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Comment by l8again | Hacker News Reader

Bernie Sanders "Medicare for All" plan makes all the sense in the world. Expand medicare for everyone. Pay the government instead of insurance premium. Medical costs go down. Doctors/hospitals might earn less, but will have guaranteed payments. Medicare, a government program, is considered the gold standard of healthcare, so this isn't the government's first rodeo.

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If you think government run healthcare is the solution you should talk to any military member or veteran; people are literally killing themselves in VA parking lots because the care is so bad.

Isn't a big part of it the huge wait times because VA hospitals are overburdened by the number of vets? If they were covered by any hospital in their area rather than specific VA hospitals, presumably the care would be a lot better.

And who controls for the number of vets and the number of VA hospitals? The government.

Do you think they would do better in a bigger version of this for the whole country?

> Doctors/hospitals might earn less

No, they HAVE to earn less.

Also, if the exact same medicare that pays out today is replicated to the whole population the medical industry will go broke overnight.

Maybe that will force the industry to increase their efficiency(hopefully not through decreased attention to patient, but through cost reduction, better negotiation power with pharma industry and all)

That's what the hospitals have been doing recently through consolidation of both hospitals and private practices. Not reducing their costs overall per se, but trying to grow as much as possible to increase buying power. I'm of the opinion that this is a bad road to go down, one with a lower degree of competition and choice compared to what we had 15 years ago.

I think you need to have incentives in place to foster innovation in healthcare somehow. Consolidating hospitals sounds like a way on monopoly, i agree, but consolidation could also happen on payer (single payer?) side, which would give some bargaining power. I think at this point US healthcare system is too complex for many of us to follow. We have different private practices, labs, hospital facilities, and all that comes with the cost of opacity. When you can't really tell how much you are going to pay to whom in advance comes with loss of power to choose (a different care-giver), which probably creates local monopolies.

No, it will cause the medical industry to do less. A big reason (though not the only reason) why the US is so expensive is because way more medical procedures are done here vs. other countries.

I dont follow. More medical procedures done should reduce cost, unless you are constrained by the supply of doctors. Is that what you are saying?

Above they mean system wide spending when they say cost.

Also, we are very likely doctor constrained. The patients/doctor in the US isn't hugely different than other countries, but it is difficult to estimate the impact of how a payment model causes them to direct their care. The current US model needs lots more doctors.

More medical procedures means a worst healthcare system

If healthcare works it prevents unnecessary medical procedures

on a second read of the original message, maybe that's exactly what he's talking about.

More medical procedures because of less preventive care, or more procedures "to cover their ass". I heard doctors tend to be on the super cautious side to reduce liabilities, and require more testing, procedures, and what not.

> More medical procedures because of less preventive care

Yes, I hit reply on the wrong box.

Source or it didn’t happen.

Look up what Medicare pays out.

The only reason it's the gold standard is because it's everywhere. Having worked in 6 hospitals since 2006, I'm not quite sure how you think expanded medicare is any sort of solution.

Nor are we quite sure how you think it’s not, other than logically fallacious argument from authority.

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