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Trump could get a big win-win on healthcare by proposing a single-payer system using the VA system as a model. It works (be patient, read article below) and cou

Trump could get a big win-win on healthcare by proposing a single-payer system using the VA system as a model. It works (be patient, read article below) and could be scaled to the entire USA. Two beneficial effects: 1) eliminates unnecessary middlemen, the private insurance companies, saving beaucoup dollars [we all love our insurance companies, don't we?] 2) solves the biggest problem the VA system currently has, namely, determining who has VA coverage. "The VA: Another reason for single payer": http://www.pnhp.org/the-va-another-reason-for-single-payer http://www.pnhp.org/the-va-another-reason-for-single-payer Furthermore, he could bring in Bernie Sanders to implement it (second article below) since Sanders is fully up-to-speed on this topic. "VA: Do we awfulize, or do we fix it? Chairman Sanders Lays Out Legislative Action Plan for Veterans": http://www.pnhp.org/news/2014/june/va-do-we-awfulize-or-do-we-fix-it http://www.pnhp.org/news/2014/june/va-do-we-awfulize-or-do-w...

dragonwriter 10y ago
> Trump could get a big win-win on healthcare by supporting a single-payer system. Sure, I'd like to see that plan regardless of who proposed it, but aside from speculation about Trump's own actual preferences and goals (which obviously play a role in what he would support), I'm not sure embracing the epitome of what Republicans have attacked as socialism would do anything but lose him support (and not just on this issue) within his own party, without buying him any support (except maybe on that one issue) from the opposing party. It would probably be a good way to Republicans in Congress on board with investigating the Russia issue, with an eye toward President Pence.
wahern 10y ago
1) eliminates unnecessary middlemen, the private insurance companies, saving beaucoup dollars [we all love our insurance companies, don't we?] The problem with single player is exactly that it would put the government in the same position as insurers. It'll give people even more reason to resent government. The fact that people still believe that both the VA and the USPS are prime examples of government gone _wrong_ should tell you everything about how well a national single-payer system would work out. Even if it was a success by the numbers, it would never be a political success. The political costs would be tremendous and perpetual. Look at Social Security. Most conservative voters think it's a broken system, even though by the numbers it's one of the most successful and well-run programs anywhere in the world, public or private. The baby boomer gap is easily fixed by adjusting the age of retirement, which was precisely how the system was designed to operate from the very beginning. But in the present political climate politicians 1) avoid proper maintenance while 2) simultaneously blaming "government" for the prospective short fall purely of their own creation. The only politically viable single-payer system would be state based. There's no European Union-wide single-payer system, either. Funding it, though, raises all sorts of problems. It's difficult for states to fund such a system independently because the Federal government soaks up so many tax dollars to spend on the military and pre-existing health programs. It's extremely difficult as a political matter to both devolve powers _and_ the requisite tax dollars back to the states. At the same time, improving the function and efficiency of federal programs is difficult given a ruling party which actively tries to sabotage those programs, even though they're politically _unable_ even among themselves to make the hard decisions that make the alternative--devolution--feasible.
- blackbagboys 10y ago
  I think you are overstating the persistent political difficulties a single-payer system would encounter. There has certainly been vocal conservative opposition to Social Security since its inception, but its beneficiaries form such a powerful lobby that it is effectively untouchable. I suspect that once enacted a single-payer system would be so popular among its beneficiaries (i.e. almost everyone) as to be unassailable. Something similar is happening right now with the ACA.
- ben_w 10y ago
  I'm in the UK (temporarily still in the EU). We have a single payer health system, much loved by the general population. However, it is also being systematically underfunded by the government, who are mostly getting away with blaming "health tourism" of foreigners rather than suffering from their own policies in elections. (This is why there was a bus with "£350 million per week" written on the side in the referendum: the NHS is really popular, and it's easy to blame outsiders). In principle, the NHS covers me when I'm anywhere in the EU, by paying for local treatment. In practice, it's not identical quality treatment, and there are edge cases. I suspect that the NHS will disintegrate under the pressure of Brexit, but on e other hand I'm extremely pessimistic about the whole thing and half the country thinks it will be great.
  - BeetleB 10y ago
    >We have a single payer health system, much loved by the general population. While technically true, in the US, when people say "single payer" they usually mean the system Canada has, which is quite different from the UK. In Canada, doctors are still private. They merely get compensated by the government (by billing them). In the UK, doctors are public employees. Doctors don't bill the government for a procedure. They just get paid a salary.
    - ben_w 10y ago
      Interesting, I did not realise that. I honestly don't know how the finances of different parts of the NHS are run (Hospitals, Primary Care Trusts, it's just jargon to me), has it ever been closer to the Canadian system than it is now?
chadgeidel 10y ago
A "big win-win" for who though? Health care insurance companies are probably among the biggest beneficiaries of the current system and contribute large sums to both parties to ensure it's continued existence.
- AnimalMuppet 10y ago
  A win-win for almost everyone. The current situation is that medical offices have to employ people to try to get insurance companies to pay them, and insurance companies employ people to try to avoid paying medical offices. This adds up to something like two people per doctor. Viewed from the perspective of the economy (or even the medical system) as a whole, those two people add no value whatsoever. All they do is work against each other, and collect paychecks. Eliminating them would be a major win for everyone except themselves (and perhaps the insurance companies as a whole).
  - chadgeidel 10y ago
    Oh, I agree completely. I just think the incentives for the politicians aren't properly aligned.
    - AnimalMuppet 10y ago
      Ah, I see. A big win for everyone except the insurance companies and the politicians they contribute to. And the problem is going to be solved politically. So, not likely to reach an optimal (for the vast majority of us) solution, then.
KirinDave 10y ago
If Trump did this he'd be doing exactly what Paul Ryan and other Republican Trump allies have been promising not to do, so while it would be nice to imagine Trump is an actual populist who might take some cues from former aggressive populists, it's quite unlikely that we'll see him do that.
untog 10y ago
> Trump could get a big win-win on healthcare by proposing a single-payer system hmm, but wha- > Furthermore, he could bring in Bernie Sanders to implement it uh... yeah, the Republicans aren't going to go for that. The President doesn't get to adopt the role of dictator for four years (as much as many would wish they do), and there is zero chance Republicans would go for this. Right now many Republicans are tolerating Trump's antics because they see him as a means to implement the legislation they've wanted for the last eight years. If that turns out to not be true they'll kick him to the curb.
dnautics 10y ago
I don't understand why people bring up the VA as a system to be emulated. My father worked for the VA for thirty years and was basically persecuted for being a whistleblower, denied promotion 'for lack of leadership' (despite the fact that as a captain in the navy he implemented the navy's first fleetwide all-digital database inventory system). Meanwhile abuse and malfeasance are systemic because employees have an attitude of entitlement about their jobs. All of those accusations leveled at Uber in the past week - are basically echoes of things that I have heard about the VA (especially the "slanty-eyed-joe" one, since my dad was asian-american, and he heard similar slurs even in hawaii where the majority of the population is asian. You don't want to be treated under a system like the VA. It is not a model.

dragonwriter 10y ago

> Trump could get a big win-win on healthcare by supporting a single-payer system. Sure, I'd like to see that plan regardless of who proposed it, but aside from speculation about Trump's own actual preferences and goals (which obviously play a role in what he would support), I'm not sure embracing the epitome of what Republicans have attacked as socialism would do anything but lose him support (and not just on this issue) within his own party, without buying him any support (except maybe on that one issue) from the opposing party. It would probably be a good way to Republicans in Congress on board with investigating the Russia issue, with an eye toward President Pence.

wahern 10y ago

1) eliminates unnecessary middlemen, the private insurance companies, saving beaucoup dollars [we all love our insurance companies, don't we?] The problem with single player is exactly that it would put the government in the same position as insurers. It'll give people even more reason to resent government. The fact that people still believe that both the VA and the USPS are prime examples of government gone _wrong_ should tell you everything about how well a national single-payer system would work out. Even if it was a success by the numbers, it would never be a political success. The political costs would be tremendous and perpetual. Look at Social Security. Most conservative voters think it's a broken system, even though by the numbers it's one of the most successful and well-run programs anywhere in the world, public or private. The baby boomer gap is easily fixed by adjusting the age of retirement, which was precisely how the system was designed to operate from the very beginning. But in the present political climate politicians 1) avoid proper maintenance while 2) simultaneously blaming "government" for the prospective short fall purely of their own creation. The only politically viable single-payer system would be state based. There's no European Union-wide single-payer system, either. Funding it, though, raises all sorts of problems. It's difficult for states to fund such a system independently because the Federal government soaks up so many tax dollars to spend on the military and pre-existing health programs. It's extremely difficult as a political matter to both devolve powers _and_ the requisite tax dollars back to the states. At the same time, improving the function and efficiency of federal programs is difficult given a ruling party which actively tries to sabotage those programs, even though they're politically _unable_ even among themselves to make the hard decisions that make the alternative--devolution--feasible.

blackbagboys 10y ago
I think you are overstating the persistent political difficulties a single-payer system would encounter. There has certainly been vocal conservative opposition to Social Security since its inception, but its beneficiaries form such a powerful lobby that it is effectively untouchable. I suspect that once enacted a single-payer system would be so popular among its beneficiaries (i.e. almost everyone) as to be unassailable. Something similar is happening right now with the ACA.
ben_w 10y ago
I'm in the UK (temporarily still in the EU). We have a single payer health system, much loved by the general population. However, it is also being systematically underfunded by the government, who are mostly getting away with blaming "health tourism" of foreigners rather than suffering from their own policies in elections. (This is why there was a bus with "£350 million per week" written on the side in the referendum: the NHS is really popular, and it's easy to blame outsiders). In principle, the NHS covers me when I'm anywhere in the EU, by paying for local treatment. In practice, it's not identical quality treatment, and there are edge cases. I suspect that the NHS will disintegrate under the pressure of Brexit, but on e other hand I'm extremely pessimistic about the whole thing and half the country thinks it will be great.
- BeetleB 10y ago
  >We have a single payer health system, much loved by the general population. While technically true, in the US, when people say "single payer" they usually mean the system Canada has, which is quite different from the UK. In Canada, doctors are still private. They merely get compensated by the government (by billing them). In the UK, doctors are public employees. Doctors don't bill the government for a procedure. They just get paid a salary.
  - ben_w 10y ago
    Interesting, I did not realise that. I honestly don't know how the finances of different parts of the NHS are run (Hospitals, Primary Care Trusts, it's just jargon to me), has it ever been closer to the Canadian system than it is now?

chadgeidel 10y ago

A "big win-win" for who though? Health care insurance companies are probably among the biggest beneficiaries of the current system and contribute large sums to both parties to ensure it's continued existence.

AnimalMuppet 10y ago
A win-win for almost everyone. The current situation is that medical offices have to employ people to try to get insurance companies to pay them, and insurance companies employ people to try to avoid paying medical offices. This adds up to something like two people per doctor. Viewed from the perspective of the economy (or even the medical system) as a whole, those two people add no value whatsoever. All they do is work against each other, and collect paychecks. Eliminating them would be a major win for everyone except themselves (and perhaps the insurance companies as a whole).
- chadgeidel 10y ago
  Oh, I agree completely. I just think the incentives for the politicians aren't properly aligned.
  - AnimalMuppet 10y ago
    Ah, I see. A big win for everyone except the insurance companies and the politicians they contribute to. And the problem is going to be solved politically. So, not likely to reach an optimal (for the vast majority of us) solution, then.

KirinDave 10y ago

If Trump did this he'd be doing exactly what Paul Ryan and other Republican Trump allies have been promising not to do, so while it would be nice to imagine Trump is an actual populist who might take some cues from former aggressive populists, it's quite unlikely that we'll see him do that.

untog 10y ago

> Trump could get a big win-win on healthcare by proposing a single-payer system hmm, but wha- > Furthermore, he could bring in Bernie Sanders to implement it uh... yeah, the Republicans aren't going to go for that. The President doesn't get to adopt the role of dictator for four years (as much as many would wish they do), and there is zero chance Republicans would go for this. Right now many Republicans are tolerating Trump's antics because they see him as a means to implement the legislation they've wanted for the last eight years. If that turns out to not be true they'll kick him to the curb.

dnautics 10y ago

I don't understand why people bring up the VA as a system to be emulated. My father worked for the VA for thirty years and was basically persecuted for being a whistleblower, denied promotion 'for lack of leadership' (despite the fact that as a captain in the navy he implemented the navy's first fleetwide all-digital database inventory system). Meanwhile abuse and malfeasance are systemic because employees have an attitude of entitlement about their jobs. All of those accusations leveled at Uber in the past week - are basically echoes of things that I have heard about the VA (especially the "slanty-eyed-joe" one, since my dad was asian-american, and he heard similar slurs even in hawaii where the majority of the population is asian. You don't want to be treated under a system like the VA. It is not a model.