The most common arguments against single-payer UHC are:
It would put insurance companies and many workers out of business. (But that’s what happens any time there is a major change for the better. The automobile put horse-drawn carriages out of business.)
It’s never been done before in America. (Everything has never been done until it’s done for the first time. Prior to Obama being elected, a black person had never been elected president.)
It would mean that people would be paying for other people’s healthcare, since your tax dollars would be used to pay for someone else’s treatment. (But that’s exactly how private insurance works, too.)
I’m leaving Republicans out of this thread since they obviously would never be the first ones to push for single-payer UHC, so there’s no point in talking about the GOP here. But Democrats have had decades to push for this and yet there’s nary hardly a peep, save for the isolated few progressive voices like Ocasio-Cortez and Bernie Sanders.
What is the price Democrats stand to pay for passing single-payer UHC? Have any insurance companies threatened them if they dare push for UHC? The number of American voters who would benefit from single-payer far exceed any number of health insurance workers or execs who would be put out of a job.
The political hurdle is just too high. You’d never get this unless you had Democrats in charge of everything, plus a filibuster-proof senate. Plus, you’d need all the Dems signed up to approve it.
You would also have major pushback from lobbyists from health insurance companies, drug companies, and hospitals/doctors. The US’ political system isn’t equipped to go to single-payer, even if you wanted it. And the public, much as they might be frustrated with our current system, would not want to give up a private option.
To me, the next move is to expand Medicare to more ages. Maybe make it available to age 60+. Maybe make it available to children. This would incrementally move the needle in the direction you’re talking about.
The ultimate US system will probably be a combination of public/private, like we have now, with more holes hopefully plugged.
BTW, I’m not personally against single-payer anymore. But I don’t ever see it happening politically.
That’s really the biggest reason to be against single-payer, because it’s tilting at windmills.
Far better to come up with something that works with/within our current system because it’s far more likely to be palatable, than to try and overturn the whole thing and replace it. One’s got a lot more chance of happening than the other.
IMO, the biggest hurdle to changing the system is proving conclusively that for most people who actually vote and pay taxes, that they will pay the same or less, and get the same standard of care or better. This means the middle/upper middle class, since as always they’re likely going to be footing the bill for the whole thing.
Yeah, the argument is that it won’t pass, because it won’t pass. You are asking hundreds of millions of people to give up their health plan for something unknown. Poison. The counter-plan is the public option, which conceivably could evolve into single payer or something much better than we have now. Start with Medicare being offered to everyone 50 years or older if they want it. For example.
Interestingly the US has single payer: it’s called Medicare. The US also has socialized medicine, where the government owns hospitals and hires physicians: it’s call the Veteran’s administration. The US has fee for service insurance. The US has managed care. And the US has an economy where in effect 2% of it is devoted to getting someone else to pay the medical bills.
Yes. Americans like options and will vote for having one.
Add in a judicious breaking-up of corporations that control too large a chunk of the markets for insurance, pharmaceuticals, general medical care, assisted living, and all the rest of it. Let competition work as well as it can in these arenas (where information is not as transparent as it should be for true market-forces to work, but…even so).
Of course the entrenched interests will wield the S word to try to stop all this. But with the recent level of interest in changing the status quo, the S word may have lost some of its power.
Dems would need stellar communicators for all of this, of course. (Put Buttigieg on it.)
The UK provides a comparison and it’s increasingly a bad one. The system has been underfunded for years, doctors are overworked and underpaid (new doctors start at £25,000, less than a living wage in London), specialists have huge waiting lists, and so on.
Creating a trillion dollar bureaucracy from scratch would take years and the switchover would awful even with the best possible intentions. The bigger and more entrenched the institution, the harder it is to replace it. Our total medical system is gigantic and deep. It would take a generation.
UHC is possible only if there were overwhelming public support from all sides. Democrats approve overwhelmingly, Republicans disapprove overwhelmingly. 72% of Democrats, 13% of Republicans support government-run system. UHC can’t win today. Wait until the country collapses; maybe things will change.
Your argument why Democrats shouldn’t support it is that it would be hard to accomplish? By that measure, we should never have adopted Social Security, Medicare, the Voting Rights Act or equal marriage.
That’s a spurious argument (not that I’m saying that you’re making it), because today, the insurance companies are controlling what gets paid for. So, those decisions are already being made by people with whom many Americans disagree, and who are already often rejecting coverage for particular treatments and drugs.
The UK has similar outcomes to the US, at a fraction of the cost. Latest figures have the UK healthcare spending at 11.3% of GDP (way up relative to the last time I looked) and the US at 16.6% of GDP.
Also, the UK is not single payer. Single payer = Medicare for all. It does not mean that the US takes over hospitals and makes physicians into government employees.
Well, certainly Republicans are against anything that would move us closer to UHC. Also, keep in mind that UHC & Single-Payer aren’t the same thing. We could get to UHC eventually even if we don’t go single-payer. And in fact, my guess is that we’ll always have multiple-payer type system, given how our system has evolved.
I think it’s something that’s part of the equation, and must be considered when analyzing options for UHC. True single-payer for the entire country will probably never happen, due to politics. I think the way forward, because of our political reality, is to do a hybrid system that eventually accomplishes UHC.
What if the single payer turns out to be unpopular? That would be quite bad for the Democrats, if they had championed it. I think having competing payers, each trying to win consumer satisfaction, is better.
However, I am skeptical of the wisdom of having for-profit payers. I believe that the Netherlands has had a good deal of discussion and decision-making on this:
While the NHS is a point of pride for many in Britain, every health care system has aspects that generate complaints. With any big change, there will be nostalgia for what came before. You want a system where the payers can improve things without an act of Congress — especially considering that half the time, the GOP controls Congress.
But we could start with Medicare- everyone like medicare, and it works. Increase the medicare tax limit to- no limit. Then lower the age to 60 or even 55. Then 55, then 50, then- you get the idea. Soon, everyone can get part A for free. Part B will have a modest fee, as usual.
Yep, Canada may be the way to look, but the NHS isnt working well.
…the UK system is “bad” because they are increasingly trying to break it in order to make it more like the US. They are doing the same thing here in NZ. Because:
the underfunding is the point. The public healthcare system is no longer able to do its job, forcing people to go private.
The UK system as it is right now is a terrible point of comparison. Because politicians so desperately want to be like the US system, and are willing to break their system, even letting people die in order to do so.
One thing about expanding Medicare is how to fund it to cover the additional expenses. It’s great to lower the age, but the payroll deduction would need to go up to pay for it. Getting the Medicare payroll deduction increased would likely be a big fight to get passed.
In my lifetime medicine has been almost entirely transformed from a service that tended to broken bones and colds to a gigantic system that provides insights and possible cures unthinkable when I grew up. This year I watched on a fluoroscope as a surgeon threaded wires into my spine with hopes of negating the nerves that were being pressed on by my crumbling spine. Spoiler. Didn’t work. My spine was too crooked to thread in the crucial second wire. In the process my body almost lifted off the table by the spasms produced. (No pain, but it stopped the procedure cold.) Three years ago other surgeons much more successfully transplanted blood vessels from my thigh to bypass heart arteries that were 90% blocked.
Any of a thousand other near miraculous advances could be mentioned, and any of tens of thousands of drugs for conditions not known or properly diagnosed in the 50s. Medicine as a field has expanded as fast or faster than computers. The frontiers of the field are astounding and should never be diminished.
These advances also took medicine out of the hands of the family doctor (now called primary care physician (PCP)) and into the hands of increasingly narrow specialists at fewer top of the heap hospitals. PCPs no longer know their patients because they are limited to 15-minute appointments, at which they function as little more than switch engines, referring patients to pharmacists to get those new drugs or specialists to get those new treatments. Nobody treats the whole body anymore. PCPs can’t possibly be expert enough in the hundreds of specialties to understand the underlying factors affecting bodies rather than responding to “it hurts here.”
We’ve built a system which rewards specialists with wildly expensive treatments and drives out doctors cheaply maintaining basic preventive health. The drive for ever-better medicine delivered by ever-more costly experts in the left kidney’s middle section has worked wonders while leaving half the population behind.
Making basic treatment available to everyone should be a possible outcome of the health care system, and does not have to accommodate every advance. Medicare and medicaid already already don’t pay for everything and anything. Doctors, though, have been screaming for years that they can’t survive on what Medicare pays them. They close their doors to Medicare patients, or close their practices, or become employees of big systems. Our system is underfunded - deliberately - today, with the half measures of a broken system, and couldn’t stand the stress of extending that system horizontally - to more people - or vertically - to cover more advances.
I know all about Big Pharma and for-profit chain hospitals and all the other issues on the non-governmental side, ripe with abuse. The government should not build their own. The failures of the VA hospital system should show that.
Money needs to pour into the system, and some of that money should be shifted from abusive elements in the current system. Where does the money come from and where does it go and who decides? The glib answer is Congress. But I don’t know a better one.
I was under the impression that most people in the UK were relatively happy with the NHS, but I haven’t looked at it recently or in detail.
In any case, the health care system in the UK has two characteristics that distinguish it from single-payer in Canada and both have the potential to be problematic.
The first is that it’s a two-tiered system, with a complete private system encompassing both private insurance and private hospitals alongside the public NHS. This is not necessarily fatal – it seems to work well enough in Germany, but with very tight regulation of both the public and private tiers. The risk is that the best doctors and facilities tend to migrate to the more profitable private tier.
The second difference is that within the public tier, doctors are salaried employees of the NHS, not independent practitioners. The potential problems with this model are obvious. It’s often not well understood that in the Canadian single-payer system, most doctors are either independent practitioners or perhaps part of an entrepreneurial limited partnership; they’re not government employees.
Yeah, I’ve read the same. Sounds like “conservatives” in the UK are taking a page from the Republican book. Purposefully wreck a government service, and then come in to argue that said government service needs “reform”. The US Post Office says hello.
What do you mean by “underfunded”? In the US, we spend about 17% of GDP on healthcare, which seems like a lot. I suppose if we went to Single-Payer, we could gain some efficiencies, and not have to spend as much overall as a country. Are you arguing that we can’t afford to make changes? If so, I don’t think I agree with that.