Are there any good reasons why Democrats should not support single-payer universal healthcare?

Politics & Elections
21

As I said above, doctors are screaming that Medicare reimbursements are entirely inadequate.

Medicaid is generally well-liked, but its bureaucracy isn’t adequate. Eligibility is normally renewed annually but nobody got kicked off during Covid. That grace period ended in 2023 and millions of lower-class users got hurt in the ensuing tidal wave of reapplications.

In addition, while the VA system is good overall, a crisis seems to occur with fair regularly, and the move toward more “community care” or private networks is sucking up dollars.

Those are systems the government funds directly. All are underfunded, despite years of promises. Guaranteeing that additional programs be funded adequately and not just cost-cut after a few years is almost a dream. As always it devolves to “Where does the money come from?”

22

Yes, Medicaid (and perhaps Medicare) reimbursement rates are low, but for most hospitals, those two government programs might provide half or more of their patients. (If you want to prove that, talk to a hospital administrator who is preparing for a Joint Commission audit. Failing that would mean no more business from those programs, so they really nervous when one is expected.)

23

“Reform” or, more plainly, “privatization.”

So employers of people of the ages in question will now pay their Medicare payroll deductions INSTEAD OF paying UnitedHealth (or competitor), since people of those ages will now have Medicare. This would be a lot less money than employers are now paying out. That savings would enable the employer to pay the overage in raised Medicare deductions for their younger employees, too.

If this were to happen in the USA it would make more difference than almost anything else yet discussed.

Of course the US health insurers would threaten all politicians with turning off the donation-spigot. And that’s huge.

24

  1. Cutting administrative costs and profits: private health insurance costs massively more than Medicare. Hospitals have much greater billing costs dealing with a huge variety of insurance companies…

  2. Tort reform: all the lawsuits result in defensive medicine where doctors order huge numbers of unneeded tests, cat scans, MRI scans…

  3. Cutting futile care: The U.S. spends a massive amounts of money prolonging the very unpleasant dying process of people who can not be healed.

  4. Paying world market prices for drugs–instead of paying twice as much as Western Europe, for example.

25

Everything we talk about here would require a big fight.

Just getting rid of the cap on the payroll tax should be the easiest and least painful.

That could work. But my idea is easier, since employers wont have to pay hardly anything more.

26

I think you may find a lot of republicans behind UHC. I wouldn’t be surprised if Trump supported it.

27

I’ve mentioned this in one of the other numerous threads on health care: one of the effects of universal health care is to reduce litigation costs, without the need for tort reform.

Why? well, ask yourself: why do people sue doctors for malpractice?

Well, if they suffer from medical malpractice, they often need additional medical care to try to fix the problem causd by the first doctor. More surgery, more drug costs, etc.

And who picks up the tab for that additional medical care?

In the US system, the health insurance provider.

That company will likely be subrogated to the claim of the patient, and they can bring suit against Doctor #1 for the cost of the malpractice. Especially if the health insurance company is a for-profit entity, it will try to recoup at least some of its loss for the medical malpractice.

And if the second round of care isn’t covered at all, or just poorly, the patient will need to bring suit, because they are facing those medical bills for the efforts to fix the malpractice. The only way they can get compensated for that expense is to sue Doctor #1.

But what happens in a UHC system with single-payer? The patient doesn’t have any medical bills for the remedial medical care to fix the malpractice injury. Since the patient doesn’t pay out for the medical bills, and the single-payer pays for all medical care, regardless of the reason for it, there’s not nearly the same incentive to sue Doctor #1. It may be that the malpractice was serious enough to cause long-term or permanent damage, affecting the patient’s quality of life or ability to earn a living, so there’s still the potential for a law suit, but since there’s no medical bills, Doctor #1 is not facing the same magnitude of a claim.

Net result: medical malpractice suits are less common in countries like Canada or the UK.

That’s not to say that some changes to tort law wouldn’t help. The two big ones are pain & suffering, and punitive damages. In other common law countries, these two heads of damage are not nearly as extreme as in the US.

In Canada, for example, there is a judicial cap on pain and suffering, imposed by the Supreme Court in 1978. It was originally $100,000 in 1978, but has been adjusted for inflation so that the pain and suffering cap is now around $400,000.

There’s also a different attitude in the courts to punitives. The civil tort system is meant to compensate for injuries suffered. It’s not meant to punish. As result, punitive damages are rare in the common law provinces, and even more rare in Quebec, which uses the civil law. Multi-million dollar punitive awards are not a thing.

28

Not gonna argue with you, these are good suggestions.

They call for massive changes to the system, of course, but that’s what this thread is all about.

29

Austria, Belgium, Germany, Israel, the Netherlands, and Switzerland have multi-payer universal health care systems. Their costs tend to be a little on the high side but not dramatically out of line with single-payer systems, and their health outcomes are also similar.

There’s no need to have single-payer to have UHC, and the political obstacles to it may make a multi-payer system more practical.

30

Agreed - there’s different ways to achieve the universal health care. Single-payer is one option. Heavily regulated insurance companies is another, as your examples indicate.

31

I think a lot of people think UHC and single-payer are synonymous, when really there are all kinds of possible systems.

Sometimes I also find there’s a left-wing version of American exceptionalism at play; instead of “America’s special, we can’t do single-payer UHC like Canada”, it’s “America’s special, we can’t do multi-payer UHC like Germany”.

32

I agree. But there’s a crucially important caveat here. In order to be effective and efficient, and not get mired in the inextricably complicated and incredibly costly mess that is US health care, third-party multi-payer systems have to be very tightly regulated. The statutory public system in Germany, for example, is so tightly regulated that all the non-profit “sickness funds” are effectively the same, making it work much like single-payer.

The importance of this degree of regulation cannot be overemphasized, and the challenge of achieving it in the American sociopolitical climate is not much different than the challenge of achieving universal single-payer. Germany was committed to public health care since the time of Bismarck. The culture was already there. In America it isn’t and never was. In a political climate that just elected Trump a second freaking time, it seems impossibly far away.

I’ve long believed that the reason that Canada evolved a pure single-tier single-payer plan the way we did, with strict prohibitions against any form of private payment for medically necessary procedures, is because of the looming presence of the enormously powerful US health insurance industry right next door. Had the Canada Health Act not laid down foundational principles of single-payer, and we had chosen instead to go with regulated private insurance, American health insurers would have dropped in here like a ton ot bricks. They would not have so much “chipped away” at the regulations as completely demolished them.

33

It feels like this thread is morphing into “how could a socialized health system work in the US?” and is getting away from the original question about why Dems should or should not make that a priority in their future campaigning.

And for me, that answer is easy: socialized healthcare would be very good for Americans, and it would be very good for the country overall. Ripping out the bloated tapeworm that is the for-profit administrative framework nestled comfortably into the gut of the healthcare industry, sucking value out of it while returning next to no value of its own, would be a massive net positive. This much is obvious.

But it would be bad for Democrats.

Why? Because the ACA, while not perfect by any means (mostly because it just provides some ground rules for the existing for-profit system to eliminate its worst abuses, rather than ending it entirely, which is the best solution), represented a reasonable positive step forward on the day it was passed (we’ll disregard how it was rapidly defanged afterward)— but this didn’t stop the swollen parasite of the insurance industry from deploying its thousands of lobbyists to attack it, and it didn’t stop the fucking Republicans from immediately denouncing it as a “failure.” There is a solid, plausible case to be made that “Obamacare” is viewed as some level of disaster in the mind of the average voter, and that a not-insubstantial degree of the political gains made by Republicans in the years since have been achieved at least in part by banging the drum against the “failure” of Obamacare.

So if the Dems tried to pick up that ball again, and run it into the electoral end zone, they would be immediately confronted by the counterargument from the Asshole Right: “The Dems already screwed up Obamacare, do you, as a voter, really want to give them another shot at something even bigger and more complex?” It will be an avalanche of bald-faced lies, but when has that stopped these corrupt bloodsuckers and their greedy minions?

It’s that simple. It’s a loser issue for the Dems because the political and media culture in the US is so broken and poisoned and dishonest.

Unless and until something really deep and fundamental changes about how Americans receive and understand their political and economic news, healthcare reform— proper reform, in which the United States yanks out all the throbbing ticks and stomps them to death— will never happen.

34

I don’t disagree with any of this. But …

What you are saying applies to every area of policy not just health care. IOW, there is nothing Dems can do in the face of widespread counterfactual fantasy propaganda. Folding our tent and sneaking of into the night is the only play that “works”; all else is doomed ineffective tilting at the illusions fostered by the Right.

Which is a pretty despairing POV. Admittedly one I’ve shared a time or two myself.

35

I’ve believed for years that the US is already a failed state, and the only reason it isn’t obvious to everyone is that it takes a long, long time for something that big and complex, with that much inertia and that many moving parts, to completely collapse, and its status is therefore arguable.

I don’t expect everyone to share my belief, either. But I did move my family elsewhere so my kids would have a better go of it.

36

This is largely a propaganda problem, as are many issues that hound the Dems. Republicans control the flow of information - through their right-wing media & insane social media triggers - to a large percentage of this country. Most voters in the US are low information voters. That’s why people have told congressmen to “keep your government hands off my Medicare”. It’s why people in Kentucky liked their health plan off of the Kentucky exchange, but hated Obamacare. It’s also why people voted for Trump to tame prices & inflation even while he was promising huge tariff increases and to deport a substantial part of our workforce. Dems don’t have a way currently to reach these low-information voters. We’re geared toward talking to high-information voters in certain venues, and need to expand our reach.

An important point is that the policies that could be pursued around healthcare are good policies. We should pursue them over time. But it’s the communication & propaganda where we fall short.

37

Well, yes. Hence:

38

While I think it’s good to support a move to UHC, I don’t think the Democrats do a good job of considering how to get their policies accepted by the general public. It’s not enough to pursue noble goals. They also have to get enough people on board to make those goals a reality. If the voters aren’t ready for a big change, then make small, incremental changes that they’ll be more comfortable with.

For instance, I think that the crazy shift in the Republicans was exacerbated and accelerated by the ACA. The opposition to the ACA was one of the major contributing factors to the formation of the Tea Party movement. The Tea Party was able to successfully get wackos elected by strategic support of primary candidates which were far right. I feel that where the Republican party is now is from riding the wave of the Tea Party movement.

This is the kind of thing I worry about from Democrats supporting major social changes. While their heart is in the right place, they don’t seem to consider how to successfully navigate through the real-world opposition to their lofty goals. This allows the opposition to strongly push back, and sometimes push back so hard that things move backwards. From what I see in society, successful changes towards single-payer and UHC will need to be small changes that don’t rile up the conservatives enough to destroy the whole thing.

39

The Tea Party movement was an astroturf movement that occurred because of Obama’s election, and no other reason. They cloaked themselves in the language & concern about debt & deficits. But that was nonsense, and eventually they gave it up and mostly have hopped on board with Trump at this point, who is the opposite of a debt/deficit hawk.

The fact is the ACA was designed to be as minimally disruptive as possible, and was even based on a paper written by a wonk at the Heritage Foundation and later implemented by a Republican governor in Massachusetts. There is no way for Dems to communicate something that avoids “the crazy shift” on the Republican side. That shift was going to happen no matter what Dems said or did.

Dems need a better propaganda eco-system to combat the nonsense on the right. I’ll give you that, and that’s been talked about alot on this board, including by me. But we’re not playing on a normal political playing field, and that won’t change anytime soon.

40

Slight correction here

Actually, the facilities required for serious medical care usually come via the NHS. For example, should I require a heart bypass, I may get check-ups or recuperation at a private hospital, but the surgery itself will be at an NHS hospital with the same surgeon. Because consultants frequently work both privately and for the NHS. So there isn’t a brain drain to the private sector.

Whilst hospital doctors are employed directly by the NHS, GPs are not. GP practices are privately owned companies. What’s more hospital physicians and surgeons tend to work both for the NHS and privately (should they choose).