Convince me to support single-payer (US)

Great Debates
1

Overall, I’m not a fan, but I’m not totally against single-payer.

I recognize that in principle, a single-payer system would have the largest possible pool and therefore could be more efficient. Major plus.

On the other hand, I am at a loss on how to fund such a system. The costs are sure to be staggering, even crediting current premiums, because more coverage means more medical care means more expenses. Major minus.

Single-payer makes medical billing easier for everybody, which reduces administrative overhead. Plus. But that’s a lot of people losing their jobs. Minus, short-term.

The cost of drugs will go down as a single-payer would have a whole lot more leverage than today’s individual payers. Plus.

But wouldn’t that just encourage even more consolidation in the drug industry? How will that affect R&D? Are we going to need to up drug grants, too? Minus.

I fear that the government will have to decide when life saving treatment is too expensive. Probably not on an individual basis (so not a death council), but as part of some national guideline. Minus?

Presumably, everybody would have health coverage. Plus.

I fear that our country’s healthcare system - not insurance, actual care - isn’t robust enough to give everybody the healthcare they need. I’m not sure how that will be dealt with. Waiting lists? Minus.

Are government guidelines about “medical necessity” going to turn in to de-facto laws on medicine? Is some bureaucratic delay going to come between a cancer patient and new, life saving treatment? Potentially a major minus.

I’m sure there’s more, hopefully some of you out there can strike down some of the arguments against.

~Max

2

I have long thought that once the government becomes the primary insurer, it will start looking at the opposite end of the equation: causes. This could lead to changes in taxes and incentives, to encourage, or perhaps coerce, people to be healthier. You could, for instance, subsist on prime rib and 64oz sodas every day, but it would be much more financially burdensome.

This is a difficult issue. On the one side, freedom, but, on the other side, there are companies raking in the profits, possibly subsidized in some cases, while firmly nudging people toward poor choices relative to the ultimate health impacts. I feel that, in general, it would probably be a net benefit.

3

Replies in bold

4

Look at health care cost vs quality in any well developed nation. Basically it boils down to we pay way more for overall sightly less quality. Research this for yourself, it’s easy to find and overwhelmingly damming against the US system.

Yes there are strengths and weaknesses of each system and somethings that the US excels at (2 of which are post opp recovery and less post opp infection.) however many other countries excel over the US in early diagnosis. I put the 2 together that other countries catch things sooner and this treat is less invasively, but in the US people, for whatever reason (cost, limited choice???) delay getting diagnosed so we are experts at treating the seriously ill who could have been diagnosed earlier and cured easier and never got to that point where infection and lengthily recovery is really a factor for many. But that’s my take.

Again if you really want to know just do the googling. If you don’t just keep questioning without research.

5

Note that in Canada we have single payer for treatment, but there is no national pharmacare program in Canada. In Ontario, your drugs are covered for seniors, low income, and children whose parents don’t have insurance. My medications run close to CAD$6000/year, which is paid for by my supplemental work insurance.

6

“That’s what insurance companies do now” is the key point here. Government is, yes, a monolithic entity, as opposed to the insurance companies, which are individual private entities competing for your business.

Except, the insurance companies formed AHIP, a sort of guild of insurers that fought hard against healthcare reform a decade ago. The insurers do not really compete against each other but work together to, ahem, insure profitability.

So, ultimately, you have a choice between one monolithic entity or a group of members of another monolithic entity. One will make decisions based on utilitarian principles while the other will make decisions based on profits. I am failing to see how the former would not be an improvement over the latter.

7

So, it is okay with you that some of the population doesn’t get the healthcare they need?
Remember, the people with the greatest healthcare needs, seniors, are on singe-payer already. If there was going to be a meltdown, it would have already happened.

8

Insurance companies mostly compete for the business of benefits managers of companies which provide medical insurance as a benefit. If they were really competing for the business of single customers, prices wouldn’t be so high.

9

It would be the largest pool of sick people but not the largest pool of financial contributors. So I wouldn’t put that in the plus column.

In the US we are 21 trillion in the red. It got that way because the people in charge were put there using a popularity contest and are not liable for 1 dollar of budgetary malfeasance.

The same people who misspent 21 trillion dollars would be in charge of budgeting and monitoring health care efficiencies.

We would have to cut back on military spending. This is something to look at and President Trump is trying to get European countries to cover more of the cost of defending Europe. Well have to see how that goes but it would mean NATO countries cutting into their health care budget.
Military spending as a percent of GDP
United States 3.2
United Kingdom 1.8
Canada 1.3
Germany 1.2

If a country like Canada had to cut back on medical spending then their average wait time of 19.8 weeks to see a specialist would continue to go up. Or they raise taxes. Either way the wait time is still an issue within their system and you can see the same thing in the UK.

Regardless of what medical system you are under it is throttled by available money. Systems that cost less have less money available to spend on medical treatment. There is no long term process that negates this fact.

At the end of the day UHC removes the financial burden to the near-poor and delays medical treatment for all.

10

It doesn’t delay medical treatment for all. It vastly shortens the time for the poor to see the doctor – often from never to sometime. Delay in seeing a doctor depends not so much on money, but the number of doctors per person (and the number of the right kinds of doctors per person. It doesn’t help a lot if you can see a dermatologist quickly if you have a heart problem). The US and Canada have about the same number of doctors per person. Wait times in the US are shorter because a large number of people in the US don’t see one.

Also and I can’t find a cite for this, but I’m pretty sure I read somewhere that the US has a greater proportion of specialist among doctors than other countries like Canada do so when you just compare wait time to see a specialist it will look worse for Canada. Presumably the US would keep that advantage under UHC.

11

This is important. The government already picks up most of the tab for the most expensive patients. Not only the 65+ that are on Medicare, but the poor and chronically ill that are on Medicaid.

Especially if you are talking about expanding the system we have now, including products like existing Medicare supplement plans.

But if you’re going to promote the elimination of private insurers, you better be able to present me with a detailed plan showing how are you going to accomplish this without disrupting patient care. Or the economy. And it better be good.

One reason radical change would be hard in healthcare is that it’s a dynamic system that can never be shut down, not even for a little while. It’s kind of like trying to fix a car while it’s driving down the highway. And if you screw it up you’ll kill people.

So I want to see exactly HOW you would eliminate private insurance. In excruciating detail.

12

It absolutely delays treatment for all if less money is available.

The poor have medicaid in a nation that sticks any unpaid bills back onto private insurance. You’re referring to the near poor.

the number of doctors are a result of money available.

that actually made me laugh out loud. It’s very common for doctors to refuse medicaid patients because they don’t receive enough money for their time. It’s entirely driven by money and when the amount is determined by the government then it’s controlled by the government. There’s no “presumably” in the equation and choice ends at that point unless you’re wealthy and can travel to another country for needed care.

Medical treatment is entirely driven by money regardless of what system is in effect. My medical coverage is vastly better than what is available in Canada or the UK. It is better because it costs more. As a private enterprise it affords more choices that are not available to UHC.

From the time I found out I had a heart murmur to surgery was measured in weeks, not months. that includes all the diagnostics, specialists and surgeons I saw which were all chosen by me. I literally chose all of that. I chose the location of the MRI/CT scans, when I wanted the scans, the Cardiologist, and the Heart Surgeon.

I almost lost my leg because of a bad diagnosis. I simply bypassed the specialist with a phone call to my doctor and had a new test done the same day I called. So from phone call to test to surgeon to more tests to surgery in less than 48 hrs. All because I thought the specialist was wrong. Which he was.

13

As soon as most people find out MFA would cost 32 trillion dollars over a decade, they reach for the smelling salts. They shouldn’t. Americans pay $3.6 trillion per year for health care costs(including insurance) NOW. If we’re going to compare costs over a decade, we should note that MFA could potentially save us $4 billion over ten years.

Or to put it another way, the choice is $3.2 trillion per year for MFA vs. 3.6 trillion per year for the current system.

Switching over might require some temporary upheaval, but other countries have already shown it’s doable.

14

The “upheaval” is loss of prompt medical care which is easily researched. You can go online to the UK’s official sites that have average wait times for various diagnostic or procedural care.

It’s great to walk into a doctor’s office or hospital and get medical service without a care in the world. Who wouldn’t want to do away with co-pays and paperwork. However, it sucks when the wait time endangers your health or leaves you in pain. You can pay less and wait or you can pay more and get faster medical care.

My first kidney stone involved a trip to the hospital, an x-ray and an MRI within a few hours. in the space of 2 weeks I saw my family doctor twice, a specialist and a surgeon. at the end of 2 weeks the surgeon gave me the option to have it physically removed and it was done the same day. 2 weeks. I’m sure it cost me money out of pocket. I’m also sure I didn’t care. It was worth it. I was in misery and the only solution if I had to wait was taking opioids.

15

I think you are unable to look outside of your current situation and that is skewing your evaluation.

A decent maxim would be to design the health system for your country without knowing whether you are in the top tier of the society or the bottom.

Rich people in the USA are fine, rich people in the UK are fine (there is no waiting for them either…or were you under the impression that we don’t have private health insurance as well?).

How well would your kidney stone treatment have gone if you did not have insurance? You may worry about waiting times under an NHS-style system but in the USA you have people who can’t even access the queue in the first place.

Incidentally, a colleagues mother was recently diagnosed, reviewed and treated for kidney stones over the course of a single weekend. All NHS, nothing to pay. So my anecdote seems to trump yours.

16

I suspect you are wrong. How much do you contribute, per month, for USA healthcare? Don’t forget to include the amount in taxes that you contribute to the various government-run systems.

We’ll make it simple for you and allow you to disregard any co-pays, let’s imagine you have a lovely healthy year.

17

Coronavirus.

Health insurers have little incentive to make sure you are still healthy after you are medicate eligible. Single player would like you to die in a sky diving accident at the age without a sick day in your life.

18

Before we go on, and trouble our little heads about the details of paying for it :smiley: let’s start with a simple question:
@ Max S. — Do you think the TOTAL spent on medical care (and associated “services” like billing) will increase or decrease in a single-payer system?

:confused: You were worried it would COST too much. Now you’re worried about money it would SAVE? :slight_smile: Please get your talking-points synchronized!

Three of the biggest expenses for drug companies are (a) Profits, (b) Marketing, (c) Research and regulatory compliance. Care to guess which of these are their biggest outgos? Hint: The ranking stays the same even if we include under “Research” marketing programs designed to kickback to doctors under the guise of “patient studies.”

In the U.S. the decisions you speak of are generally made by profit-making insurance companies. In most single-payer systems the decision are made by … wait for it … Medical Doctors.

hth

19

So, you were in misery but still had to wait two weeks? Doesn’t sound like that good of insurance to me.

20

This seems detached from the reality of the situation

No, this line of thinking only applies if less money is available for the medical professionals, and that’s where your argument falls flat and we can stop right there and address your entire argument in one step.

Doctors used to be a very lucrative profession up their with lawyers in the minds of parent’s i their wishes of what their children will be when they grow up. This is also when treatment out of pocket was affordable.

The problem is where the money goes is cutting into the doctor’s share. Doctor’s profession is not looked upon so highly anymore. We can start with the mountain of debt coming out of school, add all the technology and it’s ongoing fees, the insurance companies who try to pay the doctors as little as possible and get in the way of treatments the doctor prescribes, and the medical accountants the doctor has to hire to fight them to get a decent payment for services.

So there could be less money available overall yet more money for doctors, thus more doctors. Not to mention a program to help them keep out of early debt early on.