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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 n

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.
    - ThomPete 10y ago
      Which is why you should pay for most of your less expensive visits to the doctor so we can pay for the really serious things.
      - dpark 10y ago
        I think you're not recognizing the magnitude of difference here. I could personally pay for the normal checkups and basic healthcare for my family and my immediate neighbors with no real hardship. However, just one of the people I provided care for was diagnosed with cancer or any of a number of severe, chronic diseases, it could wipe out my savings entirely. The cost of one severe illness could cover the cost of dozens if not hundreds of generally-healthy people's healthcare. I don't strictly disagree with your assessment that people should cover their own basic healthcare needs. I just don't think that this actually does much to make coverage more affordable in general, because it's catastrophic coverage that costs so much.
        ThomPete 10y ago
        I think you are missing the point of what I am trying to say. In Denmark it's both free to go to the doctor and to go to the hospital. This model is obviously great but it has it's limits with things like treatment opportunity. What I am proposing is a model that mixes the US and the Danish system. We pay for our non-serious things but don't get bankrupted on serious illness. The price of US hospitals are inflated, they aren't the real cost which any visit to a hospital anywhere else in the world will tell you.
        dpark 10y ago
        I get your point. I just don't think it actually matters much. If you make people pay for basic care but cover the big stuff, you only cut a few percentage points off the cost of care carried by the state/insurers. I don't see how this is at all related to the inflated costs of American hospitals.
        10y ago
  - jellicle 10y ago
    > For all that is wrong with the US system it at least have access to almost any possible treatment in existence. Oh, not at all. The dialog goes like this: A: I'd like a treatment, but I can't pay for it. Hospital: Go away. Most people in the U.S. have no access to care costing more than a few hundred dollars, because that's how much money they have.
    - ThomPete 10y ago
      Again I am not saying that the current system is good just that you can get access to that kind of treatment if you can afford being on the right healthcare plan. In a single payer system like the Danish you don't even have the potentially.
      - jellicle 10y ago
        What medical care is available to the general public in the USA but not available in Denmark? I'm curious.
        ThomPete 10y ago
        Various types of cancer treatment to begin with.
        DanBC 10y ago
        Which cancer treatment?
    - infinite8s 10y ago
      That's only correct for elective treatments. Have something life-threatening? Go to the ER and you will be treated. And then everyone else will pay for it indirectly through increased costs.
      - jellicle 10y ago
        The vast majority of life-threatening conditions aren't required to be treated at any ER, and won't be, unless you can pay.
  - TheCoelacanth 10y ago
    Not really. In the US you have access to what your insurance company deems medically necessary. Not that different from other countries except that you don't get to vote on the people who ultimately decide what care you get.
    - ThomPete 10y ago
      and insurance companies give various access some to everything more or less some to very little. In a public healthcare system everyone have access to the same, but the same is less. So there is a tradeoff.
Frondo 10y ago
"you need to budget and you need to restrict who can get what, how much you can afford etc." The private insurers already do that.
- ThomPete 10y ago
  It's not the same believe me. A cost center literally puts a stop to how much you can spend, it doesn't have the flexibility of a profit center. It's a very different world where it's possible (for some) to get the latest treatment because it exist vs. a world were it doesn't because there isn't money for it. I am no fan of private insurers but it's very different.
  - dpark 10y ago
    Medical care is a cost center for insurers.
    - ThomPete 10y ago
      But they can remedy that cost by getting more insured into their fold. Edit: Not sure why this comment warrant a downvote. Anyone care to elaborate?
      - dpark 10y ago
        I didn't (and can't) downvote you, but in general you're simply wrong. You cannot add more costs to "remedy" a cost center. If an insurer takes on more clients, they might make more profit, they might mitigate some risks, but their costs will definitely go up proportionally with their client base. I'd also like to propose a thought exercise for you. Imagine a private insurer. They have, say, 50K clients. They make a couple million dollars a year in profit and make many millions of dollars in medical payments. Next year they double in size, which reduces their risk of failure and improves profit margin slightly. The better profit margin allows them to reduce costs a bit to attract more new clients. The next year they do the same, and the year after. Then they start merging with other insurers while continuing to grow. All along, as their client base grows, they improve profitability (and/or reduce costs) and their business becomes less risky. Suppose eventually all Americans use this one enormous insurance company. They have the power to negotiate the best rates with doctors, drug companies, hospitals, etc. They have such a large client base that there is no risk, just extremely predictable income and expense. They can get costs as low as the medical industry will allow because they have such a large base. Now suppose that this one enormous company is simply a part of the federal government. What changes to make single payer not work when it was working just fine before the words "federal government" were introduced?
Baeocystin 10y ago
It is true that the US has a very large illegal immigrant population, but a very large portion of them are migrant agricultural workers, and previous analysis by the state of California has worked out that the state receives a net benefit from their labor, even including ER/medical care visits. This may not hold for other forms of immigrant/refugee, but the agricultural laborers are a net boon to the state.
- ThomPete 10y ago
  I have no doubt, but how do you deal with it? Thats the question. How do you determine how is a net benefit for the country and who isn't?
  - Baeocystin 10y ago
    It is not a question with an easy answer. In general, people that come here to work are a net benefit, as they provide cheap labor, and spend much of their income locally. But this is only speaking in broad swaths. http://www.wsj.com/articles/immigration-does-more-good-than-harm-to-economy-study-finds-1474568991 http://www.wsj.com/articles/immigration-does-more-good-than-... For a good start on reading material.
- DrScump 10y ago
  Agriculture employs only a tiny percentage of those here illegally. In fact, many agricultural workers come in legally on H2-A visas.
  - Baeocystin 10y ago
    Ag work in general is only a few percent, sure, but look at the %/industry. Here in California, for example, ~45% of ag workers are estimated to be here illegally. Similar percentages are in construction, and other manual labor jobs. Also keep in mind that the job descriptions of this migrant population are fluid- who is counted as agricultural vs. construction, etc. changes by season and state.
DrScump 10y ago
What about illegal immigration, do people who are here illegally get access too? In California, yes (paid for by CA taxpayers, and debt). Generally, no.

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.
  - ThomPete 10y ago
    Which is why you should pay for most of your less expensive visits to the doctor so we can pay for the really serious things.
    - dpark 10y ago
      I think you're not recognizing the magnitude of difference here. I could personally pay for the normal checkups and basic healthcare for my family and my immediate neighbors with no real hardship. However, just one of the people I provided care for was diagnosed with cancer or any of a number of severe, chronic diseases, it could wipe out my savings entirely. The cost of one severe illness could cover the cost of dozens if not hundreds of generally-healthy people's healthcare. I don't strictly disagree with your assessment that people should cover their own basic healthcare needs. I just don't think that this actually does much to make coverage more affordable in general, because it's catastrophic coverage that costs so much.
      - ThomPete 10y ago
        I think you are missing the point of what I am trying to say. In Denmark it's both free to go to the doctor and to go to the hospital. This model is obviously great but it has it's limits with things like treatment opportunity. What I am proposing is a model that mixes the US and the Danish system. We pay for our non-serious things but don't get bankrupted on serious illness. The price of US hospitals are inflated, they aren't the real cost which any visit to a hospital anywhere else in the world will tell you.
        dpark 10y ago
        I get your point. I just don't think it actually matters much. If you make people pay for basic care but cover the big stuff, you only cut a few percentage points off the cost of care carried by the state/insurers. I don't see how this is at all related to the inflated costs of American hospitals.
        10y ago
- jellicle 10y ago
  > For all that is wrong with the US system it at least have access to almost any possible treatment in existence. Oh, not at all. The dialog goes like this: A: I'd like a treatment, but I can't pay for it. Hospital: Go away. Most people in the U.S. have no access to care costing more than a few hundred dollars, because that's how much money they have.
  - ThomPete 10y ago
    Again I am not saying that the current system is good just that you can get access to that kind of treatment if you can afford being on the right healthcare plan. In a single payer system like the Danish you don't even have the potentially.
    - jellicle 10y ago
      What medical care is available to the general public in the USA but not available in Denmark? I'm curious.
      - ThomPete 10y ago
        Various types of cancer treatment to begin with.
        DanBC 10y ago
        Which cancer treatment?
  - infinite8s 10y ago
    That's only correct for elective treatments. Have something life-threatening? Go to the ER and you will be treated. And then everyone else will pay for it indirectly through increased costs.
    - jellicle 10y ago
      The vast majority of life-threatening conditions aren't required to be treated at any ER, and won't be, unless you can pay.
- TheCoelacanth 10y ago
  Not really. In the US you have access to what your insurance company deems medically necessary. Not that different from other countries except that you don't get to vote on the people who ultimately decide what care you get.
  - ThomPete 10y ago
    and insurance companies give various access some to everything more or less some to very little. In a public healthcare system everyone have access to the same, but the same is less. So there is a tradeoff.

Frondo 10y ago

"you need to budget and you need to restrict who can get what, how much you can afford etc." The private insurers already do that.

ThomPete 10y ago
It's not the same believe me. A cost center literally puts a stop to how much you can spend, it doesn't have the flexibility of a profit center. It's a very different world where it's possible (for some) to get the latest treatment because it exist vs. a world were it doesn't because there isn't money for it. I am no fan of private insurers but it's very different.
- dpark 10y ago
  Medical care is a cost center for insurers.
  - ThomPete 10y ago
    But they can remedy that cost by getting more insured into their fold. Edit: Not sure why this comment warrant a downvote. Anyone care to elaborate?
    - dpark 10y ago
      I didn't (and can't) downvote you, but in general you're simply wrong. You cannot add more costs to "remedy" a cost center. If an insurer takes on more clients, they might make more profit, they might mitigate some risks, but their costs will definitely go up proportionally with their client base. I'd also like to propose a thought exercise for you. Imagine a private insurer. They have, say, 50K clients. They make a couple million dollars a year in profit and make many millions of dollars in medical payments. Next year they double in size, which reduces their risk of failure and improves profit margin slightly. The better profit margin allows them to reduce costs a bit to attract more new clients. The next year they do the same, and the year after. Then they start merging with other insurers while continuing to grow. All along, as their client base grows, they improve profitability (and/or reduce costs) and their business becomes less risky. Suppose eventually all Americans use this one enormous insurance company. They have the power to negotiate the best rates with doctors, drug companies, hospitals, etc. They have such a large client base that there is no risk, just extremely predictable income and expense. They can get costs as low as the medical industry will allow because they have such a large base. Now suppose that this one enormous company is simply a part of the federal government. What changes to make single payer not work when it was working just fine before the words "federal government" were introduced?

Baeocystin 10y ago

It is true that the US has a very large illegal immigrant population, but a very large portion of them are migrant agricultural workers, and previous analysis by the state of California has worked out that the state receives a net benefit from their labor, even including ER/medical care visits. This may not hold for other forms of immigrant/refugee, but the agricultural laborers are a net boon to the state.

ThomPete 10y ago
I have no doubt, but how do you deal with it? Thats the question. How do you determine how is a net benefit for the country and who isn't?
- Baeocystin 10y ago
  It is not a question with an easy answer. In general, people that come here to work are a net benefit, as they provide cheap labor, and spend much of their income locally. But this is only speaking in broad swaths. http://www.wsj.com/articles/immigration-does-more-good-than-harm-to-economy-study-finds-1474568991 http://www.wsj.com/articles/immigration-does-more-good-than-... For a good start on reading material.
DrScump 10y ago
Agriculture employs only a tiny percentage of those here illegally. In fact, many agricultural workers come in legally on H2-A visas.
- Baeocystin 10y ago
  Ag work in general is only a few percent, sure, but look at the %/industry. Here in California, for example, ~45% of ag workers are estimated to be here illegally. Similar percentages are in construction, and other manual labor jobs. Also keep in mind that the job descriptions of this migrant population are fluid- who is counted as agricultural vs. construction, etc. changes by season and state.

DrScump 10y ago

What about illegal immigration, do people who are here illegally get access too? In California, yes (paid for by CA taxpayers, and debt). Generally, no.