and drugs are cheap, the only real abuse is drug abuse (by either seekers or medical personnel). With free access to proper care those drug abuse problems will sharply decrease, killing the market (the cause of the other half of drug abuse).
The only reason there is medicare fraud to worry about right now is because not everyone is supposed to be on it, the "fraud" is attempting to get free health care. Which wouldn't exist if everyone had it.
> Sure, but adequate and auditable documentation need not involve the patient nor money. Just a "here is the medical care we dispersed, on this date, to this person, it took these resources, these people administered the care." No following up every record for payments, no arguing with insurance companies over the price.
This is naive. The source of income (whether it's insurance companies, the government, patients) are not the people who actually buy medical supplies for the hospitals. The simplest way to commit fraud is to charge the insurance company (in a privatized system) or the government (in a public system) for large amounts of care for fake patients in fake cases, which is only caught if an audit shows a mismatch between claims and supply, e.g. a hospital claims that it dispensed 5,000 doses of a $10,000 drug but can only show a purchase order for 100 doses (leading the hospital to fraudulently get $499 million).
You would think that the way to deal with that issue is to vertically integrate, i.e. the hospital issues orders for medical supplies which it doesn't pay for directly, and the medical supply company is compensated in some other way, probably by government funding. But this turns into a government-run market and it has all kinds of issues. Without pricing as a guide, hospital doctors over-prescribe supplies whose real price is far higher than older but similarly effective alternatives. Drugs which the hospital didn't order, but are absolutely crucial for patient X, are either completely unavailable (if the official supplier doesn't stock it) or tied up in medical bureaucracy (to get a special exemption for a special delivery of the drug). The quality of patient care suffers as a result.
You know there are a hundred countries where this is a solved problem, right?
> The simplest way to commit fraud is to charge the insurance company (in a privatized system) or the government (in a public system) for large amounts of care for fake patients in fake cases
Insurance fraud is a problem for the insurance company. They deal with that already so it's not relevant here. And a govt hospital can be audited just like any other govt entity.
>Sure, but adequate and auditable documentation need not involve the patient nor money.
Since almost all healthcare in the US is private (hospitals, doctors, clinics, etc.) then, yes, it needs to involve money since all those entities will want to get paid. And, no, the government can't take it all over since everyone will fight it (and win).
>Just a "here is the medical care we dispersed, on this date, to this person, it took these resources, these people administered the care." No following up every record for payments, no arguing with insurance companies over the price.
This is basically existing medical billing without the follow through (what was done, why, when and by whom). Not sure why you think money (ie: paying hospitals, doctors, etc.) needs to be removed from the equation for it to work.
>The only reason there is medicare fraud to worry about right now is because not everyone is supposed to be on it, the "fraud" is attempting to get free health care. Which wouldn't exist if everyone had it.
Fraud is also doctors, hospitals, etc. billing for things they didn't do or didn't need to do.
a clinic could mis-report (over-report?) how many patients they treated, and/or the procedure. They can then claim back more money than they actually spent, netting easy profit.
Some years ago, I met a doctor on vacation - bit of an ass, but whatever
Last year, I found out he’d gone to prison for “performing procedures” that he was mot present for, including some whilst he was on the beach in Fiji with me!
So, the federal government already has procedures to catch cheats at every level.
This happened to me. When I first moved to Boston I went to a new dentist who kept remarking how great my dental insurance coverage was. It turned out I had a cavity which was fully covered by my insurance so I went to his office, got the novocaine shot and spent an hour with the guy supposedly drilling in my mouth. I saw the dentist for about a year and had three cavities. The only three I'd ever had in my life.
A year or so later I switched to a dentist who was closer to my office. I told him I had had three cavities but they weren't showing up on the x-rays he took. We did two or three sets of x-rays before we figured out they were never going to show up because he had just been billing my great insurance for work he didn't actually do.
Solved by not allowing money to enter the circle. Results in you needing to sell the drugs/things you overcount on, which is rather easy to track and find out.
If they are public employees, they have sort of a standardized salary coming straight from the healthcare ministry/department/whatever where the specific hospital just administer the HR part. You still think in a for profit manner, where healthcare in most countries is not a for-profit endeavour. As long as it works, it's fine, even if it's a net negative. You try to limit the money you waste and inefficiencies, but not by pulling levers on the staff salaries.
>You still think in a for profit manner, where healthcare in most countries is not a for-profit endeavour.
And in the US it's not.
Assuming that you can simply remake a massive chunk of the economy (hospitals, doctors, nurses, clinics, etc, etc) to be government owned is silly. People will protest, lobbyists will be paid and it won't happen. If your only solution to the problems people point out is essentially magic then, no, it's not a valid solution.
I don't say it isn't beneficial (actually I agree with this, but I consider this more an opinion than a fact), the notion of "normal" is a bit subjective so I won't comment on this, but what did you feel was "scary-sounding"? I thought this was fairly stating something that should be obvious.
> If you are that strong a believer in the evils of socialism do you avoid Freeways, airports and the internet?
Well you are conflating a few things here, it not black and white. It is funny to see how stating something that seems obvious to me gets me downvoted and categorized as an extremist anti-socialism...
I see some evils in socialism, but probably not the one you believe. For instance claiming that healthcare is free in a socialist country is one of the most evil aspect of it. My main grief is that people treats it as something that they can waste and don't need to be careful about. Same for "free" universities: student thinking it is "free" don't have much pressure to actually take the most of it and be careful about their choice (let's do a first year of sociology studies after high school because I don't know what I really want to do, and then I can still do a first year of psychology studies, and I'll figure later what I'll do with all this...).
On the other hand, after growing up in France and now living in the US, I learnt that this is all not free and I consider this very previous for the French society. I won't advocate against these welfare benefits, on the opposite I think they should reinforced in many ways however I would like the state of mind of people to change with respect to these "free" benefits, starting by stopping to use the word "free".
As a concrete action, I would send the full healthcare statements to patients, showing how much it costs and how much the taxpayers money is offsetting. I was in the hospital in France multiple times, I have no idea how much it costs, I didn't pay anything as far as I remember, and didn't have a statement.
The same approach can be used for University and other welfare benefit.
I'm not the GP and think we probably should have more socialized hospitals.
But suggesting people who oppose publicly funded freeways should boycott publicly funded freeways is silly.
Imagine an office Christmas party where everyone is told to chip in for refreshments and then the refreshments will be whatever the boss ends up buying with that money. I may not like that arrangement, and may prefer to keep my money and bring my own food for myself. But, given that I have to pay in, I feel no need to abstain from eating the salad that the boss ends up providing using everyone's money.
Right, indeed I think that in this situation eating the salad does not prevent you from criticizing the party.
But this is the point, you were "forced" to pay for something and you would be okay with not getting it. If only the people who paid for the Christmas party were invited that would be okay.
Do you think this reasoning should also apply to streets and hospitals?
(I am specifically referring to using the word "forced" and the moral implication of using it)
> Do you think this reasoning should also apply to streets and hospitals?
Probably not.
But neither do I find it hypocritical to utilize publicly funded medicine (since you already paid in) while also opposing it (because you would be willing to forgo it to avoid paying in). The opposition is perhaps cruel or inconsiderate of others, but certainly not hypocritical. People who construe it as such are either confused or intellectually dishonest.
That's true. But I think the system could be simpler if there were fewer, and possibly just one, entities. I work in a factory, so we live by SAP. And it's complex, typical "enterprise" software, but I don't think it's even within an order of magnitude as complex as Epic.
We want an audit trail, but most of the transactions are made within a single business entity, e.g., from the stockroom to an assembly area. We've had process improvement projects that reduced the number of SAP transactions required to make something.
So maybe the key isn't so much having a government run system, but simply reducing the number of entities. For instance a hospital doesn't have to make a claim to Medicare, if the hospital is Medicare. Also, the game of figuring out how much to bill the patient goes away.
We don't even know how many entities there are in the medical system, or how much money is going to each one. Were I inclined towards cynicism, I'd suspect that this is by design.
If we had a national healthcare system the documentation would consist of proof of citizenship or permanent residency (or guardian's proof of same in the case of minors). That allows spot-checks to validate that fake or deceased people aren't being "treated" to generate fake charges.
Right now even Medicare/Medicaid need lots of process to verify you are eligible and/or enrolled. That wouldn't be a problem if everyone were covered automatically.
Right, but it’s probably done by auditing resources to treatment records. The actual patient needn’t be involved. And in countries like Canada you may end up with multiple operating agencies that are competing for efficiency, such as Coastal Health vs Providence, even though ultimately it’s the government footing the bill.
Providence is under Vancouver Coastal health. The authorities aren’t competing with each other (well, not really) as they have their own geographic catchments.
Right, but they're able to be audited against each other, even though they have separate geographic catchments. Significant discrepancies can be then analyzed.
Folks who view single-payer as a system without checks need to know how those checks do in fact occur.
There's a balance though. A huge bureaucracy to stop all fraud is expensive and cumbersome. There's going to be an acceptable level of fraud in order to keep the administration costs of the system in check.
Other countries have figured this out. The US could use the experience of our allies that already have systems that are working to design a system for us.
