# 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:** 4
**Author:** ![Snowboarder\_Bo](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/snowboarder_bo/32/229_2.png) [@Snowboarder\_Bo](https://boards.straightdope.com/u/Snowboarder_Bo)\ **Post date:** [March 5, 2020, 10:14pm UTC](https://boards.straightdope.com/t/convince-me-to-support-single-payer-us/848939/61 "2020-03-05T22:14:18Z")
> [@Magiver](#): > > 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. Well, there’s you; for one. ---
**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, 10:59pm UTC](https://boards.straightdope.com/t/convince-me-to-support-single-payer-us/848939/62 "2020-03-05T22:59:14Z")
> [@SenorBeef](#): > > So when Americans talk about some sort of single payer system, they always speak of it as if it were some sort of crazy untried radical idea that could never work. Except that literally every other rich country in the world does better than us. Technically not all are single payer, but even the ones that aren’t are so highly regulated as to be a lot closer to single payer than our system. Thank you, but actually I don’t find “it worked for other countries so it will work for us” to be convincing at all. In my opinion these are the weakest arguments. To make the full argument, you would have to show that other countries are similar in all of the relevant ways to the US, which is undermined by the unique nature and history of our healthcare system and the government that regulates it. > [@SenorBeef](#): > > This “how are we going to pay for it” argument is a sham. It’s not an argument, it’s a _concern_ that I really do have. I don’t prefer paying $1000 to private insurance over paying $1 in taxes, constitutional concerns aside, which I don’t think should be a problem here, that is you knocking down a straw-man. Can you go into more detail on how we would spend less money with a single-payer system and universal health coverage, compared to our current mash-up of public/private health insurance and less-than-universal coverage? Do you have cites on those administration costs? Billing is far under 35% of expenses in our practice, although that’s a fair guess at overhead in general. But also included are (nonmedical) office supplies, regulatory compliance, etc. Comparing Social Security’s administrative cost to the cost of doctors dealing with insurance is like comparing apples and oranges. If Social Security was analogous to anything, it would be the insurance side - not the doctor’s side. As far as I know, current insurance companies have very little overhead processing claims. They have semi-automated systems to receive the claims, automated systems to process the claims, and sometimes even automated systems to send the payments. Then, when we do appeal a claim, the burden is on us (the doctor) to show that treatment meets their existing guidelines. The only complicated part is where doctors have to keep track of all the different sets of guidelines. ~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, 11:02pm UTC](https://boards.straightdope.com/t/convince-me-to-support-single-payer-us/848939/63 "2020-03-05T23:02:49Z")
> [@Slash1972](#): > > In all the discussion here that I’ve read, in the countries where they have somehow miraculous did something that you think is impossible, the doctors decide what treatment is medically necessary and then it gets paid for. I don’t remember reading anything about committees. I’m not familiar with other countries’ healthcare systems, so I had been looking at it as sort of an expanded Medicare. Medicare has committees that write guidelines about medical necessity. If someone wants to describe the adjudication process for claims in a single-payer system, or link to a description, I will read it. ~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, 11:04pm UTC](https://boards.straightdope.com/t/convince-me-to-support-single-payer-us/848939/64 "2020-03-05T23:04:15Z")
Are you familiar enough with our system to know (without looking it up) who administers Medicare? ---
**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, 11:07pm UTC](https://boards.straightdope.com/t/convince-me-to-support-single-payer-us/848939/65 "2020-03-05T23:07:26Z")
> [@iiandyiiii](#): > > I mean the profit motive for the entire industry – if hospitals lose money by treating certain kinds of patients, then they have an incentive to refrain from treating those kinds of patients. Same goes for insurance companies. And it goes the other way too, at least for hospitals – if certain treatments are very, very profitable for hospitals, then they have an incentive to do those treatments over and over again, even if they aren’t needed. So what are you saying here? Should doctors and hospitals just submit a list of operating expenses to the government for 1:1 reimbursement, plus a fixed stipend on top? That’s a little bit out there, dude. ~Max ---
**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, 11:10pm UTC](https://boards.straightdope.com/t/convince-me-to-support-single-payer-us/848939/66 "2020-03-05T23:10:27Z")
> [@Max\_S](#): > > So what are you saying here? Should doctors and hospitals just submit a list of operating expenses to the government for 1:1 reimbursement, plus a fixed stipend on top? > > That’s a little bit out there, dude. > > ~Max No – I advocate something like the Canadian system. ---
**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, 11:15pm UTC](https://boards.straightdope.com/t/convince-me-to-support-single-payer-us/848939/67 "2020-03-05T23:15:51Z")
> [@SenorBeef](#): > > Do you think that the current health care system in the US is sustainable? I think the current federal health care system - Medicare - could be made sustainable with an increased tax. I think private insurance companies will continue to consolidate over time, up to some critical mass, and that with proper regulations that system could continue in perpetuity. ~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, 11:17pm UTC](https://boards.straightdope.com/t/convince-me-to-support-single-payer-us/848939/68 "2020-03-05T23:17:00Z")
> [@JohnT](#): > > Are you familiar enough with our system to know (without looking it up) who administers Medicare? Here it’s First Coast Service Options, it would be someone else in Texas though. ~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, 11:22pm UTC](https://boards.straightdope.com/t/convince-me-to-support-single-payer-us/848939/69 "2020-03-05T23:22:09Z")
> [@iiandyiiii](#): > > No – I advocate something like the Canadian system. Okay, but I thought the Canadians use a mix of capitation and fee-for-service, which means there is a profit motive based on the number of patients or services performed, so I don’t follow. ~Max ---
**Author:** ![eschereal](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/eschereal/32/18939_2.png) [@eschereal](https://boards.straightdope.com/u/eschereal)\ **Post date:** [March 5, 2020, 11:34pm UTC](https://boards.straightdope.com/t/convince-me-to-support-single-payer-us/848939/70 "2020-03-05T23:34:35Z")
> [@Shodan](#): > > And the government, not being for profit, would have no reason to deny coverage. So costs would go up. Really. So non-profits do no accounting? ---
**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, 11:39pm UTC](https://boards.straightdope.com/t/convince-me-to-support-single-payer-us/848939/71 "2020-03-05T23:39:48Z")
> [@Max\_S](#): > > You have the option of going off the employer health insurance and paying for individual insurance, in which case your employer stops deducting the premium from payroll. But it is more expensive since the employer isn’t contributing, either. > > ~Max That is what is called “choice”? I would really hate having that choice taken away and being forced into one insurance system. :rolleyes: ---
**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, 11:42pm UTC](https://boards.straightdope.com/t/convince-me-to-support-single-payer-us/848939/72 "2020-03-05T23:42:22Z")
> [@Max\_S](#): > > Okay, but I thought the Canadians use a mix of capitation and fee-for-service, which means there is a profit motive based on the number of patients or services performed, so I don’t follow. > > ~Max We’ve gone to about the limits of my (rather limited) knowledge on the subject – I favor the Canadian system is, in addition to all the statistics about satisfaction and outcomes I’ve seen, I’ve spoken to my Canadian relatives about it. If there’s a little profit motive in it, then I suppose they’ve found a way to manage that and prevent denial of coverage. ---
**Author:** ![The\_Tooth](https://avatars.discourse-cdn.com/v4/letter/t/c67d28/32.png) [@The\_Tooth](https://boards.straightdope.com/u/The_Tooth)\ **Post date:** [March 5, 2020, 11:54pm UTC](https://boards.straightdope.com/t/convince-me-to-support-single-payer-us/848939/73 "2020-03-05T23:54:34Z")
> [@Max\_S](#): > > Okay, but I thought the Canadians use a mix of capitation and fee-for-service, which means there is a profit motive based on the number of patients or services performed, so I don’t follow. > > ~Max Possibly. None of us are too concerned about it though because we just go to the doctor when we need to. Apparently this is a strange and wonderful thing. ---
**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 6, 2020, 12:04am UTC](https://boards.straightdope.com/t/convince-me-to-support-single-payer-us/848939/74 "2020-03-06T00:04:46Z")
> [@eschereal](#): > > Really. So non-profits do no accounting? I missed that before. We get denials from government insurance all the time. For instance, Medicare has certain secret limits on what can and cannot be billed, which our doctor in his medical judgement occasionally steps over. The claims are automatically denied and we have to convince Medicare that the services were medically necessary. Medicaid is just as tricky as private insurance, with referrals and authorizations and the formulary. And our gap Medicaid program (no Medicaid expansion) is seriously difficult for doctors to deal with. The Veteran’s Choice program is more like, Vogon Administrated - don’t get me started on that one. ~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 6, 2020, 12:20am UTC](https://boards.straightdope.com/t/convince-me-to-support-single-payer-us/848939/75 "2020-03-06T00:20:04Z")
> [@Max\_S](#): > > 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 By meltdown I meant doctors offices falling apart because of all the new patients. As for the tax, that is how the game is played. If we could somehow funnel our current payments for employer covered care (with the employer part included) into the new system, then it wouldn’t seem like that much of a tax, even though it is. If we get contributions by increasing taxes on the rich, many would even see their take home pay increase. That would help the tax go down much easier. ---
**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 6, 2020, 12:30am UTC](https://boards.straightdope.com/t/convince-me-to-support-single-payer-us/848939/76 "2020-03-06T00:30:56Z")
> [@Voyager](#): > > By meltdown I meant doctors offices falling apart because of all the new patients. Okay, I see. I don’t think that will happen, either. But I do think some doctors are going to find themselves scheduling out for months instead of days, and all other things equal I don’t think we will see enough new doctors show up to bring wait times back to their current level. Just about all of my doctors say, “don’t become a doctor!” Your note about taxes agrees with my thinking. ~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 6, 2020, 12:32am UTC](https://boards.straightdope.com/t/convince-me-to-support-single-payer-us/848939/77 "2020-03-06T00:32:10Z")
> [@Shodan](#): > > Well, plus supplemental insurance in many cases. And the reason for not being a meltdown is that the losses doctors incur are covered by higher costs to other patients. > > So it’s not so much a matter of Medicare melting down, as Medicare for All melting down. > > Regards, > Shodan First, MFA does not require that the fee schedule remains unchanged. Second, doctors would pocket the savings from not having to hire armies of insurance people. And they deserve to. Third, healthcare in the US today is incredibly inefficient. My MRI list prices includes money to cover under utilized machines my big clinic got to stay competitive. A single payer plan could drive more efficient use of resources. There are plenty of other examples. I started work at the Bell System. We thought we were pretty efficient, but when we had to really compete we drove all sorts of costs out of the system. Medicine in the US has never had to be truly efficient. Now doctors will complain. My former step-brother was a psychiatrist specializing in mental problems of the rich. My step-sister complained about how much he got for Medicare patients. He had a big house in La Jolla, so I wasn’t all that sympathetic. ---
**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 6, 2020, 12:39am UTC](https://boards.straightdope.com/t/convince-me-to-support-single-payer-us/848939/78 "2020-03-06T00:39:13Z")
> [@Voyager](#): > > Second, doctors would pocket the savings from not having to hire armies of insurance people. And they deserve to. Are not those savings already earmarked to offset the cost of the program? That is, aren’t fees going down since doctor’s don’t need billing staff? ~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 6, 2020, 12:39am UTC](https://boards.straightdope.com/t/convince-me-to-support-single-payer-us/848939/79 "2020-03-06T00:39:55Z")
> [@Max\_S](#): > > Preventative care does save money, or are you going to argue with that old proverb, _a stitch in time saves nine_? It’s just that universal health coverage loses money faster, in the short term. > > Also, your cites were in the other thread. > > ~Max Preventative care may of may not save money depending on the prevalence of the disease it prevents. An expensive test for a rare disease probably won’t save money. If you have false positives, and you always do, even worse, since most of the people you follow up on don’t have the disease. That’s why there is doubt about the benefit of breast cancer tests for everyone. (Or every woman.) ---
**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 6, 2020, 12:42am UTC](https://boards.straightdope.com/t/convince-me-to-support-single-payer-us/848939/80 "2020-03-06T00:42:03Z")
> [@Max\_S](#): > > Are not those savings already earmarked to offset the cost of the program? That is, aren’t fees going down since doctor’s don’t need billing staff? > > ~Max They aren’t going to the government, so they don’t offset the cost of the program in that sense. They should help to keep the doctor’s profitable with lower payments. But if a doctor can’t see it to fire the insurance people, the doctors would lose. [Previous page](https://boards.straightdope.com/t/convince-me-to-support-single-payer-us/848939.md?page=3) [Next page](https://boards.straightdope.com/t/convince-me-to-support-single-payer-us/848939.md?page=5)