re: Why does the healthcare debate essentially revolve around like 4% of Americans?

My point was exactly that my works, good or not, don't dictate markets as you mention. If we had single payer, my hospital system wouldn't turn people away based on ability to pay at it does now. They'd be turned away based on severity of illness or something else medically more rational. We'd still need more providers to meet the demand, but that could be addressed through providing additional incentives that could be addressed through incentivizing training additional MD's and DO's in my field and reducing regulations for NPs and PA's, foreign medical grads, additional incentives for underserved areas, etc.. Those things would reduce my salary but it would be better for patients and I'd support it (although maybe I'd like my kids to get through college first ).

What I believe is not all that incompatible with your ideas in your longer post. Americans' expectations are absolutely unrealistic and OPM systems that don't deny a lot of bad care continue to feed that.

But enough about me - you don't like Graham-Cassidy. Why not? It gives states freedom to set the markets loose. Good, right?

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My point was exactly that my works, good are not don't dictate markets as you mention.

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that was my point as well. Just like all but an insignificant minority of providers... you still expect to be paid (rightfully so).

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If we had single payer, my hospital system wouldn't turn people away based on ability to pay at it does now

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Are you sure? If.. say.. the government said: no more hip replacements for anyone over 65 years of age... your hospital would still provide hip replacements to 70 year old patients -- because the system is single payer? I'm sorry but I don't believe that.

Going to single payer won't make providers suddenly become charitable givers. They could do that now.

And to a more patient-centric perspective... how would making a government-run payer change demand for services? You know anyone turning down SS because they don't need it?

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We'd still need more providers to meet the demand

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Thanks. You proved my point for me.

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But enough about me - you don't like Graham-Cassidy. Why not?

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It's still cost-shifting. Just relocates it. Frankly, I'm unlikely to be impressed by any legislative effort.

As I said above, this isn't a legislative problem. The math doesn't work politically. The only possible legislative solutions that work fiscally will be so unpopular--they will be political suicide for anyone proposing it. Nothing practical has any hope of passage as long as voters believe in Santa Claus.

Realistically, to implement single-payer and maintain our current standard of care we would need to see tax rates double across the board and have taxable income extend down to the $30k level. Think a political party proposing taxing a "working family" making $30k/yr at 45% (inclusive of FICA) of their gross income will get re-elected?

I don't.

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I was arguing that having a single payer would likely change the kind of care for the better (tying payment to outcomes, denying certain kinds of treatments/tests outright in certain clinical situations).

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As a doc, I'm surprised you think that congress and bureaucrats. can better determine appropriate care than you can. Perhaps in your case you're right? But most docs (and patients) don't believe that.

And nothing prevents docs from making those determinations now. It's not like you need permission from the government to make appropriate treatment decisions.

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Getting rid of employer-based health insurance would raise wages considerably eventually

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emplyer-based plans are almost universally loved by employees. You think congress is going to take that away?

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I don't think they'd do a payroll tax, but would opt for a VAT instead, though

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Except that would undermine any increase in wages and negate what employers would save from eliminate healthcare benefits. Squeeze the balloon however you like. There just isn't enough money.

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If the government used debt initially to finance it and deferred new taxes a bit that might make it more palatable.

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like how congress paid off the military debt with savings from "peace dividend" when the USSR failed?

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Still, I think the Dems would be smarter politically to run on a medicare buy-in or public option

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.OF Course!! As long as they don't talk about who will be paying for it.

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Healthcare reform should be based on helping the most people lower their costs, rather than helping a select few at the expense of all others

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Which Republican proposal lowers costs?

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Why does the healthcare debate essentially revolve around like 4% of Americans?

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You do realize that 4% of Americans is about 13 million people? Also that people are rarely alone but are in families. So often, those 13 million have parents, sons, and daughters willing to go bankrupt for them, so you have to multiply that number by 2 or 3 to see the total number affected.

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We'd still need more providers to meet the demand, but that could be addressed through . . . reducing regulations for NPs and PA's, foreign medical grads

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Those things would reduce my salary but it would be better for patients

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It would be better for patients?
Perhaps your observation calls for a bit of introspection.
Seriously.

When you note NPs and PA's, foreign medical grads would improve care for your patients, it seems to imply more about your own opinion of care quality you provide than you'd probably intended to air.

Either that, or you've really not thought this out . . . at all.

So for example, would a patient who in our current system sees you, be somehow better of seeing an NP, PA, or foreign medical grad, independent of your oversight?

Would your patient-care decisions best be made by a committee of actuaries, politicians, and/or administrators instead of being made by you in concert with the individual human being you are treating?

Those are the endpoints you're moving towards ... unintentionally I'd suspect.

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Americans' expectations are absolutely unrealistic

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Are they?
Really?
or is that simply your impression based on what you've been told?

A couple of points.

(1) "Single-payer" is a compensation mechanism. That's it! It is one single third-party payer, who by virtue of a granted monopoly, unilaterally decides who to pay and how much to pay them.
"Single-payer" is not a care system. That is until the "payer" who is neither medically informed nor clinically compassionate refuses to pay for care. Even then, single-payer is no care provider. It simply hamstrings or bankrupts those who are.

(2) Fee-for-quality medicine works very well. We see that best exemplified in the world of plastic surgery where fees are set based on quality, and unfettered by third party payers. But there are many other examples of fee-for-quality efficiencies ( e.g., Surgery Center of Oklahoma). Each dramatically saves money over ANY 3rd party payer model. Each incentivizes quality. There is inherent competition based on quality, price, and outcome. Pricing in some instances runs as little as 20% of third-party payment competitors.

Regarding your perception of unrealistic "expectations", in fee-for-quality models those "absolutely unrealistic" expectations are consistently met.

So no, single-payer is not the answer. To further hammer that home, the "payer" we'd be addressing is Medicare-for-all. Medicare runs roughly twice the cost of European Models, is more expensive than fee-for-quality, and would afford poorer results.

Are you sure? Let's see what you think when it's your parent or child who is sick.

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Yes.
Just as 1% means 1%.

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First thing I got after I googled, percentage of American's will be affected by preconditions was this article:

LINK

So in this case 1% means 25%.

The Kaiser Family Foundation are the biggest pro-obamacare hacks there are, except maybe aarp because they make money off it.

Covering pre-existing conditions is not "insurance", it is welfare.

Insurance mitigates risk. It does not pay for something you already have.

Hog 61 is correct.
Previously existing condition, if it is to be covered, should be covered by "the state", not by a for profit company.

Dems aca forces company to pay. Aca was set up to assure profitability though.
Republican "plan" just ignores the people with priorly identified issues.
Graham plan may pass. If it does, dems will roll in 2018. Graham plan should go into effect after 2018 election to escape blame.