It works perfectly well in most other developed nations. Many people here still seem very opposed to it despite it being widely succesful in every nation that has it. Our healthcare system is an inefficient clusterfuck, and I think we need to hit the reset button instead of coming up with more half-measures and bizarre work-arounds. Single-payer would save a lot of lives and a lot of money. Is this just another case of american exceptionalism?
I would argue that Medicare is single payer health care and it seems to work pretty well.
I’m not convinced that single payer is necessarily the best way to go, but the current mess is unsustainable and expanding Medicare seems like the most practical solution for a rapid improvement.
Probably not. Health care costs are going up nearly as fast in Europe as they are in the US, and for the same reasons - more technology, aging populations.
We aren’t going to save any money unless we implement some form of rationing, either de jure or (more likely) de facto.
Regards,
Shodan
No cites, no evidence. But from a top-of-the-mountain view … it looks to me like a lot of heavily vested interests lose a lot of money in the event the U.S. goes single-payer. The inertia these interests can apply seems to be very great.
But that’s just an impressionistic “the way things look to me” opinion. Not much meaty debate fodder, I’m afraid.
They might be rising at the same rates, but they are also at a much lower level. Why do we spend twice as much as the rest of the world, but end up with a lot less to show for it? Many countries both spend less(even adjusted for GDP!) and have better treatment.
You’ve already created a pay to purchase culture, where a guy with great insurance can go to the hospital and get a CT scan by asking for one, pretty much. To the benefit of drug companies patients go to Dr’s and tell them the drug they want.
When all access to resources are triaged based on need, such people will lose that kind of access. And people don’t generally take well to not getting what they want when they ask!
We’re starting from a higher level of spending. Implementing single-payer isn’t going to reduce the amount of spending, unless we implement some kind of rationing. The best we can reasonably hope for is reduce our rates of increase to the same as it is for other industrialized countries with single-payer (or some other form of national health care, like Germany).
If your definition of “working” is to reduce health care spending in the US to that of other governments, that would involve some kind of rationing to patients and reducing what we pay for doctors and hospitals and so forth. That isn’t likely.
Regards,
Shodan
A former Health Minister in the UK said the NHS was, in essence, a cost control system, and since the government sets the budgets and the tariffs, that’s easily understood. I don’t know how this is done for insurance-based systems elsewhere on the Continent.
Does the US have any system for setting recommended prices and evaluating cost-effectiveness (as opposed to safety) of treatments and drugs? One thing I have noticed in online discussions is that your doctors and hospitals seem to bill for every little item, rather than flat or block rates for courses of treatment - once they’ve all had their little bits of overhead added on, that’s bound to inflate the final bills.
In Switzerland, there are certain coverage levels whose cost is set by the government. Further coverage is available but the lowest level already kicked the ass of any of the policies I had in the US, while costing about as much per year as those per month.
It’s often overlooked that the usual roles of supply and demand are almost reversed in the U.S. system!
Normally, purchasers of a service want to pay low prices. However, while insurance companies are happy to boost profits by denying care or costs in the short run, in the long run their profit will be proportional to their spending. If their payouts are doubled, their premiums will double and so will their profits!
Corporations run America, and the health insurance and HMO businesses are huge.
And don’t ask Americans to contrast their system with that of other countries. :eek: America is a unique exceptional nation (“the kindest, bravest, warmest, most wonderful country I’ve ever known in my life”), and evidence from other, possibly Marxist regimes, carries no weight here! :rolleyes:
I read a fair amount of news to the contrary, at least for the UK and Canada.
Can you show your math on this one, or at least show some basis for why you think this is a true statement?
Well sure, it’s pretty obvious that the US is just like every other country. That’s why they all have a 2nd Amendment (or Constitutions exactly like ours), more guns than people, and why our government can works exactly like theirs does (and vice versa of course)…I mean, they all have 2 party systems exactly like we do, and our government can simply implement a single payer system like they all did. Heck, really they all speak English just like us…you just have to SHOUT REALLY, REALLY LOUD, and they will understand. Obviously, we are just exactly alike!! Thanks for bringing that up, it’s such a keen observation!
As for the OP:
Well, that’s debatable (‘works perfectly well’? how many is ‘most’?), though I agree it works well in SOME countries…some better than others. Could it work here? I think so. The problem is that such a change is incredibly difficult in the US because, unlike the well poisoning of the above poster, our system doesn’t in fact work just like every other country, and it’s pretty weird. Look at how resistant we are to something like going metric, or still having a freaking penny or myriad other things that we resist doing. I think blaming Big Pharma or Big Healthcare or whatever puts the cart before the horse…those things are optimized to work in our kludged together evolutionary system that’s been with us for literally decades, and that the people are basically used to and, by and large don’t see a huge need to change to something that is unknown to them. If a large enough majority of people were actually feeling the pain of the healthcare system or weren’t getting adequate service from it then there would be change. Heck, I think there WILL be change, since business is feeling the pinch due to rising costs.
It is inefficient, but contrary to what seems to be popular believe here, it actually chugs along and benefits the majority of Americans adequately enough that there just hasn’t been a big push for major change. Look at how resistant people have been to Obama-care…and that was, relatively, minor and incremental changes to the system, not a major reset. In our political system, with our voting base, getting through major systemic changes to something as broad as healthcare is incredibly difficult…and that’s because, we aren’t just like every other country out there and we just eat more and are louder and more obnoxious. Oh, we are those things, but there are deeper differences in hour our system works. Don’t believe me? Want to think like Septimus poisoned well? I give you…THE REPUBLICANS. Show me the equivalent to them in other systems when they were converting to a single payer system, and an election system with 2 parties and first past the post voting…and all that implies. You can’t do it because no one else has a system, a Constitution and a voter base like ours.
Plus we are loud, eat a lot and are obnoxious as well.
Yeah, I think it is. Or, let’s turn it around. Give me a pathway that would actually get us to a single payer system that realistically takes into account our political system AS IT REALLY IS. Let’s say, for the sake of argument, Bernie boy gets elected. He’s large and in charge and rarin’ to go with his single payer system. What happens next? Does he just get to implement it as he likes? Just put that bitch in place and off we go? Just like Obama got to do with his (compromise and watered down…probably what he really wanted, right?) system? Show me how the US is just like every other country by giving me a run down of how we’d get to a single payer system just like they did.
You can’t do it. The ONLY way we will get there is if the system is so broken (and costly) that, not only does it not meet the needs of the average user but it’s costs are so painful that neither they nor business can afford to continue it for the majority of people. And that hasn’t happened…yet.
Actually, I think it could be done. Assuming a President and a Congressional majority were behind it, they could just start up a public health care system funded by tax revenue - basically the equivalent of Canada’s system.
And what would happen to our existing for-profit system? It my opinion it would collapse and disappear within a couple of years. Why would people want to keep on paying the exorbitant costs of the current system if they had the alternative of a public health care system. It would be a triumph of the free market with the better system replacing the less efficient one.
Of course the for-profit system claims this isn’t the case; they insist they provide a better service. I have my doubts but I’m willing to accept the possibility. If the for-profit system works as well as it claims, it’ll be able to demonstrate this by surviving the challenge offered by the public system.
Our system is so efficient that we just can’t manage to find a way to save money by changing it? It’s so near perfection that there’s just no way to improve on it?
If we were to get the amount of health care spending we spend on administration from 30-40% to under half that like single payer systems, we somehow won’t save any money?
A significant fraction of our medical spending goes to people whose only job it is to harass insurance companies into paying, and the people they do battle with, insurance staff who attempt to obfuscate the process. No savings can be had there?
Collective bargaining power on drug prices and other medical costs that would force the rest of the world to make up some of their share and not just be a free rider on the US market, no money to save there either?
You also seem to misunderstand what rationing is, since any resource that isn’t practically infinite and easy to get is rationed. Our health care is already rationed by cost and by insurance bureaucracy. We’d just be changing rationing to medical consensus rather than complex contractual interactions.
Part of the reason ACA was a success was because the Health Care Insurance providers got on board with it. They saw it as a way of getting more subscribers/customers.
I think they’d scream bloody murder if the next administration tries to pass a socialized healthcare system like most other modern/civilized nations. Insurance lobbyists would pull up with dump trucks of money to fill congressmen’s pockets.
I think there would be a lot of push-back from healthcare providers as well because better the devil you know when it comes to billing and current compensation rates.
Now, is that a reason not to implement a single payer (socialized) healthcare system in the US? Of course not. I’m okay with pulling the life support on health insurance companies and announcing time of death.
I was involved in a similar thread before my last doctor’s appointment (Ontario) so I asked him; how many billing staff does his practice have? The answer, one but the office manager helps her out a bit too. For a practice with nine physicians, four nurses, and two nurse practitioners. What would that number be in the states?
A few years ago during the ACA debate Inc magazine highlighted a hospital/clinic group that had achieved a lot of savings through efficiency and were being touted as a model for the future. They still had 1.2 billing staff for every 1.0 doctors. One of their major problems in cutting this down was the number of out-of-state patients they saw.
Of course, you have to be careful when you’re looking at the numbers for a practice like the one you describe to make sure you know how much work they do themselves. In the US, some doctors will tell you that they don’t have anyone on staff for billing. They pay a third-party service (often a % of revenue) to do the billing for them. They don’t know how many man-hours actually goes into the work, just the fee they pay
[QUOTE=Little Nemo]
Actually, I think it could be done. Assuming a President and a Congressional majority were behind it, they could just start up a public health care system funded by tax revenue - basically the equivalent of Canada’s system.
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Ok, but that’s not exactly a political path. That’s wishful thinking, at least in the current (and past) political climate. What’s the actual path to get there? Sanders gets elected (because Clinton isn’t going to try a single payer system, at least I doubt she would). Then, what? Not only do the Dems take the House, but the right sort of Dems who would be in favor of a single payer system, because not every Democrat in the House would be in lock step on this…at least I don’t think they would be. And you’d have to take the House in overwhelming numbers to not only ram this through lock step opposition by the Republicans, but you’d have to hold that majority long enough to get it implemented and in place AND demonstrating to the American people that it’s the right course. Because it’s not going to happen instantly…it’s going to be a fairly painful transition (this, of course, assumes it does work out in the end and is so demonstrably better AND cheaper that the majority of Americans are happy…I will assume this to be true for the sake of argument, and I actually think there is merit to that assumption, though not nearly as much as folks on this board think).
You see the myriad problems here? Sanders isn’t going to get elected. Just not going to happen. And Clinton is going to continue to follow the path of incremental change that Obama started. And while Trump MIGHT give the Dems a boost in the next congressional election cycle, it’s not going to be anything like the overwhelming numbers the Dems would need to even contemplate this. And all this assumes, further, that the economy is relatively stable through this time (which doesn’t seem a given right now), thus allowing the Dems to continue to make inroads on those numbers AND keep the Presidency. It also assumes nothing else major happens to distract the American people, such as another large terrorist attack, or some epic controversy on Survivor or the like.
I’m sympathetic to a single payer system. I think our current system is broken, and I don’t think the path we are on is the right one. But I also know the realities, and can see how, in our system and with our electorate as well as our history wrt how we got where we are and how healthcare in the US evolved and has been linked to jobs, and also the attitude of the American people on this, that it’s going to be a hell of a lot harder to do than folks think…and it’s not JUST because of Big Pharma and Big Healthcare.
It would work very well if it didn’t provide limitless care. But that’s the problem, if care is restricted in any way then DEATH PANELS!