We already have a single-payer system that’s wildly popular (Medicare). Why can’t we just promote legislation that would take a baby step by changing Medicare eligibility from age 65 down to 64? Nobody would be forced to sign up, and the effects would be less catastrophic to insurers.
Same applies to dentistry, at least for routine dental inspections and treatment (serious/complicated cases would be referred to a hospital specialist). But one difference is that while GPs are the staunchest defenders of the NHS principles (having initially been the most sceptical/opposed), dentists have gone through waves of withdrawing from NHS contracts they don’t like, to the point that there have been times when in parts of the country where it’s difficult to find a dentist willing to take on NHS patients.
Come to think of it , there are reports of difficulty recruiting new GPs and of existing ones feeling burnt out from the responsibilities of managing a practice.
But we understand that such problems in the system are mostly the result of not enough money going in, the remedy for which lies in our hands - to vote in a government that will tax sensibly.
I’ll link to my old “Medicare for Most” plan, which builds on this notion.
Providers in the US are normally profitable because they pay inflated costs for labor, drugs, devices etc but are able to pass that off to an insurance system that is extremely bad at negotiating prices down and forcing hospitals in turn to negotiate their prices down. The government actually is effective at negotiating prices down but providers are able to compensate for this loss by overcharging the ineffective private insurance system rather than push those downward pressures down the chain.
In countries that aren’t broken, the government has price controls over most or all of the system, whether that’s through single payer, multipayer with all-payer-rate-setting or providers directly controlled by the government as in the UK’s NHS.
The concern obviously would be getting the private system to accept massive cuts, and thats a reason I would at least start with a universal buy in option for medicare along with private price controls as long as there’s a way to do that constitutionally.
I have Medicare AND Blue Cross.
My mother has an AARP/UnitedHealthcare Medicare Advantage plan.
Medicare is not usually single payer. Private insurers shield Medicare from a lot of the anger that would occur if they were the immediate gatekeeper. This is why Democrats should not want single payer, but, rather, mullti-payer UHC.
Thank you for the corrections. The potential migration of the best doctors and surgeons to the private sector is always a strong risk, and avoiding it is hard because it’s fundamentally contrary to the incentives of the free market. If the UK has managed to do it, then kudos to them. I’d have to be convinced it isn’t a problem, but you know the system there much better than I do.
It would absolutely not be the case in the US, where even now health care access and quality is highly stratified. The uninsured are right at the bottom, of course, but even the insured are stratified according to ability to pay. There are multiple tiers of insurance even from the same company, and a vast difference between poorly resourced HMOs or limited provider networks and top-tier insurance plans.
And at the very top is a new class of super-upscale concierge services. The New York Times ran an article about this a few years ago. I provide that link as my cite for the extract below, which I obtained when the article was still free, but it’s now paywalled and only for paid subscribers (not available even with a free sign-in).
Anyway, it’s no wonder that the super-wealthy fight tooth and nail against any form of universal health care, and especially single-payer.
Money has always made a big difference in the medical world: fancier rooms at hospitals, better food and access to the latest treatments and technology. Concierge practices, where patients pay several thousand dollars a year so they can quickly reach their primary care doctor, with guaranteed same-day appointments, have been around for decades.
But these aren’t the concierge doctors you’ve heard about — and that’s intentional.
Dr. Shlain’s Private Medical group does not advertise and has virtually no presence on the web, and new patients come strictly by word of mouth. But with annual fees that range from $40,000 to $80,000 per family (more than 10 times what conventional concierge practices charge), the suite of services goes far beyond 24-hour access or a Nespresso machine in the waiting room.
Indeed, as many Americans struggle to pay for health care — or even, with the future of the Affordable Care Act in question on Capitol Hill, face a loss of coverage — this corner of what some doctors call the medical-industrial complex is booming: boutique doctors and high-end hospital wards.
Tom Lehrer 60 years ago sang about a doctor who “specialized in diseases of the rich”. This is not conceptually new.
Although it may be more brazen now and as wealth inequality has grown, so has the the degree of medical extreme inequality.
Good point.
One thing that doesnt work in America (and in other nations) is “These other nations do this, so should we”.
Right, I believe the GOP and the MAGAs have tried like a dozen? time to repeal Obamacare. And trump has claimed several time he would repeal is and substitute a “great, fantastic” plan of his own- which he has never given any details on.
Biden got a decent gun control bill passed, and even has bipartisan support. And other stuff.
Yes, the Dems can get things done, but very controversial things are that much harder.
Exactly what I proposed earlier in this threat-- except I suggested 60- then 55, etc. Just take the cap off the medicare tax, and that more than pays for it. Getting it down to 50 shouldnt be a big issue.
What does that mean? The Social Security tax (AKA FICA) is paid only on the first $X of wages. For 2024 X = $168,600.
The Medicare tax is assessed on every dollar of wages with no limit.
You’re right, I phrased that badly. There is an additional tax for wages over $200K of ,9%. Make that more like 2%.
If we’re actually serious about progressive-izing taxation, step 1 is to stop treating wages one way and investment income another.
Make $500K in wages? Huge Medicare tax owed. Make $500K in investment income? Zero Medicare tax owed.
Fix that first.
And I say that as a guy wholly supported by investment income. My wage-earning days are over.
Well, at least start with capital gains the same tax rate as other income 9minus losses, of course.
But let’s start with Medicare taxes on all income, sure.
Product of the politics of the time. After WW2, the hospitals were in desperate need of repairing/upgrading and the only practicable source of funding was the government. (And politically after the victory “big government” wasn’t per se to be feared).
The senior hospital specialists would likewise find it very difficult to find the capital to set up full-scale research/teaching hospitals (even more so as medical advances gathered pace), and were brought in by setting their contracts to allow them some proportion of their time for private interests. Also likewise, GPs/family doctors carried on as self-employed contractors with the NHS, on fairly generous terms (and much less paperwork chasing bills). As the minister in charge said at the time “We stuffed their mouths with gold”.
Which is why the private sector exists in symbiosis with the NHS, as about 10% of the market. But whether anyone could do likewise from scratch nowadays - that’s another matter.
Path dependency is a huge factor in both history as it actually unfolds and in political possibility as it tries to steer that unfolding.
I don’t think “single payer” is necessarily the right answer, but it’s absolutely clear that the Democrats need to hammer the fact that the GOP has no solutions to our health care system, and want to actively make it worse by removing the few measures that have been put in place to make it better.
Here is list of issues and which party is trusted more to handle them: Which issues do Americans think the Democratic and Republican Parties do a better job handling? | YouGov
There are basically four on which the Democrats have an advantage: LGBTQ issues, Abortion, Health Care, and the Environment. I think 2024 showed that running on LGBTQ and abortion is not enough.
I think a strongly populist message of heavy regulation of for-profit insurance companies along with an option for all Americans to buy into Medicare at a younger age (maybe 55) would be very popular. Perhaps with some plans around creating opportunities for more doctors (subsidized medical school, massive increases in residency spots funded by Medicare, etc).
You can see the political opportunity in the somewhat ambivalent response to the UHC CEO shooting. Americans hate insurance companies way more than they hate Obamacare.
Paul Krugman’s most recent Substack (Health Insurance is a Racket - by Paul Krugman) lays out the details about health insurance works in the US. The main takeaway for the purpose of this thread is that people are, by-and-large, happy with the insurance they have.
So, if Democrats went in with a plan to change all of that, they would lose tons of voters. It would be a hugely losing position to take.
Can’t they just lead off by mentioning that, if you like your plan, you can keep it?
Thank you for linking this. Very good write-up from Krugman, and he makes a point that I and some others on here have made. A big impediment to Bernie’s “Medicare for All” is people’s view of their own coverage. This is why any change will be incremental.
I work tangentially to the health insurance industry – I’m in advertising, and have had health insurance companies (various Blue Cross and Blue Shields) over the past 20 years. I’ve read similar things in the past: most Americans who are under private health insurance generally like their coverage.
I don’t necessarily disagree with that, but as Krugman notes in that article, satisfaction with insurance is lower among people who aren’t in great health. I strongly suspect that most people who are happy with their private insurance have never really had to “pressure test” it (e.g., a high-risk pregnancy, a complex disease, etc.)
Plus, people on employer-based plans foot a small percentage of the total cost of their insurance, and a lot of them probably don’t truly understand how much their insurance really costs.
I think it kind of goes deeper than that.
Because of the tie to employment, health insurance is viewed as this territorial thing that you have to claim and protect for yourself. It’s beyond some big financial decision where some people decide the premium price is worth it even if they aren’t that rich and have to make sacrifices elsewhere. It’s something where people have to attain a certain status to have the option of good healthcare, and then if they get there they get the luxury of the premiums that go into it being largely invisible. I think people do know that the healthcare they pay a small amount into is actually costing them before the paycheck, but it hits a very different psychological place than it would if it functioned like other financial decisions.