Why Single Payer in the US?

[Lord MJ]

This could also be in the presidential election thread but in talking about healthcare, the US currently has Obamacare.

What is a compelling rationale to switch to either:

1. A single payer system
2. Public Option where customer can choose between government coverage or private coverage.

About 33 million or 10% of the population is still not covered by Obamacare. But is there a compelling rationale for any plan to cover those people that increases government expenditures on healthcare more than 10%? I know Bernie Sanders health plan would certainly be more than 10% more expensive than Obamacare in terms of government spending. But Bernie's single payer proposal isn't the only single payer mechanism out there.

[Jub]

I'd say that single payer should be implemented so that the worst off have the same access to healthcare as all but the top earners. This also allows healthcare costs to go down as you treat more people in early stages of illness where treatment is quicker and cheaper. Currently, lots of people in the US only go to a doctor when things start to get dire and that can mean lots of expenses for all involved.

[Grumman]

In simplest terms, without a mandate, the health insurance industry is faced with the ultimatum: "Sell at least $1,000 of stability for $1,000, or nobody will buy your product."

If there's mandate enforced with a $500 fine for not buying health insurance, now the health insurance industry can get away with selling $600 of stability for $1,000, because being $400 worse off because you bought a shitty product is less bad than being $500 worse off because you were fined. And given their previous behaviour, they will try to take advantage of that.

On the other hand, if there is a Public Option that gives $600 of stability for $500, now the health insurance industry needs to offer at least $1,100 of stability for $1,000 to compete. Instead of your net change in value being at least +$0, or at least -$500, now it is at least +$100.

[Napoleon the Clown]

Because the deductibles are still insane, the copays are still insane, the premiums are often still insane, it's better to kill off parasites than to give them even more food (I'm referring to the insurance companies here)...

If you've got an employer plan, take your personal premium. Triple it. That may well be what your employer is on the hook for. So, basically quadruple what you see come out of your paycheck. How does that compare to what you pay in taxes now?

[Broomstick]

What is a compelling rationale to switch to either:

1. A single payer system

Because access to healthcare would no longer be dependent on personal wealth or the generosity of a stranger (employer - most people don't personally know the company owner).

Every other civilized nation manages universal healthcare for less money with better results. When are we going to stop being stupid and cruel?

[U.P. Cinnabar]

Every other civilized nation manages universal healthcare for less money with better results. When are we going to stop being stupid and cruel?

When we realize that medicine comes under the heading of "promoting the general welfare," and not something which should ever be for profit. When we dismantle the corporate medical system, and stop putting doctors and lawyers in Congress who will only continue said system, because it benefits them at our expense. When we stop letting the media scare us with the Communist bogeyman every damned single time the idea of socialized medicine is even brought up for discussion.

Until then....

[Starglider]

When we realize that medicine comes under the heading of "promoting the general welfare," and not something which should ever be for profit.

Medical equipment and drug manufacturing are always going to be for-profit unless you've turned the entire nation into a dictatorial command economy. Hospitals and ambulances are built by for-profit companies. Drug research could theoretically be solely government funded if drug patents were revoked, but it's hard to imagine public research spending rising enough that this would actually increase the rate of discovery (besides being massively disruptive). And of coures if you want to prevent people from exercising the free choice to go outside the state-approved healthcare options, you again need fascist levels of coercion and criminalisation, for negative actual gain.

'Free to end user' does not mean 'never for profit', and indeed under current economic realities 'never for profit' means 'Stalinist state'. Which will still be full of for-profit healthcare, because massive bribery and black-marketeering would be the only way to get the best healthcare (short of being a high-level party official).

[Lord MJ]

What is a compelling rationale to switch to either:

1. A single payer system

Because access to healthcare would no longer be dependent on personal wealth or the generosity of a stranger (employer - most people don't personally know the company owner).

Every other civilized nation manages universal healthcare for less money with better results. When are we going to stop being stupid and cruel?

But under our current system 90% of the people are covered by Obamacare. So if we have a system with 90% coverage would it make sense to spend more than twice what we are spending now to cover only 10%?

Not that I'm disagreeing on the benefits of Single Payer. I'm trying to justify it from a fiscal standpoint.

[Simon_Jester]

"We" wouldn't end up spending twice as much money. We, as a people and a society, would spend more tax money while saving money personally and privately. We know this because if we had a single-payer system we'd be paying far less, which we know because literally every other country with good health outcomes like ours gets them cheaper than we do.

If I could pay $2000 more taxes in exchange or spending $3000 less on insurance companies... I call that a win, and I certainly don't think it needs any special fiscal justification for doing so.

[Esquire]

The logical endpoint of any attempt to improve health care is a single payer system, because every single dollar in an insurer's profit margin is a dollar not contributing in any way to health. Additionally, with centralized administration utterly inconceivable inefficiencies can be addressed, things like the Medicaid gap of recent fame.

The US currently spends something like 17% GDP on healthcare, more than any other nation on the planet, and measures worse on literally every measure of health care quality than other first-world nations. Our system is insane, clinically.

[Welf]

This could also be in the presidential election thread but in talking about healthcare, the US currently has Obamacare.

What is a compelling rationale to switch to either:

1. A single payer system
2. Public Option where customer can choose between government coverage or private coverage.

About 33 million or 10% of the population is still not covered by Obamacare. But is there a compelling rationale for any plan to cover those people that increases government expenditures on healthcare more than 10%? I know Bernie Sanders health plan would certainly be more than 10% more expensive than Obamacare in terms of government spending. But Bernie's single payer proposal isn't the only single payer mechanism out there.

(1) The first reason I can think of is that with a private option the government will be screwed over. Health insurance providers will (left on their own) create only contracts that are interesting for young and healthy people ("good risk") and force the sick into the government option. Premiums for government coverage will surge and drive the cost up for those who can afford it the least. Unless you levy taxes on people with private coverage to make up for the difference and subsidize those with government coverage, which means you have in effect a single payer system, just with an unnecessary layer of administration. And one that is more expensive because it wants profit and thus increases costs.

(2) Another argument is that one big giant government health insurance has much bigger leverage against pharmaceutical corporations and hospitals and can get better pries. This is a major reason why medicare is so cost effective.

(3) A bit more abstract is that contracts with private companies always have an additional risk, because they might go bankrupt. For example, if you get an insurance contract when age 18, you need to be sure this company will be able to pay your costs for the next 60-90 years. If the insurance company goes broke after 50 years you're screwed. In this case the government will pay your bills, acting as a reinsurer, but one that doesn't get paid by the private health insurances.
Companies going bankrupt is by the way not something theoretical. In the 19th century insolvent insurance companies were one of the reasons Bismarck introduced public health care in Germany. Often this was intentionally, with cases where these companies used 50% of their money on "administration costs" and then went bankrupt when their members needed the money. We are just not used to that any more because that market is heavily regulated today.

(4) And there is the problem of making contracts with companies. If you make a contract for such a long time you want to make sure every possible new medical procedure is covered. But no one can extrapolate how technology and needs will change, meaning no company can offer such a contract. If they set their prices to low they will go broke (which you don't want, see 3), if they set them to high few can buy (which you also don't want, see 1). But the market equilibrium will go to a higher price or to fixed contracts. Government coverage doesn't have that problem, because they can always can change coverage by parliamentary decree and finance it with a tax.

(4b) Another issue with contracts is, that insurance companies will always make them as confusing as possible to screw you over. That is how they make money. Insurance companies aggregate information (statistics and individual behaviour) and use that to create contracts that make the expected payout smaller than the income. The bigger the gap between yours and their knowledge the bigger their profit. And creating confusing contracts is a big part of that. That effect can be reduced by laws that regulate what kind of coverage has to be delivered on what conditions, and other measure for increased transparency. (Which not coincidentally what Obamacare did with the silver and gold plans and the health insurance markets.) But to get these laws you need a government agency that is adept with setting these rules, and then your halfway to having a government agency that does the rest, too.

(4c) Little addendum: the assumption of life-long contracts is a bit idealistic. The US insurance system 'solved' of those long-term contracts by simply not having them. Costs are shifted to the customer with rising premiums even if they can't afford them and lose coverage. Which means those were an inferior product, because customers had the risk of not having the desired insurance when they made contracts specifically made to mitigate risk.

tl;dr Single payer is superior to private insurance, on both theoretical grounds and practical experience from the last 200 years.

[Arthur_Tuxedo]

What is a compelling rationale to switch to either:

1. A single payer system

Because access to healthcare would no longer be dependent on personal wealth or the generosity of a stranger (employer - most people don't personally know the company owner).

Every other civilized nation manages universal healthcare for less money with better results. When are we going to stop being stupid and cruel?

When the meteors fall?

As a civilization, we have enforced homelessness and poverty despite the cost to the rest of society being several times higher than providing actual help, incarcerated millions at an astronomical cost of dollars and lives instead of addressing the underlying problems, and instituted countless other policies that damage our long-term economic output in order to keep the economic undesirables from ever gaining a chance to contribute.

This is ostensibly to benefit the wealthy but that is specious. Anything that damages long-term economic output will also damage their wealth on an absolute basis, as they own most assets and benefit the most from economic growth. Human psychology, however, operates on a relative basis, hence the decades and centuries of idiotic self-destructive policies put forward by the rich to destroy their own wealth but cause even greater destruction to the wealth of the middle and lower classes. Since reductions in the political buying power of money only seem to happen after major economic crises like the Great Depression that force the psyche of wealthy vote-buyers into survival mode, I'm not sure if there is a benign way to coerce the wealthy into not screwing themselves and double-screwing the rest of us. It seems like a natural consequence of hunter-gatherer brains trying to cope with a society of millions.

[Terralthra]

The US government spends more public dollars per capita on health care than any industrialized western nation, and still gets worse health outcomes for a smaller percentage of the population. The public option is simply clearly better in utiles per taxpayer dollar.

[Knife]

This could also be in the presidential election thread but in talking about healthcare, the US currently has Obamacare.

What is a compelling rationale to switch to either:

1. A single payer system

Because the US spends roughly 3 trillion dollars on healthcare last year. 90% of American's are insured now due to Obama Care but by private insurance companies, and due to a law, I do believe a part of Obama Care,they have to use 80% on care and can keep 20% for administrative costs and profit. That is a very generous 600 billion a year not on your health care. That's not even counting the administrative costs of the actual hospitals and doctors which skims more off the top.

Single payer provides one provider, one set of rules, one co-pay or deductible (if any) and one system of reimbursement for doctors and facilities. It also provides bargaining power for services and goods such as pharmaceuticals. It also means it is not going to be run as a for profit company where your health is treated as a secondary concern to the profit margin.

2. Public Option where customer can choose between government coverage or private coverage.

As long as it is a good single payer system, I could care less if the super rich hire out private doctors so they can jump the line. They do it know, don't see that changing anytime soon. I'm more concerned with what is left for the rest of us and a single payer will provided a bigger chunk for the biggest bang for our buck.

About 33 million or 10% of the population is still not covered by Obamacare. But is there a compelling rationale for any plan to cover those people that increases government expenditures on healthcare more than 10%? I know Bernie Sanders health plan would certainly be more than 10% more expensive than Obamacare in terms of government spending. But Bernie's single payer proposal isn't the only single payer mechanism out there.

[/quote]

1) Basic human compassion would dictate we take care of all of our citizens.
2) Having second rate citizens only breeds further social problems.
3) Decoupling health insurance from work frees up both small business and workers for a more fair trade in services/labor, as well as provide preventative healthcare for people who in turn are healthier and work better for their companies.
4) We already do single payer for a significant portion of our population and it works. Sure there are problems both in the VA and with Medicare, but both are highly popular when services are rendered, and both are government run socialized healthcare. It works and with less expenditure. From the 2010-2013 figures I could google real quick, looks like the VA runs at approximately 15% administrative costs as opposed to the 20-25% of private insurance. Medicare ones are harder to find with quick google fu, supposedly below 10% but I can't find a good source so if I'm wrong I stand corrected.

Just kicking the middle man (insurance company) out of the picture will save you 150 billion. On top of simplifying the staff of MD's and hospitals who need at the moment large staffs to deal with multiple insurance agencies, cutting the MD and hospital overhead costs for further savings.

[Simon_Jester]

Because the US spends roughly 3 trillion dollars on healthcare last year. 90% of American's are insured now due to Obama Care but by private insurance companies, and due to a law, I do believe a part of Obama Care,they have to use 80% on care and can keep 20% for administrative costs and profit. That is a very generous 600 billion a year not on your health care. That's not even counting the administrative costs of the actual hospitals and doctors which skims more off the top.

To be fair, many of these administrative costs would exist under any system- but they wouldn't be so inflated if there weren't numerous levels of middlemen and uncontrolled price-gouging by suppliers.

[Elheru Aran]

Because the US spends roughly 3 trillion dollars on healthcare last year. 90% of American's are insured now due to Obama Care but by private insurance companies, and due to a law, I do believe a part of Obama Care,they have to use 80% on care and can keep 20% for administrative costs and profit. That is a very generous 600 billion a year not on your health care. That's not even counting the administrative costs of the actual hospitals and doctors which skims more off the top.

To be fair, many of these administrative costs would exist under any system- but they wouldn't be so inflated if there weren't numerous levels of middlemen and uncontrolled price-gouging by suppliers.

See Martin Shkreli (however the hell his name was spelled) and the massive flap over him raising one drug's price up 1000%... except that that's more or less business as usual for pharma companies, apart from the absurdly high price jack. I don't think I've ever seen a more beautiful argument for the way Canada and many other countries deal with pharmaceuticals (allowing the original creator to only keep it for a few years and then it goes generic)...

[Honorius]

What is a compelling rationale to switch to either:

1. A single payer system

Because access to healthcare would no longer be dependent on personal wealth or the generosity of a stranger (employer - most people don't personally know the company owner).

Every other civilized nation manages universal healthcare for less money with better results. When are we going to stop being stupid and cruel?

Single Payer also needs to include Ambulance Rides and Ambulance Services should be nationalized.

If you call me, and have Medicaid/Medicare which pay the most for Ambulance Rides, you're still going to get a $500 bill as it costs us $667 dollars to take you to the hospital and Uncle Sam only pays us $167 saying that is enough. Problem is that won't cover the equipment repairs, our insurance, keeping equipment up to date, etc.

Its a fucking disgrace. In Britain, the Ambulances are part of NHS and fully respected Health Practitioners in their own right. Here its a fucking mess. Kalamazoo Medics can't do shit because the Medical Director thinks Germany's EMS is the model to follow and its killing patients. In Berrien County, our medical director was a Paramedic himself, and his philosophy is if you can justify it, do it.

[Knife]

Because the US spends roughly 3 trillion dollars on healthcare last year. 90% of American's are insured now due to Obama Care but by private insurance companies, and due to a law, I do believe a part of Obama Care,they have to use 80% on care and can keep 20% for administrative costs and profit. That is a very generous 600 billion a year not on your health care. That's not even counting the administrative costs of the actual hospitals and doctors which skims more off the top.

To be fair, many of these administrative costs would exist under any system- but they wouldn't be so inflated if there weren't numerous levels of middlemen and uncontrolled price-gouging by suppliers.

True, but like I said, one system, one set of rules, one place to call/write/deal with instead of one of those per insurance company. It furthers the streamlining.

[NecronLord]

The reason I've always heard that the United States' healthcare system doesn't actually drive down costs to the consumer despite the wide variety of choice is essentially information opacity.

For markets to work effectively there can be no significant information failure affecting the decisions of consumers and producers. It is assumed that the consumer of a private good or service knows what they are getting - they are able to estimate accurately the net benefit they are likely to derive. Net benefit is the private benefit to a consumer in terms of satisfaction, or utility, less the private cost associated with buying the product. It equates to the concept of consumer surplus.

For example, when a consumer purchases a coffee from their favourite cafe they will feel that they clear about the net benefit they will derive. Consciously or instinctively they will make a calculation that buying a coffee is worth the £2 they are asked to pay. It can be assumed that the decision to make this, and similar purchases, is guided by the consumer’s rational expectations. In other words, consumers base their decision to consume on a complete range of information gathered over the past, together with a prediction of the future. In terms of the coffee example, the consumer may have bought many coffees at this cafe before, and has always been satisfied with the quality of the coffee, and the service provided - hence the £2 expenditure is a ‘safe bet’. As will be seen, there may be many situations where not all the information regarding the product is available to the consumer, and in these cases markets may fail to work efficiently.

The quote is from economicsonline.co.uk, first hit I could get, not one I'm going to argue is authoritative.

A complex product like insurance is difficult to prevent information failure appearing in, because to truly understand your own needs requires projecting your health into the future (influenced by chaotic factors like bus impacts to your body) and also having an advanced understanding of both medicine, math and law; this is something even most doctors are not equipped to do. Yes, they can understand comparative value in relative terms, but it's not a simple pick up and buy product like a coffee, you can understand the medical effects, or the legal effects, few people seem to understand everything.

Compared to that, Single Payer has economies of scale with it. The NHS can negotiate prices with a drug company from a position of power that say, Prime Healthcare, with the best will in the world, can only envy. It's not the only show in town, but it's a monopoly to all intents and purposes. When the NHS wants to push a drug price down, its leaders can literally dial up the leaders of a Sovereign Nation and tell them to rattle the cage of copyright law if they really want the nuclear option.

Single Payer Healthcare has a purchasing advantage (and in surety there's things about it that don't work so well) that drives costs down, while a US style system operates with a complexity that doesn't allow the free market to actually drive prices down, simply because the benefits of competing products are so immensely complex that competition is not effective, because the purchaser is not informed.

[Simon_Jester]

I like that summary. It also helps to explain the problem with trying to establish competition in other areas such as education and infrastructure development, though obviously information asymmetry isn't the only kind of market failure that can exist.

[PainRack]

I'd say that single payer should be implemented so that the worst off have the same access to healthcare as all but the top earners. This also allows healthcare costs to go down as you treat more people in early stages of illness where treatment is quicker and cheaper. Currently, lots of people in the US only go to a doctor when things start to get dire and that can mean lots of expenses for all involved.

I wish people won't pretend that increasing access will automatically reduce costs because preventive medicine.
http://www.commonwealthfund.org/publica ... ror-mirror

Based on surveys, the U.S. ranks highly in terms of preventive care. While the US lags behind the UK in say smoking cessation programs , the fact that the UK and Europe is trying to copy the U.S. Chronic Disease Management Program or even in areas like teen pregnancy...


The U.S. VA show us that we can't just pretend that programs can scale up to meet demand. Is there any proof that the U.S. can scale up its services to continue delivering its good preventive care to the millions added to the patient roll because of increased access? If not, without a hefty investment in healthcare, the proposed benefits of preventive care might not materialise.

[Broomstick]

The US is able to scale up due to the overall wealth of the society, the question is whether the US is willing to pay the bill.

I don't have cites handy (it's early and I have to be off the work) but it's a common effect that when access is increase there is an initial UPTICK in costs when the new people, who have been without access, are added, because of the diagnosis and treatment of problems that have been deferred due to lack of access and/or funds.

And, purely anecdotally, even a healthy person like myself is going to have that effect when entering the system - when I regained access I had to catch up on both routine exams and vaccinations. When I got dental access again there were two fillings and a bad tooth to pull. Access to vision? New glasses, hadn't been updated in years. Yep, I cost a little money that first year back in the system. Probably won't need more than routine dental exams for a decade or more, likely won't need new glasses for a couple years, vaccines caught up until at least 2018 so I'm relatively cheap at this point. That's for a healthy person. Someone who has undiagnosed/untreated diabetes or something else will start costing a lot more than simply ignoring the person until they are hospitalized (at which point they cost a fuck-ton more) or die (which is comparatively cheap, financially, but corrosive socially).

[Esquire]

I'd say that single payer should be implemented so that the worst off have the same access to healthcare as all but the top earners. This also allows healthcare costs to go down as you treat more people in early stages of illness where treatment is quicker and cheaper. Currently, lots of people in the US only go to a doctor when things start to get dire and that can mean lots of expenses for all involved.

I wish people won't pretend that increasing access will automatically reduce costs because preventive medicine.
http://www.commonwealthfund.org/publica ... ror-mirror

Based on surveys, the U.S. ranks highly in terms of preventive care. While the US lags behind the UK in say smoking cessation programs , the fact that the UK and Europe is trying to copy the U.S. Chronic Disease Management Program or even in areas like teen pregnancy...

The US does relatively well at certain very specific kinds of preventative care, in the places and subpopulations where it's available. The massive un- or under-insured underclass does not have access to these programs, and as a result must use emergency rooms (which are legally required to provide lifesaving care without compensation) to treat illness and injuries that could have been prevented or mitigated with regular medical services. An excellent CDMP is, in a way, an admission of failure; most chronic diseases are preventable. We are dead last at efficiency of care, which is to say 'health care dollars per health care value unit.'

Additionally, since the survey uses self-report survey data (with all the serious validity and reliability problems that implies) from people either in or covered by the existing health care system, it's completely missing the main problems: our system simply does not cover 1 in 10 US residents, and the ones it does cover are paying massively more than the product they receive is worth. People without insurance still get sick, and EMTALA means that the costs of (massively inefficiently) treating them are passed on to the insured through inscrutable hospital billing systems based on operating expense totals, not individual procedure costs.

The U.S. VA show us that we can't just pretend that programs can scale up to meet demand. Is there any proof that the U.S. can scale up its services to continue delivering its good preventive care to the millions added to the patient roll because of increased access? If not, without a hefty investment in healthcare, the proposed benefits of preventive care might not materialise.

The Veterans' Administration has the same problems as the wider US health care system, namely a lack of efficiency-based accountability. It has essentially a blank check, and an institutional culture that obsesses over VETERAN'S CARE SHOULD BE BEST CARE, regardless of whether a particular procedure makes any sense or not. This is anecdotal, but an acquaintance of mine who works there told me about a time when painful, expensive eye surgery with a two-month recovery time was performed on a 95-year-old man who had to be talked into it and was already in hospice care, expected to pass on in a matter of days.

I believe the figure is something like a 500% efficiency improvement from preventative care over curative care, as established by numerous scientific studies. It's an objective fact that moving population health curves is a better plan than expensive treatment of preventable diseases.

[Flagg]

I'd say that single payer should be implemented so that the worst off have the same access to healthcare as all but the top earners. This also allows healthcare costs to go down as you treat more people in early stages of illness where treatment is quicker and cheaper. Currently, lots of people in the US only go to a doctor when things start to get dire and that can mean lots of expenses for all involved.

Wow, it's like someone with a brain said the fucking obvious.

[Flagg]

What is a compelling rationale to switch to either:

1. A single payer system

Because access to healthcare would no longer be dependent on personal wealth or the generosity of a stranger (employer - most people don't personally know the company owner).

Every other civilized nation manages universal healthcare for less money with better results. When are we going to stop being stupid and cruel?

But under our current system 90% of the people are covered by Obamacare. So if we have a system with 90% coverage would it make sense to spend more than twice what we are spending now to cover only 10%?

Not that I'm disagreeing on the benefits of Single Payer. I'm trying to justify it from a fiscal standpoint.

Fuck any fiscal standpoint. 10% is over 33 million people. Richest country in the world. The only real problem is choke points and some clinics not taking some insurances and administrative bullshit. So ban private clinics.

Fiscal standpoints... It's fucking EXTORTION. Give us money so we can treat you or we won't and you die. And I've been there. I had to come up with $1500usd up front for my gallbladder removal surgery. It's a lot more if you need a new organ. They won't even put you on the list.

The ACA was a step in the right direction, but at the end of the day it's still legal extortion. "Give us money or we let you die!"