[gizmo686]

At some point, you need to decide if you want a revolution or incrementalism.

We already have a public healthcare system, it is called medicare. We can expand medicare so that private insurance takes up a smaller segment of the total market. I believe that approach will provide incremental improvement and give policy makers leverage for further incremental improvement, but it is not a revolution.

While many of our politicians are talking about revolution, what they are all proposing is incrementalism. The reason for that is very simple; revolution is a bad idea and incrementalism has a proven track record of working.

As an aside, medicare-for-all is still a long way away from a public healthcare system; it makes one area of the healthcare system public.

[jeswin]

> The reason for that is very simple; revolution is a bad idea and incrementalism has a proven track record of working.

Is there any empirical evidence to back this up? There are enough successful examples of revolution and incrementalism from around the world, but I can't find stats.

[ars]

> We already have a public healthcare system, it is called medicare. We can expand medicare

No we can't. Medicare pays below cost of care, and hospitals make it up from private payers. You can't just switch everyone to Medicare, you would have to reduce expenses somehow (which means firing people).

[cheerlessbog]

Perhaps it just pays realistic prices and "below cost of care" is the provider's way of saying "reduces the income I am accustomed to.".

The regular pricing also builds in an assumption that some patients can't or won't pay. If they can more easily get Medicare, less padding is necessary.

[pauljurczak]

This and oversupply created by for profit motive. Costs are driven up by putting a new MRI machine on every street corner, building boutique hospitals and medical buildings at the density well above of what's required. A business model a la Mattress Firm.

[ars]

Call your local hospital and ask what the wait time is for an appointment for a non-urgent MRI. If it's more than a week there is undersupply, not oversupply.

It's probably actually at least a month of waiting time.

[consp]

Considering how these things usually get booked, on need with some leeway for emergencies, a week is the same as now. I am certain the "I'm in the hospital an need an MRI" waiting time is the same day and emergencies now. Your non urgent MRI is just not important enough so get planned far ahead to create a good average load.

[pauljurczak]

There are some local fluctuations, but at far north suburbs of Chicago, where I used to live, I could get non-emergency scan the same or the next day. Bear in mind that oversupply produces overuse. Often times, the doctor ordering a scan is a direct or indirect investor in medical imaging facility. So waiting time alone may not be the best measure. Some patients wait for the scan they don't need.

[ars]

> is the provider's way of saying "reduces the income I am accustomed to.".

The "provider" is not a single person. So to reduce the income of the organization, you have to fire people or reduce their salary.

I think you are thinking you can reduce their profits, but you can't. Instead if you feel they are charging to much, that directly translates into lost jobs or lower pay.

It might be necessary, but just as long as you know what you are advocating.

Can you imagine a politician running on a platform of firing healthcare workers?

[gizmo686]

We have politicians running on a platform of abolishing insurance companies. That is as close to a platform of fireing people as you can get.

[ars]

That's true, but that's not the same as firing Dr's or Nurses.

From https://www.iii.org/fact-statistic/facts-statistics-industry... it seems insurance companies add about 20% to the cost of healthcare.

https://www.politifact.com/truth-o-meter/statements/2017/sep... says 12%.

The same article says Medicare is 2% with the assistance of industry groups, but would cost more without them.

So, abolishing insurance companies would save maybe 5%. That's not zero, but it's not exactly a lot, and would not come close to what's needed.

[cheerlessbog]

They would run on a platform of "pay less for Healthcare" and concern for Healthcare Jobs would not play a major role in the debate, if history is a guide.