4 ms·

The main source of savings in a single-payer system isn't simplified billing, but increased negotiating power on everything from drug prices to salaries. With t

The main source of savings in a single-payer system isn't simplified billing, but increased negotiating power on everything from drug prices to salaries. With that being said, I agree that if every US citizen should enjoy the quality of service, that people with premium health care coverage has, it would probably be more expensive than most European single-payer systems.

pfisch 9y ago
So we are about to have net neutrality repealed over the objection of everyone except ISPs basically. Medicare isn't even allowed to negotiate drug prices, but our govt run single payer system will definitely be immune from regulatory capture. Right?
- maxerickson 9y ago
  The drug price thing is overblown. The private companies that administer Medicare Part D are free to negotiate prices and do so. http://www.kff.org/medicare/issue-brief/searching-for-savings-in-medicare-drug-price-negotiations/ http://www.kff.org/medicare/issue-brief/searching-for-saving... At the bottom it mentions saving billions of dollars by extending a Medicaid program to some Medicare drugs, but that is not negotiated, those discounts are required by law.
adventured 9y ago
> The main source of savings in a single-payer system isn't simplified billing, but increased negotiating power on everything from drug prices to salaries. You're agreeing with the parent's original point. Salaries in healthcare are far higher in the US than they are in eg the UK or Germany. The US median income is significantly higher than all but a few nations. In the US we don't ration care nearly to the extent that they do in eg Canada, wait times are lower and Americans over-use (abuse) their healthcare and always have. In France a radiologist will make $150,000. In the US it's closer to $450,000. Nurses in the US will typically make 40%-50% more than nurses in Germany. Good luck hammering all of those pay scales back down without causing huge strikes. You have to remove a trillion dollars in cost from the system. Only about $100b can be removed from big pharma's cost share. You have to destroy a million jobs (eg the health insurance industry), and slash the pay for hundreds of thousands of healthcare workers by at least 20% to 30%. Even if some of those lost jobs can eventually be reclaimed, the upheaval will be epic.
- guyzero 9y ago
  "In the US we don't ration care nearly to the extent that they do in eg Canada" Sure you do. Poor people don't get any health care, people with insurance get all the health care they want. You ration based on income and geographic location, as opposed to making people queue for care. But it's rationing both ways.
  - adventured 9y ago
    > Poor people don't get any health care, people with insurance get all the health care they want. You just revealed that you don't know anything about the US healthcare system. Poor people have free healthcare in the US. It's the lower 20% to 40% income bracket that is getting particularly hammered. The top 50% have mostly good health coverage. The bottom 15%-20% is and has been covered by government healthcare for decades. I'll repeat it again for emphasis: if you're at or below the poverty line, you get free healthcare in the US. See: Medicaid and several other connected programs that are built just for that and are very large. If you earn near minimum wage, you're going to qualify for free healthcare in pretty much every state. And it's actually decent healthcare.
    - guyzero 9y ago
      Has the situation where few doctors accept Medicare changed since 2009? http://www.nytimes.com/2009/04/02/business/retirementspecial/02health.html?mcubz=1 http://www.nytimes.com/2009/04/02/business/retirementspecial... edit: and I should clarify that yes, this is Medicare and not Medicaid and while I do understand the US medical system I'm not a health policy expert so I sometimes get specific points confused. Sheesh. Why does it take a PhD to figure out how to get medical coverage in the US?
  - jquery 9y ago
    As typically understood, rationing is allowing each person to have a fixed amount of something no matter what. In the USA, if you want more healthcare, you have many options to increase your consumption. If you want to redefine rationing as anything that isn't yet post-scarcity, sure we have rationing. Aside: Poor people do get health care in the USA. My brother was unemployed and received over $1 million in healthcare for his son with cancer, and hundreds of thousands of dollars in care for his dialysis treatment and eventual kidney transplant.
refurb 9y ago
increased negotiating power on everything from drug prices to salaries Not really. Take a look at drugs. Canada has an entire population of ~35M. United Healthcare (biggest US private insurer) has 40M lives. UHC pays a lot more for things than Canada does. I would say the single payer benefit is that things can be done by fiat. When the gov't says you'll be paid $X for a procedure, there really isn't anything you can do about it.
- charlesdm 9y ago
  As a doctor, you could not do the procedure, and focus on procedures that pay more.

pfisch 9y ago

So we are about to have net neutrality repealed over the objection of everyone except ISPs basically. Medicare isn't even allowed to negotiate drug prices, but our govt run single payer system will definitely be immune from regulatory capture. Right?

maxerickson 9y ago
The drug price thing is overblown. The private companies that administer Medicare Part D are free to negotiate prices and do so. http://www.kff.org/medicare/issue-brief/searching-for-savings-in-medicare-drug-price-negotiations/ http://www.kff.org/medicare/issue-brief/searching-for-saving... At the bottom it mentions saving billions of dollars by extending a Medicaid program to some Medicare drugs, but that is not negotiated, those discounts are required by law.

adventured 9y ago

> The main source of savings in a single-payer system isn't simplified billing, but increased negotiating power on everything from drug prices to salaries. You're agreeing with the parent's original point. Salaries in healthcare are far higher in the US than they are in eg the UK or Germany. The US median income is significantly higher than all but a few nations. In the US we don't ration care nearly to the extent that they do in eg Canada, wait times are lower and Americans over-use (abuse) their healthcare and always have. In France a radiologist will make $150,000. In the US it's closer to $450,000. Nurses in the US will typically make 40%-50% more than nurses in Germany. Good luck hammering all of those pay scales back down without causing huge strikes. You have to remove a trillion dollars in cost from the system. Only about $100b can be removed from big pharma's cost share. You have to destroy a million jobs (eg the health insurance industry), and slash the pay for hundreds of thousands of healthcare workers by at least 20% to 30%. Even if some of those lost jobs can eventually be reclaimed, the upheaval will be epic.

guyzero 9y ago
"In the US we don't ration care nearly to the extent that they do in eg Canada" Sure you do. Poor people don't get any health care, people with insurance get all the health care they want. You ration based on income and geographic location, as opposed to making people queue for care. But it's rationing both ways.
- adventured 9y ago
  > Poor people don't get any health care, people with insurance get all the health care they want. You just revealed that you don't know anything about the US healthcare system. Poor people have free healthcare in the US. It's the lower 20% to 40% income bracket that is getting particularly hammered. The top 50% have mostly good health coverage. The bottom 15%-20% is and has been covered by government healthcare for decades. I'll repeat it again for emphasis: if you're at or below the poverty line, you get free healthcare in the US. See: Medicaid and several other connected programs that are built just for that and are very large. If you earn near minimum wage, you're going to qualify for free healthcare in pretty much every state. And it's actually decent healthcare.
  - guyzero 9y ago
    Has the situation where few doctors accept Medicare changed since 2009? http://www.nytimes.com/2009/04/02/business/retirementspecial/02health.html?mcubz=1 http://www.nytimes.com/2009/04/02/business/retirementspecial... edit: and I should clarify that yes, this is Medicare and not Medicaid and while I do understand the US medical system I'm not a health policy expert so I sometimes get specific points confused. Sheesh. Why does it take a PhD to figure out how to get medical coverage in the US?
- jquery 9y ago
  As typically understood, rationing is allowing each person to have a fixed amount of something no matter what. In the USA, if you want more healthcare, you have many options to increase your consumption. If you want to redefine rationing as anything that isn't yet post-scarcity, sure we have rationing. Aside: Poor people do get health care in the USA. My brother was unemployed and received over $1 million in healthcare for his son with cancer, and hundreds of thousands of dollars in care for his dialysis treatment and eventual kidney transplant.

refurb 9y ago

increased negotiating power on everything from drug prices to salaries Not really. Take a look at drugs. Canada has an entire population of ~35M. United Healthcare (biggest US private insurer) has 40M lives. UHC pays a lot more for things than Canada does. I would say the single payer benefit is that things can be done by fiat. When the gov't says you'll be paid $X for a procedure, there really isn't anything you can do about it.

charlesdm 9y ago
As a doctor, you could not do the procedure, and focus on procedures that pay more.