# Ben Carson: Abolish medicare and medicaid, replace them with $2000 vouchers **URL:** \ **Category:** The BBQ Pit\ **Created:** [October 24, 2015, 2:35pm UTC](https://boards.straightdope.com/t/ben-carson-abolish-medicare-and-medicaid-replace-them-with-2000-vouchers/735617 "2015-10-24T14:35:22Z")\ **Posts on this page:** 20\ **Page:** 2
**Author:** ![bobot](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bobot/32/21622_2.png) [@bobot](https://boards.straightdope.com/u/bobot)\ **Post date:** [October 24, 2015, 7:02pm UTC](https://boards.straightdope.com/t/ben-carson-abolish-medicare-and-medicaid-replace-them-with-2000-vouchers/735617/21 "2015-10-24T19:02:59Z")
I can not be bothered by whatever stupid shit Ben Carson says, because that guy is not achieving anything politically, and his dumb-fuck ideas will never impact me, or anyone else, in any way. It’s too bad I can’t say that about all of the Republican field, however, because one of those assholes is going to win the primary. ---
**Author:** ![Wesley\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wesley_clark/32/20581_2.png) [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)\ **Post date:** [October 24, 2015, 7:21pm UTC](https://boards.straightdope.com/t/ben-carson-abolish-medicare-and-medicaid-replace-them-with-2000-vouchers/735617/22 "2015-10-24T19:21:43Z")
> [@Stringbean](#): > > It’s not crappy, brutal, and evil, it’s just expensive. > > If you think it will be less crappy, brutal, evil, and expensive if managed by the government, then you own a philosophical disagreement with those who oppose single-payer. > > How do you suppose we will spend siginificantly less on healthcare, while still providing the same quality of care and access to treatment? > > The answer: pay our doctors less, and pay less for pharmaceuticals. > > The result: fewer doctors. Fewer new drugs. Fewer technological innovations. > > If that is the trade-off you seek, so be it. Others, like myself, see that as too much to give up, when moderate reforms are a wiser solution. > > Chronic demonization of a system that the vast majority of Americans believe works fine is not the way to win this debate. There are many valid reasons to call our system crappy brutal and evil: [ul] [li]It leaves 1/6 of the country uninsured[/li][li]Of insured people, it leaves such high copays, deductibles and loopholes that there is no guarantee you actually have coverage when you need it[/li][li]Health care is the #1 cause of bankruptcy[/li][li]Due to narrow networks, people are never sure if they are covered. Is the hospital covered but not the doctor, is the doctor covered but not the hospital? Is the procedure you thought was covered not covered? Other countries do not have this issue.[/li][li]Tons of red tape makes it hard for you or your doctor to determine what care to get[/li][li]We waste endless labor hours on administration[/li][/ul] And we manage to do all this while spending 2x as much as any other nation. Also medical R&D makes up $130 billion a year in the US. Of that, about 50 billion is public spending, about 80 billion in private spending. If our health system were as efficient as Israel or the UK, we would save 1.5 trillion a year. Even if you could prove conclusively that this would cut private medical R&D (it shouldn’t impact public R&D), it is still a good deal. If we lost $30 billion a year in private medical R&D but saved 1.5 trillion a year in spending, that is a great deal. If you don’t think it is a great deal, then send me $1,500 and I will mail you $30 back, then you can brag about your $30. Plus under the savings from a working health system, we could increase government funding for R&D via tax credits, subsidies, grants, research rewards, etc. etc. to make up for the loss. Also [here](http://www.oecd.org/newsroom/38976551.pdf) is a list of physicians per 1,000 people in OECD nations. As you can see, the US is in the lower third (not the top). Nation with far cheaper and more humane systems have more physicians per 1,000 people. If you want our system to be cheaper you need to do two things: 1. Stop providing medical care that provides little/no health benefit (30-50% of all health spending in the US doesn’t actually make people healthier) 2. Find a way to provide health care that offers a health benefit (the remaining 50-70%) for cheaper. Example, heart surgery costs 100k in the US but 2k in India. Find a way to do it for cheaper. Medicine that costs $200/month in the US may cost $70/month in France. however doing those 2 things requires taking on the rich powerful industries that control this country. No political group is going to do that anytime soon so we are stuck with a brutal, evil, overpriced system that victimizes people when they need help. ---
**Author:** ![Novelty\_Bobble](https://avatars.discourse-cdn.com/v4/letter/n/a3d4f5/32.png) [@Novelty\_Bobble](https://boards.straightdope.com/u/Novelty_Bobble)\ **Post date:** [October 24, 2015, 7:48pm UTC](https://boards.straightdope.com/t/ben-carson-abolish-medicare-and-medicaid-replace-them-with-2000-vouchers/735617/23 "2015-10-24T19:48:41Z")
> [@Stringbean](#): > > Probably because, as the OP cites, Medicare recipients get 3X more in healthcare services then they pay for. Right, they are old and have greater medical needs. Of course they should get more out the system than they put in. > [@](#): > > One would imagine that if they had to actually pay for what they are receiving, they would be less google-eyed with the actual cost of “free healthcare.” colour me confused. Elsewhere you state you have insurance. I’m suspecting that the reason you have that insurance is to cover you against those times when your medical needs outstrip your ability to pay. Are you saying that isn’t how it should work? Anyway, to an outsiders eye USA healthcare is a clusterfuck of horror. It should be a public service, essentially free at the point of delivery and funded by taxes or other capped and means-tested contributions. You know, like the other 99% of the first world (that have better outcomes than you and spend less of their GDP than you) People like you claim it can’t work in the USA (but never specify why) or that it will be too expensive (but never address the fact that everyone does it cheaper than you) or that your research and drugs industries will implode (but handily ignore the governmental and philanthropic advances in medicine) Health care should occupy the same place in the government remit as education, armed forces, police and judiciary, roads and infrastructure. I’ve never heard anyone come up with a decent argument for why it should be treated differently to those things and I suspect you won’t be the first. ---
**Author:** ![Budget\_Player\_Cadet](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/budget_player_cadet/32/205_2.png) [@Budget\_Player\_Cadet](https://boards.straightdope.com/u/Budget_Player_Cadet)\ **Post date:** [October 24, 2015, 8:07pm UTC](https://boards.straightdope.com/t/ben-carson-abolish-medicare-and-medicaid-replace-them-with-2000-vouchers/735617/24 "2015-10-24T20:07:20Z")
> [@Wesley\_Clark](#): > > There are many valid reasons to call our system crappy brutal and evil: > > [ul] > [li]It leaves 1/6 of the country uninsured[/li][li]Of insured people, it leaves such high copays, deductibles and loopholes that there is no guarantee you actually have coverage when you need it[/li][li]Health care is the #1 cause of bankruptcy[/li][li]Due to narrow networks, people are never sure if they are covered. Is the hospital covered but not the doctor, is the doctor covered but not the hospital? Is the procedure you thought was covered not covered? Other countries do not have this issue.[/li][li]Tons of red tape makes it hard for you or your doctor to determine what care to get[/li][li]We waste endless labor hours on administration[/li][/ul] > > And we manage to do all this while spending 2x as much as any other nation. > > Also medical R&D makes up $130 billion a year in the US. Of that, about 50 billion is public spending, about 80 billion in private spending. > > If our health system were as efficient as Israel or the UK, we would save 1.5 trillion a year. Even if you could prove conclusively that this would cut private medical R&D (it shouldn’t impact public R&D), it is still a good deal. If we lost $30 billion a year in private medical R&D but saved 1.5 trillion a year in spending, that is a great deal. If you don’t think it is a great deal, then send me $1,500 and I will mail you $30 back, then you can brag about your $30. > > Plus under the savings from a working health system, we could increase government funding for R&D via tax credits, subsidies, grants, research rewards, etc. etc. to make up for the loss. > > Also [here](http://www.oecd.org/newsroom/38976551.pdf) is a list of physicians per 1,000 people in OECD nations. As you can see, the US is in the lower third (not the top). Nation with far cheaper and more humane systems have more physicians per 1,000 people. > > If you want our system to be cheaper you need to do two things: > > 1. Stop providing medical care that provides little/no health benefit (30-50% of all health spending in the US doesn’t actually make people healthier) > 2. Find a way to provide health care that offers a health benefit (the remaining 50-70%) for cheaper. Example, heart surgery costs 100k in the US but 2k in India. Find a way to do it for cheaper. Medicine that costs $200/month in the US may cost $70/month in France. > > however doing those 2 things requires taking on the rich powerful industries that control this country. No political group is going to do that anytime soon so we are stuck with a brutal, evil, overpriced system that victimizes people when they need help. Massive props to Wesley for actually making the argument I was going for and would have made if: 1. This wasn’t the pit 2. I wasn’t responding to Stringbean 3. I was smarter ---
**Author:** ![jasg](https://avatars.discourse-cdn.com/v4/letter/j/f0a364/32.png) [@jasg](https://boards.straightdope.com/u/jasg)\ **Post date:** [October 24, 2015, 10:03pm UTC](https://boards.straightdope.com/t/ben-carson-abolish-medicare-and-medicaid-replace-them-with-2000-vouchers/735617/25 "2015-10-24T22:03:23Z")
> [@Wesley\_Clark](#): > > …however doing those 2 things requires taking on the rich powerful industries that control this country. No political group is going to do that anytime soon so we are stuck with a brutal, evil, overpriced system that victimizes people when they need help. Those industries are exactly those who would benefit from Carson’s plan. Hundreds of billions more as health insurance premiums and HSA investment accounts. Wall Street will love his plan. ---
**Author:** ![Broomstick](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/broomstick/32/246_2.png) [@Broomstick](https://boards.straightdope.com/u/Broomstick)\ **Post date:** [October 24, 2015, 11:38pm UTC](https://boards.straightdope.com/t/ben-carson-abolish-medicare-and-medicaid-replace-them-with-2000-vouchers/735617/26 "2015-10-24T23:38:30Z")
> [@Stringbean](#): > > It’s not crappy, brutal, and evil, it’s just expensive. No, it’s brutal, evil, AND expensive. Those most in need are least likely to have quality insurance, meaning they are the ones least able to access what is needed. > [@](#): > > How do you suppose we will spend siginificantly less on healthcare, while still providing the same quality of care and access to treatment? The same way _every single other first world country, AND some second tier countries do_. Don’t you get it? DOZENS of other countries cover ALL their citizens for less per capita and _get better results_. That’s why the system is crappy, brutal, and evil - we’ve been shown better ways to get the job done and yet our society refuses to use a better system that _costs less_. > [@](#): > > The answer: pay our doctors less, and pay less for pharmaceuticals. Or… we could simply eliminate the health insurance industry. Or greatly reduce it. > [@](#): > > Chronic demonization of a system that the vast majority of Americans believe works fine is not the way to win this debate. I’m not interested in what the majority of Americans “believe”, I’m interested in _facts_ and _evidence_. Those are that a lot of other nations do it better than we do, for less money, based on _results_. > [@Lobohan](#): > > It is a fact that other nations do it for cheaper and have better outcomes. The only argument I’ve ever heard for why it wouldn’t work that way here, is that Americans are especially inept. We’re “special”. Keep in mind that’s the same word reserved for people who are mentally disadvantaged/challenged. > [@Stringbean](#): > > One would imagine that if they had to actually pay for what they are receiving, they would be less google-eyed with the actual cost of “free healthcare.” No, if most elderly had to pay out of pocket for their care _they simply wouldn’t get it_ because they couldn’t afford it. > [@Stringbean](#): > > As a young person, I am less inclined to be able to pay for hundreds of thousands of dollars in healthcare expenses. Old people have been saving for their retirement and have already passed through their highest-earning years as workers. Actually, the average American _does not_ have significant retirement savings. Many people in my generation expected to have company-paid medical benefits in retirement, only to have that rug pulled out from under them. In other words, promises were made to them that weren’t kept, promises that affected their long-term fiscal planning. But I guess it’s their fault they weren’t psychic, right? > [@](#): > > Beyond that, I wouldn’t have to pay hundreds of thousands in healthcare expenses if I got sick. I have this thing called insurance for that. Hundreds of thousands? Try _millions_ - because catastrophic illness and injury can cost that. I have a nephew who at 24 suffered a head injury that cost several _million_ dollars in treatment. Yay, he’s alive, physically OK… but with permanent brain damage. He will _never_ be independent again. That can happen to _anyone_ because accidents can and do happen to people. Could you cover that cost? Could you cover living in a sheltered environment for decades out of your insurance + savings? If no, then no, you are not adequately covered for all contingencies. You are only fooling yourself. If you are injured or ill the insurance company will do anything and everything to try to get out of paying your claim - that’s how they stay in business. Compare to single-payer where they determine you’re ill or injured then proceed to treatment without having to argue about whose paying or dragging anyone into court. Much saner way to do business if you ask me. > [@](#): > > The point here is that when the elderly have free healthcare that they underpaid by 3-to-1 as younger workers to receive, using their high satisfaction as an argument in favor of Medicare is in poor form. Yet… you are using “high satisfaction” (which isn’t even true, but whatever) as an argument to keep the jacked-up US system instead of adopting one of the _many_ alternatives other nations have demonstrated are more thorough in covering the population, generate better outcomes, and cost less. So… is or isn’t “high satisfaction” a reason to keep doing something or not? Or should we make such decisions based on facts and evidence? > [@](#): > > For the record, I am in favor of Medicare and Medicaid. I would favor a “Medicaid-for-all” baseline program, with the option to purchase private insurance for those who want better services/options. In other words - the NHS or what Germany has. Basically, single-payer with an option to buy additional coverage on top. > [@](#): > > What I am not in favor of is a government-run, single-payer system. Wait - you DID just say you were in favor of that! > [@](#): > > I believe it would be inordinately expensive and would return diminishing results. The evidence, based on the results from _many_ other countries, contradicts that statement. > [@Novelty\_Bobble](#): > > Health care should occupy the same place in the government remit as education, armed forces, police and judiciary, roads and infrastructure. I’ve never heard anyone come up with a decent argument for why it should be treated differently to those things and I suspect you won’t be the first. Actually, there is a vocal segment of the US that is actively trying to privatize education, and would like to privatize police, roads, and other infrastructure. Not entirely sure about the armed forces (maybe they’d like to hire them out as mercenaries to raise some additional money) and judiciary (although some places like Chicago that’s already bought and sold almost openly. ---
**Author:** ![elucidator](https://avatars.discourse-cdn.com/v4/letter/e/8edcca/32.png) [@elucidator](https://boards.straightdope.com/u/elucidator)\ **Post date:** [October 24, 2015, 11:39pm UTC](https://boards.straightdope.com/t/ben-carson-abolish-medicare-and-medicaid-replace-them-with-2000-vouchers/735617/27 "2015-10-24T23:39:37Z")
> [@](#): > > …Wall Street will love his plan. I’m sure some in the Temples of Mammon drool over the prospect, but the clear headed and brutally realistic amongst them may not. The ACA would never have happened if it truly threatened the fiscal well being of our health insurance…ah…“providers”. And there are indications afoot that they still have a solid business plan, and have “gotten used to it”. Would it be wise to wrench that back into its previous shape? Even when there is a powerful political element opposed, one that could be expected to revisit that change at the earliest opportunity? And has already succeeded once, in the face of all the opposition that you could muster? The opportunist might crave the chance to grab some profit and run for the hills, but the prudent management _mavens_? Not so much. ---
**Author:** ![GrumpyBunny](https://avatars.discourse-cdn.com/v4/letter/g/bc8723/32.png) [@GrumpyBunny](https://boards.straightdope.com/u/GrumpyBunny)\ **Post date:** [October 24, 2015, 11:41pm UTC](https://boards.straightdope.com/t/ben-carson-abolish-medicare-and-medicaid-replace-them-with-2000-vouchers/735617/28 "2015-10-24T23:41:35Z")
> [@Stringbean](#): > > Probably because, as the OP cites, Medicare recipients get 3X more in healthcare services then they pay for. > > One would imagine that if they had to actually pay for what they are receiving, they would be less google-eyed with the actual cost of “free healthcare.” I’ve never met a Medicare beneficiary who thought it was “free”. And I worked for Medicare for the better part of two decades. > [@Novelty\_Bobble](#): > > Anyway, to an outsiders eye USA healthcare is a clusterfuck of horror. It is, and that’s on a good day. ---
**Author:** ![Wesley\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wesley_clark/32/20581_2.png) [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)\ **Post date:** [October 25, 2015, 3:20pm UTC](https://boards.straightdope.com/t/ben-carson-abolish-medicare-and-medicaid-replace-them-with-2000-vouchers/735617/29 "2015-10-25T15:20:01Z")
> [@Broomstick](#): > > The same way _every single other first world country, AND some second tier countries do_. Don’t you get it? DOZENS of other countries cover ALL their citizens for less per capita and _get better results_. That’s why the system is crappy, brutal, and evil - we’ve been shown better ways to get the job done and yet our society refuses to use a better system that _costs less_. > > . Lots of middle income countries have or are developing UHC. Much of Latin America is pushing for a UHC system or already has one. I don’t know what the quality is, but once a nation can afford it it seems one of the first things they push for aside from things like infrastructure, cleaning up pollution, universal education, etc is a UHC system. The problem to me isn’t that we don’t know how to fix our system. Our system could be fixed if we wanted to. But due to a mix of plutocratic interests controlling the system, lack of courage ont he part of politicians and a fear of change by the public I don’t see it happening. IMO, the best bet is to push for meaningful reforms on the state level. Single payer is a good idea, but that alone won’t fix our system. A single payer system in the US would still cost far more than the multi payer system in places like the Netherlands, Israel, Germany, etc. I think the ACA did 1/4 of the health reform this country needs. It was a start, but who knows if/when we will get the reform we truly need. Maybe we will do what Canada did, have some states pass meaningful reform and set a positive example that’ll domino to other states and eventually the federal government. But who knows. The pharma industry, medical device industry, hospital industry, AMA, etc is going to fight tooth and nail against meaningful reform. ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [October 25, 2015, 3:30pm UTC](https://boards.straightdope.com/t/ben-carson-abolish-medicare-and-medicaid-replace-them-with-2000-vouchers/735617/30 "2015-10-25T15:30:36Z")
Vermont tried, the economics don’t work. You can’t go from our system to single payer because people are used to a certain level of care that can’t be provided with single payer. ACA is the bst possible UHC system the US can create. I like the idea of universal HSA accounts better though. ---
**Author:** ![Broomstick](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/broomstick/32/246_2.png) [@Broomstick](https://boards.straightdope.com/u/Broomstick)\ **Post date:** [October 25, 2015, 3:44pm UTC](https://boards.straightdope.com/t/ben-carson-abolish-medicare-and-medicaid-replace-them-with-2000-vouchers/735617/31 "2015-10-25T15:44:37Z")
I don’t. Accounts work ONLY if you have decades in which to accumulate funds. My nephew at age 24 wasn’t going to have anything near what he needed if he had had to depend on a HSA account. That system is going to screw anyone with a birth defect, anyone seriously ill or hurt as a child, or adolescent, or young adult. It also provides a perverse incentive to forgo preventive treatments and routine check ups to save money against catastrophe - which is more likely to happen if you don’t use prevention and checkups. People will go to the doctor sicker, making treating serious illnesses harder. I keep hearing that the US “can’t”. _WHY NOT?_ If _everyone else_ can do this, why can’t we? Why are we so _specially_ inept and evil? We actually are not that different than anyone else, unless it’s in stubbornly clinging to ignorance and a bad system. ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [October 25, 2015, 3:58pm UTC](https://boards.straightdope.com/t/ben-carson-abolish-medicare-and-medicaid-replace-them-with-2000-vouchers/735617/32 "2015-10-25T15:58:22Z")
Single payer systems got off the ground when there wasn’t that much health care to buy. As new, expensive treatments and drugs were developed, the government systems could decide what to add and under what terms, and since they also just HAPPENED to ban advertising, the public were none the wiser. If we really wanted to wage ideological warfare against single payer systems(something a Republican President should consider), we’d have drug companies run ads all over the internet in those countries for the drugs currently unavailable. That’ll screw with 'em. But I digress. Most Americans with health insurance have pretty good coverage. It’s not always consistent and there are often gaps(although ACA closed most of those), but it’s a lot more likely to cover crazy expensive treatments. So if you go to single payer, you take a lot of that stuff away, or you just can’t afford it. And you can’t take stuff away from Americans. Like I said, Vermont tried to provide single payer. The economics just don’t work out given the cost of health care these days, and it’s not as simple as just bargaining down prices. The newest generation of biopharma drugs are five to six figures for a treatment course. There’s just no way to pay for all of that for everyone. And you’ll never get unions to give up their cadillac plans. ---
**Author:** ![Novelty\_Bobble](https://avatars.discourse-cdn.com/v4/letter/n/a3d4f5/32.png) [@Novelty\_Bobble](https://boards.straightdope.com/u/Novelty_Bobble)\ **Post date:** [October 25, 2015, 4:30pm UTC](https://boards.straightdope.com/t/ben-carson-abolish-medicare-and-medicaid-replace-them-with-2000-vouchers/735617/33 "2015-10-25T16:30:45Z")
> [@adaher](#): > > Single payer systems got off the ground when there wasn’t that much health care to buy. As new, expensive treatments and drugs were developed, the government systems could decide what to add and under what terms, and since they also just HAPPENED to ban advertising, the public were none the wiser. If we really wanted to wage ideological warfare against single payer systems(something a Republican President should consider), we’d have drug companies run ads all over the internet in those countries for the drugs currently unavailable. That’ll screw with 'em. > > But I digress. Most Americans with health insurance have pretty good coverage. It’s not always consistent and there are often gaps(although ACA closed most of those), but it’s a lot more likely to cover crazy expensive treatments. So if you go to single payer, you take a lot of that stuff away, or you just can’t afford it. And you can’t take stuff away from Americans. > > Like I said, Vermont tried to provide single payer. The economics just don’t work out given the cost of health care these days, and it’s not as simple as just bargaining down prices. The newest generation of biopharma drugs are five to six figures for a treatment course. There’s just no way to pay for all of that for everyone. > > And you’ll never get unions to give up their cadillac plans. I think the above is quite possibly the most ill-informed four paragraphs on this subject that I’ve yet read, and that is saying something. I really don’t think that anyone with this mindset is open to consider doing things differently. Is there any evidence or metric that would convince you that UHC systems in comparable nations are better and cheaper? ---
**Author:** ![Broomstick](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/broomstick/32/246_2.png) [@Broomstick](https://boards.straightdope.com/u/Broomstick)\ **Post date:** [October 25, 2015, 4:36pm UTC](https://boards.straightdope.com/t/ben-carson-abolish-medicare-and-medicaid-replace-them-with-2000-vouchers/735617/34 "2015-10-25T16:36:41Z")
Yes, I’d be interested in knowing what treatments are unavailable under, say, the UK NHS that are readily available in the US. Now, people might have to _wait_ for non-emergency things… but that ain’t going to kill you. Sorry if you need to wait an extra two months to get your knee replaced. There’s also the issue of profit motive in the US system leading to over-treatment, which brings its own pile of problems. There’s a [couple of doctors](http://abc7chicago.com/health/indiana-cardiologists-sued-for-alleged-unnecessary-surgeries/370155/) in my area that are being dragged into court for performing _unnecessary open-heart surgery_ on dozens of people who should not have been operated on. I think that sort of abuse-for-profit is less likely under a single-payer system. ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [October 25, 2015, 4:41pm UTC](https://boards.straightdope.com/t/ben-carson-abolish-medicare-and-medicaid-replace-them-with-2000-vouchers/735617/35 "2015-10-25T16:41:54Z")
> [@Novelty\_Bobble](#): > > I think the above is quite possibly the most ill-informed four paragraphs on this subject that I’ve yet read, and that is saying something. I really don’t think that anyone with this mindset is open to consider doing things differently. > > Is there any evidence or metric that would convince you that UHC systems in comparable nations are better and cheaper? Give me a metric that shows that single payer is better than multi-payer other than cost. ---
**Author:** ![Wesley\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wesley_clark/32/20581_2.png) [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)\ **Post date:** [October 25, 2015, 4:46pm UTC](https://boards.straightdope.com/t/ben-carson-abolish-medicare-and-medicaid-replace-them-with-2000-vouchers/735617/36 "2015-10-25T16:46:29Z")
> [@adaher](#): > > Vermont tried, the economics don’t work. You can’t go from our system to single payer because people are used to a certain level of care that can’t be provided with single payer. ACA is the bst possible UHC system the US can create. > > I like the idea of universal HSA accounts better though. My point is we don’t need single payer, we need reforms to drive down costs. There is tons of waste in the current system. The ACA is similar to the plan in the Netherlands. I think they have exchanges and private plans compete to get customers. However in the Netherlands they only spend 10% of GDP on coverage, nobody goes bankrupt, I doubt they have narrow networks, etc. So we could have a working system w/o single payer, we just need reform for how expensive care is and how we provide too much of it because our incentives are bad. FWIW, William Hsiao when he designed Vermonts health plan found that a public option would provide 2/3 of the cost savings that single payer would. Single payer would drive down costs by 24% over a decade, a strong public option would drive them down by 16%. > **[William Hsiao's single payer proposal for Vermont - PNHP](https://pnhp.org/news/william-hsiaos-single-payer-proposal-for-vermont/)** > > Statement by William C. HsiaoVermont State LegislatureJanuary 19, 2011Although advocates of the pure single payer model will find some problems with this report on a reform proposal for Vermont, there is very good news in this analysis. The report... > [@](#): > > In analyzing the three options, we determined that all will yield significant savings. However, our research and analysis indicate that the single-payer options will have a more dramatic impact on reducing cost than the public option because they incorporate a uniform benefits package and reduce much of the administrative structure needed to compensate multiple payers. Therefore, we estimate that Option 1 [single payer] will produce savings of 24.3% of total health expenditure between 2015 and 2024. Option 2 [a strong public option] will produce savings of 16.1% of total health expenditure between 2015 and 2024. Finally, Option 3 will produce savings of 25.3% of total health expenditure between 2015 and 2024. Option 3 produces additional savings as compared to Option 1 because it incorporates a public/private partnership in governance and administration. I have no idea why states aren’t pushing for a strong public option. Probably because hospitals, pharma, medical device industries, insurance companies and the AMA don’t like it. Also single payer basically just means expanding medicare to cover everyone. I don’t think that would be uber controversial, as medicare is a well liked system. A strong public option, a medicare buy in option, state single payer, etc. are all forms of health reform that should be possible soon. Economically Vermont’s system would’ve saved money had they gone through with it. Had they funded it by just continuing to collect insurance premiums but redirecting those funds to a single payer system and slowly transitioned to a tax based payment system I think that would’ve gone over easier. However single payer would be so controversial that any problems would be magnified 100x by the media. So it would have to be a very well run system to not fall apart and set health reform back. ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [October 25, 2015, 4:47pm UTC](https://boards.straightdope.com/t/ben-carson-abolish-medicare-and-medicaid-replace-them-with-2000-vouchers/735617/37 "2015-10-25T16:47:17Z")
> [@Broomstick](#): > > Yes, I’d be interested in knowing what treatments are unavailable under, say, the UK NHS that are readily available in the US. > > Now, people might have to _wait_ for non-emergency things… but that ain’t going to kill you. Sorry if you need to wait an extra two months to get your knee replaced. > > There’s also the issue of profit motive in the US system leading to over-treatment, which brings its own pile of problems. There’s a [couple of doctors](http://abc7chicago.com/health/indiana-cardiologists-sued-for-alleged-unnecessary-surgeries/370155/) in my area that are being dragged into court for performing _unnecessary open-heart surgery_ on dozens of people who should not have been operated on. I think that sort of abuse-for-profit is less likely under a single-payer system. Too much testing and over prescribing of drugs is definitely an issue, although that’s a tort problem as well as a profit motive problem. Single payer systems deal with that issue as well by not allowing big settlements. Tort reform and single payer go hand-in-hand. As for treatments unavailable, NICE denies drugs all the time for failing to meet cost/benefit estimates base on quality life years remaining. Yes, a number is actually put on people’s lives. > [@](#): > > NICE guidance supports the use of quality-adjusted life years (QALY) as the primary outcome for quantifying the expected health benefits associated with a given treatment regime. By comparing the present value (see discounting) of expected QALY flows with and without treatment, or relative to another treatment, the net/relative health benefit derived from such a treatment can be derived. When combined with the relative cost of treatment, this information can be used to estimate an incremental cost-effectiveness ratio (ICER), which is considered in relation to NICE’s threshold willingness-to-pay value.[24] > > As a guideline rule, NICE accepts as cost-effective those interventions with an incremental cost-effectiveness ratio of less than £20,000 per QALY and that there should be increasingly strong reasons for accepting as cost-effective interventions with an incremental cost-effectiveness ratio of over a threshold of £30,000 per QALY.[26] > > Over the years, there has been great controversy as to what value this threshold should be set at. Initially, there was no fixed number. But the appraisal teams created a consensus amount of about £30,000. However, in November 2008 Alan Johnson, the then Secretary of State, announced that for end-of-life cancer drugs the threshold could be increased above £30,000. [27] > > The first drug to go through the new process was Lenalidomide. And its ICER was £43,800.[28] > **[National Institute for Health and Care Excellence](https://en.wikipedia.org/wiki/National_Institute_for_Health_and_Care_Excellence#Quality-adjusted_life_years)** > > The National Institute for Health and Care Excellence (NICE) is an executive non-departmental public body, in England, of the Department of Health and Social Care, that publishes guidelines in four areas: > These appraisals are based primarily on evidence-based evaluations of efficacy, safety and cost-effectiveness in various circumstances. > It serves both the English NHS and the Welsh NHS. It was set up as the National Institute for Clinical Excellence in 1999, and on 1 April 2005 joined with ... And an example of a drug refused: > **[Breast cancer drug Kadcyla is too expensive for the NHS – not to pay for it...](https://www.theguardian.com/commentisfree/2014/apr/25/kadcyla-cancer-drug-too-expensive-nhs)** > > Deborah Orr: The NHS watchdog, Nice, is being portayed as penny-pinching over its refusal to fund a hugely expensive new cancer drug. But shouldn't we be asking why its manufacturers want to charge so much? ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [October 25, 2015, 4:49pm UTC](https://boards.straightdope.com/t/ben-carson-abolish-medicare-and-medicaid-replace-them-with-2000-vouchers/735617/38 "2015-10-25T16:49:02Z")
The economics of Medicare-for-all don’t work. As an earlier poster pointed out, Medicare is funded by the majority paying for the minority. If it has to entirely fund itself for everyone, it doesn’t work. Medicaid-for-all has always been the realistic way to think of single payer. Medicare is a special circumstance since it’s paid for by all but only the elderly get it. ---
**Author:** ![elucidator](https://avatars.discourse-cdn.com/v4/letter/e/8edcca/32.png) [@elucidator](https://boards.straightdope.com/u/elucidator)\ **Post date:** [October 25, 2015, 4:52pm UTC](https://boards.straightdope.com/t/ben-carson-abolish-medicare-and-medicaid-replace-them-with-2000-vouchers/735617/39 "2015-10-25T16:52:55Z")
Uh, yeah. Hence the name, “Medicare for all”. You see, the idea is to take the basic structure of Medicare and alter that central fact, making it “for all” rather than just “for the old”. Don’t hesitate to ask questions, we are here to help. ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [October 25, 2015, 4:54pm UTC](https://boards.straightdope.com/t/ben-carson-abolish-medicare-and-medicaid-replace-them-with-2000-vouchers/735617/40 "2015-10-25T16:54:06Z")
Which is known as Medicaid. “Medicare-for-all” is propaganda. Medicaid for all is the reality of single payer. [Previous page](https://boards.straightdope.com/t/ben-carson-abolish-medicare-and-medicaid-replace-them-with-2000-vouchers/735617.md?page=1) [Next page](https://boards.straightdope.com/t/ben-carson-abolish-medicare-and-medicaid-replace-them-with-2000-vouchers/735617.md?page=3)