This only makes sense if you believe that inserting the government into the equation does not decrease the overall efficiency of the system. Most conservatives, having a healthy distrust of government, do not buy that assumption in the slightest.
A raging flood once hit a small town, threatening to wipe it out. A family in a truck, fleeing the danger, saw a man fretting outside his house as the rain came down. “Jump in the truck and be saved!” the family yelled. The man said, “No, the Good Lord will provide!”
Hours later, the man was forced into the second story of this house by the water. A police boat came to his window, a the skipper yelled, “Jump in the boat and be saved!” The man said, “No, the Good Lord will provide!”
Hours later, the man is on his roof. A National Guard helicopter sees him and lowers the hoist. The pilot yelled, “Jump in the helo and be saved!” The man said, “No, the Good Lord will provide!”
Moments later, the man is washed away and drowns.
Up at the Pearly Gates, the man tells God, “Lord, I have been your devoted servant all my life. Why did you not look out for me?”
God says, “I sent a truck, a boat, and a helicopter, can’t you take a fucking hint?”
Conservatives looking for more efficiency in healthcare should take the fucking hint.
What’s the difference? In a single-payer system, your populace will be paying taxes, and getting in return health care with no other out-of-pocket cost. The taxes ARE the costs in that model, as far as the citizen is concerned.
In other words, will the total cost to your average middle-class person on say… an annual basis in terms of taxes paid for a single payer system be more or less than what they currently pay in health insurance premiums, copays, deductibles and out-of-pocket fees?
And if the answer is yes, then it’s going to be a hard sell. In effect, you’re costing people more money out of pocket than before for two things that most people don’t actually see any advantage from- helping the un/underinsured, and situations that are theoretical for most people for the time period where this would differ significantly from Medicare.
You’re effectively saying “Pay more money for other people who you don’t know or care about, and also so if something dire happens, you’re better off than you would have been. Oh, and it’ll be less of a pain in the ass… we think.”
Now if the total tax increase is less than most people pay out in terms of copays, deductibles, out of pocket, etc… then that would probably be an easy sell, if the standard of care, ability to choose, and ability to get scheduled is still there as it is today. But that’s a big “IF”- there are a lot of variables that might preclude you from seeing your current doctor in a timely fashion under a single-payer system.
Can you describe some of those variables - because right now, in a not single-payer system, I hear people talking about being unable to get in to see their primary doctor within a week when they are sick. I don’t know why they have this problem - but if the issue is that there is there is only one doctor for 11,000 square miles, I don’t see that getting worse with single-payer. I can’t imagine that in a country with a single-payer system there will be more doctors that don’t participate in the single-payer plan and will rely on self-pay patients- we have doctors like that now, but not that many who don’t take any insurance (except in specialties that are not typically covered by insurance). There will no longer be doctors who participate in eleventy-billion insurance plans but either stopped taking mine since my last visit or never took mine to begin with.
The only variable I can truly see is that some people have unrealistic expectations of what "seeing your doctor in a timely fashion means". Because while some people complain that they can't see their primary doctor within a week when they are sick, others complain that they can't call on Monday to get an appointment for the camp physical on Tuesday that is due back to the camp on Wednesday.
Can you be more specific? Like Doreen, I’m curious what are the «lot of variables» in a single-payer system that you believe prevent you from seeing a doctor in a timely fashion. What specifically do you have in mind?
Hope your mind doesn’t explode when you go on Medicare. I had a top notch private plan, damn good, but Medicare is even better.
Plus I don’t get five letters at the beginning of each year telling me to certify that my wife doesn’t have insurance. I respond to each one, but I guess they were hoping.
I voted that mine is “okay” but I’d happily drop it in an instant. Having “okay” insurance is still a big financial drain.
The only “great” insurance we ever had was when my wife was a department manager at a hospital.
You think there’s no inefficiency now? Think of the work your doctor’s office has to do for insurance claims. First there’s the receptionist who checks if you have insurance, makes a copy of your card and ID, and gives you a form allowing the office or hospital to bill insurance. Then there are people in the back office who file the claim, which entails, among other things, determining the code number for each of the charges. These folks also deal with insurance companies’ questions or issues with claims. Then you have bookkeepers and others who process insurance payments and bill patients for what’s not covered.
Pretty inefficient.
Yes, the open market has done a wonderful job :rolleyes:
My employer provided insurance is just sort of… there. I don’t think about it all that much which would mean I don’t love it.
I’ve always had employer provided insurance so I’m sure I take it for granted. I’m sure I would miss it if it wasn’t there.
What I’m seeing happen is a large surge in people who were un/underinsured and/or those for whom a copay or deductible visit was a hardship showing up to the doctor in the first place, or much more often than they used to.
I mean, I have known a lot of reasonably well off, but not financially flush people who avoided going to the doctor until they were sure they were well and truly sick, because they didn’t want to pay the $35 copay or for a visit outright if they had a high deductible plan. Under a single-payer system, they’d likely go more often as there would be no impact to their finances.
Meanwhile, the number of doctors will continue to decline, meaning that the ones that are left will be at capacity. And that doesn’t consider the number that will go self pay-only (assuming they can in the first place- having the whole self-pay option sets back up for insurance and undermines the single-payer system).
This tracks with what someone was saying in a thread somewhere around here about the situation in his part of Canada- you could get seen for free, but it wasn’t necessarily convenient or timely.
The other things I foresee is much higher (and probably mandated) use of mid-level providers, which some people are fine with, and others are not. I mean, I don’t have a problem seeing a PA or NP for a cold or sinus infection or whatever other routine illness I might have, but some people want to see an honest-to-God doctor for everything, and if they’re essentially forced to see PAs and NPs for minor stuff, they’re going to view that as crappy.
The other thing that bears mentioning is that the burden of proof is on the side of the UHC proponents- that’s basically what I’ve been trying to say the whole time. I’m actually for UHC, but I think they’ve got a very steep uphill fight right now.
Personally, I don’t like referring to subsidized employer provided insurance as “private.” To me, private insurance is the insurance you go and purchase without employer or tax-subsidies.
Doctors say that the reason they don’t like doctoring anymore is that have spend so little of the time actually doctoring; they spend very little time with patients and most of their time dealing with paperwork and red tape to justify to insurance companies what they’re doing. And they have to pay for any number of staff to handle the insurance billing. Taking that off the table would certainly encourage the numbers of doctors to increase.
Also, there’s no reason that a nation-wide commitment to universal health care couldn’t include additional low-cost training. The citizenry needs tens of thousands of primary care physicians, trained people who can deal with the common ailments and recognize when they have to kick more complicated cases upstairs. And it could still be a good six-figure career for the people who take advantage of that training.
It can become a priority if we make it a priority.
Based on my experience in the health care industry, it’s not so much the insurance directly, but rather that doctors have to spend a bunch of time dicking around with stuff like electronic health records- entering CPT and ICD10 codes for the actual doctoring they did, as well as notes, orders for labs and procedures, and prescriptions. In many cases that stuff can take 2x the time or more than the actual clinical visit.
All that’s necessary for insurance coverage, and I’m 100% certain that won’t go away under UHC.
Another consideration is that over some time frame, there’ll almost certainly be new reporting requirements and/or system interface requirements under UHC, as the government is going to want to collect “big data” about health care for analysis and optimization in a way that they currently can’t under the current regime. That stuff costs pretty big money- who’s going to pay? The doctors?
I have great insurance but I think the concept of a copay sucks and would prefer a Canadian style system.
I feel the argument that people would use doctors more without a copay is ridiculous. I have never met anyone who “enjoys” going to the doctor. I wouldn’t go any more often if I had zero copays. I go when I’m truly concerned about something.
We don’t treat the military, police departments, fire departments and public schools as profit making centers and neither should we treat healthcare that way. These are all entities that keep the population at large from harm.
When we have a safe, secure and healthy populace all other business can maximize its profits.
But would you go less if every time you went, it cost you $150? I know I would go to the doctor a little more often–maybe 1-2 times a year for the family–if I had a copay, and not a high deductible. I would expect there to be a lot more doctor visits if people on high deductible plans or no plan suddenly had the option to go for less. But that’s not an argument against MCA.
I wonder how many people who ‘love’ their private insurance have tested it - have they done something like gotten a Coronavirus test because they came back from China, and had a reasonable charge? The guy in Florida who tried to be responsible got billed $3200 by the hospital, of which $1400 he had to pay after insurance. I think a lot of people that ‘love’ their health coverage have not had to deal with things more complicated than basic doctor’s office procedures and specialist tests. My experience is that dealing with something serious or non-standard done results in a whirling miasma of ‘hopefully this is covered’ where you find yourself making lots of payments for hundreds or thousands of dollars without really knowing what it’s for or if it’s the final cost.
I might go less if I had to pay $150 each time* , but bump was talking about people going to the doctor less often because they have a $35 copay as well as people avoiding doctor visits because they would have a high deductible plan. I don’t think a $35 copay is keeping anyone from the doctor - if you’re inclined to go every time you sneeze, it might but I suspect there are other issues that keep people from seeing the doctor for every sneeze.
- And I say might because my primary no longer accepts my insurance and it costs $70 each time I go rather than my $20 copay. I still go the same 3-4 times a year as I did when he accepted it. If he raised the price to $150, I’d still go the same 3-4x and if there was no copay I wouldn’t go any more frequently. The cost is not the reason I go 3-4x a year. I need blood tests 3x a year and most years I don’t come down with any illnesses that aren’t self-limiting.
It will require raising taxes.
Now, if that’s as far as you inquire, that might sound scary, or bad, or wasteful, or unfair, or whatever. And because too many Americans are mental incompetents, politicians therefore fear telling you this.
But, yes, it will require raising taxes.
However, and as proponents say repeatedly, it will lower overall costs.
How is that possible, some might ask, because they know that raising taxes actually results in people paying more money.
Well, the answer is people will no longer have to pay insurance premiums, copays, or endure high deductibles, meaning it’s a wash for the typical person.
The reason that this doesn’t seem to resonate with enough people is because health insurance, insofar as it is usually wrapped into payroll, is obscured and hidden, even though it is an expense wholly unrelated to the relationship between you, your employer, and your job. Simply put, if people actually cut a check each month to their insurance company, and were being promised not to have to write that check each month, they might have a better perspective on how a bump in taxes compares to overall costs.
It is important to add, though, that this comparison should not be the sole basis for considering a medicare for all type system.
Other benefits of such a system relate to a lowering of overhead and costs for doctors (who are relieved of the arcane system of navigating insurers) while also improving services for patients (who are no longer faced with whether a medical provider is ‘in network’).
And for those who are concerned about ‘death panels’, I’d suggest that you’ve just described what insurance companies already do: ration care despite what a doctor and patient decide is necessary. Under a universal system that is not profit driven, that death panel is disbanded.