# What it would take for me to support single payer **URL:** \ **Category:** Politics & Elections\ **Created:** [September 19, 2017, 10:28am UTC](https://boards.straightdope.com/t/what-it-would-take-for-me-to-support-single-payer/796715 "2017-09-19T10:28:49Z")\ **Posts on this page:** 20\ **Page:** 3
**Author:** ![E-DUB](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/e-dub/32/403_2.png) [@E-DUB](https://boards.straightdope.com/u/E-DUB)\ **Post date:** [September 20, 2017, 1:53am UTC](https://boards.straightdope.com/t/what-it-would-take-for-me-to-support-single-payer/796715/41 "2017-09-20T01:53:44Z")
the biggest problem with health care is that everybody realizes that health care has to be rationed but nobody wants it to be. ---
**Author:** ![Isamu](https://avatars.discourse-cdn.com/v4/letter/i/7c8e57/32.png) [@Isamu](https://boards.straightdope.com/u/Isamu)\ **Post date:** [September 20, 2017, 2:02am UTC](https://boards.straightdope.com/t/what-it-would-take-for-me-to-support-single-payer/796715/42 "2017-09-20T02:02:08Z")
> [@adaher](#): > > I want to know that you are aware of things like cancer survival rates and wait times and lack of access to GPs, and have either a plan or a justification. This had me curious. So why _does_ the USA have higher cancer mortality rates than, say, Canada and NZ? ---
**Author:** ![Fiveyearlurker](https://avatars.discourse-cdn.com/v4/letter/f/da6949/32.png) [@Fiveyearlurker](https://boards.straightdope.com/u/Fiveyearlurker)\ **Post date:** [September 20, 2017, 2:19am UTC](https://boards.straightdope.com/t/what-it-would-take-for-me-to-support-single-payer/796715/43 "2017-09-20T02:19:47Z")
> [@adaher](#): > > Single payer can work at the state level just fine. It can only “work” better at the federal level because it’s easier for the feds to hide the costs or just fund it through deficit spending. But that’s something that can’t be allowed to happen. > Single payer is hard. It’s going to mean big taxes, which will be mostly offset by not having to pay insurance premiums. But the choice has to be transparent and clear, and Vermont and California thought it wasn’t going to sell. That’s worrisome, because it means Dems might go for the “hide the cost” approach, which is much easier to pull off at the federal level. You can rest assured that Republicans won’t let them get away with that without paying a big price and I’ll be right with them if that’s how it all goes down. Well, the Senator from Louisiana is trying to [insert language to block state](http://www.huffingtonpost.com/entry/john-kennedy-single-payer-states-rights_us_59c15b89e4b0f22c4a8d1ce7)s from going single payer. “I think single payer is a mistake and I think it would be bad for a blue state,” Kennedy told reporters on Capitol Hill. “That’s part of my job in the United States Senate, to make value judgments like that.” ---
**Author:** ![Quartz](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/quartz/32/267_2.png) [@Quartz](https://boards.straightdope.com/u/Quartz)\ **Post date:** [September 20, 2017, 7:15am UTC](https://boards.straightdope.com/t/what-it-would-take-for-me-to-support-single-payer/796715/44 "2017-09-20T07:15:09Z")
> [@adaher](#): > > Single payer is hard. It’s going to mean big taxes, which will be mostly offset by not having to pay insurance premiums. I ran the numbers a while back and IIRC the USA would **save** US$1 Trillion by switching to a UK-style NHS. ---
**Author:** ![PatrickLondon](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/patricklondon/32/4422_2.png) [@PatrickLondon](https://boards.straightdope.com/u/PatrickLondon)\ **Post date:** [September 20, 2017, 7:17am UTC](https://boards.straightdope.com/t/what-it-would-take-for-me-to-support-single-payer/796715/45 "2017-09-20T07:17:14Z")
> [@Wesley\_Clark](#): > > Basically, my impression of systems like the UK NICE system (someone correct me if I’m wrong) is that all it means is that extremely expensive therapies will not be given if you are terminal. Extremely expensive therapies will be given if you aren’t terminal (you have a car wreck at 35 for example), and less expensive therapies will be given if you are terminal. Technically, NICE is a system for providing the evidence base on which treatments (for whom, and in what circumstances) _must_ be funded by local NHS organisations, rather than what may not: local NHS organisations are, AFAIK, allowed to fund treatments prescribed by the clinicians, but not within NICE guidance, if they consider they have the funding (and then it’s down to political debate as to whether there is enough funding in the system, which is of course permanently ongoing). To pick up the point about transparency above: there is another aspect, the transparency of overall costs and budgeting (i.e., factoring in salaries, fixed and incidental overheads, and all those things like bandages and post-operative painkillers that, AIUI, tend to be billed per item of service in the US). That could be a difficult sticking point in any transition in your system, to put it mildly. But for the equivalent of [NICE](https://www.nice.org.uk/) (and NHS Improvement, which supervises [service management](https://improvement.nhs.uk/improvement-hub/) and [finances](https://improvement.nhs.uk/resources/national-tariff-1719/)), you could try starting it as an advisory and information service, rather than prescriptively… ---
**Author:** ![PatrickLondon](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/patricklondon/32/4422_2.png) [@PatrickLondon](https://boards.straightdope.com/u/PatrickLondon)\ **Post date:** [September 20, 2017, 7:19am UTC](https://boards.straightdope.com/t/what-it-would-take-for-me-to-support-single-payer/796715/46 "2017-09-20T07:19:38Z")
> [@Fiveyearlurker](#): > > Well, the Senator from Louisiana is trying to [insert language to block state](http://www.huffingtonpost.com/entry/john-kennedy-single-payer-states-rights_us_59c15b89e4b0f22c4a8d1ce7)s from going single payer. > > “I think single payer is a mistake and I think it would be bad for a blue state,” Kennedy told reporters on Capitol Hill. “That’s part of my job in the United States Senate, to make value judgments like that.” Is he telling Louisiana voters he doesn’t believe in states’ rights? ---
**Author:** ![Evan\_Drake](https://avatars.discourse-cdn.com/v4/letter/e/b487fb/32.png) [@Evan\_Drake](https://boards.straightdope.com/u/Evan_Drake)\ **Post date:** [September 20, 2017, 11:27am UTC](https://boards.straightdope.com/t/what-it-would-take-for-me-to-support-single-payer/796715/47 "2017-09-20T11:27:55Z")
No, no, no. He _lurves_ States’ Rights ! _“I love, I believe in states’ rights,” Kennedy told HuffPost. “But I also believe in the supremacy clause, and I believe the United States Congress has a legal and a moral obligation to, on occasion, set down national rules.”_ Even the most embarrassing kind of Tory, such as that little Davies fellow, who uses ‘ **British** ’ as self-congratulation as much as any Yankee uses ‘ **American** ’, would take pause before saying ‘he loved and believed’ in the rights of county councils. ---
**Author:** ![asahi](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/asahi/32/8693_2.png) [@asahi](https://boards.straightdope.com/u/asahi)\ **Post date:** [September 20, 2017, 1:04pm UTC](https://boards.straightdope.com/t/what-it-would-take-for-me-to-support-single-payer/796715/48 "2017-09-20T13:04:50Z")
> [@PatrickLondon](#): > > Is he telling Louisiana voters he doesn’t believe in states’ rights? Afraid of single payer is more like it – afraid it could work. Fortunately for the John Kennedy’s of the world, I tend to doubt that single payer would work at the state level. It might work in some states but flop miserably in others. If there’s an unintended silver lining of single payer healthcare that might please conservatives, it’s that even progressives in California might be forced to take a tougher stance on illegal immigration. ---
**Author:** ![asahi](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/asahi/32/8693_2.png) [@asahi](https://boards.straightdope.com/u/asahi)\ **Post date:** [September 20, 2017, 1:15pm UTC](https://boards.straightdope.com/t/what-it-would-take-for-me-to-support-single-payer/796715/49 "2017-09-20T13:15:50Z")
I don’t see single payer happening in the United States without some sort of economic catastrophe first, and by a catastrophe, I mean something that would be so cataclysmic that it would essentially liquidate much of corporate America and froce a redistribution of economic and political power. As it is now, any single payer measure would be amended and watered down so as to be ineffectual. I doubt we’d have the ability to get most Americans to agree to the taxes to finance a single payer startup under seemingly ‘normal’ circumstances. Meanwhile, we have other entitlement systems like social security and then there’s the military behemoth. ---
**Author:** ![Broomstick](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/broomstick/32/246_2.png) [@Broomstick](https://boards.straightdope.com/u/Broomstick)\ **Post date:** [September 20, 2017, 2:45pm UTC](https://boards.straightdope.com/t/what-it-would-take-for-me-to-support-single-payer/796715/50 "2017-09-20T14:45:45Z")
> [@Fiveyearlurker](#): > > Well, the Senator from Louisiana is trying to [insert language to block state](http://www.huffingtonpost.com/entry/john-kennedy-single-payer-states-rights_us_59c15b89e4b0f22c4a8d1ce7)s from going single payer. > > “I think single payer is a mistake and I think it would be bad for a blue state,” Kennedy told reporters on Capitol Hill. “That’s part of my job in the United States Senate, to make value judgments like that.” Ah, yes - states’ rights except when someone disapproves of what a state is doing. Typical. ---
**Author:** ![DigitalC](https://avatars.discourse-cdn.com/v4/letter/d/ebca7d/32.png) [@DigitalC](https://boards.straightdope.com/u/DigitalC)\ **Post date:** [September 20, 2017, 2:55pm UTC](https://boards.straightdope.com/t/what-it-would-take-for-me-to-support-single-payer/796715/51 "2017-09-20T14:55:30Z")
> [@adaher](#): > > So to sum up, it must be budget neutral, funded sustainably, honestly sold, completely transparent, and the right to pay for alternatives must be preserved. You expect the Democrats to be entirely transparent and honest otherwise you are going to join the side that will be blatantly lying to oppose them? Whatever the Republicans do to oppose single payer or whatever program Democrats want to propose will be based entirely of lies propaganda and complete fabrications. And they will do that because IT WORKS. ---
**Author:** ![Velocity](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/velocity/32/18006_2.png) [@Velocity](https://boards.straightdope.com/u/Velocity)\ **Post date:** [September 20, 2017, 3:45pm UTC](https://boards.straightdope.com/t/what-it-would-take-for-me-to-support-single-payer/796715/52 "2017-09-20T15:45:55Z")
5% income taxes to pay for single-payer + retroactive penalties for hospitals who overcharged in the past + a modest deductible to deter misuse of the system + measures taken to prevent long wait times for specialists like in the UK or Canada. ---
**Author:** ![jasg](https://avatars.discourse-cdn.com/v4/letter/j/f0a364/32.png) [@jasg](https://boards.straightdope.com/u/jasg)\ **Post date:** [September 20, 2017, 8:00pm UTC](https://boards.straightdope.com/t/what-it-would-take-for-me-to-support-single-payer/796715/53 "2017-09-20T20:00:57Z")
> [@asahi](#): > > If there’s an unintended silver lining of single payer healthcare that might please conservatives, it’s that even progressives in California might be forced to take a tougher stance on illegal immigration. I have never been able to understand this objection. In every UHC system I have heard of, you need a national healthcare ID card. For that matter, I have one - my Medicare card. Why aren’t we already overrun with illegal seniors taking advantage of free Medicare? ---
**Author:** ![Snowboarder\_Bo](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/snowboarder_bo/32/229_2.png) [@Snowboarder\_Bo](https://boards.straightdope.com/u/Snowboarder_Bo)\ **Post date:** [September 20, 2017, 8:13pm UTC](https://boards.straightdope.com/t/what-it-would-take-for-me-to-support-single-payer/796715/54 "2017-09-20T20:13:29Z")
> [@jasg](#): > > Why aren’t we already overrun with illegal seniors taking advantage of free Medicare? I greased the steps, the ramps AND the handrails. 😃 Seriously tho, I’d be interested in seeing this question [del]deflected[/del] answered by **asahi**. ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [September 21, 2017, 12:36pm UTC](https://boards.straightdope.com/t/what-it-would-take-for-me-to-support-single-payer/796715/55 "2017-09-21T12:36:17Z")
Asahi is actually referring to California’s proposed single payer plan, which would have covered undocumented immigrants. There’s just no way to make that work, because under such a system you literally can just cross the border and go to a hospital. Even the most liberal economist would have sprayed his drink all over his screen reading about California’s plan. I’d also note that most single payer plans aren’t run by the national government. Decentralization has been most countries’ friend in this regard. Doing a national system in a country this big would truly be unprecedented. Canada didn’t choose that route, why would we? ---
**Author:** ![Ravenman](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/ravenman/32/2929_2.png) [@Ravenman](https://boards.straightdope.com/u/Ravenman)\ **Post date:** [September 21, 2017, 1:10pm UTC](https://boards.straightdope.com/t/what-it-would-take-for-me-to-support-single-payer/796715/56 "2017-09-21T13:10:50Z")
> [@adaher](#): > > There’s just no way to make that work, because under such a system you literally can just cross the border and go to a hospital. Unless you had to show something like a state-issued card to receive non-emergency medical services. I guess you’re right, it is totally impossible to implement such a complex program. I mean, think of the logistics involved! Someone has to design a membership card. And write specific numbers on it. And have some sort of “computer program” that links the numbers with a person. And then hospitals have to have someone look at the card, and maybe even enter the numbers in a computer! And who is to say that the finance departments of hospitals even HAVE computers?!?! ---
**Author:** ![Caldazar](https://avatars.discourse-cdn.com/v4/letter/c/8e8cbc/32.png) [@Caldazar](https://boards.straightdope.com/u/Caldazar)\ **Post date:** [September 21, 2017, 2:42pm UTC](https://boards.straightdope.com/t/what-it-would-take-for-me-to-support-single-payer/796715/57 "2017-09-21T14:42:22Z")
> [@Ravenman](#): > > Unless you had to show something like a state-issued card to receive non-emergency medical services. I guess you’re right, it is totally impossible to implement such a complex program. > > I mean, think of the logistics involved! Someone has to design a membership card. And write specific numbers on it. And have some sort of “computer program” that links the numbers with a person. And then hospitals have to have someone look at the card, and maybe even enter the numbers in a computer! And who is to say that the finance departments of hospitals even HAVE computers?!?! This still doesn’t solve the problem, because the California plan requires that enrollment be free. So you cross into California, enroll for free, and then get your services without having paid taxes to support the system. From [California SB-562](https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201720180SB562): > [@](#): > > “Resident” means an individual whose primary place of abode is in the state, without regard to the individual’s immigration status. > > Every resident of the state shall be eligible and entitled to enroll as a member under the program. > > A member shall not be required to pay any fee, payment, or other charge for enrolling in or being a member under the program. > > A member shall not be required to pay any premium, copayment, coinsurance, deductible, and any other form of cost sharing for all covered benefits. So yes, you can free-load under such a proposed system so long as you can whip up fake documents showing some evidence of residency. Which is a lot easier to do that coming up with a fake driver’s license plus social security card (work eligibility), although of course the latter does happen as well. There are sound ways and unsound ways to implement a single-payer system. I would argue that California’s plan falls into the latter category, for this and other reasons. ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [September 21, 2017, 3:41pm UTC](https://boards.straightdope.com/t/what-it-would-take-for-me-to-support-single-payer/796715/58 "2017-09-21T15:41:22Z")
> [@Ravenman](#): > > Unless you had to show something like a state-issued card to receive non-emergency medical services. I guess you’re right, it is totally impossible to implement such a complex program. > > I mean, think of the logistics involved! Someone has to design a membership card. And write specific numbers on it. And have some sort of “computer program” that links the numbers with a person. And then hospitals have to have someone look at the card, and maybe even enter the numbers in a computer! And who is to say that the finance departments of hospitals even HAVE computers?!?! If illegal immigrants are covered, then you can just get the card. Any foreign national can just show up, get a card, go get a hip replacement. ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [September 21, 2017, 3:44pm UTC](https://boards.straightdope.com/t/what-it-would-take-for-me-to-support-single-payer/796715/59 "2017-09-21T15:44:35Z")
> [@Caldazar](#): > > This still doesn’t solve the problem, because the California plan requires that enrollment be free. So you cross into California, enroll for free, and then get your services without having paid taxes to support the system. From [California SB-562](https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201720180SB562): > > So yes, you can free-load under such a proposed system so long as you can whip up fake documents showing some evidence of residency. Which is a lot easier to do that coming up with a fake driver’s license plus social security card (work eligibility), although of course the latter does happen as well. > > There are sound ways and unsound ways to implement a single-payer system. I would argue that California’s plan falls into the latter category, for this and other reasons. This weird idea that Sanders and many progressives have of no co-pays and no premiums and no limitations on coverage is also rather batty. Hey, let’s provide the most generous health care benefits in the world, and then be surprised at how much it will cost and then scrap the whole thing! Which is what they did. ---
**Author:** ![Caldazar](https://avatars.discourse-cdn.com/v4/letter/c/8e8cbc/32.png) [@Caldazar](https://boards.straightdope.com/u/Caldazar)\ **Post date:** [September 21, 2017, 4:26pm UTC](https://boards.straightdope.com/t/what-it-would-take-for-me-to-support-single-payer/796715/60 "2017-09-21T16:26:58Z")
> [@adaher](#): > > This weird idea that Sanders and many progressives have of no co-pays and no premiums and no limitations on coverage is also rather batty. > > Hey, let’s provide the most generous health care benefits in the world, and then be surprised at how much it will cost and then scrap the whole thing! Which is what they did. Applicable to the California plan, but I don’t feel that’s an accurate portrayal of Sanders’ latest “Medicare For All” bill ( S.1804 ). In S.1804, it does call for the Center for Clinical Standards and Quality to make determinations on what’s considered medically necessary and for HHS to establish fee schedules, as is typical for UHC systems. No cost estimate, though. For services currently covered by Medicare, I imagine you can just use existing coverage as a starting point to calculate those costs, minus some scaling factor to account for “improved efficiency” or what have you. But S.1804 adds additional coverage items on top, and there’s no real guidance on what will and will not be covered for these new categories of covered treatments. I do agree with the sentiment that this is just an intellectual exercise, with no real chance of being implemented in the foreseeable future. [Previous page](https://boards.straightdope.com/t/what-it-would-take-for-me-to-support-single-payer/796715.md?page=2) [Next page](https://boards.straightdope.com/t/what-it-would-take-for-me-to-support-single-payer/796715.md?page=4)