How much do you think it costs to maintain all these negotiated contracts VS just having a single payer system with the same price for all procedures?
* Small hospitals in low-density, underserved areas have to make up for underutilized equipment and personnel costs. They raise prices on unrelated, common procedures to break even (This is very common)
* CMS (medicare/medicaid) sets a low price for a procedure that's overly common in a particular facility, now that facility loses money for each occurrence. They choose other procedures to raise the price to try to break even.
* Larger hospitals have higher administrative and operations costs (for things like training and research) that benefit society, but need to be averaged out across all procedure costs. This differs from hospital to hospital.
* Smaller professional facilities or physicians groups (like Ambulatory Surgery Centers) have much lower administrative costs and a smaller staff, so they have lower overhead per procedure. They are designed to be efficient, and can handle lower prices. However if there are any major complications, they won't be able to service the patient, and have to send to a hospital. This then pushes all the highest-cost, ICU-type procedures into hospitals, where there is already a higher overhead, causing hospitals to need separate pricing to cover more complex patients.
A large single payer price set will probably force efficiencies into the healthcare system. It'll be great for folk's costs, but we may see many facilities close, and lines of care will be consolidated into specialty centers. (more travel to get imaging, procedures, or to see a specialist)
This is precisely why most Doctors I speak with are abhorrently against a single payer system.
Source: once engaged to a doctor who had doctor friends and doctor parents/family.
Doctors’ salaries account for only about 8% of U.S. healthcare costs. A 40% cut in these salaries would reduce healthcare spending by only about 3% [1][2].
Doctor salaries are not a huge way to cut costs. If anything this would make the problem worse.
[1] https://www.latimes.com/opinion/story/2021-09-14/dont-blame-...
[2] https://pnhp.org/news/doctors-salaries-are-not-the-big-cost/
It’s irrelevant how much of the budget it is. It’s about perception and power. If you try to cut soap in the operating room or other supplies, you’ll look bad for endangering the patient. If you try to cut procedures you’ll look bad. If you try to cut doctor salaries, those “overpaid” doctors look bad for complaining.
Doctors have a reputation in america for being extremely well paid. If you tel people making $60k a year that their tax bill for medical costs could be lower if you reduce it by taking $50k from a doctor making $500k (taxpayer dollars!) they’ll support that. Even if it’s not a big amount.
Reducing healthcare spending 3% without any systemic change in medical treatments or equipment or negotiation with pharmaceutical companies is a huge and easy win.
The net cost of insurance represents 6.4% of all healthcare spending.
https://www.ama-assn.org/delivering-care/patient-support-adv...