# Convince me to support single-payer (US) **URL:** \ **Category:** Great Debates\ **Created:** [March 5, 2020, 12:55am UTC](https://boards.straightdope.com/t/convince-me-to-support-single-payer-us/848939 "2020-03-05T00:55:05Z")\ **Posts on this page:** 20\ **Page:** 10
**Author:** ![Red\_Wiggler](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/red_wiggler/32/13190_2.png) [@Red\_Wiggler](https://boards.straightdope.com/u/Red_Wiggler)\ **Post date:** [March 10, 2020, 6:38pm UTC](https://boards.straightdope.com/t/convince-me-to-support-single-payer-us/848939/181 "2020-03-10T18:38:05Z")
> [@Max\_S](#): > > Sorry, I seem to have overlooked your post. This particular line of replies leads to your claim, [POST=22174184]post #77[/POST], that “doctors would pocket the savings from not having to hire armies of insurance people.” If the fees go down so the doctor who fires billing staff comes out just as profitable as before, that doctor does not pocket any savings from culling his staff. > > ~Max Maybe he just practices more medicine. ---
**Author:** ![Cheesesteak](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/cheesesteak/32/3694_2.png) [@Cheesesteak](https://boards.straightdope.com/u/Cheesesteak)\ **Post date:** [March 10, 2020, 6:42pm UTC](https://boards.straightdope.com/t/convince-me-to-support-single-payer-us/848939/182 "2020-03-10T18:42:52Z")
> [@Max\_S](#): > > Sorry, I seem to have overlooked your post. This particular line of replies leads to your claim, [POST=22174184]post #77[/POST], that “doctors would pocket the savings from not having to hire armies of insurance people.” If the fees go down so the doctor who fires billing staff comes out just as profitable as before, that doctor does not pocket any savings from culling his staff. So, it’s the rest of us pocketing the savings while the doctor is kept whole? ---
**Author:** ![Max\_S](https://avatars.discourse-cdn.com/v4/letter/m/46a35a/32.png) [@Max\_S](https://boards.straightdope.com/u/Max_S)\ **Post date:** [March 10, 2020, 7:01pm UTC](https://boards.straightdope.com/t/convince-me-to-support-single-payer-us/848939/183 "2020-03-10T19:01:22Z")
> [@Cheesesteak](#): > > So, it’s the rest of us pocketing the savings while the doctor is kept whole? Correct. ~Max ---
**Author:** ![Voyager](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/voyager/32/133_2.png) [@Voyager](https://boards.straightdope.com/u/Voyager)\ **Post date:** [March 10, 2020, 7:39pm UTC](https://boards.straightdope.com/t/convince-me-to-support-single-payer-us/848939/184 "2020-03-10T19:39:33Z")
> [@Max\_S](#): > > Sorry, I seem to have overlooked your post. This particular line of replies leads to your claim, [POST=22174184]post #77[/POST], that “doctors would pocket the savings from not having to hire armies of insurance people.” If the fees go down so the doctor who fires billing staff comes out just as profitable as before, that doctor does not pocket any savings from culling his staff. > > ~Max Right. We do, and the doctor is not hurt. (I think there should be some way of increasing pay for GPs, such as forgiving med school debts, but that’s different.) Since being a surgeon is one of the best ways of getting into the 1%, I don’t think we need to worry about increasing their profitability. ---
**Author:** ![GIGObuster](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/gigobuster/32/421_2.png) [@GIGObuster](https://boards.straightdope.com/u/GIGObuster)\ **Post date:** [March 10, 2020, 9:17pm UTC](https://boards.straightdope.com/t/convince-me-to-support-single-payer-us/848939/185 "2020-03-10T21:17:50Z")
> [@Max\_S](#): > > Even so, my argument was that it would be worse for the economy if more hospitals “shutter” under a single-payer system. I don’t believe you have refuted my argument. Uh, your argument is indeed based on a hypothetical, I just countered it with what is happening in real life, and others will have to notice that you ignored what happens with the single payer VA, it is harder to justify the closing of hospitals, far from it, more are likely to be built, specially to replace old ones. > [@Max\_S](#): > > You responded by claiming that hospitals would shutter even with our current health insurance system, and I responded by clarifying that I meant more hospitals than our current health insurance system. Sorry, you are not getting it, the argument I made was that hospitals **already** are being closed. And the reason for mentioning the VA single payer system was to show that it is less likely that hospitals would be shuttered, because there is one item that you conveniently forget to make your argument work: it is the government the entity that has to answer to their constituents for any future closings if a single payer system is in place. > [@Max\_S](#): > > I laid out some criteria where a single-payer system might not result in more hospitals shuttering than under our current system. Instead of taking that admission and completing a counterargument, you seem to have reverted to the previous point, which I have already told you is irrelevant. I’m sorry, **GIGObuster** , but you have lost me here. Sorry, that will not work, as I pointed already you are the one ignoring many items to make your argument work, and BTW I’m not posting just for you. That is the nature of a message board. > [@Max\_S](#): > > I would be interested in cites, if you have them. Both for California expanding Medicare and for a decrease in the closure of rural Californian hospitals. And here one has to make a notice other readers: you are showing others that you ignored, or you are not reading cites. The cite I made does link to studies that showed that, not just for California. > [@Max\_S](#): > > Even if you mean Medi-Cal (which I suspect you are referring to), and even if there is a direct link between the expansion of Medi-Cal and the solvency of rural hospitals, I’m not sure if that constitutes evidence against my argument. I would also need to understand how the expansion of Medi-Cal and its effects on rural Californian hospitals would be similar to single-payer. The overall argument from you is to dismiss evidence that could lead to support single-payer. Not very effectively. BTW in this reply you already did notice that I pointed at the reports pointing at how Medicare expansion (again, not just California) is helping to keep hospitals open. While one can technically say that that is not single payer, it is IMHO not so different, the federal government and the state one are the payers. If we eventually we get a single payer it will likely still involve the state government in some form. So, as this was clearly missed, here are the links to the studies that were in the link already made: > **[Rural hospital closings lead to more deaths, study finds](https://www.nbcnews.com/news/us-news/rural-hospital-closings-cause-mortality-rates-rise-study-finds-n1048046)** > > Populations served by rural hospitals — which have limited access to health care and other services — saw mortality rates rise 5.9 percent after a hospital closed. > [@](#): > > The population in nonmetro counties decreased by 200,000 people from 2010 to 2016, the National Advisory Committee on Rural Health and Human Services found, the first such loss ever recorded. > > “These problems are exacerbated in rural areas, especially due to the recent economic downturns and job losses leading to outmigration and shrinking populations, leaving behind populations that are older, sicker and more reliant on Medicaid and Medicare,” the researchers wrote. > > It’s also an issue that some believe is exacerbated in the 14 states that have refused to expand Medicaid — a perspective supported by a [January 2018 study from the University of Colorado.](https://www.healthaffairs.org/doi/10.1377/hlthaff.2017.0976) > > Researchers there studied hospitals’ financial health and closings from 2008 to 2016 and concluded that hospitals in states that did not expand Medicaid saw a sharp increase of hospital closings, while states that expanded Medicaid saw closure rates decrease. ---
**Author:** ![Max\_S](https://avatars.discourse-cdn.com/v4/letter/m/46a35a/32.png) [@Max\_S](https://boards.straightdope.com/u/Max_S)\ **Post date:** [March 10, 2020, 10:45pm UTC](https://boards.straightdope.com/t/convince-me-to-support-single-payer-us/848939/186 "2020-03-10T22:45:39Z")
> [@GIGObuster](#): > > Uh, your argument is indeed based on a hypothetical, I just countered it with what is happening in real life, and others will have to notice that you ignored what happens with the single payer VA, it is harder to justify the closing of hospitals, far from it, more are likely to be built, specially to replace old ones. I didn’t think the VA was relevant because the hospital is actually run by the government. The financial situation with the VA is not comparable to private hospitals. Are you suggesting that a single-payer system should include government-run hospitals? Not only that, but you brought up _consumer satisfaction_ with the VA health care system - totally unrelated, as far as I can tell. > [@GIGObuster](#): > > Sorry, you are not getting it, the argument I made was that hospitals **already** are being closed. You are right, I am not getting it. My argument is, if more hospitals will shutter under a single-payer system than under the current system, then a single-payer system is worse for the economy (in this respect). You are pointing out that hospitals are already being closed, under our current system. I will concede that hospitals are already being closed. _So what?_ > [@GIGObuster](#): > > Sorry, that will not work, as I pointed already you are the one ignoring many items to make your argument work, and BTW I’m not posting just for you. That is the nature of a message board. You may not be posting for my sake (I am posting for my sake), but I think you and I are having a debate. I am merely pointing out that I do not understand your argument. You are under no obligation to explain things to my personal satisfaction; however, I hope we can come to an agreement in the end. > [@GIGObuster](#): > > And here one has to make a notice other readers: you are showing others that you ignored, or you are not reading cites. The cite I made does link to studies that showed that, not just for California. > > […] > > The overall argument from you is to dismiss evidence that could lead to support single-payer. > > Not very effectively. BTW in this reply you already did notice that I pointed at the reports pointing at how Medicare expansion (again, not just California) is helping to keep hospitals open. While one can technically say that that is not single payer, it is IMHO not so different, the federal government and the state one are the payers. If we eventually we get a single payer it will likely still involve the state government in some form. I have read your NBC article. First, there is no such thing as Medicare expansion, you are probably thinking of Medicaid, which is discussed in the article and called Medi-Cal in California. Second, Medicaid rates are abysmal. Medicare rates for hospital services are below the cost of care, and Medicaid rates are only a fraction of the Medicare rates. I thought this was common knowledge. You cannot sustain a private hospital on a single-payer with Medicaid rates - it is impossible. A charity hospital could survive, perhaps. The reason Medicaid expansion helps hospitals is because before, they weren’t getting paid at all for the near-poor demographic, and now they are getting paid some - though not enough to actually cover the costs of services without raising prices for commercial patients. Third, and this is my fault, I don’t want to pay for access to the “Colorado study”. Therefore I will take your word, and NBC’s word, for whatever its contents may be. Fourth, and most importantly, you still have not connected single-payer and Medicaid expansion’s dent in hospital closures. You haven’t brought any of this full circle to counter my arguments. ~Max ---
**Author:** ![Banquet\_Bear](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/banquet_bear/32/373_2.png) [@Banquet\_Bear](https://boards.straightdope.com/u/Banquet_Bear)\ **Post date:** [March 10, 2020, 11:04pm UTC](https://boards.straightdope.com/t/convince-me-to-support-single-payer-us/848939/187 "2020-03-10T23:04:08Z")
> [@Max\_S](#): > > Are you suggesting that a single-payer system should include government-run hospitals? > [@Single Payer](#): > > Single-payer healthcare is a type of universal healthcare[1] that covers the costs of essential healthcare for all residents, with costs covered by a single public system (hence ‘single-payer’).[2][3] > > Single-payer systems may contract for healthcare services from private organizations (as is the case in Canada) **or may own and employ healthcare resources and personnel (as is the case in the United Kingdom).** > **[Single-payer healthcare](https://en.wikipedia.org/wiki/Single-payer_healthcare)** > > Single-payer healthcare is a type of universal healthcare in which the costs of essential healthcare for all residents are covered by a single public system (hence "single-payer"). > Single-payer systems may contract for healthcare services from private organizations (as is the case in Canada) or may own and employ healthcare resources and personnel (as is the case in the United Kingdom). "Single-payer" describes the mechanism by which healthcare is paid for by a single public authority, not a pri... …it isn’t an extraordinary suggestion. Government run hospitals in single-payer systems are quite common. That you don’t think its relevant is even stronger evidence that you don’t know what “single payer” or “universal healthcare” is or how taxes or how health insurance actually works. > [@](#): > > My argument is, if more hospitals will shutter under a single-payer system than under the current system, then a single-payer system is worse for the economy (in this respect). My argument is, if less hospitals will shutter under a single-payer system than under the current system, then a single-payer system is better for the economy (in that respect.) Do you see how poor your argument actually is? Its barely an argument. Its an assertion based on a hypothetical that can easily be flipped around. What makes you think more hospitals will close under single payer? What leads you to think that? ---
**Author:** ![GIGObuster](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/gigobuster/32/421_2.png) [@GIGObuster](https://boards.straightdope.com/u/GIGObuster)\ **Post date:** [March 10, 2020, 11:56pm UTC](https://boards.straightdope.com/t/convince-me-to-support-single-payer-us/848939/188 "2020-03-10T23:56:25Z")
> [@Banquet\_Bear](#): > > [Single-payer healthcare - Wikipedia](https://en.wikipedia.org/wiki/Single-payer_healthcare) > > …it isn’t an extraordinary suggestion. Government run hospitals in single-payer systems are quite common. That you don’t think its relevant is even stronger evidence that you don’t know what “single payer” or “universal healthcare” is or how taxes or how health insurance actually works. > > My argument is, if less hospitals will shutter under a single-payer system than under the current system, then a single-payer system is better for the economy (in that respect.) > > Do you see how poor your argument actually is? Its barely an argument. Its an assertion based on a hypothetical that can easily be flipped around. What makes you think more hospitals will close under single payer? What leads you to think that? Yep, **Banquet Bear** explains it and replied better than I could to the weak sauce arguments **Max S** is making. I have to admit I had a brain fart when confusing Medicare with Medicaid, but notice how Max S then does decide with very little logic that it is just applicable to California when I’m not doing that. More hospitals remaining open is something that is happening more in states were some elements of what one could consider to be single payer (really, it is the government regardless if it is two payers, the state or the federal gov.) is helping to keep hospitals open. Just like in the VA, it will be harder to close hospitals once single payer is in place because again, constituents are more active in demanding their governments to make things work better. ---
**Author:** ![Max\_S](https://avatars.discourse-cdn.com/v4/letter/m/46a35a/32.png) [@Max\_S](https://boards.straightdope.com/u/Max_S)\ **Post date:** [March 10, 2020, 11:59pm UTC](https://boards.straightdope.com/t/convince-me-to-support-single-payer-us/848939/189 "2020-03-10T23:59:14Z")
> [@Banquet\_Bear](#): > > [Single-payer healthcare - Wikipedia](https://en.wikipedia.org/wiki/Single-payer_healthcare) > > …it isn’t an extraordinary suggestion. Government run hospitals in single-payer systems are quite common. That you don’t think its relevant is even stronger evidence that you don’t know what “single payer” or “universal healthcare” is or how taxes or how health insurance actually works. Hmm. Perhaps I _don’t_ know what single-payer is. Something like nationalized hospital services and public doctors doesn’t really fit with my beliefs about the proper role of government. You and **GIGObuster** are free to try and convince me on this, and I might budge for small-scale and local government and military operations, but I am warning you that it would be an uphill battle. > [@Banquet\_Bear](#): > > Do you see how poor your argument actually is? Its barely an argument. Its an assertion based on a hypothetical that can easily be flipped around. What makes you think more hospitals will close under single payer? What leads you to think that? I approach single-payer as something like our current Medicare system, which means unless the hospital rates go up significantly, I expect lots of hospitals to close. See for example, MedPAC’s [March 2019 report](http://www.medpac.gov/docs/default-source/reports/mar19_medpac_ch3_sec.pdf?sfvrsn=0) to Congress, p.66, showing that even the most efficient hospitals lose money on Medicare patients: “\*\*Medicare payments and providers’ costs–\*\*_In 2017, hospitals’ aggregate Medicare margin was -9.9 percent, down slightly from -9.7 percent in 2016. The profit margin for relatively efficient providers was about -2 percent. The decline in margins from 2016 to 2017 was primarily due to a decline in supplemental payments for uncompensated care and health information technology. Patient care margins, which exclude uncompensated care payments, increased slightly since 2016 due to a large increase in spending on Part B drugs, which have higher profit margins (in part due to the 340B program) than other hospital services. We project that the overall Medicare margin will decline to about -11 percent in 2019._” ~Max ---
**Author:** ![GIGObuster](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/gigobuster/32/421_2.png) [@GIGObuster](https://boards.straightdope.com/u/GIGObuster)\ **Post date:** [March 11, 2020, 12:15am UTC](https://boards.straightdope.com/t/convince-me-to-support-single-payer-us/848939/190 "2020-03-11T00:15:01Z")
> [@Max\_S](#): > > I approach single-payer as something like our current Medicare system, which means unless the hospital rates go up significantly, I expect lots of hospitals to close. See for example, MedPAC’s [March 2019 report](http://www.medpac.gov/docs/default-source/reports/mar19_medpac_ch3_sec.pdf?sfvrsn=0) to Congress, p.66, showing that even the most efficient hospitals lose money on Medicare patients: > “\*\*Medicare payments and providers’ costs–\*\*_In 2017, hospitals’ aggregate Medicare margin was -9.9 percent, down slightly from -9.7 percent in 2016. The profit margin for relatively efficient providers was about -2 percent. The decline in margins from 2016 to 2017 was primarily due to a decline in supplemental payments for uncompensated care and health information technology. Patient care margins, which exclude uncompensated care payments, increased slightly since 2016 due to a large increase in spending on Part B drugs, which have higher profit margins (in part due to the 340B program) than other hospital services. We project that the overall Medicare margin will decline to about -11 percent in 2019._” > > ~Max Very incomplete as usual, as it turns I always check what the ones you think are telling you that more hospitals will close because of medicare decline in payments is that what MedPac has said actually is that Medicare can be the item that will help keep those hospitals open. > **[47 hospitals have closed in 2019, MedPAC reports](https://www.hfma.org/payment-reimbursement-and-managed-care/payment-trends/47-hospitals-have-closed-in-2019-medpac-reports/)** > > Hospital closures have doubled so far in 2019, compared with 2018, according to a MedPAC analysis. > [@](#): > > MedPAC previously recommended a policy to allow isolated rural hospitals with low inpatient volumes to convert to stand-alone emergency departments. > > Factors that MedPAC staff cited as contributing to hospital closures included: > > ``` > Excess inpatient capacity > Decreases in patient volumes > Lack of Medicaid coverage expansion > > ``` Yes, once again what was mentioned early, a lack of monies that come from a state not having Medicaid coverage expansion. ---
**Author:** ![Banquet\_Bear](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/banquet_bear/32/373_2.png) [@Banquet\_Bear](https://boards.straightdope.com/u/Banquet_Bear)\ **Post date:** [March 11, 2020, 12:30am UTC](https://boards.straightdope.com/t/convince-me-to-support-single-payer-us/848939/191 "2020-03-11T00:30:53Z")
> [@Max\_S](#): > > Hmm. Perhaps I _don’t_ know what single-payer is. Something like nationalized hospital services and public doctors doesn’t really fit with my beliefs about the proper role of government. You and **GIGObuster** are free to try and convince me on this, and I might budge for small-scale and local government and military operations, but I am warning you that it would be an uphill battle. …this is absolutely hilarious. It isn’t as if the definition of “single payer” is a hard thing to look up. Was this thread an early April fools joke? If you want to debate the proper role of government I would suggest that you redefine exactly what it is you want to debate. Because these are the objective truths: people in almost every country that has single-payer pays less than what Americans do for healthcare systems that (almost always) guarantee access to healthcare for all of its citizens, and those healthcare systems offer comparable (and often better) results than you get in the States. If you want to reject those objective truths because of your “beliefs in the proper role of government” then all I have to say is that your priorities are all out of whack. > [@](#): > > I approach single-payer as something like our current Medicare system Well that would be a REALLY big mistake then. The OP isn’t an argument against your “current Medicare system.” The thread is titled “convince me to support single payer.” The OP doesn’t even mention Medicare. It only talks about single payer. Its just like in the other thread. We are all talking about “single-payer” and you are talking about something completely different. You haven’t even got the basic definitions correct. I would suggest that you take the time to figure out exactly what it is you want to debate. ---
**Author:** ![PatrickLondon](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/patricklondon/32/4422_2.png) [@PatrickLondon](https://boards.straightdope.com/u/PatrickLondon)\ **Post date:** [March 11, 2020, 8:04am UTC](https://boards.straightdope.com/t/convince-me-to-support-single-payer-us/848939/192 "2020-03-11T08:04:42Z")
> [@](#): > > I approach single-payer as something like our current Medicare system As the Wikipedia link above describes very lucidly, such a system can be designed in any of a number of ways, depending on what you set, a priori, as its objectives (and by extension, as potential drawbacks that you might or might not be willing to compromise on in order to achieve the objective). For most people, in most countries that have such a system, universal access is the overriding objective, but they each have different compromises (and ongoing debate about them) on drawbacks. So what, in your view, is the overriding objective in your current and preferred system(s), and what aspects would you be willing (or not) to compromise on? ---
**Author:** ![wolfpup](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wolfpup/32/10618_2.png) [@wolfpup](https://boards.straightdope.com/u/wolfpup)\ **Post date:** [March 11, 2020, 8:23am UTC](https://boards.straightdope.com/t/convince-me-to-support-single-payer-us/848939/193 "2020-03-11T08:23:46Z")
In Canada, these are the five principal objectives that must be met in order to meet the health care funding requirements of the Canada Health Act: [https://www.cna-aiic.ca/~/media/cna/page-content/pdf-en/fs01\_canada\_health\_act\_june\_2000\_e.pdf](https://www.cna-aiic.ca/~/media/cna/page-content/pdf-en/fs01_canada_health_act_june_2000_e.pdf) [PDF] ---
**Author:** ![Max\_S](https://avatars.discourse-cdn.com/v4/letter/m/46a35a/32.png) [@Max\_S](https://boards.straightdope.com/u/Max_S)\ **Post date:** [March 11, 2020, 1:52pm UTC](https://boards.straightdope.com/t/convince-me-to-support-single-payer-us/848939/194 "2020-03-11T13:52:56Z")
> [@GIGObuster](#): > > Very incomplete as usual, as it turns I always check what the ones you think are telling you that more hospitals will close because of medicare decline in payments is that what MedPac has said actually is that Medicare can be the item that will help keep those hospitals open. > > [47 hospitals have closed in 2019, MedPAC reports](https://www.hfma.org/topics/news/2019/12/47-hospitals-have-closed-in-2019--medpac-reports.html) You are again confusing Medicare with Medicaid, and you are confusing my arguments too. **Banquet Bear** asked why I thought hospitals would close under single-payer, and I responded that I assume a single-payer proposal would be an expansion of Medicare. If every hospital patient pays at current Medicare rates, even efficient hospitals would be operating at a loss. Therefore, a single-payer proposal based on the Medicare model would have to increase rates by at least 10% for hospital procedures, otherwise all non-charity private hospitals would go out of business. Whenever we finally get to cost estimates of such a single-payer system, I will be checking to make sure they account for this. Whether hospitals have recently closed more often in states without Medicaid expansion is irrelevant. Under a single-payer system, there won’t be Medicaid. Mr. Daly’s article does not contradict me. I already explained that Medicaid expansion helps hospitals because it reduces the number of bills that go unpaid entirely. That problem goes away with single-payer, or any universal healthcare proposal. Once you have universal healthcare, expanding Medicaid loses its utility. Currently, hospitals operate at a loss with Medicare and Medicaid rates. They make up for this loss by charging more to treat patients with commercial insurance. Under a single-payer system, hospitals lose the option to make up for losses through commercial insurance, because commercial insurance ceases to exist. Ergo, if the single-payer rates are still below the cost of care, hospitals will be forced to operate at a loss for _all_ patients, and thus will become unsustainable. ~Max ---
**Author:** ![Max\_S](https://avatars.discourse-cdn.com/v4/letter/m/46a35a/32.png) [@Max\_S](https://boards.straightdope.com/u/Max_S)\ **Post date:** [March 11, 2020, 2:17pm UTC](https://boards.straightdope.com/t/convince-me-to-support-single-payer-us/848939/195 "2020-03-11T14:17:09Z")
> [@Banquet\_Bear](#): > > …this is absolutely hilarious. It isn’t as if the definition of “single payer” is a hard thing to look up. Was this thread an early April fools joke? > > If you want to debate the proper role of government I would suggest that you redefine exactly what it is you want to debate. Because these are the objective truths: people in almost every country that has single-payer pays less than what Americans do for healthcare systems that (almost always) guarantee access to healthcare for all of its citizens, and those healthcare systems offer comparable (and often better) results than you get in the States. > > If you want to reject those objective truths because of your “beliefs in the proper role of government” then all I have to say is that your priorities are all out of whack. I will concede both of your “objective truths”, yet they do not imply that the American government should actually provide health care. All forms of single-payer are within the scope of this thread, as I see it. Normally single-payer implies Medicare for All, at least in American politics, and that is the basis of some of my concerns in the original post, but I recognize that there are other arrangements, and I am willing to consider arguments in support of them. The working definition I am using for single-payer is simply that there is only one risk pool for the entire populace of the country. There are other definitions because it is a nebulous concept, and I am willing to adopt something else for the sake of argument, if you insist on it. ~Max ---
**Author:** ![Max\_S](https://avatars.discourse-cdn.com/v4/letter/m/46a35a/32.png) [@Max\_S](https://boards.straightdope.com/u/Max_S)\ **Post date:** [March 11, 2020, 2:40pm UTC](https://boards.straightdope.com/t/convince-me-to-support-single-payer-us/848939/196 "2020-03-11T14:40:54Z")
> [@PatrickLondon](#): > > As the Wikipedia link above describes very lucidly, such a system can be designed in any of a number of ways, depending on what you set, a priori, as its objectives (and by extension, as potential drawbacks that you might or might not be willing to compromise on in order to achieve the objective). For most people, in most countries that have such a system, universal access is the overriding objective, but they each have different compromises (and ongoing debate about them) on drawbacks. > > So what, in your view, is the overriding objective in your current and preferred system(s), and what aspects would you be willing (or not) to compromise on? The only _overriding_ objectives I bring to this debate is that a proposal is both better than the status quo, and sustainable. See also my [POST=22173893]post #58[/POST]. Now, I do have _preconceived notions_ about the role of government which are at odds with de-jure or even de-facto government-run health services. These notions are not well developed. I may or may not end up compromising, it is impossible for me to say without first hearing the arguments. I could attempt to argue why the government should _not_ provide actual healthcare, but I would be arguing from ignorance. See also [POST=22180227]my post #43[/POST] in **Banquet Bear** ’s concurrent thread. ~Max ---
**Author:** ![PatrickLondon](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/patricklondon/32/4422_2.png) [@PatrickLondon](https://boards.straightdope.com/u/PatrickLondon)\ **Post date:** [March 11, 2020, 3:26pm UTC](https://boards.straightdope.com/t/convince-me-to-support-single-payer-us/848939/197 "2020-03-11T15:26:12Z")
> [@Max\_S](#): > > I may or may not end up compromising, it is impossible for me to say without first hearing the arguments. I could attempt to argue why the government should _not_ provide actual healthcare, but I would be arguing from ignorance. But you can’t hear arguments without defining what you would be arguing about If your a priori starting point is that medical care should not be a government/public service, then ignorance about possible schemes for its doing so is irrelevant anyway. But if you’re saying that you would accept it if it were proven to be no worse than the present system, and sustainable, then you need to define what you see as good and sustainable about the present system, since those are clearly your a priori principles. ---
**Author:** ![Max\_S](https://avatars.discourse-cdn.com/v4/letter/m/46a35a/32.png) [@Max\_S](https://boards.straightdope.com/u/Max_S)\ **Post date:** [March 11, 2020, 4:15pm UTC](https://boards.straightdope.com/t/convince-me-to-support-single-payer-us/848939/198 "2020-03-11T16:15:40Z")
> [@PatrickLondon](#): > > If your a priori starting point is that medical care should not be a government/public service, then ignorance about possible schemes for its doing so is irrelevant anyway. You misunderstand, my default position is that nothing should be a public service. This isn’t an _a priori_ conclusion, it is just the default. All of the public services that I do support - the institution of government itself - are exceptions to the rule. Assuming we don’t run into constitutional issues, pragmatism should be enough to overcome my conviction. And constitutional issues can be overcome with constitutional amendments. > [@PatrickLondon](#): > > But if you’re saying that you would accept it if it were proven to be no worse than the present system, and sustainable, then you need to define what you see as good and sustainable about the present system, since those are clearly your a priori principles. I don’t think the present system is sustainable. The current system does allow some people to get some healthcare some of the time. It is better than nothing. In case it is not clear, I am shifting the burden of proof here, because I am not the one proposing changes to our healthcare system. ~Max ---
**Author:** ![GIGObuster](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/gigobuster/32/421_2.png) [@GIGObuster](https://boards.straightdope.com/u/GIGObuster)\ **Post date:** [March 11, 2020, 4:23pm UTC](https://boards.straightdope.com/t/convince-me-to-support-single-payer-us/848939/199 "2020-03-11T16:23:08Z")
> [@Max\_S](#): > > You are again confusing Medicare with Medicaid, and you are confusing my arguments too. **Banquet Bear** asked why I thought hospitals would close under single-payer, and I responded that I assume a single-payer proposal would be an expansion of Medicare. If every hospital patient pays at current Medicare rates, even efficient hospitals would be operating at a loss. Therefore, a single-payer proposal based on the Medicare model would have to increase rates by at least 10% for hospital procedures, otherwise all non-charity private hospitals would go out of business. Whenever we finally get to cost estimates of such a single-payer system, I will be checking to make sure they account for this. You are correct on the terminology, but still not in the most important item, namely if you really have support for your assumptions. I will have to attribute my terminology misses to the severe flu I’m having (that thanks to the USA not having single payer, this is not being looked by a doctor), luckily my wife has medical training. > [@Max\_S](#): > > Whether hospitals have recently closed more often in states without Medicaid expansion is irrelevant. Under a single-payer system, there won’t be Medicaid. Mr. Daly’s article does not contradict me. :rolleyes: Of course under a single payer system there won’t be Medicaid (Duh), the point stands, as well as the single payer VA hospitals for that matter. It is thanks to government intervention (that would be better with a further expansion and an increase of funds) AKA as proto-“single payer” (or dual payer if one gets technical) that hospitals that would be closed are not as we are speaking. It is even more likely that under a single payer system more funds will be available after getting rid of a lot of overhead and waste that then the proposed plans will have more money for the increases that you are so worried about that will be needed to cover procedures. [https://thehill.com/blogs/congress-blog/healthcare/484301-22-studies-agree-medicare-for-all-saves-money](https://thehill.com/blogs/congress-blog/healthcare/484301-22-studies-agree-medicare-for-all-saves-money) ---
**Author:** ![Max\_S](https://avatars.discourse-cdn.com/v4/letter/m/46a35a/32.png) [@Max\_S](https://boards.straightdope.com/u/Max_S)\ **Post date:** [March 11, 2020, 5:12pm UTC](https://boards.straightdope.com/t/convince-me-to-support-single-payer-us/848939/200 "2020-03-11T17:12:32Z")
> [@GIGObuster](#): > > You are correct on the terminology, but still not in the most important item, namely if you really have support for your assumptions. I will have to attribute my terminology misses to the severe flu I’m having (that thanks to the USA not having single payer, this is not being looked by a doctor), luckily my wife has medical training. I will admit that the argument relies on the assumption that we are looking at an expansion of Medicare. If that is not the case, for example if we are talking about single-payer with socialized health services (such as the VA), the argument fails. > [@GIGObuster](#): > > It is thanks to government intervention (that would be better with a further expansion and an increase of funds) AKA as proto-“single payer” (or dual payer if one gets technical) that hospitals that would be closed are not as we are speaking. It is even more likely that under a single payer system more funds will be available after getting rid of a lot of overhead and waste that then the proposed plans will have more money for the increases that you are so worried about that will be needed to cover procedures. > > [https://thehill.com/blogs/congress-blog/healthcare/484301-22-studies-agree-medicare-for-all-saves-money](https://thehill.com/blogs/congress-blog/healthcare/484301-22-studies-agree-medicare-for-all-saves-money) I will need more time to review the 22 studies, or at least the ones I can access. The [Mercator study](https://www.mercatus.org/system/files/blahous-costs-medicare-mercatus-working-paper-v1_1.pdf), for its part, is assuming an expansion of Medicare at current rates. Ergo, it is overlooking my concern about hospitals going under. It expressly admits so much, devoting pages 10-12 to this issue. ~Max [Previous page](https://boards.straightdope.com/t/convince-me-to-support-single-payer-us/848939.md?page=9) [Next page](https://boards.straightdope.com/t/convince-me-to-support-single-payer-us/848939.md?page=11)