Single Payer

[Aargh]

Everybody pays. Sometimes you come out ahead. Sometimes you come out behind. It would be like auto insurance, except there would be a single provider and a single payer.

I haven't had an auto insurance claim against me for at least the last $20,000 I've paid in auto insurance, but I still pay my share to contribute to the ability of crappy drivers to not be forced into bankruptcy. That's very much like taxing someone to pay for someone else's medical care.

I never had any kids. I'm still paying to educate your kids and your grandkids. We don't always get a benefit to ourselves personally when we contribute to the welfare of the country or the community.

[Aargh]

The Republicans have painted themselves into a corner on health care. Repeal and replace didn't work. Repeal, but don't replace didn't work.

One of the other strategies I've heard is to let ACA fail. The problem is that if it fails, is will fail when Republicans control the White House and both houses of Congress. That would be an absolute disaster in 2020.

To put this in a form that is more easily understood on a personal level, let me try this example. If it's on camera that you've told the local Sheriff that you want to kill your wife, then you'd better make sure your wife doesn't die.

[jdshock]

Everybody pays. Sometimes you come out ahead. Sometimes you come out behind. It would be like auto insurance, except there would be a single provider and a single payer.

I haven't had an auto insurance claim against me for at least the last $20,000 I've paid in auto insurance, but I still pay my share to contribute to the ability of crappy drivers to not be forced into bankruptcy. That's very much like taxing someone to pay for someone else's medical care.

I never had any kids. I'm still paying to educate your kids and your grandkids. We don't always get a benefit to ourselves personally when we contribute to the welfare of the country or the community.

I don't like the auto insurance analogy for a couple of reasons. First, there's still a private market place, there's just a mandate to own insurance. This is closer to our current system than a single payer system. Second, auto insurance doesn't just protect you. It's primarily to protect the people you harm. That's why additional coverage for underinsured and uninsured motorists is always optional, since that insurance solely protects you.

I do like the education analogy. Our society has large economic benefits of investing in education even if at the individual level some people are worse off. Under a single payer system, some people would definitely be worse off, but we'd hopefully see some increased efficiency (both in terms of preventative care and in terms of a unified system). Many states have created constitutional rights to education, which indicates we believe there is some intrinsic right to education. It's not a stretch to say that people should have a right to health care. In fact, our current system seems to support such a finding, since people don't get turned away.

[ShockTalk]

Everybody pays. Sometimes you come out ahead. Sometimes you come out behind. It would be like auto insurance, except there would be a single provider and a single payer.

I haven't had an auto insurance claim against me for at least the last $20,000 I've paid in auto insurance, but I still pay my share to contribute to the ability of crappy drivers to not be forced into bankruptcy. That's very much like taxing someone to pay for someone else's medical care.

I never had any kids. I'm still paying to educate your kids and your grandkids. We don't always get a benefit to ourselves personally when we contribute to the welfare of the country or the community.

I'll add to what @jdshock: said. Good drivers pay less than not so good drivers, not so good drivers pay less than bad drivers, and some can loose their right to drive. This is not the same as paying for others medical care.

Most all, in some way, pay for education "without" kids in that there is a good portion of our lives without school age children. We also, in a way, all benefit from having children educated, or, at least, trying to give them an education.

[jdshock]

I'll add to what @jdshock said. Good drivers pay less than not so good drivers, not so good drivers pay less than bad drivers, and some can loose their right to drive. This is not the same as paying for others medical care.

I like to think about ways to implement a similar mechanism under a single payer system. How do you charge people more for smoking or reward people for getting check-ups or regularly attending the gym or something? I think you could implement various revenue neutral taxes such as a federal cigarette tax or offer a small tax credit to folks with gym memberships or who got an annual check up.

I don't know that I think this is actually a problem unique to a single payer system, though. It's not like I had to get a fitness exam when I enrolled with my employer's health insurance, and there are certainly some folks on the plan that raise everyone's premiums. I think there needs to be more accountability for unhealthy behaviors and more reward for healthy behaviors even under our current system (or maybe especially under our current system with the lack of pre-existing conditions).

[MoValley John]

I'll add to what @jdshock: said. Good drivers pay less than not so good drivers, not so good drivers pay less than bad drivers, and some can loose their right to drive. This is not the same as paying for others medical care.

Most all, in some way, pay for education "without" kids in that there is a good portion of our lives without school age children. We also, in a way, all benefit from having children educated, or, at least, trying to give them an education.

Furthermore on education taxes, as children, every single one of us had the benefit of a public education, whether or not our parents chose public or private education, we all had the option. As adults, we are paying for our children, but those that have no children should consider their school taxes as also repaying a benefit they were entitled to as children.

[im4wsu]

Single payer: VA doesn't work. Medicare doesn't work very well as it just transferred costs of healthcare to non-Medicare recipients (have you looked at a Medicare billing statement? Medicare approves about 30% to 90% of the amount charged and pays 80% of that -- just shifts the cost to others).

[Rocky Mountain Shock]

Under a former employer's insurance, we received rate reductions if we belonged to a gym and met other criteria that I can't remember. Rates were higher if you smoked or made other unhealthy lifestyle choices. Health factors that were beyond your control, such as a history of heart disease in the family, did not affect your rates. I don't know why this kind of rate structure isn't more common. It was the only insurance plan I've ever had that was like it. My current life insurance plan does have rate incentives for healthy lifestyle choices, and I did have a basic physical before coverage started to establish a baseline of health.

On a philosophical level, I do have some issues that our country is literally the only one in the civilized world that puts the health of our population in the hands of private for profit corporations. I understand why some of you have reservations about government having the same role, but I don't think you understand the other side. Until that bridge is crossed it's going to be difficult to have a meaningful national conversation about the future of health care. And I don't believe Democrats have done a very good job in articulating the inherent irony in corporate health care--probably because big business is lining their pockets almost as much as the Republicans. When we get corporations out of politics, maybe things can change.

[pinstripers]

"Once upon a time, there were two military veterans who recently discovered they had brain cancer. One was a senator who was immediately checked into the Mayo Clinic. The other still sits in a VA Hospital waiting room."

----------------from today's Wichita Eagle Opinion Line

[WuDrWu]

Single payer was always the goal. We're going to be there, and it will be awful. Much, much worse than today. There just aren't enough people like me left anymore.

[Dan]

I like to think about ways to implement a similar mechanism under a single payer system. How do you charge people more for smoking or reward people for getting check-ups or regularly attending the gym or something? I think you could implement various revenue neutral taxes such as a federal cigarette tax or offer a small tax credit to folks with gym memberships or who got an annual check up.

I don't know that I think this is actually a problem unique to a single payer system, though. It's not like I had to get a fitness exam when I enrolled with my employer's health insurance, and there are certainly some folks on the plan that raise everyone's premiums. I think there needs to be more accountability for unhealthy behaviors and more reward for healthy behaviors even under our current system (or maybe especially under our current system with the lack of pre-existing conditions).

I totally agree with this. It's like getting a discount on auto insurance for having a clean record or taking driver's safety. If the ultimate goal is help us have a healthier society, we need to help those lower their costs if they choose to live a healthier life. I would be all for annual fitness checkups if it meant keeping my costs down.

[wufan]

My REAL issue with single payer isn't an over extension of the fed (though I'm philosophically opposed to that). My real issue is that I don't see it being cost neutral. I believe cost will go up and/or service will go down. If there were reasonable assurances that healthcare would be cost/service neutral and not negatively impact the economy, then I could get on board.

Also, I don't like the phrase that "healthcare is a right." I feel the correct phrase is close to "healthcare is a responsibility."

[ShockerPrez]

We're going to be in the same boat after single payor.

Rich people will have additional private insurance and or be willing to pay for private healthcare and poor and now middle class people will be stuck with whichever doctors decide to treat those on public healthcare plans.

Unless the government is going to outlaw that and force all doctors to treat everyone and accept government rates that are paid. At which point, the incentives to become a doctor will decrease, increasing the shortage of doctors.

I believe that with single payor, our overall quality of healthcare will decline drastically. But, it will all be fair, right? And we'll all feel good, right?

Oh, and taxes for all will inevitably go up.

I just think that our overall quality of life would decline, even if it all worked, which it wouldn't. Because government doesn't fix anything.

[Play Angry]

Lower quality at the middle and upper tiers of care;

lower efficiency at the middle and upper tiers of care;

probably significantly cheaper for the segment of the population making between $30k - $75k and currently paying through an employer plan or especially on the open market;

much more expensive for those in the upper tax brackets;

overall systemic costs may be lower (or higher) than what we see now (but will be far higher IMO than what could have been under a reformed private care system - note this was never sincerely attempted by its supposed champions in Congress).




Overall I do not like it one bit as a small government conservative, but if this is where we're headed then they might as well get on with it. My team lacks the backbone to pursue a credible alternative.

[Dan]

Also, I don't like the phrase that "healthcare is a right." I feel the correct phrase is close to "healthcare is a responsibility."

Exactly. Healthcare starts with caring for yourself.