8 ms·

There is no benefit. The benefit is for the legislatures who passed the law. There was no way that we'd get single payer here in the US because our Congress is

There is no benefit. The benefit is for the legislatures who passed the law. There was no way that we'd get single payer here in the US because our Congress is very much in the pocket of the health care industry. As such, the markets were a compromise measure enacted by congress to make it easier for people to choose health care. Before Obamacare, it was sort of a black box where only HR people could figure out pricing structures and health care providers didn't really compete in any way with each other. Obamacare did do some good things that needed to be done, but essentially, everything about it was a bandaid intended to kick this shitty system down the road to the next person who had to deal with it. But hey, at least health care companies can't just turn you down because you have Diabetes or are too fat anymore.

eridius 10y ago
There's no way that we'd get single payer here because the Republican party has convinced their base that single-payer health care is socialism and that socialism is evil, which leads to the situation where poor people who desperately need health care and can't afford it still oppose single-payer even though they stand to gain the most from it.
- dikaiosune 10y ago
  Of course, the constituencies which oppose single-payer seem often to be composed of the same people who will vote out anyone who messes with their Social Security, Medicare, or VA benefits.
  - Randgalt 10y ago
    That's an excellent point. Medicare and SSI are equally bad programs that should be phased out.
    - VonGuard 10y ago
      I often wonder if John Galt ever found himself living alone in a room with no one to take care of him in his old age.
      - Randgalt 10y ago
        Galt doesn't need anyone to take care of him.
        wavefunction 10y ago
        It's true, Galt was a fictional caricature.
        mr_tyzic 10y ago
        Ayn Rand sure did though.
      - nappy-doo 10y ago
        Who is John Galt? :)
      - tn13 10y ago
        I think John Galt would prefer to die than use someone else's money by force to take care of himself. I think that is very honorable.
      - splintercell 10y ago
        > I often wonder if John Galt ever found himself living alone in a room with no one to take care of him in his old age. I hope you understand that to Objectivists that sounds like saying "I often wonder if Frederick Douglass ever found himself suffer an accident at work with no master to take care of him because he isn't a slave". I am sure there are better arguments possible against objectivist position, but the one you made is rather naive one.
  - tbihl 10y ago
    The same people: "those barbarians over there," no matter where you're standing.
- danielweber 10y ago
  The situation is not helped when proponents of single-payer say things like "there will be no denial of claims." I think there are things to support about single-payer, but it really, truly, I swear to fucking God, has trade-offs, and since it has been sold as not having any honest trade-offs, we can't actually implement the hard parts of single-player. http://www.vox.com/2016/1/17/10784528/bernie-sanders-single-payer-health-care http://www.vox.com/2016/1/17/10784528/bernie-sanders-single-...
  - VonGuard 10y ago
    Yes, there are trade-offs. In my opinion, they are worth the switch, and amount to a difference between "choosing which hand to reattach and letting the other go dead," and "No lap-band for you fatty." The latter being the single payer option. Anyway, in almost all world single payer systems, rich people can still pay for vanity doctors.
    - danielweber 10y ago
      > and amount to a difference between "choosing which hand to reattach and letting the other go dead," and "No lap-band for you fatty." No, it tends to be a lot of care that isn't worth the cost that gets denied. This is very different from what an American expects, which is that everything they "need" (or what their doctor says they should do) ought to be covered. The lap-band often passes, because it can be a relatively low-cost way to add a bunch of QALYs to a patient's life. NB: I think having care decided on a cost-basis is a pretty good approach, at least to start from, but it is immensely unpopular in the US. On both sides of the aisle. > Anyway, in almost all world single payer systems, rich people can still pay for vanity doctors. Often. Not always. In Canada only recently could a doctor offer the same services the government offered, and that was against the will of the legislature. Their supreme court had to rule on it. https://en.wikipedia.org/wiki/Chaoulli_v_Quebec_(AG) https://en.wikipedia.org/wiki/Chaoulli_v_Quebec_(AG)
  - tbihl 10y ago
    A family friend, who was at the time the chief neurosurgeon of a significant Canadian hospital, pointed out once back in the late 80s, "America will never make single payer work because you won't be able to place a cut off where you stop paying to delay death." And of course it's completely true. The claim that there wouldn't be any "death panels" was of the most damning aspects of the legislative battle, because it proved that no one wanted to let reality in.
- im_down_w_otp 10y ago
  It wasn't Republicans that removed the "Public Option" or the Drug re-importation initiatives from the ACA. FWIW.
  - ende 10y ago
    I wonder how many people would trade individual mandate for public option.
    - danielweber 10y ago
      You can't get rid of the individual mandate without completely destroying the whole law. It's the unpopular part of the law. But pretty much anything that works is going to have some unpopular component that needs to be swallowed in order for the whole thing to work. When Republicans talk about getting rid of the individual mandate, it's because they are, in actuality, trying to kill the law. When Democrats talk about it, I really don't know what's going through their heads. Leftist wonks like Krugman or Klein keep on telling them exactly why it's needed.
      - ende 10y ago
        Sure, but not really what I meant. Adding public option and subtracting individual mandate would basically be a step towards having single payer with secondary private market.
        dragonwriter 10y ago
        > Adding public option and subtracting individual mandate would basically be a step towards having single payer with secondary private market. I don't see how it would be, unless by "subtracting individual mandate" you mean "replacing an individual mandate backed with a fee/tax/penalty for failure to comply with a universal tax, an option to select a private option with the tax refunded as a subsidy, and a default of using the public option if no private option is selected". Which, really, is retaining the individual mandate, but making it impossible to break rather than penalizing breaking it.
- MichaelGG 10y ago
  And yet the current front runner of that party has been strongly in favour of a single payer system over the years. (Though I'm guessing recently there's a shift away from that, publicly anyways.)
- maxxxxx 10y ago
  I am still waiting for the Republicans vote for abolishing Medicare and the VA. Those programs are pure evil and seniors and vets must be liberated from them.
- ecommerceguy 10y ago
  I think you'll be remiss to find that the majority of insurance company donations go to the Democratic party. Of course poor people have been voting Democrat for over 50 years and they are, for the most part, still poor. Que Einstein quote.
  - eridius 10y ago
    > I think you'll be remiss to find that the majority of insurance company donations go to the Democratic party. I'm not sure what you're saying here. Are you saying I'll determine that to be the case if I'm lacking attention, or are you saying that I'm lacking attention and therefore don't know that? I'm also not sure what the point is either way, why the truth or falsehood of this statement is relevant to my comment. > Of course poor people have been voting Democrat for over 50 years and they are, for the most part, still poor. This also doesn't make any sense. Nobody said that voting for either party would make you rich. Making health care accessible to the poor doesn't make them less poor, it just gives them health care. > Que Einstein quote. What quote?
- jcbeard 10y ago
  >which leads to the situation where poor people who desperately >need health care and can't afford it still oppose single-payer >even though they stand to gain the most from it. I'd think education is the way around this. Start off with a "whats the worst case that could happen" then move to "whats the best that could happen." To me, you can convince people as long as you explain that their not going over a cliff. To me, this argument was never made. All I heard on the news was "it's socialism" or "it's good" but no selling the public on why it was in fact good. In this case, our leaders who were the proponents of single payer failed us. Single payer will happen, it'll just take a bit longer. The commercial healthcare industry is on a path to failure....there is no fixing it for the US. Eventually we'll end up with a system, that likely looks like what Germany/UK have (some mix of public/private).
- tn13 10y ago
  Pardon my use of words but I think it is foolish not to accept that there are pretty serious trade-offs involved here and there are perfectly legitimate reasons why single payer is a very bad idea. I personally think a single payer system in USA would pretty much resemble Veterans Affairs. Corrupt, inefficient and something that makes consumers profoundly unhappy while taking away a good chunk of your hard earned wealth.
Frondo 10y ago
Obamacare has had one significant, lasting effect: culturally, the idea is now that everyone should have access to health care. That's the default. Bringing in a public option will be an easy, natural next step, if not for Clinton, then for whoever succeeds her.
- VonGuard 10y ago
  If Clinton brings us single payer, I will worship at her altar forever. She used to promise this stuff in the 90's, but basically gave it all up when she actually went into politics and gained public office, later saying single payer will not work. If she does get us single payer, she's the greatest trojan horse ever in American politics.
  - nappy-doo 10y ago
    > If she does get us single payer, she's the greatest trojan horse ever in American politics. Arguably, that'd be Trump instead of Clinton.
    - VonGuard 10y ago
      I think Trump is more of an infected pot of filth catapulted over the walls... Not sure he's hiding much.
      - jessaustin 10y ago
        I'm torn. Sometimes I think Trump would be the most average President ever, and sometimes I think we have no idea at all what he would do. I'm quite sure it's unlikely he'll do anything that he's campaigned on. Wall-building is work.
- sweettea 10y ago
  I believe statistics say that expanding Medicaid added 8 million covered folks, about 15% of uninsured Americans, and otherwise Obamacare has only gotten an additional few percent of uninsured Americans to become insured. I don't think the norm is that everyone should have access to health insurance any more than it was before due to Obamacare's negligible increases in coverage. [http://www.heritage.org/research/reports/2014/10/obamacares-enrollment-increase-mainly-due-to-medicaid-expansion http://www.heritage.org/research/reports/2014/10/obamacares-...]
tn13 10y ago
> Our Congress is very much in the pocket of the health care industry. When you question some group's integrity please show restraint and back it up with solid evidence. Without that these statements are on part with racist statements like "all blacks are criminals". It is absolutely true that government regulation is hurting healthcare in USA. It has drove the prices up and made understanding healthcare far more difficult. Hospitals do not benefit by these regulations, Insurance providers don't benefit either, Patients don't benefit either. The shi*load of these regulations has already crossed the mark where anything makes sense. Government regulation is driven less by healthcare industries willingness to get hurt in the butt but by the voters who want government to do "something" everytime someone dies. https://www.quora.com/What-are-the-profit-margins-in-the-healthcare-industry https://www.quora.com/What-are-the-profit-margins-in-the-hea... Profit margins of insurance companies are nothing worth boasting about. If the congress is really in pocket of insurance companies let me say they are doing a lousy job for their masters.

eridius 10y ago

There's no way that we'd get single payer here because the Republican party has convinced their base that single-payer health care is socialism and that socialism is evil, which leads to the situation where poor people who desperately need health care and can't afford it still oppose single-payer even though they stand to gain the most from it.

dikaiosune 10y ago
Of course, the constituencies which oppose single-payer seem often to be composed of the same people who will vote out anyone who messes with their Social Security, Medicare, or VA benefits.
- Randgalt 10y ago
  That's an excellent point. Medicare and SSI are equally bad programs that should be phased out.
  - VonGuard 10y ago
    I often wonder if John Galt ever found himself living alone in a room with no one to take care of him in his old age.
    - Randgalt 10y ago
      Galt doesn't need anyone to take care of him.
      - wavefunction 10y ago
        It's true, Galt was a fictional caricature.
      - mr_tyzic 10y ago
        Ayn Rand sure did though.
    - nappy-doo 10y ago
      Who is John Galt? :)
    - tn13 10y ago
      I think John Galt would prefer to die than use someone else's money by force to take care of himself. I think that is very honorable.
    - splintercell 10y ago
      > I often wonder if John Galt ever found himself living alone in a room with no one to take care of him in his old age. I hope you understand that to Objectivists that sounds like saying "I often wonder if Frederick Douglass ever found himself suffer an accident at work with no master to take care of him because he isn't a slave". I am sure there are better arguments possible against objectivist position, but the one you made is rather naive one.
- tbihl 10y ago
  The same people: "those barbarians over there," no matter where you're standing.
danielweber 10y ago
The situation is not helped when proponents of single-payer say things like "there will be no denial of claims." I think there are things to support about single-payer, but it really, truly, I swear to fucking God, has trade-offs, and since it has been sold as not having any honest trade-offs, we can't actually implement the hard parts of single-player. http://www.vox.com/2016/1/17/10784528/bernie-sanders-single-payer-health-care http://www.vox.com/2016/1/17/10784528/bernie-sanders-single-...
- VonGuard 10y ago
  Yes, there are trade-offs. In my opinion, they are worth the switch, and amount to a difference between "choosing which hand to reattach and letting the other go dead," and "No lap-band for you fatty." The latter being the single payer option. Anyway, in almost all world single payer systems, rich people can still pay for vanity doctors.
  - danielweber 10y ago
    > and amount to a difference between "choosing which hand to reattach and letting the other go dead," and "No lap-band for you fatty." No, it tends to be a lot of care that isn't worth the cost that gets denied. This is very different from what an American expects, which is that everything they "need" (or what their doctor says they should do) ought to be covered. The lap-band often passes, because it can be a relatively low-cost way to add a bunch of QALYs to a patient's life. NB: I think having care decided on a cost-basis is a pretty good approach, at least to start from, but it is immensely unpopular in the US. On both sides of the aisle. > Anyway, in almost all world single payer systems, rich people can still pay for vanity doctors. Often. Not always. In Canada only recently could a doctor offer the same services the government offered, and that was against the will of the legislature. Their supreme court had to rule on it. https://en.wikipedia.org/wiki/Chaoulli_v_Quebec_(AG) https://en.wikipedia.org/wiki/Chaoulli_v_Quebec_(AG)
- tbihl 10y ago
  A family friend, who was at the time the chief neurosurgeon of a significant Canadian hospital, pointed out once back in the late 80s, "America will never make single payer work because you won't be able to place a cut off where you stop paying to delay death." And of course it's completely true. The claim that there wouldn't be any "death panels" was of the most damning aspects of the legislative battle, because it proved that no one wanted to let reality in.
im_down_w_otp 10y ago
It wasn't Republicans that removed the "Public Option" or the Drug re-importation initiatives from the ACA. FWIW.
- ende 10y ago
  I wonder how many people would trade individual mandate for public option.
  - danielweber 10y ago
    You can't get rid of the individual mandate without completely destroying the whole law. It's the unpopular part of the law. But pretty much anything that works is going to have some unpopular component that needs to be swallowed in order for the whole thing to work. When Republicans talk about getting rid of the individual mandate, it's because they are, in actuality, trying to kill the law. When Democrats talk about it, I really don't know what's going through their heads. Leftist wonks like Krugman or Klein keep on telling them exactly why it's needed.
    - ende 10y ago
      Sure, but not really what I meant. Adding public option and subtracting individual mandate would basically be a step towards having single payer with secondary private market.
      - dragonwriter 10y ago
        > Adding public option and subtracting individual mandate would basically be a step towards having single payer with secondary private market. I don't see how it would be, unless by "subtracting individual mandate" you mean "replacing an individual mandate backed with a fee/tax/penalty for failure to comply with a universal tax, an option to select a private option with the tax refunded as a subsidy, and a default of using the public option if no private option is selected". Which, really, is retaining the individual mandate, but making it impossible to break rather than penalizing breaking it.
MichaelGG 10y ago
And yet the current front runner of that party has been strongly in favour of a single payer system over the years. (Though I'm guessing recently there's a shift away from that, publicly anyways.)
maxxxxx 10y ago
I am still waiting for the Republicans vote for abolishing Medicare and the VA. Those programs are pure evil and seniors and vets must be liberated from them.
ecommerceguy 10y ago
I think you'll be remiss to find that the majority of insurance company donations go to the Democratic party. Of course poor people have been voting Democrat for over 50 years and they are, for the most part, still poor. Que Einstein quote.
- eridius 10y ago
  > I think you'll be remiss to find that the majority of insurance company donations go to the Democratic party. I'm not sure what you're saying here. Are you saying I'll determine that to be the case if I'm lacking attention, or are you saying that I'm lacking attention and therefore don't know that? I'm also not sure what the point is either way, why the truth or falsehood of this statement is relevant to my comment. > Of course poor people have been voting Democrat for over 50 years and they are, for the most part, still poor. This also doesn't make any sense. Nobody said that voting for either party would make you rich. Making health care accessible to the poor doesn't make them less poor, it just gives them health care. > Que Einstein quote. What quote?
jcbeard 10y ago
>which leads to the situation where poor people who desperately >need health care and can't afford it still oppose single-payer >even though they stand to gain the most from it. I'd think education is the way around this. Start off with a "whats the worst case that could happen" then move to "whats the best that could happen." To me, you can convince people as long as you explain that their not going over a cliff. To me, this argument was never made. All I heard on the news was "it's socialism" or "it's good" but no selling the public on why it was in fact good. In this case, our leaders who were the proponents of single payer failed us. Single payer will happen, it'll just take a bit longer. The commercial healthcare industry is on a path to failure....there is no fixing it for the US. Eventually we'll end up with a system, that likely looks like what Germany/UK have (some mix of public/private).
tn13 10y ago
Pardon my use of words but I think it is foolish not to accept that there are pretty serious trade-offs involved here and there are perfectly legitimate reasons why single payer is a very bad idea. I personally think a single payer system in USA would pretty much resemble Veterans Affairs. Corrupt, inefficient and something that makes consumers profoundly unhappy while taking away a good chunk of your hard earned wealth.

Frondo 10y ago

Obamacare has had one significant, lasting effect: culturally, the idea is now that everyone should have access to health care. That's the default. Bringing in a public option will be an easy, natural next step, if not for Clinton, then for whoever succeeds her.

VonGuard 10y ago
If Clinton brings us single payer, I will worship at her altar forever. She used to promise this stuff in the 90's, but basically gave it all up when she actually went into politics and gained public office, later saying single payer will not work. If she does get us single payer, she's the greatest trojan horse ever in American politics.
- nappy-doo 10y ago
  > If she does get us single payer, she's the greatest trojan horse ever in American politics. Arguably, that'd be Trump instead of Clinton.
  - VonGuard 10y ago
    I think Trump is more of an infected pot of filth catapulted over the walls... Not sure he's hiding much.
    - jessaustin 10y ago
      I'm torn. Sometimes I think Trump would be the most average President ever, and sometimes I think we have no idea at all what he would do. I'm quite sure it's unlikely he'll do anything that he's campaigned on. Wall-building is work.
sweettea 10y ago
I believe statistics say that expanding Medicaid added 8 million covered folks, about 15% of uninsured Americans, and otherwise Obamacare has only gotten an additional few percent of uninsured Americans to become insured. I don't think the norm is that everyone should have access to health insurance any more than it was before due to Obamacare's negligible increases in coverage. [http://www.heritage.org/research/reports/2014/10/obamacares-enrollment-increase-mainly-due-to-medicaid-expansion http://www.heritage.org/research/reports/2014/10/obamacares-...]

tn13 10y ago

> Our Congress is very much in the pocket of the health care industry. When you question some group's integrity please show restraint and back it up with solid evidence. Without that these statements are on part with racist statements like "all blacks are criminals". It is absolutely true that government regulation is hurting healthcare in USA. It has drove the prices up and made understanding healthcare far more difficult. Hospitals do not benefit by these regulations, Insurance providers don't benefit either, Patients don't benefit either. The shi*load of these regulations has already crossed the mark where anything makes sense. Government regulation is driven less by healthcare industries willingness to get hurt in the butt but by the voters who want government to do "something" everytime someone dies. https://www.quora.com/What-are-the-profit-margins-in-the-healthcare-industry https://www.quora.com/What-are-the-profit-margins-in-the-hea... Profit margins of insurance companies are nothing worth boasting about. If the congress is really in pocket of insurance companies let me say they are doing a lousy job for their masters.