Why go to a system that makes the problem worse? If we use Singapore’s system then there is no one to lobby for money. The way to get money is to compete with other providers for customers. Any system the US implements are not going to be run by Sweden’s technocrats but by the US congress. Therefore the less politics, the better and single payer is all politics.
Does it? Again, Medicare runs a 2 percent overhead even with an elderly, high-care customer base.
If Congress leaves the technocrats alone, as it generally does with Medicare, sure it can.
The implementation is, sure, like any major change. There is no case to be made that operation of it is anywhere close to being as politicized as the postwar US system, or could be.
Medicare is run by the US government, and Americans seem to be happy with it. My mother does well by it.
I have to give kudos to puddleglum for a novel argument. America isn’t capable of doing what other countries do.
That’s giving in to the people who are intentionally sabotaging our politics. “We shouldn’t try to do anything new or useful because Congress will intentionally fuck it up”.
How about, instead of thinking like that, we try to change Congress?
There were terrible scams going on at the inception of the NHS.
My favourite example, and I lost the link, was a shocking example of thievery, and possibly mopery, witnessed by an American writer who declared it was common for people now in receipt of false teeth and free spectacles and free wigs for the first time in their lives to make a bee-line for the local pub — Brits love their boozers so, and gather around joannas and sing honky-tonk songs and music-hall melodies whilst puffing gaspers and raising their pints to the queen, gawd bless 'er — and sell off these freely acquired trinkets to anyone who wanted a pair of false teeth fitted for another in exchange for a drink.
This was in a 1940s/50s pamphlet produced by an American ‘Liberty for Doctors’ type thing foundation who seemed pretty outraged at socialized medicine. Almost to a comical effect.
As to Grim Render’s point: To Europeans , that fear is like being afraid of Goblins. Its not something you worry about in the modern age. In these discussions, the people who fear not getting healthcare are always American, as a Brit I can say I’ve virtually never thought about healthcare in my life, nor needed it much ( apart from dentistry, and since I had little income at the time, this too was free ).
Reagan eased his way into politics by way of shilling for the AMA, which opposed Medicare:
How’s that workin’ out for ya, Ronny?
Oh, and, showing that some things never change:
There wasn’t, of course. There isn’t now and never will be, either.
I would favor single payer in America if there were a corresponding cutback in taxes elsewhere to ensure that the overall tax burden remains largely unchanged.
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I have to give kudos to puddleglum for a novel argument. America isn’t capable of doing what other countries do.
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Nothing novel about it…nor is it as ridiculous an argument as some of you who are handwaving it away seem to think. It’s a fundamental structural change for us to get from where we are today to some ill defined ‘let’s do it like the Europeans’ goal, and I’ve yet to see a good way to do it except to gradually move people from the current system to Medicare somehow, which means we will have two systems we will be supporting for some ill defined number of years through a transition that will cost some ill defined amount of money and have some ill defined amount of disruption.
Because other countries have UHC or single payer systems doesn’t mean that the US can just do the same thing because they did. You can’t handwave away all of the political ramifications, nor the entrenched corporate and health care provider issues, no even the issues that Americans know the system we have and would need to be convinced that the pain of moving from where we are to some ill defined final goal will be worth it in the end, especially since no one can really say what we will get to in the end, considering that it will probably be a compromise system and probably won’t end up what it started out as, considering that there will most likely be several administrations and changes in Congressional majorities between the theoretical start and finish. These are issues that other countries didn’t have to deal with in getting from where ever they started to where they are today because no one else is structured like we are politically and socially.
When one of you becomes god Emperor of the US and can simply do whatever you want by fiat, then come back. Until then handwaving away reality is really just mental masturbation and doesn’t do anything constructive to the real issues.
It would be like me saying that we should build hundreds of nuclear power plants because that would be the best thing we can do for global warming and that we could do this because France already has over 70% of their power generation via nuclear…why can’t the US do that too if France can?? Well, we can’t because we aren’t France.
His claim wasn’t that the existing system is too heavily entrenched, but that Americans are somehow inherently more prone to game systems than are people elsewhere.
And even if it were, obstacles exist so they can be overcome. Giving in to despair over the prospect is surrendering before the war even starts.
Do you favor that the money most corporations pay to provide health care for their workers become profits to them, or increased compensation for employees, or lower prices … or perhaps that via taxes could finance the health care.
In the US in 2013, 2.9 trillion was spent on health care. In fiscal year 2014, the federal government collected $3.02 trillion in taxes. If the federal government pays for all our health care with no increase in total taxes, there’s not going to be a whole lot else they can do. Interest on the debt alone is over $400 billion so even that could not be paid.
Oh. Well, my apologies then.
I think it’s a worthy goal, and I’m for it if the details can be nailed down. I think it’s obvious to everyone that we have to do something. Even my dad, one of the more conservative people I know, agrees that things have to change. But getting from where we are to where we want to be (assuming that is ever even nailed down) is going to be VERY difficult, and saying that the Europeans or Japanese or Canadians have done it really is meaningless in the context of the US, since in order for us to do it is going to mean buy in not just from the voters (like herding cats) but from both political parties, and business both small and large, plus the medical service companies and organizations. One party is never going to be able to do it.
Really and realistically from where we are at it would be better to start at the state level and build it there. If it can be made to work at that level in just a few states then you could use that success (assuming you got success) to build consensus as people could see and understand the example and put it in a context of their own experience and how it would work for them.
But in the end I have no more idea how to actually do it than I do in convincing my fellow citizens that this global warming thingy is important and that we should be building nuclear power plants like mad.
Absolutely, it has to be done in stages, and absolutely, one party can’t do it alone, especially with the other in auto-obstruct mode.
But we have the basis for a national system already in place and working well, with essentially no complaints or organized opposition. Rather than depend on state governments, with all the same institutional resistance to overcome but less ability to combat it, why not just phase in expanded eligibility of the fine system we already have? Opposition would have a much harder time coalescing, and the final result would be pretty much optimal.
That’s preposterous. You’re currently paying insurance on one hand and taxes on the other. So you’re in favor of having the government take the burden of your insurance off your back but only if you don’t have to pay a nickel for it?
Maybe once you begin to lose the obstructive white noise of lobbyists and special interests change can happen quickly, especially with moden technology and the option of learning from the mistakes of other systems.
Already people up thread are saying they want Singapore and not this or that.
The biggest issue will surely be changing the mindset.
The Singaporean health savings accounts were discussed here (it picks up in two places to keep watching)
But what you left out of that diatribe is the fact that Singapore mandates a garnishment of wages to put into those healthcare savings accounts (oh no government MANDATES !!!), they also dictate the prices for drugs and how much doctors and hospitals can pay for more things (again, oh no GOVERNMENT MANDATES !!!).
I don’t know how easy a system like that would be to set up here, but the big hurdle will still be to the remove the white foam from conservative mouths while trying to get them to acknowledge that the better systems involve different government policy and constraints.
Case in point.
This is why I made such a big deal about finding a way to break through these sorts of axiomatic beliefs about the way things should be, beliefs impervious to practical results and more focused on an almost aesthetic preference about the way things ought to be. But these beliefs have consequences and need to be ground to dust. It is not enough to let them stand because a bunch of people with thick skulls believe them.
The Medicare 2% overhead myth is achieved by comparing apples to oranges. Try taking all things into account:
He decries price controls, but that single fact seems to be one of the largest factors in why Americans spend so much more on health care costs. I don’t think healthcare functions like a normal market because the product is human life and its quality. There is virtually no premium people would not be willing to pay if they are able. This is why it’s one of the largest causes of bankruptcies. You parent needs care, or your child needs care that is not covered by insurance? What are you going to do? Let them die? Especially in the case of children, parents often take out mortgages on their own property to pay for medical service.
This is not like skipping out on the latest high end retina mac, this is about life and death, and the premiums people are impelled to pay for their own lives and the lives of their families is much higher. For these reasons among others, we need other ways to check the costs of healthcare. That guy mentioned cross subsidies as if they were a bad thing.
I didn’t cite the paper for his criticism of price controls. I cited it for his analysis of what the true administrative costs of Medicare are. Hint: they are a lot higher than 2%.
It’s great debates so “hint” isn’t really carrying too much weight. How about a cite?
So that source is saying Medicare does its side of the admin for 1%, the private insurers side adds 5% - which is kind of the whole ball game in a single number.
My grandmother is 101. Her blood tests are A-OK. She’s got minor mobility problems and some arthrosis (uses a walker, or a cane she waves like Charlot and a person to hold onto; needs help with blouses). High hearing loss. Eyesight ridiculously good, thank you. Sometimes she presents fecal blood. Medication: an OTC painkiller, as needed.
Doctors and family agree that at her age, the most likely CoD without an autopsy will be “old age”, excuse me, “cardiorespiratory arrest”.
The procedures to find out where the blood is coming from would be invasive. She hates being in bed. She hates not being allowed to move around. She has been asked “Mom, you know sometimes you shit black?” “Oh yeah.” “You know what that means?” “I shit blood! Do you think I’m stupid, woman?” “No, Mom, I don’t think you’re stupid. I think a lot of nasty things about you but I’ve never thought you were stupid. The doctors say we can maybe take you to the hospital, see if they can find out where that blood comes from. Do you want to do that?” “No, I don’t want to go to the hospital!”
What, should we bundle her up into an ambulance, grunting her negative impression of everybody under the sun, because maybe we can find out where she’s got an ulcer or something?
I cited the paper. It’s in there.
For the private market, non-benefit costs are about 11-14 percent of total premiums, while the direct administrative costs reported for Medicare are about 3 percent of Medicare outlays. A reasonable allocation of a share of outlays for general government functions and for the administration of justice increase direct and indirect administrative—that is, non-benefit—outlays as reported in the federal budget to about 6 percent of Medicare outlays.
…
Because the federal tax system is an institution necessary for financing all federal programs, including Medicare, the unmeasured costs borne by the economy as a result of the tax system are a real cost of federal spending, and the lowest plausible assumption about the magnitude of that excess burden has the effect of raising the non-benefit costs of Medicare to about 24-25 percent of Medicare outlays, or about double the net cost of private health insurance. A more realistic assumption raises the true cost of delivering Medicare benefits to about 52 percent of Medicare outlays, or about four to five times the net cost of private health insurance.
See bolded.