11 ms·

Agree cost is a huge factor, but another key issues is the inconvenient fact that most Americans with employer-provided coverage are satisfied with it. Convinci

Agree cost is a huge factor, but another key issues is the inconvenient fact that most Americans with employer-provided coverage are satisfied with it. Convincing them to take a leap into the dark with no credible promises that they could still see the same PCPs and specialists they can see today and with similar wait time/referral requirements would be politically Herculean.

jellicle 9y ago
> they could still see the same PCPs and specialists they can see today What do you think single-payer is? There's no such thing as "out of network".
- twoodfin 9y ago
  I don't think single-payer works the way you seem to think it does in nations where it's been implemented. I have an expensive employer-provided plan. I can, without any referral, make an appointment with a specialist (surely making $300K+) at a top teaching hospital and expect to wait weeks at the most. There is no way to offer that level of service to anyone and not explode costs, let alone contain them.
  - dyeje 9y ago
    Do you have anything to backup that claim?
    - smokeyj 9y ago
      Is that whole "supply and demand" thing not convincing enough?
  - toomuchtodo 9y ago
    > There is no way to offer that level of service to anyone and not explode costs, let alone contain them. * Import more doctors from other countries with a streamlined visa process * Provide free training to doctors for underserved specialties This is not hard. It is supply and demand. If demand increases, you find ways to increase supply in a cost-efficient manner.
  - Brakenshire 9y ago
    The French system is similar to that. You're right it's more expensive in terms of government expenditure than the US, although quite a lot cheaper in terms of combined public-private cost.
    - twoodfin 9y ago
      Is the French system true single-payer? I thought it was a hybrid system that allowed for significant private supplement.
      - Brakenshire 9y ago
        I think it's a single payer system with an additional premium coverage, which can be covered either by copayment in the event, or with private insurance.
  - vertex-four 9y ago
    The UK has a dual model - NHS for everybody, and if you have spare money, you can additionally pay for additional services through insurance providers such as BUPA or paying directly. BUPA et al have reduced costs due to not having to cover a range of conditions, not having to indirectly fund A&E departments, being able to deny people coverage for preexisting conditions, etc etc. It's very unlikely that the US would ever deny people the ability to pay for healthcare if they chose to.
    - twoodfin 9y ago
      Then we should stop using the term "single-payer", which describes a system like Canada's, where private payments to providers are illegal. In any event, you'd still be asking millions of Americans to switch health care plans when they're satisfied with what they already have.
      - vertex-four 9y ago
        We do have single-payer healthcare for all NHS services. You cannot pay for NHS services, and NHS services will cover almost everything you'll ever need so long as the treatment is actually proven to work - it's a newspaper-worthy situation when the NHS denies treatment, and usually that only comes into play with e.g. very new cancer treatments. Every citizen of the UK can use NHS services as a right, whether they pay taxes or not. If you have an emergency, you will be taken to an NHS A&E department. BUPA et al primarily provide slightly nicer rooms for inpatients, might be more flexible on times you can see a doctor, might provide more personalised information on general health stuff (e.g. "how do I lose weight/get fit?"), and might allow you to see a doctor slightly sooner for stuff that's not going to kill you. I do not believe that Americans as a whole are satisfied with what they have. I believe that you are, since you have significant income and can get coverage for anything you like. I talk to people on a daily basis who have to worry about what treatments they are able to afford for their diagnosed disorders. For many of them, surgery is required for which they have to save up for a number of years and then visit another country, while paying extortionate (in relation to their income) prices for life-saving medication all the while.
  - jellicle 9y ago
    But of course that "service" is mostly waste. If you self-refer yourself to Dr. Smucker, the best [foo] surgeon in the business, you're likely to find that your [foo] isn't broken at all and even if it was, it doesn't need surgery. So you've wasted Ms. Smucker's time and your insurance company's money, and you haven't made anyone, including yourself, any healthier. And of course, there's like a 50-50 chance that Ms. Smucker is actually out of network by the time you see her, and you'll get a $2,000 bill to pay. Take out the profit motive and you can build systems to actually make people healthier: networks of clinics and registered nurses and family physicians to handle the bulk of the work (which is, after all, mostly routine) backed up by specialists for the hard cases, and everyone with a mandate to do what is best for the patient rather than what makes the most money. That's what other countries do and it works extremely well, providing better health outcomes than the USA for a fraction of the cost.
    - twoodfin 9y ago
      We can argue about the potential cost savings of restricting who patients can see and when, but that's my point! Politically, telling folks who are happily "wasting" money on medicine that the government and not their doctors will decide what they can and can't have is a huge loser. Currently, their insurers are not heavily restricting them, because they're paying for the privilege.
      - jernfrost 9y ago
        Insurance companies are not different than government, they also try to limit your usage of health services. Every time you get service it is an expense for them. But honestly I think single payer is just part of the solution. You also need public hospitals, because hospitals have no incentive to suggest a good but cheap solution to a medical problem. I read a book, where an American went all around the world with the same ailment, got examined and suggestions for procedure to treat it. A VERY telling outcome was that in the US only the most expensive and complicated procedure was suggested to the patient. In other countries he was informed about cheaper and far less invasive procedures. Which btw worked and made him happy, so he avoided a complicated and potentially risky surgical procedure. This is a problem with the US system. There are something like 2-3x as many surgical procedures that needed often simply worsening the well being of the patient. This is the flawed American thinking that good health care is the same as getting lots of complicated medical procedures. The drug consumption is also astonishing. When using American health care I was shocked by how aggressively they pushed medication on me. People are trying to push medication on people everywhere in the US. Doctors, commercials, drug stores etc. You are not a patient. You are just a customer. The US system really just leads to the health care sector focusing on pushing as many expensive drugs and procedures on the people who can pay for them an ignoring the rest, regardless of whether that brings better health or not.
  - pg314 9y ago
    > I don't think single-payer works the way you seem to think it does in nations where it's been implemented. I don't think single-payer works the way you seem to think it does. > I have an expensive employer-provided plan. I'm happy for you. What happens when you lose your job? I live in Belgium. I'm covered by the basic social security health insurance, just like any other Belgian. > I can, without any referral, make an appointment with a specialist (surely making $300K+) at a top teaching hospital and expect to wait weeks at the most. So can I. I've never had to wait more than a couple of weeks at most. If it's urgent, they fit you in on the same day or a couple of days later at the latest. That seems to be corroborated by [1]. One exception is mental health care, where the waiting lists are long. > There is no way to offer that level of service to anyone and not explode costs, let alone contain them. That is wrong. According to [2], health spending accounted for 10.9% of GDP in Belgium in 2012, which is much lower than the 16.9% the US spends. [1] http://focusonbelgium.be/en/international/belgium-has-shortest-waiting-time-healthcare-europe http://focusonbelgium.be/en/international/belgium-has-shorte... [2] http://webcache.googleusercontent.com/search?q=cache:2VeNWmBzMy0J:www.oecd.org/belgium/Briefing-Note-BELGIUM-2014.pdf+&cd=1&hl=en&ct=clnk&gl=be http://webcache.googleusercontent.com/search?q=cache:2VeNWmB...
    - twoodfin 9y ago
      The Belgian system contains costs in other ways. For example, doctors (especially GP's) are paid significantly less. Belgium is also over 10x as population dense as the U.S., which offers significant opportunities for more efficient care delivery. Anyway, it's not clear to me that Belgium has anything like a single-payer system[1]: The Belgian population enjoys good health and increasing life expectancy of 79.5 years (2004). Most Belgians have access to health care of high quality, financed mainly through social security contributions and taxation. Compulsory health insurance is combined with a mostly private system of health care delivery, based on independent medical practice, free choice of physician and predominantly fee-for-service payment. That doesn't sound at all like single-payer. [1] http://www.euro.who.int/__data/assets/pdf_file/0007/96442/E90059.pdf http://www.euro.who.int/__data/assets/pdf_file/0007/96442/E9...
      - pg314 9y ago
jernfrost 9y ago
I can only compare to Norway, which is not single payer but socialized kind of like NHS. But it is in no way as complicated and inconvenient as people in the US seem to think. I can go directly to a specialist in the private sector at short notice and pay out of pocket if I like. That costs about 100 dollars. If I need to go frequently I can simple buy extra private health insurance which doesn't cost a lot, since they don't have to cover all that much given that they can utilize the existing public health care. Lots of companies already offer this in Norway. Anyway then you typically visit your GP to get a referral but that is done very quickly, and is really just a formality. I can go the same day and spent a couple of minutes to do that. Then I can go to a specialist covered by my private insurance on short notice. I think the private/public divide we got in Norway works quite well. Public health care usually handles well most health care needs in a timely fashion and with good quality. The problem is usually things like elective surgery where there can be long waiting times. But these cases are handled quite well by the private sector. You can pay for private health insurance to handle those cases. That is cheap because there are really just clinics open from 9 to 5, which does surgery, then transport you to a public hospital for recovery afterwards. That makes their operations cheap as they don't need to be open 24/7 and don't need their own emergency care, ambulances etc. All that is handled by the public sector.
DiNovi 9y ago
As someone who likes their employer healthcare, I would like to be able to seek other work or build my own business without having to worry about getting injured.

jellicle 9y ago

> they could still see the same PCPs and specialists they can see today What do you think single-payer is? There's no such thing as "out of network".

twoodfin 9y ago
I don't think single-payer works the way you seem to think it does in nations where it's been implemented. I have an expensive employer-provided plan. I can, without any referral, make an appointment with a specialist (surely making $300K+) at a top teaching hospital and expect to wait weeks at the most. There is no way to offer that level of service to anyone and not explode costs, let alone contain them.
- dyeje 9y ago
  Do you have anything to backup that claim?
  - smokeyj 9y ago
    Is that whole "supply and demand" thing not convincing enough?
- toomuchtodo 9y ago
  > There is no way to offer that level of service to anyone and not explode costs, let alone contain them. * Import more doctors from other countries with a streamlined visa process * Provide free training to doctors for underserved specialties This is not hard. It is supply and demand. If demand increases, you find ways to increase supply in a cost-efficient manner.
- Brakenshire 9y ago
  The French system is similar to that. You're right it's more expensive in terms of government expenditure than the US, although quite a lot cheaper in terms of combined public-private cost.
  - twoodfin 9y ago
    Is the French system true single-payer? I thought it was a hybrid system that allowed for significant private supplement.
    - Brakenshire 9y ago
      I think it's a single payer system with an additional premium coverage, which can be covered either by copayment in the event, or with private insurance.
- vertex-four 9y ago
  The UK has a dual model - NHS for everybody, and if you have spare money, you can additionally pay for additional services through insurance providers such as BUPA or paying directly. BUPA et al have reduced costs due to not having to cover a range of conditions, not having to indirectly fund A&E departments, being able to deny people coverage for preexisting conditions, etc etc. It's very unlikely that the US would ever deny people the ability to pay for healthcare if they chose to.
  - twoodfin 9y ago
    Then we should stop using the term "single-payer", which describes a system like Canada's, where private payments to providers are illegal. In any event, you'd still be asking millions of Americans to switch health care plans when they're satisfied with what they already have.
    - vertex-four 9y ago
      We do have single-payer healthcare for all NHS services. You cannot pay for NHS services, and NHS services will cover almost everything you'll ever need so long as the treatment is actually proven to work - it's a newspaper-worthy situation when the NHS denies treatment, and usually that only comes into play with e.g. very new cancer treatments. Every citizen of the UK can use NHS services as a right, whether they pay taxes or not. If you have an emergency, you will be taken to an NHS A&E department. BUPA et al primarily provide slightly nicer rooms for inpatients, might be more flexible on times you can see a doctor, might provide more personalised information on general health stuff (e.g. "how do I lose weight/get fit?"), and might allow you to see a doctor slightly sooner for stuff that's not going to kill you. I do not believe that Americans as a whole are satisfied with what they have. I believe that you are, since you have significant income and can get coverage for anything you like. I talk to people on a daily basis who have to worry about what treatments they are able to afford for their diagnosed disorders. For many of them, surgery is required for which they have to save up for a number of years and then visit another country, while paying extortionate (in relation to their income) prices for life-saving medication all the while.
- jellicle 9y ago
  But of course that "service" is mostly waste. If you self-refer yourself to Dr. Smucker, the best [foo] surgeon in the business, you're likely to find that your [foo] isn't broken at all and even if it was, it doesn't need surgery. So you've wasted Ms. Smucker's time and your insurance company's money, and you haven't made anyone, including yourself, any healthier. And of course, there's like a 50-50 chance that Ms. Smucker is actually out of network by the time you see her, and you'll get a $2,000 bill to pay. Take out the profit motive and you can build systems to actually make people healthier: networks of clinics and registered nurses and family physicians to handle the bulk of the work (which is, after all, mostly routine) backed up by specialists for the hard cases, and everyone with a mandate to do what is best for the patient rather than what makes the most money. That's what other countries do and it works extremely well, providing better health outcomes than the USA for a fraction of the cost.
  - twoodfin 9y ago
    We can argue about the potential cost savings of restricting who patients can see and when, but that's my point! Politically, telling folks who are happily "wasting" money on medicine that the government and not their doctors will decide what they can and can't have is a huge loser. Currently, their insurers are not heavily restricting them, because they're paying for the privilege.
    - jernfrost 9y ago
      Insurance companies are not different than government, they also try to limit your usage of health services. Every time you get service it is an expense for them. But honestly I think single payer is just part of the solution. You also need public hospitals, because hospitals have no incentive to suggest a good but cheap solution to a medical problem. I read a book, where an American went all around the world with the same ailment, got examined and suggestions for procedure to treat it. A VERY telling outcome was that in the US only the most expensive and complicated procedure was suggested to the patient. In other countries he was informed about cheaper and far less invasive procedures. Which btw worked and made him happy, so he avoided a complicated and potentially risky surgical procedure. This is a problem with the US system. There are something like 2-3x as many surgical procedures that needed often simply worsening the well being of the patient. This is the flawed American thinking that good health care is the same as getting lots of complicated medical procedures. The drug consumption is also astonishing. When using American health care I was shocked by how aggressively they pushed medication on me. People are trying to push medication on people everywhere in the US. Doctors, commercials, drug stores etc. You are not a patient. You are just a customer. The US system really just leads to the health care sector focusing on pushing as many expensive drugs and procedures on the people who can pay for them an ignoring the rest, regardless of whether that brings better health or not.
- pg314 9y ago
  > I don't think single-payer works the way you seem to think it does in nations where it's been implemented. I don't think single-payer works the way you seem to think it does. > I have an expensive employer-provided plan. I'm happy for you. What happens when you lose your job? I live in Belgium. I'm covered by the basic social security health insurance, just like any other Belgian. > I can, without any referral, make an appointment with a specialist (surely making $300K+) at a top teaching hospital and expect to wait weeks at the most. So can I. I've never had to wait more than a couple of weeks at most. If it's urgent, they fit you in on the same day or a couple of days later at the latest. That seems to be corroborated by [1]. One exception is mental health care, where the waiting lists are long. > There is no way to offer that level of service to anyone and not explode costs, let alone contain them. That is wrong. According to [2], health spending accounted for 10.9% of GDP in Belgium in 2012, which is much lower than the 16.9% the US spends. [1] http://focusonbelgium.be/en/international/belgium-has-shortest-waiting-time-healthcare-europe http://focusonbelgium.be/en/international/belgium-has-shorte... [2] http://webcache.googleusercontent.com/search?q=cache:2VeNWmBzMy0J:www.oecd.org/belgium/Briefing-Note-BELGIUM-2014.pdf+&cd=1&hl=en&ct=clnk&gl=be http://webcache.googleusercontent.com/search?q=cache:2VeNWmB...
  - twoodfin 9y ago
    The Belgian system contains costs in other ways. For example, doctors (especially GP's) are paid significantly less. Belgium is also over 10x as population dense as the U.S., which offers significant opportunities for more efficient care delivery. Anyway, it's not clear to me that Belgium has anything like a single-payer system[1]: The Belgian population enjoys good health and increasing life expectancy of 79.5 years (2004). Most Belgians have access to health care of high quality, financed mainly through social security contributions and taxation. Compulsory health insurance is combined with a mostly private system of health care delivery, based on independent medical practice, free choice of physician and predominantly fee-for-service payment. That doesn't sound at all like single-payer. [1] http://www.euro.who.int/__data/assets/pdf_file/0007/96442/E90059.pdf http://www.euro.who.int/__data/assets/pdf_file/0007/96442/E9...
    - pg314 9y ago

jernfrost 9y ago

I can only compare to Norway, which is not single payer but socialized kind of like NHS. But it is in no way as complicated and inconvenient as people in the US seem to think. I can go directly to a specialist in the private sector at short notice and pay out of pocket if I like. That costs about 100 dollars. If I need to go frequently I can simple buy extra private health insurance which doesn't cost a lot, since they don't have to cover all that much given that they can utilize the existing public health care. Lots of companies already offer this in Norway. Anyway then you typically visit your GP to get a referral but that is done very quickly, and is really just a formality. I can go the same day and spent a couple of minutes to do that. Then I can go to a specialist covered by my private insurance on short notice. I think the private/public divide we got in Norway works quite well. Public health care usually handles well most health care needs in a timely fashion and with good quality. The problem is usually things like elective surgery where there can be long waiting times. But these cases are handled quite well by the private sector. You can pay for private health insurance to handle those cases. That is cheap because there are really just clinics open from 9 to 5, which does surgery, then transport you to a public hospital for recovery afterwards. That makes their operations cheap as they don't need to be open 24/7 and don't need their own emergency care, ambulances etc. All that is handled by the public sector.

DiNovi 9y ago

As someone who likes their employer healthcare, I would like to be able to seek other work or build my own business without having to worry about getting injured.