Single Payer

[wufan]

Epinephrine is dirt cheap. Syringes are dirt cheap. No neep for an epipen. Learning how to self inject is easy, even for children.

Epinephrine + syringe is around $10.00. Epinephrine in a delivery device similar to the Epipen, but not name brand is about $60.00. My plant manufactures both in the millions per year.

[wufan]

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.

I meant the cost of quality. If prices go down services go down, and quality costs money.

About quality...those people with golden insurance programs aren't using more insurance than the total cost, so its cost neutral. If several individuals are getting way more procedures than expected, the premium will go up and viseversa. In effect, someone is already paying for it, so if you remove their insurance, the amount spent per person might go down, but not the cost of medical coverage for an individual.

On administrative efficiency, how are the health professionals going to bill someone without the administrators? See the discussion about billing and Medicaid. Are all the codes going to go away? If so, couldn't we do that now?

Edited to add last paragraph.

[Dan]

I'm just trying to figure out how I can make some money in this fiasco.

[MoValley John]

Epinephrine + syringe is around $10.00. Epinephrine in a delivery device similar to the Epipen, but not name brand is about $60.00. My plant manufactures both in the millions per year.

Screenshot_20170801-182621.jpg
This is what I use now. Ten bucks. I have a bee sting allergy. If I get stung, I swell up like Veruca Salt and can't breathe. I used to keep an epipen, but when it expired I got this. You have to ask your doctor to specifically prescribe preloaded epinepherine, a prescription for an epipen gets you an epipen, no substitutions.

[wufan]

There's a young billionaire hedge fund manager with a strange name (I can't remember) who bought the rights to a cancer-treatment drug and bumped the price from double digits to thousands per treatment. Epi-Pens had a huge price increase.

There isn't enough competition among many larger American industries for there to be an incentive for business to compete for customers by lowering prices. When the product is something vital to life and something for which the population will pay any price (water, health care), there is no incentive to lower prices. Have you ever head of anyone shopping for the lowest dollar heart surgeon? Have you ever tried to get an estimate for a medical procedure?

Do you believe that breweries (I'm only using breweries as an example) price their beer at the lowest possible price point in order to attract customers from competitors? Pricing pressure is almost invariably upward as long as market share remains in a desired range. One brewery raises their prices. Any competitors quickly follow suit. Market share will stay about the same, the higher profits will look good to investors, and management will get huge bonuses for raising profits.

The free market model is functioning about as well as the Trump Presidency.

Why is it that elective (cosmetic) plastic surgery and lasik have decreased in cost under free market? We comparison shop. You certainly don't have the opportunity to ER shop, so maybe we do need universal ER coverage, but if the hospital wants an MRI, that's about $3000. An outpatient facility will charge about $1800. Perhaps ERs should do what they do best and routine care should be comparison priced.

[SB Shock]

The anti-ObamaCare group has had 7 years to come up with a better solution and failed.

Lets be honest about the situation - the Republicans just can't do whatever they want, in fact their ability to do anything is very limited due to the split in the Senate. That is not saying if they had a filibusterer proof majority they would have a good plan, but their options are very limited and not very good.

The only way a better solution is going to be found is if their is a bipartisan group that emerges who want to develop a fix to improve the area of the ACA where their is common ground and fix those things they know are broken. It would mean compromise - which I don't see happening. Republicans see it as weakness if they reach across lines, Democrats see this as an opportunity to get power back if they do nothing.

[Aargh]

Lets be honest about the situation - the Republicans just can't do whatever they want, in fact their ability to do anything is very limited due to the split in the Senate. That is not saying if they had a filibusterer proof majority they would have a good plan, but their options are very limited and not very good.

The only way a better solution is going to be found is if their is a bipartisan group that emerges who want to develop a fix to improve the area of the ACA where their is common ground and fix those things they know are broken. It would mean compromise - which I don't see happening. Republicans see it as weakness if they reach across lines, Democrats see this as an opportunity to get power back if they do nothing.

The Republicans had many years to develop and tweak a plan. They had a lot more time to work on something than the time used to come up with ACA.

All that time was spent saying how bad ACA was and apparently doing nothing to come up with something better. When it was finally time for them to reveal their plan, the plan seemed to be to cut off insurance coverage for about 20 million people, reduce the amount of money spent on Medicaid, and then take the savings from that and use it to offset tax breaks for a small percentage of the populace that has very high incomes. That's the "better" plan that was developed over a 7-year period?

If they hadn't tied that tax cut to health reform, they might have been able to get the health portion worked out.

[wufan]

Well for an expectant mother EVERY OTHER MODERN INDUSTRIAL COUNTRY. Pasting this again for emphasis: https://ourworldindata.org/the-link-...nding-us-focus

So yeah...we have the highest life expectancy in the whole freaking world when you remove vehicular and gun related deaths....also we have the same healthy infant mortality rate as the rest of the world until about 1 month of age...so bad parents are likely the cause, or perhaps it's the fact that almost half of all children are born out of wedlock. http://www.huffingtonpost.com/darryl..._13463690.html

Healthcare is expensive, not bad in this country.

[wufan]

According to this, it's not clear that insurance expansion improves health: https://www.nytimes.com/2017/03/29/o...lifesaver.html

[WuDrWu]

The Republicans had many years to develop and tweak a plan. They had a lot more time to work on something than the time used to come up with ACA.

All that time was spent saying how bad ACA was and apparently doing nothing to come up with something better. That's the "better" plan that was developed over a 7-year period?

This is, what I think, frustrates both sides of the aisle, politically. Hammer the negative points that score votes, and MAYBE if there is time left over (basically never) talk about your plan to fix, replace or repair, or just do differently and better...and explain why (without belittling the other side, again, almost never).

@SB Shock: talks about what would have to happen for a fix....I think we all know the only way "moderates" will come together is if 20 or so agree to fund the others hot buttons. There will never be a bill where the GOP says if you cut A we'll cut B and then we're there. It's always the other way around.

A Senator's niece dies in a tragic swimming accident....the next year every businessman with a pool is out $1000 (and another $1000 each time that device goes out). That's all they mostly care about....what's important to themselves, and keeping their power, jobs and perks.


And just for the record @Aargh:, " the plan seemed to be to cut off insurance coverage for about 20 million people" is just false.

[wufan]

I actually think most senators/representatives come in with political ideals and good intentions. I believe that often times their principles and lack of compromise stop forward progress. I also believe that as they spend additional time in office, the principles tend to fade as the politics takes over. Term limits baby!

[SB Shock]

The Republicans had many years to develop and tweak a plan. They had a lot more time to work on something than the time used to come up with ACA.

All that time was spent saying how bad ACA was and apparently doing nothing to come up with something better. When it was finally time for them to reveal their plan, the plan seemed to be to cut off insurance coverage for about 20 million people, reduce the amount of money spent on Medicaid, and then take the savings from that and use it to offset tax breaks for a small percentage of the populace that has very high incomes. That's the "better" plan that was developed over a 7-year period?

If they hadn't tied that tax cut to health reform, they might have been able to get the health portion worked out.

The house had a plan and it was passed. You may disagree with it, but they passed their plan within the limits of the budget reconciliation bill - but with the Senate demographics it was DOA. So you get the "Skinny Repeal" in the Senate. Skinny repeal would remove the individual and employer mandate. It also removed some taxes that the ACA implemented. The loss in insured was projected based on people not being forced to take insurance opting out. Therefore the CBO then predicted a premium increase of 20-30% because only people buying insurance would be sick people, this in turnwould cause other who didn't find value or could not afford it to drop out.

The AHCA (which is what the House passed) got rid of the mandates, changed how premiums could be determined. Premiums were no longer determined if you were a smoker or what region you lived in, but age now was a the main factor. The subsidy to family was no longer determined by income, but age also factored in. Caps on medicaid were to be instituted as opposed to being open ended. It was also projected to reduce the government deficit by over $119 Billion. Yes it did have a tax cuts - but I guess that was to offset some of the 20+ tax increases that the ACA levied.
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[jdshock]

I meant the cost of quality. If prices go down services go down, and quality costs money.

I guess I still don't know what prices are going down. And I'm really not trying to play dumb. I'm talking about dollars expended per person on healthcare. That's the graph that caused me to say "I think we would see a decrease after switching to single payer," which caused your response. Those dollars could be paid out via insurance companies, via the government, or via an individual's pocket. None of the reasons that we would see a decrease per person had to do with prices.

About quality...those people with golden insurance programs aren't using more insurance than the total cost, so its cost neutral. If several individuals are getting way more procedures than expected, the premium will go up and viseversa. In effect, someone is already paying for it, so if you remove their insurance, the amount spent per person might go down, but not the cost of medical coverage for an individual.

I don't follow this logic. "The amount spent per person might go down" is exactly the argument that we're having. I responded to a graph about per person expenditures and that is the post you responded to. If you agree that "The amount spent per person might go down" like you said, then we do not disagree.

On administrative efficiency, how are the health professionals going to bill someone without the administrators? See the discussion about billing and Medicaid. Are all the codes going to go away? If so, couldn't we do that now?

Hospital administrators would still exist. Aetna would not. That eliminates a whole bunch of salaries that have to be paid for out of general spending on health care.

[ShockCrazy]

So yeah...we have the highest life expectancy in the whole freaking world when you remove vehicular and gun related deaths....also we have the same healthy infant mortality rate as the rest of the world until about 1 month of age...so bad parents are likely the cause, or perhaps it's the fact that almost half of all children are born out of wedlock. http://www.huffingtonpost.com/darryl..._13463690.html

Healthcare is expensive, not bad in this country.

That article asserts something without data, and then you go to the published paper and it does the same... Sooo again unless there is actual data to back this I am skeptical. The thing the article does is add in uncertainty levels, even with that USA barely climbed into the top 10 on the high end. In fact I did the math: 2,626,418 deaths in 2015, 15,696 homicides, and 35,092 auto deaths. So lets compare to say Norway which is middle of pack in life expectancy. The average life taken in order to account for the difference would have to have been 134.98 years younger than the average expectancy. And that's even before accounting for Norways homicide and auto death rate. So no it does not follow. Hell just looking at the numbers of roughly 50K versus 2.6 million it's pretty clear it is not responsible for the entire difference in life expectancy.

[Jamar Howard 4 President]

The reason the US has higher infant mortality rates, is because we have the most advanced technology to handle PREMATURE births! We have more premature births in the world, and we count each of those births as a live birth. In nearly every other country listed, a baby born less than 500 grams is not considered a viable child and their death is not counted against them! Many of those countries listed also consider a kid that dies within 24 hours to be a "stillbirth" (regardless whether it had a heartbeart) and does not count them in their statistic. Not the US -- we count every one of them. Our advanced medicine allows us to take on these substantially riskier efforts, and that shows up in our stats, while it is completely ignored in all those other countries.

If you have a child with a complication, there is absolutely no better place to be than in the U.S., period, and honestly, it's not even close.

Thank you. Thank you. Thank you.

I've been reading this thread just waiting for this to be said. Statistics are not kept the same way from country to country. For all the ugliness that is abortion in the U.S., we often forget that we do some things really well when it comes to babies prior to reaching full term. If a baby is going to be born multiple months early, the U.S. is absolutely the best place for it's chances. I fully admit that I can't back up the following statement with stats, but I'm convinced that culturally, the U.S. places MUCH more value on the life of a premie baby than most of these other "developed, civilized" countries that are being praised.

To put it bluntly, other countries are effectively saying "look at these freaks, they don't count", and then following that with pats on the back for how well they do with "normal" births. I mean, seriously, I'm a pretty good golfer if you excuse all those imperfect lies in the rough I get from time to time.

Some days, I just hate politics because it seems all the data is biased and there isn't any common ground set of good data to even begin honest discussions with.