Even in Vermont, single payer ended up crashing on the shoals because all the taxes and disruption were, at the end of the day, too big a lift. Vermont. Home of Bernie Sanders (and Howard Dean for that matter). If voters in that state of all places balked, what do you think is going to happen in Ohio?
These are difficulties that people here, and more broadly most progressives who are rallying behind the MFA banner, just aren’t honestly reckoning with.
You realize that those aren’t just magic words that make an argument vanish, right? I quoted you and replied. If I misrepresented what you said (given the context that you had previously said you can’t just assume two countries are the same), you’ll have to explain how.
Or were you saying “straw man” to announce that you were just about to set one up [my bold]…
The perfect is the enemy of the good.
Given that their costs are generally half our costs or less, nor do I. But you’re implying that’s a reason not to do it!
Surely that massive disparity is pretty fucking compelling evidence that we could at least get our costs under control by adopting UHC funded through general taxation, and eventually down maybe 10% or 20%? That’s even without the moral aspect - you know, the “universal” part, that a civilized rich country shouldn’t be letting many of its citizens just suffer and die.
So do you care about precedent or not? I call your Vermont precedent, and raise you the precedent of every other country in the world.
You’re pulling the same nonsense as the gun lobby, conflating unwillingness to do something properly with impossibility. The fact that we may not have the political will to implement UHC sensibly at the federal level, accompanied by all the other massive reforms that are essential, does not mean it’s impossible.
Of course it’s possible. If our system were like China’s, we could just implement any policy the experts recommended. Which is a true strength of theirs. But we have to treat the political hurdles as part of the landscape and adjust our ambition accordingly.
Fine, so are you’re now following Shodan’s lead, and revoking any claim that UHC is a bad idea in principle, or that it’s impossible to implement in the U.S. in principle?
It was never in dispute that it’s going to be extremely difficult to gain the political will to do it, to dispel the propaganda and blatant lies that have convinced the Republican working class “base” to vote against their own economic interest for decades. But just as with gun control, a lack of political consensus to change anything does not imply that the answer that is staring you in the face is “impossible”.
I’m interested in what’s plausible, realistic, not just theoretically possible. I think a universal HDHP/HSA entitlement fits that bill. (And I also think single payer of the type my wives and children benefited from is bad policy, even if political hurdles were not a factor.)
No one here, or anywhere else AFAIK, has argued that all benefits would be immediate and without other disruption. You do keep presenting that as a strawman of your own, for some reason.
And would continue to build in all the inefficiencies of the current system.
Um, reducing medical care is a *good *thing to you? Gotta part ways with you there.
Nor would universal eligibility for Medicare. One can always decline to use it, or buy private Medicare supplemental insurance. That’s the case right now.
I think slacker’s concern is that, in a market environment, healthcare is regulated by natural market forces: if it costs me money to see a doctor, I will use that service judiciously, but if it is free, I will be seeing the doctor for every faintest twinge. Presumably, medical facilities will be staffed by morons who have no ability to assess my actual level of need or implement any kind of policy that would, say, leave me waiting in the lobby for hours because the triage nurse determined that my complaint was frivolous.
Americans, after all, are notoriously stupid, wasteful and almost impossible to educate and/or train into better habits, so UHC is doomed to fail because we cannot have nice things.
Does that happen under Medicare now? No? Then why would it happen under expanded Medicare?
The irony is that under the current system, even for those with good non-Medicaid insurance, profligacy and irrationality in treatment is rife. So much hinges on the whim of what a private insurance company will pay for, rather than the doctor’s rational assessment of what treatment is appropriate and necessary. Both doctors and patients just get inured to the tiresome “game” with the insurance companies.
An example from recent personal experience, although surely everyone in the U.S. is familiar with similar nonsense. I had a serious fall in the Grand Canyon a couple of years ago. I needed a second operation on my broken arm. First conversation with the scheduler is prioritizing insurance over medical need: the doctor thinks it would be best to wait until February, but that will cost you about $3000 in copay/deductible; if you have the operation in December it will cost you nothing, because you have already exceeded your max out-of-pocket this year. Later on, I spend months going back and forth with the insurance company about whether they will pay for a rehab device that the doctor recommends. They pay for a rental for 3 months, then finally decide they will buy it. At that stage, I’m much better and probably don’t need it. But I take it anyway, at a cost to the insurance company of several thousand dollars, because if I have a setback and do need it, who knows if they will agree to pay for it next time?
What dos this mean here, anyway? does that mean that people will ignore chronic medical conditions, lowering the quality of life, productivity in the marketplace, and eventually leading to more expensive medical costs down the road when the condition finally becomes life threatening?
Or is this more like when my sciatica flares up, and a visit to a doctor for some muscle relaxers will clear it up in a day or so, or I can try to do the same with alcohol, which is barely effective enough to get me through the night, and lets the flare up last weeks?
People don’t go to a doctor because they can go to a doctor for free. They go to a doctor because there is something wrong with them that they need professional help to address.
OTOH, if people cannot afford a doctor, then even if there is something wrong with them that they need a professional to address, they don’t do so.
The entire point of a UHC is to get people to use the medical services that they need. I do not see a UHC spurring people to consume medical resources that they do not need, but I do see it as allowing people who currently are denied medical services to be able to get them.
There is a related issue that I still have not gotten a proper response to, probably because it is almost impossible to answer.
One of the reasons healthcare is expensive in the US is because of malpractice insurance – I saw a table that showed it into six figures for ob/gyn practice in certain areas. But with single-payer, surely that dynamic would change. For one thing, if I am not paying money to my doctor, I might be less likely to sue him for just any little thing. And he has the government covering his backside.
So what happens there? Can doctors taking money from the UHC system also rely on it to cover their malpractice insurance (for which they might also go out and buy supplemental)? How does this fit into the UHC picture, and how does it affect the excessive orders for tests/procedures?
The entire cost of malpractice is maybe $10 billion out of a $3 trillion industry, less than half of a percent. It’s a relative non-issue.
In the very near term, healthcare costs may rise regardless of policy. But …
Suppose my roof leaks. Is it better to
(a) fix the roof. with costs in the following years declining because we no longer have to keep repairing water damage; or
(b) spend the money we’d have spent on the roof to hire clowns who try to brainwash the wife into thinking we can’t afford a roof.
Shodan picks (b). Which do you pick, Slacker?
I know what a high-deductible health plan is. And I know what a Health Savings Account is. And I know how the two work in tandem. In fact, that was my health insurance for the last few years of my employment. It worked well for my spouse and me.
But I don’t know what a ‘universal HDHP/HSA entitlement’ is. And a quick Google search yields no explanation.
Can you provide a cite that explains what this is?
Part of medical malpractice is the fact that you need to pay your medical bills. If they messed up, then you not only have bills to pay for an ineffective procedure, you may have bills to pay for further corrective procedures, that may be of even greater costs. You may have a lowered standard of living, or quality of life, and need more assistance with normal activities. You may need a much longer hospital stay. There are many costs associated with a botched medical procedure that are currently borne by the patient, and therefore, would need to be covered by malpractice insurance.
If medical coverage is “free”, then much of that concern is no longer an issue. Then you just have costs associated with reduced quality of life or needs for assistance, and maybe punitive for negligent acts.
There are the costs associated with doctors playing CYA to avoid a malpractice suit. If they know that they will be sued if they did not properly diagnose a condition that shows up one in a thousand times, then they will run the very expensive test on everyone.
Well, it depends. If I pay the clowns the money for the roof, but they give me a kick back on part of it to fund my man cave, then my wife stops complaining about the roof, and I get a new toaster oven.
For anyone who’s interested in hard numbers, here’s per-capita healthcare costs and outcomes for 18 countries (from here, Table 2, with details that I haven’t bothered to summarize):
Country Per-Capita Healthcare Spending % of US Spending Avoidable deaths per 100,000
Australia $4,207 44.93% 62
Canada $4,728 50.49% 78
China $420 4.49%
Denmark $5,012 53.52% 82
France $4,620 49.34% 61
Germany $5,119 54.67% 83
India $215 2.30%
Israel $2,353 25.13%
Italy $3,207 34.25% 75
Japan $4,152 44.34%
Netherlands $5,227 55.82% 72
New Zealand $4,038 43.12% 87
Norway $6,432 68.69% 64
Singapore $2,752 29.39%
Sweden $5,306 56.66% 69
Switzerland $6,787 72.48% 55
United Kingdom $4,094 43.72% 85
United States $9,364 112
(Anyone who knows how to make that display more readable please feel free to re-post)
To summarize the above table: The US spends vastly more than any other country on healthcare, and gets worse outcomes.
More specifically, we spend almost 40% more on healthcare than the next-most-profligate spender, but have almost 30% more avoidable deaths than the next-worst performing country (though to be fair, I don’t have avoidable deaths numbers for India or China, both of which spend less than 5% of what we do on healthcare).
I think there’s a word for people who look at these results, throw their hands in the air, and say “how could we possibly do any better”.
Here you go:
Per-Capita
Healthcare % of US Avoidable deaths
Country Spending Spending per 100,000
Australia $4,207 44.93% 62
Canada $4,728 50.49% 78
China $ 420 4.49%
Denmark $5,012 53.52% 82
France $4,620 49.34% 61
Germany $5,119 54.67% 83
India $ 215 2.30%
Israel $2,353 25.13%
Italy $3,207 34.25% 75
Japan $4,152 44.34%
Netherlands $5,227 55.82% 72
New Zealand $4,038 43.12% 87
Norway $6,432 68.69% 64
Singapore $2,752 29.39%
Sweden $5,306 56.66% 69
Switzerland $6,787 72.48% 55
United Kingdom $4,094 43.72% 85
United States $9,364 112
But, hey, the more morbidly obese we are, the less reason we have to do anything about it.
It’s important to have an idea of the state of play of public opinion. Here’s Gallup in 2018:
So the status quo defenders will cite that first part and neglect to mention the “crisis” finding. OTOH, the MFA advocates will cherrypick just that last part as justification for why we need to blow everything up and start over. But neither approach is tenable. Most people are happy with what they have personally, so they will feel threatened if you talk about taking it away and replacing it with something else. But they do think the system overall needs change, so they will be receptive to a change that helps others as long as it doesn’t hurt them.
Uh, yeah. I don’t understand how this is ironic, or a rebuttal of the concerns I and others have. This profligacy and irrationality won’t simply disappear just because you install single payer. That’s pretty much the exact point I’ve been making over and over.
Apparently you missed my NPR cite about ambulance drivers who are constantly going on 911 calls for stuff that is far from an emergency or, often, anything that needs professional medical care at all. And you also missed my cite about the Oregon randomized experiment in which thousands of people went from having no insurance to having Medicaid, and increased their ER usage dramatically, including many visits for non-emergency issues. It found that they accessed significantly more medical care than the group that was randomized not to get Medicaid, yet other than the Medicaid group being happier, there was no significant difference in health outcomes between the groups. (That is, of course, very surprising and hard to explain.)
I pick (c): Provide subsidies that help people fix their roofs, but which require those who can afford it to pay a portion of the cost. A program that allows anyone to get a free roof at any time is guaranteed to be wasteful and result in people getting new roofs prematurely.