11 ms·

I've said it before, we need a single payer system. Insurance companies and Pharmaceutical companies can more or less dictate the prices they'll charge because

I've said it before, we need a single payer system. Insurance companies and Pharmaceutical companies can more or less dictate the prices they'll charge because if you're chronically ill, you can't just choose not to be treated (unless you're ok with dying.) This behavior should not be surprising. Until the American people get pissed off enough, we'll continue to have these shenanigans.

burkaman 10y ago
Obama said that too, once. I think most Democrats in office have said that at one point, even if they don't want to say it in public anymore. The ACA was not passed because it was better than single payer, it was just the closest thing that could possibly get through Congress.
- Fomite 10y ago
  I think this is the greatest obstacle to the "...and Replace" part of Repeal and Replace. The ACA was already the workable compromise.
  - GiorgioG 10y ago
    Workable politically, practically it's been completely ineffective in reducing healthcare costs.
    - ejstronge 10y ago
      The ACA's goal was not to rein in healthcare spending (this potential shortcoming was discussed before it even passed). While there is funding for experiments aimed at reducing costs, none of the bill's major facets deal with this issue. Here's an article where one of the bill's intellectual architects talks about the topic: http://www.nejm.org/doi/full/10.1056/NEJMp1006571 http://www.nejm.org/doi/full/10.1056/NEJMp1006571
    - deleted 10y ago
      [deleted]
    - kapauldo 10y ago
      This is factually wrong. I have been providing health care for my employees since 2001. Pre ACA, rates rose 20% per year. Post ACA we've seen 5% raises most years, one year we saw a decrease, and this year, we saw 9%.
      - GiorgioG 10y ago
        Maybe on paper you're factually correct. My rates didn't go up this year ($1800/month) but my benefits went down costing me about $3,000 more than last year.
    - jellicle 10y ago
      Actually, it has saved Americans trillions of dollars: http://fortune.com/2016/06/21/us-health-care-costs/ http://fortune.com/2016/06/21/us-health-care-costs/
  - gozur88 10y ago
    Except that it wasn't workable. It was never financially sound and was doomed without additional funding for which the public was never prepared politically. It was rammed through Congress without a single Republican vote using a procedural trick, so politically the best play for the GOP was to let it fail and then hang the failure on the Democrats. I have no idea what Trump's plan is, but I hope whatever it is the Republicans don't play games with the GAO accounting and they also bring Democrats on board so both parties have a political stake in success.
    - jljljl 10y ago
      What procedural trick? It received 60 votes in the Senate and a majority in the House.
      - gozur88 10y ago
        The final bill would not have survived a filibuster because the Democrats no longer had 60 votes. From wikipedia: "House Democrats had expected to be able to negotiate changes in a House-Senate conference before passing a final bill. Since any bill that emerged from conference that differed from the Senate bill would have to pass the Senate over another Republican filibuster, most House Democrats agreed to pass the Senate bill on condition that it be amended by a subsequent bill.[165] They drafted the Health Care and Education Reconciliation Act, which could be passed by the reconciliation process.[166][169][170] As per the Congressional Budget Act of 1974, reconciliation cannot be subject to a filibuster. But reconciliation is limited to budget changes, which is why the procedure was not used to pass ACA in the first place; the bill had inherently non-budgetary regulations.[171][172] Although the already-passed Senate bill could not have been passed by reconciliation, most of House Democrats' demands were budgetary: "these changes—higher subsidy levels, different kinds of taxes to pay for them, nixing the Nebraska Medicaid deal—mainly involve taxes and spending. In other words, they're exactly the kinds of policies that are well-suited for reconciliation."[169]" Despite the gloss the wiki authors put on it, this is highly irregular. It's within the letter of Senate rules, but if you're expecting to ever get cooperation from the opposition party this is not the sort of stunt you want to pull. I saw a headline that said something along the lines that the Republicans plan to repeal the ACA using reconciliation, which would be poetic if true.
  - chrisan 10y ago
    > The ACA was already the workable compromise. At the time of Republican minority. Power has shifted to the Republicans and there can be a new "compromise"
- dragonwriter 10y ago
  > The ACA was not passed because it was better than single payer, it was just the closest thing that could possibly get through Congress. The ACA was deliberately modelled on Republican/Industry plans with the hope it would have been a bipartisan solution. This was, of course, a vain hope as we now know, but it was fundamental to why it had the shape it did.
blisterpeanuts 10y ago
>>> Insurance companies and Pharmaceutical companies can more or less dictate the prices they'll charge because if you're chronically ill, you can't just choose not to be treated (unless you're ok with dying.) How is this consistent with the pre-ACA availability of high deductible, low premium PPO plans in low-regulation states? As an example, in 2008, a middle aged man could buy such a plan in Arizona for $70/month with a $10K deductible and $2 million lifetime coverage. This included free annual wellness visits, women's wellness checkups, etc. Keep $10K in the bank for emergencies, and you're good to go. Millions of self-employed people and people working jobs that provided no group insurance benefits were able to take advantage of these products. I was able to insure my family of three for $330 a month at that time, and the coverage was quite good. I don't fully understand the single payer concept, except that it essentially is a form of national health insurance similar to the British NHS. For a country as big and diverse as the U.S., it sounds expensive and unworkable. I would propose as an alternative a hybrid of low-regulation plans such as we had prior to ACA, plus support for those who can't even afford one of these low price plans. Free or low fee clinics for the needy, less regulatory load on hospitals and small practices, e.g. remove or delay the electronic medical record requirement, attack the causes of high malpractice insurance, stop incentivizing physicians to "turf" challenging patients off to specialists and overprescription of tests to cover their liability. There has to be a way that works, short of a national Medicare for all that I fear would lead to great mediocrity.
- GiorgioG 10y ago
  > I don't fully understand the single payer concept, except that it essentially is a form of national health insurance similar to the British NHS. Here's why single payer works to keep costs in check everywhere it's implemented: Providers and pharmaceutical companies have only 1 organization to negotiate with. Another alternative that won't see the light of day is cost regulation for the entire industry. My sons type 1 diabetes supplies for a quarter bill my insurance plan $6000. There's not more than a couple of hundred dollars worth of materials there (and I'm being generous.) A friend of mine takes Gleevec, a leukemia drug, costing his insurer $14,000 per month. Generics are now coming on the market for a much "cheaper" $38,000/year. That same generic in Canada is $8,800/year. We're being systematically ripped off.
jobu 10y ago
Single payer would be ideal for most Americans, but those in power (both government and industry) seem to prefer the high deductible health plans with health savings accounts. Unfortunately I don't see high deductible plans working for anyone unless healthcare providers and pharmacies are required to list all prices up-front. As it is there's no way for consumers to "shop around" because they can't get prices for most tests, procedures, or even medications until they bill through insurance (which can take weeks).
- scotch_drinker 10y ago
  Exactly this. It's a falsehood to think that HSA/HD will cause you to be a better consumer because you can't be a better consumer when the sellers refuse to provide price information. We had our first child this year and the hospital coded some things to my wife and some to my daughter which caused us to pay two deductibles. I tried to get an itemized breakdown repeatedly from the hospital and was met with "we can't do that." Never mind the fact that you can't exactly shop around for places to deliver when your OB/GYN only has admitting privileges at one hospital. I'm about as free market as they come but when the providers flat refuse to tell you what they are going to charge you. Try going to one of those corner ERs, you'll have to sign a form saying you are solely responsible for all charges but they sure won't tell you what those charges are until you sign it.
  - dpark 10y ago
    Does anyone claim that HD plans make people more savvy consumers? I've always thought it was a transparent way to make people of moderate means think twice about any care that could be considered elective. Whether it's a good idea or not, paying out of pocket for a $3000 procedure might make you question the need for a CAT scan. High deductible plans definitely don't make anyone smarter consumers. The market is opaque and your options are limited to in-network in the best case.
- GiorgioG 10y ago
  High-deductible plans are not the answer. They are a symptom of the problem. You assume risk up to say $10,000 (your high deductible) because you don't expect to need it unless you wind up in the hospital. If you have a chronic illness, high deductible plans don't do shit for you. As long as we view this as a "not my problem, I'm not sick" issue, this will never be fixed.
gozur88 10y ago
Lots of people have said it. Single payer has advantages and disadvantages, and we haven't decided, as a country, whether that makes sense.
ThomPete 10y ago
So obviously single payer is a system that is what most would strive for. But could it work in the US? I am from Denmark originally where we have it and it's not without issues because suddenly you turn a profit center into a cost center which means you need to budget and you need to restrict who can get what, how much you can afford etc. What about illegal immigration, do people who are here illegally get access too? These are all questions that are very hard to answer IMO because the US after all is such an open society.
- nodamage 10y ago
  > I am from Denmark originally where we have it and it's not without issues because suddenly you turn a profit center into a cost center which means you need to budget and you need to restrict who can get what, how much you can afford etc. Are the same decisions not still made when health care is for-profit? Except it becomes the insurance companies that get to decide who gets treatment and who is too expensive to treat so we'll just drop their coverage instead?
  - ThomPete 10y ago
    For all that is wrong with the US system it at least have access to almost any possible treatment in existence. So yes the individual insurances are limited to various degrees but there are for some access to he best of the best. In my world the major problem in the US is that you can "go bankrupt" by being too sick too long. It should be so that everyone pay to go to the doctor for minor things but no one go broke if they happen to be sick. Why this balance can't be found baffles my mind.
    - dpark 10y ago
      > It should be so that everyone pay to go to the doctor for minor things but no one go broke if they happen to be sick. > Why this balance can't be found baffles my mind. Because paying for a doctor visit for a minor infection is the cheap part of healthcare. "Being sick too long" is extremely expensive. Getting a shot of penicillin costs a couple hundred dollars. Treating cancer can cost tens of thousands.
Loughla 10y ago
Honest question. What chance do you think, or how would you propose we start this discussion with people who genuinely believe the market as it is now, with 'choice' is the best option for consumers? I live in flyover country, and people legit believe that letting the market make choices is best, and single payer is a quick step to full on communism. I'm looking for positive arguments to counter that nonsense.
- cordite 10y ago
  It seems like we need a state or two to become an experiment (in the same nature as pot). However I fear that any attempt to will result in companies suing the state for unfair competition or the like.
  - maxerickson 10y ago
    It's likely that providers would flee any smaller state that attempted to do single payer. Not universally of course, but enough to have a big impact on availability of services. California might be able to try it.
    - kurttheviking 10y ago
      > California might be able to try it. This. California democrats recently achieved a supermajority[1] making such an experiment possible. If California cannot push state legislators hard enough to give it a shot, the idea that a fractured national Congress will is fatally flawed. Voters rejected the idea in Vermont[2] (Bernie country[3]) -- so, can California be different? Granted, a California experiment must balance the fact the CMS money originates from federal sources, but that should not completely inhibit an experiment. [1] http://www.latimes.com/politics/essential/la-pol-ca-essential-politics-updates-democrats-nab-a-supermajority-after-1480383488-htmlstory.html http://www.latimes.com/politics/essential/la-pol-ca-essentia... [2] http://www.politico.com/story/2014/12/single-payer-vermont-113711 http://www.politico.com/story/2014/12/single-payer-vermont-1... [3] https://en.wikipedia.org/wiki/Vermont_Democratic_primary,_2016 https://en.wikipedia.org/wiki/Vermont_Democratic_primary,_20...
  - 10y ago
oldprogrammer2 10y ago
Let's not ignore the providers themselves. Excluding the middlemen, my wife had a bill for a lithrotripsy procedure (she was there for approximately 4 hours) of nearly $10,000, and most of that went to the hospital. That was before insurance negotiated their rate.
wyager 10y ago
> Pharmaceutical companies can more or less dictate the prices This is a problem with overreaching intellectual property law, not with having a choice in health providers.

burkaman 10y ago

Obama said that too, once. I think most Democrats in office have said that at one point, even if they don't want to say it in public anymore. The ACA was not passed because it was better than single payer, it was just the closest thing that could possibly get through Congress.

Fomite 10y ago
I think this is the greatest obstacle to the "...and Replace" part of Repeal and Replace. The ACA was already the workable compromise.
- GiorgioG 10y ago
  Workable politically, practically it's been completely ineffective in reducing healthcare costs.
  - ejstronge 10y ago
    The ACA's goal was not to rein in healthcare spending (this potential shortcoming was discussed before it even passed). While there is funding for experiments aimed at reducing costs, none of the bill's major facets deal with this issue. Here's an article where one of the bill's intellectual architects talks about the topic: http://www.nejm.org/doi/full/10.1056/NEJMp1006571 http://www.nejm.org/doi/full/10.1056/NEJMp1006571
  - deleted 10y ago
    [deleted]
  - kapauldo 10y ago
    This is factually wrong. I have been providing health care for my employees since 2001. Pre ACA, rates rose 20% per year. Post ACA we've seen 5% raises most years, one year we saw a decrease, and this year, we saw 9%.
    - GiorgioG 10y ago
      Maybe on paper you're factually correct. My rates didn't go up this year ($1800/month) but my benefits went down costing me about $3,000 more than last year.
  - jellicle 10y ago
    Actually, it has saved Americans trillions of dollars: http://fortune.com/2016/06/21/us-health-care-costs/ http://fortune.com/2016/06/21/us-health-care-costs/
- gozur88 10y ago
  Except that it wasn't workable. It was never financially sound and was doomed without additional funding for which the public was never prepared politically. It was rammed through Congress without a single Republican vote using a procedural trick, so politically the best play for the GOP was to let it fail and then hang the failure on the Democrats. I have no idea what Trump's plan is, but I hope whatever it is the Republicans don't play games with the GAO accounting and they also bring Democrats on board so both parties have a political stake in success.
  - jljljl 10y ago
    What procedural trick? It received 60 votes in the Senate and a majority in the House.
    - gozur88 10y ago
      The final bill would not have survived a filibuster because the Democrats no longer had 60 votes. From wikipedia: "House Democrats had expected to be able to negotiate changes in a House-Senate conference before passing a final bill. Since any bill that emerged from conference that differed from the Senate bill would have to pass the Senate over another Republican filibuster, most House Democrats agreed to pass the Senate bill on condition that it be amended by a subsequent bill.[165] They drafted the Health Care and Education Reconciliation Act, which could be passed by the reconciliation process.[166][169][170] As per the Congressional Budget Act of 1974, reconciliation cannot be subject to a filibuster. But reconciliation is limited to budget changes, which is why the procedure was not used to pass ACA in the first place; the bill had inherently non-budgetary regulations.[171][172] Although the already-passed Senate bill could not have been passed by reconciliation, most of House Democrats' demands were budgetary: "these changes—higher subsidy levels, different kinds of taxes to pay for them, nixing the Nebraska Medicaid deal—mainly involve taxes and spending. In other words, they're exactly the kinds of policies that are well-suited for reconciliation."[169]" Despite the gloss the wiki authors put on it, this is highly irregular. It's within the letter of Senate rules, but if you're expecting to ever get cooperation from the opposition party this is not the sort of stunt you want to pull. I saw a headline that said something along the lines that the Republicans plan to repeal the ACA using reconciliation, which would be poetic if true.
- chrisan 10y ago
  > The ACA was already the workable compromise. At the time of Republican minority. Power has shifted to the Republicans and there can be a new "compromise"
dragonwriter 10y ago
> The ACA was not passed because it was better than single payer, it was just the closest thing that could possibly get through Congress. The ACA was deliberately modelled on Republican/Industry plans with the hope it would have been a bipartisan solution. This was, of course, a vain hope as we now know, but it was fundamental to why it had the shape it did.

blisterpeanuts 10y ago

>>> Insurance companies and Pharmaceutical companies can more or less dictate the prices they'll charge because if you're chronically ill, you can't just choose not to be treated (unless you're ok with dying.) How is this consistent with the pre-ACA availability of high deductible, low premium PPO plans in low-regulation states? As an example, in 2008, a middle aged man could buy such a plan in Arizona for $70/month with a $10K deductible and $2 million lifetime coverage. This included free annual wellness visits, women's wellness checkups, etc. Keep $10K in the bank for emergencies, and you're good to go. Millions of self-employed people and people working jobs that provided no group insurance benefits were able to take advantage of these products. I was able to insure my family of three for $330 a month at that time, and the coverage was quite good. I don't fully understand the single payer concept, except that it essentially is a form of national health insurance similar to the British NHS. For a country as big and diverse as the U.S., it sounds expensive and unworkable. I would propose as an alternative a hybrid of low-regulation plans such as we had prior to ACA, plus support for those who can't even afford one of these low price plans. Free or low fee clinics for the needy, less regulatory load on hospitals and small practices, e.g. remove or delay the electronic medical record requirement, attack the causes of high malpractice insurance, stop incentivizing physicians to "turf" challenging patients off to specialists and overprescription of tests to cover their liability. There has to be a way that works, short of a national Medicare for all that I fear would lead to great mediocrity.

GiorgioG 10y ago
> I don't fully understand the single payer concept, except that it essentially is a form of national health insurance similar to the British NHS. Here's why single payer works to keep costs in check everywhere it's implemented: Providers and pharmaceutical companies have only 1 organization to negotiate with. Another alternative that won't see the light of day is cost regulation for the entire industry. My sons type 1 diabetes supplies for a quarter bill my insurance plan $6000. There's not more than a couple of hundred dollars worth of materials there (and I'm being generous.) A friend of mine takes Gleevec, a leukemia drug, costing his insurer $14,000 per month. Generics are now coming on the market for a much "cheaper" $38,000/year. That same generic in Canada is $8,800/year. We're being systematically ripped off.

jobu 10y ago

Single payer would be ideal for most Americans, but those in power (both government and industry) seem to prefer the high deductible health plans with health savings accounts. Unfortunately I don't see high deductible plans working for anyone unless healthcare providers and pharmacies are required to list all prices up-front. As it is there's no way for consumers to "shop around" because they can't get prices for most tests, procedures, or even medications until they bill through insurance (which can take weeks).

scotch_drinker 10y ago
Exactly this. It's a falsehood to think that HSA/HD will cause you to be a better consumer because you can't be a better consumer when the sellers refuse to provide price information. We had our first child this year and the hospital coded some things to my wife and some to my daughter which caused us to pay two deductibles. I tried to get an itemized breakdown repeatedly from the hospital and was met with "we can't do that." Never mind the fact that you can't exactly shop around for places to deliver when your OB/GYN only has admitting privileges at one hospital. I'm about as free market as they come but when the providers flat refuse to tell you what they are going to charge you. Try going to one of those corner ERs, you'll have to sign a form saying you are solely responsible for all charges but they sure won't tell you what those charges are until you sign it.
- dpark 10y ago
  Does anyone claim that HD plans make people more savvy consumers? I've always thought it was a transparent way to make people of moderate means think twice about any care that could be considered elective. Whether it's a good idea or not, paying out of pocket for a $3000 procedure might make you question the need for a CAT scan. High deductible plans definitely don't make anyone smarter consumers. The market is opaque and your options are limited to in-network in the best case.
GiorgioG 10y ago
High-deductible plans are not the answer. They are a symptom of the problem. You assume risk up to say $10,000 (your high deductible) because you don't expect to need it unless you wind up in the hospital. If you have a chronic illness, high deductible plans don't do shit for you. As long as we view this as a "not my problem, I'm not sick" issue, this will never be fixed.

gozur88 10y ago

Lots of people have said it. Single payer has advantages and disadvantages, and we haven't decided, as a country, whether that makes sense.

ThomPete 10y ago

So obviously single payer is a system that is what most would strive for. But could it work in the US? I am from Denmark originally where we have it and it's not without issues because suddenly you turn a profit center into a cost center which means you need to budget and you need to restrict who can get what, how much you can afford etc. What about illegal immigration, do people who are here illegally get access too? These are all questions that are very hard to answer IMO because the US after all is such an open society.

nodamage 10y ago
> I am from Denmark originally where we have it and it's not without issues because suddenly you turn a profit center into a cost center which means you need to budget and you need to restrict who can get what, how much you can afford etc. Are the same decisions not still made when health care is for-profit? Except it becomes the insurance companies that get to decide who gets treatment and who is too expensive to treat so we'll just drop their coverage instead?
- ThomPete 10y ago
  For all that is wrong with the US system it at least have access to almost any possible treatment in existence. So yes the individual insurances are limited to various degrees but there are for some access to he best of the best. In my world the major problem in the US is that you can "go bankrupt" by being too sick too long. It should be so that everyone pay to go to the doctor for minor things but no one go broke if they happen to be sick. Why this balance can't be found baffles my mind.
  - dpark 10y ago
    > It should be so that everyone pay to go to the doctor for minor things but no one go broke if they happen to be sick. > Why this balance can't be found baffles my mind. Because paying for a doctor visit for a minor infection is the cheap part of healthcare. "Being sick too long" is extremely expensive. Getting a shot of penicillin costs a couple hundred dollars. Treating cancer can cost tens of thousands.

Loughla 10y ago

Honest question. What chance do you think, or how would you propose we start this discussion with people who genuinely believe the market as it is now, with 'choice' is the best option for consumers? I live in flyover country, and people legit believe that letting the market make choices is best, and single payer is a quick step to full on communism. I'm looking for positive arguments to counter that nonsense.

cordite 10y ago
It seems like we need a state or two to become an experiment (in the same nature as pot). However I fear that any attempt to will result in companies suing the state for unfair competition or the like.
- maxerickson 10y ago
  It's likely that providers would flee any smaller state that attempted to do single payer. Not universally of course, but enough to have a big impact on availability of services. California might be able to try it.
  - kurttheviking 10y ago
    > California might be able to try it. This. California democrats recently achieved a supermajority[1] making such an experiment possible. If California cannot push state legislators hard enough to give it a shot, the idea that a fractured national Congress will is fatally flawed. Voters rejected the idea in Vermont[2] (Bernie country[3]) -- so, can California be different? Granted, a California experiment must balance the fact the CMS money originates from federal sources, but that should not completely inhibit an experiment. [1] http://www.latimes.com/politics/essential/la-pol-ca-essential-politics-updates-democrats-nab-a-supermajority-after-1480383488-htmlstory.html http://www.latimes.com/politics/essential/la-pol-ca-essentia... [2] http://www.politico.com/story/2014/12/single-payer-vermont-113711 http://www.politico.com/story/2014/12/single-payer-vermont-1... [3] https://en.wikipedia.org/wiki/Vermont_Democratic_primary,_2016 https://en.wikipedia.org/wiki/Vermont_Democratic_primary,_20...
- 10y ago

oldprogrammer2 10y ago

Let's not ignore the providers themselves. Excluding the middlemen, my wife had a bill for a lithrotripsy procedure (she was there for approximately 4 hours) of nearly $10,000, and most of that went to the hospital. That was before insurance negotiated their rate.

wyager 10y ago

> Pharmaceutical companies can more or less dictate the prices This is a problem with overreaching intellectual property law, not with having a choice in health providers.