re: Spinoff: The Commonwealth Fund Healthcare 2017 rankings. US basically ranked last

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Seen that way by "who" in the healthcare world?

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Large hospital systems, the big 5 insurers, and recipients of the ACA's welfare. All very powerful political groups.

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(I know you meant welfare here as a pejorative but it shouldn't be).

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No, not really. It's just a point of fact. It is what it is. I would define SS recipients as the same. There is no malice behind it. But there is truth in saying once someone starts receiving it, it's damn hard to take it away (politically).

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You can add the American people to that list now since approval now is >50% for the ACA

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Not in it's current state. Only 25%-30% believe it's ok as is. The rest either want to repair, repeal, replace, or a combination of the 3.

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But the theme of their data and conclusions has been consistent since I was in school 9+ years ago. I wholeheartedly disagree with alot of their positions, much to the chagrin of certain professors, but they aren't deceptive, IMO

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Out of curiosity, since you are educated in the area, what do you think the solution is? And does that align with the majority of your professors?

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Out of curiosity, since you are educated in the area, what do you think the solution is?

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I don't think there is a solution that will satisfy everyone. We're not going to be able to stabilize all 3 pillars (cost/quality/access). Well, no one country has been able to yet, and I don't think our political environment puts us in a position to be the first.

I think comprehensive legislation for healthcare is about as stupid an approach as there possibly could be. But recognize that our political environment wouldn't support a long-term, well though out, piece meal process for HC legislation. But that's how we should do it. Individual legislation on each pillar, each one implemented over a 2-3 year span to limit and react to the unintended consequences that arise. Do it in whatever order you want, though I think cost should be the foundation for the other 2.

Functionally, it has to be a dual private/public model of delivery. I think a public option, though not ideal, is inevitable. I think the big 5 will reduce down to the big 2 or 3. And I think you will end up with 3 seperate healthcare markets.

The public option patients that will deal with rationing, long waits, foreign medical grads and mid levels, and an extremely tight network. FFS providers will be phased out of this market in favor of shared risk and value based payment models with public health systems. I think your commercial patients will have access to the larger, private health systems and hospitals thorough a national insurer or through corporate sponsored plans that contract directly with private docs and health systems. I suspect both FFS and shared risk models would be used. These plans will mostly be employer sponsored. And I think you will see another surge of concierge and subscription based medical practices come to fruition. This would naturally be the most expensive option, but its already a fast growing niche in private practice. And when you compare the total annual expense of a subscription based practice to your current annual Health insurance expense, its not that drastic of a difference. It's a good option for diabetics and other with chronic conditions that require maintenance.

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And does that align with the majority of your professors?

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The majority of my professors, except for the former hospital CEO that was my mentor, believed we would have already passed single payer legislation. The ACA was/is a disappointment in their eyes. Like I said, they were big proponents of The CommonWealth Foundation.

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End transmission.

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If only

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Do you think a single payer system would lower costs?

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Hell no. Single payer would result in unsustainable utilization rates that spelled financial disaster. I don't think we have the stomach to implement the needed rationing that would allow single payer to be considered a "success". I also firmly believe it mostly goes against everything this country supposedly stands for when you consider the resulting fallout and regulation that would be necessary for single payer to "succeed". It's impact on doctors, insurers, huge private health systems, pharma, biotech, etc... All these associated industries work with a profit motive, and the regulation that would be necessary to remove that motive would either crush the sector or have it monopolized by one favored entity working directly with the government payer. Which is why I think the market will turn into what I posted above, and not a true single payer.

I don't think America truly has the stomach for single payer healthcare. Just the concept as presented by a guy like Bernie.

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You can only cut reimbursements so far.

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What do you mean? You can definitely cut reimbursements far enough. What if you raise taxes and implement a single payer that has Medicaid level reimbursement or lower for everything

For the record I think single payer (the way we would do it) would increase spending, but I just don't follow your logic here

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Screw up one of those things and you are looking at serious litigation.

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Another important reason I don't think single payer will ever be implemented here. Who are you gonna sue when all the healthcare entities you frequent are run by the government? Do we really think the current rate of litigation would be allowed to continue if the feds were the defendants? No chance in hell. And the legal lobby won't allow that.

Even using their measures, the system they rank #1 overall is 10th in "Outcomes"

If their measures are meaningful, then...why bother?