# 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:** 16\ **Page:** 4
**Author:** ![septimus](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/septimus/32/410_2.png) [@septimus](https://boards.straightdope.com/u/septimus)\ **Post date:** [September 21, 2017, 4:53pm UTC](https://boards.straightdope.com/t/what-it-would-take-for-me-to-support-single-payer/796715/61 "2017-09-21T16:53:22Z")
I thank **adaher** for asking these questions. Still I’m unclear whether his underlying message is “I really want single-payer; here’s how we can cooperate to get it.” Or is the message “You can’t have single payer; here’s why.” ? Here are my 2¢: - Some of the big advantages of single-payer are reduced costs and regulated costs. Won’t a parallel system of private insurers interfere with that? Isn’t the success of Canada’s single-payer due in large part to prohibitions against private payments? - If some states create state-wide single payer and other states do not, Americans with pre-existing conditions will have incentive to move to a UHC state. Is this considered a problem? (I suppose healthy people would have an incentive to move _away_ from the UHC state.) - What happens to existing employer-sponsored insurance for workers and retirees? If they’re voided, the employees will suffer a sudden surge in payroll taxes, with their salaries still lower than normal to reflect benefits that are no longer paid. - The Tobin tax can not be used as a major revenue source. (I support Tobin tax because it reduces liquidity, not despite it! Recent financial crises have resulted from obsessively excessive liquidity.) > [@Richard\_Parker](#): > > The lesson the Democrats are taking from 2016 is that you shouldn’t run on white papers. You should run on big ideas without being forthright about costs, tradeoffs, and political difficulties. I agree that U.S. politics are increasingly dysfunctional. I think this is due to the powerful influence of money in opinion formation. Political progress will not be easy in the U.S. until the dumbing-down of politics is reversed. As is, with political discourse at 4th-grade level, politicians no longer even try to fool sixth-graders, as in this example: > [@Fiveyearlurker](#): > > “I think single payer is a mistake and I think it would be bad for a blue state,” [a Senator strongly supporting “states’ right”] told reporters on Capitol Hill. “That’s part of my job in the United States Senate, to make value judgments like that.” Finally, > [@Evan\_Drake](#): > > The Media expected Trumpo to lose until the moment he didn’t. > > And then their tiny shrivelled black hearts broke. What? 😕 ---
**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 21, 2017, 6:25pm UTC](https://boards.straightdope.com/t/what-it-would-take-for-me-to-support-single-payer/796715/62 "2017-09-21T18:25:33Z")
> [@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?!?! Every subject in Britain is issued with an NHS number, very probably at birth ( unlike the National Insurance number, for work/taxes which one applies for after school ) so one then gets free treatment for most things. Of course emergency treatment is available for all in the country, subject or not. It’s all most humiliating having a number as a condition for getting free stuff; just like as if they were to issue you a number in the army. Faceless civil servants directing nameless cyphers in the brutal Orwellian machine, instead of the warm and fuzzy welcoming understanding of efficient American bureaucracy. _“Would you like cookies with that ?”_ > [@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): Our European neighbours and ourselves have reciprocal agreements. So we don’t get a lot of Swiss and Italians sneaking in. We have illegal immigrants, but them getting free healthcare is one tenth of the concern over the future water supply. > [@adaher](#): > > 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. Doesn’t seem to happen here. ---
**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, 8:29pm UTC](https://boards.straightdope.com/t/what-it-would-take-for-me-to-support-single-payer/796715/63 "2017-09-21T20:29:51Z")
> [@adaher](#): > > 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. By the text linked to earlier, residents are eligible for service regardless of immigration status. That doesn’t mean that everyone is a resident, regardless of immigration status. It just means that Mexican citizens who live in California are treated like American citizens living in California; and Mexican citizens who live in Mexico are treated like American citizens who live in Oregon. Mind you, I’m not saying I think this policy is necessarily wise. But your criticism that anyone can pop over the border at their whim and have tons and tons of medical care is valid. ---
**Author:** ![Anny\_Middon](https://avatars.discourse-cdn.com/v4/letter/a/bc79bd/32.png) [@Anny\_Middon](https://boards.straightdope.com/u/Anny_Middon)\ **Post date:** [September 21, 2017, 11:40pm UTC](https://boards.straightdope.com/t/what-it-would-take-for-me-to-support-single-payer/796715/64 "2017-09-21T23:40:13Z")
> [@asahi](#): > > 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. Why doesn’t corporate America support single payer? If that happened, no economic catastrophe would be necessary. Suppose a case was presented to large employers that the payroll tax they’d have to pay for single payer would be significantly (like, say, 20%) lower than what they are typically paying in health care premiums. Plus of course they can get out of the whole business of administering health care insurance, which is a monumental pain in the butt. The only reason I came up with as to why corporations wouldn’t be lining up for such a deal is that they’d think they were losing flexibility. But let’s face it – most of that flexibility is illusory. ---
**Author:** ![bizzwire](https://avatars.discourse-cdn.com/v4/letter/b/958977/32.png) [@bizzwire](https://boards.straightdope.com/u/bizzwire)\ **Post date:** [September 22, 2017, 1:39am UTC](https://boards.straightdope.com/t/what-it-would-take-for-me-to-support-single-payer/796715/65 "2017-09-22T01:39:03Z")
One aspect that seems to always be overlooked in these discussions is that companies will no longer have to provide health insurance to their employees. My previous employer paid 75% of my monthly premiums. Multiply this by all the workers currently covered by employer contributions, and you have a yuuuuge pool of ‘free money’ that is now available for reinvestment (or massive bonuses). Anyone have an idea of how that would stack up against corporate tax breaks? ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [September 22, 2017, 2:14am UTC](https://boards.straightdope.com/t/what-it-would-take-for-me-to-support-single-payer/796715/66 "2017-09-22T02:14:19Z")
> [@septimus](#): > > I thank **adaher** for asking these questions. Still I’m unclear whether his underlying message is “I really want single-payer; here’s how we can cooperate to get it.” Or is the message “You can’t have single payer; here’s why.” ? It’s neither, actually. What I’ve come to realize since the REpublicans took over everything is that we’re going to have to have universal health care. So now it becomes a matter of how best to deliver it. ACA has advantages over single payer and single payer has advantages over ACA. The biggest advantages of single payer are that it is undoubtedly constitutional, whereas ACA had some infirmities in that regard, and it’s the cheapest solution. ACA’s best aspects are competition, choice, and less of a government funding commitment than single payer would entail. I believe the cost of ACA right now is something like $120 billion/year for the government’s share, whereas single payer would end up costing at least 10 times that. My own preference would probably lean towards fixing ACA now, but I don’t think either party is really invested in that law. The GOP hates it and Democrats are already looking beyond it. So we’ll have to see how the single payer fight goes first, plus what condition ACA is in, when the dust settles. > [@](#): > > - If some states create state-wide single payer and other states do not, Americans with pre-existing conditions will have incentive to move to a UHC state. Is this considered a problem? (I suppose healthy people would have an incentive to move _away_ from the UHC state.) Canada isn’t far. I don’t see this as much of a problem, provided states have strict residency requirements. ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [September 22, 2017, 2:15am UTC](https://boards.straightdope.com/t/what-it-would-take-for-me-to-support-single-payer/796715/67 "2017-09-22T02:15:57Z")
> [@Ravenman](#): > > By the text linked to earlier, residents are eligible for service regardless of immigration status. That doesn’t mean that everyone is a resident, regardless of immigration status. It just means that Mexican citizens who live in California are treated like American citizens living in California; and Mexican citizens who live in Mexico are treated like American citizens who live in Oregon. > > Mind you, I’m not saying I think this policy is necessarily wise. But your criticism that anyone can pop over the border at their whim and have tons and tons of medical care is valid. It is, because how does an illegal immigrant prove residency. Also when dealing with illegals, you have the issue of trusting whatever documentation they do provide. California’s history suggests they won’t be too concerned about checking. ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [September 22, 2017, 2:18am UTC](https://boards.straightdope.com/t/what-it-would-take-for-me-to-support-single-payer/796715/68 "2017-09-22T02:18:13Z")
> [@Anny\_Middon](#): > > Why doesn’t corporate America support single payer? If that happened, no economic catastrophe would be necessary. > > Suppose a case was presented to large employers that the payroll tax they’d have to pay for single payer would be significantly (like, say, 20%) lower than what they are typically paying in health care premiums. Plus of course they can get out of the whole business of administering health care insurance, which is a monumental pain in the butt. > > The only reason I came up with as to why corporations wouldn’t be lining up for such a deal is that they’d think they were losing flexibility. But let’s face it – most of that flexibility is illusory. Corporate America probably would support single payer if it substantially reduced their costs. The problem is that most American single payer plans feature corporations and rich individuals bearing 90% of the cost, which means they pay a lot more than they do now. I’m sure if Europe could have funded UHC that way, they would have. But politically it’s a nonstarter and the funding numbers don’t work out in any case. Put forward a plan where UHC is primarily funded by a social insurance tax or sales tax, and that would probably gain a lot of corporate support. ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [September 22, 2017, 2:31am UTC](https://boards.straightdope.com/t/what-it-would-take-for-me-to-support-single-payer/796715/69 "2017-09-22T02:31:06Z")
BTW, one overlooked aspect of single payer that I think Republicans should fight for if single payer appears to be inevitable, is enhancing state sovereignty by funding it in part by elimination of all federal funding to states. States should still see a huge spending reduction because they will no longer be responsible for Medicaid spending. The feds could defray some of that cost by eliminating all money to states and every state should still come out well ahead. And states would no longer be dependent on the federal government for anything and could be freer to implement their own policies on a variety of issues. I don’t know about GOP politicians, but I think if you made that kind of offer that a lot of conservative/libertarian intellectual types not in politics would be intrigued. ---
**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 22, 2017, 2:31am UTC](https://boards.straightdope.com/t/what-it-would-take-for-me-to-support-single-payer/796715/70 "2017-09-22T02:31:06Z")
> [@Evan\_Drake](#): > > The Media expected Trumpo to lose until the moment he didn’t. > And then their tiny shrivelled black hearts broke. _EVERYBODY_ expected trump to lose. He even expected it _himself_ given all the "rigged election talk he was putting out there beforehand. ---
**Author:** ![survinga](https://avatars.discourse-cdn.com/v4/letter/s/cab0a1/32.png) [@survinga](https://boards.straightdope.com/u/survinga)\ **Post date:** [September 22, 2017, 2:54am UTC](https://boards.straightdope.com/t/what-it-would-take-for-me-to-support-single-payer/796715/71 "2017-09-22T02:54:33Z")
> [@asahi](#): > > 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. I think you might be right. One thing to remember with our health insurance system is that, dysfunctional as it seems, about 91% of America is covered with something, either private or public, and 90% of them are OK with what they have. And even though everyone complains about our health-care system, the vast majority of people are OK with what they themselves have. So, single-payer would be a huge reorganization of part of the economy where probably 4 out of 5 people are OK with what they have. In any other topic, that would be a gigantic consensus. But in healthcare, it’s considered a problem, because other countries have 100% universal coverage, and the like. Personally, I like not having single-payer. I don’t want it. But it’s not the Bolshevik plot that some make it out to be. Single-payer is a real thing that can work, as has been shown in other countries. I just happen to like the US system, which while not perfect, is very dynamic with great doctors, and some very good innovative care, etc. I think our system evolved as a patch-work, and that’s fine with me. We should add another patch to the quilt, and get the coverage up above 95%. That, to me, would be the next logical step. ---
**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 22, 2017, 9:16am UTC](https://boards.straightdope.com/t/what-it-would-take-for-me-to-support-single-payer/796715/72 "2017-09-22T09:16:56Z")
> [@bizzwire](#): > > One aspect that seems to always be overlooked in these discussions is that companies will no longer have to provide health insurance to their employees. It will end up as tax to pay for UHC. ---
**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 22, 2017, 12:20pm UTC](https://boards.straightdope.com/t/what-it-would-take-for-me-to-support-single-payer/796715/73 "2017-09-22T12:20:34Z")
> [@adaher](#): > > It is, because how does an illegal immigrant prove residency. Also when dealing with illegals, you have the issue of trusting whatever documentation they do provide. California’s history suggests they won’t be too concerned about checking. So you are asserting that California will not check the residency of suspected Mexican residents to the same degree they will check the residence of suspected Arizona residents? ---
**Author:** ![bizzwire](https://avatars.discourse-cdn.com/v4/letter/b/958977/32.png) [@bizzwire](https://boards.straightdope.com/u/bizzwire)\ **Post date:** [September 22, 2017, 1:31pm UTC](https://boards.straightdope.com/t/what-it-would-take-for-me-to-support-single-payer/796715/74 "2017-09-22T13:31:50Z")
> [@Quartz](#): > > It will end up as tax to pay for UHC. Are you suggesting that instead of pocketing that money, they would hand it over to the government to pay for UHC? Such a scenario would still be revenue-neutral to my company (who would pay that money to the government instead of an insurer). I wouldn’t have to pay my insurance contribution (giving me a 7% increase in take-home pay), and a large part of the tax burden to pay for universal coverage would be reduced. Let’s say the tax cost is an additional 7%. That would mean that my company doesn’t pay any additional money than it already does, I would take home the same amount of money, and everyone gets health care. I think you’re on to something here… ---
**Author:** ![jasg](https://avatars.discourse-cdn.com/v4/letter/j/f0a364/32.png) [@jasg](https://boards.straightdope.com/u/jasg)\ **Post date:** [September 23, 2017, 1:29am UTC](https://boards.straightdope.com/t/what-it-would-take-for-me-to-support-single-payer/796715/75 "2017-09-23T01:29:29Z")
> [@bizzwire](#): > > Are you suggesting that instead of pocketing that money, they would hand it over to the government to pay for UHC? Such a scenario would still be revenue-neutral to my company (who would pay that money to the government instead of an insurer). I wouldn’t have to pay my insurance contribution (giving me a 7% increase in take-home pay), and a large part of the tax burden to pay for universal coverage would be reduced. Let’s say the tax cost is an additional 7%. That would mean that my company doesn’t pay any additional money than it already does, I would take home the same amount of money, and everyone gets health care. > > I think you’re on to something here… Also, corporate America is then freed from annual negotiations with insurers and having to deal with employee questions about healthcare. HR departments from coast to coast would cheer. IMHO, the push here might come from small business - rate changes and hassle for small firms is much greater than for firms with a large risk pool. Plus rates for small firms is rising faster and as a result the number of small firms offering healthcare is [falling](https://www.nytimes.com/2017/09/19/health/health-insurance-premiums-employer.html). I am not sure employee take home pay would rise but employee healthcare costs could stabilize. ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [September 23, 2017, 5:20am UTC](https://boards.straightdope.com/t/what-it-would-take-for-me-to-support-single-payer/796715/76 "2017-09-23T05:20:17Z")
> [@Ravenman](#): > > So you are asserting that California will not check the residency of suspected Mexican residents to the same degree they will check the residence of suspected Arizona residents? No, they’ll just verify residency with exactly as much rigor as they verify it on their voting rolls. In other words, the honor system. [Previous page](https://boards.straightdope.com/t/what-it-would-take-for-me-to-support-single-payer/796715.md?page=3)