…will require MASSIVE cost cuts (IMO) resulting in LOTS of people making LOADS less money if there’s any hope of success and sustainability.
Right?
[I know nothing is “free.” Please ignore my choice of words.]
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It depends on how you account for it. As a Canadian with single payer healthcare, there is a huge difference in efficiency between our system and the US. My GP shares a secretary with three other doctors - there are about a dozen doctors in the practice. She swipes my health card when I get there to ensure it is still valid (expires every 5 years) and I’m done.
There are no co-pays, in network issues, billing assistants, etc. He receives an annual fee to have me rostered as a patient and bills the province for additional office visits.
Isn’t “efficiency” just a euphemism for less people getting a cut of the money moving around?
No, it means you won’t need to pay who spend their days figuring out how to code all the procedures for umpy-eleven insurance companies. It means hospitals not having multiple price lists.
I’m on Medicare nd had a bunch of stuff done, and the price Medicare paid is about 1/4 the list price. I bet no insurance company pays the list price either.
We don’t have employees pumping gas anymore in almost all the states. We managed the greater efficiency.
I have no qualms concerning insurance company stockholders making less money.
No, you’re exactly right in that some people will be out of work - health insurance providers and sales as well as admin staff, insurance specialists at doctors offices, debt collectors and so forth.
There’s some argument that some of those will find homes in the new bureaucracy - which I believe will employ fewer people - but that’s really an unknown.
But then there’s the question of ‘is higher employment or higher income for certain people worth lower life expectancy and worse outcomes for American citizens?’ I’d say that’s a fair question.
Would you or anyone you know volunteer to shave three years off your life - or see an increase in infant mortality by 1% - to provide what is essentially a jobs program? Because that’s really where it is. Countries with some form of nationalized health service see longer - and healthier - lifespans while spending a smaller percentage of their GDP on healthcare in general.
All policy regards trade-offs because all policy is essentially about the allocation of scarce resources. The question becomes where does one fall?
One way free health care and free college would work well together is to remove the massive student loans required to go into high paying medical professions, which is a large part of the reason salaries have to be high–not just to recoup the cost of the education, but to account for the risk of taking those loans long before you make any money, and with no confidence that you would be able to pay them back. It boggles the mind that we say to 22 year olds “Ok, here’s the deal. You take on a cool half million in debt, and then hopefully around 30 you’ll start making $250K a year and paying them back. If you aren’t good at this, don’t like it, or for any other reason can’t do this, you are pretty much screwed. Also, don’t specialize in any of the areas that people actually need–they pay the worst”.
Doctors wouldn’t need to make “doctor salaries” if they started making real money earlier, and if they didn’t have such ungodly debt loads.
That’s just healthcare of course.
In terms of college - or post-high school education, at any rate - the equation is a little different.
It’s pretty clear that a better-educated workforce is more productive in terms of innovation and GDP production per worker. We like those things.
The question then becomes is it worth it for the USA as a whole to encourage those things. Right now the student loan system is both unsustainable - we’re already seeing private colleges fail and public ones consolidate - and, frankly, a crime against the weakest among us. It actively discourages some kids from heading to higher education or trade schools.
Is the growth in GDP - and IMHO the overall good of a better-educated population - by having a more educated workforce more than the cost of providing both trade and higher ed at low or no cost? I think it would be but I can’t say for sure as I haven’t looked at the numbers.
Right now, as it is, we see a massive transfer of wealth from the poorer segments of society - college students, recent grads and failed-to-grads - to banks and lenders (not quite the same thing). It also requires an enormous bureaucracy to support in it Sallie Mae. Eliminating that things would allow the young to get off to a better start, spend money, buy homes, invest and so forth and therefore both increase GDP through consumer spending AND increase it through greater productivity.
What’s best? Who knows? Maybe the German system where all kids are tracked in high school toward either trade school or higher best based on performance. Maybe some other system. Who knows?
The one thing we DO know is that the current curve is unsustainable - again - and change will come either through planning or chaos. We have to make that call. Right now, the main force behind keeping the current system is only those who directly benefit from it. Lenders and those politicians to whom they give money.
Cutting out middlemen is a benefit of single payer, not a drawback.
I agree but if I were a middleman “efficiencied” out of a job I would not.
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There’s a phrase you don’t here ever. “Why won’t someone please think of the middlemen!?”
If Supply-Side economics is a thing there should be no reason those same adherents wouldn’t support Educated-Side economics.
Incentives across the board are kind of skewed. A middleman per se doesn’t have to be bad or inefficient, but we have a lot of oddball incentives in the United States that make healthcare a complete and utter f’ing cluster-f. This doesn’t mean single-payer must be the solution, though. That has its own negatives.
Medicare for all will, but I don’t see why free public college will.
Public college is already heavily subsidized. In state students have around 60-70% of their tuition paid by the state, and that isn’t even including state or federal college grants like pell grants. Free college just means the public sector pays the remaining 30% of the bill for public college, which will cost something like 80 billion a year.
Medicare for all will cost a lot more. Plus because medicare has lower reimbursement rates, yeah a lot of medical providers will suffer. But sadly our health system is 2x as expensive as any other nation, so they are going to have to learn to do more with less. Our health care system isn’t sustainable, and it is starting to wreck our economy due to how much wealth it extracts and how inefficient it is.
I don’t think that offering “free” public college tuition would be all that costly, as it’s already subsidized to a large extent. And it wouldn’t cost jobs, and on a net basis, it would benefit the economy. There would be a tax increase, but it wouldn’t be all that noticeable, IMO.
“Free” healthcare is a very different animal. The cost estimates are much more variable with some actually estimating that it would cost more, and other saying less. No one really knows the impact to costs, or the dislocation of the economy. If we went with the Sanders plan, for instance, it would essentially eliminate an industry. But we don’t know if it would save money.
Of the two topics, the college side is much more simple and less disruptive than the healthcare side.
It is obvious that college educated people are more productive. It is not obvious if that is because college makes people productive or because more productive people go to college. If it is the former than sending more people to college will make the economy better, and if it is the latter than sending more people to college will make the economy worse. Likely it is somewhere in the middle where the economy would benefit from some people going to college and would benefit from other people not going to college.
The debate about free college ignores that there is already a portion of college which is very low priced, community college. The average cost of an associates degree is less than 7 grand, which could be earned working summers. Despite this less than 25% of college students are enrolled in community college. This suggests price is not what is motivating students to not go to college.
Not every country with free healthcare has longer lifespans. Russia has free healthcare and Americans live on average 6 years longer. What if we aim for Switzerland healthcare and end up with Russian healthcare?
There is also a huge difference in costs, the average doctor in Canada makes less than half what the average doctor in the US makes. In order to get costs down to Canadian level the salaries of doctors in the US would need to be slashed drastically.
How do you figure? I just looked up two state colleges and about 20 something percent of their budget is from state appropriations.
I like this one - the problem in the US is all the previously blue collar workers being absolutely certain that their children [well, boys] will all go to college and will by damn have an office job, and be better than they were … though there is absolutely nothing wrong with working with ones hands [someone needs to fix the plumbing and cars, and wait tables, sell groceries and take care of children] And admittedly, some people simply do not have the right type of ‘smarts’ to go to college but are mechanical whizzes. I agree that the whole cold war space race and wanting to better over the soviets was also a major part of the problem.
While I did do the tech track in high school [and apprenticed as an inside/outside mechanic] I did also go to college [and got a degree, political science with a minor in sociology that I never really used as I never went into politics like Dad wanted me to.] I would have been happy to have just gone tech the whole way, or to go college the whole way [though perhaps a different degree program, maybe accounting or something] but we never really got guided one way or the other - and some kids in high school that my brother went with were disruptive because they did the NY state minimum and had almost a full day of study hall and were bored out of their minds and could have benefitted by being sent off to a tech school. [NY the senior year the only required courses were phys education and English, junior as I seem to recall was Math, English and phys ed]