Big Sky Cairn

The physician pay cut problem got me thinking on the broader health insurance issue.

One of the bigger flaws of single payer systems is provider reimbursements. This Medicare fiasco should serve as a warning of the dangers of letting bureaucrats - or formulas created by bureaucrats - dictate the payments for our doctors and hospitals.

Taking a look at the CBO score for the recent Medicare bill, it looks like it will cost $10.7 billion to maintain last year’s payment levels. Part of this is covered by assuming Congress will cut their pay by $5.2 billion in 2013-2014. A nice touch I thought.

This is an incredibly expensive operation here, and it is only for one section of the population. Obviously the country does need to take a hard look at our current system, but I do not see how we can afford single payer. I really do not see why any prospective medical student would want to work in such a system. Your wages are subject D.C. politics every year and rarely meet the cost of providing care, you are held hostage to increasing high medical liability costs, and your student loans are astronomical.

It is not rocket science why we have a shortage of primary care doctors. They are the most reliant on Medicare and Medicaid payments showing what happens when you combine all the above.

It is relatively easy to get everyone health insurance. The trick is to get providers to accept that coverage. Heck you could have the greatest insurance plan on paper, but if no doctor or hospital accepts it, who cares? For some reason, those on the left have been quiet about this part of the debate.

Government does have a role in providing safety net coverage, but it should not be the insurer of first resort.

The private care system cannot, by definition, insure that broad swath of the population that is already sick or likely to get sick - read about adverse selection. So they pay sales people ungodly fees to sift through the population and find potentially profitable clients. To everyone else they say “F*** off!”

As a result, non-profitable clients are dumped on government or left without insurance of any kind. That’s why the government insures seniors and poor children, and why even states like Montana offer incredibly expensive public alternatives for people who have been ditched by the private sector. But its’ not enough.

Medicare is not the perfect model - VA does it better, But Great Britain and France do it better. All of these countries manage to insure all their citizens for less than half what we pay here while excluding 47 million.

Your notion that there is a magic bullet in the private sector that is merely underutilized is frankly laughable.