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Please don't assume my comment implies unvarnished support for the ACA. Except for the somewhat cynical last line, I tried to keep it fairly factual. If you do

by agar 10y ago

Please don't assume my comment implies unvarnished support for the ACA. Except for the somewhat cynical last line, I tried to keep it fairly factual. If you do want my personal opinion, I'll give it here: 1. From an economic standpoint, single-payer healthcare fundamentally makes sense. Put everyone in a single pool to reduce risk, drive efficiency, and maximize negotiating power. 2. From a free market standpoint, the current model of tying healthcare coverage to your employer hurts both employers and employees. As an employer, why am I responsible for paying this "benefit"? If too many of my employees get horribly ill, my premiums go up to the point that I can't provide a competitive benefit; my costs increase, my employees' contribution increases, and my ability to recruit talent suffers. As an employee, why must I forego an entrepreneurial opportunity because I can no longer afford healthcare for my children without an employer footing the majority of the bill? 3. From an efficiency standpoint, the current model wastes tremendous medical resources (bureaucracy, physician time, lack of cost transparency, treatment limits, etc.). I have friends in the medical industry (doctors, executives, med tech providers), all of whom dream of a single-payer system. 4. From a constitutional standpoint, I believe healthcare falls under "promote the general welfare" and "secure the blessings of liberty to ourselves and our posterity." A national, taxpayer-funded health program is no different than any number of other government-funded programs that free us to maximize our potential as citizens. And yes, we pay taxes to fund those services whether we use them or not. So yes, I'm a believer in a single-payer model. Yes, I believe the ACA is essentially a handout to insurance companies. And yes, I was very disappointed when Obama took single payer "off the table." However, I also think it's better than pre-ACA, despite its flaws. And at this point, it's certainly better than the chaos that will arise from simply abandoning it. Understanding its compromises, I can't really envision a "replacement ACA" that will pass a Republican congress that can be better. If Congress delivers a better ACA, I'll happily embrace it. Heck, I'd even give credit to the Republicans if they just tweaked the ACA, renamed it "Winningest Solid Gold Trumpcare" and fully backed the result to make it successful. But I see no positive outcome if they go down the "repeal and delay" path.

twoodfin 10y ago
1. From an economic standpoint, single-payer healthcare fundamentally makes sense. Put everyone in a single pool to reduce risk, drive efficiency, and maximize negotiating power. Like the U.S. military has maximum negotiating power with its contractors? I mean, who else is going to pay for the F-35? Monopsonies aren't inherently more efficient than monopolies.
- agar 10y ago
  Nor are they inherently less efficient. Do you truly feel military procurement is equivalent to healthcare delivery? Have you ever sold products to the US government? Do you believe the primary financial gains would come from negotiating power? (Hint, the list I provided is in order of impact.) Are you familiar with the impact Medicare Part D had on prescription drug prices? (Spoiler alert: it "substantially lowered the average price and increased the total utilization of prescription drugs by Medicare recipients" [1].) Do you believe the decisions behind funding defense are in any way influenced by non-economic factors? (Hint: defense budgets increase even when the military itself requests lower funding. Does government healthcare funding follow the same pattern? Why not?) Are you familiar with the many estimates of the cost of a single payer program in the US? [2] I could go on, but won't. This is not Reddit. Sound-bite caliber anecdotal arguments are a problem, not a solution. [1] http://faculty.som.yale.edu/FionaScottMorton/documents/TheEffectoftheMedicareDrugBenefitonPharmaceuticalPricesandUtilization.pdf http://faculty.som.yale.edu/FionaScottMorton/documents/TheEf... [2] http://www.pnhp.org/facts/single-payer-system-cost http://www.pnhp.org/facts/single-payer-system-cost
  - chimeracoder 10y ago
    > Nor are they inherently less efficient. "Less efficient" is actually a nonsensical term to economists[0], but monopsonies are inherently inefficient, and it's rather straightforward to demonstrate that economically, the same way it's straightforward to demonstrate that a monopoly is always inefficient, even in cases of so-called "natural monopolies". > Are you familiar with the impact Medicare Part D had on prescription drug prices? It "substantially lowered the average price and increased the total utilization of prescription drugs by Medicare recipients You can't use Medicare Part D as an example of the impact that negotiating power would or would not have, because Medicare doesn't "negotiate" (read: unilaterally determine by fiat) the prices it pays for drugs, which it does do for providers. > Are you familiar with the many estimates of the cost of a single payer program in the US? [2] Yes, and most of those (including the ones you linked) are based on Medicare's reimbursements as a baseline. But that's totally baseless, because according to Medicare's own financial reports, they pay below-sustainable reimbursement rates to providers[1], which means that they are essentially subsidized by the premiums paid by privately insured patients. If Medicare were expanded to include everyone, they would have to massively increase their reimbursement rates, because the private insurance market wouldn't exist. [0] Efficiency is best explained to a non-economist as a binary property; there does not exist a total (or even partial) ordering of inefficient states. [1] They pay below COGS, which means that even if all doctors, nurses, and staff worked for free, they would still make a loss on Medicare patients in the aggregate, if they were not able to charge the difference to private insurers. Incidentally, that's why uninsured patients see such high bills - those are the prices that are used as a starting point when negotiating with insurers, and they're massively inflated to cover the gap.
occamrazor 10y ago
In all fairness, Switzerland and the Netherlands have privatised medical insurance with universal coverage and the people are generally satisfied. Other countries, e.g. France and Germany, have mixed systems which also work well. The flaws of ACA are not inherent to a privatised system, they are the result of this specific implementation.

by agar 10y ago

twoodfin 10y ago

1. From an economic standpoint, single-payer healthcare fundamentally makes sense. Put everyone in a single pool to reduce risk, drive efficiency, and maximize negotiating power. Like the U.S. military has maximum negotiating power with its contractors? I mean, who else is going to pay for the F-35? Monopsonies aren't inherently more efficient than monopolies.

agar 10y ago
Nor are they inherently less efficient. Do you truly feel military procurement is equivalent to healthcare delivery? Have you ever sold products to the US government? Do you believe the primary financial gains would come from negotiating power? (Hint, the list I provided is in order of impact.) Are you familiar with the impact Medicare Part D had on prescription drug prices? (Spoiler alert: it "substantially lowered the average price and increased the total utilization of prescription drugs by Medicare recipients" [1].) Do you believe the decisions behind funding defense are in any way influenced by non-economic factors? (Hint: defense budgets increase even when the military itself requests lower funding. Does government healthcare funding follow the same pattern? Why not?) Are you familiar with the many estimates of the cost of a single payer program in the US? [2] I could go on, but won't. This is not Reddit. Sound-bite caliber anecdotal arguments are a problem, not a solution. [1] http://faculty.som.yale.edu/FionaScottMorton/documents/TheEffectoftheMedicareDrugBenefitonPharmaceuticalPricesandUtilization.pdf http://faculty.som.yale.edu/FionaScottMorton/documents/TheEf... [2] http://www.pnhp.org/facts/single-payer-system-cost http://www.pnhp.org/facts/single-payer-system-cost
- chimeracoder 10y ago
  > Nor are they inherently less efficient. "Less efficient" is actually a nonsensical term to economists[0], but monopsonies are inherently inefficient, and it's rather straightforward to demonstrate that economically, the same way it's straightforward to demonstrate that a monopoly is always inefficient, even in cases of so-called "natural monopolies". > Are you familiar with the impact Medicare Part D had on prescription drug prices? It "substantially lowered the average price and increased the total utilization of prescription drugs by Medicare recipients You can't use Medicare Part D as an example of the impact that negotiating power would or would not have, because Medicare doesn't "negotiate" (read: unilaterally determine by fiat) the prices it pays for drugs, which it does do for providers. > Are you familiar with the many estimates of the cost of a single payer program in the US? [2] Yes, and most of those (including the ones you linked) are based on Medicare's reimbursements as a baseline. But that's totally baseless, because according to Medicare's own financial reports, they pay below-sustainable reimbursement rates to providers[1], which means that they are essentially subsidized by the premiums paid by privately insured patients. If Medicare were expanded to include everyone, they would have to massively increase their reimbursement rates, because the private insurance market wouldn't exist. [0] Efficiency is best explained to a non-economist as a binary property; there does not exist a total (or even partial) ordering of inefficient states. [1] They pay below COGS, which means that even if all doctors, nurses, and staff worked for free, they would still make a loss on Medicare patients in the aggregate, if they were not able to charge the difference to private insurers. Incidentally, that's why uninsured patients see such high bills - those are the prices that are used as a starting point when negotiating with insurers, and they're massively inflated to cover the gap.

occamrazor 10y ago

In all fairness, Switzerland and the Netherlands have privatised medical insurance with universal coverage and the people are generally satisfied. Other countries, e.g. France and Germany, have mixed systems which also work well. The flaws of ACA are not inherent to a privatised system, they are the result of this specific implementation.