Vermont is a rather small population to make a single payer system work. You need a large population so that the costs are spread out. Each individual pays in a small amount, and the system pays for the care everybody needs. Your provider is not part of a ‘network’ or ‘care group’, they just are reimbursed by the government.
The U.S. is very inefficient in providing health care. For the amount that is spent in this country on health care every year, every person in the country could see a doctor two or three times in other systems. And that is not the total, because that figure does not include all health care insurance fees. What healthy people are paying into the system is not usually included in the amounts that are publicized.
The concept of collecting ‘premiums’ in a single payer system does not make sense to me, as it would be part of the tax structure. I see health care as taking care of the productive capacity of the country, the same as investing in maintenance for an assembly line or a factory building. People are what actually create wealth, so keeping them fit and healthy is in everyone’s best interest.
Canadians provinces do it. The individual provinces are not very big. Vermont is even smaller, of course, but I’m not sure that 1 million is the critical mass, whereas 600,000 is too small to be viable. Canada started health care in one of its least populated provinces after all, and its success is what led to Medicare. Vermont had ambitions of doing something similar and it failed due to the fact it’s 2015, not 1970.
Does anyone here know when the last single payer system was established? I think it was Canada’s, and a lot has changed in the health care market since then.
BTW, California, a state the size of France population–wise, has passed single payer bills and had them vetoed by Arnie. Mysteriously, they stopped trying to pass single payer once Jerry Brown took office. What happened to their balls? Did they use the single payer bills just to excite liberals but didn’t actually want them to pass?
It’s a non-issue in both cases. It’s a non issue because there’s no reason why an UHC system, whether already existing or newly implemented, would prevent you from picking and/or keeping your family doctor.
Googling shows that the last one, SB 810, died on 3rd reading in 2012 and as far as I can see was introduced in 2009. The ones before that passed in '08 and '06. I don’t think it’s particularly mysterious that they didn’t try a fourth time yet when they didn’t have the votes with this senate makeup.
Where does the savings come from? If you changed to a UHC system tonight doctors and nurses would still want to get paid tomorrow. Patients would still want the same level of service. Pharmacists, laboratories, and hospitals would still demand payment.
The only way to reduce costs in UHC would be for congress to pass a bill either dramatically cutting the amount of healthcare services people could get or dramatically cutting the amount of payment providers get. Look at the history of the Medicare doc fix to see what happens when you try to cut provider’s payments. Politically, cutting the amount of services people could get would be even harder.
Someone can correct me if my guess is wrong, but I’d guess that Britain and Canada started out paying market rates to providers and then simply allowed payments to increase at a slower rate than elsewhere.
I’d say it’s more efficiencies in the system, less paperwork and admin costs and volume discounts. Large companies in the US pay less for medical than smaller or medium sized companies because of these things, after all, so it most likely is the same with a UHC system.
You have choice there as well. However one of the ways costs are lowered (I believe this is true in many UHC systems) is that your GP acts as a “gatekeeper” - you require his recommendation for seeing a specialist.
Single-payer does not reduce these costs; it shifts them from higher prices for the insured to higher taxes for the 54% of the US who pay taxes.
That is what I mean. If the state pays your family doctor the same as your insurance company, you don’t save any money.
As mentioned, if we want to reduce health care spending, we have a choice between reducing payments to health care providers, or rationing care. Simply changing who pays for it doesn’t reduce anything.
We have done this discussion before. Obama promised that Obamacare would reduce the average family’s premiums by $2500 a year. They didn’t.
No, as mentioned by XT above you can save money through effeciencies and volume discounts. In addition to the bargaining power of being the sole legal buyer. And rationing care probably wouldn’t be that bad an idea in some cases. We don’t need an MRI for every belly ache.
Obamacare isn’t single payer so that’s kind of irrelevant.
I don’t think you two understand where the US extra costs originate. You both seem to assume that the US system already operates at the same cost efficency as the other nations systems. That is very far from the truth I am afraid.
The excess costs in the US system originate from the following sources, in order:
Excessive administration and bureaucracy. This is the 800-pound gorilla. In the US, there is a vast number of people who deal with billing, credit-checking, liasing and negotiating with insurance companies, chasing down payments, and filling in forms to the insurance companies. As far as I know, there are no standard of forms, coverage or prices. This also leads to a lot of duplicate work. Some hospitals, I am told, have more people working these jobs than they have beds!
This is a major expense of the American system. Other systems just don’t have these jobs. At all. When a patient comes into our office, we pull out his journal, and when he is done we put it back updated. Thats it.
Next is medical waste and inefficiency. Two hospitals on different city blocks can both have MR-machines, CT-scanners, specialised technical staff, and use them maybe 1/3 of their potential time. The US system also encourages profitable surgery and interventions that don’t actually improve outcomes.
Then there are medical insurance. Even discounting the for-profit companies profits, there are over 600 000 people working in medical insurance in the US today, at generally very good salaries.
Other nations mostly consider this a pointless middleman, and don’t have anyone like that.
Below that there are minor issues. Defensive medicine, stuff done just not to get sued. Tort and malpractice insurance. Higher salaries for physicans. None of which are very large drivers of costs compared to the top three.
You are assuming that the only change is going to be in where the money comes from. But the current US system shovels so many layers into the mess, that just managing the interaction between them is a massive amount of work -often duplicated over and over again- that other systems just don’t have. The cost of this then manifests in price markups -outpatients, for example is particularily visible in comparisons.
Primarily insurance profits. Insurers have had ridiculous overheads, to the extent that less than half a dollar spent on premiums actually ended up involved in medical care for anyone. Obamacare requires insurers to spend at least 80% of their take on care services. Government run Medicare, being not-for-profit, has overhead in the neighborhood less than 1% (more than 99% of Medicare revenue goes to actual medical care). Fucking wasteful, inefficient government bureaucracy.
You do realize, you could have the most expensive single payer system in the world, and still save more money each year than you current military budget?
Problem with Vermonts attempt, as I understand it is that it would not be single payer, it would have resulted in a uniquely American setup with all the American cost-adders- Basically, you’d still be having all the public and private systems and just added one more on top of them. Of course that wouldn’t result in any savings.
To get a single payer system, you’d have to take the money currently going to Medicare, Medicaid, VHA, Indians etc, and make a single system out of it.
Single payer seem to work quite well in Iceland (300 000 people) and the Faroes (50 000 people).
Don’t quote me, but I think it was Taiwan in 1995. I’ve heard good things about their process of investigating other systems, and looking for good features while discarding poor ones. NI system.
Actually, I’d suspect it was more at least in the UK. Bevans stuffed mouths with gold after all.
I think it bears repeating that other first world nations manage to provide healthcare to everyone, while spending far less money and most getting better results than the US. I’ve seen no convincing argument that the US is immune to the laws of economics.
I think I should add that in healthcare in Norway we have a considerable amount of choice.
In order to reduce the amount spent on healthcare in the US to the average of other countries the US would have to cut 1.7 trillion dollars. Total profit from the five largest health insurance companies amounts to about 12 billion dollars. If you generously figure the rest of the insurance industry makes 8 billion in profit, then removing all the profit from the insurance industry would save 20 billion dollars. That is 1% of the savings needed.