# 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:** 2
**Author:** ![septimus](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/septimus/32/410_2.png) [@septimus](https://boards.straightdope.com/u/septimus)\ **Post date:** [March 5, 2020, 1:22pm UTC](https://boards.straightdope.com/t/convince-me-to-support-single-payer-us/848939/21 "2020-03-05T13:22:59Z")
> [@Novelty\_Bobble](#): > > … 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… I don’t know whether you’re referring to that 18th-century Prussian philosopher or reaching all the way back to Rabbi Yeshu ben Pantera, or whoever it was. BUT start another thread to debate ancient history or the Philosophy of Ethics. This here thread is about the _United States of America_, a place where the “decent maxim” you define only appears at [TheOnion.com](http://TheOnion.com). ---
**Author:** ![iiandyiiii](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/iiandyiiii/32/7924_2.png) [@iiandyiiii](https://boards.straightdope.com/u/iiandyiiii)\ **Post date:** [March 5, 2020, 1:39pm UTC](https://boards.straightdope.com/t/convince-me-to-support-single-payer-us/848939/22 "2020-03-05T13:39:11Z")
The profit motive means that the industry has lots and lots of incentive to deny coverage to non-profitable patients (i.e. chronically ill, those who can’t afford insurance but don’t qualify for assistance, etc.). This will never go away unless we get rid of the profit motive for treating illness and injury. We should retain the profit motive for innovation in new pharmaceutical and medical technology, but that doesn’t require a profit motive for the care itself. ---
**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 5, 2020, 2:44pm UTC](https://boards.straightdope.com/t/convince-me-to-support-single-payer-us/848939/23 "2020-03-05T14:44:06Z")
> [@Max\_S](#): > > I’m sure there’s more, hopefully some of you out there can strike down some of the arguments against. Do they happen in the countries that already have UHC? Are those countries unable to fund their cost of healthcare that is 40% less than ours? Have drug companies already consolidated or reduced R&D due to 80% of their customer base being on UHC? Do the people of other countries get denied treatment from their UHC more often than people in the US get denied treatment from their insurance? Do we count the millions who don’t have any insurance and just suffer through whatever their ailment is without any treatment? Magiver told us about his 2 weeks of misery waiting for his kidney stone, I wonder what he would have done if he didn’t have any insurance. I wonder what he expects the uninsured to do if they get a kidney stone. Should they just take 2 tylenol and go to the ER when it feels like they’re about to die? ---
**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 5, 2020, 3:00pm UTC](https://boards.straightdope.com/t/convince-me-to-support-single-payer-us/848939/24 "2020-03-05T15:00:03Z")
> [@iiandyiiii](#): > > The profit motive means that the industry has lots and lots of incentive to deny coverage to non-profitable patients (i.e. chronically ill, those who can’t afford insurance but don’t qualify for assistance, etc.). That’s the bit that would horrify us, morally speaking. I don’t know what happens in countries with a more or less universal, but insurance-based (i.e., individual reimbursement), basis. But in the NHS, treatments might AFAIK not be offered, on occasion but not automatically, only if they are not cost-effective, or not clinically essential, calculated \*on a whole population basis, NOT in terms of each individual on each oaccasion \*. Is it really fundamental to medical care to charge, and chase payment for, each individual item of treatment for each individual patient? That must be a substantial part of the overhead costs for you, but is there really no alternative funding mechanism? ---
**Author:** ![wguy123](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wguy123/32/3161_2.png) [@wguy123](https://boards.straightdope.com/u/wguy123)\ **Post date:** [March 5, 2020, 4:34pm UTC](https://boards.straightdope.com/t/convince-me-to-support-single-payer-us/848939/25 "2020-03-05T16:34:26Z")
> [@Slash1972](#): > > So, you were in misery but still had to wait two weeks? Doesn’t sound like that good of insurance to me. I have really good medical insurance through my employer (I still pay $100/month for it). I have been living with neck pain since the end of December. I finally see a specialist next week. That is over 2 full months. I saw my primary care giver, then went to get an xray. It took a week to get approval to get an MRI. Then it took a week to get approval to schedule with the specialist. And the specialist is backed up so appointment is weeks out. And, I have to travel an hour and half to get there. RAH RAH RAH USA! ---
**Author:** ![septimus](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/septimus/32/410_2.png) [@septimus](https://boards.straightdope.com/u/septimus)\ **Post date:** [March 5, 2020, 5:10pm UTC](https://boards.straightdope.com/t/convince-me-to-support-single-payer-us/848939/26 "2020-03-05T17:10:48Z")
> [@PatrickLondon](#): > > That’s the bit that would horrify us, morally speaking. I don’t know what happens in countries with a more or less universal, but insurance-based (i.e., individual reimbursement), basis. But in the NHS, treatments might AFAIK not be offered, on occasion but not automatically, only if they are not cost-effective, or not clinically essential, calculated \*on a whole population basis, NOT in terms of each individual on each oaccasion \*. > > Is it really fundamental to medical care to charge, and chase payment for, each individual item of treatment for each individual patient? That must be a substantial part of the overhead costs for you, but is there really no alternative funding mechanism? You foreigners just don’t understand the problems of running a BIG country. One of our state like Florida or Texas is bigger than one of your entire itsy-bitsy COUNTRIES like Britain or France. And you don’t have the problems of ethnic diversity we do. Come back and give us advice after YOU save the world from Hitler or Soviet Russia single-handedly. * * * Disclaimer: The above may not be the views of **septimus**. Instead I am mimicking comments posted or recited by right-wing talk-show hosts and many of the more intellectual GOP voters. ---
**Author:** ![Shodan](https://avatars.discourse-cdn.com/v4/letter/s/9f8e36/32.png) [@Shodan](https://boards.straightdope.com/u/Shodan)\ **Post date:** [March 5, 2020, 5:51pm UTC](https://boards.straightdope.com/t/convince-me-to-support-single-payer-us/848939/27 "2020-03-05T17:51:54Z")
> [@OldGuy](#): > > More coverage means problems are found earlier avoiding many later high expenses. And treatments are given in doctor’s offices rather than emergency room which is a major savings. Overall, preventative care does not save money (already cited many times in the past). One of the ideas of Obamacare was to reduce ER visits on the belief that patients would go to their PHPs instead. Both ER visits, and PHP visits, went up under Obamacare (also previously cited). > [@](#): > > That’s what insurance companies do now, and most of them are for-profit so they have even stronger reasons to deny coverage. And the government, not being for profit, would have no reason to deny coverage. So costs would go up. Regards, Shodan ---
**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 5, 2020, 5:59pm UTC](https://boards.straightdope.com/t/convince-me-to-support-single-payer-us/848939/28 "2020-03-05T17:59:00Z")
> [@OldGuy](#): > > More coverage means problems are found earlier avoiding many later high expenses. And treatments are given in doctor’s offices rather than emergency room which is a major savings. I don’t know if there’s a way to quantify those savings, though. Could you point me to a paper or something? > [@OldGuy](#): > > That’s what insurance companies do now, and most of them are for-profit so they have even stronger reasons to deny coverage. Yes, but at least right now I have a choice when I sign up for the policy. If the plan offered doesn’t cover my favorite medical treatment, I don’t have to sign the contract, and I don’t have to pay premiums. With single-payer, presumably if I don’t like the coverage, too bad so sad because I still have to pay taxes (the premium). I lose my leverage as an individual. ~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 5, 2020, 6:02pm UTC](https://boards.straightdope.com/t/convince-me-to-support-single-payer-us/848939/29 "2020-03-05T18:02:17Z")
> [@eschereal](#): > > 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. I’m not too worried about single-payer leading to sin taxes on unhealthy foods, etc. If that’s what you’re getting at. ~Max ---
**Author:** ![wguy123](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wguy123/32/3161_2.png) [@wguy123](https://boards.straightdope.com/u/wguy123)\ **Post date:** [March 5, 2020, 6:13pm UTC](https://boards.straightdope.com/t/convince-me-to-support-single-payer-us/848939/30 "2020-03-05T18:13:47Z")
> [@Max\_S](#): > > Yes, but at least right now I have a choice when I sign up for the policy. If the plan offered doesn’t cover my favorite medical treatment, I don’t have to sign the contract, and I don’t have to pay premiums. With single-payer, presumably if I don’t like the coverage, too bad so sad because I still have to pay taxes (the premium). I lose my leverage as an individual. > > ~Max My wife and I both work for different companies that both provide healthcare (we still have payroll deductions to pay for part of it). We have no choice in the health insurance company. I guess if we want a different choice in our health insurance we can simply change jobs to one that has a policy we like. Easy-peasy. ---
**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 5, 2020, 6:24pm UTC](https://boards.straightdope.com/t/convince-me-to-support-single-payer-us/848939/31 "2020-03-05T18:24:45Z")
> [@kanicbird](#): > > Research this for yourself, it’s easy to find and overwhelmingly damming against the US system. > > […]Again if you really want to know just do the googling. If you don’t just keep questioning without research. If you have a cite, please post it. I did try and do some cursory searching before making this thread, but nothing convinced me that single-payer is the way to go. I found that sometimes the US is better at screening, for example, see this paper reporting that the US screens for breast cancer slightly more often than Canada. [https://doi.org/10.2105/ajph.90.5.799](https://doi.org/10.2105/ajph.90.5.799) Then, you know, there are wait times. I’ve read that the average wait time to see a specialist could be months in some countries, compared to \<1mo here. I think I raised this in the original post, too. ~Max ---
**Author:** ![Slash1972](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/slash1972/32/6461_2.png) [@Slash1972](https://boards.straightdope.com/u/Slash1972)\ **Post date:** [March 5, 2020, 6:25pm UTC](https://boards.straightdope.com/t/convince-me-to-support-single-payer-us/848939/32 "2020-03-05T18:25:24Z")
> [@wguy123](#): > > I have really good medical insurance through my employer (I still pay $100/month for it). I have been living with neck pain since the end of December. I finally see a specialist next week. That is over 2 full months. I saw my primary care giver, then went to get an xray. It took a week to get approval to get an MRI. Then it took a week to get approval to schedule with the specialist. And the specialist is backed up so appointment is weeks out. And, I have to travel an hour and half to get there. > > RAH RAH RAH USA! This can’t be right. People in this very thread are saying how fast and efficient private insurance is, and how there would be unacceptable wait times in a UHC system. Wait times that just do not exist in private insurance. Except for the two weeks that \*\*Magiver \*\*had to wait, and the months you had to wait. ---
**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 5, 2020, 6:26pm UTC](https://boards.straightdope.com/t/convince-me-to-support-single-payer-us/848939/33 "2020-03-05T18:26:45Z")
> [@Max\_S](#): > > Yes, but at least right now I have a choice when I sign up for the policy. If the plan offered doesn’t cover my favorite medical treatment, I don’t have to sign the contract, and I don’t have to pay premiums. Oh, you have a ‘favorite’ medical treatment, do you? Before we go any farther, you should be thanking Obama up and down for making it possible for you to get coverage with your pre-existing condition. Without him, and the ACA the Republicans are trying to destroy, it wouldn’t matter if your treatment was covered or not, no plan would offer you a contract to sign. Because, dude, I was there. Pre-ACA, when my friend lost his job during the recession, he was on his way to “completely broke” with COBRA payments, and I asked why didn’t he just take his chances and drop coverage. His answer… “because I’ll never get coverage again.” But, please tell me again about your “leverage as an individual”. ---
**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 5, 2020, 6:26pm UTC](https://boards.straightdope.com/t/convince-me-to-support-single-payer-us/848939/34 "2020-03-05T18:26:32Z")
> [@FinsToTheLeft](#): > > Note that in Canada we have single payer for treatment, but there is no national pharmacare program in Canada. Right, but don’t you have national price controls? ~Max ---
**Author:** ![Slash1972](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/slash1972/32/6461_2.png) [@Slash1972](https://boards.straightdope.com/u/Slash1972)\ **Post date:** [March 5, 2020, 6:27pm UTC](https://boards.straightdope.com/t/convince-me-to-support-single-payer-us/848939/35 "2020-03-05T18:27:34Z")
> [@Max\_S](#): > > Yes, but at least right now I have a choice when I sign up for the policy. If the plan offered doesn’t cover my favorite medical treatment, I don’t have to sign the contract, and I don’t have to pay premiums. With single-payer, presumably if I don’t like the coverage, too bad so sad because I still have to pay taxes (the premium). I lose my leverage as an individual. If you don’t mind saying, how do you get your health insurance? Is it through your job? If so, you had a choice on which plan you wanted to sign up for? ---
**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 5, 2020, 6:33pm UTC](https://boards.straightdope.com/t/convince-me-to-support-single-payer-us/848939/36 "2020-03-05T18:33:12Z")
> [@eschereal](#): > > Except, the insurance companies formed [AHIP](https://en.wikipedia.org/wiki/America%27s_Health_Insurance_Plans#History), 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. As far as I know, AHIP is about lobbying. When doctors negotiate rates, they do not go to AHIP. When drug companies negotiate coverage, they do not go to AHIP. I don’t think the insurance companies of America are a monolith at all. ~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 5, 2020, 6:41pm UTC](https://boards.straightdope.com/t/convince-me-to-support-single-payer-us/848939/37 "2020-03-05T18:41:58Z")
> [@Voyager](#): > > 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. I don’t know if it’s okay with me or not. I’m not quite sure what you mean by “a meltdown”, but I wouldn’t expect anarchy or WWIII because of some healthcare tax. At least, not directly… ~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 5, 2020, 6:44pm UTC](https://boards.straightdope.com/t/convince-me-to-support-single-payer-us/848939/38 "2020-03-05T18:44:26Z")
> [@Magiver](#): > > 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. Would you care to explain how a single-payer healthcare system does not get the largest possible pool of financial contributors? ~Max ---
**Author:** ![JohnT](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/johnt/32/15048_2.png) [@JohnT](https://boards.straightdope.com/u/JohnT)\ **Post date:** [March 5, 2020, 6:46pm UTC](https://boards.straightdope.com/t/convince-me-to-support-single-payer-us/848939/39 "2020-03-05T18:46:19Z")
Max, seriously, before there’s a debate, what are your desired policy goals? Because your goals may be completely incompatible with a single payer/M4A system, which means debating _for_ single payer is a fruitless effort. ---
**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 5, 2020, 6:47pm UTC](https://boards.straightdope.com/t/convince-me-to-support-single-payer-us/848939/40 "2020-03-05T18:47:47Z")
> [@Magiver](#): > > 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. Be that as it may, I am working on the assumption that a single-payer healthcare system will be counterbalanced by sufficient taxes and/or savings to become budget neutral. ~Max [Previous page](https://boards.straightdope.com/t/convince-me-to-support-single-payer-us/848939.md?page=1) [Next page](https://boards.straightdope.com/t/convince-me-to-support-single-payer-us/848939.md?page=3)