Reply
 
Thread Tools Display Modes
  #51  
Old 09-20-2017, 09:55 AM
DigitalC DigitalC is offline
Guest
 
Join Date: Nov 2006
Location: Obamatopia
Posts: 9,882
Quote:
Originally Posted by adaher View Post

So to sum up, it must be budget neutral, funded sustainably, honestly sold, completely transparent, and the right to pay for alternatives must be preserved.
You expect the Democrats to be entirely transparent and honest otherwise you are going to join the side that will be blatantly lying to oppose them? Whatever the Republicans do to oppose single payer or whatever program Democrats want to propose will be based entirely of lies propaganda and complete fabrications. And they will do that because IT WORKS.
Advertisements  
  #52  
Old 09-20-2017, 10:45 AM
Velocity Velocity is offline
Guest
 
Join Date: Jun 2014
Posts: 10,036
5% income taxes to pay for single-payer + retroactive penalties for hospitals who overcharged in the past + a modest deductible to deter misuse of the system + measures taken to prevent long wait times for specialists like in the UK or Canada.
  #53  
Old 09-20-2017, 03:00 PM
jasg jasg is online now
Charter Member
 
Join Date: Nov 2001
Location: Upper left hand corner
Posts: 4,314
Quote:
Originally Posted by asahi View Post
If there's an unintended silver lining of single payer healthcare that might please conservatives, it's that even progressives in California might be forced to take a tougher stance on illegal immigration.
I have never been able to understand this objection.

In every UHC system I have heard of, you need a national healthcare ID card. For that matter, I have one - my Medicare card. Why aren't we already overrun with illegal seniors taking advantage of free Medicare?

Last edited by jasg; 09-20-2017 at 03:01 PM.
  #54  
Old 09-20-2017, 03:13 PM
Snowboarder Bo Snowboarder Bo is offline
Guest
 
Join Date: May 2005
Location: Las Vegas
Posts: 20,033
Quote:
Originally Posted by jasg View Post
Why aren't we already overrun with illegal seniors taking advantage of free Medicare?
I greased the steps, the ramps AND the handrails.



Seriously tho, I'd be interested in seeing this question deflected answered by asahi.

Last edited by Snowboarder Bo; 09-20-2017 at 03:15 PM.
  #55  
Old 09-21-2017, 07:36 AM
adaher adaher is offline
Guest
 
Join Date: May 2003
Location: Florida
Posts: 27,064
Asahi is actually referring to California's proposed single payer plan, which would have covered undocumented immigrants. There's just no way to make that work, because under such a system you literally can just cross the border and go to a hospital. Even the most liberal economist would have sprayed his drink all over his screen reading about California's plan.

I'd also note that most single payer plans aren't run by the national government. Decentralization has been most countries' friend in this regard. Doing a national system in a country this big would truly be unprecedented. Canada didn't choose that route, why would we?
  #56  
Old 09-21-2017, 08:10 AM
Ravenman Ravenman is offline
Charter Member
 
Join Date: Jan 2003
Location: Washington, DC
Posts: 21,565
Quote:
Originally Posted by adaher View Post
There's just no way to make that work, because under such a system you literally can just cross the border and go to a hospital.
Unless you had to show something like a state-issued card to receive non-emergency medical services. I guess you're right, it is totally impossible to implement such a complex program.

I mean, think of the logistics involved! Someone has to design a membership card. And write specific numbers on it. And have some sort of "computer program" that links the numbers with a person. And then hospitals have to have someone look at the card, and maybe even enter the numbers in a computer! And who is to say that the finance departments of hospitals even HAVE computers?!?!
  #57  
Old 09-21-2017, 09:42 AM
Caldazar Caldazar is offline
Guest
 
Join Date: Aug 2000
Posts: 770
Quote:
Originally Posted by Ravenman View Post
Unless you had to show something like a state-issued card to receive non-emergency medical services. I guess you're right, it is totally impossible to implement such a complex program.

I mean, think of the logistics involved! Someone has to design a membership card. And write specific numbers on it. And have some sort of "computer program" that links the numbers with a person. And then hospitals have to have someone look at the card, and maybe even enter the numbers in a computer! And who is to say that the finance departments of hospitals even HAVE computers?!?!
This still doesn't solve the problem, because the California plan requires that enrollment be free. So you cross into California, enroll for free, and then get your services without having paid taxes to support the system. From California SB-562:

Quote:
"Resident" means an individual whose primary place of abode is in the state, without regard to the individual’s immigration status.

Every resident of the state shall be eligible and entitled to enroll as a member under the program.

A member shall not be required to pay any fee, payment, or other charge for enrolling in or being a member under the program.

A member shall not be required to pay any premium, copayment, coinsurance, deductible, and any other form of cost sharing for all covered benefits.
So yes, you can free-load under such a proposed system so long as you can whip up fake documents showing some evidence of residency. Which is a lot easier to do that coming up with a fake driver's license plus social security card (work eligibility), although of course the latter does happen as well.

There are sound ways and unsound ways to implement a single-payer system. I would argue that California's plan falls into the latter category, for this and other reasons.
  #58  
Old 09-21-2017, 10:41 AM
adaher adaher is offline
Guest
 
Join Date: May 2003
Location: Florida
Posts: 27,064
Quote:
Originally Posted by Ravenman View Post
Unless you had to show something like a state-issued card to receive non-emergency medical services. I guess you're right, it is totally impossible to implement such a complex program.

I mean, think of the logistics involved! Someone has to design a membership card. And write specific numbers on it. And have some sort of "computer program" that links the numbers with a person. And then hospitals have to have someone look at the card, and maybe even enter the numbers in a computer! And who is to say that the finance departments of hospitals even HAVE computers?!?!
If illegal immigrants are covered, then you can just get the card. Any foreign national can just show up, get a card, go get a hip replacement.
  #59  
Old 09-21-2017, 10:44 AM
adaher adaher is offline
Guest
 
Join Date: May 2003
Location: Florida
Posts: 27,064
Quote:
Originally Posted by Caldazar View Post
This still doesn't solve the problem, because the California plan requires that enrollment be free. So you cross into California, enroll for free, and then get your services without having paid taxes to support the system. From California SB-562:



So yes, you can free-load under such a proposed system so long as you can whip up fake documents showing some evidence of residency. Which is a lot easier to do that coming up with a fake driver's license plus social security card (work eligibility), although of course the latter does happen as well.

There are sound ways and unsound ways to implement a single-payer system. I would argue that California's plan falls into the latter category, for this and other reasons.
This weird idea that Sanders and many progressives have of no co-pays and no premiums and no limitations on coverage is also rather batty.

Hey, let's provide the most generous health care benefits in the world, and then be surprised at how much it will cost and then scrap the whole thing! Which is what they did.
  #60  
Old 09-21-2017, 11:26 AM
Caldazar Caldazar is offline
Guest
 
Join Date: Aug 2000
Posts: 770
Quote:
Originally Posted by adaher View Post
This weird idea that Sanders and many progressives have of no co-pays and no premiums and no limitations on coverage is also rather batty.

Hey, let's provide the most generous health care benefits in the world, and then be surprised at how much it will cost and then scrap the whole thing! Which is what they did.
Applicable to the California plan, but I don't feel that's an accurate portrayal of Sanders' latest "Medicare For All" bill ( S.1804 ). In S.1804, it does call for the Center for Clinical Standards and Quality to make determinations on what's considered medically necessary and for HHS to establish fee schedules, as is typical for UHC systems.

No cost estimate, though. For services currently covered by Medicare, I imagine you can just use existing coverage as a starting point to calculate those costs, minus some scaling factor to account for "improved efficiency" or what have you. But S.1804 adds additional coverage items on top, and there's no real guidance on what will and will not be covered for these new categories of covered treatments.

I do agree with the sentiment that this is just an intellectual exercise, with no real chance of being implemented in the foreseeable future.
  #61  
Old 09-21-2017, 11:53 AM
septimus septimus is offline
Guest
 
Join Date: Dec 2009
Location: The Land of Smiles
Posts: 14,411
I thank adaher for asking these questions. Still I'm unclear whether his underlying message is "I really want single-payer; here's how we can cooperate to get it." Or is the message "You can't have single payer; here's why." ?

Here are my 2˘:

* Some of the big advantages of single-payer are reduced costs and regulated costs. Won't a parallel system of private insurers interfere with that? Isn't the success of Canada's single-payer due in large part to prohibitions against private payments?

* If some states create state-wide single payer and other states do not, Americans with pre-existing conditions will have incentive to move to a UHC state. Is this considered a problem? (I suppose healthy people would have an incentive to move away from the UHC state.)

* What happens to existing employer-sponsored insurance for workers and retirees? If they're voided, the employees will suffer a sudden surge in payroll taxes, with their salaries still lower than normal to reflect benefits that are no longer paid.

* The Tobin tax can not be used as a major revenue source. (I support Tobin tax because it reduces liquidity, not despite it! Recent financial crises have resulted from obsessively excessive liquidity.)

Quote:
Originally Posted by Richard Parker View Post
The lesson the Democrats are taking from 2016 is that you shouldn't run on white papers. You should run on big ideas without being forthright about costs, tradeoffs, and political difficulties.
I agree that U.S. politics are increasingly dysfunctional. I think this is due to the powerful influence of money in opinion formation. Political progress will not be easy in the U.S. until the dumbing-down of politics is reversed. As is, with political discourse at 4th-grade level, politicians no longer even try to fool sixth-graders, as in this example:
Quote:
Originally Posted by Fiveyearlurker View Post
“I think single payer is a mistake and I think it would be bad for a blue state,” [a Senator strongly supporting "states' right"] told reporters on Capitol Hill. “That’s part of my job in the United States Senate, to make value judgments like that.”
Finally,
Quote:
Originally Posted by Evan Drake View Post
The Media expected Trumpo to lose until the moment he didn't.

And then their tiny shrivelled black hearts broke.
What?
  #62  
Old 09-21-2017, 01:25 PM
Evan Drake Evan Drake is online now
Guest
 
Join Date: Nov 2016
Posts: 2,558
Quote:
Originally Posted by Ravenman View Post
Unless you had to show something like a state-issued card to receive non-emergency medical services. I guess you're right, it is totally impossible to implement such a complex program.

I mean, think of the logistics involved! Someone has to design a membership card. And write specific numbers on it. And have some sort of "computer program" that links the numbers with a person. And then hospitals have to have someone look at the card, and maybe even enter the numbers in a computer! And who is to say that the finance departments of hospitals even HAVE computers?!?!

Every subject in Britain is issued with an NHS number, very probably at birth ( unlike the National Insurance number, for work/taxes which one applies for after school ) so one then gets free treatment for most things.

Of course emergency treatment is available for all in the country, subject or not.


It's all most humiliating having a number as a condition for getting free stuff; just like as if they were to issue you a number in the army. Faceless civil servants directing nameless cyphers in the brutal Orwellian machine, instead of the warm and fuzzy welcoming understanding of efficient American bureaucracy.


"Would you like cookies with that ?"


Quote:
Originally Posted by Caldazar View Post
This still doesn't solve the problem, because the California plan requires that enrollment be free. So you cross into California, enroll for free, and then get your services without having paid taxes to support the system. From California SB-562:

Our European neighbours and ourselves have reciprocal agreements. So we don't get a lot of Swiss and Italians sneaking in. We have illegal immigrants, but them getting free healthcare is one tenth of the concern over the future water supply.



Quote:
Originally Posted by adaher View Post
If illegal immigrants are covered, then you can just get the card. Any foreign national can just show up, get a card, go get a hip replacement.

Doesn't seem to happen here.
  #63  
Old 09-21-2017, 03:29 PM
Ravenman Ravenman is offline
Charter Member
 
Join Date: Jan 2003
Location: Washington, DC
Posts: 21,565
Quote:
Originally Posted by adaher View Post
If illegal immigrants are covered, then you can just get the card. Any foreign national can just show up, get a card, go get a hip replacement.
By the text linked to earlier, residents are eligible for service regardless of immigration status. That doesn't mean that everyone is a resident, regardless of immigration status. It just means that Mexican citizens who live in California are treated like American citizens living in California; and Mexican citizens who live in Mexico are treated like American citizens who live in Oregon.

Mind you, I'm not saying I think this policy is necessarily wise. But your criticism that anyone can pop over the border at their whim and have tons and tons of medical care is valid.
  #64  
Old 09-21-2017, 06:40 PM
Anny Middon Anny Middon is online now
Guest
 
Join Date: Oct 2012
Posts: 739
Quote:
Originally Posted by asahi View Post
I don't see single payer happening in the United States without some sort of economic catastrophe first, and by a catastrophe, I mean something that would be so cataclysmic that it would essentially liquidate much of corporate America and froce a redistribution of economic and political power. As it is now, any single payer measure would be amended and watered down so as to be ineffectual. I doubt we'd have the ability to get most Americans to agree to the taxes to finance a single payer startup under seemingly 'normal' circumstances. Meanwhile, we have other entitlement systems like social security and then there's the military behemoth.
Why doesn't corporate America support single payer? If that happened, no economic catastrophe would be necessary.

Suppose a case was presented to large employers that the payroll tax they'd have to pay for single payer would be significantly (like, say, 20%) lower than what they are typically paying in health care premiums. Plus of course they can get out of the whole business of administering health care insurance, which is a monumental pain in the butt.

The only reason I came up with as to why corporations wouldn't be lining up for such a deal is that they'd think they were losing flexibility. But let's face it -- most of that flexibility is illusory.
  #65  
Old 09-21-2017, 08:39 PM
bizzwire bizzwire is offline
Guest
 
Join Date: Feb 2001
Location: right behind....YOUR EAR!
Posts: 1,662
One aspect that seems to always be overlooked in these discussions is that companies will no longer have to provide health insurance to their employees. My previous employer paid 75% of my monthly premiums. Multiply this by all the workers currently covered by employer contributions, and you have a yuuuuge pool of 'free money' that is now available for reinvestment (or massive bonuses). Anyone have an idea of how that would stack up against corporate tax breaks?

Last edited by bizzwire; 09-21-2017 at 08:41 PM. Reason: Crap...just saw Anny's post....never mind.....
  #66  
Old 09-21-2017, 09:14 PM
adaher adaher is offline
Guest
 
Join Date: May 2003
Location: Florida
Posts: 27,064
Quote:
Originally Posted by septimus View Post
I thank adaher for asking these questions. Still I'm unclear whether his underlying message is "I really want single-payer; here's how we can cooperate to get it." Or is the message "You can't have single payer; here's why." ?
It's neither, actually. What I've come to realize since the REpublicans took over everything is that we're going to have to have universal health care. So now it becomes a matter of how best to deliver it. ACA has advantages over single payer and single payer has advantages over ACA. The biggest advantages of single payer are that it is undoubtedly constitutional, whereas ACA had some infirmities in that regard, and it's the cheapest solution. ACA's best aspects are competition, choice, and less of a government funding commitment than single payer would entail. I believe the cost of ACA right now is something like $120 billion/year for the government's share, whereas single payer would end up costing at least 10 times that.

My own preference would probably lean towards fixing ACA now, but I don't think either party is really invested in that law. The GOP hates it and Democrats are already looking beyond it. So we'll have to see how the single payer fight goes first, plus what condition ACA is in, when the dust settles.



Quote:
* If some states create state-wide single payer and other states do not, Americans with pre-existing conditions will have incentive to move to a UHC state. Is this considered a problem? (I suppose healthy people would have an incentive to move away from the UHC state.)
Canada isn't far. I don't see this as much of a problem, provided states have strict residency requirements.
  #67  
Old 09-21-2017, 09:15 PM
adaher adaher is offline
Guest
 
Join Date: May 2003
Location: Florida
Posts: 27,064
Quote:
Originally Posted by Ravenman View Post
By the text linked to earlier, residents are eligible for service regardless of immigration status. That doesn't mean that everyone is a resident, regardless of immigration status. It just means that Mexican citizens who live in California are treated like American citizens living in California; and Mexican citizens who live in Mexico are treated like American citizens who live in Oregon.

Mind you, I'm not saying I think this policy is necessarily wise. But your criticism that anyone can pop over the border at their whim and have tons and tons of medical care is valid.
It is, because how does an illegal immigrant prove residency. Also when dealing with illegals, you have the issue of trusting whatever documentation they do provide. California's history suggests they won't be too concerned about checking.
  #68  
Old 09-21-2017, 09:18 PM
adaher adaher is offline
Guest
 
Join Date: May 2003
Location: Florida
Posts: 27,064
Quote:
Originally Posted by Anny Middon View Post
Why doesn't corporate America support single payer? If that happened, no economic catastrophe would be necessary.

Suppose a case was presented to large employers that the payroll tax they'd have to pay for single payer would be significantly (like, say, 20%) lower than what they are typically paying in health care premiums. Plus of course they can get out of the whole business of administering health care insurance, which is a monumental pain in the butt.

The only reason I came up with as to why corporations wouldn't be lining up for such a deal is that they'd think they were losing flexibility. But let's face it -- most of that flexibility is illusory.
Corporate America probably would support single payer if it substantially reduced their costs. The problem is that most American single payer plans feature corporations and rich individuals bearing 90% of the cost, which means they pay a lot more than they do now. I'm sure if Europe could have funded UHC that way, they would have. But politically it's a nonstarter and the funding numbers don't work out in any case.

Put forward a plan where UHC is primarily funded by a social insurance tax or sales tax, and that would probably gain a lot of corporate support.
  #69  
Old 09-21-2017, 09:31 PM
adaher adaher is offline
Guest
 
Join Date: May 2003
Location: Florida
Posts: 27,064
BTW, one overlooked aspect of single payer that I think Republicans should fight for if single payer appears to be inevitable, is enhancing state sovereignty by funding it in part by elimination of all federal funding to states. States should still see a huge spending reduction because they will no longer be responsible for Medicaid spending. The feds could defray some of that cost by eliminating all money to states and every state should still come out well ahead. And states would no longer be dependent on the federal government for anything and could be freer to implement their own policies on a variety of issues.

I don't know about GOP politicians, but I think if you made that kind of offer that a lot of conservative/libertarian intellectual types not in politics would be intrigued.

Last edited by adaher; 09-21-2017 at 09:31 PM.
  #70  
Old 09-21-2017, 09:31 PM
E-DUB E-DUB is offline
Guest
 
Join Date: Mar 2013
Posts: 3,014
Quote:
Originally Posted by Evan Drake View Post
The Media expected Trumpo to lose until the moment he didn't.


And then their tiny shrivelled black hearts broke.
EVERYBODY expected trump to lose. He even expected it himself given all the "rigged election talk he was putting out there beforehand.
  #71  
Old 09-21-2017, 09:54 PM
gtyj gtyj is offline
Guest
 
Join Date: Sep 2017
Posts: 2
Quote:
Originally Posted by asahi View Post
I don't see single payer happening in the United States without some sort of economic catastrophe first, and by a catastrophe, I mean something that would be so cataclysmic that it would essentially liquidate much of corporate America and froce a redistribution of economic and political power. As it is now, any single payer measure would be amended and watered down so as to be ineffectual. I doubt we'd have the ability to get most Americans to agree to the taxes to finance a single payer startup under seemingly 'normal' circumstances. Meanwhile, we have other entitlement systems like social security and then there's the military behemoth.
I think you might be right. One thing to remember with our health insurance system is that, dysfunctional as it seems, about 91% of America is covered with something, either private or public, and 90% of them are OK with what they have. And even though everyone complains about our health-care system, the vast majority of people are OK with what they themselves have. So, single-payer would be a huge reorganization of part of the economy where probably 4 out of 5 people are OK with what they have. In any other topic, that would be a gigantic consensus. But in healthcare, it's considered a problem, because other countries have 100% universal coverage, and the like.

Personally, I like not having single-payer. I don't want it. But it's not the Bolshevik plot that some make it out to be. Single-payer is a real thing that can work, as has been shown in other countries. I just happen to like the US system, which while not perfect, is very dynamic with great doctors, and some very good innovative care, etc. I think our system evolved as a patch-work, and that's fine with me. We should add another patch to the quilt, and get the coverage up above 95%. That, to me, would be the next logical step.
  #72  
Old 09-22-2017, 04:16 AM
Quartz Quartz is online now
Charter Member
 
Join Date: Jan 2003
Location: Home of the haggis
Posts: 27,154
Quote:
Originally Posted by bizzwire View Post
One aspect that seems to always be overlooked in these discussions is that companies will no longer have to provide health insurance to their employees.
It will end up as tax to pay for UHC.
__________________
Quartz
  #73  
Old 09-22-2017, 07:20 AM
Ravenman Ravenman is offline
Charter Member
 
Join Date: Jan 2003
Location: Washington, DC
Posts: 21,565
Quote:
Originally Posted by adaher View Post
It is, because how does an illegal immigrant prove residency. Also when dealing with illegals, you have the issue of trusting whatever documentation they do provide. California's history suggests they won't be too concerned about checking.
So you are asserting that California will not check the residency of suspected Mexican residents to the same degree they will check the residence of suspected Arizona residents?
  #74  
Old 09-22-2017, 08:31 AM
bizzwire bizzwire is offline
Guest
 
Join Date: Feb 2001
Location: right behind....YOUR EAR!
Posts: 1,662
Quote:
Originally Posted by Quartz View Post
It will end up as tax to pay for UHC.
Are you suggesting that instead of pocketing that money, they would hand it over to the government to pay for UHC? Such a scenario would still be revenue-neutral to my company (who would pay that money to the government instead of an insurer). I wouldn't have to pay my insurance contribution (giving me a 7% increase in take-home pay), and a large part of the tax burden to pay for universal coverage would be reduced. Let's say the tax cost is an additional 7%. That would mean that my company doesn't pay any additional money than it already does, I would take home the same amount of money, and everyone gets health care.

I think you're on to something here....
  #75  
Old 09-22-2017, 08:29 PM
jasg jasg is online now
Charter Member
 
Join Date: Nov 2001
Location: Upper left hand corner
Posts: 4,314
Quote:
Originally Posted by bizzwire View Post
Are you suggesting that instead of pocketing that money, they would hand it over to the government to pay for UHC? Such a scenario would still be revenue-neutral to my company (who would pay that money to the government instead of an insurer). I wouldn't have to pay my insurance contribution (giving me a 7% increase in take-home pay), and a large part of the tax burden to pay for universal coverage would be reduced. Let's say the tax cost is an additional 7%. That would mean that my company doesn't pay any additional money than it already does, I would take home the same amount of money, and everyone gets health care.

I think you're on to something here....
Also, corporate America is then freed from annual negotiations with insurers and having to deal with employee questions about healthcare. HR departments from coast to coast would cheer.

IMHO, the push here might come from small business - rate changes and hassle for small firms is much greater than for firms with a large risk pool. Plus rates for small firms is rising faster and as a result the number of small firms offering healthcare is falling.

I am not sure employee take home pay would rise but employee healthcare costs could stabilize.
  #76  
Old 09-23-2017, 12:20 AM
adaher adaher is offline
Guest
 
Join Date: May 2003
Location: Florida
Posts: 27,064
Quote:
Originally Posted by Ravenman View Post
So you are asserting that California will not check the residency of suspected Mexican residents to the same degree they will check the residence of suspected Arizona residents?
No, they'll just verify residency with exactly as much rigor as they verify it on their voting rolls. In other words, the honor system.
Reply

Bookmarks

Thread Tools
Display Modes

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is Off
HTML code is Off

Forum Jump


All times are GMT -5. The time now is 04:46 PM.

Powered by vBulletin® Version 3.8.7
Copyright ©2000 - 2017, vBulletin Solutions, Inc.

Send questions for Cecil Adams to: cecil@chicagoreader.com

Send comments about this website to: webmaster@straightdope.com

Terms of Use / Privacy Policy

Advertise on the Straight Dope!
(Your direct line to thousands of the smartest, hippest people on the planet, plus a few total dipsticks.)

Publishers - interested in subscribing to the Straight Dope?
Write to: sdsubscriptions@chicagoreader.com.

Copyright © 2017 Sun-Times Media, LLC.

 
Copyright © 2017