Socialized Medicine? Who’s on first?

There must be such a thing as socialized medicine, but no-one is exactly sure what it ‘is’. We know all the things that it isn’t. Include in that long list that it is not single-payer and/or ‘Medicare for all’.

It’s not in Canada, A survey by the Fraser Institute found a median wait of 20 weeks for “medically necessary” treatments and procedures in 2016 , more than double the wait times reported in 1993.

The survey looked at total wait times faced by patients starting from the time they received a referral from a general practitioner, to the consultation with a specialist, to “when the patient ultimately receives treatment.”

What socialized medicine might ‘be’, can’t ‘be’ while medical monopolies are too big to challenge. Until they are pried apart, what is actually is behind the curtain of ‘socialized medicine, medicare-for-all or one payer, is super-high-cost corporate welfare.

How we got ‘here’. In 1995, sixty independent drug companies competed in America’s pharmaceutical markets. Independent, locally owned pharmacies had not yet been displaced in most communities by giant chains like CVS and Walgreens. Most doctors still worked as independent sole practitioners or in small group practices. Most hospitals were locally owned, community-focused institutions. In most metro regions of any size, they still faced real competition from other local hospitals over insured patients.

That competition was far from perfect. Regulatory barriers to entry tightly constrained the supply of health care professionals and limited the building of new hospitals. Informal cartels and kickback arrangements between hospitals and doctors were not uncommon. But it was rare for providers to exercise full-fledged monopoly power. In fact, starting in the 1980s and continuing through the ’90s, most found themselves at the mercy of increasingly monopolistic health insurance companies. Doctors and hospitals were put on the defensive as insurers merged with one another and forced providers to make price concessions if they wanted to keep their insured patients. Insurers used their increasing monopsony power to put the screws on drug companies and everyone else in the medical supply chain. This explains why, for a brief moment in the 1990s, the nation’s overall health care bill actually declined.

Then came a counter-revolution. Those sixty drug companies combined into ten, hospitals, outpatient facilities, physician practices, labs, and other health care providers began merging vertically and horizontally into giant, integrated, corporate health care platforms that increasingly dominated the supply side of medicine in most of the country. These are ‘life’ platforms that have extended their power by controlling the very marketplace in which customers and suppliers have to do business.

An interesting use of rhetor in corporate America is to call everything a platform. “The Arby’s platform”, the Oldtown coffee “brand and platform”. It is legal arbitrage. “Don’t regulate us like a XYZ, we’re a platform…”

Single payer within our corrupt model of kickback induced ‘medicine’ would addict more people to Oxycontin and then heroin. 30K saved by ACA last year vs 60K dying of drug overdoses.

2017 health care is WORSE than 2015 health care because of concentration. The system is getting worse rapidly.

 

  • Giant hospital systems are buying doctor’s practices, billing software is super-concentrated, private equity is all over ambulances and urgent care
  • Syringe monopolist Becton Dickinson’s $24 billion merger with Bard.
  • CVS’s $69 billion purchase of Aetna.
  • UnitedHealth’s purchase of one of the nation’s largest doctor’s group, DaVita.

Independent surgeons can’t stay in business if the only hospital in town won’t grant them admitting privileges, or if it grants “affiliated” surgical teams better terms. Many of these platforms became part of large chains operating in multiple regions; others achieved dominance in a single city, which still gave them extraordinary market power. And, as we learn from Amazon eating the retail world, ‘local power is everything’ in health care. Most health care services can’t be imported from China or even from the next county over.

So what would happen today if a government program like Medicare were given responsibility for purchasing all health care in the United States? At first it might seem that giving the government that kind of concentrated purchasing power is just what we need to contain the growing monopoly power of hospitals.

But what happens when a single payer finds itself negotiating with a single provider?

LP in Venture Capital hot water and creeping normality Socialized medicine