because Medicare reimburses at a fraction of the cost of the healthcare provided we will lose access to care.
Medicare reimbursements are carefully calculated from the “direct” cost of procedures with a reasonable profit allowed. They do not account for cost shifting of unpaid billing or collection costs, which are consequences of our insurance-based system. They also don’t reimburse for excessive administration costs, also a product of our for-profit insurance system. These savings account for much of the incentive (beyond insuring everyone) to switch to single-payer and will allow the same profit now realized by providers.
The other factor involved is the simple fact that the federal government is not revenue constrained and should higher reimbursements be needed to assure the continuation of care it makes no difference to the government that would just pay more. Cost of care also varies considerably across regions and will be similarly adjusted for so providers don’t further migrate to affluent areas.
It is about rethinking how (and where) healthcare is provided. But that is a revolutionary change, and I’m afraid that the necessary and good rural hospitals will be caught in the fire.
I’m sure you are aware that currently much of non-emergency care is provided in the ER to uninsured patients. This is the most expensive and inefficient method possible and very little of that gets reimbursed. I’m quite sure that primary care would shift to neighborhood clinics mostly staffed by nurse practitioners, causing many beneficial effects overall.
Patients would seek care earlier if they didn’t have to pay out of pocket expenses and that care was provided locally, so secondary transmissions would be drastically reduced. This would also allow lower dose antibiotic use, minimizing our escalating antibiotic-resistant infection problem. Smaller and more localized patient care means providers can form better relationships with their patients and become involved in their total health maximization, not just fix them when they are sick.
The problem is we haven’t heard (from the candidates at least) what that strategy is for increasing reimbursement rates (taxes, MMT, etc) and when they will be brought back down again. (This as I see it would push efficiency in the system without a complete market failure)
Showing people how the sausage is made is never a good political strategy. I know Bernie fully understands MMT and plans to use it to our nation’s benefit simply because of his long association with Dr. Kelton who always occupies a top spot on his econ team, but behind the scenes. There is an old saying among political strategists that goes something like “If you are splainin’ you are losing”. I have no doubt that she would occupy a cabinet position and be responsible for communicating a more in-depth policy analysis to the people. She is a confident and competent communicator who always conveys an attitude of calming assurance with a knack for making the truth obvious in easily understood terms.
During a campaign is not the time to teach the voters economic theory, and his targets for punitive taxation would need to be targeted whether one believes taxes pay for government or not, so he isn’t really straying far from MMT by presenting such as “payfors”. MMT is just a description of how our system works now, not something that would require a lot of revamping and new legislation. Only us policy wonks who have done deep dives into the minutia of our monetary system give it more than passing thought unless prompted by politicians. Much of the opposition to MMT currently emanates from economists and academia who feel threatened by the sheer simplicity of it, but that is also one of its strengths when presenting it to non-elites.
