Bob–

Narrow networks are here to stay.

Maybe 5% of the population–or less– can afford the premiums needed to pay those hospitals and specialists that use their market clout and brand name to overcharge.

At this point, 95% of individuals and employers buying insurance care most about price. They have no choice.

Meanwhile more and more research shows no correlation between
paying more and better care.
Under the ACA, infection rates at these supposedly
“primo” academic medical centers will be published — and more and more Americans will become skeptical about hte brand names. .

Higher infection rates because patients are sicker?
No a well-known doctor at a prestigious academic medical center explains: “The administration is terrified of the
“rain-maker” doctor and so no one is allowed to tell them they must wash their hands” (or use check-lists, or. . .)
The administration is afraid that rain-makers will take their
wealthy, well-insured patients to other hospitals. Hospitals in NYC compete for these guys.

Bottom line: as narrow networks continue to tighten, many of these providers will lower their prices. And as Medicare and insurers demand value for healthcare dollars, they will have to reduce errors & infections– and improve quality.

H–

Yes, many hospital CEO’s are overpaid. But put all of their salaries together and you are looking at a tiny fraction of what we spend on health care–Far, far, less than 1%.

Woolhander and Himmelstein aren’t very good on the economics of healthcare.

I began as a financial journalist and so am pretty good at analyzing the numbers. When you “follow the money” closely who can see where the waste is.

One reason we don’t want Medicare for All (or single-payer) is because Medicare is very very wasteful. About $1 out of $3 is wasted on unnecessary and/or over-priced products and treatments. See the Dartmouth Atlas for research that goes back more than 20 years. (www.dartmouthatlas.org)

W and H don’t talk much about overtreatment. Instead they exaggerate how much of our healthcare dollars go to insurance companies (it’s actually a small percentage.) The big money goes to doctors, drug-makers and device makers. (Some single-payer advocates acknowledge that this true. But the leaders of the single-payer movement are not open to criticism. AS one former
single-payer doctor told me: “It’s my way or the highway.”

We overpay our specialists. we grossly over-pay for medical devices, and we over pay for drugs. We overpay academic medical centers. There is also much fraud– particularly in for-profit nursing homes and for-profit hospitals.

We also overpay hospitals for preventable mistakes. When a doctor removes the wrong leg (and this happens more often than you would believe) both he and the hospital are paid a second time to remove the correct leg. Surgical infections kill some people. In other cases they survive, but stay in the hospital longer and need a second operation. Again, both the hospital and doctor are paid a second time.

Bedsore are actually the most expensive “preventable mistake.” In some cases they kill people. In other cases bed sores lead to much longer hospital stays– sometimes the patient never goes home. He is simply transferred to a nursing home where he is bedridden for the rest of his life.

It is very easy to prevent bedsores by “turning patients” throughout the day. But hospitals that refuse to hire enough nurses to do the job let patients stay in one position for too long. This is how bedsores develop.

Many single-payer advocates are reluctant to blame doctors and hospitals for the waste. Some like W and H are themselves doctors. They would rather blame insurance companies and
administrators.

If we expanded Medicare to cover everyone of all ages we could never afford it.

We must reform Medicare first–then consider whether we want single-payer (Medicare for all.)

But only after Medicare reduces overpayemnts and squeezes out waste. When Medicare spending is cut by 15% or 20% (adjusted for regular inflation) then we talk about
Medicare for All. .

H–

Yes, many hospital CEO’s are overpaid. But put all of their salaries together and you are looking at a tiny fraction of what we spend on health care–Far, far, less than 1%.

Woolhander and Himmelstein aren’t very good on the economics of healthcare.

I began as a financial journalist and so am pretty good at analyzing the numbers. When you “follow the money” closely who can see where the waste is.

One reason we don’t want Medicare for All (or single-payer) is because Medicare is very very wasteful. About $1 out of $3 is wasted on unnecessary and/or over-priced products and treatments. See the Dartmouth Atlas for research that goes back more than 20 years. (www.dartmouthatlas.org)

W and H don’t talk much about overtreatment. Instead they exaggerate how much of our healthcare dollars go to insurance companies (it’s actually a small percentage.) The big money goes to doctors, drug-makers and device makers. (Some single-payer advocates acknowledge that this true. But the leaders of the single-payer movement are not open to criticism. AS one former
single-payer doctor told me: “It’s my way or the highway.”

We overpay our specialists. we grossly over-pay for medical devices, and we over pay for drugs. We overpay academic medical centers. There is also much fraud– particularly in for-profit nursing homes and for-profit hospitals.

We also overpay hospitals for preventable mistakes. When a doctor removes the wrong leg (and this happens more often than you would believe) both he and the hospital are paid a second time to remove the correct leg. Surgical infections kill some people. In other cases they survive, but stay in the hospital longer and need a second operation. Again, both the hospital and doctor are paid a second time.

Bedsore are actually the most expensive “preventable mistake.” In some cases they kill people. In other cases bed sores lead to much longer hospital stays– sometimes the patient never goes home. He is simply transferred to a nursing home where he is bedridden for the rest of his life.

It is very easy to prevent bedsores by “turning patients” throughout the day. But hospitals that refuse to hire enough nurses to do the job let patients stay in one position for too long. This is how bedsores develop.

Many single-payer advocates are reluctant to blame doctors and hospitals for the waste. Some like W and H are themselves doctors. They would rather blame insurance companies and
administrators.

If we expanded Medicare to cover everyone of all ages we could never afford it.

We must reform Medicare first–then consider whether we want single-payer (Medicare for all.)

But only after Medicare reduces overpayemnts and squeezes out waste. When Medicare spending is cut by 15% or 20% (adjusted for regular inflation) then we talk about
Medicare for All. .