MangoMan wrote: ↑Sun Feb 16, 2020 8:31 am
D1984 wrote: ↑Sun Feb 16, 2020 3:40 am
AFAIK you can do that in Canada too. Canada doesn't fully ban full price up front in cash-on-the-barrelhead private medical practice; it bans private health
INSURANCE. Physicians (whether singly or in group practice), surgicenters, clinics, imaging centers, etc can opt out of the public payment system (their province's Medicare system) but in doing so they forfeit the right to bill Medicare for ANYTHING for a certain period; also, in some provinces (Ontario does this and I presume at least some of the other provinces do as well)
physicians who opt out of Medicare and bill patients privately for cash cannot charge said patients above the agreed-upon provincial Medicare fee schedule anyway unless they are treating non-insured persons (i.e. persons for whom Medicare would not be the first-line payer...stuff like workmen's comp cases, auto accident victims, persons who are not Canadian citizens or PRs, etc).
Again, as far as I know both the Single Payer bill by Bernie and the one by Jayapal do similarly as above in allowing cash-only medicine but prohibiting providers from billing Medicare for a set period (IIRC it is 3 years) should they choose to be cash-only/prepaid/concierge practices.
This defeats the whole purpose and incentive for opting out as a provider (capitlism!). If you can't charge more for delivering a better (or, in this case, more timely) service, you may as well stay in the system for the increased volume. The only reason the concierge model works here is because of supply and demand coupled with un restrictive pricing.
I guess if you asked Ontario's Minister for Health he/she would say that was the whole point; they want to avoid as much as feasible a two-tiered system and by keeping as many doctors practicing in the public system as possible (and incentivizing as few of them as possible into cash-only practices) this helps to ensure that the vast majority of the wealthy use the same system everyone else does and thus have an incentive to want to see it working well just like the poor and middle class do.
Most countries with universal healthcare don't regulate what cash-only doctors can charge but EVERY country with universal healthcare does directly or indirectly regulate what providers can charge those insured under the system (whether that system is socialized medicine a la the NHS, single-payer like in Canada, single-payer with additional optional private insurance for stuff the public system doesn't fully cover like France, single-payer but with the ability for those who can afford and wish to to buy a private insurance policy and totally bypass the public system like Australia, government-funded hospitals, government catastrophic insurance and private health savings accounts like in Singapore, or a mandatory private but not-for-profit system like Switzerland where you are required/mandated to buy insurance--and subsidized if you are too poor--but can choose from a variety of not-for-profit private insurers and switch if you are unsatisfied); we alone in America do not have universal healthcare and don't do any kind of nationwide or statewide regulation of what providers can charge and thus we get ripped off by some of the highest prices for medical care in the world....see the IFHP reports if you don't believe this.
We already basically have socialized medicine here in the US in most cities, it just looks different. If you practice here in Chicago in a non-concierge practice, you are limited to charging the fees set by insurance contracts or medicare since almost all of your patients have one or the other, and if you don't participate in the PPOs, you won't have any patients at all as they will just go to the guy 2 doors down who is in-network. And the premiums of the wealthier people help pay for those receiving subsidies. Voila: defacto socialized medicine.
If a doctor doesn't like the prices the private insurance companies offer and doesn't like what Medicare offers either he/she can just run a cash-only practice. They would likely have plenty of cash-only patients if they charged, say, from $11 to $45 for an office visit--which is the range of prices for an office visit (not copayments...actual prices in full...and this is to see a regular GP, not an NP or a PA) in other countries (again, as per the IFHP reports...granted, this is from the 2013 and 2010 reports--they issue a report every few years but not every report includes the cost of a routine office visit--so prices may be a little higher in other countries since then due to inflation....but I'd be willing to bet US prices rose just as fast if not faster). And yes, I know that to do this (have doctors charge such low prices for a basic GP office visit) we would have to be more like other countries and revamp our whole education system and have heavily subsidized (or free) college and medical education so that doctors didn't graduate med school with a $260K (or more) millstone around their necks that makes them see the need for much higher salaries than in other countries and we'd also have to start paying them decent wages during internship/residency rather than 45K or so a year (and while we're at it, also stop working them so many crazy excessive hours during said internship/residency which means we'd need to lift the Medicare MCE cap and fund training of several thousands or tens of thousands of doctors more each year so we'd actually have enough docs without overworking/burning out the ones we have during the immediate postgrad training like we do now)...all of which I'd be fine with BTW; it would cost more upfront but it would likely save money over the long term.
We don't have de facto socialized medicine; socialized medicine is when the government runs the hospitals/clinics directly and the doctors/nurses are all salaried government employees. We
do have a system of quasi-price regulation by insurance companies and Medicare but Medicare cannot negotiate as low of prices as the universal systems in other countries because it is not the monopsony buyer--since it does not cover everyone but only covers the elderly and those with ESRD-- and because since private insurance exists as well (private insurance exists in plenty of other countries too but in all of those countries private insurers negotiate with providers on a nationwide/provincewide/cantonwide basis and so have some serious negotiating clout owing to the fact that in such a situation these private insurers are negotiating all as one and are thus a quasi-monopsony buyer as well) so if Medicare offers too little in the eyes of providers they can just say no and refuse Medicare and only take privately insured patients; private insurers have little/no negotiating clout here in the US because there are typically ten (or more) of them competing whereas in many/most areas providers are effectively a monopoly or an oligopoly and so the providers (hospitals/doctors/drug companies/medical device makers) can name their price and the private insurer has little choice but to take it.
If we had universal Medicare for all (or at least all-payer rate setting where all the private insurers + Medicare + Medicaid negotiated prices all as one on a national or regional basis and thus functioned as a monopsony buyer de facto even if not de jure) then the power would be back in the buyer's lap and medical prices would likely come down to be somewhat closer to the prices in the rest of the OECD countries. We don't so we get stuck with some of the highest healthcare prices in the developed world.