# Why can't single-payer healthcare work in the USA? **URL:** \ **Category:** Great Debates\ **Created:** [June 30, 2016, 5:09pm UTC](https://boards.straightdope.com/t/why-cant-single-payer-healthcare-work-in-the-usa/758794 "2016-06-30T17:09:45Z")\ **Posts on this page:** 20\ **Page:** 4
**Author:** ![Little\_Nemo](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/little_nemo/32/3120_2.png) [@Little\_Nemo](https://boards.straightdope.com/u/Little_Nemo)\ **Post date:** [July 3, 2016, 9:53pm UTC](https://boards.straightdope.com/t/why-cant-single-payer-healthcare-work-in-the-usa/758794/61 "2016-07-03T21:53:14Z")
> [@puddleglum](#): > > Here is a [cite](http://www.theatlantic.com/business/archive/2012/02/us-taxes-really-are-unusually-progressive/252917/)that quotes an OECD report that the US has either the first or second most progressive tax system in the world depending on how you measure progressivity. > The US raises 1.5 trillion dollars in income taxes. The private sector in the US spends 1.7 trillion on healthcare. That means in order to raise enough taxes to pay for single payer the US would have to double the money raised on income tax. To do so through a regressive payroll tax would be slightly easier. But if a rich taxpayer is paying 40% marignal rate in income tax and 5 in state tax then a 15% healthcare tax would mean he is paying 60% of income and is a reduction in take home pay of 27%. But you’ve screwed up the real figures by focusing on “income tax”. Income tax is only paid on money that is classified as income. And guess what the money earned by wealthy people is classified as? Often times it’s capital gains - that’s when you make your money through investments rather than a salary. Warren Buffet is one of the richest men in the country - but his salary is just $100,000 a year. What’s the tax rate on capital gains? It maxes out at 20% - just above half of the max income tax rate of 39.6%. And up to 2012, the max rate was only 15%. So the reality of tax rates is that wealthy people generally pay a far lower tax rate than middle class people do. But do go on about how unfair the system is to rich people. ---
**Author:** ![puddleglum](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/puddleglum/32/137_2.png) [@puddleglum](https://boards.straightdope.com/u/puddleglum)\ **Post date:** [July 4, 2016, 6:24pm UTC](https://boards.straightdope.com/t/why-cant-single-payer-healthcare-work-in-the-usa/758794/62 "2016-07-04T18:24:55Z")
> [@Little\_Nemo](#): > > But you’ve screwed up the real figures by focusing on “income tax”. Income tax is only paid on money that is classified as income. And guess what the money earned by wealthy people is classified as? Often times it’s capital gains - that’s when you make your money through investments rather than a salary. Warren Buffet is one of the richest men in the country - but his salary is just $100,000 a year. > > What’s the tax rate on capital gains? It maxes out at 20% - just above half of the max income tax rate of 39.6%. And up to 2012, the max rate was only 15%. > > So the reality of tax rates is that wealthy people generally pay a far lower tax rate than middle class people do. > > But do go on about how unfair the system is to rich people. This is not true. [The average](http://taxfoundation.org/article/summary-latest-federal-income-tax-data-2015-update) tax rate for the top 1% is 27%, the average rate for the top 10% is 20.75%. The average rate for those in the top 25-50% is 7.31% and the average rate for the bottom 50% is 3.3%. When you include all t[axes the picture does not change](http://www.bloomberg.com/news/articles/2015-04-10/how-much-americans-really-pay-in-taxes#media-3). Very few wealthy people make most of their money in capital gains and for most people capital gains only makes up a large portion of their income when they sell a house. Buffet pays himself a relatively small salary so he pays a relatively low rate. Most of his wealth is in unrealized capital gains and you only pay money on capital gains when they are realized. However, his companies pay a 25% tax rate and he owns 33% of his companies. As a shareholder he is actually paying hundred of millions of dollars in tax. So if you took the money he actually pays in taxes it is ten or more times his nominal income of 100,000. ---
**Author:** ![Wesley\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wesley_clark/32/20581_2.png) [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)\ **Post date:** [July 5, 2016, 2:01am UTC](https://boards.straightdope.com/t/why-cant-single-payer-healthcare-work-in-the-usa/758794/63 "2016-07-05T02:01:22Z")
> [@jsgoddess](#): > > It’s dangerous to assume that health care must be about making someone healthier. Very few of us are getting healthier as we age. We want to slow decline, or stop it when possible. But there is no cure for aging, and no cure for disability, in addition to there being no cure for some significant diseases and disorders like Alzheimer’s and Parkinson’s. Yes but if health care doesn’t reduce morbidity or mortality, what is the point? The care I’m talking about is care that is not clinically any better than doing nothing (and many times worse than doing nothing). Or the excess we spend on administration. Stuff like this. [http://www.wsj.com/articles/SB10001424052970203674704574332771250497610](http://www.wsj.com/articles/SB10001424052970203674704574332771250497610) 30-50% of health spending doesn’t make people healthier, it just adds expense and risk. Health care is the third leading cause of death and causes millions of injuries. So care no better than placebo doesn’t serve any function. > **[IOM: 30% of health spending was waste](https://www.advisory.com/daily-briefing/2012/09/07/iom-report)** > > Advances in science and technology have the potential to improve the U.S. health care system, which wasted about $750 billion in 2009, according to a report released Thursday by the Institute of Medicine. > **[How the U.S. Can Reduce Waste in Health Care Spending by $1 Trillion](https://hbr.org/2015/10/how-the-u-s-can-reduce-waste-in-health-care-spending-by-1-trillion)** > > Reforms will have to address both supply and demand. ---
**Author:** ![wonky](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wonky/32/393_2.png) [@wonky](https://boards.straightdope.com/u/wonky)\ **Post date:** [July 5, 2016, 2:06am UTC](https://boards.straightdope.com/t/why-cant-single-payer-healthcare-work-in-the-usa/758794/64 "2016-07-05T02:06:55Z")
> [@Wesley\_Clark](#): > > Yes but if health care doesn’t reduce morbidity or mortality, what is the point? Your initial statement could have encompassed treatments and care that slow the progression of disease or improve quality of life without changing the course of a disease. That’s my only issue with your wording. ---
**Author:** ![Trinopus](https://avatars.discourse-cdn.com/v4/letter/t/2bfe46/32.png) [@Trinopus](https://boards.straightdope.com/u/Trinopus)\ **Post date:** [July 5, 2016, 2:45am UTC](https://boards.straightdope.com/t/why-cant-single-payer-healthcare-work-in-the-usa/758794/65 "2016-07-05T02:45:25Z")
> [@Wesley\_Clark](#): > > . . . Health care is the third leading cause of death and causes millions of injuries. So care no better than placebo doesn’t serve any function. . . . There is a startling statistical fallacy here. How many deaths does health care prevent (or, obviously, postpone)? How many of the people killed by failed health care would have died anyway? i.e., if I give you a heart transplant, and it fails, it’s preposterous to say, “Health care was the cause of your death.” A heart transplant was the only possible hope you had left. ---
**Author:** ![boffking](https://avatars.discourse-cdn.com/v4/letter/b/858c86/32.png) [@boffking](https://boards.straightdope.com/u/boffking)\ **Post date:** [July 5, 2016, 3:05am UTC](https://boards.straightdope.com/t/why-cant-single-payer-healthcare-work-in-the-usa/758794/66 "2016-07-05T03:05:55Z")
> [@Trinopus](#): > > There is a startling statistical fallacy here. How many deaths does health care prevent (or, obviously, postpone)? How many of the people killed by failed health care would have died anyway? i.e., if I give you a heart transplant, and it fails, it’s preposterous to say, “Health care was the cause of your death.” A heart transplant was the only possible hope you had left. What about the disasterous hospital-borne infections? I have heard horror stories of people going to the hospital for easily treatable issues, and then dying of MRSA or C. Dificile. If you have a sprained ankle, go to the hospital for treatment, and die from a MRSA infection, I would say that you did die from healthcare. ---
**Author:** ![Wesley\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wesley_clark/32/20581_2.png) [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)\ **Post date:** [July 5, 2016, 3:29am UTC](https://boards.straightdope.com/t/why-cant-single-payer-healthcare-work-in-the-usa/758794/67 "2016-07-05T03:29:58Z")
> [@Trinopus](#): > > There is a startling statistical fallacy here. How many deaths does health care prevent (or, obviously, postpone)? How many of the people killed by failed health care would have died anyway? i.e., if I give you a heart transplant, and it fails, it’s preposterous to say, “Health care was the cause of your death.” A heart transplant was the only possible hope you had left. Nope. Medical errors, hospital acquired infections, side effects from medications, side effects from surgeries done properly, etc. is the third leading cause of death behind heart disease and cancer. [https://www.washingtonpost.com/news/to-your-health/wp/2016/05/03/researchers-medical-errors-now-third-leading-cause-of-death-in-united-states/](https://www.washingtonpost.com/news/to-your-health/wp/2016/05/03/researchers-medical-errors-now-third-leading-cause-of-death-in-united-states/) > [@](#): > > Their analysis, published in the BMJ on Tuesday, shows that “medical errors” in hospitals and other health-care facilities are incredibly common and may now be the third-leading cause of death in the United States — claiming 251,000 lives every year, more than respiratory disease, accidents, stroke and Alzheimer’s. Seeing how a (potentially huge) chunk of health care is no better than placebo, and that many treatments have NNTs in the triple digits, it is a serious issue to consider. ---
**Author:** ![Wesley\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wesley_clark/32/20581_2.png) [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)\ **Post date:** [July 5, 2016, 3:33am UTC](https://boards.straightdope.com/t/why-cant-single-payer-healthcare-work-in-the-usa/758794/68 "2016-07-05T03:33:12Z")
> [@jsgoddess](#): > > Your initial statement could have encompassed treatments and care that slow the progression of disease or improve quality of life without changing the course of a disease. That’s my only issue with your wording. Semantics. My definition of healthier is anything that improves quality of life and reduces morbidity and mortality. ---
**Author:** ![puddleglum](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/puddleglum/32/137_2.png) [@puddleglum](https://boards.straightdope.com/u/puddleglum)\ **Post date:** [July 5, 2016, 8:49pm UTC](https://boards.straightdope.com/t/why-cant-single-payer-healthcare-work-in-the-usa/758794/69 "2016-07-05T20:49:02Z")
> [@dracoi](#): > > I don’t get it… why would infrastructure be so expensive? The government already has a massive health care infrastructure in the form of Medicare. Furthermore, if you’ve put the health insurance industry out of business, you have a glut of people who already know how to administer health insurance plans. It’s not like the proposal is for free, unlimited passenger travel to the moon. > > Furthermore, why stay stuck on funding it through taxes? If the system breaks when you fund it through taxes, the logical solution seems to be: don’t fund it through taxes. If you must, keep the ACA mandates in place, and the [healthcare.gov](http://healthcare.gov) marketplace. The only difference will be that every plan offered will be from one company. Infrastructure is expensive because you need to double the current heath care infrastructure. Since these are now government employees they have all the benefits that go along with that. That is expensive. You saw from the rollout of [healthcare.gov](http://healthcare.gov) how good the government at creating new computer systems. Medicare fraud is already a huge problem, if you want to have any shot at stopping people from ripping of tens of billions from the system you need ways to monitor who is getting the benefits and to make sure they are actually being treated. If you kept the current system in place and just used one company, then you would have either many people uncovered or many poor people stuck with expensive health insurance. If are going to subsidize the cost of poor people’s insurance then you need to raise taxes to get that. So either you have to raise taxes anyway or you have just screwed a bunch of poor people. ---
**Author:** ![Saint\_Cad](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/saint_cad/32/18907_2.png) [@Saint\_Cad](https://boards.straightdope.com/u/Saint_Cad)\ **Post date:** [July 5, 2016, 11:06pm UTC](https://boards.straightdope.com/t/why-cant-single-payer-healthcare-work-in-the-usa/758794/70 "2016-07-05T23:06:24Z")
> [@Shodan](#): > > 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. I disagree. Right now there is no linkage between true costs of equipment and time with health care costs. Add to that that we know that insurance companies get discounts off of the billed costs and ISTM there is a lot of room to cut spending while providing the same care. ---
**Author:** ![Hoserted](https://avatars.discourse-cdn.com/v4/letter/h/8c91f0/32.png) [@Hoserted](https://boards.straightdope.com/u/Hoserted)\ **Post date:** [July 13, 2016, 7:34pm UTC](https://boards.straightdope.com/t/why-cant-single-payer-healthcare-work-in-the-usa/758794/71 "2016-07-13T19:34:06Z")
As a Canadian I think Americans should keep there current system as it seems to work for them. They like it. Most people down in the states don’t actually “lose their house” because of paying off medical bills from a serious illness. That’s a myth. ---
**Author:** ![kenobi\_65](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/kenobi_65/32/13178_2.png) [@kenobi\_65](https://boards.straightdope.com/u/kenobi_65)\ **Post date:** [July 13, 2016, 7:43pm UTC](https://boards.straightdope.com/t/why-cant-single-payer-healthcare-work-in-the-usa/758794/72 "2016-07-13T19:43:00Z")
> [@Hoserted](#): > > As a Canadian I think Americans should keep there current system as it seems to work for them. They like it. Most people down in the states don’t actually “lose their house” because of paying off medical bills from a serious illness. That’s a myth. Welcome to the SDMB, Hoserted! Generally speaking, we like to back up statements here with citations (or “cites”). While you’re technically correct, statistics show that almost 2/3 of personal bankruptcies in the US result from medical expenses. Now, filing bankruptcy may well be what _prevents_ you from losing your house, but bankruptcy is also usually a fairly drastic measure, and damages a family’s finances for years to come. > **[Top 10 Reasons People Go Bankrupt](https://www.huffpost.com/entry/top-10-reasons-people-go_b_6887642)** > > In today's economic climate, personal bankruptcy has climbed at an alarming rate. Here are the top 10 reasons why people go bankrupt. ---
**Author:** ![Hoserted](https://avatars.discourse-cdn.com/v4/letter/h/8c91f0/32.png) [@Hoserted](https://boards.straightdope.com/u/Hoserted)\ **Post date:** [July 13, 2016, 9:07pm UTC](https://boards.straightdope.com/t/why-cant-single-payer-healthcare-work-in-the-usa/758794/73 "2016-07-13T21:07:11Z")
> [@kenobi\_65](#): > > Welcome to the SDMB, Hoserted! > > Generally speaking, we like to back up statements here with citations (or “cites”). While you’re technically correct, statistics show that almost 2/3 of personal bankruptcies in the US result from medical expenses. Now, filing bankruptcy may well be what _prevents_ you from losing your house, but bankruptcy is also usually a fairly drastic measure, and damages a family’s finances for years to come. > > [Top 10 Reasons People Go Bankrupt | HuffPost Impact](http://www.huffingtonpost.com/simple-thrifty-living/top-10-reasons-people-go-_b_6887642.html) I am sorry for not putting in the citations. From who I have talked to (in the real world) medical coverage nightmares are relatively rare for most insured Americans. What do you guys think about our Canadian healthcare? do you have any positive opinions. ---
**Author:** ![kenobi\_65](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/kenobi_65/32/13178_2.png) [@kenobi\_65](https://boards.straightdope.com/u/kenobi_65)\ **Post date:** [July 13, 2016, 9:17pm UTC](https://boards.straightdope.com/t/why-cant-single-payer-healthcare-work-in-the-usa/758794/74 "2016-07-13T21:17:17Z")
> [@Hoserted](#): > > From who I have talked to (in the real world) medical coverage nightmares are relatively rare for most insured Americans. Rare in the absolute, perhaps, but if the article’s numbers are right, roughly 900,000 people in the US file individual bankruptcy due to medical expenses annually. The article also points out that most people who file for bankruptcy due to medical bills _do_ have some sort of health insurance. Also, despite 3 years of Obamacare, there are still roughly 32 million in the US with no health insurance. > **[Key Facts about the Uninsured Population | KFF](https://www.kff.org/uninsured/issue-brief/key-facts-about-the-uninsured-population/)** > > This issue brief describes trends in health coverage in 2022, examines the characteristics of the nonelderly uninsured population, and summarizes the access and financial implications of not having coverage. ---
**Author:** ![Trinopus](https://avatars.discourse-cdn.com/v4/letter/t/2bfe46/32.png) [@Trinopus](https://boards.straightdope.com/u/Trinopus)\ **Post date:** [July 13, 2016, 11:11pm UTC](https://boards.straightdope.com/t/why-cant-single-payer-healthcare-work-in-the-usa/758794/75 "2016-07-13T23:11:29Z")
> [@Hoserted](#): > > . . . What do you guys think about our Canadian healthcare? do you have any positive opinions. I don’t know a lot about it, but admire all I’ve heard. I have a friend who is an Australian doctor, and he keeps sending me wonderful books on the Australian health-care system. Makes me wish we had something that good! (Australia’s system is informally two-tiered. Basic coverage is free, but anyone who has any money buys a private supplemental policy, for extras like a private room instead of a bed in a ward, etc. Taxes on the private policies help fund the basic, universal coverage. Great for everybody.) ---
**Author:** ![Nava](https://avatars.discourse-cdn.com/v4/letter/n/da6949/32.png) [@Nava](https://boards.straightdope.com/u/Nava)\ **Post date:** [July 14, 2016, 6:38am UTC](https://boards.straightdope.com/t/why-cant-single-payer-healthcare-work-in-the-usa/758794/76 "2016-07-14T06:38:07Z")
> [@Shodan](#): > > I am talking about rationing based on cost-benefit analysis. As in “no, we are going to let your 1500 gram newborn die” or “the waiting list for a hip replacement is six months - you will have to manage somehow until then” or “that drug may work 10% better, but you can’t have it because it costs too much” or “we don’t cover mammograms for women under 50” or “statin drugs don’t affect life expectancy so we don’t cover them”. The ones on the newborn and mammograms wouldn’t be considered under any of the UHC systems I’ve been a part of. Take into account that any procedure is recommended or not for a series of reasons, not just one, and for example mammograms were recommended for me based on family history way before they would have been based on age. The others would. ---
**Author:** ![Shodan](https://avatars.discourse-cdn.com/v4/letter/s/9f8e36/32.png) [@Shodan](https://boards.straightdope.com/u/Shodan)\ **Post date:** [July 14, 2016, 2:15pm UTC](https://boards.straightdope.com/t/why-cant-single-payer-healthcare-work-in-the-usa/758794/77 "2016-07-14T14:15:46Z")
> [@Nava](#): > > The ones on the newborn and mammograms wouldn’t be considered under any of the UHC systems I’ve been a part of. Take into account that any procedure is recommended or not for a series of reasons, not just one, and for example mammograms were recommended for me based on family history way before they would have been based on age. The others would. If you mean they wouldn’t be covered under UHC, then I agree and that is much of my point. They shouldn’t be covered if we want to save money. Regards, Shodan ---
**Author:** ![Nava](https://avatars.discourse-cdn.com/v4/letter/n/da6949/32.png) [@Nava](https://boards.straightdope.com/u/Nava)\ **Post date:** [July 14, 2016, 2:38pm UTC](https://boards.straightdope.com/t/why-cant-single-payer-healthcare-work-in-the-usa/758794/78 "2016-07-14T14:38:56Z")
No, what I mean is that they are very much covered. The other items may or may not be covered. Which medications are covered for which situations is under constant review, for example. But nobody, nobody, would declare “underweight” a reason to not do anything for a newborn - specially not a weigh which is barely a 7-monther! Micropreemies much smaller than that are saved almost routinely nowadays: a “routine” which still involves a lot of care and a lot of stress, but still, routine enough to not make news unless there was half a dozen of them. ---
**Author:** ![Shodan](https://avatars.discourse-cdn.com/v4/letter/s/9f8e36/32.png) [@Shodan](https://boards.straightdope.com/u/Shodan)\ **Post date:** [July 14, 2016, 2:53pm UTC](https://boards.straightdope.com/t/why-cant-single-payer-healthcare-work-in-the-usa/758794/79 "2016-07-14T14:53:24Z")
> [@Nava](#): > > But nobody, nobody, would declare “underweight” a reason to not do anything for a newborn - specially not a weigh which is barely a 7-monther! I don’t know how it works in Spain - in the US 1500 grams is considered very low birth weight. [Babies who have very low weight at birth (less than 1,500 grams, or three pounds, five ounces) have a 22 percent chance of dying within their first year.](http://www.childtrends.org/?indicators=low-and-very-low-birthweight-infants) Regards, Shodan ---
**Author:** ![Nava](https://avatars.discourse-cdn.com/v4/letter/n/da6949/32.png) [@Nava](https://boards.straightdope.com/u/Nava)\ **Post date:** [July 14, 2016, 2:56pm UTC](https://boards.straightdope.com/t/why-cant-single-payer-healthcare-work-in-the-usa/758794/80 "2016-07-14T14:56:47Z")
And I am telling you that in Spain, France, Switzerland, Sweden or the UK it is considered very low but that doesn’t mean “worth doing nothing”. You apparently think those countries should and would have a 100% death rate. [Previous page](https://boards.straightdope.com/t/why-cant-single-payer-healthcare-work-in-the-usa/758794.md?page=3) [Next page](https://boards.straightdope.com/t/why-cant-single-payer-healthcare-work-in-the-usa/758794.md?page=5)