# 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:** 2\ **Page:** 11
**Author:** ![RickJay](https://avatars.discourse-cdn.com/v4/letter/r/bb73d2/32.png) [@RickJay](https://boards.straightdope.com/u/RickJay)\ **Post date:** [March 11, 2020, 6:53pm UTC](https://boards.straightdope.com/t/convince-me-to-support-single-payer-us/848939/201 "2020-03-11T18:53:36Z")
> [@Northern\_Piper](#): > > This arrangement is consistent with the findings of health care economists, which is a highly specialized field of economics. They have found that the usual rules of the market don’t work with the funding systems for health care, for reasons mentioned in this thread. This is an odd way pf phrasing it. In fact, all the customary rules of markets work. The failures of non-single-payer health care systems are entirely predictable with standard economic theory. > [@](#): > > That doesn’t happen when funding is provided by the government, as a public service, for the purpose of paying for health care. The purpose isn’t to make a profit, but to ensure people get health care. This is only half true. The economics of political behaviour, and a degree of common sense and clear-eyed observation, dictate the the government’s funding level is in fact affected by quite a lot of things besides ensuring people get health care. Mostly, it is affected by the desire of politicians to be elected and re-elected, to gain political capital to achieve other goals, and by budgetary limitations. That is why we do, in fact, have wait times and health care frustrations in Canada, but (almost never) to the point that it becomes a life-threatening travesty; there is no point pretending it works perfectly. Resources are sometimes not quite enough, but the government doesn’t just blindly throw more money at it, so just providing health care clearly isn’t the only goal. The government spends the level of money they feel will minimize political damage to them without severely compromising other needs regarding spending and fiscal policy. ---
**Author:** ![survinga](https://avatars.discourse-cdn.com/v4/letter/s/cab0a1/32.png) [@survinga](https://boards.straightdope.com/u/survinga)\ **Post date:** [March 15, 2020, 5:45pm UTC](https://boards.straightdope.com/t/convince-me-to-support-single-payer-us/848939/202 "2020-03-15T17:45:01Z")
> [@Max\_S](#): > > 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 Single-Payer works very well in most of the world, although every country has its own challenges. And it could work in America. But there are a lot of questions, and a lot of reasons for people to be skeptical. I’ve listed some below. I support UHC, but by means that maintain private insurance as an option in America, not by turning ourselves over to Bernie’s Medicare For All. 1. Will it save money? The NYT surveyed some studies on costs, and it’s a mixed bag, with some predicting savings and other predicting cost increases. > **[Would ‘Medicare for All’ Save Billions or Cost Billions? (Published 2019)](https://www.nytimes.com/interactive/2019/04/10/upshot/medicare-for-all-bernie-sanders-cost-estimates.html)** > > We asked a handful of economists and think tanks to find out. The Urban Institute in particular thinks it will increase costs, and that’s not anyone’s idea of a right-wing think-tank. 1. Will it hurt or help doctors and hospitals? Well, opinions vary, but there would certainly be dislocation in some areas of healthcare delivery. > **[Medicare for All Should Hurt (Some) Hospitals and Doctors](https://nymag.com/intelligencer/2019/04/medicare-for-all-should-hurt-some-hospitals-and-doctors.html)** > > Achieving health-care justice in the U.S. will require taking on price-gouging hospitals and overpaid specialists. Currently, Medicare and Medicaid pay far less than Private Insurance. So, if we go to single-payer and try to save money, government would likely force doctors/hospitals to accept less. And that might be fine to accept. But what will this mean to rural areas that are already short on providers? Will it cause there to be a shortage in certain areas or certain types of doctors? We don’t know, but it’s something that might happen. There’s no free lunch here. 1. What would happen to Medicare-for-All the next time this country elects a Donald Trump or the first time this country elects a Ron Paul type? Currently, with our patchwork system, Republicans can’t attack the entire thing. They can only attack pockets. If we put everyone under one single-payer system, such as Bernie’s M4A, then Republicans’ ability to attack and undermine could go much further and do more damage than anything they’re currently doing under the patchwork system we have now. 1. Public Opinion on healthcare and health insurance in this country shows strong majorities like what they themselves have. [Most Americans Still Rate Their Healthcare Quite Positively](https://news.gallup.com/poll/245195/americans-rate-healthcare-quite-positively.aspx) So, if we go to M4A, what are we telling the 70% who like their own health insurance and 80% who like their own healthcare? Maybe M4A without private insurance would be better. But you would be replacing a system where strong majorities like what they have. 1. And most Americans want to have a choice to keep private insurance (that includes me, by the way): > **[Americans Still Favor Private Healthcare System](https://news.gallup.com/poll/268985/americans-favor-private-healthcare-system.aspx?utm_source=Newsletter&utm_medium=Email&utm_content=morelink&utm_campaign=the_health_202&wpisrc=nl_health202&wpmm=1)** > > Although support for a government-run healthcare system has edged up in the past five years, the majority of Americans continue to prefer a system based on private health insurance. Gallup’s survey shows a majority of Americans favor private insurance, while at the same time a similar majority thinks government has a responsibility to ensure that everyone has healthcare coverage. People are OK with the idea of UHC, but not so much in favor of single-payer. 1. Let’s also be clear about Bernie’s M4A. It’s eliminating an entire industry, i.e., the Private Health Insurers. This is a large dislocation of jobs. That may be great to some people. But we have to honest about what we’re doing. We’re looking at hundreds of thousands or millions, and telling them we’re removing their job. > **[Analysis: A Health Care Overhaul Could Kill 2 Million Jobs, And That’s OK -...](https://kffhealthnews.org/news/analysis-a-health-care-overhaul-could-kill-2-million-jobs-and-thats-ok/)** > > Reform has a cost. But the point of a health care system is to treat patients, not to buttress the economy. [Previous page](https://boards.straightdope.com/t/convince-me-to-support-single-payer-us/848939.md?page=10)