How do we compare apples to apples (between countries)? Compare health expenditure per capita (public and private) with multiple health indexes. I.e. get the bang for buck.
In the list of nations with the best bang for buck healthcare programs, you will notice that top 20 healthcare programs are mostly single payer.
But there are single payer healthcare systems with bad health indexes, you might say... Well, combine single payer healthcare systems and add some transparency in healthcare and you now have an unmissable correlation.
The top 20 bang for buck healthcare programs (mostly single payer systems), have an average ranking in terms of healthcare transparency of 18.7.
Are you from the USA? Notice the countries with universal healthcare, who have a similar healthcare transparency ranking to that of the USA: Luxembourg, Canada, Germany, France, Belgium, Ireland, and Chile. Their bang for buck rankings are 16, 30, 25, 1, 21, 19, 33 respectively. All of these countries have a better bang for buck ranking than the USA's 37.
In one sentence... Universal and transparently managed healthcare consistently gives more bang for buck.
And now to quote the original article... "It is a bedrock economic principle that if we can find a way to do something more efficiently, it’s possible for everyone to come out ahead."
EDIT: Check page 18 in the first source. Check chapter 11 in the second source.
"And now to quote the original article... 'It is a bedrock economic principle that if we can find a way to do something more efficiently, it’s possible for everyone to come out ahead.'"
That's a really important "possible" though. It is a near certainty that if were to transition to single payer healthcare we would not do the transfers to hold everyone profiting from the current system harmless (e.g. health insurance employees). In any realistic scenario there would be winners and losers which is why you see fierce lobbying on both sides of the issue.
This simplification seems disingenuous. Would switching to single payer solve your last sentence / quote from the article? Aka, would putting the US government in the middle make things simpler and more efficient (and cheaper) for the end user (health care patients)? I can't say I'm convinced.
Compare with the current system, where any given user is still effectively dealing with a single payer -- their insurance provider. Their insurance provider is one level of removal from the health system that has to be paid.
Now, the idea of transparency? That's lovely, and would force accountability and that sort of thing which could potentially have impact. I can't disagree with that. I'm not sure that just putting the government in the middle fixes that either, though.
As /u/frgtpsswrdlame points out, we have the most expensive health care, which seems like the bigger issue that isn't addressed. If we lessened the cost of health care in the US, that would probably be a better start, imo. Does single payer fix that? I would think that private, competing companies would seek out better deals vs a single government entity who couldn't really negotiate, but perhaps I've got that backwards.
I'm not disagreeing with the thought on the whole, I just don't see how single payer fixes these problems.
I lived in Italy for a number of years, and the Italian government is no nordic model of efficiency and propriety. And the health care system is still mostly better than in the US :-/
You're right that costs need containing though, and it's not quite as simply as "just" switching to a singly payer system.
>I would think that private, competing companies would seek out better deals vs a single government entity who couldn't really negotiate
That's the biggest advantage of single payer, one buyer can negotiate better deals with suppliers because there are no other buyers. It's basically a reverse monopoly.
> I want proof. I only see numbers. Everything else is conjecture.
But wait, is this not conjecture, since it doesn't currently exist? Sure, you have sources where it has worked, but the proof would only be implementing it here.
> Or is the US government not a leading force in fighting corruption anymore?
What? I don't understand what you're getting at here. My point isn't that the government is corrupt, it's that it's inefficient.
> But wait, is this not conjecture, since it doesn't currently exist? Sure, you have sources where it has worked, but the proof would only be implementing it here.
Universal and transparently managed healthcare consistently gives more bang for buck. Note that I said "consistently", not just in a few places.
Yes, obviously you can't know what's going to happen in the US until you try it. But if it has consistently worked around the world, the best guess is that it will work in the US as well. Surely your argument, can't be... "how can I know this ball is going to fall into the Earth, if I haven't dropped it yet".
> What? I don't understand what you're getting at here. My point isn't that the government is corrupt, it's that it's inefficient.
And my point is that transparency in healthcare + single payer makes the system efficient.
Are there other countries that have transitioned from a high-cost system like ours to a single-payer system? How quickly did their costs go down?
For example (according to the first Google links for "usa/uk average doctor salary"), the average doctor salary in the UK is $128,500, compared to $189,000 in the US. How are we going to cut salaries by 32%?
My guess is that there are salary discrepancies across the medical industry.
> transitioned from a high-cost system like ours to a single-payer system? How quickly did their costs go down?
I did not look this up. But I know one thing, eventually you will save money. I don't suppose that it would take longer than 20 years to save money, but I frankly don't know. Maybe you could look it up to expand on your point:-D
> average doctor salary in the UK.. Compared to... In the US.
That is not apples to apples. There are countries with lower and higher pay, both overall and relative. Plus you have think of differences in cost of living, taxation, malpractice insurance, and even their own medical insurance.
Interesting. Why is the U.S. less corrupt than most? Would giving the U.S. government a big bump in the amount of power it weilds in the form of single payer health care improve the curruption situation or make it worse?
0xffff2 - that's correct. Personally I am more lenient, given that my country of birth struggles.
But in the context of the conversation, I think #18 is good enough to make the cutoff for single payer. After all, other countries with lower healthcare transparency are still more efficient with their universal systems.
krupan - I don't have the data for what has happened with transparency when countries implemented universal healthcare. So I don't have the answer for that.
The US is 18/176 on the list on that page; not even in the top 10%. Personally, I would say the top 5% or so could reasonably be called leaders. Where would you draw the line?
This is a really good point. One problem I think though is that not everyone will come out ahead in a single payer system. Our system is explicitly organized around the fact that you must pay for care and we have the best and most expensive care in the world. Our system is setup so that those at the top of the economic ladder can buy a level of care they could not get anywhere else. They will undoubtedly receive worse care were the US to switch to a system which diminished the effect of personal wealth.
This is not true, and can be trivially observed to be not true by counterexample, viz. looking at other countries that have a hybrid public/private system e.g. here in Australia.
Incidentally, "level of care" is almost meaningless in most first-world systems. The difference I experience, due to my private health insurance here, is not in outcomes, but in time to service for elective procedures, and access to private facilities (most notably a private room for overnight/extended hospital stays). And that time-to-service difference vanishes for emergency care.
EDIT: additional insider tip. If you have private health cover in such a system, and are being treated for a major medical issue, ask for a private room in a public hospital, because that is where our clinicians spend most of their day-to-day. If you are in a room in a private hospital, there are often no specialist clinicians on site. Whilst this may make no difference for most cases, any sudden complication may be dealt with much more quickly. This is possible in our hybrid system because the hospital is a separate institution from the state and happily does both public and private billing.
Actually, the 1% would have private healthcare, i.e. pay twice.
This is directly analogous to private primary education: the wealthy still pay taxes to fund public schools, while paying addition for private schools as well.
You're going to have to provide a lot more support for that claim. All you've really provided is the implication that "most expensive" = "best". But expense is also a result of inefficiencies, and we "undoubtedly" have a less efficient system (more administrative overhead.. I can cite sources if anyone doubts it).
Other single-payer systems, for example, also provide complementary or supplementary private options.[1] And since these private options have to compete with a baseline of quality public care, they may be more affordable.
> And since these private options have to compete with a baseline of quality public care, they may be more affordable.
In such a hybrid system the public hospitals also experience competitive pressures. I can confirm pretty much first-hand[1] that this is why pathology turn-around times in a major metropolitan Australian public health service are measured in hours, whilst in the UK they are measured in weeks.
[1] I am married to the medical director of this service.
>They will undoubtably receive worse care were the US to switch healthcare systems.
If the US switches to mostly single payer, but still allows for private insurance and private doctors to exist, the wealthy will probably have to pay more to access them, but they'll still be able to access them.
That is conjecture. I could similarly hypothesize that things would improve under a single payer system, even for the rich... because of the compounding scientific advances of government backed healthcare.
BUT we could go back and forth all day with conjecture... Give me some apples to apples numbers; that's what I joined HN for.
Indeed. One of the core ways single payer systems achieve such great results in terms of bang-for-buck is by not covering treatments that offer bad value for money, and this is almost certainly not politically viable in the US. For example, I understand the ACA specifically forbids assessing the cost-effectiveness of treatment based on dollars per QALY, which is how the NHS in the UK rations care to reduce costs.
It simply does not follow that, because single payer systems offer better value in terms of benefit gained for the dollars spent, those efficiency improvements mean it's possible for everyone to come out ahead. Those last few iotas of healthcare improvement are a lot more expensive than the lower-hanging fruit.
This is flat wrong mis-statement of both the facts and the outcomes.
The NHS does not assess cost-effectiveness of treatment in the UK in that fashion, and does not deny it on that basis.
Cost-effectiveness by QALY is one factor included in assessments by a separate body, NICE, which a) is not part of the NHS and b) does not inhibit NHS bodies from offering any particular treatment. If NICE gives a treatment option the green light, then the NHS trusts are obliged to offer it in applicable circumstances. If NICE does not, then individual (local) NHS trusts can make their own assessment. If there is a local cost constraint, that is considered as a matter of simple necessity.
It is a common falsehood often repeated by opponents of single-payer systems that doctors in such systems are directly prevented from offering treatments by faceless beancounters. It simply isn't so. Quite the opposite. The assessors may say "you must offer this treatment". They do not say "you must not".
However, QALY itself is IMO a terrible metric mainly because it is sufficiently describable to non-practitioners to become a political football.
Part of running an "efficient" healthcare system is that cost constraints are always a factor. Sure, NHS trusts are legally allowed to offer treatments that aren't approved by NICE, but they have piles of money lying around to do expensive things beyond the basics that are required of them at the best of time, and this isn't the best of times - like many countries the UK has a healthcare funding crisis right now.
At best, requiring a treatment rejected by NICE leaves your fate up to a postcode lottery where your location determines whether you have access to it. At worst, nowhere will cover it. Also, cost per QALY is one of the main factors NICE uses, and the ACA means it and similar measures cannot be used as any kind of factor at all in the US.
NICE was founded to reduce that postcode lottery by creating a base set of what is nationally achievable. Over time, that set grows. It's grossly unfair to misrepresent it as some kind of net-negative body, or to suggest that doctors won't treat a patient. Indeed one of the effects is to encourage research into more affordable treatments. This is in antithesis to the US system where, for example, the drug companies are incentivized to R&D long-term treatments for symptoms, not cures for diseases.
I like the incentives that NICE creates instead. Over time, it's a strong net national benefit.
The failure to include such a mechanism in the ACA seems more to do with US politics than any intrinsic characteristic of single-payer systems.
The NHS has apparently been under-funded for decades, far too long a period to call it a "crisis". I would maintain it is simply grossly inefficient at spending the money it does receive, due to horrible management. Again, this is not an intrinsic characteristic of such systems.
> ACA specifically forbids assessing the cost-effectiveness of treatment based on dollars per QALY, which is how the NHS in the UK rations care to reduce costs.
This.
And lets put it in concrete terms.
If you are 40 and get cancer you get treatment.
If you are 82 and get cancer you get pain meds.
And there is no US politician that is going to fall on that grenade.
It's still absurd to me that we make the false differentiation between taxes and insurance premiums. If you've got a family, neither is negotiable. If you have a job that pays, I promise you it affects your check in nearly identically the same way as payroll taxes do. There's a tradition in America where the price isn't actually the real price, we artificially advertise fake prices to get you in the door and stuff a bunch of surcharges on the back end. I wish we'd cut it out-- our taxes aren't crazy, but the way they're presented make people flip their shit.
Whenever I've visited the U.S. this drives me crazy. I always wonder how people shop for anything, given that the only time you find out the actual price of things is when you're about to pay for them. Do you just in your head have to tack on 10 to 20 percent (depending on the context)?
Basically yeah. I bought a car last month and I paid an extra... twenty percent before I walked out the door. Drives me nuts. That and fucking tipping, man. Enough already. Just put the price on the menu- I'm good for it, I swear.
Tipping is. Meh. If you're broke, don't do it. It's not compulsory/mandated by law. (There are states where waiters don't get compensated, if patrons don't tip enough, but you're still broke, so don't feel too bad.)
The problem with tipping is that it's spreading, as wages aren't keeping up with cost of living, but employers won't hand out raises. Uber driver? Tip. Sandwich shop? Tip. Coffee shop? Tip. Pizza delivery? Delivery fee plus tip. Have I been in drive-throughs with a tip jar? You better believe I have.
It's never going away, I don't think. Workers love getting extra money, and most food industry operations are barely staying alive as it is. I'm annoyed enough to whine, but I still tip.
>Do you just in your head have to tack on 10 to 20 percent (depending on the context)?
Yes - and I actually prefer shopping at places that don't use manipulative ($x.99) pricing or if they do, at least tax has already been included in the price (a local card shop does that). If something is $0.99 I should be able to buy it if I only have $1.00 with me, but after tax it comes out to $1.08. Infuriating.
I just tack 10% onto everything mentally, actual rate is 8.25% but 10% is easier to do mentally.
I imagine both single-payer and a truly free market health care system would be substantially cheaper than the current system -- which has none of the benefits of either approach.
With the federal government unable to act, turning healthcare back to the states to test a number of different solutions seems entirely reasonable. Let California try single-payer and Texas try something different -- after a few years see if we've found a solution that could work for the whole country.
The problem with a 'each state do their own thing' solution is the very problem with health care in this country in general - the freeloader problem.
If California implements a single payer system, it would make people in other states more likely to choose not to get healthcare; if they get sick, they can just move to California.
This is the reason the ACA has the 'individual mandate' to go along with preventing the denial of care because of pre-existing conditions - without some coercive force, there is no reason to buy health care until you get sick.
This is why a national single payer system is the solution.
I'm not convinced this is insurmountable. How do countries with single payer handle this?
Surely you could require an newly established resident who wants treatment to pay a portion since they hadn't been funding it directly via taxes, and then add a further penalty if they move back out of state within a certain period of time (to discourage moving in-state just for treatment).
Countries like Germany don't have this problem because they have the power to control their borders. Accessing Germany's healthcare system requires being a German resident. That, in general, requires applying for immigration, which the government may or may not grant. EU citizens can, of course, become German residents without applying for immigration, but every EU state has universal healthcare so there is no incentive to free-ride.
And there's a push within Germany and other countries to limit access to welfare benefits for new residents, even ones from other EU countries: https://www.theguardian.com/world/2016/oct/12/german-governm.... U.S. states don't have the power to do that.
The German benefits the article talks about are not health insurance (but rather things like welfare for unemployed). It is not considered a benefit, it is considered an insurance. In fact, health insurance laws make (apart from some edge cases) no difference based on nationality or type of residence. If you become a member of a health insurance fund (which you are required to if you work in Germany) you are fully covered from day one including pre-existing conditions. Plans to change that are not even on the horizon.
But you are of course right, it's not possible to simply move to Germany just to receive treatment under health insurance. To become member of a health fund you need to fulfil certain conditions, e.g. by starting employment. This applies even to German citizens moving from abroad.
This is a really good question. The most recent case I could find here is the one Rayiner cited, Saenz v. Roe. If you read it, both the opinion and the dissent grapple explicitly with college tuition.
The reasoning goes, it seems, that only bona fide citizens of (say) California will consume welfare in California (you don't move to California to consume California welfare benefits in Ohio). But college education benefits are "portable"; you could conceivably move to California solely for the purpose of accumulating the benefits of a UC education, then take it back with you to Ohio.
Further, the way in-state tuition benefits are structured, the residency requirement is (supposedly) carefully tailored to address just that scenario, by imposing relatively short durational requirements on residency, rather than evidence of permanent residency.
It's tricky to piece out how health care would fit into this rubric. Depending on the condition, you might move to California to benefit from their health care and return to Ohio when you're cured, or you might need to stay in California indefinitely to treat a manageable illness.
This is interesting; I wasn't aware of this particular ruling. That would make running a universal healthcare program on a state-by-state basis very difficult, if it in fact applied.
It isn't insurmountable, it basically comes down to having to choose to deny care to someone.
However, it is really hard to do it in a fair and humane way; to deny care to people trying to freeload but not deny care to people who aren't.
The whole point of universal, single payer, healthcare is to avoid having to make this determination.
This isn't an issue for a country because the number of new residents (immigrants) is not a large percentage of the total number of citizens. If it was a state, though, that ratio might not work out; there is a VERY large pool of possible 'freeloaders' who are legally allowed to move to the state whenever they want.
In Canada, generally you have to be a legal resident (i.e. hold a valid immigration status, not just limited to permanent resident or citizen) of the relevant province, and actually living there for a majority of the time, before being eligible for coverage under the province's health plan.
This problem is exactly why a single payer system would fail entirely, imagine if you could easily be a freeloader without having to move at all?
I don't think the US has the same demographics as the other countries where this currently appears to succeed. There are way more people who can't pay in the US, we're far too big for this.
If by "truly free market" you mean that healthy people can opt out of being insured, no, that would drive the costs up.
Risk selection is a very driver of prices in health insurance. If you can spread the risk between healthy and sick people, the price goes down. If you can't, the price goes up.
Secondly, having a population that has no health insurance means less prevention, i.e. worse health problems down the road, again driving the costs up
Spreading the price around more people isn't the only way for price to go down. If there were less supply side regulation of doctors than there would be more of them, and their time would be less expensive.
No the point of free market is that insurance is cheap enough that even healthy people buy it. Or even better, that healthcare costs are low enough that you don't even need insurance (that won't happen though because of the healthcare monopolies).
>Or even better, that healthcare costs are low enough that you don't even need insurance
See, this is what I don't get. I'm fairly inexperienced with this stuff, but it's starting to become relevant in my life. Despite my new employer offering insurance, I'm staying on my parents' until I'm 26 (this was part of their policy even before Obamacare).
However, this is the question I've been asking ... why do I even need health insurance? Why can't the money I pay in the form of premiums just be used to pay for my health care? The answer: well, it can be really expensive, so this way the cost is shared. But why is it expensive? Why don't I ask how much something is versus whether my insurance will cover it?
Again, like I said, I don't have a lot of experience, so go easy on me. But I think my questions are valid.
Part of health insurance is a bit like fire insurance on your house. There is a really small chance that your house will burn down next year (say 1 in 10,000) but if it does you'll lose a ton of money (say $500,000). So you pay $55 to get a year of fire insurance (500,000 / 10,000 = 50 + 5 in profit for the insurance company).
This is a great deal for you. $55 is no big deal and now if your house burns down you don't suffer a tremendous financial loss.
Similarly there is a really low chance you'll get cancer next year. But if you do it could cost a ton (millions of dollars possibly) to treat. So insurance is a good deal for this too.
Now, in the US 2 other things get lopped on to health insurance that make things a bit more complicated:
1) For a lot of people health insurance covers cheap and predictable expenses like an annual checkup. There are a lot of people that think using insurance for this is a bad idea. But some people think it's a good idea. It's complicated.
2) Health insurance (especially after Obamacare) can be a form of social insurance where healthy and/or rich people pay more than they otherwise would so that unhealthy and/or poor people pay less. This reduces economic inequality. There is a lot of political disagreement about whether this is a good idea.
Did this help? I've glossed over a ton of details but maybe it's enough to get started.
Don't forget babies. Child birth is expensive and the reason why young women had to pay more than young men pre-ACA.
Also, skipping your annual health check ups is bad for your insurance company in the long run, so this, at least, they have a huge incentive to make sure you go.
Most people are interested in health care and not health insurance, meaning, we know we are going to use the doctor for something...it isn't a big surprise when your wife gets pregnant (well...I mean...). It isn't a big surprise when you start breaking down toward the end of your life, which is why ~40% of our health care is already socialized via Medicare.
Ya, babies/pregnancy are (in my mind) a subset of my point #2. For those (and a few other) reasons women tended to pay more for health insurance then men so some people are in favor of a social insurance system to even that out.
Yes, quite helpful, thank you. "True" insurance (car, fire, flood, etc.) makes sense to me, but health insurance is much more complicated. I guess it's point 1 that never made a lot of sense to me. So, I suppose you can put me in the group that considers it a bad idea to use insurance for such purposes.
It's worth noting that #1 and #2 from my list can get kind of mixed together. If you're poor enough maybe an annual doctors checkup is a big expense for you. So maybe government subsidized health insurance should just cover it for you so that small health problems get taken care of before they turn into big problems(1). And once you're bundling this stuff in for poorer people you might as well just bundle it in for everyone.
I'm mostly with you in that I don't necessarily think this is a great idea, but that's the general thinking.
1. Though there is less evidence than you might think that this actually works.
Why do you imagine it wouldn't!? The portions of health care universally not covered by insurance are not subject to the same cost disease of the industry as a whole. Lo and behold, the real cost of eg. breast augmentation is declining (total cost of about 4K)! The cost of lasik has decreased ~50% over the last 15 years, current results are better, and the surgery has the highest rating of patient satisfaction in the entire industry! A similar result anywhere else in medicine in the US is completely unimaginable.
> Regardless... You must also then ask the question, whether a "truly free market health care system" would be ethical.
Nonsense. The important question is: 'would a "truly free market health care system" be more ethical than the current system'.
Elective procedures work well in a free market system. That is not surprising at all, nor is it incredibly meaningful when trying to look at the health care industry as a whole.
> Nonsense. The important question is: 'would a "truly free market health care system" be more ethical than the current system'.
If you want to be overly semantic, which you clearly do, that's actually not "the important question" since it actually tells you less than my original question. You care about "a truly free market health care system's" relative ethicality not just in relation to the current system, but also in relation to (all) other potential alternative health care system (like a single payer system)...
> Elective procedures work well in a free market system.
Dental work is only semi-elective, and prices are driven down thanks to transparent pricing.
Likewise, one can argue that vision services are also non-elective (e.g. people need to see), and prices go through a very large range.
Many medical conditions are not "emergencies". And even so, I often get referrals from my doctor to external imaging services. If those prices were transparent, I imagine a downwards pressure on prices would happen quite quickly.
To give an example, ultrasounds for pregnancies cost ~$250, ultrasounds for almost anything else are 50% to 100% higher in price. In a similar vein, x-rays at the dentist are next to nothing (despite involving a cool robot that rotates around my head, and a digital x-ray sensor that lets me look at images right away!), x-rays for anything else can end up in the hundreds.
Hospitals would also benefit from transparent pricing, if there was a legal mandate that all suppliers be open and honest, prices would drop for everyone. When a hospital sees that other hospitals in the area can offer the same service at a lower cost, meeting the same quality standards, then they can start pushing their vendors to lower prices.
>Why do you imagine it wouldn't!? The portions of health care universally not covered by insurance are not subject to the same cost disease of the industry as a whole. Lo and behold, the real cost of eg. breast augmentation is declining (total cost of about 4K)! The cost of lasik has decreased ~50% over the last 15 years, current results are better, and the surgery has the highest rating of patient satisfaction in the entire industry! A similar result anywhere else in medicine in the US is completely unimaginable.
In addition to not being covered by insurance those procedures are all elective. For elective procedures a free market is more likely to produce better results.
There is no way to make money insuring or treating poor, sick patients. The free market just can't do it.
The inherent problem here is that the math behind traditional free market economics breaks down when it comes to life saving goods and services. There is no equilibrium to be had, because of a combination of issues.
First the answer to how much will you pay to access this live saving drug is "anything" for 99% of the population. Second, life saving services are time sensitive--customers often can't choose a different supplier except the closest one. Third patent law ensures that there often isn't an alternative supplier.
It's a fun thought experiment, but we'd never do it.
A free market would look something like this:
1) everybody buys their own insurance in a genuinely free marketplace (this is ENTIRELY not the case now and would probably require significant gov intervention to defeat cartel-seeking behavior from insurance co's. There are good reasons insurance is so highly regulated, only the first of which is that insurance companies are highly incentivized to not pay out since they already have your money, and you can't go elsewhere with your claim.)
Point two would be a hell of an incentive to get insurance, by the by. Beats the hell out of some candy-ass tax penalty. "Young invincible bet wrong, got caught in some freak skateboarding accident? Sucks to be you. You an organ donor by any chance?"
> Point two would be a hell of an incentive to get insurance, by the by. Beats the hell out of some candy-ass tax penalty. "Young invincible bet wrong, got caught in some freak skateboarding accident? Sucks to be you. You an organ donor by any chance?"
It wasn't before, so it probably wouldn't serve as one in the future. The issue is that people aren't very good at estimating risk.
I'm young, healthy, and no one in my family has been in a serious car accident/gotten cancer/had a heart attack in the last 15 years. Obviously that happening is a low risk compared to the financial penalty of maintaining insurance today, so why should I worry? Besides, I'm sure I can get some kind of plan from an insurance company if something bad does happen[1]
[1] I'll be sure to look into the feasibility of this statement as soon as I finish all the other important things on my todo list...
Oh yeah, I don't mean it'd work, I think healthcare neatly falls in the category of collective action problems that are poor fits for the capitalistic profit motive. A lot of people would suffer and die unnecessarily. And in a democracy, enough people would be incentivized to vote for exception after exception to destroy any semblance of market competition. Old people are very very good at two things: getting sick and voting. The pathological dysfunction of American healthcare is pretty much inevitable if you try to stuff for-profit healthcare into a democracy.
I'm really not a socialist, I promise. I just don't see how you'd do it any other better, and it's pretty clear to me that the results are definitively in for our free market experiment.
It's funny how we all pretty much agree the govt should be in charge of stuff like roads, schools, military, police, fire dept, courts, quite a long list of stuff, but adding anything to that is marketed as creeping socialism.
In that case, why would the person choose to do skateboarding? Also, does the individual has any family / friend / church support? If you have no family, no friend, not involved in any community, why do you risk yourself for fun? Because "the society" have to pay for your stupidity?
States or the feds could offer re-insurance for your primary insurance provider. That removes the incentive to not pay out, since astronomical risk moves into a larger pool (either the entire state or the entire US).
Lotta people talk about charity as a replacement for government services, but folks give around 3% of their income to charity (tax deductible) in the US. That ain't gonna get it done. Not even close.
People would have you believe they would give more if they didn't pay as much in taxes, but there is not one shred of evidence that is the case based on variations in local tax rates. And that's a hell of a gap to bridge based on a such a dubious promise.
Occam's razor, and the available evidence, suggests that people would just pocket the difference and the poor can go to hell. They're happy to argue the point until they're blue in the face, but if the past year has taught us nothing at all, it's that people are more than capable of crafting any number of passionate arguments around their self-interest, truth be damned.
And so we should put government in control of health care. But who runs government? Oh, it's people, who you just argued are all hopelessly greedy and self-centered.
It's not as if we don't have experimental data on both the ability to run a government that is more or less functional with a bunch of self-interested actors in general, or the relative merits of the free market vs socialized healthcare in specific. We ran the numbers. It isn't working. The arguments around doubling down on the free market I find intellectually spurious, and the most convenient explanation from my perspective is the fact that we are thus far wealthy and powerful enough to afford the application of a one-size-fits-all ideology to avoid the emotional strain of admitting we were wrong all these years.
Which would mark the second time in 241 years those states agreed upon something...
In all seriousness, state run healthcare is a great idea, but the government is just such a big stakeholder in having a healthy population that I do not see a good reason for it [at some level] to stay out of that line of business. Single payer works, so much better than the current setup...why not start there and try iterate?
That would all be fine and dandy if it weren't for that pesky 200yr old document that explicitly denies the federal government the right to micromanage except in very specific circumstances.
sure, so like i said...use the state government. The point i was trying to make is basically this: as a government [local, state, fed...you pick] my interest would be in having a productive and happy workforce. One of the best tools i have to influnce that would be healthcare...hence, i see no outcome where the government [again - local, state, fed...whatever] should probably be involved in that.
ORRRRR....you do what you've done 27 times before, and you amend the 200 yr old document :) We all make mistakes, sometimes the best option is to own up to them and do something different.
That would require both ideological sides to agree on objectives, agree on what counts as successful, agree on metrics. Something I doubt will ever happen at this point.
Isn't the objective for both sides to provide affordable healthcare? I think they agree on the objectives, the means of getting there are where the disagreement comes from.
> Who's not receiving healthcare right now that would be ultimately saved by the government?
People not receiving basic preventative care with problems that are only going to snowball until emergency services can try to treat a much more complex situation in the future?
> Secondly let's cut the hyperbole and have a rational conversation about this.
You could have maybe had a point by quoting "but the market will win", but "Americans will die needless deaths from not receiving basic healthcare" is literally what's at stake. What exactly do you think the downsides of people not being able to afford healthcare are?
One is happening right now, the other has a ton of evidence in every other developed country that the downsides are workable.
Yes it will be complicated, and yes, even if healthcare is guaranteed to all, profit motive is still an important driver for efficiency and innovation.
All of that, but it's still irrelevant to your dismissal of actual deaths due to our healthcare system as "appeal to emotion nonsense".
Making an emotional appeal is not inherently nonsense, so you will have to provide a little more of an argument as to why it's not a valid point to make.
The federal government already pays for 64.3% of healthcare costs http://www.pnhp.org/news/2016/january/government-funds-nearl.... In a centralized managed system this would likely cover the cost of all healthcare. It's roughly what other industrialized nations pay, per person, for single-payer.
This is what I don't understand. The feds are paying a bunch of money via Medicare/Medicaid/VA but clearly aren't covering everyone. What is the mechanism whereby more people are covered but no additional funds are required? Yes, there's some profit in private insurance companies, but it's not _that_ much.
Let's say I'm in the business of selling normal goods (say, backpacks). Now, instead of just people going to my website or looking at crowdsourced backpack reviews, there's some cartel that has figured out how to dominate search engines and other sources so that almost all the customers see their middle-man stuff and buy through them instead of directly (even more extreme, maybe they spend massively on lobbying to achieve real rent-seeking via outlawing direct purchases by consumers, although that's not necessary for my argument).
These middle-men charge much higher prices than we'd see if everyone bought directly. But dominating the search-engines while the algorithms constantly change is ENORMOUS work, so these cartel companies pay almost all their revenue to a huge number of employees who work constantly to update their systems and maintain their middle-man dominance. You could say they "barely make a profit!"
So, in that scenario above, it's painfully obvious that the system is horribly wasteful and all-around negative for the economy aside from all the bullshit work of the cartel employees directly providing them income. The room for efficiency improvements are, in this case, nearly the entire REVENUE of the middle-men, minus only the costs of the goods themselves, not just their profits!!
Insurance companies do TONS of bullshit economic waste that is both necessary to the system as it is today yet unnecessary in a single-payer system. All of that waste is NOT profit but IS available margin for efficiency improvements.
But really, insurers are just one aspect. There's also total craziness in the core pricing that providers set and lots of other complete insanity in the status quo.
P.S. the middle-man issues described above are potential market-failures for any market system and just one of many reasons that dogmatic "free market" ideology is bullshit. That said, there's cases where actions to fix market failures only make things worse. Recognizing that free-market dogma is bullshit does NOT mean the opposing dogma is correct.
Our current system is seriously inefficient. Look at how much we spend compared to similar industrialized countries that have single-payer systems. These numbers include the ~13% of the population that didn't have health insurance at the time this chart was created. So we currently pay roughly twice as much to cover 87% of our population. If we had a system similar to Germany we could do it with $600/capita/year in private money added. I would gladly split an additional $50/month in healthcare costs with my employer.
> One is that administrative costs average only about 2 percent of total expenses under a single-payer program like Medicare, less than one-sixth the corresponding percentage for many private insurers.
Anti-fraud enforcement is a tiny nit compared to the overall poor performance of US healthcare compared to other single payer nations. We pay roughly double per capita, cover fewer people (which means the people who do pay in our system are paying more than double), and have lagging health measures such as life expectancy and infant mortality rates (2-3x higher in the US!).
Anti-fraud measures can be evaluated for cost-benefit in isolation, but when the fundamental cost structures are so completely out of whack then we should prioritize discussion of the fundamental problems - which is lack of single payer universal healthcare in America.
"The researchers compared data on infant health and mortality in the U.S.; Austria, whose rate of 3.8 is roughly average among European nations; and Finland, whose rate of 2.3 is one of the lowest in the world. One of the biggest differences, they found, was in the definition of what could be considered a live birth. “Extremely preterm births recorded in some places may be considered a miscarriage or still birth in other countries,” they wrote. Although the chance of survival for babies born before 23 weeks is low (the American Academy of Pediatrics recommends that doctors don’t resuscitate babies born before that point), they’re recorded as live births in the U.S."
This is often brought up, so show the corrected or aggregate miscarraige and mortality numbers to get some point of comparison. Leaving it just open seems incomplete...
Edit: Absent more aggregated numbers, it looks like Canada records similar to the US, while also having some similar issues with a higher pre-term birth rate, and US rate is still 50% higher than Canadas.
They do discuss the adjusted data a few paragraphs down:
"This difference in reporting, they found, accounted for around 40 percent of the U.S.’s relatively high rate compared to Austria and Finland, a result supported by the CDC report—when analysts excluded babies born before 24 weeks, the number of U.S. deaths dropped to 4.2 per 1,000 live births.
...
When the researchers broke the statistics down by age, they discovered that neonatal deaths were actually less frequent in the U.S. than in Austria and Finland."
Good find, but aren't neonatal deaths are a subpopulation of the overall infant mortality stats, so there is unfortunately, still no clarity. Canada it was noted had similar pre-term birth rate as America (and presumeably higher than Austria and Finland).
It's like a grim logic puzzle where one gets a pile of facts and try to discern the answer.
Country A has higher infant mortality rate than country B.
Country A has higher preterm birth rate than country C.
Country B has a higher neonatal death rate than country A.
etc..
Which is why those companies hire entire departments dedicated to fraud. If a government agency stepped in and instead offered to do fraud investigation for free, that would provide a rather nice reduction to their overhead costs.
Switching to a single payer would reduce fraud. Because simplified rules are easier to adult. A cynic might even say the USA's healthcare system is purpose built to maxmize fraud.
Here's the other thing about administrative costs: Medicare's patients cost a lot more per person than private insurance.
In other words, if it costs you $500 in administration costs and one patient has care that totals $5,000 and another has care that totals $10,000, then their administrative costs are 10% and 20%.
And yet we think that if we shifted more people onto a Medicare-like system, we'd save money.
Medicare patients are more expensive because of who it currently covers: elderly and disabled people, two groups that use more services than the general population. The whole point of a single payer AKA Medicare for all system is to cover the entire population, which would (because math) bring down the average cost per person.
I've always read that the problem with Medicare is that it's unfair to hospitals because they pay lower than the average rate (but can't negotiate on medicine). Do the savings from lower care costs not balance out the higher drug costs? (From a steady state of 1 surgery can lead to a lifetime of drugs, I'd guess the balance isn't great)
Medicare is also currently prevented by law from negotiating for drug prices. If we shift more people onto Medicare, we need to fix that problem too. The overall structure of a single payer/administrator is most likely to save money, but we need to be vigilant about the specific rules it is imposed with too.
Further it is not a good argument by itself. One could imagine a program with no administrative overhead that because of that lack of administration ended up costing far more than a program with higher administrative overhead. I'm not saying that's the case here, but the argument needs to be made that it isn't.
> The most important source of cost savings under single-payer is that large government entities are able to negotiate much more favorable terms with service providers.
If there are no other options for clients, it's essentially the government telling doctors how much their services are worth.
Living in what is essentially a single-payer health care system (Norway), I assure you we don't see many MDs sleeping in cardboard boxes under freeway overpasses.
On a more serious note - education and skills tend to pay off.
Around here, doctors with their own practice are reimbursed by the state via several mechanisms, the two most significant ones are probably a fixed sum for each patient they are responsible for (they get this regardless of whether the patient sees them or not) and a fixed sum for each treatment, prescription filled &c.
Anecdotally, an MD with his own practice earns approx. $100k-$150k annually before taxes; this is 2-2,5 times the national average. (Very roughly speaking, but in the right ballpark)
I said that the government would be dictating what a doctor's time and efforts would be worth instead of letting it figure itself out without any artificial restrictions
University tuition is free (well, tax-funded, to be precise) - so students typically take out a student loan of approx. $1k/month to cover living expenses. A lot (most?) work part-time on the side to make ends meet.
Part of this loan (methinks ~30%) is converted into a scholarship once you pass your exams, thus leaving you (very roughly) $50,000 in debt after six years in med school.)
Oh, you didn't - and I hope my flippant comment didn't mislead anyone into thinking you did.
There's already so many factors distorting the health care market that it is imho hardly an argument against single payer that doctors would have to negotiate compensation against a powerful customer. (It would, after all, at the same time remove a number of other distortions from the mix - while unlikely to leave doctors in the gutter in the process.)
External circumstances change in a lot of professions all the time; for instance, I do not expect the government to help me out (working in the petroleum industry) now that oil prices are more than halved from their peak - that's life. Better adjust to it.
It's not just doctors, its drug and health insurance companies, etc... but really? Is the argument is that we as a nation should pay double what other modern nations pay so doctors can be well paid?
Edit: Here's a deal, lets pay for doctor's educations, implement universal healthcare and call it even.
Is it that the USA is paying more than we should? Or is it that other nations are paying less than they should?
Also, doctors aren't the only thing we should be talking about. That's probably the easiest subject to think about.
It's much, much more difficult to talk about drug and device prices. Should the government dictate how much a new drug or device costs? What are the risks and downsides of doing that?
The risk is that compared to single payer universal health care in other nations, thousands of people die in the US who aren't covered or poorly covered due to their inability to pay for their health care. Millions probably endure worse health than necessary with cost discouragements to getting the care they already pay to carry as insurance. Should profit margins dictate how much a new drug or medical device costs?
No, if we're implementing universal healthcare, they're negotiating in a labor market which has decided to collectively bargain for the purchase of services.
Consider it the physcians version of labor globalization. Or workers labor negotiations vs ever larger corporations. Only this time its for a public good.
Yes, it's a euphemism for price controls. Which may or may not be a no-go depending on your political bent.
Another issue here is termination shock - if a provider comes up under the current system, getting into massive student debt in anticipation of a highly remunerative medical career, how will price controls effect him?
By my back of the envelope account it might cost about $36 Billion to forgive the student debt (say $200k average) of a fifth (early career) of all physicians in the US (28 patient care docs per 10,000)
This doesn't stop lobbyists and special interests from moving the goalposts for how much a thing is worth or whether a new procedure should be covered. It does solve a medical office having to hire X administrators to cover his own health care just to negotiate with all of the insurance providers so they can get paid at all.
To me what we have already doesn't feel like a market. It's not like I feel doctors are being paid net/15 and that is why they get a discount. Or that they invest in their health care networks so costs are reduced for them in the long run. Insurance company hedges their bets so that they have the money to pay, but then when you get to a certain age you are chucked to the curb and then society has to pay for it. I just don't see where insurance companies are being fantastic middlemen or support networks for medical professionals or linking those who need care and appropriate medical professionals and producing value above and beyond what a single-payer system provides elsewhere. They just seem to complicate the costs significantly and do not create a market where resources feel distributed efficiently.
To me the biggest weirdness of health insurance is why they are a for-profit industry or largely for profit in the non-competing model they have right now. I want the employees of a insurance company to be smart, paid well and distribute all the resources in a smart way, but instead the goal is making money. If the market was competitive like it is for car insurance and other insurances that is fine because there are actual competitors but the whole equation doesn't work because most individuals making health insurance purchasing decisions have effectively the same amount of choice as whether or not you have Comcast.
> "The most important source of cost savings under single-payer is that large government entities are able to negotiate much more favorable terms with service providers. In 2012, for example, the average cost of coronary bypass surgery was more than $73,000 in the United States but less than $23,000 in France."
A more useful comparison would be the average cost of coronary bypass surgery for someone with a employer-provided health plan versus the cost that Medicare, Medicaid, or the VA pays. And then compare the average wait times of each along with recovery time/effectiveness.
I feel like the numbers they picked are intentionally misleading. Is the $73,000 the cost for no insurance or with insurance? I know it says average, but average out of which group?
Yes, a single-payer system would save money, but you have to be honest about the downsides. It's unfortunate that they are not honestly discussed in the article. Or, for that matter, almost anywhere.
The vast majority of the savings come from government price fixing. This is what the article means by "large government entities are able to negotiate much more favorable terms with service providers." It's not really a negotiation; at least not like it is in the private sector. When the government controls an entire market, they set prices. They can (and should) take input from providers and drug/device developers, but at the end of the day, whatever they say goes.
There are incredible risks when the government sets prices for a good/service. We should not take on those risks lightly.
Pricing in health care is currently not a negotiation. The customer often doesn't know the price before services are rendered -- they're left to negotiate the bill after the fact. And in the case of life-saving care like chemotherapy, your choice is "pay or die". That's not a negotiation; that's an ultimatum.
You rip NYT for not openly discussing the downsides, yet after reading your comment about the 'risks', you haven't talked about the downsides either.
Aside from "negotiation is not negotiation in the private sector", you aren't adding much to the discussion. Yes, government negotiation is still negotiation and yes it is not like in the private sector but it doesn't make it any less legitimate.
I'm not really an expert at all either when it comes to healthcare or economics. I feel not particularly qualified to get into the downsides. I'm just a regular person trying to understand the debate and take an informed position. That said, I'll try and take a stab at answering your comment in an honest way.
> Yes, government negotiation is still negotiation and yes it is not like in the private sector but it doesn't make it any less legitimate.
When the government owns an entire industry (as is being proposed in this case with the health insurance industry) I'm not sure if there is any meaningful difference between the sentences, "the government will set a price" and "the government will negotiate a price with providers."
We are talking about price controls as a means of lowering prices. It seems to be about that simple.
I'm a bit confused by what you mean when you say that when the government does it, "it doesn't make it any less legitimate." I'm not arguing about it would be illegitimate or unlawful of the government to set prices. I am, however, suggesting that there are known negative consequences of government price controls.
The general criticism of price controls, as I understand it, is that when the government sets prices too low, it causes shortages. Applied to healthcare, I would imagine that we risk slower development of new drugs and devices, lower quality service from doctors and nurses, and shortages of drugs and devices.
One of the risks is that the doctors and nurses you need to actually provide the healthcare will find work elsewhere that actually pays them well. This seems to be happening to a certain extent in the UK right now.
Suppose the current price for "two tylenol handed to a patient in a paper cup" is $50, and a giant insurer^W^W EVIL GOVERNMENT says it will only pay $40 next year. What do you suppose will happen? Societal collapse?
I suppose the hospital will lay off a pharmacist, increasing the workload for the rest of the pharmacy team, and instead of your Tylenol showing up in 15 min it will show up in 45 min.
The article makes the assumption that the goal is to save money. Perhaps the way things are keeps the status-quo alive for those who make the rules, and that's why we don't have single payer.
I hate to be the conspiracy theorist, but I can't help but think that's the truth.
Anytime one person saves money, it is also costing someone else money (the person or people that money was going to). Saving money on healthcare will cost money for people who are currently making money from the excessive costs of healthcare.
This is not a secret, and not really a conspiracy; the groups that make money from the current system are always the ones opposed to change. It just sucks because there aren't nearly as many of them as the rest of us, but they just have more to lose than the rest of us have to gain - a classic example of concentrated benefits and diffuse costs.
While conversion single-payer would result in health insurance employees/employers being temporary "losers" it is absolutely not true that one person saving money costs someone else money. Improved productivity saves money yet frequently results in increased wealth for all parties involved and has historically been the prime driver for economic growth.
But the 'rest of us' can only gain for as long as those people stick around to pay for it. There is a lot of wealth in this country, for now. If you wanna really see things go down hill then watch the wealth scramble out of the country as soon as we tell them they're going to have to fund the healthcare of everyone else.
I was talking about people making money off of the health care industry, not wealthy people in general. We aren't asking them to fund the healthcare of everyone else, just not make profit off of waste.
Also, scramble out of the country.... where? There are very few places they can 'run off to' that don't already have a single payer health care system. People don't seem to be 'fleeing' those countries.
Those countries have way less population who can't contribute. The US is huge, there's so many more people who need healthcare but don't pay any taxes.
Why would the absolute number of people who don't pay taxes matter? Wouldn't it be more about the percentage of people? It is not easier for 100 people to support 1 than 1000 to support 10...
> "Of course, having to pay taxes is itself a mandate of a sort, but it’s one the electorate has largely come to terms with."
Some taxes maybe? The whole "mandate vs. tax" argument was at the core of the opposition to the Affordable Care Act. I would argue that this issue is not decided by a long shot and a great deal of people are still upset by this.
Further, this article addresses aggregate costs but doesn't acknowledge that costs of the change to single payer will impact people in much different ways. Some folks will be asked to pay a lot MORE, and some will be asked to pay LESS, and it may settle out to be cheaper in aggregate, but cheaper to whom? These impacts (especially felt in the short term) need to be considered and mitigated.
Certainly, the legal issue of a tax vs. a mandate is decided, but Americans' comfort with this tax to cover other Americans as a matter of preference is not.
Agency costs. Fools (& idealistic Americans) be thinking of "administrative costs" as able to be managed like the phone center that books your appointment, mail shop that sends your test results or janitors that clean the floor. Yes, these kinds of costs are basically in proportion to medical services provided, and yes, economies of scale apply. But if you have worked for a giant corporation or government, you might understand the danger of agency costs: not only can't be controlled, but in time, you get a worse product. Sad!
No, there's no perfect solution, but there must be a balance of market forces and semi-trustworthy regulators to make it work.
I would like to understand better what is meant by "single payer". I think I know what it should mean, but then I see France as an example of single-payer system. France has a complex system of insurance bodies (public entities, privates companies, some weird stuff in between)...
If I understand correctly the biggest savings come from the mandatory nature of the coverage - everybody is covered at least partially by the State, + employees by their employers, + private offers for the others + universal coverage for immigrants and the most destitute. Risk is shared between the healthy and sick people, and prevention can be maximized.
In France when you work you have to pay a percentage of your salary for the national healthcare to cover you and your family. This national healthcare reimburse you about 60 to 80% of the bills depending on the type of treatment. The remainder is paid by a private healthcare that your employer is chosing and paying for you. The difference between the many private healthcare is usually the amount reimbursed for dental treatment and eyeglasses.
If you have no work, there is an universal healthcare to cover you, but you cannot get fancy glasses or good tooth implant.
The prices are regulated by deciding the amount reimbursed by the national healthcare for each medical act. The private healthcare reimbursement are based on these prices. Doctors are free to ask more money, but you are going to pay the delta.
Savings are mainly achieved by having both sick and healthy people paying. Also, the fact that any medical treatment is basically free encourages you to see your doctor everytime you are beginning to be sick, preventing complications leading to a stay in hospital.
Note also that many private healthcare are mutual insurance which are lowering the rates if there is a profit.
When I see it in the NYTimes, I assume it means that the health care fairy pays for it. As you've noted, very few people are wonky enough to be able to discern any difference between the systems in the UK, France, Germany, and Switzerland. Instead, they're all lumped into "European single payer" regardless of the level of truth or correctness.
Germany has both private and public krankenkasse-s (sick people funds, so healthcare insurance providers).
The UK has NHS, a big public insurance system.
And so on.
The economics are pretty well understood, so like climate change, it's not 100%, because it's big and complex as fuck, but a lot more certain, than a 50-50 coin flip.
Of course people will have to still pay. The question is, what's the fair amount to ask from people. And it seems a progressive healthcare tax would be fair.
I find it hilarious that this article uses state government taking over road maintenance as an analogy and claim it will save money, while it's known that California has a bad reputation in road repair, due to funding problem.
Yeah plus what a terrible analogy. The road is shared equally by everyone for the most part, my car tools along in a single lane. However if I smoke cigarettes and get cancer or eat myself into heart disease, this still doesn't cost any more for the road. It's something that can be mostly shared in a fair way. Healthcare cannot be shared in a fair way.
Plus if I don't play well with others the government will take away my license so I can't drive anymore. I don't want the government standing between me and healthcare in any sense of the term. If they are the ones in charge of a limited resource that means they are also the ones that have to say 'no' when there isn't enough to go around.
>“I think the missing element in this is Republican votes and identified Republican support,” said Brian Kelly, secretary of the California State Transportation Agency.
>California’s reliance on gas taxes to repair its transportation network is becoming less and less tenable. Increased fuel economy standards have led to less spending on gasoline
Why stop at saying it's a funding problem? (Allegedly) Obstructionist Republicans won't allow the government to react to changing conditions to update laws needed to fix the funding problem.
Hey man, I'm just repeating what the article said. If the article is wrong go after the poster. They included an article link in their argument that it was a funding problem, and the article doesn't say that.
> It thus makes no sense to reject single-payer on the grounds that it would require higher tax revenues. That’s true, of course, but it’s an irrelevant objection.
> The most important source of cost savings under single-payer is that large government entities are able to negotiate much more favorable terms with service providers.
I agree these objections are not relevant for the overall system. But certain individuals and groups within the current system will get screwed.
The wealthy and upper middle-class will oppose any tax increases, as it will decrease their take-home income. Plus the resentment of having to pay for someone else (the moochers).
Providers will oppose any haircut that comes with single-payer rates and price controls. No more millionaire doctors, specialists, or dentists.
And of course the overhead of health insurance middle-men and the huge administrative bureaucracy costs.
This is the crux of the problem. We could have a reasonably good system for everyone. But it requires a lot of people with heavily vested interests into a less ideal situation.
Yeah, and we ban people from public roads for bad behavior. Will we ban people from public healthcare for bad health choices? Do we really want to give the government that kind of exclusive control over a service while giving up control of our bodies?
Smokers typically exhibit compressed mortality. Yes, they die younger than non-smokers, and yes, they have health issues. But the health issues are typically of the sort that get deadly in short order and so actually save money.
"An underappreciated advantage of the single-payer approach is that it sidesteps the mandate objection by paying to cover everyone out of tax revenue.
Of course, having to pay taxes is itself a mandate of a sort, but it’s one the electorate has largely come to terms with. Apart from fringe groups that denounce all taxation as theft, most people understand that our entire system would collapse if tax payments were purely voluntary."
Seriously? This is the argumentation from someone that has absolutely no idea what the other side is thinking.
What is more likely, insurance companies beat more than 50% more care per dollar out of doctors/hospitals etc, or people would be better of getting rid of the giant middleman? Insurance companies don't heal you. Medicine does. Get rid of the 33% overhead of insurance and gain the free 50% extra money for healthcare. Then all the people in that industry can move on to better gainful employment.
The government (county, state, or federal) pays for infrastructure, safety, defense, (public) schools, and a lot of other things. All out of tax revenue. With the help of _private_ contractors. Through a bidding process for contracts and work - thereby getting the lowest price (even if not necessarily value).
It blows my mind that health is treated differently. It seems to me a lot of middle-America mistakenly assumes it's socialist, which single provider is. Single-payer is similar to most systems we already enjoy. It's the only way prices will come down. You need negotiating leverage and a single-payer system that a majority of your population uses is the only way to have that kind of leverage over drug companies and healthcare providers.
Single payer universal healthcare with more expensive private plans (for those who can afford) is the only system that can come close to fixing the broken healthcare system in this country.
I personally think Medicare for all could potentially be a good system. But this article doesn't make a good argument at all.
> Voters need to understand that this cost objection is specious. That’s because, as experience in many countries has demonstrated, the total cost of providing health coverage under the single-payer approach is actually substantially lower than under the current system in the United States.
Not a valid comparison. They literally give examples of three liberal states where there were cost concerns. And the response? It is not to compare to states where single payer actually worked, bit compare it to different countries with widely different budgets and levels of centralization from medical research, medical school to employment of doctors. Just not a valid comparison at all.
> It is a bedrock economic principle that if we can find a way to do something more efficiently, it’s possible for everyone to come out ahead.
Useless fluff statement
> By analogy, suppose that your state’s government took over road maintenance from the county governments within it, in the process reducing total maintenance costs by 30 percent. Your state taxes would obviously have to go up under this arrangement
How is this an "obvious " point? Need some justification for this very important point !
Hence this statement doesn't follow as the premise is not established
> Likewise, it makes no sense to oppose single-payer on the grounds that it would require additional tax revenue.
.
> One is that administrative costs average only about 2 percent of total expenses under a single-payer program like Medicare, less than one-sixth the corresponding percentage for many private insurers. Single-payer systems also spend virtually nothing on competitive advertising, which can account for more than 15 percent of total expenses for private insurers.
Finally, some relevant fact and justified points. These are good points in favor of single payer.
> The most important source of cost savings under single-payer is that large government entities are able to negotiate much more favorable terms with service providers
Ah this is infuriating. The link compares USA to other countries. Why not given evidence of Medicare compared to private insurers? That would be such a strong point in favor of Medicare. I just don't think you can compare the entirety of the American healthcare system to other countries without controlling for the wide disparity in the systems as mentioned above.
> In 2012, for example, the average cost of coronary bypass surgery was more than $73,000 in the United States but less than $23,000 in France
Sad reality but again this comparison is meaningless without controlling. Why not compare states with single payer with states that don't have it? Or why not compare Medicare bypass surgeries with those of private? If none of those support the argument for single payer, then at least control for the variables when comparing countries... Otherwise the comparison is just lazy (or worse, just narrative building ).
> In short, the evidence is clear that single-payer delivers quality care at significantly lower cost than the current American hybrid system. It thus makes no sense to reject single-payer on the grounds that it would require higher tax revenues. That’s true, of course, but it’s an irrelevant objection.
I agree with this point, I am willing to take a higher tax hit to support single payer but the tax question is not an irrelevant object at all!
Anyway, sorry if I sound bitter. I really want to see the US have a robust single payer system that respects it's ability to innovate with drugs and provide great healthcare to everyone. I just hope defenders of single payer (especially economics professors like the author ) can build a better case for it. I hope.
> Ah this is infuriating. The link compares USA to other countries. Why not given evidence of Medicare compared to private insurers?
If Medicare covered the same set of people as private insurers it might be a good comparison. However in the U.S. Medicare currently covers certain groups (elderly, disabled) that have very different profiles from most private insurance customers.
I'm still wondering if it's possible to little by little add single-payer. If we could agree for basic 6-month checks at a doctor for preventive heads-up, basic immunizations, a single child delivery, and potentially a few other things; I wonder whom would get on-board. If at least very basic healthcare is guaranteed, why couldn't we as a nation at least provide that?
Interested to see what someone more knowledgable would say is wrong with trying that.
I'd like to see more about how that "negotiation" over costs would work. Would it be like retail suppliers negotiating with Walmart? Or like military suppliers negotiating with the Pentagon?
There's also the tough questions, such as who gets access to the best doctors, at the best hospitals?
A big part of this to is drs in places like Canada get training on how to save costs which generally means not providing service. I had to switch to a private system in Canada to get drs who would take a proactive approach.
Oftentimes, not providing any service is better for patient outcomes then providing unnecessary services. Especially if those services are surgeries. [1]
Not sure why the downvote there is a lot of truth in his statement. Everyone gets access to healthcare on one end which is good but on the other end newer meds are denied because of costs. On average doctors are trying to reduce the number of patients they serve so there is always a feeling like they are doing you a favor by even seeing you. Other little things you don't expect like it's very hard to get a second opinion.
I have no idea how life is when you rely on an insurance company to approve of your level of care. That sounds like a nightmare.
Wish there was something in the middle where you paid a little bit but had choice.
Cost saving measures can also result in better care. We use Kaiser Permanente, and they often use nurse practitioners and physicians assistants to initially screen patients. It may sound like that's a lower level of care than seeing an MD, but in practice, it's much easier to be seen by someone quickly, and every single one of the providers we've seen has been excellent.
Another point: health care outcomes are better in Canada. There may be more than just health care working there (ie, lower obesity), but it's worth noting.
It's also worth noting that more than a few Canadians come to the United States for treatment because they can either get treatment faster, or they can get treatments that aren't available in Canada.
What are the odds they're traveling to the same hospitals that Americans travel to when they're seriously ill? I doubt that Canadians are hopping the border to go to Montana's hospital system - they're more likely going to the Cleveland Clinic just like someone from Texas would.
because they found cancer and removed it, in addition to doing things like ordering tests, like ultrasounds to find out why a shoulder was in pain instead of just dismissing it.
Once my mother in law was given nitro and told to come back in a week, we went to a different hospital later that night after symptoms reappeared and then they did a test and she had open heart surgery that night.
Yea, I am all for more government cost controls, and maybe a public option for a more tiered system. But it seems like universal single payer is not really realistic for the US.
In the list of nations with the best bang for buck healthcare programs, you will notice that top 20 healthcare programs are mostly single payer.
http://www.who.int/healthinfo/paper30.pdf
But there are single payer healthcare systems with bad health indexes, you might say... Well, combine single payer healthcare systems and add some transparency in healthcare and you now have an unmissable correlation.
https://www.transparency.org/whatwedo/publication/global_cor...
The top 20 bang for buck healthcare programs (mostly single payer systems), have an average ranking in terms of healthcare transparency of 18.7.
Are you from the USA? Notice the countries with universal healthcare, who have a similar healthcare transparency ranking to that of the USA: Luxembourg, Canada, Germany, France, Belgium, Ireland, and Chile. Their bang for buck rankings are 16, 30, 25, 1, 21, 19, 33 respectively. All of these countries have a better bang for buck ranking than the USA's 37.
In one sentence... Universal and transparently managed healthcare consistently gives more bang for buck.
And now to quote the original article... "It is a bedrock economic principle that if we can find a way to do something more efficiently, it’s possible for everyone to come out ahead."
EDIT: Check page 18 in the first source. Check chapter 11 in the second source.