“I’m opposed to it because too many other people are opposed to it.”
Your summary is still wrong, then, but whatever. Are you aware of the GOP opposition? I assume so. Do you understand what that means in the terms I’m trying to explain and what the ramifications of that opposition are, and how that opposition must be shifted before anything can be accomplished on this? Seemingly not. Do you make the connection to how our political system, our voters and our business and corporate culture is different than those others who adopted UHC or a single payer system? Seemingly not.
I think we can have UHC or something like it in the US. I think it will eventually happen too. But the argument that others have done it so we can too is flawed by not acknowledging how different we are, even from Canada (let alone Europe), and how much more it’s going to take to accomplish it here than it did there…and how, in the end, we will get some sort of compromise system that is STILL not going to be what they have.
I know…TL and you DR.
Never mind
I’m not a conservative but I do have objections to single payer. My main objection is one of principle. I don’t think government’s proper role is to pay for people’s healthcare. On that score, arguments about efficiency of other country’s systems are unpersuasive. I think this is a major disconnect in discussing this topic. Not only do they not acknowledge the differences we have in this country vs. others, I simply don’t care. There are many things that theoretically can be done more efficiently if they were centralized.
Taking it one step further, even if we were to defeat this argument that the government’s role was to pay for people’s healthcare then it should be in the least intrusive way possible. A voucher system may be workable but I’ve not given it a lot of thought. Having a the government be the monolithic entity that controls and centralizes the payment is not the least intrusive way to implement.
A more pragmatic objection is that having single payer stifles innovation. Assume there is a drug that can treat some condition that afflicts 100,000 people. The drug will cost X dollars to bring to market with a risk of 25% it will never pan out. With single payer, the government can fix the price it will pay for this drug, let’s say that is Y/unit. If Y x 100,000 is less than X plus an acceptable profit margin as well as an amount to compensate for risk, this drug will never be created. This type of analysis would apply to all sorts of innovations - we’d never know what didn’t get pursued.
That being said, most of my opposition is defeated with antipathy. I have good insurance and I’ve used it for myself and my family. The experience on multiple occasions was abysmal in every way possible. What we have/had doesn’t work. For that I’m willing to try something else. Not necessarily anything else, but something. I would prefer smaller trials as experiments over national efforts that become immediately entrenched regardless of the efficacy.
Ah, so we are talking about Doctors “gaming the system” under UHC, not the patients? That bit wasn’t clear to me.
Do you think government has a role paying for healthcare for people who can’t afford it on their own, the poor? Do you think government has a role paying for insurance for people who mostly wouldn’t be able to afford it, the elderly?
If government or anyone pays the doctor bills they need to negotiate a rate in advance, which is intrusive. I’m not sure how money from taxes going to a general fund used to pay doctors bills is more intrusive than money from my paycheck and money that might be in my paycheck without my employer’s contribution going to an insurance company and then going to a doctor. I think the doctor would find dealing with one insurer a lot less intrusive than dealing with n insurers all with different rules and different forms.
You seem to think that the government is by definition more intrusive than private insurers. This isn’t at all clear to me.
We already have this problem, especially for drugs that will treat a small number of very sick people. If insurance companies are unwilling to pay the massive costs of such drugs, they won’t get developed. If government, with a larger insured base and no profit motive, will, there is more chance that this innovation will happen.
Government of course is already involved in paying for basic research that the drug companies would never fund, being too high risk.
So, your against having the people who pay for health care know where their money goes? As someone who does some data analysis I can say that this “gaming” can lead to a more efficient system than dumping everything in one pot. If he charged $62 for the visit, no one would be able to wonder why it costs $10 to copy a record.
This “gaming” happens everywhere - it is why we get charged to check our luggage these days.
Yes. But I can’t immediately think of a way that patients would game the system under UHC that they couldn’t do now.
If you meant patients seeking treatment under UHC because it is perceived as “free”, probably not, at least to much degree. I can see someone who currently has no health care who would want treatment for some condition that he currently just puts up with, because he can’t afford to pay. But that’s not “gaming the system” in the sense that I was thinking of.
But trying to get anti-biotics for a viral infection, or something like that, no, not to any significant degree. The more general question “will demand for health care go up if everybody is covered”, then probably yes. The law of supply and demand would indicate that this is true. To what degree it would is harder to say.
Regards,
Shodan
I am not sure what you mean.
It is more a response to attempts to limit medical costs than UHC - I first noticed it working on our DRG system.
What I was talking about was, we implement single payer, and the government then says “this is what we pay for X, and no more”. Then doctors (and hospitals and clinics) charge for X, and then charge for Y that used to be included under X. Or, as I mentioned, the hospital changes differently for someone admitted thru the ER vs. referral from the SNF. Or hundreds of other ways of “gaming the system”. That’s not more efficient.
Regards,
Shodan
But they do that already. It’s not a response to UHC.
Was this a parenthetical comment, or one of OP’s requested “conservative arguments against single payer health care”?
Providing health care for people who don’t have it now, is the purpose of UHC. Pardon for stating the obvious but, in some of these discussions, I’ve learned one can’t take commonality of comprehension for granted.
I believe government has a role to play in caring for those that cannot care for themselves. The safety net should provide a minimum amount of assistance in the least intrusive way possible. The level of assistance should be as minimal as possible.
The government is force. Private insurers are voluntary, or at least they used to be.
Do you think this problem increases, decreases, or stays the same if there is single payer? I think it increases.
The need for healthcare isn’t voluntary and having insurance is the way we meet that involuntary need.
You could argue that meeting that need is voluntary, people can instead choose to suffer or even die, but by that definition, pretty much everything is voluntary. Eating is voluntary. Breathing is voluntary. Working is voluntary. Paying your bills is voluntary. Responsible people don’t choose to not do those things if they can avoid it.
I would assume the Demand is already in place, with your 300 million + population. But at present paying for the Supply is uncertain for many.
How do you define minimal? If you are given 20 pills and told to take 1 a day until finished, being give 10 pills may save money in the short run but will cost in the long run.
Not really, not if you don’t want to take the chance of going broke due to unexpected health costs. The big difference between health care and other things is that we can choose to not watch TV, but we can’t choose not to get sick.
I’d say stay the same or decrease. The reason for the problem is the conflicting profit motives of the insurers and the pharmaceutical companies. And the problem is that neither of them are holding back these drugs because they are evil. Pharma can’t justify spending $100 million on a drug with expected sales under a controlled pricing scheme if $10 million. Insurers may not be able to pay the immense prices needed for these drugs for its clients, not and be competitive. If one company is first, all the patients will flock to them and they’ll be in big trouble.
With a single payer system you can spread the risk out over everyone, which makes it more affordable. And government can negotiate a price to let Pharma make a profit on the drug without gouging.
The profit motive is great, but in some cases it causes problems.
Here’s the problem. Market fundamentalists notice that caviar being really expensive reduces the demand for it. With reduced demand no one is trying to get the government to pay for it.
Therefore, they say, since cancer treatments are expensive the demand for them should be low also, so government shouldn’t be asked to pay.
Or, more bluntly, the riffraff don’t deserve caviar. Also, the riffraff don’t deserve cancer treatment.
Have you considered letting them consume cake?
That’s nice and all, but that’s not the statement that was being responded to. The statement was whether government paid care is more intrusive than private paid care. Do you think they are the same level of intrusiveness, or one is greater than the other? I believe private paid care is less intrusive.
You must mean something other than cost. Private insurance, laden with executive bonuses and general administrative red tape, is a hell of a lot more intrusive to my income than if those expenses weren’t there.
Or are you upset at the thought of your life being partly controlled by government bureaucrats instead of corporate bureaucrats? The government type doesn’t have the same incentive to screw you, you know.
Let me give you an example - I had a sick relative. She needed in home care the details of which I’m not quite sure since I wasn’t involved in some of the transactions. The county (city?) sent out a person to assess the level of need. One of the early things she asked was if my relative needed a mobile phone, and that could be provided for free. The family declined, she already had a mobile phone and if she didn’t she could get one on her own. The person was very surprised at why she wouldn’t accept the free phone.
Next, the person noticed that my relative lived in a house that had stairs. She said, we can install a machine that will help lift the wheelchair up the stairs. But see, my relative already had an elevator. She was surprised she didn’t accept it. They also offered to provide a service where a nurse would come to the house, except we already had either a nurse or family members there 24 hours a day. She was surprised we didn’t accept that. She followed up with other offers of service which we declined, and then offered the phone again. All in all we declined all assistance - the family had it covered.
That’s not minimal. I’m not sure if there is a hard and fast definition - but the level of assistance that is provided should still cause great discomfort to incent recipients to alleviate that discomfort.
Then we have a fundamental disagreement. I think on balance it’s an increase - you think the opposite. Currently the US leads the world in medical innovation, right? Why aren’t the other countries leaders in this area? I agree that in some places the profit motives can create undesirable outcomes. On balance I think it’s more beneficial than the alternatives.