Single Payer Healthcare
People who answer “single payer healthcare” every time a problem with the U.S. healthcare system is brought up are part of the problem.
Mashing the SPH button every time the grownups are talking simplifies the conversation about US healthcare to a useless degree. SPH is the goal, but just injecting those three magic words into every conversation does nothing to address the complexity and nuance, and only allows the person saying it to feel good. Most of them are just as uneducated as people who want it to remain a for-profit system.
If you are in favor of SHP, as every sane person should be, then you need to get your hands dirty and educate yourself on some things. Here, I’ll start you off:
1. Torte reform. Want to curb over testing and over prescribing? Torte reform. Doctors need to be able to not worry about being sued because they missed your zebra or something unrelated to what you saw them for, and they need to feel comfortable saying, “No, Barbara, you can’t have a zpak for your virus”. TORTE. REFORM.
2. The cost of med school. As it stands, most students leave med school with 300-400k in debt. As single payer statistically speaking involves a drop in pay, this becomes untenable. They should not be paying a mortgage when they get out of school.
3. Residencies are underfunded. Doctors can sometimes come out of school, with the debt mentioned above, and not be able to match into a residency and finish their training.
4. Doctor shortage. 2 & 3 would help address this, but if we want to switch to SPH we need more doctors to handle the load, otherwise you’ll be waiting weeks to see one. Plenty of smart, potentially qualified people go to a different field because they don’t want to take on the crushing debt.
5. Preventative care. The whole conversation around this needs to change, to emphasize it over emergency care. Treating stage 1 cancer is cheaper than treating stage 4. 2, 3, and 4 are related to this. A heavier primary care load means we need more primary care doctors.
6. Transparency of pricing. Everyone involved in the process, especially doctors, need to know what things cost. This also goes towards over testing (Noticing a pattern? It’s all connected.). Right now that’s not the case, and to avoid being sued, expensive tests are probably being ordered in excess of what is necessary if there’s an efficient cheap one.
7. Profit limits. Now, I tend to lean more capitalist than most of Tumblr does, so I don’t have a problem with some profit being made. BUT. There needs to be a limit to how much drug companies, hospitals, and insurance companies can over charge. That could be a flat %, I don’t know. But it would definitely help limit the expenses and how much is paid in general (which makes it easier to switch to SPH.). Drug companies especially.
8. Doctors need to be educated about how the admin side works (thanks @md-admissions for that one.) so they can be better prescribers and be more aware of what it’s like on the other side of the fence. Here’s the quick and dirty: Dr. dxs and codes for that. –> treatments are added in the form of HCPCs –> After the appt, stay, etc. is over the billers charge the insurance company, after going through a whole host of corrections. Mostly because of the next step, and because you can only use certain ICD codes with certain HCPC codes –> bill goes to a clearinghouse, whose only purpose is to check it for errors. It’s an automated system that will reject for completely minor things. Bill is either accepted and sent to the payer, or rejected and sent back to the provider for corrections –> Biller performs corrections and resubmits. This part can literally go on for months, but it’s eventually sent to the payer, or the exasperated provider gives up –> once at the payer (insurance demon I mean company), they look it and either pay it or reject it. Often they refuse to give you more reason for the rejection than an arcane code. If it’s medicare you may or may not get a human-readable report. It’s a crapshoot if you get a 277 or 999, as far as I can tell. If the payer rejects it sometimes they won’t even discuss it with the provider, and insist you use the clearing house as a go-between. They look for any reason to reject and providers lose *millions* to this BS. –> After all of this, the balance is either written off or forwarded on to the pt.
9. Eliminate clearing houses and insurance companies. This would happen as a by-product of switching to single payer, but none-the-less, it still addresses the problem of administrative waste that would still need to be watched out for under a SPH system. Clearinghouses are useless. People who do the job of checking the coding and whatnot tho (coding is important and necessary, because it allows for tracking of illness for stat reasons but also because that’s how they know what to pay.) could be transitioned to the same job in a SPH system.
Ok this isn’t exhaustive, but I think it’s a good start.
So please, SHP people, before you go beating that drum make sure you’re ready to address the complex mess that is American healthcare because I’m tired of listening to your smug assertion of “single payer would fix this” and I agree with you. It’s lazy and uninformed.