Single payer healthcare, would it work?

In reply to fifty:

Exactly... there is no free market in healthcare, by its nature. A free market requires the buyer be able to walk away and choose a different seller.

On this board I think I'm relatively well known as being an Ex Pat Brit. I was born and lived in England until I was 25 when I moved here. I'm now 48, let's call it half my life here in America. So I have 48 years of knowledge and experience with the National Health service (25 for myself and 48 years of friends and family) Do you know how many people I've met or know of in the UK who have gone bankrupt after a car accident for medical costs? Do you know how many people I know who have lost their life savings after a health insurance company retroactively decided an emergency procedure wasn't needed after all and withdrew payment? Do you know how many people had to pay for the birth of their own child as they changed jobs mid pregnancy (this has changed now)? Do you know how many people have been given the wrong general anesthetic THREE TIMES IN A ROW which has medically killed them, had to be resuscitated even though they told them not to use that anesthetic for the 2nd and 3rd op? Then the team charged them for the prevelage of killing them and brining them back? Do you know how many un-needed practices I know of that have added cost to the consumer and done nothing? It's at least one person for everything above here in America. It's Zero for all and any issues I'm aware of in the UK, all while the over all cost to the public is half what it is here.

Also a single payer system doesn't me no competition or no private health care. A National Health system means that everyone get's what they want it when they want it. Which means NOW. Now then, I will agree it's not perfect. IF you have a non essential or non life threatening issue, you will have to go on a wait list. It's not as long as the always highlighted single case here or there, but they do exist. But that's why some people also have private health insurance. They can jump queues and getter better private rooms in hospital etc. But for 99% of people in 99% of cases the NHS works despite the occasional short falls and issues that the press over here just love to seize on and promote as the norm. It's not.

I have a close friend who works for a non profit credit counseling company. They give genuinely free help to people with financial issues, not these 'Pay us lot's of money and we'll sort out your credit score' an actual not for profit company. She spent a few years on the phones before being promoted within the company. She was one of the people who went through customers helping them. Even in the 09-11 period at the depths of the 'great recession' when according to the press every second person was going bankrupt due to over extending themselves buying half million dollar homes on a $50K salary, do you know who even then their biggest customer were people going through bankruptcy for medical bills, not loss of jobs, not too much debt but medical bills.

I'm not a 1%er, but I am very lucky. I have a good job, good benefits and good health care. I was still out of pocket $5K last year over and above my share of the insurance premiums. Luckily I can adsorb that in my budget but many can't (Back surgery) People point out that any hospital by law must see anyone no matter if they can pay or not. The issue is because of the cost of treatment millions of working people who have very high deductible health insurance but don't qualify for medicaid end up in emergency rooms because they had treatable issues, but couldn't afford the treatment or medication so they escalate and end up in an emergency room costing the rest of us that much more as we have to adsorb the emergency costs. If we had had a chance to adsorb the lower pre emergency costs it would have cost all of us far far less.

At the end of the day I not only think a single payer healthcare system can work, I honestly believe it's the only system that can work. I find the concept that most health care in this country is for profit as morally reprehensible.

If people want to point at inefficiency in the current government run health systems, let's start with congress who make it illegal for medicare to even try to negotiate drug prices. They have to pay the asking price. So one of the biggest inefficiencies in our government systems is something put there by people trying to prove that the government is by nature inefficient.

To me health care is a basic human right that should be available as and when needed to everyone for free.

And don't get me started on the utterly immoral concept of annual or life time max overage leaving people dying as they've run out of health coverage and don't have millions to continue. YEs those are very rare situations, but not as rare as the failing of the British system people love to point out as proof that a single payer can't work.

Toyman01 wrote: I find it amazing to me that anyone who has had experience with the bureaucracy, waste and incompetence, that is Government in this country, would ever be willing to subject themselves to a government run healthcare system. The ACA is a disaster. Just imaging what a single payer system will look like after the blithering idiots in DC get done with it. To think they will have your best interest at heart is foolish.

That assumes that corporate bureacacy is better than governments.

It isn't.

The only reason you hear of government issues is that we are supposed to because we all pay taxes for it. But you hear corporate issues from Dilbert, showing the same thing. But for a profit. I see it every day, and it drives me nuts.

In reply to Adrian_Thompson:

You hit every one of the points my employer makes any time the issue of healthcare comes up at work.

BTW, the general statistic for bankruptcies due to medical bills is 40-45%.

I live in Ontario and we have a single payer single provider plan that works for the most part and more importantly, works for every single citizen regardless of income.Far from perfect but workable for the most part except for elective medicine.

South of the border the challenge that needs to be overcome is that healthcare is first and foremost a very competitive "For Profit" industry. The relationship between patient, insurer hospital should be symbiotic. The current model is parasitic, with the patient being the host and the other two being parasites. While all the current dialog is around who and how the parasites are going to get fed by the host, there is no dialogue that looks at making healthcare fiduciary to the healthcare consumer.

In keeping with the spirit of competition, there is an interesting opportunity here for the Canadian healthcare system and the Californian public. One of the reasons that Canadian healthcare can keep cost down is that they are also a single purchaser with gargantuan buying power. No need for profits and the economy of scale would make them a formidable competitor if they moved in to the US market simply leaving the entire insurance industry out of the equation. The payoff for the Canadian healthcare provider industry would be to increase their economy of scale and pull cost down even further.

Just some random thoughts on this:

I'd like to see the national budgets for countries that have a single payer system. How much do they spend on defense, education, infrastructure, Socail Security, etc, and how does that compare to the US? I'm guessing there would need to be massive changes to the way the US operates, which presents a challenge in paying for all of this.

The example of public education as a government run entity is interesting to me. I went to public school. I turned out fine. That being said, I understand when people of means don't want to send their children to what they consider to be under performing public schools. They feel that the service received from a private school is better. Would this not happen with healthcare as well? Wouldn't the best doctors avoid working in public medicine, and work at private hospitals or doctors offices where they could earn a higher salary? Would we end up with a system where the wealthy are the only ones with access to the best medical care? I'm sure this is already the case to a point, but does single payer just make it worse?

I think, instead of focusing on who is paying for all of this, the better approach is to work towards lowering medical costs. If an MRI goes from costing $5k to costing $2k, then insurance costs should drop, and more people would be able to afford their care. So, how do we get costs down? I'd say regulation. I think the model for this already exists within the utility industry. We've decided as a society that things like electricity, natural gas, and water are fundamental to a decent life. As such, the government has regulatory committees in place to make sure that rates for those services aren't artificially inflated. I'd like to see a similar approach with healthcare costs.

IF we do go single payer, I'd like to see it funded via sales tax, instead of income tax. One of the big problems the government has, is a lack of income vs what we spend. There are lots of people in this country that aren't paying for the services that are used, because they're not working here, or are working off the books. Switching to a sales tax model would ensure that anybody who is here with even a little buying power would be contributing. Workers, non-workers, legal, illegal, citizens, visitors would all be paying and contributing.

In reply to STM317:

An interesting statistic is that people who have secondary education pay 12 times as much in taxes over the course of their lives as people who don't. So you would think that it would be in the country's best interests to have more people with secondary education (college degrees, trade certificates, whichever) simply as an investment mechanism - the government would get more out of it than we pay in.

As for only the weathy having access to the "best" medical care. That is the system we have now. The problem is, that is all we have. In a car analogy, you can drive a Bentley, or you can do without until it is far too late, and your only choice is to go to the ER (which is REALLY expensive!!!) and get the Bentley then let the public soak up the highly inflated costs anyway.

This is why I see it as an insult to say the US "has the best medical in the world". That is great if you're obscenely rich. It sucks if you're not.

In reply to Knurled:

You don't have to be rich to get the best care, plenty of not rich people have access, while plenty of rich people die every day. Trying to make it a rich vs poor issue is foolish.

MDJeepGuy wrote: In reply to Knurled: You don't have to be rich to get the best care, plenty of not rich people have access, while plenty of rich people die every day. Trying to make it a rich vs poor issue is foolish.

Except that it is. Someone without insurance will get care in an emergency, sure.

But long term care with prescriptions? Not so much.

As for "paying their fair share"- as soon as someone gets something serious, the "insurance" model of healthcare means they are getting a lot more than someone who rarely visits the doctor using the same coverage.

Everyone will get sick. You are born in a hospital and almost all who die will be there too, or a different kind of covered care. This isn't car insurance in that way. Healthy people will rarely use the system, chronic sick or Ines with allergies will. This is something that you can't avoid by driving smart and parking in a spot a long way from others.

This is why I see it as an insult to say the US "has the best medical in the world".

I don't think anybody says that anymore.

I find this interesting. The only non GRM Canadian I know, recently had to wait 8 weeks for bypass surgery.

Did he live? That's how the system works. People who need it more urgently tend to get it right away. Just like my MRI's. As far as the stroke/drug thing, that's probably more of a problem in the US than it is here.

In reply to alfadriver:

So only poor people die and Steve Jobs is still alive? Well then, your point is valid. Sorry.

In reply to MDJeepGuy:

This has been a great discussion so far, let's try to add only those posts that contribute positively and further the conversation.

In reply to EastCoastMojo:

Do you believe only rich people have access to health care? I don't. Am I not allowed to disagree with someone that believes that?

Having been involved with Medicare since I retired here is how it works. First a sizeable chunk is paid from my social security. Medicare then contracts with an insurance company and I pay the difference to said company. Then I pay the doctor or medical facility a co pay.

In reply to Beer Baron: That is sort of how Medicare works.

You are allowed to believe whatever you want. What I am asking here is that your contributions be beneficial to the discussion. Topics get closed when it devolves into a back and forth and I really dislike having to close the door on what is otherwise calm, civil discourse. If you wish to discuss it further, please contact me via PM.

Other than to shareholders, what is the value proposition of the insurance industry to the healthcare matrix?

This has been fun to read. Everything from the ACA to insurance to single payer.

So here is my compromise solution. Open up the insurance market nationally. With the rule that to sell in one state you have to sell in all states at the same rate structure. So that eliminates insurance companies cherry-picking healthy areas and not insuring non-healthy areas. Now every company is playing on a level playing field by the same rules. True open national free market. Now open the Medicare/Medicaid system for companies and people (we will call them Clients) to join. Now open this at a true cost premium no profit/no loss. No government subsidies to the Clients, so no new taxes based on this system.

Now the beauty of this system is simple. No more picking and choosing who you get to insure and don't. Also the argument of Free Market vs Public Sector would finally get settled.

If the private insurance companies jack around too much with rates and services, people go to Medicare for all. If Medicare jacks around with services, the Clients can leave and go to a private insurer.

To make sure this stays fair, any Dr that drops Medicaid/Medicare patients personally and professionally can take no non-direct care related compensation from insurance companies for 10 years. That way insurance companies can't buy a Dr out to eliminate Medicare competition in a region causing people to jump ship. I am sure there are a bunch of other back door preventing rules that would have to be enacted, but that is my idea.

Because in the end Insurance =/= Health Care. They are the bank account. Insurance is a huge problem in the whole system being another profit center in the chain adding costs, but I can't figure away around that part.

As a small cog in the great USA healthcare machine, I'll add my 2 cents.

Universal healthcare works well in many other countries, including Canada. These countries spend less per capita on their health than we do and yet lead longer healthier lives than we do. You can find horror stories sure, but I can show you ten American lives ruined by healthcare for every one foreign life.

The problem with transitioning to such a system is exactly how much pain we are willing to go through to get there. Massive layoffs in insurers and pharma, and probably lower wages for those in healthcare are just the start.

Lots of people make lots of money off our current system and will fight tooth and nail to keep their piece of the pie. They've made enough money to bend the ear of every politician in DC and buy their attention.

It would be a very difficult faucet to turn off.

bastomatic wrote: Lots of people make lots of money off our current system and will fight tooth and nail to keep their piece of the pie. They've made enough money to bend the ear of every politician in DC and buy their attention. It would be a very difficult faucet to turn off.

https://www.youtube.com/embed/IFyxmdnv3qE

So it sounds like so far we have done the worst thing that we could have done with the ACA. We didn't fix any of the contributing factors to the high price of health care, but added more access and required an increased amount of care.

I see three distinct issues that people want to see addressed.

1) Health coverage for those who cannot afford insurance. As I said before, these people do not need insurance. Making them buy insurance is a waste of resources. You can call government assistance insurance all day long, but it doesn't make it insurance. So we need to figure out the most cost effective way to provide healthcare for people who cannot afford insurance.

2) Reducing the cost of healthcare. Prevention, portability of insurance, competition, removing layers of red tape, both public and private. I love the idea of published prices, a menu if you will, at least for routine procedures, and allowing people to shop around. Maybe truley save the insurance for catastrophic needs, and encourage health savings accounts for the day to day.

3) Added benefits- reduced restrictions. We want no lifetime caps, no refusal of coverage, and keeping kids on our policies until 26. This will add cost, and I'm sure most of us are okay with that. But how much, and can we reduce costs enough to offset the increase?

In reply to FlightService:

So who gets to decide what business is and is not for profit? You want to force arbitrary rules on Doctors, are you ok if they decide your profession is next?

Boost_Crazy wrote: So it sounds like so far we have done the worst thing that we could have done with the ACA. We didn't fix any of the contributing factors to the high price of health care, but added more access and required an increased amount of care.

That depends on if your perspective is "increasing profitability" or "decreasing the number of uninsured".

I do agree with your assessments, mind you. "Access" versus "insured" is an interesting subtlety that I think is lost on a lot of people used to the US system.

profit vs nonprofit is a tax status nothing more. There are plenty of rules and regulations today. Want to get paid by Medicare or any insurance company? If yes there are rules. Free (ish) country. If you don't want to follow those rules you can practice as cash only. No one is suggesting conscripting doctors or forcing anyone into a profession they don't want to be in.