Single Payer

[SB Shock]

Here is a big part of our nationa problem with healthcare in this graph. Will throwing more money at it fix the problem?

[ShockerPrez]

Here is a big part of our nationa problem with healthcare in this graph. Will throwing more money at it fix the problem?

Perhaps a per capita breakdown would be better?

Just kinda thinking that the US is at least twice as big as all of those countries, so it would make sense that we spend more.

[Rocky Mountain Shock]

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."

I believe it is both.

I have a responsibility to myself, my family, and to our society to live a healthy life. I am philosophically opposed to having you pay for bad decisions that I've made, for example had I smoked for 50 years and developed lung cancer.

At the same time, there is absolutely no reason--NONE--that someone of lessor means cannot afford access to medical care, or a family goes bankrupt trying to pay for their 7 year old kid's leukemia treatments. Unless of course, you believe everyone that is economically disadvantaged is lazy. I haven't seen everything, but I've been around this world long enough to have met quite a few people who have low paying jobs that are more hard working and honest than some spoiled trust fund baby ever will be. Just because you're rich doesn't mean you've earned anything in life, just as being poor isn't your "fault," but unfortunately our society is becoming more judgmental based on economic status.

This country used to fight poverty. Now we fight poor people. And we say if you can't afford your medication or your skyrocketing health insurance that it's your fault. We have become self serving, cold hearted bastards. A feeling of entitlement isn't what's wrong with our society now, it's an increasing lack of empathy.

[SB Shock]

Perhaps a per capita breakdown would be better?

Just kinda thinking that the US is at least twice as big as all of those countries, so it would make sense that we spend more.

I believe those numbers are per person.

[ShockerPrez]

I believe those numbers are per person.

My apologies, my eyes suck. And i am on my phone.

[jdshock]

Here is a big part of our nationa problem with healthcare in this graph. Will throwing more money at it fix the problem?

I have a hard time believing a true single-payer system would see an increase in per person expenditures. In fact, Obamacare wanted to tackle some of this issue with the attack on Cadillac plans.

[ShockCrazy]

It's not just life expectancy, we have higher child and maternal mortality than pretty much any other developed country. Data: https://ourworldindata.org/the-link-...nding-us-focus

[SB Shock]

I have a hard time believing a true single-payer system would see an increase in per person expenditures. In fact, Obamacare wanted to tackle some of this issue with the attack on Cadillac plans.

I think you would have to really dig into how those numbers were arrived at, before you could develop a model of what the effects of single payer would or would not do.

What that chart is telling me is our system is inefficient in delivering healthcare to American people for the money the people are expending. I have a hard time believing government intervention will fix that unless they take over total control.

[wu_shizzle]

No, just no...

[CBB_Fan]

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).

The VA is actually single-provider, versus Medicare which is single-payer. It is well worth pointing the difference because in practical terms they represent two fairly different levels of government intervention.

In a single payer system, the government pays. You go to the hospital, get treated, and eventually the hospital gets the money for the service from the government (and them, from tax payers). There is a still a private market of hospitals, insurers, and pharmaceutical companies competing to keep costs low.

In single provider, the government provides. They run the hospitals, the run the pharmaceutical companies, they run the research. If they don't think a procedure is worth paying for, you can't turn to a competitor because the government is the only option.

A big reason the VA is so inefficient (even over other government programs) is that the government directly administers VA Medical Centers. This results in all sorts of silly mandated inefficiencies. For example, the government makes VA doctors translate medical records from one hospital to another themselves (a big problem when every military branch has its own set of medical records). Private hospitals hire medical records specialists, which is far more efficient and doesn't force doctors into doing needless paperwork. Then you have use-it-or-lose budgeting, impossible to fire administrative employees, long wait times, etc.

Even if we do go to single-payer, it will be more like Medicare and less like the VHA, and it isn't really a choice. To have something like the VHA or NHS the government would need to essentially buy out or bring in every hospital and private practice. Just the dealing with the laws of 50 different states would make it difficult, let alone trying to bring in 4,862 hospitals and about a million doctors into the federal system (which currently has 212 hospitals, to give some idea to the scale).

[Rocky Mountain Shock]

What about single payer but that is a quasi-governmental agency?

Like the USPS or the FDIC. Chartered and funded by the US government, but managed privately. Having a BOD by presidential appointment with Senate approval may remove some political influence.

Replacing the profit motive of private insurers with a patient-centered motive may satisfy the left. Limiting government influence in healthcare may satisfy the right. Thoughts?

[wufan]

I have a hard time believing a true single-payer system would see an increase in per person expenditures. In fact, Obamacare wanted to tackle some of this issue with the attack on Cadillac plans.

I believe that the market delivers the quality required in order to stay in business. You need to show me why you think the cost would go down.

[jdshock]

I believe that the market delivers the quality required in order to stay in business. You need to show me why you think the cost would go down.

Did you mean quality or quantity? I don't know that "cost" is really the right word, but maybe it is. I believe per person expenditures would likely stay the same or drop under a true single-payer system. There are a few reasons this would be true:

1. Under a single payer system, some folks will probably have worse healthcare than they do now. These are folks with premium insurance plans that cover everything under the sun, and they are constantly spending on routine healthcare. Under a single payer system, some of the healthcare expenditures that are presently covered under insurance would no longer be covered since there would likely be a "medical necessity" type test for healthcare. Some of these people would likely agree to pay out-of-pocket for extra healthcare (neutral effect on per capita spending), but some would likely reduce their consumption (reduced per capita spending).
2. At the other end of the spectrum, some folks without health insurance are going to end up with much better healthcare (increased per capita spending). Ideally, you hope the relatively low cost of annual check-ups ends up being less than the huge cost of an emergency visit, which is what happens when someone doesn't have insurance now. Preventative care is always going to be cheaper than emergency care. Without citing a study on this point, I would still think you're looking at an increase to per capita spending, though.
3. And then lots of folks in the middle aren't going to be spending more or less on healthcare.
4. And the point most related to cost would be administrative efficiency. You're talking about wiping out an entire industry that makes billions in profit from healthcare. It would just radically shift the environment for things like billing departments, pharmaceutical sales, etc. (This reduces per capita spending).

To be honest, when I've read criticisms of single-payer systems, they never seem to suggest per capita spending would increase. The focus is always on quality of care, wait times, doctors leaving the system, government overreach, or other unrelated topics. I've truthfully never read a compelling criticism that suggested per capita spending would increase.

[ShockerPrez]

Is healthcare more necessary than water? Why not single payor for water first?

[Aargh]

Is healthcare more necessary than water? Why not single payor for water first?

Not many people get a catastrophic water bill.