Follow the money!! We do not have single-payer health care because the insurance companies, the drug companies, and some doctors are making under the current system. Why kill the goose that lays the eggs.
50
The Republicans are trying to change the narrative and discussion to single payer. There is absolutely no reason for any democrat to argue for single payer as long as the republicans are in power.
If asked about it, simply pivot and say that is not the issue at hand. The issue at hand is the Republican desire to give a $890,000,000,000 tax cut to rich and take insurance away from 22,000,000 Americans.
Don't take the bait and allow the Republicans to change the discussion and put Democrats on the defensive. Be smart Dem's and stay on the offensive. Republicans are only effective when they have someone to make the enemy.
If asked about it, simply pivot and say that is not the issue at hand. The issue at hand is the Republican desire to give a $890,000,000,000 tax cut to rich and take insurance away from 22,000,000 Americans.
Don't take the bait and allow the Republicans to change the discussion and put Democrats on the defensive. Be smart Dem's and stay on the offensive. Republicans are only effective when they have someone to make the enemy.
19
To me this is a duh and has been for a very long time. Next step would be to cut out fraud and use computers to take medical histories-- something humans get very bored by when they have to do it. Costs of medical care can be reduced by quite a bit...
And bring back the very fair 10% luxury tax... on wants not needs... or do I need a personal jet plane (possibly) but prob not a schooner or a 210 million Gauguin. The playthings of the super wealthy now cost unmentionable/deplorable amounts... and too bad Bill Clinton got rid of George HW Bush's luxury tax. (PS we had it in the 50s as well and I don't know when it went away. LUXURY TAX AGAIN.
And bring back the very fair 10% luxury tax... on wants not needs... or do I need a personal jet plane (possibly) but prob not a schooner or a 210 million Gauguin. The playthings of the super wealthy now cost unmentionable/deplorable amounts... and too bad Bill Clinton got rid of George HW Bush's luxury tax. (PS we had it in the 50s as well and I don't know when it went away. LUXURY TAX AGAIN.
21
Everyone pays something, and everyone is covered. The people know and want to simply the health insurance and health care bureaucracy.
Now we just need to replace the term taxes with a term for health insurance premiums paid to the govt. Just as FICA deduction from paychecks is really our social security contribution, we need a new acronym for govt. Health Insurance Contribution, HIC.
Now we just need to replace the term taxes with a term for health insurance premiums paid to the govt. Just as FICA deduction from paychecks is really our social security contribution, we need a new acronym for govt. Health Insurance Contribution, HIC.
15
As Dan Savage stated in his SLOG column, "L'esprit de L'escalier & Some More Advice For Democrats On Messaging" in Thursday's edition of The Stranger, the Dems must stop calling healthcare-for-all "single-payer" healthcare. (http://www.thestranger.com/slog/2017/07/06/25269997/lesprit-de-lescalier...
Words are important and progressives must choose their words for universal healthcare carefully. Call it universal healthcare, healthcare for all, Medicare for all, or something else but not single-payer. We all must get on board with this change in terminology. The GOP has made single-payer a dirty word and it, in and of itself, carries negative connotations. Not all synonyms are equal, take "anti-abortion" v.s. "Right to life as an example. progressives need to own their message and the words to convey it.
Words are important and progressives must choose their words for universal healthcare carefully. Call it universal healthcare, healthcare for all, Medicare for all, or something else but not single-payer. We all must get on board with this change in terminology. The GOP has made single-payer a dirty word and it, in and of itself, carries negative connotations. Not all synonyms are equal, take "anti-abortion" v.s. "Right to life as an example. progressives need to own their message and the words to convey it.
21
Articles such as this need to begin by quoting the current cost to Californians of their healthcare through private insurance, in addition to quoting the reported salaries of CEOs such as Stephen Hemsley of United Healthcare - i.e., $28 million in a recent year. He does not deserve to earn more than an oncologist because he is less valuable to society.
California Nurses' Association head Rosanne DeMoro nailed it when she commented that Democratic politicians will campaign on single payer but will not deliver on it. Putting private insurers out of business and the Stephen Hemsleys out of a job is where the rubber hits the road, according to DeMoro. Achieving single payer in the U.S. will require a lot more than changing the composition of our legislatures. It will require a change in the culture over time. The appropriate question to be asking people today is not whether they favor single payer, but whether they are prepared to remove the private insurance industry from the American people's healthcare.
California Nurses' Association head Rosanne DeMoro nailed it when she commented that Democratic politicians will campaign on single payer but will not deliver on it. Putting private insurers out of business and the Stephen Hemsleys out of a job is where the rubber hits the road, according to DeMoro. Achieving single payer in the U.S. will require a lot more than changing the composition of our legislatures. It will require a change in the culture over time. The appropriate question to be asking people today is not whether they favor single payer, but whether they are prepared to remove the private insurance industry from the American people's healthcare.
26
Yes, yes, yes, Mr. Frank.
Take the profit loving insurance companies out of the equation!
A single federal system can negotiate with leverage. I don't mind paying a doctor, nurse, hospital and all that comes with it. I do mind some CEO of an insurance company making millions. I do mind the pharmaceutical industry raping everyone for the sake of profit.
Sure, the ACA is imperfect. But it helped a lot of people who really needed help and now it appears that it may have exposed "that man behind the curtain" who does nothing but sit back and make money for the the sake of making money. Yes, the CEOs of insurance companies. And the members of Congress who do their bidding.
Something has to give, and it shouldn't be the health and well being of any American. We all deserve good health insurance at an affordable rate. It's about time we got it. Good riddance to insurance companies!
Take the profit loving insurance companies out of the equation!
A single federal system can negotiate with leverage. I don't mind paying a doctor, nurse, hospital and all that comes with it. I do mind some CEO of an insurance company making millions. I do mind the pharmaceutical industry raping everyone for the sake of profit.
Sure, the ACA is imperfect. But it helped a lot of people who really needed help and now it appears that it may have exposed "that man behind the curtain" who does nothing but sit back and make money for the the sake of making money. Yes, the CEOs of insurance companies. And the members of Congress who do their bidding.
Something has to give, and it shouldn't be the health and well being of any American. We all deserve good health insurance at an affordable rate. It's about time we got it. Good riddance to insurance companies!
30
I can't wait to hear the explanations for the budget over runs when we finally destroy the insurance industry that owns Congress (when hell freezes over) and pass Medicare for all or some other national single payer system. the budget will balloon to unimaginable size. Putting down health insurance industry will be easy compared to the public outrage with having to curb their appetite for doing everything and Cadillac expensive high tech over treatment.
5
"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."
Nonsense. The bedrock economic principle is There Ain't No Such Thing As A Free Lunch. There will obviously be plenty of losers if the U.S. adopts a single payer system, and it's beneath an alleged economist to argue otherwise.
Nonsense. The bedrock economic principle is There Ain't No Such Thing As A Free Lunch. There will obviously be plenty of losers if the U.S. adopts a single payer system, and it's beneath an alleged economist to argue otherwise.
28
We cost more because we are the most obese, use the most prescription drugs and pay our providers more. Basic math people.
40
Lucky for me, I'm a dual Canadian/American citizen (only American from the US govt's point of view.) So I can more-easily head north if I want to escape the madness. Here's the thing - I'm happy in the States - with so many aspects of my life. I WANT to stay in the USA!
I'm SURE there's a way the GOP can spin this and go toward single payer. They can. They must. I'm ok if they take credit for it...just do it.
I'm SURE there's a way the GOP can spin this and go toward single payer. They can. They must. I'm ok if they take credit for it...just do it.
50
Single payer could and should be built on the already existing framework of Medicare and should operate in the same way. Everyone gets Part A Hospital Insurance, people can opt into Part B Medical Coverage and Part D Drug Coverage. People can bundle A, B and D into Part C offered by private insurers if they wish. Premiums should be tiered based on income just as they are now for retirees. Medicaid could still exist for the purpose of covering premiums/copays/coinsurance for low income people. Employers get out of the business of providing health insurance and the Medicare payroll tax is increased modestly. A shared burden is easier to bear when it's spread all around. The only losers are insurance companies.
86
If it operated "in the same way", patients would have to pay taxes for decades before becoming eligible for benefits.
Am I missing something... or are you?
Am I missing something... or are you?
11
Those who object to single payer because it would be more efficient and thus eliminate administrative jobs are baffling me. There are so many useful things that need doing that I see no need to keep any job that is not adding value. If we think of healthcare as a part of the larger context of making our lives better then we don't need to go down the wormhole of job creation, but rather focus on what would be of real value.
Single payer seems inevitable given its strong support. When that happens then health care will be a public issue not controlled by insurance companies, and the real debates will begin. When everyone has a stake in it, then we will all have responsibility to one another to think of our health as a part of a larger organism, and maybe we can start to address what is making us sick in the the first place.
Healthcare needs to be part of the bigger picture which includes ending war, ending poverty, protecting environmental health and having a social conscience which guides our politics. Single payer healthcare will need to be supported by a more conscious electorate, which actually might happen if the electorate has access to decent healthcare.
Single payer seems inevitable given its strong support. When that happens then health care will be a public issue not controlled by insurance companies, and the real debates will begin. When everyone has a stake in it, then we will all have responsibility to one another to think of our health as a part of a larger organism, and maybe we can start to address what is making us sick in the the first place.
Healthcare needs to be part of the bigger picture which includes ending war, ending poverty, protecting environmental health and having a social conscience which guides our politics. Single payer healthcare will need to be supported by a more conscious electorate, which actually might happen if the electorate has access to decent healthcare.
72
Sounds just the the political candidate who promises to balance the budget with no tax increases and no cutsi in services by eliminating fraud, waste and duplication. Hows it worked?
No is a single payer a cure all. We pay our medical professionals more than anyone else, we have fancier hospitals and more and fancier equipment some of which have to be replaced every few years (the equipment is refurbished and sold abroad). Our tort system adds a few percentage points but who's counting. Those costs have been baked in over the last 50 years. A government single payer will not reduce those costs. What politician will deprive her constituents or donors?
No is a single payer a cure all. We pay our medical professionals more than anyone else, we have fancier hospitals and more and fancier equipment some of which have to be replaced every few years (the equipment is refurbished and sold abroad). Our tort system adds a few percentage points but who's counting. Those costs have been baked in over the last 50 years. A government single payer will not reduce those costs. What politician will deprive her constituents or donors?
19
The economic benefits of a single payer health care system are made clear by Robert H. Frank's article. However, he neglects the possibility that the political will to make such a system an effective means to provide health care to a population with diverse needs does not exist.
Americans are divided regarding the role of government to provide security in their everyday lives. Given the results of the 2016 elections, a substantial portion of both middle income and high income taxpayers agree that individuals should be responsible for their basic needs and should not rely on government assistance.
Our opinions also differ on the degree to which people should be held accountable for their lifestyle choices. Those who consume health care resources in the setting of what is regarded as unhealthy behavior (smoking, drug addiction, failure to follow dietary recommendations} are looked upon with opprobrium (See 'Who Turned My Blue State Turn Red?', New York Times, 11/20/2015). Endless debate over resource allocation between the "deserving" and "undeserving" claimants in a single payer health care system is likely given that this allocation will ultimately be determined through the political process.
Americans are divided regarding the role of government to provide security in their everyday lives. Given the results of the 2016 elections, a substantial portion of both middle income and high income taxpayers agree that individuals should be responsible for their basic needs and should not rely on government assistance.
Our opinions also differ on the degree to which people should be held accountable for their lifestyle choices. Those who consume health care resources in the setting of what is regarded as unhealthy behavior (smoking, drug addiction, failure to follow dietary recommendations} are looked upon with opprobrium (See 'Who Turned My Blue State Turn Red?', New York Times, 11/20/2015). Endless debate over resource allocation between the "deserving" and "undeserving" claimants in a single payer health care system is likely given that this allocation will ultimately be determined through the political process.
9
No lets stick with the facts. The overall cost of providing health care would fall. The rest of your arguments are straw men.
1. People like to be responsible for there own care.
2. Politicians will screw it up.
I just sat at a lunch with friends from a prior job that were in town and what we the table discussion. What will happen to health care? Do other people in developed nations spend this much time and energy worrying about healthcare. I doubt it. I spoke with someone from Canada about there system. They love it although the wife worked in a medical office. She thought that there should be a copay so at people did not abuse the system. I asked how much would she suggest. $5 dollars. Why do for heath care this way?? its stupid.
1. People like to be responsible for there own care.
2. Politicians will screw it up.
I just sat at a lunch with friends from a prior job that were in town and what we the table discussion. What will happen to health care? Do other people in developed nations spend this much time and energy worrying about healthcare. I doubt it. I spoke with someone from Canada about there system. They love it although the wife worked in a medical office. She thought that there should be a copay so at people did not abuse the system. I asked how much would she suggest. $5 dollars. Why do for heath care this way?? its stupid.
4
US military service members who retire after 20 years, and their "dependents" (spouses and minor children), are eligible for TriCare, a single-payer government health insurance program. This program has been in place for decades, and it works very well.
50
Just do a global comparison.
1. Countries with single payer system (Australia, Canada, Denmark, France, Germany, Holland, Ireland, Japan, Korea, Norway, Sweden, Taiwan, etc.) where health care spending exceeds 10% of GDP: Zero
2. Countries without single payer system where health care exceeds 18% of GDP: One (You guessed it: USA)
Global comparison shows countries with single payer health care systems spend a smaller share of their GDP on health care.
1. Countries with single payer system (Australia, Canada, Denmark, France, Germany, Holland, Ireland, Japan, Korea, Norway, Sweden, Taiwan, etc.) where health care spending exceeds 10% of GDP: Zero
2. Countries without single payer system where health care exceeds 18% of GDP: One (You guessed it: USA)
Global comparison shows countries with single payer health care systems spend a smaller share of their GDP on health care.
100
I don't know about all those countries, but Germany does not have single payer healthcare.
10
SIngle payer not only reduces cost of healthcare service, but what conservatives fail to realize is that by creating a single payer Health Care system everyone may have to pay a little more taxes, but they will not have to give insurance companies their money. I do not understand why republicans do not understand they will be putting more money in more peoples pockets. In other words, a family of four that pays the insurance companies $1600 a month for health insurance will get to keep every penny of it. Not only that Corporations will save millions of dollars by no longer having to pay for the health insurance of their employees. We would all have to pay taxes, but we will no longer be supporting 150 million dollar paydays for insurance execs. Let them insure gun owners and not people in need of medical care
78
I fully agree the single payer system implemented in United States like other developed countries. I still don't know why the insurers exist because insurers just make us harder to access healthcare services by making profits from healthcare system. Government should be responsible to provide healthcare as a basic right as same as other counties such as Canada and Britain. Government provides healthcare to EVERY AMERIV. But On one hand, government taxes everyone and firms for healthcare system based on individual income. On the other hand, establishing a monthly deductible based on income is to prevent people waste medical resources. In addition, government should be mandate the medical institutes like hospital to run not for profits. I believe this ways could be helpful on lower medical expenditures and sustainable on a healthy healthcare system.
16
Sounds good in theory. If adopted on country wide basis, I am sure it would be cheaper and more efficient. However, a single state single payer system would inevitably attract folks from less fortunate states. Adverse selection magnet, much like the homeless issue we deal with in CA.
4
Not really understanding why having an attractive place to live would be a problem? Adverse selection magnet in the mirror.
7
"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."
The salaries of everyone in the US health care system are much higher than in France. The hospitals are more luxurious, the machines are more elaborate and expensive, and the number of aides, social workers, and therapists much higher. Costs are baked into the system that are not easily removed.
OK, a hospital has to cut costs. How can they do it? They still have to pay rent, or pay interest on their construction bonds. They still have to pay their staff, their insurance company, their lawyers. Where are these cuts going to come from?
One man's cost is another man's revenue. Every dollar spent in the US health care system is received by someone, and that someone is going to be very unhappy if he is told he has to take less. In a lot of cases, they will say that's the price, take it or leave it. Unions will say that's the contract, honor it or we'll go on strike. Landlords will say if you don't pay the agreed rent, we'll kick you out.
So cutting costs is not as easy as it seems. It is much better not to let costs get this high in the first place. Now everyone has expenses to match their revenue, and they would not be able to pay their bills if they don't get the revenue.
The salaries of everyone in the US health care system are much higher than in France. The hospitals are more luxurious, the machines are more elaborate and expensive, and the number of aides, social workers, and therapists much higher. Costs are baked into the system that are not easily removed.
OK, a hospital has to cut costs. How can they do it? They still have to pay rent, or pay interest on their construction bonds. They still have to pay their staff, their insurance company, their lawyers. Where are these cuts going to come from?
One man's cost is another man's revenue. Every dollar spent in the US health care system is received by someone, and that someone is going to be very unhappy if he is told he has to take less. In a lot of cases, they will say that's the price, take it or leave it. Unions will say that's the contract, honor it or we'll go on strike. Landlords will say if you don't pay the agreed rent, we'll kick you out.
So cutting costs is not as easy as it seems. It is much better not to let costs get this high in the first place. Now everyone has expenses to match their revenue, and they would not be able to pay their bills if they don't get the revenue.
15
I'm curious about your opinions regarding healthcare in France since their outcomes surpass those in the US.
26
"One man's cost is another man's revenue. Every dollar spent in the US health care system is received by someone, and that someone is going to be very unhappy if he is told he has to take less."
Yes they will be. That will be the shareholders and executives of insurance companies. My heart bleeds for them.
Yes they will be. That will be the shareholders and executives of insurance companies. My heart bleeds for them.
37
I was a health care business lawyer for 20 years. I used to oppose single payer plans. No more: the level of profiteering in health care has reached unconscionable levels. True, we don't have visible rationing, but achieving decent coverage is now a lottery. The only way to achieve reasonable coverage for all is to squeeze out unnecessary administrative expenses and extortionate profits, and to efficiently manage care. These goals can only be reached through a single payer plan. That system will not be without faults either, but it will be much, much better for many, many more people.
131
Profiteering abounds - my son charged $35 for one Tylenol at the hospital. The kicker: he never received a Tylenol. And that's just the simplest charge to explain. Insidious.
10
Since states are constitutionally prohibited from having a deficit, health care is just one of those things that need to be done at the national level, not the state level. If it's attempted at the state level, it will fail; as soon as there is a recession -- which is when people will need help with medical expenses the most -- this is exactly when the state will least be able to afford it. This is not just a theoretical concern. California had a relatively generous "Medi-Cal" program back in the early '80's that they needed to cut back on as soon as the first recession hit.
13
All of us need to call, write and email the publishers of the New York Times to support universal health care. Other media will take note and at least be forced to consider getting on the bandwagon. If you won't support a candidate who doesn't support universal health care, why subscribe to a newspaper that won't? Trust me, the publishers don't care what readers write about in this comments section. We need to get in their face with non-stop phone calls and maybe more than a few protest signs blocking the entrance to their offices.
29
I thought newspapers were supposed to report news.
You want them to do political bidding.
The NYT does that already.
You want them to do political bidding.
The NYT does that already.
7
Single payer will become a vehicle for rationing. This single payer authority will begin to restrict reimbursement in order to meet the budget for covered people. As payments go down, this will lead to loss of access and rationing. There is rationing now based on ability of people to afford insurance. This criterion will change but rationing will be there and worse.
We hear from every one the Canadian health care ( single payer ) is so great. They will say this as long as they do not have to deal with system. I just visited relatives in Montreal. My impression is that Canadian health care system is great as long as you have life or limb threatening emergency. Every one else gets in line. Your hip is arthritic and you need a hip replacement - get in line. In US for people with insurance - this surgery occurs within a few weeks of wanting the surgery. That will change dramatically. I think this is the rationing that will happen.
We hear from every one the Canadian health care ( single payer ) is so great. They will say this as long as they do not have to deal with system. I just visited relatives in Montreal. My impression is that Canadian health care system is great as long as you have life or limb threatening emergency. Every one else gets in line. Your hip is arthritic and you need a hip replacement - get in line. In US for people with insurance - this surgery occurs within a few weeks of wanting the surgery. That will change dramatically. I think this is the rationing that will happen.
9
No it won't and hasn't in other wealthy countries with single-payer.
4
RJ:
You're wrong. All countries with these systems ration. Patients don't even think about it. They're used to it. Americans are not.
You're wrong. All countries with these systems ration. Patients don't even think about it. They're used to it. Americans are not.
8
My experience both as a patient and as a medical biller is that major surgery takes much longer than 3 weeks to arrange. It takes 3 weeks just to get a consultation with a specialist, who will (correctly) not authorize surgery until non-surgical options have been exhausted. This can take many months. If insurance pre-authorization is required at each stage, it can be over a year. For-profit insurances know this, and use it to their advantage. Medicare is not the easiest insurance to work with, but it does not play games with the patient's health as private insurances do.
16
There will be a period of adjustment while all the people working as middlemen in the insurance racket get retrained. Advertising agencies will lay off extra workers. Medical offices will be able to lay off the clerical staff doing insurance billing but they will need to hire more healthcare providers. We need a comprehensive plan.
27
Of course the insurance industry would be frozen out of the health care system under such a plan, and would deploy their huge lobby to derail it. Since they claim to prefer market competition, why not allow them to compete with the Medicare for all plan. If they can be competitive, then so much the better. If not, perhaps,it is time for them to leave the healthcare marketplace.
32
They could create something similar to the current Medicare Advantage plans, or managed Medicaid. CMS pays insurers to create such options, as long as they meet coverage requirements and don't cost the government any more than traditional Medicare/Medicaid would. Insurance companies currently make money doing this. It is an avenue for competition. (Medicare Advantage plans do siphon off the younger and healthier Medicare beneficiaries; that's how they can cover everything cheaper than Medicare.)
4
Correction to this comment. Medicare Advantage plans costs the government one-third more than traditional plans. The companies that sell these plans make a profit on insured who do not need much actual care.
13
The road maintenance analogy is a poor one. If our county had any of its expenses taken over by the state, our county taxes would not go down. Indeed, at best the freed up money could go to pay down our underfunded public retirement plans. But there's no question that our state taxes would go up as would our total tax bill. (California just increased gas taxes to pay for road maintenance.) This is not to dismiss the possible benefits of a single-payer health care system, but only to suggest that health care may suffer if public health funding gets diverted to other public demands.
5
My problem with "Medicare for All" is that the present Medicare is a wonderful honeypot for thieves. I would not believe projections that it would be less costly than a system relying primarily on private insurers. Medicare is not run to be efficient; it is run to provide benefits to a certain constituency and then funded by the Congress to pay the cost. I've followed stories of heroic federal officials trying to stop theft, but the Congress is always niggardly in funding these efforts. At least some countries with single-payer systems solve this problem by rationing care.
9
I winder how many people realize that there are middlemen in the pharmaceuticals industries. Over my lifetime I have met several people who have made a fortune controlling the sales of certain medications to hospitals and drugstores, including cancer drugs. I wonder why big drugstore chains don't buy directly from pharmaceutical manufacturers.
10
Perhaps we should tie passage of single payer with serious tort reform. I wonder how much of the $50,000 cost gap for bypass surgery between France and the US can be explained by the hospital's and doctor's liability insurance premiums.
7
Very little, believe you or not. Actually , the cost of malpractice insurance was going down for years. And 50,000 gap is definetly cannot be explained by the cost of malpractice insurance
12
It is not single vs. multiple payer. The German Health Insurance is NOT single payer, but delivers health care at 2/3 of the cost.
What counts is
a) How well the industry is regulated
b) If it is run for profit or not-for profit
See
https://www.theatlantic.com/health/archive/2014/04/what-american-healthc...
What counts is
a) How well the industry is regulated
b) If it is run for profit or not-for profit
See
https://www.theatlantic.com/health/archive/2014/04/what-american-healthc...
15
Alas, Americans are not Germans. Can you imagine Germans going to the ER because it's more convenient? Of course, things may change with their influx of immigrants.
6
The worst problem of America's health care system is that it costs too much. Haggling over Obamacare or the Republican plan do nothing to change that fact. Single payer could be cheaper if Congress could keep its corruption from ruining it. Although I observe that pharma has its hands on Congress and has gotten provisions which are clearly designed to enhance pharma's profits while eliminating competition.
Still, no health care system will work in America if it costs 18% of GDP.
Still, no health care system will work in America if it costs 18% of GDP.
10
If single payer is the "Be-All-End-All", then let's do this:
Being that the Left loves to say that Hillary won the popular vote, let Single-Payer fans devise their own Single-Payer plan.
The Left says that Trump was voted in by only "30% of Americans voters".
So that leaves 70% of American voters. Isn't that enough people to create their own plan? After all, France's entire population is 67 million.
Go for it.
Being that the Left loves to say that Hillary won the popular vote, let Single-Payer fans devise their own Single-Payer plan.
The Left says that Trump was voted in by only "30% of Americans voters".
So that leaves 70% of American voters. Isn't that enough people to create their own plan? After all, France's entire population is 67 million.
Go for it.
3
It was tried in California, (a state that I suppose constitutes the most realistic grouping of the type you were suggesting,) but a Democratic speaker, who takes donations from private health insurance companies, unilaterally and unexpectedly shelved it.
8
The California proposal didn't have any details. It also didn't contemplate what to do with Kaiser Permanente, which is a traditional full-service HMO model that is part insurer and part provider. And which is a huge employer in the state. It just wasn't well enough fleshed out and thought out to be voted upon.
But I do think the blue states could create a single payer system for themselves, if there were enough of them and they could get their voters to say yes. California, Oregon, Washington, Colorado, maybe Nevada and Utah, but I don't think those are ballot initiative states. It would be administratively possible, but might not be politically possible. If they actually created one and it worked, other states would want to join.
But I do think the blue states could create a single payer system for themselves, if there were enough of them and they could get their voters to say yes. California, Oregon, Washington, Colorado, maybe Nevada and Utah, but I don't think those are ballot initiative states. It would be administratively possible, but might not be politically possible. If they actually created one and it worked, other states would want to join.
9
CA is a ballot initiative state. Currently there is a plan in the works to get a single-payer bill added to the ballot in the 2018 midterm election.
1
You simply cannot point to Medicare's administrative costs of 2-3% as demonstrating efficiency versus the private market. For starters, Medicare pays for the most expensive Americans, those 65 and older. Their claims cost are significantly higher than those in group or individual plans. This makes CMS' costs expressed as a percent of claims look lower. Secondly, CMS' direct expenses do not include other agencies (such as the IRS).
I also take issue with any assertion that single payer wouldn't balloon budgets and significantly increase our deficits. What if someone cannot afford to pay a fair amount into the system? There are only two outcomes: (1) other people pay more or (2) the program runs at a loss. Both are quite frankly unacceptable.
Finally, if the author feels it's good social policy to squeeze doctors, administrators, drug makers, hospitals, etc., I disagree. Without a reasonable incentive we won't have innovation and that leaves everyone worse off.
I also take issue with any assertion that single payer wouldn't balloon budgets and significantly increase our deficits. What if someone cannot afford to pay a fair amount into the system? There are only two outcomes: (1) other people pay more or (2) the program runs at a loss. Both are quite frankly unacceptable.
Finally, if the author feels it's good social policy to squeeze doctors, administrators, drug makers, hospitals, etc., I disagree. Without a reasonable incentive we won't have innovation and that leaves everyone worse off.
11
"Without a reasonable incentive we won't have innovation and that leaves everyone worse off."
*****
The profit motive has its advantages. It's a great stimulus toward innovation. I really don't think single payer advocates have thought this through carefully.
*****
The profit motive has its advantages. It's a great stimulus toward innovation. I really don't think single payer advocates have thought this through carefully.
1
Glad to see this article in the NYT. So unfortunate that Paul Krugman and others at the NYT wouldn't acknowledge the facts this article outlines during the primaries or the election.
10
Single-payer will cost as little as it does in other countries if US doctors. hospital executives, and nurses earn as little as they do in other countries. Since this would mean pay cuts of 60-70% for doctors and hospital executives, and 40% for nurses, good luck with that.
14
So wouldn't it be great if we would also lower the cost of their education so that they don't feel the "need" to earn so much? Honestly, there is always a give and take and some things do take time to adjust to. So, over time, doctors and nurses will become accustomed to the appropriate salaries. That said, I daresay that salaries are not the main cost of our healthcare. It is profits. Profits of corporations, hospital conglomerates, insurance companies. Just a guess but I think it's possible that professional salaries wouldn't have to change a great deal if at all to make way for single payer.
2
It is quite expensive in other countries, which leads to their making rationing decisions all the time. Imagine how much worse it would be in the US without a population raised on rationing but one on choice and expediency? Good luck with that.
1
The person who may be the one who determines whether you live or die is often the "first responder." Despite extensive training in handling disasters and emergencies, just as medics on fields of battle just do, civilian EMTs and Paramedics earn as little as $9.50 an hour in many states! And some of them are in the back of ambulances (or driving them) over winter snowy or icy roads in states like Idaho. How often do we read of medieval helicopters crashing in terrible weather? Do you know how little many of them are paid?
11
Single-payer is not only economically rational, it is also the only way to ensure a certain basic fairness that can be summarized in a single sentence:
Everyone benefits, so everyone pays.
To clarify: the benefit we all receive every day is simply having a modern health care system ready and waiting to take care of us if we should need it.
It's like the interstate highway system - we don't all drive it every day, but we all pay to make sure it is there whenever we need it - the difference being that many people can do without the Interstate, but scarcely anyone can get through life without needing health care.
Everyone benefits, so everyone pays.
To clarify: the benefit we all receive every day is simply having a modern health care system ready and waiting to take care of us if we should need it.
It's like the interstate highway system - we don't all drive it every day, but we all pay to make sure it is there whenever we need it - the difference being that many people can do without the Interstate, but scarcely anyone can get through life without needing health care.
52
Advocating for a single payer system and only looking at cost is clearly misleading. Cost should be measured relative to the quality of Healthcare. What good is low Cost Healthcare that is not effective at treating patients and results is significantly higher rates of morality?
The single payer system does not solve the underlying problem with Healthcare in our country. Why do we have such a high demand for Healthcare? (Therefore leading the costs to sky rocket )
If we look at Medicaid, Medicaid insures a lot more smokers than private insurance companies do. We could all agree that smokers occurs a higher Healthcare cost, but why should the public subsidize their poor choices? (some individuals may very well be smoking against their will but I doubt the majority is) The same can be said for obesity. A single payer health system doesn't solve the root of the problem which poor behaviors are causing the demand for Healthcare to soar. It doesn't solve the high cost of drugs created by patents and regulatory requirements. It doesn't solve the low supply of physicians (10-15 years of schooling and residency requirements). A single payer system is not the solution
The single payer system does not solve the underlying problem with Healthcare in our country. Why do we have such a high demand for Healthcare? (Therefore leading the costs to sky rocket )
If we look at Medicaid, Medicaid insures a lot more smokers than private insurance companies do. We could all agree that smokers occurs a higher Healthcare cost, but why should the public subsidize their poor choices? (some individuals may very well be smoking against their will but I doubt the majority is) The same can be said for obesity. A single payer health system doesn't solve the root of the problem which poor behaviors are causing the demand for Healthcare to soar. It doesn't solve the high cost of drugs created by patents and regulatory requirements. It doesn't solve the low supply of physicians (10-15 years of schooling and residency requirements). A single payer system is not the solution
6
A lot of obesity is due to bad advice over the last 40 years from the FDA and the AHA, based on fraudulent advice from people like Ancel Keyes. It has taken debunking research from people like Gary Tubes and Nina Teicholz to reveal those errors, and many, many nutritionists still won't let go of their old, bad advice. As to schooling doctors, it takes four years in med school, then four of internship/residency. Some specialties take a few more years; 15 is an exaggeration.
8
The "deserving sick should get treatment but we shouldn't have to pay for undeserving sick" is not only a morally bankrupt position but also indefensible at a most practical level. Public health initiatives can and do lessen problematic "behaviors" that contribute to disease and mortality. The high cost of drugs can be ameliorated through programs such as those proposed by the Center for American Progress. Shortage of health care providers is a long-standing issue especially in rural areas, and there are efforts to address these through loan forgiveness, telemedicine, and Area Health Education Centers. A single -payer system is not intended to solve these issues but rather to increase access to health care from birth to death to ALL at a lower cost than our current, outrageously expensive and BAD health care system.
15
We all have auto insurance and those of us who are lucky enough to never have an accident can be said to subsidize those who do. Likewise, some people never get ill and others, through the bad luck of genetics or environment get cancer, heart disease, etc. Not all bad health is due to bad choices in life. Some are born to good parents with good genes and some are not. Circumstances of ones birth can be said to be a crap shoot. No one hopes to get the short end of the stick, but many do.
5
Sorry but some people will benefit from a single payer system while other people will suffer under a single payer system. It will provide less adequate healthcare to more people while some people will pay less and others will pay more.
If citizens of specific States what to create a State single payer system than they are welcome to try. Do not try to impose your communist/socialist agenda upon the entire country...
If citizens of specific States what to create a State single payer system than they are welcome to try. Do not try to impose your communist/socialist agenda upon the entire country...
5
As a military spouse, I've been more than happy with our government healthcare. I go to preferred doctors where a price has been agreed for all Tricare members. I've never had poor service or care. Ever. I had a friend with a child with cancer, the child received excellent care and is thriving. I don't think only "bad" doctors accept government policies. But, if I want to go to another doctor who does not have a price agreement, I simply pay the difference. We also have a standard version of our insurance. If I don't want to be limited on where I go, I opt out of the prime all inclusive coverage and choose standard. This means I pay some copays and have low max out of pocket cap.
33
I currently receive Medi-Cal (CA's version of Medicaid), and I receive excellent care. in fact, it's much better than what I previously had through a private insurer. I see the doctors I wish to see and am not treated any differently than someone with private insurance. I have never had to appeal a claim or deal with having to prove a service was necessary, unlike my previous insurance. Single payer is not advocating single provider care. It cuts out the middleman insurance companies that put up bureaucratic roadblocks and cause doctors nothing but frustration.
Doctors don't have time to try and remember which plans cover which medications to try and avoid prescribing something that the patient can't afford because their health plan doesn't cover it. they don't have time to sit on the phone with the insurance company to get a preauthorization for a particular treatment (something I have seen my doctor do under my previous insurance.) They would much rather get paid the same rate for the same service every time, instead of variable rates depending on what they have negotiated with different insurance companies.
Please explain how removing these time- and energy-wasting roadblocks would somehow decrease quality of care?
Doctors don't have time to try and remember which plans cover which medications to try and avoid prescribing something that the patient can't afford because their health plan doesn't cover it. they don't have time to sit on the phone with the insurance company to get a preauthorization for a particular treatment (something I have seen my doctor do under my previous insurance.) They would much rather get paid the same rate for the same service every time, instead of variable rates depending on what they have negotiated with different insurance companies.
Please explain how removing these time- and energy-wasting roadblocks would somehow decrease quality of care?
18
This editorial should make it into every paper nationwide.
The arguments against single-payer tend to sound like "don't believe your eyes. No, don't look at Germany or France or Sweden or even Canada. Listen to what we say about bad government!"
Is the U.S. doomed to bad policies because of the ocean of money in our politics?
The arguments against single-payer tend to sound like "don't believe your eyes. No, don't look at Germany or France or Sweden or even Canada. Listen to what we say about bad government!"
Is the U.S. doomed to bad policies because of the ocean of money in our politics?
39
I think single payer will have to evolve in the US by osmosis. If California, or a smaller progressive-minded state could incorporate it, eventually critics would see how well it works and be silenced. Then, maybe other like-minded states could follow suit.
In Canada, taxes are higher and we can't claim mortgage interest on our income taxes like you can, but health care-wise we are covered from cradle to grave. I just had my gall bladder removed and it didn't cost a nickle. I was quickly referred to a specialist, waited three weeks and went in for day surgery and that was it.
Watching the drama of the Republican health care bill from afar, it seems, as this piece suggests, that the time is now for some state to take the first step, tell the Republicans to "shove it" and pass single payer legislation.
In Canada, taxes are higher and we can't claim mortgage interest on our income taxes like you can, but health care-wise we are covered from cradle to grave. I just had my gall bladder removed and it didn't cost a nickle. I was quickly referred to a specialist, waited three weeks and went in for day surgery and that was it.
Watching the drama of the Republican health care bill from afar, it seems, as this piece suggests, that the time is now for some state to take the first step, tell the Republicans to "shove it" and pass single payer legislation.
29
who pays to defend Canada's vast size and mineral wealth from Russia and China? it's the people of the US, not Canada. That leaves lots of money left over for universal healthcare. Just think of your single-payer system as paid for in fact by two payers, not one, and one of them is Uncle Sam.
4
Baloney. The US chooses to have a huge military to protect its own overseas business interests (e.g. the oil industry) and to reward the military-industrial sector which loves conflict because it makes big bucks for stock holders. I am not aware of a single US military base in Canada, although we have them in Iraq, Afghanistan, Qatar, Japan, South Korea, Italy, Germany, Lebanon, and lots of Pacific Islands, and probably lots more.
16
No, we have things like taxes on gasoline, higher sales taxes, higher alcohol taxes, etc. And we can defend ourselves.
10
We could have had single payer Obamacare but for the guileless Joe Lieberman doing the bidding of his home state Hartford insurance companies when he refused to supply the necessary final vote to get the bill passed with a single payer plan.
Thanks Joe, you are a gift to American healthcare that keeps on giving.
Thanks Joe, you are a gift to American healthcare that keeps on giving.
53
And how ironic that the Hartford is now leaving Connecticut. So much for bowing down to corporate interests!
1
Mr. Frank missed some very big cost savings for a single payer system. Profits for health insurance companies. Also excessive salaries for execitives.UHC chairman Stephen Hensley took in $66,000,000 in 2014.
31
This article would have a lot more credibility if it had begun with an example other than California.
To many Americans, a bigger system just means much more fraud and waste. (Medicaid fraud doubled under the Obamacare Medicaid expansion.) Americans will never agree to a government program like single payer until they're convinced it won't be just an expansion of government ineptitude.
10
Totally specious.
Single payer "works" because of rationing.
I had chemotherapy at $18K/cycle and it took 6 cycles.
Would "health care from the DMV" pay for this for a 60 year old male?
How do you add users, cut costs and maintain quality?
You don't;fast, cheap, good - pick 2.
Why the big push for assisted suicide - usually from the same far-left bunch that demands single payer?
Single payer "works" because of rationing.
I had chemotherapy at $18K/cycle and it took 6 cycles.
Would "health care from the DMV" pay for this for a 60 year old male?
How do you add users, cut costs and maintain quality?
You don't;fast, cheap, good - pick 2.
Why the big push for assisted suicide - usually from the same far-left bunch that demands single payer?
6
There is always "rationing", whether it be from insurance company underwriting in the past, insurance company declinations in the past, insurance company rated premiums in the past, benefit caps in the past, out-of-network providers providing less benefits to beneficiaries, co-pays, coinsurance, deductibles. All are rationing benefit methods. If Medicare was the model for a SP system, it has, and would have, less rationing than what we had before Obamacare. With Obamacare we have less rationing that we had prior to. And "assisted suicide" is nothing more than nonsensical right-wing hypebole.
15
ssilberstein:
Actually, under Obamacare the rationing is self-inflicted. Those not subsidized or on Medicaid simply refuse to get medical care because of their high out-of-pockets.
Actually, under Obamacare the rationing is self-inflicted. Those not subsidized or on Medicaid simply refuse to get medical care because of their high out-of-pockets.
3
Gray wolf: My 31 year old daughter is married to a Canadian and has applied for canadian citizenship. She was diagnosed with Multiple Sclerosis in early 2015
and has had superb medical care, including $75,000 treatment with Lemtrada, after her treatment with copaxin (not as expensive), Tisibri (very expensive was stopped when she was positive for a virus that increases the risk of a often fatal side effect) and fingomolod ($2700/month) proved ineffective. These drugs were all covered between the Canadian national health and private insurance her husband purchased when they got married (I think the private insurance is $300/month for coverage for my daughter, her husband and their 2 year old.
By cutting out theInsurance industry and big Pharma 's extortioner hold on american health care a single payer system can work for everyone without
costing as much as our current system costs.
and has had superb medical care, including $75,000 treatment with Lemtrada, after her treatment with copaxin (not as expensive), Tisibri (very expensive was stopped when she was positive for a virus that increases the risk of a often fatal side effect) and fingomolod ($2700/month) proved ineffective. These drugs were all covered between the Canadian national health and private insurance her husband purchased when they got married (I think the private insurance is $300/month for coverage for my daughter, her husband and their 2 year old.
By cutting out theInsurance industry and big Pharma 's extortioner hold on american health care a single payer system can work for everyone without
costing as much as our current system costs.
17
I suggest Mr. Frank go back an re-learn Econ 101.
8
I suggest you study Econ beyond 101, namely Macroeconomics and why fully private healthcare just doesn't work.
14
Do you know any doctors? Most I know think they worked and work very hard and deserve tremendous amounts of money. Do you really see them agreeing to see their renumeration reduced?
Cut out the insurance companies, will doctors change?
Cut out the insurance companies, will doctors change?
7
And they do work hard, making kids and death decisions every single day, as do nurses.
Ok gang...especially if there are any Trump supporters here..Repeat after me.
Single payer or something like it.
Single payer or something like it.
Single payer or something like it.
Most of the rest of the civilized world has figured it out except for us.
We have a de facto criminal health policy in this country.
Single payer or something like it.
Single payer or something like it.
Single payer or something like it.
Most of the rest of the civilized world has figured it out except for us.
We have a de facto criminal health policy in this country.
28
There is only one response to everything stated in this piece: Duh.
6
Under Single-Payer, every person becomes a Baby Charlie Gard. Depending on "Who You Are", you could get an about-face decision due to public outcry. Emotion, not medical science, will rule.
5
Under the current system there are hospitals and doctors who "donate" services to the Charlie Gards of the world, often to no avail, but pass up the opportunity to help that 35 year old worker who needs a kidney transplant and even has a donor lined up, but is turned down by his state system. This happened a few years back in Arizona and the patient died, leaving his wife and several children with no breadwinner. Before his illness he had been a very productive worker and could have been again. Wonder what the final cost to society was in this case!?
15
@Susan H-I hear you--but where is the "guarantee" that Single Payer would have stepped up? Did the particular patient have other extenuating problems to deny the coverage you pointed out? Under Single Payer, a similar person over the age of, say 50, would likely be aged-out of coverage or face such scrutiny by doctors under Single Payer pressure to "diagnose other ailments" as to render him/her "too sick" to justify a transplant.
Single Payer sounds terrific in theory. In tangible real-case scenarios, something has to give. Doctors aren't going to treat out of the goodness of their hearts when the "Single-Payer Gods" say "Nope". Darwinism will make a strong comeback.
Single Payer sounds terrific in theory. In tangible real-case scenarios, something has to give. Doctors aren't going to treat out of the goodness of their hearts when the "Single-Payer Gods" say "Nope". Darwinism will make a strong comeback.
Of course single payer "saves" money.
If you're over 70 and need medical care, you'd be on your own. Single-payer Big Brother says shove off on an iceberg. Dr. Emmanuel said himself that those over 75 "owed it to us to die".
Need to book those radiation treatments? Happy to see you in about 10 months! By then there's a good chance you're dead, SO SINGLE PAYER SAVES MONEY!
Anyone who thinks single-payer is a great concept is a naive fool at best.
Go back to the old system and provide coverage for pre-existing conditions under a separate arrangement.
If gov't entities are able to negotiate more favorable terms, why weren't we doing that 70 years ago? If our old insurance was covering a bypass for $73,000, why wasn't it $200,000? There had to be some kind of ceiling in place. This article leaves out some key information.
As for fraud, reward the whistle-blower a percentage of the amount that was being paid to the fraudulent health-care provider. You'll get a lot of singing canaries.
If you're over 70 and need medical care, you'd be on your own. Single-payer Big Brother says shove off on an iceberg. Dr. Emmanuel said himself that those over 75 "owed it to us to die".
Need to book those radiation treatments? Happy to see you in about 10 months! By then there's a good chance you're dead, SO SINGLE PAYER SAVES MONEY!
Anyone who thinks single-payer is a great concept is a naive fool at best.
Go back to the old system and provide coverage for pre-existing conditions under a separate arrangement.
If gov't entities are able to negotiate more favorable terms, why weren't we doing that 70 years ago? If our old insurance was covering a bypass for $73,000, why wasn't it $200,000? There had to be some kind of ceiling in place. This article leaves out some key information.
As for fraud, reward the whistle-blower a percentage of the amount that was being paid to the fraudulent health-care provider. You'll get a lot of singing canaries.
7
You're saying then that the United States is dumber than every other industrialized country in the world. If these other countries have figured it out I would hope that the "greatest country on earth" could also do so.
11
McMama:
Americans are smart enough to assess their federal government's capabilities.
Americans are smart enough to assess their federal government's capabilities.
2
What rock have you been living under? Those of us over 65 have a single payer system. It is called Medicare. It may only cover 80% but it is possible to get supplemental insurance to cover the rest if necessary. And for some it is necessary. We have paid for it all during our working years and continue to pay premiums for it in retirement, the amount of the premiums based on our income.
As to why weren't government entities negotiating better prices years ago, it is because the Legislature in its wisdom didn't allow it. Still doesn't allow it for medications.
As to why weren't government entities negotiating better prices years ago, it is because the Legislature in its wisdom didn't allow it. Still doesn't allow it for medications.
21
On the cost reduction front, one thing is missing: eliminate not just the profit takers, but also the profiteers: regulate malpractice tort down to inexistence outside of criminal courts.
6
It's important to note that while overall costs will go down it also entails that for a small set of Americans their incomes will go down, in the short-run. I applaud this but in our culture overtly decreasing peoples' incomes, even if they are ill-gotten to begin with, is nary impossible. If we bargain lower drug prices, lower payments for services, etc. this directly translates into less revenues for drug companies and doctors. If we cut out the insurance companies we nix thousands of jobs occupied by medial coders and bill collection specialists just to name a few.
I still think we should go this route but we need to have this direct and frank conversation. People will loose jobs and incomes but the rest of us get cheaper, simpler, and more comprehensive medical coverage. We will no longer need to cling on to sad jobs while we wait for Medicare to kick in. We can take risks and quit jobs without fear of losing medical coverage. Going to the doctor will not induce the stress of receiving mysterious bills. Can I ask my doctor about a pain I have at a wellness visit or will that "discussion" result in a new code and a separate bill? That folly will cease.
I still think we should go this route but we need to have this direct and frank conversation. People will loose jobs and incomes but the rest of us get cheaper, simpler, and more comprehensive medical coverage. We will no longer need to cling on to sad jobs while we wait for Medicare to kick in. We can take risks and quit jobs without fear of losing medical coverage. Going to the doctor will not induce the stress of receiving mysterious bills. Can I ask my doctor about a pain I have at a wellness visit or will that "discussion" result in a new code and a separate bill? That folly will cease.
12
Buggy whip makers lost their jobs and far fewer farriers have work!
Given the cost of coverage, a single payer plan is more likely to be Medicaid for all, not Medicare for all.
Having worked in the healthcare industry, I agree with the assessment that the largest amount of savings will come from dramatically lower reimbursements to doctors and hospitals. Which ultimately makes single payer politically untenable. When your doctor calls and asks you to write your Congressman to vote against a single payer plan, even Democrats will look fondly at the status quo.
Having worked in the healthcare industry, I agree with the assessment that the largest amount of savings will come from dramatically lower reimbursements to doctors and hospitals. Which ultimately makes single payer politically untenable. When your doctor calls and asks you to write your Congressman to vote against a single payer plan, even Democrats will look fondly at the status quo.
9
On the other hand, doctors are already leaving the profession in large numbers, and new doctors are often burdened with student loan debt in the hundreds of thousands. Don't assume there will always be doctors around if the pay drops dramatically while expectations remain high and the expenses associated with becoming a doctor remain extreme.
7
The federal government, being monetarily sovereign, has no need to tax its citizens in order for it to issue the dollars it creates out of thin air. The purpose of taxation is to prevent too much money from entering the economy. Federal taxes destroy dollars, federal spending creates dollars. If the federal government creates more than it destroys via taxation, the result is a federal deficit - one that is equal to the private sector surplus, to the penny. Every dollar we own and can keep is a dollar of untaxed federal deficit spending. States and local governments all depend on taxes to function; the federal government does not.
So "affordability" of healthcare for all is not the issue. The federal government can "afford" all payments of all amounts into infinity, even if all taxation went to zero. It could, if need be, financed entirely by federal deficit spending alone. The only question is how much deficit spending can we allow without overheating the economy? With more than $18 trillion floating around among the world's population, I'd say we've got plenty of room to spare.
Healthcare for all.
So "affordability" of healthcare for all is not the issue. The federal government can "afford" all payments of all amounts into infinity, even if all taxation went to zero. It could, if need be, financed entirely by federal deficit spending alone. The only question is how much deficit spending can we allow without overheating the economy? With more than $18 trillion floating around among the world's population, I'd say we've got plenty of room to spare.
Healthcare for all.
4
One other benefit of universal healthcare is that it would obviate worker's compensation, another system rampant with fraud and excess cost due to gaming by lawyers and certain providers as well as abuse by employees who otherwise do not have health insurance.
That is not to say that there should not be OSHA standards. But companies have liability insurance and are logically required to maintain a safe work place and safe work practices.
However, think about that logic this way, if I get a cold, it needs treatment...it is of little importance whether I contracted it in the house, on the train, at my office, in my school, etc beyond the possible impact it could have on the practice of sanitizing surfaces....
US companies that are saddled with healthcare costs suffer a competitive disadvantage compared to other multinationals that have a larger proportion of their workforce in a country with universal healthcare...
That is not to say that there should not be OSHA standards. But companies have liability insurance and are logically required to maintain a safe work place and safe work practices.
However, think about that logic this way, if I get a cold, it needs treatment...it is of little importance whether I contracted it in the house, on the train, at my office, in my school, etc beyond the possible impact it could have on the practice of sanitizing surfaces....
US companies that are saddled with healthcare costs suffer a competitive disadvantage compared to other multinationals that have a larger proportion of their workforce in a country with universal healthcare...
12
Funding health care with private insurance is just another way we socialize risk and privatize profits. Private insurers, in general, insure workers, most of whom are, well, healthy enough to work. Add to this the fact that most of a person's lifetime of health care costs are incurred in the last 6- to 12-months of life, e.g., when most of them have hit 65 and are now on Medicare.
Where'd all those premiums go when you were working? Right into the profit column. Don't believe the politicians that there's just not enough money, when it's 1/6 of our economy. There's plenty of money. It's just that the government picks up the tab for the elderly and disabled; and private insurance picks up the tab for the healthy. What a great gig we've set up for insurance companies.
Where'd all those premiums go when you were working? Right into the profit column. Don't believe the politicians that there's just not enough money, when it's 1/6 of our economy. There's plenty of money. It's just that the government picks up the tab for the elderly and disabled; and private insurance picks up the tab for the healthy. What a great gig we've set up for insurance companies.
78
Good to see this in the NYT. The "cost" issue is a canard. The reason we don’t have it here is demonstrably *not* because it would cost more. It's the absence of SP that costs more--for every person and in the aggregate. Single-payer is the only proven solution on offer for serious cost-control. The absence of single-payer does not cut costs; it means, in fact, that healthcare will cost more for every person and in the aggregate. The resistance to single-payer isn’t about costs to the people or to the state; it’s about profits for the private health insurance and pharma companies. It’s about saving the profit-making opportunities for those companies at the expense of the health of the people—and even of the capitalist economy!—as a whole.
Some smart capitalists, like Warren Buffet and Mark Cuban, understand this. Unfortunately, too many American are enmeshed it a self-defeating capitalist class solidarity that insists on never allowing any profit-making industry to be displaced, no matter what the cost to the general welfare. The first political force that embraces single-payer wholeheartedly—and it may be on the right—will benefit enormously from it.
And it is possible, and would be a game-changer if enacted, in CA--the sixth largest economy in the world: http://www.thepolemicist.net/2017/06/california-scheming-single-payer.html
Some smart capitalists, like Warren Buffet and Mark Cuban, understand this. Unfortunately, too many American are enmeshed it a self-defeating capitalist class solidarity that insists on never allowing any profit-making industry to be displaced, no matter what the cost to the general welfare. The first political force that embraces single-payer wholeheartedly—and it may be on the right—will benefit enormously from it.
And it is possible, and would be a game-changer if enacted, in CA--the sixth largest economy in the world: http://www.thepolemicist.net/2017/06/california-scheming-single-payer.html
22
After cost, which is hardly a canard, the greatest obstacle to single payer may be the ineptitude of the federal government. Exhibit A: Obamacare. CBO estimates relating to Medicaid were way off. Medicaid fraud doubled under it. The government couldn't even produce a simple front-end system to access some databases (ex., an exchange system). The president repeatedly promised things that turned out to be lies.
It might be a hard sell after Obamacare. It will certainly take more than an "embrace." This is the US. The government has its critics, and they're heavily armed with facts.
It might be a hard sell after Obamacare. It will certainly take more than an "embrace." This is the US. The government has its critics, and they're heavily armed with facts.
5
The facts support a single-payer healthcare system for all. Go no further than looking at the developed world and their single-payer systems. Plus, Medicare is working just fine, but would work even better with younger, healthier beneficiaries. Plus, it would take the workload and cost down from employers, enhancing their global competiveness. Plus, it would even the playing field for all those who do not have employer-based group health insurance. Plus, it would lower premiums and deductibles compared to what we have now or what we had before, but a long way.
As far as CBO estimates, they are not guarantees, but nonpartisan and closer than any other estimates, by far.
Get with the program, SP would be a winner for most everyone. Much better than the ACA, better than pre-ACA, and extremely better than what we've seen from the House and the Senate.
As far as CBO estimates, they are not guarantees, but nonpartisan and closer than any other estimates, by far.
Get with the program, SP would be a winner for most everyone. Much better than the ACA, better than pre-ACA, and extremely better than what we've seen from the House and the Senate.
11
If the critics of government are so heavily armed with facts, why must they so consistently employ misinformation?
8
The Federal Government can pick up the tab. It has total control over the dollar, courtesy the Constitution, and can never go broke. Who's complaining now about the Fed bailing out the banks with the humungous $28 Trillion spent between 2008 and 2010? The government can do it for healthcare, welfare and education. All that spending is not a drag on the economy. The opposite in fact, as long as it's not drained off by the banks it will grow the economy, making the whole exercise revenue neutral.
11
In addition to huge costs savings from administrative waste, marketing and promotions, single payer offers more freedom to individual citizens. Imagine if insurance were not tied to having a job, or you didn't have to get your insurance via a spouse. There are not only systemic benefits to the federal budget, but personal benefits if the US were to take out employer and spousal considerations in insurance - more freedom. If the payer is standardized and can actually negotiate rates with the drug companies and providers, I think we can possibly avoid bankruptcy as a nation.
As we know, every other civilized nation has this basic support for its citizens. Only the US has the capacity to make such an awful mess of a basic human need that keep this essential need out of the reach of so many. I see no way it can cost more than our current system. We pay the most and get mediocre care relative to any other country with single paper.
As we know, every other civilized nation has this basic support for its citizens. Only the US has the capacity to make such an awful mess of a basic human need that keep this essential need out of the reach of so many. I see no way it can cost more than our current system. We pay the most and get mediocre care relative to any other country with single paper.
20
I agree that single-payer is far superior to the current "system". However, how can it be implemented by one state alone, unless the federal government allows that state's taxpayers to pay their Medicare taxes (and the portion of their income taxes that fund Medicaid, the VA, etc.) to the state instead of the IRS? The author's analogy to road maintenance - that increased state taxes would be offset by reduced county taxes - only works if the level of government that is relieved of the expense of providing medical coverage also gives up the corresponding tax revenue. How likely is that?
4
Anyone who's examined a hospital bill, or fee for service doctor bill, of a family member enrolled in traditional Medicare or Medicaid sees, almost instantly, that Medicare and Medicaid have the strongest pricing power in the industry. No private insurer comes close to negotiating rates as low.
The public needs to know this call our every elected official who argues that private insurers can negotiate rates as low, or lower. It's a fallacy that the open market can price with power equivalent to the federal governement's. One will also find oneself in awe of Medicare and Medicaid's efficiency.
Doctors like dealing with Medicare and Medicare because they pay their bills on time.
Make Medicare every American's default insurance; everyone pays in. Private insurers can help administrate the system (if they're efficient and cost effective) and private insurers could offer policies with which they're free to try to earn a profit.
The idea that the profit motive of private insurers will produce the lowest cost, best, most efficient, health care of all is a belief without evidence.
The public needs to know this call our every elected official who argues that private insurers can negotiate rates as low, or lower. It's a fallacy that the open market can price with power equivalent to the federal governement's. One will also find oneself in awe of Medicare and Medicaid's efficiency.
Doctors like dealing with Medicare and Medicare because they pay their bills on time.
Make Medicare every American's default insurance; everyone pays in. Private insurers can help administrate the system (if they're efficient and cost effective) and private insurers could offer policies with which they're free to try to earn a profit.
The idea that the profit motive of private insurers will produce the lowest cost, best, most efficient, health care of all is a belief without evidence.
10
The idea that "Doctors like dealing with Medicare and Medicare because they pay their bills on time" (did you mean Medicare and Medicaid?) is "a belief without evidence". Would you be thrilled if your employer paid you half of your regular wage or salary but paid you "on time"? Are you aware of how many doctors do not participate in Medicare or Medicaid or how they limit the number of patients on those programs that they will see?
https://www.forbes.com/sites/brucejapsen/2014/02/01/as-obamacare-brings-...
https://www.forbes.com/sites/brucejapsen/2014/02/01/as-obamacare-brings-...
5
Doctors in our reasonably small town- flat-out- do not accept some private insurers and some Medicare Advantage plans- because they wait months to be paid. We learned this the hard way when we had to drive an elderly uncle 75 miles to another town because none of the four orthopedic surgeons in town would accept the Medicare Advantage plan in which he was enrolled. He was in the most cost effective Medicare Advantage plan for his epilepsy but not for his broken wrist.
When we asked the local orthopedic surgeons why they didn't accept our uncle's plan, their answer was blunt '...because they don't pay their bills.'
When we asked the local orthopedic surgeons why they didn't accept our uncle's plan, their answer was blunt '...because they don't pay their bills.'
5
Actually government run healthcare achieves its savings through rationing care.
Something democrats don't seem to want to acknowledge
Something democrats don't seem to want to acknowledge
6
Why is it so difficult to grasp that a government entity with no profit motive, no advertising budget, and demonstrably lower overhead could provide the exact same services as the existing private market more efficiently? No rationing of care required.
13
Currently commercial health insurance won't cover certain medicines or procedures either at all, or until you've followed some protocol to "prove" you need it. That protocol can involve trying cheaper medicines, even if they haven't worked before for you, or getting your doctor to file an appeal.
So rationing already exists.
So rationing already exists.
12
Maybe (although I won't fully concede that point). However healthcare is currently rationed - based on if you have coverage, your ability to pay, and (if enrolled) what providers are in your network.
Choosing between these two forms of rationing I'll take the form that prioritizes need for care (single-payer) over financial status (existing system) every time.
Choosing between these two forms of rationing I'll take the form that prioritizes need for care (single-payer) over financial status (existing system) every time.
12
Question- would the author include the workers compensation bureaucracy in his list of current single payer components, like Medicare and VA? On its own merits (or lack thereof), it is certainly a separate nightmare, and likely because it has multiple insurers, as well as government involvement, it would also be considered a messy expensive patchwork latched on to the rest of our overly complicated health care/health insurance system. As a former employer, I can attest to the expense, and endless and needless time I spent navigating WC. If the republicans really cared about small business, or any business, they'd embrace single payer if for no other reason to eliminate WC as a separate system. It's one "regulation" about which they are curiously silent. But of course, if they cared about business at all, they'd jump on single payer because your place of employment it is such a stupid, inefficient, unfair place to leave health insurance choices. I winced and agonized every year when I alone had to make the plan coverage choices for 50+ people and their families. I found it inappropriate and wasteful of their and my resources. But this is how Repubs define "freedom" I guess!
8
Before puberty, when a Rubik’s cube still holds great appeal, a nerdy kid should be able not only to solve the cube, but also then to spell OHIO on a four-box pattern.
1
There was a very informative article [those-indecipherable-medical-bills-theyre-one-reason-health-care-costs-so-much March 29, 2017] discussing the "industry" of opaque medical billing and how it contributes to rising costs. That article describes the invention of new code systems to get around the limits imposed by standard Medicare medical billings codes. But it also describes how the medical billing code industry works to inflate (or optimize, depending on your point of view) costs even within the system of Medicare medicare billing codes.
I would amend the title to "How Single-Payer Health Care Might Save Money". The problem is that there is still potential to game the system. In the end, the primary goal is to eradicate gaming of the system - Single-Payer Health Care is just one approach to solving that problem, and it can fail depending upon it's execution. Perhaps the reason ACA was passed at all was the wiggle room left in for gaming the system.
I would amend the title to "How Single-Payer Health Care Might Save Money". The problem is that there is still potential to game the system. In the end, the primary goal is to eradicate gaming of the system - Single-Payer Health Care is just one approach to solving that problem, and it can fail depending upon it's execution. Perhaps the reason ACA was passed at all was the wiggle room left in for gaming the system.
1
Population Health seems to be the new buzzword in Healthcare as well as bundled payments... Humans are like fingerprints where some patients cost more to get healthy than others. Medicare does not cover the costs of the unhealthy outlier patient, and if your facility has more of those type of patients coming into your door the less likely you will be able to stay in business. Healthcare is very complex, where successful organizations can innovate and provide better care due to technological advances in equipment/care path technology/and training... NHS system in UK is overwhelmed in inefficiency, low moral, doctor shortages per capita, [Professor John Appleby, chief economist at the King's Fund, which specialises in health care policy, said: "The next government will inherit a health service that has run out of money and is operating at the very edge of its limits.]
is this where we want to be as a country? Iv'e been to England and I don't like the hospitals with drapes hanging out the bldgs. windows... old outdated buildings, etc. we are better than that.
The solution is that we have to go back to insurers being non-profit organisations where the membership has a say in the performance of the mutual insurance company. Once Blue Cross plans like Anthem turned into a FOR PROFIT insurer - all they are concerned about are stockholders... at least that would be a step in the right direction.
Baby boomers will strain the system soon enough.
is this where we want to be as a country? Iv'e been to England and I don't like the hospitals with drapes hanging out the bldgs. windows... old outdated buildings, etc. we are better than that.
The solution is that we have to go back to insurers being non-profit organisations where the membership has a say in the performance of the mutual insurance company. Once Blue Cross plans like Anthem turned into a FOR PROFIT insurer - all they are concerned about are stockholders... at least that would be a step in the right direction.
Baby boomers will strain the system soon enough.
3
Medicare does cover quite a few "outlier" patients. Don't forget that Medicare covers people so disabled that they cannot work. Medicare disability is a much higher standard to overcome than Long Term Disability through your employer.
So people with chronic illness, or physical injuries like paraplegics can be on Medicare.
So people with chronic illness, or physical injuries like paraplegics can be on Medicare.
3
The image of the Rubik’s Cube accompanying this article is quite apropos.
Many individuals try to solve the puzzle by lining up two images and then proceeding with attempts to line up more as they disrupt the alignment of those already in place. Yet experts have mastered the Rubik’s Cube by approaching it in total, easily bringing all images into alignment.
Health policy is similar. We listen to the politicians discuss various isolated elements of financing, recommending changes that disrupt other features of the health care financing system. This is the problem with ACA, AHCA and BCRA.
Yet we have policy experts who put all of the elements together, actually bringing into alignment the various policies that would make the system work well for all of us. Professor Frank shows us how easy it is when the problem is approached in total as with a single payer system.
And we don’t even have to experiment with the single payer model. Several other nations have done that for us, proving that the model is much more efficient, effective, and equitable, bringing health care to everyone at a cost that all of us can afford.
Many individuals try to solve the puzzle by lining up two images and then proceeding with attempts to line up more as they disrupt the alignment of those already in place. Yet experts have mastered the Rubik’s Cube by approaching it in total, easily bringing all images into alignment.
Health policy is similar. We listen to the politicians discuss various isolated elements of financing, recommending changes that disrupt other features of the health care financing system. This is the problem with ACA, AHCA and BCRA.
Yet we have policy experts who put all of the elements together, actually bringing into alignment the various policies that would make the system work well for all of us. Professor Frank shows us how easy it is when the problem is approached in total as with a single payer system.
And we don’t even have to experiment with the single payer model. Several other nations have done that for us, proving that the model is much more efficient, effective, and equitable, bringing health care to everyone at a cost that all of us can afford.
11
Single-payor just makes sense. However, before we reinvent the wheel, focus must be placed on negotiating prices, and more specifically drug prices. If we have a medicare-for-all/single-payor system, but compromise on negotiating prices, it won't work. In fact, it would make things worse. We need mandates, we need stiffer penalties on people dodging payroll taxes, and clear transparency on health care prices, when, and where they are delivered. Then, and only then, will single-payor result in lower costs overall in the system.
10
Kudos to Mr. Frank for pointing out the VA is a single payer system.
I'm just wondering if Mr. Frank has been reading up on current events as to how the VA has been doing the last few years. And, given the state it's in, whether he wants that implemented nationwide without recourse.
I'm just wondering if Mr. Frank has been reading up on current events as to how the VA has been doing the last few years. And, given the state it's in, whether he wants that implemented nationwide without recourse.
7
The Republican Congress has refused to increase funding for the VA enough to match the influx of newly disabled military personnel from the current wars.
9
pdxtran:
Right on cue, someone blames...not enough spending. What's the excuse for the poor Medicaid outcomes then? Obamacare spent $100 billion more and the outcomes didn't improve.
When all democrats want to do is throw more money at problems, they just make it that much harder to reach consensus on a single payer system. Even now their claims that reducing the exploding Medicaid expansion costs will result in deaths diminish their credibility significantly.
It's not about spending but about outcomes. Democrats have yet to mention outcomes except when they were promising how much better they would be if Obamacare was passed. (They weren't.)
Right on cue, someone blames...not enough spending. What's the excuse for the poor Medicaid outcomes then? Obamacare spent $100 billion more and the outcomes didn't improve.
When all democrats want to do is throw more money at problems, they just make it that much harder to reach consensus on a single payer system. Even now their claims that reducing the exploding Medicaid expansion costs will result in deaths diminish their credibility significantly.
It's not about spending but about outcomes. Democrats have yet to mention outcomes except when they were promising how much better they would be if Obamacare was passed. (They weren't.)
2
Treating MORE disabled veterans--including some who would have died during World War II or even Vietnam, but now survive with more severe disabilities than before, given advances in medical knowledge in the past 50 years--without a matching rise in funding doesn't make sense as basic arithmetic.
Correlation does not equal causation. The problems of the Medicaid population are complex, including patients having gotten into bad habits during their years without medical care or needing treatment for more severe conditions since they couldn't get the early stages treated before Medicaid was expanded.
Correlation does not equal causation. The problems of the Medicaid population are complex, including patients having gotten into bad habits during their years without medical care or needing treatment for more severe conditions since they couldn't get the early stages treated before Medicaid was expanded.
7
I haven't gone through all the comments so maybe I'm repeating what someone else has already said. I like the idea of a single payer system a lot. However, it is inevitable that some aspect of whatever were to be enacted will be less than perfect. Therefore, it is absolutely crucial that a completely unsubsidized (no tax deductions for example) private alternative be available. If you don't like the government medical system, fine then go private ON YOUR OWN DIME. One could pay out of their own pocket or buy insurance in a much smaller private health insurance market. My understanding is that most countries with "socialized medicine" have this function and that it frequently means that rich people get elective procedures (joint replacement for example) in a private system rather than wait in long lines in the government system. If the government system is as horrible as some would claim (and I myself don't think would be the case), a private alternative might be an effective, if expensive, escape valve.
11
Amen. Americans will NEVER agree to a system without their having some private options. The greatest criticism of Obamacare, aside from high costs, is the removal of choice. This is why republicans always mention returning "choice" to Americans. They're responding to their constituents.
Americans have a long history of government suspicion and a deep libertarian streak. We are not Sweden and will never be. The American solution will have to work for Americans, not any other nationalities.
Americans have a long history of government suspicion and a deep libertarian streak. We are not Sweden and will never be. The American solution will have to work for Americans, not any other nationalities.
5
So you want me to pay for your care while I then pay for my own?
Here is an idea, you pay for yours and I will pay for mine.
Here is an idea, you pay for yours and I will pay for mine.
3
Others will be paying for yours too remember. How's that for an idea?
1
TOTALLY agree with this article. However anyone who takes the trouble to so thoroughly discuss single payer has to propose one or two ways to PAY for it. The casual mention of increased taxes is lame. Be specific. I hope you would NOT expect American employers to provide the cash. Do you think we should radically raise income taxes? My suggestion for decades has been that a national Value Added Tax (VAT) is best, maybe 10% to 15%. Many advantages. The cost is spread over all of us and basic health care is available also to all of us.
3
I don't see an issue with requiring employers to pay for some or all of the cost. Don't most people of working age get insurance through an employer of some sort?
I propose a tax that's proportional to the number of hours worked (with no minimum number of employees or hours - I'm looking at you, employers who manipulate hours to stay under the ACA coverage requirements).
I propose a tax that's proportional to the number of hours worked (with no minimum number of employees or hours - I'm looking at you, employers who manipulate hours to stay under the ACA coverage requirements).
7
Single payer would relieve most large employers of a big cost -- that of providing health insurance to their employees. It only makes sense that they would have to provide some of the financing. Plus, it would make American companies more competitive with international corporations that currently are not saddled with the cost of providing health care to their employees.
3
There are lots of other related benefits with Single payer that people dont mention.
* Car insurance and personal liability insurance is cheaper as you dont need to sue for medical costs. Fewer court cases and lawyers
* Health policy gets more interested in making people healthier as it reduces the countries' bill
* People are more likely to quit jobs and start smaller companies as they dont need to work at the corporation for the health benefits.
* Car insurance and personal liability insurance is cheaper as you dont need to sue for medical costs. Fewer court cases and lawyers
* Health policy gets more interested in making people healthier as it reduces the countries' bill
* People are more likely to quit jobs and start smaller companies as they dont need to work at the corporation for the health benefits.
66
Also, labor can be more mobile as healthcare is wholly transferable.. If employers pay no part of the cost, the conflict caused by religious beliefs may disappear.
10
The argument is completely specious. The reason virtually every EU country as well as Australia has lower costs than the US has nothing to do with the payment system. It's due entirely to the fact that each of those countries has at least 50% more doctors per capita than the US. If you increase the supply of healthcare by increasing the number of doctors then of course the price will fall. It's simple supply and demand. Subsidizing healthcare just drives up the cost if you don't also increase the supply. That was the lesson from Obamacare. And it will also be the lesson from single payer if they are ever able to get it passed.
6
http://bigthink.com/strange-maps/185-the-patients-per-doctor-map-of-the-...
The number of doctors in the U S is not sufficiently lower than in most EU nations and in fact Canada, Britain, and Australia have more patients/doctor than we do. What we don't know is how many of the 390 people/doctor don't get medical attention because they have no insurance.
The number of doctors in the U S is not sufficiently lower than in most EU nations and in fact Canada, Britain, and Australia have more patients/doctor than we do. What we don't know is how many of the 390 people/doctor don't get medical attention because they have no insurance.
2
Two corrections:
1. The US spends at least 40% more than 'actually' any European country. And 100% more than the average industrialized (OECD) country.
2. The numbers of doctors per capita vary widely. I just checked the numbers on the OECD database. Number of practicing physicians per 1,000 inhabitants in 2014 (latest numbers for USA):
USA 2.6
Japan 2.2, Korea 2.3
Poland 2.3, Belgium 2.8, Ireland 2.8, UK 2.8
Canada 2.5
France 3.1, Italy 3.9, Germany 4.1, Switzerland 4.1
1. The US spends at least 40% more than 'actually' any European country. And 100% more than the average industrialized (OECD) country.
2. The numbers of doctors per capita vary widely. I just checked the numbers on the OECD database. Number of practicing physicians per 1,000 inhabitants in 2014 (latest numbers for USA):
USA 2.6
Japan 2.2, Korea 2.3
Poland 2.3, Belgium 2.8, Ireland 2.8, UK 2.8
Canada 2.5
France 3.1, Italy 3.9, Germany 4.1, Switzerland 4.1
4
Very simple question:
Compared to what we have today, who would benefit under a single payer system when all is said and done?
If the answer is the poor, old, and disabled - good luck. Plans that bank on sympathy rarely work.
If the answer is everyone (all consumers regardless of income), then I suspect the hospitals, doctors, and pharmaceutical companies will lose big time from what you describe as price negotiation.
Additionally, what are we going to do with all the low wage administrative assistants who will be displaced? Not an excuse to delay single payer, but it's a real cost that needs to be considered.
Compared to what we have today, who would benefit under a single payer system when all is said and done?
If the answer is the poor, old, and disabled - good luck. Plans that bank on sympathy rarely work.
If the answer is everyone (all consumers regardless of income), then I suspect the hospitals, doctors, and pharmaceutical companies will lose big time from what you describe as price negotiation.
Additionally, what are we going to do with all the low wage administrative assistants who will be displaced? Not an excuse to delay single payer, but it's a real cost that needs to be considered.
3
Prof. Frank is thinking like an economist. In behavioral economics, efficiency and human well-being are the end goal. They are the sublime realization of human decision making. He's absolutely right but he misunderstands the political friction. If the United States is charging $73,000 for a procedure where the procedure should cost $23,000, the excess $50,000 has to go somewhere. Someone profits from the inefficiency.
Your mind might leap to fat-cat billionaires but regular people make a living off health care complexity too. Think about the HR negotiator or the clinic administrator. Healthcare represents 1/6th of the economy. That's roughly 17 percent. If we use the cost savings from above, single-payer would reduce costs by nearly 69 percent. Consumption equals production. We've just eliminated the usefulness of around 10 percent of the economy.
I agree that single-payer is the way to go. However, we've done nothing to inform people about what that transition might look like. If you work for a insurance call center, you might justifiably be concerned about a negative impact on your livelihood. Presumably, the employee's health care coverage is derived from waste in the system elsewhere. I think we need to do a better job visualizing the change in addition to glorifying the outcome. We need to show people how America gets to single-payer.
Your mind might leap to fat-cat billionaires but regular people make a living off health care complexity too. Think about the HR negotiator or the clinic administrator. Healthcare represents 1/6th of the economy. That's roughly 17 percent. If we use the cost savings from above, single-payer would reduce costs by nearly 69 percent. Consumption equals production. We've just eliminated the usefulness of around 10 percent of the economy.
I agree that single-payer is the way to go. However, we've done nothing to inform people about what that transition might look like. If you work for a insurance call center, you might justifiably be concerned about a negative impact on your livelihood. Presumably, the employee's health care coverage is derived from waste in the system elsewhere. I think we need to do a better job visualizing the change in addition to glorifying the outcome. We need to show people how America gets to single-payer.
10
Debate will probably go on for a long time about whether it was wise for the Democrats to try to compromise with the Republican Party by accepting a Republican-designed system like Obamacare, and it should.
Clearly Obamacare didn't win the Democrats any Republican votes and it didn't head off Republican sabotage and even subversion of the law of the land.
But on the other hand, it has provided cover for many Democrats in the short term, and it may turn out to have been a sound step from a strategic perspective, for all the drawbacks it has when viewed in isolation. Time will tell.
Clearly Obamacare didn't win the Democrats any Republican votes and it didn't head off Republican sabotage and even subversion of the law of the land.
But on the other hand, it has provided cover for many Democrats in the short term, and it may turn out to have been a sound step from a strategic perspective, for all the drawbacks it has when viewed in isolation. Time will tell.
4
Have the Democrats come out against single payer. I'll bet the Republicans would pass it in a minute. There was a time when they actually supported the idea just like the supported the individual mandate.
3
Single payer is the best choice.
The Federal and State governments now pay 64% of all US health care spending (1.8 Trillion) and this will increase to 67% in 2024. Canada, single payer country, pays 71%. 20% of this cost in the US is due to the loss of revenue from the tax deductions for all costs paid by employers (300 billion). This means there is only a 4% difference in government costs between the two countries. Yet, the cost to individuals is 3X in the USA. (Am Journ Public Health 2016).
We hear Republicans complaints about the Canadian system but the USA corporations in Canada love it.
Russ Hunt, financial director of Costco Canada, says today that having employees covered by Canada’s Medicare program is a tremendous savings for the firm’s Canadian unit, compared to its parent company in the U.S., where Costco has a reputation as an “enlightened” employer offering good benefits. In an interview, Hunt hastened to add that even in Canada, the company has to turn to private insurers to provide its workers with supplemental coverage beyond just doctor and hospital. (Cost to employers about $1000 per employee versus $10,000 in USA)
The Federal and State governments now pay 64% of all US health care spending (1.8 Trillion) and this will increase to 67% in 2024. Canada, single payer country, pays 71%. 20% of this cost in the US is due to the loss of revenue from the tax deductions for all costs paid by employers (300 billion). This means there is only a 4% difference in government costs between the two countries. Yet, the cost to individuals is 3X in the USA. (Am Journ Public Health 2016).
We hear Republicans complaints about the Canadian system but the USA corporations in Canada love it.
Russ Hunt, financial director of Costco Canada, says today that having employees covered by Canada’s Medicare program is a tremendous savings for the firm’s Canadian unit, compared to its parent company in the U.S., where Costco has a reputation as an “enlightened” employer offering good benefits. In an interview, Hunt hastened to add that even in Canada, the company has to turn to private insurers to provide its workers with supplemental coverage beyond just doctor and hospital. (Cost to employers about $1000 per employee versus $10,000 in USA)
6
After 25 years in the healthcare industry, OF COURSE a single-payer medical and healthcare services delivery system is cheaper to cover the greatest number of people. OF COURSE--that will always be true when taking out profit and Marketing & Sales from the costs.
BUT--where is the cost in the number of jobs lost in the current healthcare system, and ripple effects on the overall economy, in this analysis? In California alone, it's estimated 913,000 jobs will be lost moving to a single-payer system. Those are good-paying jobs. Where's that in your analysis?
BUT--where is the cost in the number of jobs lost in the current healthcare system, and ripple effects on the overall economy, in this analysis? In California alone, it's estimated 913,000 jobs will be lost moving to a single-payer system. Those are good-paying jobs. Where's that in your analysis?
2
But demand (and therefore income) will increase.
The greatest flaw in most of The Times' coverage is the dearth of bottom line cost analysis. This piece certainly doesn't cut it. Just more speculation posing as "economic analysis."
Medicaid costs increased by $100 billion and fraud doubled after Medicaid was expanded under Obamacare. People aren't fools.
Medicaid costs increased by $100 billion and fraud doubled after Medicaid was expanded under Obamacare. People aren't fools.
1
As one who lived in a country which had single payer health cover for all of my life up to the age of 74 years, I can attest to the effectiveness and relative low cost of our system. It started when I was four years old and had given me a healthy life up to 2008. I married a woman from USA then and we moved off to Australia, whose health scheme was similarly effective and low cost.
The cost in my country is 4000USD per person per annum. The US system up to this year, here in USA is double that and lots of change. I can see it working here if only on a per state basis, as proposed for California, easily and without any of the stated problems anticipated by comments in the Times.
The cost in my country is 4000USD per person per annum. The US system up to this year, here in USA is double that and lots of change. I can see it working here if only on a per state basis, as proposed for California, easily and without any of the stated problems anticipated by comments in the Times.
8
As a Canadian, I am totally in favour of single-payer. Americans who have come here to work are generally thrilled that the process of getting treatment is so simple - show your card, it's good everywhere, there are no different levels of care for you versus someone who earns more or less than you do. But something that's not mentioned in this article - most of our hospitals are government owned and run. There are no CEO and shareholders trying to make a profit. Medical bigger part of your economy than just how much your health care costs: jobs in insurance (whose purpose is to deny care), hospital billing departments would go, those corporations that own the hospitals might have to divest. It's staff are paid a salary, wages, or fee for service. Single-payer would change a not a quick fix, which is why Obamacare's baby steps in that direction made sense. But I cannot imagine living as Americans do.
12
Robert Frank,
"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."
No fringe group here, but yes taxes are involuntary confiscation of money from individuals. If I did it to you it would be called theft. Taxes cannot be voluntary, but should only be used for things that only governments can provide. These are primarily issues that suffer from under investment caused by free riders. Health care does not suffer from free rider problems. It is quite possible for individuals to purchase the health care they consume.
The fact that individuals choose to dedicate the limited resources they control to things other than health care and health insurance, does not justify forcing someone else to pay.
SMV
"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."
No fringe group here, but yes taxes are involuntary confiscation of money from individuals. If I did it to you it would be called theft. Taxes cannot be voluntary, but should only be used for things that only governments can provide. These are primarily issues that suffer from under investment caused by free riders. Health care does not suffer from free rider problems. It is quite possible for individuals to purchase the health care they consume.
The fact that individuals choose to dedicate the limited resources they control to things other than health care and health insurance, does not justify forcing someone else to pay.
SMV
4
"Apart from fringe groups that denounce all taxation as theft,"....The fringe group to which you refer is headed by Paul Ryan and includes almost every member of the House of Representatives. I only wish they were a fringe group.
5
" It is quite possible for individuals to purchase the health care they consume." You must be wealthy, or medically lucky, or both. Many medical encounters cost $50-100,000 or more, which bankrupts many victims, who did not have the funds to buy medical insurance. People at and below the poverty level simply did and do not have the funds to buy medical insurance. And before the ACA the pre-existing conditions clauses shut out many people. You seem to lack real-world experience, or empathy, or both.
2
The function of business is to extract the greatest profit from a market. The function of the market is to provide the greatest benefit to those who deliver the best products. Healthcare does not operate on this premise, because: 1) the supply of 'the best' cannot be determined; finding "the best" is not supported or practical; and no human continuously operates at his or her best (we are not widgets); 2) The demand for healthcare is largely dependent on unexpected events, no on fixed desires or needs; 3) the fragmentation of the market promotes higher rather than lower prices; 4) the creative destruction of capitalism, supports a strong resistance to change, and thus places 'potholes' in the road to provide consistent and reliable healthcare. Universal health care can solve all of these problems by increasing, effectiveness, efficiency, and outcomes in a consistent, reliable way while reducing costs at the same time. The idea that markets are the only way to deliver 'common goods' to human civilization is the equivalent of using 'stone axes' rather than guns to hunt (for those conservatives who need analogy), and it is the the equivalent of ignoring the advances that we humans have made by using technology to extend our senses, our micro-mechanical skills (machine surgery), our ability to manage and extract new information from large scale data collection and analysis, and artificial intelligence, in general, ie, average humans augmented by machines.
3
Single-payer or Medicare for all biggest savings would be setting up a cost schedule for all medical procedures. The government, not doctors or hospital would determine medical procedural cost. There is no logical reason for a bypass operation costing 23K in France should cost 73K in the US, other than the medical-industrial complex thinks they can get away with charging this much and insurance companies will pay it and just pass the cost to their customer base. Same with drugs - there is no reason other than greed for companies to continue to raise prices on older non-patent drugs year and year, especially when there is not production cost increase. They do it, because the insurance companies will pay.
11
Health care is a necessity if one is to live a long an healthy life. The costs of health care are very high, even for relatively routine services, so to assure that all receive what they need, it's essential that the risks be shared by all and the costs to paid by all. The ability to predict health care costs for an entire population is very good, it simply requires keeping good records and the statistics speak for themselves. The ability to predict health care costs for an individual is not very good, when we consider the risks of someone developing some disease from any given set of circumstances significance is measured with as little as 5% correspondences. This means that notions like people being able to expect less health care because of their family history and habits may be statistically correct but still leaves a great amount uncertainty as to whether anyone might develop the infirmity. In reality until we have lived out our lives nobody can be assured of how much they must spend on health care. The costs and profitability of insurance depends upon predictability of outcomes for those insured and so we see that unless all are participating the feasibility of serving everyone's needs is simple impossible to predict. This is why it is very likely that in the end the U.S. will adopt a single payer system to fund universal health care coverage.
2
Single payer would also have a major impact in reducing our deficit and debt. It would substantially reduce the cost of entitlement spending, which would allow us to pay down our debt more quickly.
7
Just one question: how do we convince our congressmen to vote in favor of eliminating one of their largest sources of campaign funding?
Look what happened after the Sandy Hook shootings - not even the mindless slaughter of innocent children and a majority of US citizens in favor of increased background checks was enough to convince our "public servants" to abandon their NRA funding sources and vote yes on common sense legislation. So how likely are they to abandon a much larger cash cow from pharmaceuticals, health care providers, and insurance companies, just because it would be good for the country and preferred by a majority of citizens?
Look what happened after the Sandy Hook shootings - not even the mindless slaughter of innocent children and a majority of US citizens in favor of increased background checks was enough to convince our "public servants" to abandon their NRA funding sources and vote yes on common sense legislation. So how likely are they to abandon a much larger cash cow from pharmaceuticals, health care providers, and insurance companies, just because it would be good for the country and preferred by a majority of citizens?
31
Isn't one promise of capitalism that companies merging into larger companies creates a more efficient system? If all the medical insurance companies were to merge into one behemoth, there would finally be one risk pool consisting of ALL Americans, including the elusive young and healthy.
Single payer would immediately create that universally large pool.
In addition to cutting admin costs single payer would make Workers Comp & Disability insurance redundant.
You would no longer need to purchase medical liability for your home or automobile.
With single payer, we would have no need for separate VA and TRICARE health programs.
It should also remove need for malpractice insurance doctors carry, as they could be indemnified by the system.
Single payer would relieve businesses of having to assemble creditable health care options for their workers. Both the employer's and the individuals' portions of insurance premiums currently being paid would be redirected to the single payer / Medicare pool, and allow businesses to concentrate on their business, not providing health care.
Government at the same time could
a) rectify Part D's lack of funding stream
b) include language for price breaks on drugs created with federal funds and at public institutions
c) increase pipeline capacity for applicants wanting to become doctors (both college admissions and teaching hospitals) to eventually increase the ratio of doctors to population.
Single payer would immediately create that universally large pool.
In addition to cutting admin costs single payer would make Workers Comp & Disability insurance redundant.
You would no longer need to purchase medical liability for your home or automobile.
With single payer, we would have no need for separate VA and TRICARE health programs.
It should also remove need for malpractice insurance doctors carry, as they could be indemnified by the system.
Single payer would relieve businesses of having to assemble creditable health care options for their workers. Both the employer's and the individuals' portions of insurance premiums currently being paid would be redirected to the single payer / Medicare pool, and allow businesses to concentrate on their business, not providing health care.
Government at the same time could
a) rectify Part D's lack of funding stream
b) include language for price breaks on drugs created with federal funds and at public institutions
c) increase pipeline capacity for applicants wanting to become doctors (both college admissions and teaching hospitals) to eventually increase the ratio of doctors to population.
3
Anti-monopoly laws and rulings seem to indicate that is not always an expected promise from larger companies.
2
By that logic, we should have single payer everything.
1
Nice comment, but the fact is that the single payer experiment has been run and it isn't just a little less expensive, it is a lot less expensive. The Canadian healthcare system provides universal coverage, has better health care outcomes, and costs 40% less per person than we are now paying in the U.S. But I guess maybe you are not interested in having the country save $1.2 trillion dollars every year.
9
I'm all for it. But the devil will be in the details. For example....Will health care connected republicans insert a clause such as "single payer cannot seek out a cheaper price for drugs" like Bush did..... Foreign hospitals will be beating down the doors to come in and offer better services at our hugely inflated prices, will that be restricted?
This article made a gigantic error by not showing the current government spending on healthcare. We could repurpose our horribly inefficient current spending into Medicare For All will little on none extra government spending. https://www.forbes.com/sites/theapothecary/2015/01/27/conservative-think...
5
Put everyone on Medicare. Cradle to grave. The bureaucracy needed to run such a system is already there. Let's do it.
12
Clearly, the technical points in this article are correct.
But there are a couple of other aspects of single-payer that need to be mentioned.
One, if financed out of general revenues, it will constitute a wealth transfer. You really have to acknowledge that, I think. The great mass of citizens would be much better off under single-payer, not just from the greater efficiency, but because it would probably be paid for by progressive taxation.
Think of the current system of premiums as a poll (per-capta, head) tax. Same amount per person. Single-payer converts that to an income tax. Lower-income individuals win.
The second thing that people never think of is that you-know-who, or someone like him, might end up running your single-payer system. So if you love the way Scott Priutt is defending the environment over at EPA ... I hope you get the drift.
You could very well end up putting all your eggs in one basket, then handing the basket over to an incompetent lunatic. So some thought need to go into providing safeguards against the purposeful mis-handling of a single payer system. You really need to put some thought into how you'd prevent the next Scott-Pruitt-analog from purposefully destroying single payer.
But there are a couple of other aspects of single-payer that need to be mentioned.
One, if financed out of general revenues, it will constitute a wealth transfer. You really have to acknowledge that, I think. The great mass of citizens would be much better off under single-payer, not just from the greater efficiency, but because it would probably be paid for by progressive taxation.
Think of the current system of premiums as a poll (per-capta, head) tax. Same amount per person. Single-payer converts that to an income tax. Lower-income individuals win.
The second thing that people never think of is that you-know-who, or someone like him, might end up running your single-payer system. So if you love the way Scott Priutt is defending the environment over at EPA ... I hope you get the drift.
You could very well end up putting all your eggs in one basket, then handing the basket over to an incompetent lunatic. So some thought need to go into providing safeguards against the purposeful mis-handling of a single payer system. You really need to put some thought into how you'd prevent the next Scott-Pruitt-analog from purposefully destroying single payer.
4
The thought of senators -- both democratic and republican -- being paid billions in bribes by Big Pharma, etc., making my medical decisions isn't particularly alluring either.
4
National-level single-payer can be easily created by expanding Medicare to cover everyone. By "easily," I refer not to getting such a thing passed and paying for it, but rather implementing it. CMS would have to expand, but Medicare has a nationwide system in place to bill for services and measure the things it pays for. And providers know how to bill Medicare.
One problem with the Colorado initiative (among many) was the time, expense and hassle to create a new payer from nothing. The state was going to create a commission to spend two years figuring it out, before any implementation could be done. It was going to create and fund an entire new state entity. California's skeleton of a proposal would face the same hurdle. This reality, coupled with the need for a pool of insured people that needs to be as large as possible, is the reason that single-payer needs to be done at the national level, not the state level.
One problem with the Colorado initiative (among many) was the time, expense and hassle to create a new payer from nothing. The state was going to create a commission to spend two years figuring it out, before any implementation could be done. It was going to create and fund an entire new state entity. California's skeleton of a proposal would face the same hurdle. This reality, coupled with the need for a pool of insured people that needs to be as large as possible, is the reason that single-payer needs to be done at the national level, not the state level.
4
Doesn't matter that single-payer health care saves money. The HMS and medical system will make sure that their lobbyists get their message across to their senators and congresspeople! Besides, the Trumpster and Republicans want to make cuts, and it's their agenda that counts - who cares for the people of the USA?
4
Crunching the numbers to yield a meaningful analysis is the ultimate task to convince people that single payer can work. The devil is in the details: For example, the suggestion that 15% would be saved by eliminating advertising is a generalized statement. Advertising is communication. A single payer plan would require a new form of ongoing communication to the public about the plan, which costs money. So the entire 15% would probably not be available. Every shift of functions or costs can lead to a variety of outcomes regarding savings. The biggest challenge is to convince people the analysis is accurate.
1
It would be more relavant if you addressed the fact that the Canadian universal coverage, single-payer costs 40% less per person than we are now already paying. The only analysis you have to do to assume a large amount of money would be saved is that Americans are at least half as smart as Canadians.
4
Our politicians represent the insurance companies. They don't represent us. If they represented us, there would be no healthcare debate as the Single-Payer solution is simple:
1. Abolish the employer-based system while simultaneously requiring employers to maintain the SAME level of “Total Employee Compensation". This results in the average employee who has family health coverage through their employer receiving $18,000/year in additional salary (rather than spent on health insurance).
2. Expand Medicare as a universal coverage to ALL Americans.
3. Fund the program with a federal consumption tax on all consumer spending (all goods and services).
The consumption tax would be more than offset by the additional salary one would receive from their employer that is currently paid to insurance companies.
The math works, unfortunately our politicians don't work for us. They are insurance company puppets...especially the corporate Democrats. https://theintercept.com/2017/07/01/dick-gephardt-single-payer-health-in...
1. Abolish the employer-based system while simultaneously requiring employers to maintain the SAME level of “Total Employee Compensation". This results in the average employee who has family health coverage through their employer receiving $18,000/year in additional salary (rather than spent on health insurance).
2. Expand Medicare as a universal coverage to ALL Americans.
3. Fund the program with a federal consumption tax on all consumer spending (all goods and services).
The consumption tax would be more than offset by the additional salary one would receive from their employer that is currently paid to insurance companies.
The math works, unfortunately our politicians don't work for us. They are insurance company puppets...especially the corporate Democrats. https://theintercept.com/2017/07/01/dick-gephardt-single-payer-health-in...
8
We've had 8 years of time to really think about the ACA (a plan originally developed by conservative leaning think tanks as a viable alternative to single payer). Though I think the ACA can be a decent way to provide health insurance in ideal circumstances. Some reforms are doable, such as Getting insurance pools big enough to even out the sick enrollees and provide enough market for insurance companies to want to be a part of (doable in many ways, the simplest would be to have all government employees, including public school teachers, into ACA marketplace plans). But the underlying problems exist -- Even with many people on high deductible plans nowadays (since many private companies, and even many state-government plans, have shifted to them), there is still no signs that medical care can be or will be value-shopped to bring down costs. And there is no way to get around the logistics (and costs) involved in providers dealing with multiple insurance companies, each who manage multiple plans. There is also some inability for insurance companies to negotiate things like drug costs, whereas foreign governments are very successful at this. After 8 years of chewing over the ACA, it is clear to me, at least, that only single-payer healthcare can legitimately reduce and control healthcare costs. A free market only works when prices are transparent, options are abundant, and the product is an elective purchase. Healthcare fails on all three categories.
2
Mr. Frank, you are "preaching to the choir". I doubt that there are many NYT readers who are NOT in favor of Single Payer health care...............For a starter and an eye-opener, just go spend some time in Canada: single-payer is expensive, but it works.
5
Finally a story in the New York Times about the benefits of a single-payer system. I was beginning to wonder if the insurance lobby had paid you off as well as the politicians.
20
Prof. Frank, You say that even though taxes would go up, single payer would be less expensive per capita than our current system. Would you mind being more concrete about how individuals would save money. I'm not denying your claim; I'm asking for a clear description of how the average person would actually find himself with more money.
Thanks.
Thanks.
4
How do individuals save money? Look at your paycheck and see how much both you and your employer are paying for health care premiums. Add that to how much you spend a year in copays and other out of pocket costs. Those costs are all gone in a single payer, and replaced with higher taxes. Because single payer is cheaper, the higher taxes should be less than what the average person is paying in premiums and out of pocket expenses. To me, a healthy individual with a health wife and kid, the amount we pay for healthcare (including what our employers pay on our behalf) and it is about $20,000, which is more than my total federal income tax ($18,000). The trick, and uncertainty, is to make sure that the taxes are raised in a way that employers aren't just pocketing their savings in premium coverage (and hr costs associated with healthcare management) as higher profits while taxes are raised on workers. So there is a devil in the details.
6
Since Professor Frank is not likely to respond to your comment, let me take a stab at it. If I understand him correctly, the basic idea is that the increase in your (federal) taxes necessary to fund such a program would be less than the amount currently paid for your health care. The economic benefit is straightforward if you currently pay for your own insurance/health care “out-of-pocket”. If your employer provides you with health care as part of your “total compensation”, this requires (I believe) the additional assumption that employers will replace health care benefits for individual workers with salary. Whether that replacement would need to be “dollar for dollar” to put more money in the hands of an individual employee/taxpayer, and what incentive, other than the goodness of their hearts and a sense of fairness, employers would have to do this at all could be difficult issues. If this is an accurate picture, and given the high proportion of Americans covered by employer-sponsored health plans, these issues would have to be addressed in order to translate the presumed lower costs of a single-payer system into economic benefits for individuals.
2
Of course taxes would have to go up because much of the money we that we are now paying comes from employers who provide health insurance for their workers. But if you captured all of the money from all of the sources that we are now already paying for healthcare the net savings to the country would probably be enough to balance the Federal budget and put additional cash in eveyones pocket. That we are not already doing so is a form of economic insanity.
2
People seem to fail to understand that their current insurance premium is higher than the increase in taxes required for single-payer. Republicans have done a great job of demonizing taxes and government inefficiency, as well as convincing people taxes, are unpatriotic socialism. Democrats have done a poor job of proving government can be very efficient, that taxes can reduce overall household costs and that socialism is already a part of our government.
31
Well said. You hit the nail on the head.
'Single Payer' such as England's National Health should not be confused with other EU countries where there is a role for private insurance. The US has the most inefficient health care delivery system, but there are multiple alternatives worthy of consideration. The conundrum is that demand for health care is essentially infinite whereas resources are not. It is a political, economic and systems problem. The UK and Swiss systems are very different. It behoove us to look at all the viable alternatives and avoid the use of the politically charged label 'single payer'.
13
I've found that many people advocating for "single payer" have no idea about the different models. Often they believe in a utopian model that doesn't even exist in the countries they cite.
The first step is to educate Americans about the different models. The last thing we need is another utopian program pushed based on unrealistic ideas (like Obamacare).
The first step is to educate Americans about the different models. The last thing we need is another utopian program pushed based on unrealistic ideas (like Obamacare).
2
There are some clear benefits to a single-payer system, but the author's economic argument is not a valid one. There would be efficiencies in having a uniform methodology in contracting and paying providers. But unlike private insurers, Medicare does not employ nurses, physicians, and social workers who provide services directly to beneficiaries and providers to help coordinate care; especially for the very costly beneficiaries. Private insurers have shown that they can spend more in administrative costs to save much greater dollars in medical costs. If the federal government were a single payer the government should bid out the management of the health system to private companies for a set fee. These firms would provide administrative services to beneficiaries and providers, coordinate beneficiaries’ care, design incentive systems for providers to deliver quality care in the most efficient manner, and develop incentive systems for members to take better care of themselves. The winning bidders would have targets for cost and quality and would compete for the business in various geographical areas. It seems to me the only way have a single-payer system with some control over quality and cost.
The main advantage of single payer is that everyone is covered. No reform of the individual health system is sustainable without a stronger individual mandate. This does not require a single-payer system; a private payer system like the Swiss have or like Medicare Part D works fine.
The main advantage of single payer is that everyone is covered. No reform of the individual health system is sustainable without a stronger individual mandate. This does not require a single-payer system; a private payer system like the Swiss have or like Medicare Part D works fine.
1
Wrong. The authors economic argument is not only valid, it is understated. The reduced amount of paper work required in itself would be a significant savings ignoring the fact that the increased leverage would would be even more effective. You would have to argue that Americans are so dumb they can't establish a single payer system like Canada which costs 40% less per person than what we now pay - that 40% would only be an anuual savings of $1.2 trillion dollars or two and a half times our present Federal deficit.
5
"Private insurers have shown that they can spend more in administrative costs to save much greater dollars in medical costs." --
"The stealth battle between hospitals and insurers over bills for each hospitalization, office visit, test, piece of equipment and procedure is costly for us all. Twenty-five percent of United States hospital spending — the single most expensive sector in our health care system — is related to administrative costs, “including salaries for staff who handle coding and billing,” according to a study by the Commonwealth Fund. That compares with 16 percent in England and 12 percent in Canada." ['Those Indecipherable Medical Bills? They're One Reason Health Care Costs So Much' - March 29, 2017 NYT]
"The stealth battle between hospitals and insurers over bills for each hospitalization, office visit, test, piece of equipment and procedure is costly for us all. Twenty-five percent of United States hospital spending — the single most expensive sector in our health care system — is related to administrative costs, “including salaries for staff who handle coding and billing,” according to a study by the Commonwealth Fund. That compares with 16 percent in England and 12 percent in Canada." ['Those Indecipherable Medical Bills? They're One Reason Health Care Costs So Much' - March 29, 2017 NYT]
1
Baloney. The massive cost estimates, substantially accurate, are due to the fact that many more people would be covered. Obamacare and the flawed Republican replacement proposals are financed by tax credits and outright subsidies. I.e., those who can are being tolled to treat those that can't. The fundamental question, which goes to the heart of the American ethos, is: 'Why should I pay for your health care?'
3
Because you already do. If I am brought to a hospital I am treated first and billed later. If I can't pay then that cost is passed on to Other patients. It's easy to imagine an uninsured accident victim landing in an emergency room and running up many thousands of dollars of care that is then not paid for. A hospital has costs that must be met so that money will be recouped somehow. Unless you wish to deny care based on ability to pay single payer makes economic sense.
11
Because you will pay for mine. My taxes pay for your disaster funding (FEMA) & your taxes pay for mine. That's why we have a government.
5
The majority of Americans would most likely stick with private insurance, if single-payer were available, so they could see their doctors without waiting and choose which doctors they wanted to see. I fear any single-payer plan would become a second-tier Medicaid where some doctors would refuse patients and good healthcare would be difficult to obtain.
I have had some experience with the three single-payer plans (Medicare , Medicaid and the VA). Medicare is a good plan but it requires a supplemental plan, many doctors do not accept Medicaid and it can be difficult to get good care, the less said about the VA the better. I don't see single-payer as the perfect solution the way so many others do. Fixing ACA is a better alternative.
I have had some experience with the three single-payer plans (Medicare , Medicaid and the VA). Medicare is a good plan but it requires a supplemental plan, many doctors do not accept Medicaid and it can be difficult to get good care, the less said about the VA the better. I don't see single-payer as the perfect solution the way so many others do. Fixing ACA is a better alternative.
4
"The majority of Americans would most likely stick with private insurance, so they could see their doctors without waiting and choose which doctors they wanted to see."
I have even more experience with single payer systems, Lynn. I live in Canada and I don't wait to see a doctor, I can see any doctor I want (including specialists), I can go to any hospital and receive treatment, and I have never had to co-pay for services in my 60+ years. I probably pay more in taxes but I will never go bankrupt or lose my house due to medical bills, nor will my neighbour, which is kind of the point.
I'm stunned that some Americans believe the GOP canard that single payer is somehow worse than the for-profit system that puts money ahead of patient well-being. Perhaps you should stop listening to myths and get the facts.
I have even more experience with single payer systems, Lynn. I live in Canada and I don't wait to see a doctor, I can see any doctor I want (including specialists), I can go to any hospital and receive treatment, and I have never had to co-pay for services in my 60+ years. I probably pay more in taxes but I will never go bankrupt or lose my house due to medical bills, nor will my neighbour, which is kind of the point.
I'm stunned that some Americans believe the GOP canard that single payer is somehow worse than the for-profit system that puts money ahead of patient well-being. Perhaps you should stop listening to myths and get the facts.
80
1. I have private insurance and I always have to wait for medical care. I have to make a healthy check-up appointment about 3 months in advanced, a dentist appointment about 4 months in advance, and a eye appointment is still 2 months in advance. When I wanted a vasectomy, I had to wait 2 months before the urologist I was referred to could see me, and that was for a 15 minute consultation, after which, I had to wait another 4 months for the actual snip. When my kid is sick, I am more often than not having to go to a strange doctor a couple of days away for her to be seen by anyone at her pediatrician's clinic. The argument that you may have to 'wait' for healthcare under single payer is a complete and utter joke because in the current system you have to wait anyways!
2. Doctor choice is also an odd over-hyped claim. Now, I do know that in some markets, there isn't that many doctors that take certain government
services, and that is a legitimate issue. But is anyone really that married to their doctor that they would pay a premium to see him/her? All the doctors I have ever had just aren't that special, maybe I am missing out on those magical doctors that I would pay twice the price for.
2. Doctor choice is also an odd over-hyped claim. Now, I do know that in some markets, there isn't that many doctors that take certain government
services, and that is a legitimate issue. But is anyone really that married to their doctor that they would pay a premium to see him/her? All the doctors I have ever had just aren't that special, maybe I am missing out on those magical doctors that I would pay twice the price for.
13
Where in Canada do you live? FWIW I fully support single payer and think the Canadian system is fantastic. However, my in-laws usually wait around a year to get an appointment with their GI specialist. On the other hand, they don't have to worry about medical bankruptcy.
1
Just to take your math one step further:
A savings of about 10% on administrative costs over the entire American population (including supplemental insurance to Medicare) amounts to possibly $300 billion per year or $3 trillion over ten years. It's money that could be spent directly on health care delivery....and that's before we find more efficiencies in heath care delivery.
Please send your article to our senators, representatives, and president.
A savings of about 10% on administrative costs over the entire American population (including supplemental insurance to Medicare) amounts to possibly $300 billion per year or $3 trillion over ten years. It's money that could be spent directly on health care delivery....and that's before we find more efficiencies in heath care delivery.
Please send your article to our senators, representatives, and president.
12
The cost savings from eliminating the "middle man" should be obvious to all. Still this is an unusual article in stating the obvious. (Gee, you have a nose on your face!)
But what's needed is actual figures. What are the profits for the pharmaceutical and health insurance industries? Let's name names here. And how have the profits changed through time?
Most recently, Big Pharma got its way: no approval for ACA without negating bargaining power on drug prices. I want to know how that lobby worked, whose flimsy arms are pulled, who sold us out? It's time to name names now.
We already know theres a nose on our faces.
But what's needed is actual figures. What are the profits for the pharmaceutical and health insurance industries? Let's name names here. And how have the profits changed through time?
Most recently, Big Pharma got its way: no approval for ACA without negating bargaining power on drug prices. I want to know how that lobby worked, whose flimsy arms are pulled, who sold us out? It's time to name names now.
We already know theres a nose on our faces.
45
Trump in campaign mode indicated he would demand negotiations with big pharma as part of his deal-making skills. He backed down. At what cost to the citizens of the U.S. but the gain of the insurance companies? We may never get the figures.
A couple of differences should have been discussed in the article: The V.A. owns its own facilities, and its employees are government employees, both of which characteristics also are true of European single-payer systems. So to scale up to a state or nationwide single payer system, the state or the federal government would have to own the hospitals and have staff as government employees. Would that ownership change come without a present-value payment to owners of existing hospitals, or would the state or federal governments build new ones? Either state or federal governments could pay for the education of new employees and thereafter ask and expect that they work for the entity which paid for their education, but how many currently-skilled health care professionals would be willing to work for government pay levels? The notion of an instant change is an incompleteness assumption in the nature of an anachronism, which proponents (and I too see the eventual benefit) must build into their idealization, but haven't so far. The book "An America Sickness" details a number of the ways the current private-ownership of insurance companies, hospitals and medical practices provides a large and growing part of health care costs to wealth-seeking corporations and individuals, and is a portrait of a cohort of interests who will fight tooth and nail to keep their cornucopia flowing.
6
The idea that existing single-payer systems consist of government-run facilities and government-employed personnel is not even remotely true. Just Google something like "who owns German hospitals" or "Japan has more private hospitals than the US". Even in Great Britain, there are some private hospitals and physicians.
The obvious US model for single payer is Medicare, where direct government provision of services is zero. Or Medicaid, ditto.
Heck, even the modern VA does not provide services entirely through government-run facilities and government-employed physicians. The VA will pay community physicians for care via the Veteran's Choice program.
Single-payer systems span the spectrum from purely financial arrangements like Medicare to full command-and-control systems like the core of the VA.
Implementing some form of single-payer in the US does not necessarily entail any massive change in ownership of anything.
Heck, if you look at the German Sickness Funds model, it's not even clear that you have to get rid of multiple insurers in order to have "single payer".
There are just a lot of ways to do some version of single payer.
The obvious US model for single payer is Medicare, where direct government provision of services is zero. Or Medicaid, ditto.
Heck, even the modern VA does not provide services entirely through government-run facilities and government-employed physicians. The VA will pay community physicians for care via the Veteran's Choice program.
Single-payer systems span the spectrum from purely financial arrangements like Medicare to full command-and-control systems like the core of the VA.
Implementing some form of single-payer in the US does not necessarily entail any massive change in ownership of anything.
Heck, if you look at the German Sickness Funds model, it's not even clear that you have to get rid of multiple insurers in order to have "single payer".
There are just a lot of ways to do some version of single payer.
18
clearly medicare for all persons is a tough issue and i assume the health insurance companies and their ceo's will fight it tooth and nail. the insurance companies and their top officials make a lot of money. they will not go quietly. the insurance companies have done a better job at fighting fraud than our government has done in fighting medicare fraud. that could change if the government decided to spend the time and money fighting the fraud by the doctors, lawyers and associates in the crimes.
the article makes the point that the "providers" of the health care are still private doctors etc. this would be true. the doctors would simply have to deal with the government regulators rather than ignorance company regulators.
single payer should be considered for all persons without the "talking points" by the persons who might lose money such as the insurance industry.
the article makes the point that the "providers" of the health care are still private doctors etc. this would be true. the doctors would simply have to deal with the government regulators rather than ignorance company regulators.
single payer should be considered for all persons without the "talking points" by the persons who might lose money such as the insurance industry.
7
The New York Health Act, which would create a single-payer system to cover all New York residents' medical, dental, vision, hearing, mental, and reproductive care and prescriptions, with no co-pays or deductibles, passed the NY Assembly in 2017 for the third year in a row and was ONE Senator away from a majority in the NY Senate. It would have saved $45 billion in health care costs in the first year alone and lowered health care expenses in 98% of NY households based on a progressive tax.
It will be reintroduced in 2018, so get informed and get involved! Media like the New York Times are, unfortunately, not interested in spreading awareness of progressive bills like this in their own state (they didn't mention the bill by name once this year). So we need to spread awareness as much as we can! Visit http://www.nyhcampaign.org/ for more info.
It will be reintroduced in 2018, so get informed and get involved! Media like the New York Times are, unfortunately, not interested in spreading awareness of progressive bills like this in their own state (they didn't mention the bill by name once this year). So we need to spread awareness as much as we can! Visit http://www.nyhcampaign.org/ for more info.
32
One of the right-wing scare tactics is "your taxes will go up."
Yes, but you'll never have to pay premiums or deductibles again, nor will you have to wonder if your doctor or hospital or lab is in-network or out-of-network, nor will the quality of your health care depend on your annual income. (That's the part that right-wingers REALLY hate. Deep down, they believe that wealthy people are a better breed of human being and deserve better health care just because they're so wonderful.)
Yes, but you'll never have to pay premiums or deductibles again, nor will you have to wonder if your doctor or hospital or lab is in-network or out-of-network, nor will the quality of your health care depend on your annual income. (That's the part that right-wingers REALLY hate. Deep down, they believe that wealthy people are a better breed of human being and deserve better health care just because they're so wonderful.)
138
Plus maybe prescription drug prices can be standardized from state to state. The purchasing power alone of a single payer could result in as much as $16 billion saving per year. (source: AARP)
4
And it would work to eliminate the insurance CEO's million-dollar salaries!
8
Also, the part of your home and car insurances that deal with medical issues---liability---will go away with single payer---saving still more money for people.
1
Unfortunately, this "economic" analysis misses the central political point--a more efficient system means that people lose their jobs. We have the most inefficient medical delivery system in the history of the universe, which contributes mightily to it also being the least effective, because it creates the most jobs possible. Every practitioner and institution and company in the system is rewarded for getting bigger, not for taking better care of people. That's why "health care" accounted for 17.8% of GDP in 2015. If we had a rational system, it would be about 10%. Which means that we'd have a jump in unemployment of about 8%. Solving the "health care" crisis would require 8% of the workforce and the heads of some of the largest corporations in the world to cheerfully give up their careers--in the public interest--and find something new and productive to do with their lives. With the thanks of a grateful nation, of course.
10
The comparison to roads is specious - the challenge is that age-old bugbear - the tragedy of the commons. When you have a limited good and unchecked demand you get a disaster - what you have to do is ration that good via some means. Here is how the UK and Canada do it:
1. Long wait times to see a doctor and even longer to see a specialist. Boston has more MRI's than in all of Ontario, Canada
2. Not everyone gets a Dr. - in canada up to 25% of the population has no Dr.
3. You don't get procedures that you think you need- you get the procedures that the gatekeepers allow you - see by way of example that poor baby in the UK this week.
4. You can't purchase service outside of the system in your own country - why do you think Adele gets treatment in the US? Why do you think Canadian Premiers get treatment in the US?
1. Long wait times to see a doctor and even longer to see a specialist. Boston has more MRI's than in all of Ontario, Canada
2. Not everyone gets a Dr. - in canada up to 25% of the population has no Dr.
3. You don't get procedures that you think you need- you get the procedures that the gatekeepers allow you - see by way of example that poor baby in the UK this week.
4. You can't purchase service outside of the system in your own country - why do you think Adele gets treatment in the US? Why do you think Canadian Premiers get treatment in the US?
7
I could be mistaken, but I also am under the impression that Canadian's are assigned a doctor, they cannot choose one, and they may not switch to a different one.
1
1. MRIs are used a lot more than necessary. Long wait times? One of my friends has worrisome neurological symptoms. She has to wait five weeks to see a specialist. That's in the U.S. with private insurance.
If she were uninsured, she would have to wait forever.
2. There are towns in the U.S. without a doctor, mostly in the Republican strongholds of the rural Midwest and Great Plains states.
3. The "poor baby" in the UK has a catastrophic genetic condition that is always fatal. The parents are trying to artificially prolong a life of suffering. Even the American doctor who was initially willing to treat him withdrew the offer. I've even seen an article by a Catholic theologian saying that this is a case where extraordinary measures lead to greater suffering.
By the way, the British and Canadian systems are run and financed completely differently, although the right-wing propagandists will never tell you that. Nobody but nobody is proposing a British-style, completely government-run system with all the doctors as government employees.
4. Why do you think Americans go to places like Costa Rica for affordable medical care?
I've seen no evidence of hordes of Canadians crossing the border for medical care. Rich people always want to jump the queue, and they do it in the U.S. as well.
If she were uninsured, she would have to wait forever.
2. There are towns in the U.S. without a doctor, mostly in the Republican strongholds of the rural Midwest and Great Plains states.
3. The "poor baby" in the UK has a catastrophic genetic condition that is always fatal. The parents are trying to artificially prolong a life of suffering. Even the American doctor who was initially willing to treat him withdrew the offer. I've even seen an article by a Catholic theologian saying that this is a case where extraordinary measures lead to greater suffering.
By the way, the British and Canadian systems are run and financed completely differently, although the right-wing propagandists will never tell you that. Nobody but nobody is proposing a British-style, completely government-run system with all the doctors as government employees.
4. Why do you think Americans go to places like Costa Rica for affordable medical care?
I've seen no evidence of hordes of Canadians crossing the border for medical care. Rich people always want to jump the queue, and they do it in the U.S. as well.
8
Adele gets treatment in the U.S. because it's better and provided with less waiting. No one else decides if she "needs" it. She picks her own doctor and hospital.
Did you EVER hear of anyone going to the U.K. for medical treatment?? [Other than ex-pats who want "free treatment"] Nope. Germany, Switzerland and/or Sweden maybe. But not the U.K. Their care is sub-standard by many comparisons.
Did you EVER hear of anyone going to the U.K. for medical treatment?? [Other than ex-pats who want "free treatment"] Nope. Germany, Switzerland and/or Sweden maybe. But not the U.K. Their care is sub-standard by many comparisons.
1
I can't believe you didn't discuss the big offset to consumers for rise in federal taxes - the complete elimination of insurance premiums.
Certainly that would ease the pain of any tax increase for thousands of homes and families and individuals.
That premium reflects insurance companies real estate expenses and payroll for huge labor pools and benefits to them and office furniture and computer systems and billing software and advertising and marketing and all that glossy stuff they send you in the mail and call you about and you see on TV and their CEO and executive pay and their Board compensation and their sales incentives and entertainment budget and big fancy conference rooms and jets - oh, and I forgot - their huge, never before seen, obscene - wait for it - Profits - that come after all that other stuff is paid for - and every dollar of which - all the above - is in your premiums before they pay for a dollar of your health care.
Gone. Poof.
No plans to pick, no company to trust, no salesman to talk to, no fine print, no cancellations, no preexisting conditions, no caps.
No premiums - just a bump in your taxes and you walk into the doctor or check into the hospital and there's no bill - ever - for you or your loved ones.
What's so bad about that?
Certainly that would ease the pain of any tax increase for thousands of homes and families and individuals.
That premium reflects insurance companies real estate expenses and payroll for huge labor pools and benefits to them and office furniture and computer systems and billing software and advertising and marketing and all that glossy stuff they send you in the mail and call you about and you see on TV and their CEO and executive pay and their Board compensation and their sales incentives and entertainment budget and big fancy conference rooms and jets - oh, and I forgot - their huge, never before seen, obscene - wait for it - Profits - that come after all that other stuff is paid for - and every dollar of which - all the above - is in your premiums before they pay for a dollar of your health care.
Gone. Poof.
No plans to pick, no company to trust, no salesman to talk to, no fine print, no cancellations, no preexisting conditions, no caps.
No premiums - just a bump in your taxes and you walk into the doctor or check into the hospital and there's no bill - ever - for you or your loved ones.
What's so bad about that?
120
Oops. I forgot. No co-pays or deductibles to pay or compare between plans. Even better.
11
This was in fact the central point I tried to make in the piece. Should have been clearer.
6
Check out single payer plans in the real world. There are co-pays and deductibles I.e. Medicare also some national single payer plans in Europe are structured with those items. The result is a robust private market for supplemental plans to fill out the insurance needs.
2
It might save money, will is a lie. No other country has our diverse population nor our care delivery system. Try proving it, failure I bet.
1
Yes, purely speculative. Like the CBO's projections on Obamacare, many of which were almost 50% off.
3
nonsense. Canada's population is just as diverse (maybe even more) than America's and our single payer system works fine and costs much less per capita than your for-profit insurance schemes.
11
What does our "diverse population" have to do with anything, since Canada's population is even more diverse? There is no such thing as a Western country without a diverse population. Even Iceland and Japan have immigrants.
What is your reasoning? Are you saying that:
1. People of diverse backgrounds are too stupid to take good care of themselves and follow doctors' instructions
or
2. People of diverse backgrounds are inferior to middle class white Americans and don't deserve good health care?
What is your reasoning? Are you saying that:
1. People of diverse backgrounds are too stupid to take good care of themselves and follow doctors' instructions
or
2. People of diverse backgrounds are inferior to middle class white Americans and don't deserve good health care?
8
A common talking point against single-payer that was especially used during Dem primaries last year was that "it didn't work in Vermont, so how can it work for the country?" What people forget is that even private health-insurance (the current system) can not survive if it only existed in Vermont and no-where else. Single-payer (or any "insurance") works only when the "risk is spread".
10
Spread how and to who? Is California large enough?
2
California has the 6th largest economy in the world. Its GDP is higher than France's.
3
It was never fully implemented in Vermont anyway, so that is a bogus talking point.
My question is how does single payer work with considerations to medical liability litigation?
I know that some states, like California, have consumer protections built into their Constitution, and the ability to sue for medical mistakes is a right that people have, but I have heard that this will have to go away once single payer is enacted. Is there any truth to this, or what will happen to the existing tort system?
I know that some states, like California, have consumer protections built into their Constitution, and the ability to sue for medical mistakes is a right that people have, but I have heard that this will have to go away once single payer is enacted. Is there any truth to this, or what will happen to the existing tort system?
If you Google how it works in countries that already have single payer, you may find the answer. In any case, legislation could be adjusted to fit the new system.
1
Single-payer health care saves money and boosts patient satisfaction by eliminating the expense and hassle of health care insurance.
We already have such a system, Medicare. It is huge, efficient, and wildly popular. It covers only the elderly, the most expensive segment of the population. Unfortunately, it doesn't extend to children, the least expensive and most promising segment, or to working age adults, on whose backs and shoulders the economy rests.
Medicare already has in place a mechanism to handle the increased clerical burden from rapid expansion. Under Medicare Advantage, private insurers compete to administer Medicare. (Insurance companies are efficient at clerical and accounting, but hopelessly irresponsible at managing health care.)
Medicare should be offered to all Americans, and piecemeal government programs such as Medicaid and CHIP, should be terminated. Many financial arrangements and government subsidies are possible. For working-age adults and their children, Medicare premiums could be experience-based by age, with subsidies for low-income families.
Regardless of the financial arrangements for paying Medicare premiums, Medicare-for-all would reduce overall medical costs, up to 20%, by eliminating insurance companies from healthcare management.
We already have such a system, Medicare. It is huge, efficient, and wildly popular. It covers only the elderly, the most expensive segment of the population. Unfortunately, it doesn't extend to children, the least expensive and most promising segment, or to working age adults, on whose backs and shoulders the economy rests.
Medicare already has in place a mechanism to handle the increased clerical burden from rapid expansion. Under Medicare Advantage, private insurers compete to administer Medicare. (Insurance companies are efficient at clerical and accounting, but hopelessly irresponsible at managing health care.)
Medicare should be offered to all Americans, and piecemeal government programs such as Medicaid and CHIP, should be terminated. Many financial arrangements and government subsidies are possible. For working-age adults and their children, Medicare premiums could be experience-based by age, with subsidies for low-income families.
Regardless of the financial arrangements for paying Medicare premiums, Medicare-for-all would reduce overall medical costs, up to 20%, by eliminating insurance companies from healthcare management.
16
It is expensive, full of fraud and you have their buracracy and insurance as well. It is popular because it appears cheap to the user. It has massive subsidies!
3
The United States is the only country in the world that runs a FOR PROFIT health system as well as one that is tied (chiefly) to employment. And people of this nation support it? The whole concept baffles me.
Listen, healthcare costs money but there are many ways to pay for it and many ways to reduce the cost. Get rid of the insurers who add no value whatsoever, allow nurses to manage more levels of basic care; allow pharmacists to "dispense" basic medications for things like the flu and birth control and therefore ease the burden on doctors, for example.
Our country would benefit in terms of economics as well. Consider how many people could embark on entrepreneurial, creative, and artistic careers if they didn't have the fear of not having employer-sponsored healthcare or the burden of paying for it themselves? There would certainly be more people willing to open up small businesses if they no longer had to shoulder the enormous expense of healthcare for themselves and their employees.
In so many ways, healthcare has become another dividing line between classes in this country. The haves and the have-nots, the healthy and the sick.
Listen, healthcare costs money but there are many ways to pay for it and many ways to reduce the cost. Get rid of the insurers who add no value whatsoever, allow nurses to manage more levels of basic care; allow pharmacists to "dispense" basic medications for things like the flu and birth control and therefore ease the burden on doctors, for example.
Our country would benefit in terms of economics as well. Consider how many people could embark on entrepreneurial, creative, and artistic careers if they didn't have the fear of not having employer-sponsored healthcare or the burden of paying for it themselves? There would certainly be more people willing to open up small businesses if they no longer had to shoulder the enormous expense of healthcare for themselves and their employees.
In so many ways, healthcare has become another dividing line between classes in this country. The haves and the have-nots, the healthy and the sick.
99
I would add, make hospitals not for profit, or government-run. You don't need CEOs and shareholders looking to wring the last bit of money out of the system.
2
I agree with all that you said, but sadly nurses are now fighting against a bureaucracy that wants to dumb us down. Nursing judgment has always been a part of the job, and nurses (and nurse practitioners) are trained to do far more than we are allowed to do - but the newest thing is to forbid any sort of nursing judgment. I'm not sure if this is filtering down from physicians' groups or elsewhere, but it's not looking good. I'm increasingly grateful that I only have another dozen years before I can retire, if I can last that long, before they just replace us with robotic automatons.
This is accurate and well-reasoned. Unfortunately, there are two reasons this well-reasoned argument will fall on deaf ears. First, the GOP does not have the same goal. They're not trying to make a workable healthcare system. They're trying to fund a massive tax-cut to the wealthy donors who unduly influence them. Second, since Lee Atwater, the GOP have abandoned reason in favor of hyperbole and often outright lies. As you make this entirely reasonable and empirically-supported argument, they will simply scream "death panels" or something near enough to it.
30
Unfortunately, it's not just the GOP. The public option part of the ACA was blocked by seven Democrats who received large contributions from insurance companies.
9
Basically an opinion not backed by evidence!
1
Why is there so little written about the enormous savings in getting the insurance industry completely out of the health care loop? Their million dollar managers, their voluminous paper work and the cost of clerical work imposed on clerks in medical offices dealing with multiple ins. companies - all balloon health care costs. Obama care courageously put health care on the national agenda. It is flawed because of the many concessions necessary to get it passed. Now we can take the next step, as the rest of the world did long ago, and move to single payer
65
And let's not forget the "conflict of interest" aspect of "private insurance" - why does the insurance company determine whether the procedure is "necessary ?" Aetna denied my husband's MRI for his back (he was supposed to get a steroid injection to alleviate the pain and reduce the swelling, but the doctor wanted to be sure there wasn't bone fragment in his spine causing the pain, or he could have been rendered paralyzed)... meanwhile he is in agony and out of work... but denying the MRI helps the insurance companies "bottom line": so my husband is out of work, our finances take a hit and Aetna's CEO gets to protect his bottom line, that of his stockholders and his own annual bonus ($27.9 million total compensation 2015 - see article www.courant.com/business/connecticut.../hc-aetna-executives-pay-20160408.... Meanwhile, we get to pay approx $18K/yr in premiums for a family of 3 - and denial of service... Anybody see a problem with that picture ???
2
It's important to understand that when single-payer advocates are talking about "medicare for all", it's not really about taking the existing Medicare system and adding everyone to it. The current "Medicare for All" bill in the house (which currently has a majority of house democrats as cosponsors) describes this; it's basically "single payer, but we're calling it Medicare".
The key thing is that it makes the system simpler. That not only reduces costs, but it makes all the stakeholders in the system much happier with the result.
The key thing is that it makes the system simpler. That not only reduces costs, but it makes all the stakeholders in the system much happier with the result.
4
You assume much, those paying and providers might not be happy.
1
I am a fan of single-payer. Having said that, I also understand how, for example, county taxes do not necessarily fall by the same amount (or at all?), when the state takes on what had been county responsibilities.
A great commentary but your road maintenance analogy stops short of illustrating a real - and justified - fear of tax payers: yes, once the state takes over the cost goes down from efficiencies and other taxes could be reduced. But it's much more likely that the other taxation would continue and revenues applied somewhere else. That's the perception. You'll never convince people to move to single payer through logic and financial arguments.
2
Questionable financial arguments. If I believed it I would support it. Prove it in some state or region with them paying.
1
Why it will never happen.....
1- The massive Insurance company Lobby.
2- "Socialized medicine", "death committees". As soon as the single payer idea surfaces again and again, these despised terms inevitably follow, and the public's knee-jerk reaction is that its a bad idea.
Its a terrible shame. The system we have is an embarrassment.
1- The massive Insurance company Lobby.
2- "Socialized medicine", "death committees". As soon as the single payer idea surfaces again and again, these despised terms inevitably follow, and the public's knee-jerk reaction is that its a bad idea.
Its a terrible shame. The system we have is an embarrassment.
20
We don't have a Health Care System. We have a Health Care Industry. That is the problem.
39
So-called death panels are already here in the form of insurance companies that decide what medical services will and will not be covered. Health care would also be rationed under a single-payer system. Do single-payer advocates want a Betsy De Vos- type deciding what medical services will be covered under the government plan?
5
Invite Canadians down to talk about our health system. We laugh at people who talk about death committees. Doctors decide who get operations based on their professional judgment, and life-saving operations go first always. And my 99 year old grandfather had a cataract done. So death committees are just propaganda spouted by politicians who are supported by donations from Big Healthcare. When you read obituaries in the paper they all thank the providers for the care they get. Americans need to do their own research and investigate the different systems. Come on you guys, you are the outlier in the developed world and it is only refusal on your politicians' parts that keeps you from not have to worry about bankruptcy from being sick.
303
Saving over 30% in just advertising and administrative costs is astounding. What is holding us back from single payer? Is it the right's opposition to government "intrusion" into private endeavours?Is it lack of understanding by the general population how this would be paid for? I've seen estimates of a 2% tax to cover the cost of single payer, what are we waiting for?
17
Those savings are estimated, biased totally!
1
Wait~don't our Senators and Representatives have single payer healthcare? It doesn't seem like it's failing for them, does it?
That's the unfairest of all, that "They" give themselves a health plan that's SO much better than what they deign to cram down our throats.
That's the unfairest of all, that "They" give themselves a health plan that's SO much better than what they deign to cram down our throats.
20
They apparently want to protect the insurance companies who fund their campaigns...
1
Medicare offers a good model for universal affordable health care. Both Traditional fee-for-service Medicare and Medicare Advantage require a Part B premium of $134.
But Traditional Medicare has unlimited co-insurance risk, so many people buy a supplemental policy that can cost up to another $300 a month to eliminate most OOP expense.
Medicare Advantage is more typical of private insurance, with deductibles and co-insurance with a cap on OOP expense. Insurers get a fixed amount per enrollee, health risk adjusted. No supplement is needed, though modest extra premiums can enhance coverage.
Both are based on lower DRG reimbursement rates set by Medicare, a system put in place by the Reagan Administration.
Both could be extended to the whole population through expanded payroll taxes and premiums, removing this burden from employers, making American workers more globally competitive.
Health care providers will use their vast Congressional influence purchasing power to prevent this from happening. So don't hold your breath, unless the current disjointed system falls apart.
But Traditional Medicare has unlimited co-insurance risk, so many people buy a supplemental policy that can cost up to another $300 a month to eliminate most OOP expense.
Medicare Advantage is more typical of private insurance, with deductibles and co-insurance with a cap on OOP expense. Insurers get a fixed amount per enrollee, health risk adjusted. No supplement is needed, though modest extra premiums can enhance coverage.
Both are based on lower DRG reimbursement rates set by Medicare, a system put in place by the Reagan Administration.
Both could be extended to the whole population through expanded payroll taxes and premiums, removing this burden from employers, making American workers more globally competitive.
Health care providers will use their vast Congressional influence purchasing power to prevent this from happening. So don't hold your breath, unless the current disjointed system falls apart.
4
Why - why - why has an "in depth" study of Single Payer systems around the world not been conducted. What works where - what does it cost - who pays - effect on overall health - on and on! Come on New York Times - come on Washington Post - DO SOMETHING!!!
16
Worthless, it has been done but our population is very different!
2
Lots of these already exist. PBS has several. Search for "Health Costs: How the U.S. Compares With Other Countries."
1
Such a study is beyond the resources of a journalistic outlet. However, there are numerous other research institutions that have good information. I would point to the OECD that has in-depth studies and publicly accessible data on all aspects of health care systems in their 35 member countries, mostly the richest industrialized and emerging economies. Start with http://www.oecd.org/health.
If Ken Arrow thought single-payer was the best among all other options I don't need to hear anymore from anyone else (https://promarket.org/there-is-regulatory-capture-but-it-is-by-no-means-.... Majority of Aemricans and even bigger %-ge of Dems support single-payer (http://www.gallup.com/poll/191504/majority-support-idea-fed-funded-healt.... It is the single-most important issue at the moment and if Dems make single-payer their foremost priorities they will win those elusive electoral colleges. But they will not adopt it into their platform, instead they spend all their time on "Russia/Trump collusion".
3
You believe those folks. Believe me instead single payer would be a massive disaster!
1
Yes, I "believe" you because I see this "massive disaster" in Europe, Canada and elsewhere!
2
How do you know this? Are you already on Medicare and finding it a massive disaster? If not, why should we believe you?
Big change in US health care financing has only ever come about when the existing stakeholders get paid off. With original Medicare doctors and hospitals were pretty directly reimbursed for the cost of care and insurance companies became claims processors; in Medicare part D drug companies were assured that the government wouldn't hold down drug costs; and with the ACA they were guaranteed more enrollees with no sacrifice on their part.
Now that health care accounts for 17% of GDP it's not clear where those bribes will come from, even if single payor ultimately promises to be more efficient.
Now that health care accounts for 17% of GDP it's not clear where those bribes will come from, even if single payor ultimately promises to be more efficient.
14
I have lived under both systems (USA & Canadian) and I can tell you factually that a single payer system works. 40 years in USA and 12 in Canada so I have first hand knowledge. As a matter of fact, if my fellow Americans truly knew what they are missing out on there would be a revolt.
Most comments posted against a single payer system show their ignorance as they don't really know what they are writing about. One shouldn't weigh in with a comment when it is only based upon conjecture or parroting back what the Republican Party line is.
It is unfortunate that the facts and experts alone can't carry the day. We need to get off of the emotion and see through the entrenched agendas as this only serves to obfuscate the truth.
Up and beyond everyone being covered by health insurance there are many other benefits that shouldn't be discounted. Here's a few:
1.) No more fighting with insurance companies resulting in a huge time savings and less stress. 2.) Start a company - be an entrepreneur....since health insurance is "covered" one can focus on the new business. 3.) Piece of mind if you are laid off or change jobs....again you are still covered 4.) Creates less class division as everyone is covered.
BTW, what is not covered in Canada is Optical, Dental and Prescription drugs. These are still covered by private insurance. So if you still want to fight or be denied coverage you still have these 3 options to select from.
Most comments posted against a single payer system show their ignorance as they don't really know what they are writing about. One shouldn't weigh in with a comment when it is only based upon conjecture or parroting back what the Republican Party line is.
It is unfortunate that the facts and experts alone can't carry the day. We need to get off of the emotion and see through the entrenched agendas as this only serves to obfuscate the truth.
Up and beyond everyone being covered by health insurance there are many other benefits that shouldn't be discounted. Here's a few:
1.) No more fighting with insurance companies resulting in a huge time savings and less stress. 2.) Start a company - be an entrepreneur....since health insurance is "covered" one can focus on the new business. 3.) Piece of mind if you are laid off or change jobs....again you are still covered 4.) Creates less class division as everyone is covered.
BTW, what is not covered in Canada is Optical, Dental and Prescription drugs. These are still covered by private insurance. So if you still want to fight or be denied coverage you still have these 3 options to select from.
154
Although I have a bit longer in the Canadian system, this mirrors my experience as well, especially the last sentence of your first paragraph, John.
3
Also, if single payer is financed from general tax revenues, based on ability to pay, rather than on each individual paying (before subsidies) the same, it is fairer. And nobody is priced out of the market.
Couple that with universal income and we would suddenly be "progressive " and open up the economy to true growth.
Couple that with universal income and we would suddenly be "progressive " and open up the economy to true growth.
15
You are basing this cost argument on a sensible implementation of single payer. Cost is not the root problem though, political clout is the root problem. The for profit health care industry has been sucking from the biggest money river ever for decades. They can afford to spend billions to prevent anything that might reduce health care costs. You can't expect them to sit by and watch their money river dry up to a trickle. Single payer is probably the end result we want, but getting there from here will require a war with the for profit health care industry and they have all the weapons.
60
You imply, but you might just as well make it explicit, that particular components of the current system are vastly inflated by patent protections (drug companies) as well as by the kind of false competition that drug - and caregiver - advertising costs.
One less dramatic option might be to legislate free international sales of licensed medical substances, and/or regulated pricing of drugs and treatments based on NIH research. The real savings of a universal system is through prevention - since low cost preventive treatment is so much less expensive than long deferred critical care. Yet it seems that no one has assembled that case. Maybe that's because it pays too well to do what we now do.
I wonder why medical students don't wake up and undercut their mentors' greed.
One less dramatic option might be to legislate free international sales of licensed medical substances, and/or regulated pricing of drugs and treatments based on NIH research. The real savings of a universal system is through prevention - since low cost preventive treatment is so much less expensive than long deferred critical care. Yet it seems that no one has assembled that case. Maybe that's because it pays too well to do what we now do.
I wonder why medical students don't wake up and undercut their mentors' greed.
2
Or better in the us we get the lowest price for drugs in the developed world. Issue solved!
2
The numbers are always going to be debatable:
it is roughly true: administrative costs average only about 2 percent of total expenses under a single-payer program like Medicare. However, Medicare costs are about 3 times the per person amount of the under 65 coverage.
It is true that the mandate is critical. Omitting the mandate while maintaining other terms (guaranteed issue) is like allowing people to buy home insurance while their house is on fire. In addition, some people game the system - claim they don't want health insurance while they automatically have access to emergency care because hospitals can't turn them away.
The insurance companies aren't the enemy. By law, administrative costs are capped at 15-20% of premium which is a level that many charities operate at.
The big dollars are in other areas:
- cost of care, as sited in the article
- practices of care by physicians that can take 20 years to adapt to new research
- an American attitude that everything that could be done for a patient should be done, whether the treatment has a reasonable chance of working or not.
This last one is the toughest. We all feel for families who have a member who is running out of options. However, if we want to provide $500,000 treatments that have less than 1% chance of succeeding, then costs will be high.
Unfortunately, our government seems to be more focused on the short term politics of the situation than trying to deal with the very difficult long term questions.
it is roughly true: administrative costs average only about 2 percent of total expenses under a single-payer program like Medicare. However, Medicare costs are about 3 times the per person amount of the under 65 coverage.
It is true that the mandate is critical. Omitting the mandate while maintaining other terms (guaranteed issue) is like allowing people to buy home insurance while their house is on fire. In addition, some people game the system - claim they don't want health insurance while they automatically have access to emergency care because hospitals can't turn them away.
The insurance companies aren't the enemy. By law, administrative costs are capped at 15-20% of premium which is a level that many charities operate at.
The big dollars are in other areas:
- cost of care, as sited in the article
- practices of care by physicians that can take 20 years to adapt to new research
- an American attitude that everything that could be done for a patient should be done, whether the treatment has a reasonable chance of working or not.
This last one is the toughest. We all feel for families who have a member who is running out of options. However, if we want to provide $500,000 treatments that have less than 1% chance of succeeding, then costs will be high.
Unfortunately, our government seems to be more focused on the short term politics of the situation than trying to deal with the very difficult long term questions.
4
I completely agree with your message. I could never read it to my Trumpist neighbor . Too many words. The graphic is brilliant, a complicated puzzle solved..by by excluding profit takers from medicine. My neighbor believes all politicians are crooks and therefore votes and grunts against taxes as a strain on his hard working back. Remind him of benefits like shared roads and he vehemently refers to graft and waste as more proof that government servants are thieves. I have had many neighbors who were tax refusers (not me) who might be proud AND insulted by the word "fringe". They think they have a higher calling that guides them to starve the parasites who would squander taxes.
I try to appeal to their thrifty nature. Single payer is a good deal. But they don't trust government. They know corporations rule and regulations simply make things expensive. Your article plays perfectly to my ear but I can't use it with my neighbor. The graphic might open the conversation but I need a more condensed set of words. The army turned to comic books with frank, sexist overtones to teach complicated concepts to the american average joe. Maybe the army..which has single payer...should be teaching my neighbors about the benefits of sharing a burden. I can't convince anyone that government is a shared Good, to my neighbor I am likable relic, a curious member of the left wing fringe.
I try to appeal to their thrifty nature. Single payer is a good deal. But they don't trust government. They know corporations rule and regulations simply make things expensive. Your article plays perfectly to my ear but I can't use it with my neighbor. The graphic might open the conversation but I need a more condensed set of words. The army turned to comic books with frank, sexist overtones to teach complicated concepts to the american average joe. Maybe the army..which has single payer...should be teaching my neighbors about the benefits of sharing a burden. I can't convince anyone that government is a shared Good, to my neighbor I am likable relic, a curious member of the left wing fringe.
230
You wouldn't want to live with the Army single payer system. I did for many years. It's great when you're healthy, which most young soldiers are, but the minute you have a problem that's more complex than an average ear infection, good luck. They are chronically short of doctors, especially specialists, short of all sorts of medical testing devices. My husband was active duty (they get priority of care) and had an ongoing problem that was flagged for about 4 years on his physical. It came up in the blood tests. Every year they passed it off. No scans. He retired and had to get a physical for disability insurance (which they denied). When the labs came back the doctor asked him what his last scan had said and was shocked that he never had one. The next week he had one done and they found cancer. He is alive today , but had he been in the great Army system he'd be dead. I wish everyone that wanted single payer could live with it for a year. Of course, we also know how well it works in the VA.
7
Welcome to The Age of Manufactured Consent.
5
Michael, here's a short response to your neighbor:
Americans spend over 17% of GDP on health care; Brits 9.7%.
American life expectancy is 79 years, British 81.
Look it up!
Americans spend over 17% of GDP on health care; Brits 9.7%.
American life expectancy is 79 years, British 81.
Look it up!
1
Society is better off when a people have access to affordable health care. Stability and stress is lower even if you and your kids are healthy. That translates to higher productivity for adults and better conditions for kids. Single payer health care is the cheapest way to get this done.
Why haven't we done it? Many resent health care benefits for segments of society other than their own. It seems that folks using increased coverage to say the ACA was successful were providing evidence of the ACA's failure to the resentful group.
Why haven't we done it? Many resent health care benefits for segments of society other than their own. It seems that folks using increased coverage to say the ACA was successful were providing evidence of the ACA's failure to the resentful group.
7
Sorry, but this just isn't true of the Medicaid population. Spending rises but outcomes don't improve.
I'm not saying everyone shouldn't have access to care. I appreciate the stability of good coverage. (Which is why I hated losing my doctors, specialists, hospitals and plan.)
I am saying it's time to deal in facts and dispense with the fantasy that "access" is a panacea. It is not. Eventually, single payer advocates will have to stop railing against insurers, Big Pharma, greedy doctors, etc., and acknowledge that Americans are also responsible for the high cost of health care in this country.
These same Americans will drive our health care costs up whether under Medicaid or single payer.
I'm not saying everyone shouldn't have access to care. I appreciate the stability of good coverage. (Which is why I hated losing my doctors, specialists, hospitals and plan.)
I am saying it's time to deal in facts and dispense with the fantasy that "access" is a panacea. It is not. Eventually, single payer advocates will have to stop railing against insurers, Big Pharma, greedy doctors, etc., and acknowledge that Americans are also responsible for the high cost of health care in this country.
These same Americans will drive our health care costs up whether under Medicaid or single payer.
2
Your assumption is just that. Society would be best served by a healthy population who needs much less care. Government paid will result in massive increases in use and waste.
2
"Government paid will result in massive increases in use and waste."
Speaking of assumptions...
Speaking of assumptions...
1
The greatest argument for single payer is that the people want it, as demonstrated by polls which consistently show 60% or more support. But the wealthy of the country don't want it, so a small slice of the population holding virtual veto power over a popular policy proposal is presented by the corporate-media, from liberal to conservative, as the normal functioning of a democratic country.
20
Sure the people want free stuff, where is my Tesla and beach house. I want them!
4
You are going on the basis that we live in a democracy and our votes or thoughts count. Our representatives are bought off by lobbyists and we live in a kleptocracy.
2
Why are health insurance and life insurance so different?
Why, with it's 100% payout certainty, is life insurance so much cheaper and viable than health insurance? Why is qualifying for such a policy so much easier? After all, death is a pre existing concern for us all, but it makes no difference to the marketers of such policies. In fact, the certainty of death is exactly what their selling! Literally! $100,000,000 in term coverage, guaranteed to your survivors, for far less than an average health insurance premium?
Because the vast majority of subscribers don't die in a given year, leaving profits for the companies that offer such coverage, and all without government subsidies.
Well, the vast majority of healthcare subscribers also don't use their coverage in a given year too.
We really can make sense of all this If we tried.
Why, with it's 100% payout certainty, is life insurance so much cheaper and viable than health insurance? Why is qualifying for such a policy so much easier? After all, death is a pre existing concern for us all, but it makes no difference to the marketers of such policies. In fact, the certainty of death is exactly what their selling! Literally! $100,000,000 in term coverage, guaranteed to your survivors, for far less than an average health insurance premium?
Because the vast majority of subscribers don't die in a given year, leaving profits for the companies that offer such coverage, and all without government subsidies.
Well, the vast majority of healthcare subscribers also don't use their coverage in a given year too.
We really can make sense of all this If we tried.
3
Roberto asks: "Why are health insurance and life insurance so different?"
Life insurance has a payout defined at purchase; health insurance does not.
Life insurance has a payout defined at purchase; health insurance does not.
4
So then, define the payout for healthcare, much as it used to be. How is that any different? How many people reach a healthcare usage of $1,000,000, or for that matter, $100,000 in their lifetime versus those that do not? Any actuarial minds out there?
Compare that to the those that reach the $1,000,000 payout on their lives. If you do, bingo for your survivors, and it literally happens every day, without complaint from the insurance companies who supply life policies.
Government involvement could be limited to supplying supplemental policies for those that exceed $100,000,000.
Compare that to the those that reach the $1,000,000 payout on their lives. If you do, bingo for your survivors, and it literally happens every day, without complaint from the insurance companies who supply life policies.
Government involvement could be limited to supplying supplemental policies for those that exceed $100,000,000.
Roberto:
Because of sudden death, some people will receive no payout from their payment of health insurance premiums. Others will receive a range of payouts, depending upon their general health and longevity.
Because of sudden death, some people will receive no payout from their payment of health insurance premiums. Others will receive a range of payouts, depending upon their general health and longevity.
An iron rule of capitalism: Economies of Scale.
3
Jerry Brown knows this but he is fighting us tooth and nail. Come on, Jerry. Help us! Remeber 1992?? You explained all this during your presidential campaign. Where are you now when we can actually do this? I don't want to speculate on your motives!
3
Wouldn't the "higher taxes" paid to fund the single-payer option be at least partially offset by the reduction/elimination of the private health insurance premiums employers and employees pay currently?
9
Wow!! Such an incredibly perceptive and honest essay! How in the world did it make it into The Upshot?!
Thank you, Professor Frank.
Now let's see if The Upshot's conservative pundits get on board. Clearly, they can't argue that single-payer isn't right for America. The facts have been laid out here.
Thank you, Professor Frank.
Now let's see if The Upshot's conservative pundits get on board. Clearly, they can't argue that single-payer isn't right for America. The facts have been laid out here.
10
If we were to adopt single-payer and my federal income taxes jumped up, would the increase be more than what I and my employer pay monthly for my health insurance? I doubt it. Let's do this.
52
Newspapers urge that the Republican plan to modify Obamacare be dumped because the OMB estimated it would have very negative cost consequences which would drive insurers out of the market. Now California's estimates say that a single- payer system there would cost more than the entire state budget. The author says not so, but doesn't explain why. When will we get some straight information we can analyze?
3
He DOES say why. He explains it in the several following paragraphs.
3
Perhaps reread? The answer to the "question" you ask is literally in the article.
4
Never such are estimated with little accuracy.
1
Folks what costs money is the IT systems to run a Single Payer system, that's the big hurdle that CA was looking at when there was not even a mention of the fact that $180 million was simply dumped as it was bad code for the updated Medicaid IT system. That's right, dumped after being in development since 2007, so expense for a state single payer IT system would much more than that. The only way CA could afford it is to have more prisoners write code to offset the cost like what's going on in San Quentin, Jerry Brown said he would hire them.
I don't know why news articles don't include this huge expense in coverage as folks want to live in virtual worlds and think a big IT system will fall to earth right out of the sky as it takes time and money to build it, so years in development, or do the most awful thing around, contract Untied Healthcare, only insurer with IT system large enough to run it as a contractor, those are the choices. Live in the real world for a while, would you?
http://ducknetweb.blogspot.com/2015/06/virtual-world-values-and-real-wor...
I don't know why news articles don't include this huge expense in coverage as folks want to live in virtual worlds and think a big IT system will fall to earth right out of the sky as it takes time and money to build it, so years in development, or do the most awful thing around, contract Untied Healthcare, only insurer with IT system large enough to run it as a contractor, those are the choices. Live in the real world for a while, would you?
http://ducknetweb.blogspot.com/2015/06/virtual-world-values-and-real-wor...
6
Why don't news articles include this "huge" expense?
Because a NATIONAL single-payer IT system that is already in use by every provider exists. It's the system that runs Medicare.
A single-state, single-payer system is a different story. But the expansion of the infrastructure that already runs Medicare would not present these huge costs.
Because a NATIONAL single-payer IT system that is already in use by every provider exists. It's the system that runs Medicare.
A single-state, single-payer system is a different story. But the expansion of the infrastructure that already runs Medicare would not present these huge costs.
26
The argument is specious deflection in the extreme, at the same level of intellectual honesty as saying single payer will make taxes go up.
There is absolutely nothing about a single payer mandate that means a system must be built from scratch or even by a government agency. So yes, in fact, even putting aside extension of existing single payer models to do the job (Veteran's Affairs, Medicare, Medicaid) the administration of such a system could be contracted out at an expense ratio of 2% rather than the current 12%. Because as noted that cost saving is simply the icing on the cake.
Where the current system falls down is providers; either there aren't enough and insurers can't squeeze them, so there IS NO INSURANCE; or they limit insureds to their network, with little incentive to move past a cost plus model(the real "cost plus" being : out of network is out of pocket for insureds).
As noted, the real win on costs is negotiating with providers, which the current system really doesn't care about.
There is absolutely nothing about a single payer mandate that means a system must be built from scratch or even by a government agency. So yes, in fact, even putting aside extension of existing single payer models to do the job (Veteran's Affairs, Medicare, Medicaid) the administration of such a system could be contracted out at an expense ratio of 2% rather than the current 12%. Because as noted that cost saving is simply the icing on the cake.
Where the current system falls down is providers; either there aren't enough and insurers can't squeeze them, so there IS NO INSURANCE; or they limit insureds to their network, with little incentive to move past a cost plus model(the real "cost plus" being : out of network is out of pocket for insureds).
As noted, the real win on costs is negotiating with providers, which the current system really doesn't care about.
4
I seriously question whether our government could handle the IT requirements behind a single payer system. It would have to merge existing Medicaid, Medicare, etc., systems. Now, there are programs that do this (ex., merge big systems), but I wonder whether our federal government could even pull it off.
Consider the Obama Administration could not even get a simple front end built. (That's all the exchange was.) It actually cost more than the development of the original iPhone.*
Our federal IT process is byzantine and so outdated that it costs us billions just for contractors to get through it, often with no product at the other end (as California demonstrated).
What we should really be spending our efforts on is developing best practices in IT. Then our government could actually deliver anything.
******
* "Developing Obamacare's Health Care Exchanges Has Cost More Than Apple's Original iPhone",
https://www.forbes.com/sites/timworstall/2013/10/17/developing-obamacare...
Consider the Obama Administration could not even get a simple front end built. (That's all the exchange was.) It actually cost more than the development of the original iPhone.*
Our federal IT process is byzantine and so outdated that it costs us billions just for contractors to get through it, often with no product at the other end (as California demonstrated).
What we should really be spending our efforts on is developing best practices in IT. Then our government could actually deliver anything.
******
* "Developing Obamacare's Health Care Exchanges Has Cost More Than Apple's Original iPhone",
https://www.forbes.com/sites/timworstall/2013/10/17/developing-obamacare...
2
Except he ignores several reasons why single payer is less expensive. They include far less end of life care, longer wait times for elective surgery, fewer pharma options and much lower salaries for health care professionals.
2
The single payer system is not going to be to blame for longer wait times and less end of life care. The industrialization of health care started that ball rolling a long time ago when the HMOs, instead of doctors, started to determine what was the correct course of action in a given health situation. The era of the local doctor's office and independent hospitals also ended a long time ago. Now all the doctors work for a health care "system", and they pay the doctors. The USA is the only country that does not negotiate drug prices or ban to-consumer advertising, and as a result we pay the most for the same drugs everyone around the world is using.
57
You've been brainwashed by insurance company and Big Pharma propaganda, and Republican lies! I've lived for a time in three of the modern countries that enjoy universal, hassle-free. I didn't see or hear complaints about long waits and less care of the dying,
Statistics indicate that life expectancy is longer, and the general health of the population at every age is better, in the modern nations that have universal health care.
Statistics indicate that life expectancy is longer, and the general health of the population at every age is better, in the modern nations that have universal health care.
171
The cost of drugs is NOT the major problem. A big part of the problem is that hospitals and doctors know how to "game" the system.
A cardiologist making $2 mill. per year is an obscenity. I know of several who do. Limiting the number of medical schools and the number of medical students doesn't help. [Thank Clinton for that]
The idea that savings will be passed on to the consumer is wishful thinking.
If you like the way the Post Office is operated, you'll LOVE a government run healthcare system.
A cardiologist making $2 mill. per year is an obscenity. I know of several who do. Limiting the number of medical schools and the number of medical students doesn't help. [Thank Clinton for that]
The idea that savings will be passed on to the consumer is wishful thinking.
If you like the way the Post Office is operated, you'll LOVE a government run healthcare system.
5
And, as detailed in another article in today's paper, individual taxes could be offset in part by increased tax collections from businesses that would no longer be deducting their employee heath care costs as a business expense.
35
A Belgian friend said "sure our taxes are high, but the retirement pension, health care, and kids' college expenses are provided for." Sign me up for sanity.
359
It may come as a surprise to you, but I do not want to pay for your kid's college expenses. I pay for your kid's primary and secondary schools.
4
You also pay for my roads and bridges that you don't use. Guess what? It's the cost of living in a society that shares the expenses and the benefits with everyone.
16
When your kid gets turned down for college because he didn't score high enough on the national exam, get back to me.
2
All of the financial arguments against single payer are cynically and intentionally misleading: They defend the morally indefensible middle man profits which are the core problem of our current system. Health "insurers" provide zero health care (and prevent a lot of needed care), while generating billions in profits. These companies will pay our elected representatives whatever it takes to keep Congress from eliminating them from the picture, despite the fact that their elimination would be a genuine advance for bringing economical, quality health care to every American.
296
Discussions in California have also stalled because the Speaker of the Assembly receives huge payouts from the insurance industry. Before legalized bribery of our politicians is addressed, nothing is going to change. Just see the payouts from the pharmaceutical industry to Cory Booker, who conveniently voted against an amendment to allow the importation of drugs from Canada until public outraged caused him to change his mind.
Always follow the money. It usually leads somewhere that is bad for the American people, and both parties feed at the same trough.
Always follow the money. It usually leads somewhere that is bad for the American people, and both parties feed at the same trough.
93
You're not wrong about the Speaker of the Assembly in California (as far as I can tell) but something that's been left out of most discussions on the California single payer bill is that California has an odd budget rule that states that 50% of the budget must be spent on education. This would mean that however much money the single payer system would cost, tax revenue would have to be increased by double that. The bill that died in the legislature did not address this fact, and I have read that even if passed there would have been numerous more hurdles to overcome before a single payer system is actually put in place. Check out this article for more on the specifics of the fight: https://theintercept.com/2017/06/30/california-single-payer-organizers-a....
1
In Germany, I believe there is a type of dedicated tax for healthcare at about 6 or 8%. This would do the trick to provide coverage for all. And yes, this money could be extracted from every paycheck, even those that are small enough to avoid income taxes.
This idea, of course, must pierce the AMA lobby's myth of the innovation that our overpaying for healthcare provides. The reality is that MDs might have to drive fewer Mercedes, but outcomes could actually be improved.
This idea, of course, must pierce the AMA lobby's myth of the innovation that our overpaying for healthcare provides. The reality is that MDs might have to drive fewer Mercedes, but outcomes could actually be improved.
22
"extracted from every paycheck"
That's the catch. Some people don't have paychecks - they don't work.
That's the catch. Some people don't have paychecks - they don't work.
2
Make it 20 pct.
1
beyond belief that this is even close to debatable.....the fact it works in other countries, at much lower costs, longer life expectancies, lower infant mortality rates and 100% of citizens/legal immigrants are covered.....isn't that enough?
americans are not exactly going boldly where no human has ever gone before.
americans are not exactly going boldly where no human has ever gone before.
208
No it is not since we have a different population.
1
Infant mortality rates are not measured equally. There is widespread underreporting of the earliest deaths by other countries. Since these make up 75% of all neonatal deaths*, that number is skewed.
The US strictly follows the WHO's definition of "live birth", which is a life of any health and duration. In France , Spain and Belgium, on the other hand, an infant has to live a certain period to be considered a "live birth". There's also a difference in how the terms, "still birth", "miscarriage", etc., are interpreted.
The US also aggressively intervenes, both in utero and in premature births. According to National Review, the US actually has superior infant morality rates for premature and low-birth-weight babies, the newborns who actually need medical care and who are at highest risk of dying.
******
*"Critics of U.S. health care disseminate misinformation cloaked as data."
http://www.nationalreview.com/article/276952/infant-mortality-deceptive-...
The US strictly follows the WHO's definition of "live birth", which is a life of any health and duration. In France , Spain and Belgium, on the other hand, an infant has to live a certain period to be considered a "live birth". There's also a difference in how the terms, "still birth", "miscarriage", etc., are interpreted.
The US also aggressively intervenes, both in utero and in premature births. According to National Review, the US actually has superior infant morality rates for premature and low-birth-weight babies, the newborns who actually need medical care and who are at highest risk of dying.
******
*"Critics of U.S. health care disseminate misinformation cloaked as data."
http://www.nationalreview.com/article/276952/infant-mortality-deceptive-...
1
vulcanalex....yes. you are unique. we are all humans, but americans are....what exactly? you have nothing to learn from any other country. you are the only western democracy that isn't 100% white and has people from all over the world. biggest difference is that your two parties are right wing and extreme right wing. your 'free thinking rugged individualists' can be bought off by attack commercials, plus your political system is incredibly corrupt with huge companies with an outsized influence on public policy.
you're different alright.
you're different alright.
8
I'm in favor of single payor. It's cheaper, for the reasons laid out in the article; it assures universal coverage; and a system of competing health plans hasn't give us lower costs or better products. Even the most controlled of rich-country systems, the British NHS, allows people to carry additional private insurance if they want faster or care or more choices.
While not unique to the transition to single payor, a major issue would be the distributional effects of any change. For instance, implementation would require some kind of across-the-board taxes but the initial savings (premiums no longer paid) would accrue only to specific individuals and companies. Over time more and more people/companies would have an incentive to join the public system, but initially it would be difficult to craft a fair transition.
Single payor would almost certainly be more efficient but whether it can be achieved will depend at least partly on whether an equitable transition plan can designed and then implemented.
While not unique to the transition to single payor, a major issue would be the distributional effects of any change. For instance, implementation would require some kind of across-the-board taxes but the initial savings (premiums no longer paid) would accrue only to specific individuals and companies. Over time more and more people/companies would have an incentive to join the public system, but initially it would be difficult to craft a fair transition.
Single payor would almost certainly be more efficient but whether it can be achieved will depend at least partly on whether an equitable transition plan can designed and then implemented.
7
Nobody talks about the costs to employers who provide health care. The time and energy devoted to negotiating and administering health care. Freeing our employers from much of that burden should be emphasized. The impact on wages isn't often discussed either.
Over the past twenty years my employer often gave us less than cost of living under the justification that our healthcare costs were soaring. Often the premiums were in fact soaring but when we proposed substantially cheaper health care coverage they still didn't want to give us cost of living.
Over the past twenty years my employer often gave us less than cost of living under the justification that our healthcare costs were soaring. Often the premiums were in fact soaring but when we proposed substantially cheaper health care coverage they still didn't want to give us cost of living.
128
Another aspect not discussed, that is frustrating to me, is the enormous costs of sending people to the emergency room with non emergent healthcare issues. It can often soar into over a million dollars for chronic users of the system.
51
Fire Captain:
People use the ER because of the convenience and because hospitals cannot deny them care. Exhibit A: After Obamacare enrolled all those people in Medicaid, ER usage didn't drop.
It's hard to imagine how under a single payer system, the Medicaid population would suddenly change its behavior.
The reality is that the behavior of the Medicaid population is very difficult to change. It is one of the reasons why Medicaid outcomes are so poor. Coverage simply doesn't translate into better health. But it does lead to exorbitant costs, as the $100 billion rise in Medicaid costs after the expansion illustrated.
This is, in fact, a strong argument for states' control over programs for the disabled poor. Management of their care has to happen at the level of care -- ex., doctor's office.
People use the ER because of the convenience and because hospitals cannot deny them care. Exhibit A: After Obamacare enrolled all those people in Medicaid, ER usage didn't drop.
It's hard to imagine how under a single payer system, the Medicaid population would suddenly change its behavior.
The reality is that the behavior of the Medicaid population is very difficult to change. It is one of the reasons why Medicaid outcomes are so poor. Coverage simply doesn't translate into better health. But it does lead to exorbitant costs, as the $100 billion rise in Medicaid costs after the expansion illustrated.
This is, in fact, a strong argument for states' control over programs for the disabled poor. Management of their care has to happen at the level of care -- ex., doctor's office.
2
Why would that change?
1
Two thing to keep in mind:
Most single payer health care systems have a highly centralized management of health care resources and budgets. This can be good or bad but it typically means that all the big decisions about coverage, budgets & spending, allocation, training, licensing, are made at the Federal or regional level. This is a big reason that administrative overhead is lower.
SP doesn't pay for everything. In most European systems there is still a role for private health insurance as supplemental coverage for all the things that the SP system doesn't cover. In Canada, for example, about 12% of health care spending is covered by Private supplemental health plans. An additional 14% of health care spending is out-of-pocket co pays and cost sharing.
You can a learn quite a lot about universal coverage and Single payer in other countries at the Commonwealthfund.org web site and selecting"International Health Care System Profiles"
Most single payer health care systems have a highly centralized management of health care resources and budgets. This can be good or bad but it typically means that all the big decisions about coverage, budgets & spending, allocation, training, licensing, are made at the Federal or regional level. This is a big reason that administrative overhead is lower.
SP doesn't pay for everything. In most European systems there is still a role for private health insurance as supplemental coverage for all the things that the SP system doesn't cover. In Canada, for example, about 12% of health care spending is covered by Private supplemental health plans. An additional 14% of health care spending is out-of-pocket co pays and cost sharing.
You can a learn quite a lot about universal coverage and Single payer in other countries at the Commonwealthfund.org web site and selecting"International Health Care System Profiles"
68
Neither does Medicare in the US, which is why there are Medicare supplement policies
5
Medicare doesn't pay for "everything" either. Part B does pay better (80%) than our system in France (65%). In the USA you have MediGap to pay for your out of pocket expenses and in France we have "mutuelles". One big distinction is that in France, if you have a health problem that lasts for life (diabetes, MS, heart disease, etc), procedures, drugs and doctors are paid at 100% through single payer. Our new president had proposed that our SP system also provide better coverage for dental, vision and audition devices than it currently does. The "mutuelle" that my spouse and I have (a 40 and a 60 year old) costs us 140 Euros/month. We have better access and better quality of care than we would find in the USA. Living in the USA would bankrupt us. My spouse has MS and I have 2 "pre-existing" conditions. Get the insurance companies, the AMA and pharma out of the lobbying $ machine dear congress and start doing your jobs.
5
No one wants health insurance; however, virtually everyone wants access to good healthcare when they need it.
If all sides can agree to that objective then the issue is simply - how do we do this? Single-payer would displace all of the other schemes now in place, many of which are duplicative and profit-oriented. It seems to me that if the will were there, the "greatest country in the world" could get this done. What stands in the way is the ideology of those now in power (who, BTW, already get health care via a single-payer program for members of Congress).
This really isn't hard - technically. What is needed is a consensus that citizens of the US have a right to access to quality healthcare, as we expect a common defense, highway system, etc.
If all sides can agree to that objective then the issue is simply - how do we do this? Single-payer would displace all of the other schemes now in place, many of which are duplicative and profit-oriented. It seems to me that if the will were there, the "greatest country in the world" could get this done. What stands in the way is the ideology of those now in power (who, BTW, already get health care via a single-payer program for members of Congress).
This really isn't hard - technically. What is needed is a consensus that citizens of the US have a right to access to quality healthcare, as we expect a common defense, highway system, etc.
62
No we don't agree, there should be no legal right to health care, and your need might not be mine.
I strongly support Single Payer, Universal, Not-for-Profit Health Insurance for all Americans.
As a compromise and intermediate step I propose the following:
1- Allow individuals under age 65 to buy Medicare Insurance coverage at cost +5%. This would allow many to buy affordable health coverage and add younger people to the insurance pool.
2- Mandate that employers providing private health coverage offer Adult employees the option of buying into Medicare instead at the same cost +5% rate. This would also add younger people to the pool.
This would allow voluntary participation in Medicare, add younger and healthier people to the insured population, act as a competitive agent on private health plan rates, restore patient choice as Medicare is not a PPO or HMO arrangement and give valuable data to the cost estimates for universal Medicare.
As a compromise and intermediate step I propose the following:
1- Allow individuals under age 65 to buy Medicare Insurance coverage at cost +5%. This would allow many to buy affordable health coverage and add younger people to the insurance pool.
2- Mandate that employers providing private health coverage offer Adult employees the option of buying into Medicare instead at the same cost +5% rate. This would also add younger people to the pool.
This would allow voluntary participation in Medicare, add younger and healthier people to the insured population, act as a competitive agent on private health plan rates, restore patient choice as Medicare is not a PPO or HMO arrangement and give valuable data to the cost estimates for universal Medicare.
157
Me too on SP. Great idea for an interim solution.
5
David,
It's not so simple to define "cost." Is it age adjusted? Gender adjusted? Should any other risk factors be taken into account?
It's not so simple to define "cost." Is it age adjusted? Gender adjusted? Should any other risk factors be taken into account?
1
Cost should be same as Medicare beneficiaries, also means tested as currently done
2
Right on! Amen!
We all have the pre-existing condition of an unknown use-by human mortality date. We are all destined to die when, where and how we are supposed to. The notion that there is a free market capitalist solution to health care is a delusional denial of human nature.
The idea that when we are faced with either a chronic illness or a terminal medical condition that we will be seeking the best option for private shareholder and management wealth enhancement at the expense of any recommended medical options is ludicrous. We have neither clear nor perfect information about the medical options nor the financial costs. While we prefer the medical choice that lessens our suffering and extends our life regardless of costs. End of life and chronic care along with an emergency room trip is the costliest healthcare of all.
We all have the pre-existing condition of an unknown use-by human mortality date. We are all destined to die when, where and how we are supposed to. The notion that there is a free market capitalist solution to health care is a delusional denial of human nature.
The idea that when we are faced with either a chronic illness or a terminal medical condition that we will be seeking the best option for private shareholder and management wealth enhancement at the expense of any recommended medical options is ludicrous. We have neither clear nor perfect information about the medical options nor the financial costs. While we prefer the medical choice that lessens our suffering and extends our life regardless of costs. End of life and chronic care along with an emergency room trip is the costliest healthcare of all.
26