Damn, it really pains me to post this, but (at least for now) Vermont has sidelined its push for SP.
Yet another liberal pipe dream dashed on the sharp rocks of reality. That is the problem with liberalism, eventually you run out of other people’s money.
Funny thing is, that particular “liberal pipe dream” is running quite successfully in every industrialized nation on earth, whose citizens are quite happy to be paying on average about half as much for health care as the US, getting more for it, and never worrying about out-of-pocket costs or bankruptcy brought on by medical costs.
Maybe what you should be asking yourself is how come the US is afflicted with such a toxic political climate that it can’t do a simple essential thing that every civilized country on earth did a long time ago. Maybe you should be asking yourself how come the US is afflicted with such a toxic political climate that characterizing an essential of life – basic universal health care – as a “liberal pipe dream” can be considered a sane political position.
I’m pretty disappointed, as well. I was hoping Vermont’s experiment proved to be effective, efficient and affordable, so we could move away from the ACA monstrosity. The "A"CA is anything but “affordable” for me. Being self-employed, I have to find my own policy. For 2015, I will be paying $993 a month for a family of four, 59 percent higher than 2014. That’s within spitting distance of $12k a year, plus I’m on the hook for up to $7,200 in copays and deductibles.
Doctors and hospitals hate the ACA, too. It seems the only ones who like it are people getting large subsidies (welfare, basically) and the insurance companies, who are making out like bandits with this whole mess. The system is so costly and inefficient that I was hoping that Vermont’s experiment would provide a reasonable alternative, but it looks like it was too costly, too. I don’t know where we go from here.
And, no, I’m not trolling. Something needs done, but I have no idea what.
What’s the average SP premium/tax? 7% of income a year? 9%?
In a low-tax state it might work, in a high-tax state the burden might be very heavy.
You’re missing an important point… right now health care costs are a sort of aggregate cost to the economy and society in general. And single-payer would make that aggregate go down. Nobody’s disputing that.
However, the states aren’t paying 100% of that aggregate cost right now, and under single-payer, they would be, and that’s where the problem lies.
Pulling numbers out of my ass, if they’re currently paying 60 billion (60% of 100 billion total costs), and move up to paying 100% of 80 billion, the total costs went down by 20%, but the total cost to the state went up by 33%.
This is essentially what Puddleglum is getting at as well.
So? People will pay 20 billions more in taxes and 40 billions less in insurance premiums, in your example. I fail to see where the problem is.
In Canada, it’s not a specific tax. It’s paid out of general tax revenue, at both the federal and provincial levels of Gov’ts.
Like puddleglum said, in some cases, that 20 billion more in taxes is an undue tax burden for the people of particular states, and politically very unpopular.
I’d be curious to see what the break-even income would be on average for a SPHC system. By that I mean what income for a single person would pay enough in taxes on average to offset the average person’s health care costs. I’d be willing to bet it’s fairly high, and that most SPHC schemes end up looking a lot like Robin Hood type programs.
Vermont’s giving up on single-payer health care over ballooning costs
Tax hikes required to pay for the system would include a 11.5 percent payroll tax as well as an additional income tax ranging all the way up to 9.5 percent. Shumlin admitted that in the current climate, such a precipitous hike would be disastrous for Vermont’s economy.
…
But beyond federal funding, the report also admits that the single-payer system won’t save money as Vermont officials had planned. While both previous reports on Green Mountain Care had assumed “hundreds of millions of dollars” in savings in the very first year of operation, Shumlin’s office is now admitting that’s “not practical to achieve.”
“State government and providers need to partner to bend cost curve over time,” the report concluded. And the state admitted that while it would need to “ease the transition” for Vermont’s businesses, it would be “extremely expensive” to do so.
Shumlin also cited slow economic recovery in Vermont as reason to delay, and hopes to try again in the future. But its failure, especially on economic grounds, is a resounding defeat for single-payer advocates.
This is the essential point. In order to achieve cost savings single payer systems have historically contained cost growth better over time than the US system. Suddenly changing to a single payer system can only save money by suddenly cutting provider salaries, which is politically impossible, or suddenly cutting patient benefits which is also politically impossible. Any theoretical saving on adminstrative costs would be dwarfed by the cost of creating the new bureaucracy to administer the plan. So theoretically if Vermont had switched this year it would be possible for overall costs to be less ten years from now than the alternate scenario but it costs this year would be higher.
While I am not aware of the exact difference in dead weight loss in taxation between state and federal taxes, it seems to me that it would be higher for state taxes. Since dead weight loss of federal taxes is estimated at 20% it is unlikely that a single payer system at a state level could achieve enough savings to counteract that in less than a couple of decades.
Single payer will bring massive tax increases and loss of economic growth for a couple of decades before achieving its theoretical cost savings. That is why it will never happen at the state level.
These are two important points overlooked or downplayed by single-payer advocates. We have close friends in Spain, including several physicians. Physician pay is far, far lower in Spain, and one of our friends simply decided to stop performing certain surgeries because he was compensated too little for them. Both of the doctor friends said they don’t think it makes financial sense to become a physician anymore in Spain.
Although this table doesn’t include Spain, I would assume Spain falls in line with neighboring Portugal and Italy, where average physician salaries are one-third of the US.
http://b-i.forbesimg.com/theapothecary/files/2013/05/DoctorPay.png
As for patient benefits, the oft-repeated claim that it can take a long time to see a doctor or have a procedure done was mentioned as well. Or that some procedures are simply denied, despite both patient and doctor thinking it’s appropriate.
There is no perfect system, and there are well-known problems with any structure. I wonder how much lobbying was underway in VT by physicians, hospitals and other care givers to try and stop (proposed or anticipated) reductions in fees, treatments and reimbursements?
It seems to me that conservative/Republican types are all disputing exactly that.
[ul]
[li]That is the problem with liberalism, eventually you run out of other people’s money. [/li]
[li]By that I mean what income for a single person would pay enough in taxes on average to offset the average person’s health care costs. I’d be willing to bet it’s fairly high, and that most SPHC schemes end up looking a lot like Robin Hood type programs. [/li]
[li]… the report also admits that the single-payer system won’t save money as Vermont officials had planned … its failure, especially on economic grounds, is a resounding defeat for single-payer advocates.[/li][/ul]
I agree that it’s difficult for any state to unilaterally start true single-payer on its own in part because of the complexities of the ACA, Medicare, and Medicaid, most of which are intentionally designed to work with private insurance. But the province of Saskatchewan did manage to do it on its own, mostly by virtue of a huge amount of political will and against strident opposition by the usual gang of misinformed conservatives, self-serving insurance lobbies, and a misguided medical establishment, and it eventually became a model for national implementation. In the US, realistically, I do agree that it would likely need federal government support and a very determined political effort. The insurance lobby, AHIP, provided a clear demonstration during the ACA debates of its awesome political muscle. With the very existence of its members at stake, AHIP would fight this with every tool, every lie, every dollar, every fear tactic at its disposal to make sure it never happened. It takes pretty strong political leadership to overcome that.
Physician pay may be much lower, but so is the cost of living. In fact it may be that the system is mismanaged in Spain and doctors really are underpaid, but that’s not intrinsic in SP. Doctors are doing just fine in Canada. On paper they earn less than their US counterparts, but their expenses are far lower, too, and they have the security of knowing that they always get paid in full. Ironically, the same argument you just made – that some in Spain feel it doesn’t make financial sense to become a doctor – is exactly the same claim I’ve heard made in the US. The argument here is that the extreme and increasing hassles and expenses of simply getting paid for their services among a hodgepodge of unethical insurance companies and deadbeat patients is discouraging many people from the medical profession.
Wait times can happen, but always related to elective procedures, not urgent ones – this is a critical point. Beyond that, this is just a resource issue that some countries manage better than others. It’s also an issue directly related to costs. There were some threads in another forum here asking why CT and MRI scans are so incredibly expensive in the US. One reason why is that there is a vicious circle where high costs due to lack of cost controls make it feasible from a business standpoint to have a glut of these devices and still make a profit. So what you have are million-dollar machines and technical staff sitting idle so that people can claim they have “no wait times”, but somebody has to pay for that. Having queues for expensive resources isn’t an evil, it’s classical methodology for efficient utilization.
As for denial of procedures “despite both patient and doctor thinking it’s appropriate”, you are describing the most central premise of private insurance, not single-payer. This is the basic mechanism by which private insurance controls costs, indeed the only one available to it. Single-payer controls costs up front, through uniform contractual fee negotiation. It never meddles in the doctor-patient relationship except perhaps in some very very rare and unusual circumstance, such as the use of some unconventional super-expensive unapproved experimental drug or technique. Indeed there isn’t even normally any mechanism to deny a claim. I’ve lived in the single-payer system in Canada all my life and have never heard of such a thing. If I see a doctor, or go the hospital, I present my health card and that’s it. Done. The doctor enters a claim code and a government computer somewhere transfers the set fee into his account.
Agreed that there’s no perfect system. It’s just that some systems are a lot less perfect than others. In my view, in a civilized society there is no place for profit-making private enterprise in insurance for medically necessary procedures. They can feel free to peddle their wares in the area of supplementary services, but not essential services, not in matters of life and death and human suffering.
I’ll repeat something I’ve said before. Whenever I read about how various attempts like the ACA or the Vermont initiative for SP have failed, or will fail, the correctness of those observations is always in proportion to how poorly those initiatives have been implemented. Let’s be clear: single-payer doesn’t work with half-assed implementations that try to appease and compromise with private insurers, which have engendered a system that is the root of all the cost problems and all the problems of people who need health care not being able to get it. The effect of single-payer legislation in all Canadian provinces, and of the Canada Health Act that supports it and partially funds it, has essentially been to tell private insurance companies to pack their bags and take their sordid criminal business the hell out of the country, because medically necessary health care is considered a basic human right and by law cannot be privately insured for human beings, only for our pets.
No argument. The cost to become a doctor in the US is exorbitant, and reimbursement rates, non-payments and insurance administration costs all reduce pay. And you can’t overlook malpractice insurance, which is terribly expensive for many physicians. I can see how a single-payer system, along with tort reform, would reduce many of these costs.