4 ms·

> We need a single payer system or at the very least a single body that negotiates the price of all drugs and health care services on behalf of all Americans. F

> We need a single payer system or at the very least a single body that negotiates the price of all drugs and health care services on behalf of all Americans. Frankly I'm surprised that the insurance companies aren't lobbying for such a thing as it could be their only hope for continued existence very soon. Insurance companies are legally obligated to pay out 80-90% of their receipts for treatment. Since they can't become more profitable on a percentage basis, they have every economic incentive to drive the cost of medicine up. What's better than making $500/year/customer? Making $1000/year/customer because medicine costs twice as much. You don't even need to get more customers! There's definitely a whole slew of market failures piled up on top of one another in the healthcare system here in the US. There are people who are afraid of single payer for silly reasons, but there are also people who are scared of rationing. That's a legitimate fear! And it's not one that can really be assuaged because we've seen that while it's very difficult to get laws passed today, that's nothing compared to rolling them back. So everyone could go into single payer with the best of intentions but it only takes a few changes of administration for things to start to go off the rails, and then it'll be nearly impossible to get the mess sorted out. I mean, look at the ACA! The whole thing was done with the best of intentions but even before it made it to being a law it got all messed up. And now that it is a law, it's maybe not necessarily having the intended effect. Couple that with the idea that everyone in the US is about to "make it" or that everyone thinks they're middle class or upper middle class and fears about rationing can seem entirely well founded. Anecdotally I had a prof who was from Vancouver who had a knee problem and needed an MRI to make sure it wasn't cancerous before they operated. 9 month wait list fo r the MRI or a half day excursion to Seattle and about a grand and he had his imaging. It doesn't prove that everyone in Canada experiences rationing the same way, but it does mean that fears aren't completely unfounded.

mgkimsal 10y ago
" but even before it made it to being a law it got all messed up" Requiring legislators to read legislation (and maybe even take a test on bills that are larger than 10 pages?) before they vote on it might help. Being told "we have to pass it before we can look inside of it" is... I can't think of anything less sane. Re: Canada and other countries. I know in the UK you can get private insurance and "go private" for most services, or you can take the public option, which may involve waiting. Why we think here it's going to be 100% one thing... I don't understand. Your canada story already demosntrates that - someone with more money paid for faster service. I have a strong suspicion he could have had that done privately someone in canada for $x, but seattle was closer/easier (?)
- 0xcde4c3db 10y ago
  Technically, a senator can require that a bill be read aloud by the clerk. However from what I understand that pretty much never actually happens because even if a senator makes the relevant objection, the schedule can just be reworked so that the bill is no longer considered at that time.
- maxerickson 10y ago
  I don't know the details, but there are restrictions on the services that private clinics can offer in Canada.
  - mgkimsal 10y ago
    Interesting - perhaps UK is a bit less restrictive? Or perhaps things have changed there some (my wife left a long time ago).
- kefka 10y ago
  > Being told "we have to pass it before we can look inside of it" is... I can't think of anything less sane. There's the republican influence for you. That quote Pelosi said was about the disparate bills in House and Senate. In order to see the final bill, each side had to pass it so a merge committee would be made to combine the bill. Then the merge-bill would be re-forwarded back to Senate/House for a final vote. Or what she should have said: "We have to pass the House Bill before we can see the Merged bill." But a 10 second republican talking point snippet makes her look bad. But if you know how Congress works, it makes a heck of a lot of sense.
unclenoriega 10y ago
Healthcare is always rationed, though. It can be rationed by need, ability to pay, or some other way, but there's no system for infinite healthcare yet developed.
- msandford 10y ago
  Yup! Everything is rationed so far, except maybe for air. But the point is, you're going from implicit rationing (you can have whatever you can afford) to explicit rationing (we can only do X MRIs per week and it'll take 37 weeks until it's your turn). There are a lot of folks who don't like that idea, and I can see why. A lot of proponents of single-payer completely play this down and pooh-pooh folks who bring up that point by saying "oh it'll never be like soviet medicine where only well connected people get better" but don't explain at all how our government will be 100% guaranteed not to do that. And if you can't lay out how that'll happen in blindingly obvious detail and personally promise them that we'll start executing people if it goes badly, well, there are a lot of folks who aren't terribly trusting. And they're not necessarily wrong.

mgkimsal 10y ago

" but even before it made it to being a law it got all messed up" Requiring legislators to read legislation (and maybe even take a test on bills that are larger than 10 pages?) before they vote on it might help. Being told "we have to pass it before we can look inside of it" is... I can't think of anything less sane. Re: Canada and other countries. I know in the UK you can get private insurance and "go private" for most services, or you can take the public option, which may involve waiting. Why we think here it's going to be 100% one thing... I don't understand. Your canada story already demosntrates that - someone with more money paid for faster service. I have a strong suspicion he could have had that done privately someone in canada for $x, but seattle was closer/easier (?)

0xcde4c3db 10y ago
Technically, a senator can require that a bill be read aloud by the clerk. However from what I understand that pretty much never actually happens because even if a senator makes the relevant objection, the schedule can just be reworked so that the bill is no longer considered at that time.
maxerickson 10y ago
I don't know the details, but there are restrictions on the services that private clinics can offer in Canada.
- mgkimsal 10y ago
  Interesting - perhaps UK is a bit less restrictive? Or perhaps things have changed there some (my wife left a long time ago).
kefka 10y ago
> Being told "we have to pass it before we can look inside of it" is... I can't think of anything less sane. There's the republican influence for you. That quote Pelosi said was about the disparate bills in House and Senate. In order to see the final bill, each side had to pass it so a merge committee would be made to combine the bill. Then the merge-bill would be re-forwarded back to Senate/House for a final vote. Or what she should have said: "We have to pass the House Bill before we can see the Merged bill." But a 10 second republican talking point snippet makes her look bad. But if you know how Congress works, it makes a heck of a lot of sense.

unclenoriega 10y ago

Healthcare is always rationed, though. It can be rationed by need, ability to pay, or some other way, but there's no system for infinite healthcare yet developed.

msandford 10y ago
Yup! Everything is rationed so far, except maybe for air. But the point is, you're going from implicit rationing (you can have whatever you can afford) to explicit rationing (we can only do X MRIs per week and it'll take 37 weeks until it's your turn). There are a lot of folks who don't like that idea, and I can see why. A lot of proponents of single-payer completely play this down and pooh-pooh folks who bring up that point by saying "oh it'll never be like soviet medicine where only well connected people get better" but don't explain at all how our government will be 100% guaranteed not to do that. And if you can't lay out how that'll happen in blindingly obvious detail and personally promise them that we'll start executing people if it goes badly, well, there are a lot of folks who aren't terribly trusting. And they're not necessarily wrong.