Single payer healthcare, would it work?

No arguments there. The only reason I mentioned military spending is because it's been brought up already in this thread, and it is an area where the US is an outlier.

Does anyone know how countries with single payer health care handle malpractice claims? I couldn't find anything on it in my brief search. I'm guessing that this is a direct driver of health care costs in the country, both in claims paid and defensive medicine to avoid claims.

Keith Tanner wrote:

jamscal wrote: in general...

Just going to point out that the population density of Canada is a little lower than that of the US Really, Canada and the US are not all that different in terms of demographics so it's a good comparison. Canada has their poor areas and their powerhouses. Some provinces subsidize the others - directly by cash transfer, actually. Individual wealth is pretty similar. Sure, the per-capita military spending is lower (I don't think anyone first world country beats the US on that metric) but if you cut health care costs in half (see per-capita costs on graph above) that frees a lot of money up to spend on bombs and bullets.

In general...

plus about 90% of Canadians live within 100 miles of the US border. Calculate population density on that...but the other countries on the list are pretty dense and homgeneous.

Population of Canada: 35 million

Population of California: 39 million

Also, demographics seem very different to me.

Yes, most of the population is packed into a small area - but the healthcare has to cover all of it, including the 36,000 people that live in Nunavut, 3 times the size of Texas. That's actually a real challenge. And yes, Canada's able to make this work with a population that's smaller than that of California, and with demographics that range from the north to the poor Maritime fishing provinces to the big cities like Toronto. It's not ALL Toronto. The two countries have a whole lot in common.

You can keep looking for ways that the US is special and different and why what works in the rest of the world will never work here - or you look at what IS working everywhere else, and what you can learn from that despite any potential differences. Too many people seem happy to focus on the former and not the latter.

I don't think ignoring the former and only considering the latter is likely to be a fruitful approach. Perhaps considering both would be more apt to be illuminating.

fifty wrote: We are moving to a single payer system by default. Up until the mid-2000s, the majority of medical school graduates went into private practice. The majority now work for larger health care systems. Lower reimbursement rates are forcing industry consolidation.

We are being moved that direction by design, not by default.

FlightService wrote: any Dr that drops Medicaid/Medicare patients personally and professionally can take no non-direct care related compensation from insurance companies for 10 years.

This is quite simply not true.

OHSCrifle wrote: I'd really like to know if (other developed nation's HC system) level of care is comparable. I've seen some anecdotal evidence in this conversation that indicates it is. The "life expectancy" metric is powerful and simple.

It is simple and powerful, which is too bad, as it is not instructive in a meaningful way.

Keith Tanner wrote: Really, Canada and the US are not all that different in terms of demographics so it's a good comparison.

I find this statement to be completely inaccurate. A fairly homogeneous society that effectively has no problem with illegal, sorry, undocumented immigrants vs the United States of America is a poor comparison.

Focus on one != ignore the other, although it's definitely a more exciting way to recast my statement. Saying my statement that the US and Canada are highly alike is "completely inaccurate" is another over the top phrase. These carefully chosen inflammatory and definitive phrases are the sort of thing that make actual discussion difficult.

Canada's society might look homogeneous from the viewpoint of the US news, but it doesn't look like that from inside. Ask an Edmonton resident about the native population, for example.

Are illegal immigrants the primary cause of the US healthcare issues? I didn't know that. It's certainly one of the hot buttons for discussion, and as someone who has actually immigrated into the US as opposed to simply having US parents I have some strong feelings on the subject. But if they're paying taxes, then they should be covered. If they're not paying taxes, well, that's a different problem that needs to be addressed separately.

In reply to Boost_Crazy:

I wanted to try to address the "folks without much to lose don't need insurance" aspect you've mentioned a couple of times. I think where this might have issues is that for folks who don't have much to lose, losing it also doesn't put a big dent in the bill they were supposed to pay. If I've got $5k to my name and have a $100k accident, someone's out the $95k worth of blood which can't be squeezed from a turnip. So the upshot is that they default (on their medical bills, and if they're bankrupt, then also their car, or ???), which means that the rest of us (those paying for insurance) still absorb the cost of their lack of insurance when their unpaid bill drives up the cost of being a hospital, which is in turn passed along to everyone who pays for care there, whether insured or even a cash customer.

I recognize I may also have missed something about this, so apologies if I'm mischaracterizing your idea. But in general, the way I look at it is that nobody is really outside the risk pool, because everybody eventually gets care at a hospital, and the hospital always has to pass on the cost of being a hospital to whoever is paying.

Boost_Crazy wrote: Does anyone know how countries with single payer health care handle malpractice claims? I couldn't find anything on it in my brief search. I'm guessing that this is a direct driver of health care costs in the country, both in claims paid and defensive medicine to avoid claims.

I don't know how it's handled in other countries, but eliminating medical malpractice alone is unlikely to bring costs back in check. This article in Forbes notes that malpractice suits and defensive medicine makes up about 2.4% of all money spent on healthcare. There are savings to be had there sure, but it's not a major part of driving costs upward.

Keith Tanner wrote: Focus on one != ignore the other, although it's definitely a more exciting way to recast my statement. Saying my statement that the US and Canada are highly alike is "completely inaccurate" is another over the top phrase. These carefully chosen inflammatory and definitive phrases are the sort of thing that make actual discussion difficult.

It's called a Straw man or Straw man fallacy and it's the reason that it's nearly impossible to have a meaningful discussion on this board without it falling apart. Know what it is, and deal accordingly. Some people here use it to derail almost every discussion.

Carry on.

Here's the kicker question for the "single payer in other countries is cheaper" crowd. I get that the out of pocket expenditure at the time of service is cheaper. I doubt there are any doubts about that. But what are their tax rates? Income? Sales? Import? Etc?

Look we should all know that there is no free lunch. Free healthcare is far from free and has to be paid from someplace. Where is that money coming from?

Bobzilla wrote: Here's the kicker question for the "single payer in other countries is cheaper" crowd. I get that the out of pocket expenditure at the time of service is cheaper. I doubt there are any doubts about that. But what are their tax rates? Income? Sales? Import? Etc? Look we should all know that there is no free lunch. Free healthcare is far from free and has to be paid from someplace. Where is that money coming from?

I can't say for certain, but my understanding is that they generally have higher tax rates but receive more services for them. It really depends on country, but given that the norm in Europe is to go on holiday for 6 weeks every year, it would appear that people in these countries still have quite a bit of discretionary money.

In the case of health care, those numbers of how much each country spends aren't how much private citizens spend. They're total spending. So even though the government may take a few more dollars in taxes, they are still taking less than what the average person in the U.S. has to pay for private insurance.

In reply to Boost_Crazy:

I agree with the shift from one area of spending to another. Rhetoric, politics, stated priorities aside, you spend money on what you care about. “Don't tell me what you value, show me your budget, and I'll tell you what you value.” ~said the famous man. It's true, but I am trying to focus on just healthcare in this thread. Although your more comprehensive approach would make the most fiscal and legislative sense.

But back to health care, right off the top, we have multiple profit layers built into the system. Insurance companies, medical administrators, the actual service providers (dr's, techs, nurses, expenditures, research costs). So there are multiple levels of profit that are adding to costs without actually providing a service.

Then you look at the costs of a procedure, like the ACA or not, this disclosure is a gift. Your procedure costs $X, negotiated rate is usually half to an order of magnitude less (wife had emergency surgery and the negotiated rate was 1/3, for her woman's issues surgery it went from $50k to $3k, so more than an order) and then there is what the insurance companies pay then on to you.

What is interesting, is I have seen that negotiated rate different for the same hospital, for the same insurance company but a different plan. I know each thing is a unique case, but how what changes based on plans is amazing.

I won't even get into the drug price differences, let's just say $300 for a script to $24 for the same script, same provider, the different plan has been observed (Louisiana to Virginia and the employer is the difference).

At the end of the day, I honestly believe the people we trust for this have taken the care out of health care and put it into their personal wealth care.

We need to completely overhaul the system. We need more transparency, more information, less variation. We need to level the playing field in favor of the consumer and not the corporate providers.

I found this, The world's most expensive medical care league: How breaking a bone in the US could cost you almost a year's wages. The Daily Mail is hardly a journalistic standard, but even as an approximation this non-US analysis needs to be taken into consideration as the validation of this entire thread and overhauling of the health care system as whole and not just tweaking it.

Since the primary argument against a completely revamped system on this thread seems to be based on higher taxes. I have a serious question I don't think has been asked (If it has, please just point me to the response and my apologies in advance)

What is the difference in paying more in taxes with no insurance payment vs paying less in taxes plus an insurance payment provided that the more in taxes is equal to or less than taxes plus insurance?

When I calculate my money doing my bills, I don't calculate it gross or minus taxes, I calculate it based on what goes into my bank account. That includes taxes, insurance, retirement, SSI ect. I personally don't care which line item goes up or down in the take outs as long as the total take outs go down. So I personally don't care if my taxes go up if I can eliminate or reduce something else the same amount or more (so same take home or more)

Same fence, Same sides.

I guess is comes down to this. Do you trust your government? Do you think a government employee is going to do as good of a job as a private citizen? Do you think a government run institution is going to have your interests at heart. Do you want to be "taken care of" by the government?

From 20 years of experience in working with and around government institutions, from the VA, to the civilian side of the Air Force, Nave, Marine Corps, Count and State Governments, State Hospitals, and the local Federal Complex, my answer is a resounding NO. The level of incompetence, laziness, and just general apathy by the large majority of government workers, toward their jobs, is amazing to me. Plodders, for the most part. Doing the minimum to make their 40 hours and 30 years. There are some good people there, but they are unfortunately the exception, rather than the rule.

I think we are ultimately headed toward single payer. The liberal side will keep pounding on it until it happens. I think it will be a disaster of epic proportions. I don't feel that the US government is capable of accomplishing this. I hope and pray that I am wrong.

That said, I'm going to go to church, and then I'm going to play with cars. Enjoyed the conversation.

Happy Easter!

He is Risen!

FlightService wrote: But back to health care, right off the top, we have multiple profit layers built into the system. Insurance companies, medical administrators, the actual service providers (dr's, techs, nurses, expenditures, research costs). So there are multiple levels of profit that are adding to costs without actually providing a service. Then you look at the costs of a procedure, like the ACA or not, this disclosure is a gift. Your procedure costs $X, negotiated rate is usually half to an order of magnitude less (wife had emergency surgery and the negotiated rate was 1/3, for her woman's issues surgery it went from $50k to $3k, so more than an order) and then there is what the insurance companies pay then on to you. What is interesting, is I have seen that negotiated rate different for the same hospital, for the same insurance company but a different plan. I know each thing is a unique case, but how what changes based on plans is amazing. I won't even get into the drug price differences, let's just say $300 for a script to $24 for the same script, same provider, the different plan has been observed (Louisiana to Virginia and the employer is the difference).

This, this, this. I will forego my usual rant on the topic, but I cannot fathom how any level of "constricting/confusing bureaucracy" is any worse than the total dumpster-fire that is medical billing currently.

The reason there is no "upfront pricing"? They don't know! They don't know what their costs are and they don't know what their margins are. Because they might have dozens of different billing items depending on who is insuring and what the individual's coverage is.

This is why I am not in favor of any kind of "voucher" plan. That would only serve to increase waste and do nothing to solve the real problem. The only way I see to fix it is to cut the Gordian's Knot and eliminate all the different plans and coverages.

This won't happen, because there is a very large, thriving, and profitable industry dedicated to dealing with the current system/problem.

In reply to FlightService:

The first difference between taxes and personal spending is choice. You choose where your money goes. Competing for that money is an amazing and highly adaptive driver of cost control. When the decisions on where that money goes become a government concern the costs and services are determined by lobbyists and committee and have very little ability to adapt. The second is taxes are forever. Any tax that is initiated will probably never go away and will likely increase. If it doesn't increase in cost it will decrease in effectiveness without a decrease in tax. Then the cry goes out for another tax.

A personal aside that I don't understand: Why does everyone trust the government to fix their problems in a way they like? At any given time slightly more or slightly less than 50% of the politicians (and probably population) share a political view that is significantly different than theirs. Those politicians make the rules that govern the way any government regulated system works. That means about 1/2 of what they do is going to disagree with what you want.

In reply to MrJoshua:

Why people look to government? Private industy lets them down.

Again, to pretend that private companies do things better than government is just as bad as the opposite. There is massive waste and biased spending for corporations, too. Or worse, since that level of detail is only known for government entities.

In reply to alfadriver:

In a nutshell.

Government entities can, in theory and in practice, be held accountable, up to and including jail time for individuals. It seems that corporate corruption is rarely visible and when it is, it results in shut-up bonuses and golden parachutes.

alfadriver wrote: In reply to MrJoshua: Why people look to government? Private industy lets them down. Again, to pretend that private companies do things better than government is just as bad as the opposite. There is massive waste and biased spending for corporations, too. Or worse, since that level of detail is only known for government entities.

You and I disagree on optimum levels of government involvement, that is unlikely to change. My take: The corporation is self limiting. That waste is built into the price. If the cost for service gets too high due to waste they fail. Straightforward immediate feedback. Government by default is self perpetuating. Now, when the lines blur between governments and corporations you can get the worst of both.

I was guessing single payer is where we would end up until the current administration. We still might but it's hard to guess. IMO it was the end game of the ACA from the beginning. I personally think a base level of care like medicare and medicaid for everyone with a concurrent free market insurance is probably better than what we currently have.

In reply to MrJoshua:

You don't work for a big company, do you.

There is more waste and dumb politics in companies that most think, then.

In theory, you are right, it should be self regulating. It isn't, by a long shot. Human nature steps in too much to "prove right" when the best option would be to focus on the consumer.

It's not that I'm not suspect of government. It's that I can't trust corporations. Especially when the phrase "shareholder value" get raised.

MrJoshua wrote: I personally think a base level of care like medicare and medicaid for everyone with a concurrent free market insurance is probably better than what we currently have.

That's probably the best we will be able to do, in this country, with our mindsets. We're a stubborn people, after all. That's our greatest strength and weakness.

Bobzilla wrote: Here's the kicker question for the "single payer in other countries is cheaper" crowd. I get that the out of pocket expenditure at the time of service is cheaper. I doubt there are any doubts about that. But what are their tax rates? Income? Sales? Import? Etc?

There's no question the money has to come from somewhere. And if that somewhere happens to be from the government, then the government is going to have to collect and redistribute that money. That means higher taxes. But it's already coming from somewhere! Assuming that the overall costs are lower, it should also mean that non-tax expenditures by individuals should drop by a larger amount on average.

This is one of the things that makes people see red, of course. Taxes bad! If you spend an extra $6k/year in taxes, that's the end of the world. Even if it means you no longer need your $12k/year medical insurance? Doesn't matter! Taxes bad!

It's also that "on average" aspect that gets people wound up, because there will always be some people at a given point in time that are paying more. As noted earlier, this happens with insurance as well. That's exactly the game insurance companies play.

I've never done a full comparison between US and Canadian tax rates, but I was paying both for a while. Naturally taxes are ridiculously complicated so a direct comparison is almost impossible, but IIRC they're not that different at the federal level. I think provincial/state is higher in Canada, and there's a notable difference in federal and provincial sales tax between Colorado and Ontario.

The US does have a very adversarial relationship with its own government, that's one notable difference between the US and Canada. Americans rely on their government but want it to go away

I've lived in Canada all of my life. I'm more than willing to admit our system is far from perfect. We have waiting lists for many elective procedures that are well beyond acceptable, but the reason we have waiting lists is because everyone is on the list. I pay far more in taxes (income, sales, gas, etc) than I would in the States. I accept this because our healthcare system, public school system, social safety net and infrastructure are all solid by in large. Every of these institutions could use work and improvement but they work.

What I find astounding is whenever a proposal is made, up here, to turn over parts of the medical system to private industry there is a hue and cry that we'll end up with an "American style" healthcare system. It appears the same can be said in the States just with the opposite point of view. There are areas that private industry simply does a better job. The issue I have with private industry is it is profit driven and, if left unchecked, profit will always trump the public welfare.

Both systems have their positives and their drawbacks. Both sides can and should take lessons from the other.

alfadriver wrote: In reply to MrJoshua: Why people look to government? Private industy lets them down. Again, to pretend that private companies do things better than government is just as bad as the opposite. There is massive waste and biased spending for corporations, too. Or worse, since that level of detail is only known for government entities.

This all day. Yes Government has its problems, yes it is not perfect, but has it got better? Absolutely. Toymans 20 year analogy is almost worthless at this point. As a current Government employee, we are constantly going through quality and efficiency reviews and improvements. It has been and continues to be a primary focus.

My mother has become a huge VA improvement advocate. She goes to the town halls, meetings with reps and about every publicly posted event involving the VA in South and Central Florida. All of this because of her local VA being "crap".

Then she saw my private insurance prices and out of pocket costs when I was in Louisiana and she went to a different VA and her opinions quickly realigned to the facts. Private insurance sucks for a significant portion of the Americans and the quality of care you get at VAs varies widely from location to location. She even admitted at the "crap" VA was better than what I was getting in private insurance and care. So now she is advocating for higher standards and benchmarking to known high performers with metrics that matter to the quality of care for our veterans.

I am reading a lot of "I don't trust the government but I trust the private sector" which is fine, but I have to ask when it comes to a public service is,

why?

The Private sector is driven by pure profit for the company and the shareholders, not your care. Actually, you dying from a serious illness as opposed to them treating you is in their best interest. The Government isn't driven by profit, costs maybe, but profit isn't the fundamental motivator of most agencies. I work for one of the few agencies that do turn a tidy profit for the Government and what we get is a tenth of what the attorneys that get to file with us receive (patent office).

In the end, the comparison comes down to this for me. Do I trust a large cumbersome slow moving bureaucratic organization that I have the legal right to effect change through multiple channels or do I trust people who have a personal financial incentive to not provide me with the services promised?

Sloth that you can effect vs Greed you have zero say in (oversimplified straw man argument?) Unfortunately those are your choices, pick one.

TL:DR? Then this VVVV

Wayslow wrote: The issue I have with private industry is it is profit driven and, if left unchecked, profit will always trump the public welfare. Both systems have their positives and their drawbacks. Both sides can and should take lessons from the other.

I think we may be on to something here with the private vs public sector.

I went to a few insurance companies and looked at their investor information. Here is what I found.

Cigna
UnitedHealthcare Particularly look at the 2016 Annual Report starting on page 2
Blue Cross/Blue Shield is a conglomerate of 38 separate companies so it is hard to pin down, but looking at Anthems 2017 Proxy statement, here is an interesting quote from page 14 "Due to existing contractual obligations with the Blue Cross Blue Shield Association (“BCBSA”), we are required to maintain a classified board structure."

I can keep going but this isn't how I want to spend my Sunday.

Have fun, Happy Easter.