5 ms·

Isn't it in everyone's best interest to revamp healthcare? Who exactly loses here? Rich people in the health industry? I don't get it. I read somewhere that ha

by tabeth 9y ago

Isn't it in everyone's best interest to revamp healthcare? Who exactly loses here? Rich people in the health industry? I don't get it. I read somewhere that half a trillion a year[1] would be saved by single-payer. It's probably an exaggeration, but even if its an order of magnitude too high... sounds good to me. [1] http://www.pnhp.org/sites/default/files/docs/2012/Dollars%20and%20Sense.pdf http://www.pnhp.org/sites/default/files/docs/2012/Dollars%20...

jerkstate 9y ago
My take is that any kind of fair renegotiation removing the regulatory capture and the anti-competitive behavior allowed (and in some cases, required) by decades of lobbying would improve the situation. Single payer would work, free(er) market would work, but we're currently reaping the fruits of generations of entrenched political class for sale.
- ashark 9y ago
  > Single payer would work, free(er) market would work, but we're currently reaping the fruits of generations of entrenched political class for sale. Single payer or similar universal coverage systems would be the safe (dare I say conservative?) bet, since we have tons of examples of systems like that working well in countries similar to ours while saving lots of money per-capita over our system. Looks like an easy win. Messing with our regulations and hoping the market fixes things might work, but it's more of a gamble.
  - jerkstate 9y ago
    There are also examples of free market healthcare working very well, see Singapore.
    - tormeh 9y ago
      Singapore has multiple providers, like Germany, but it's not a Free Market (TM) by any means.
Synaesthesia 9y ago
Absolutely, except for the wealthy private interests like pharmaceutical companies and insurance. Polls show the majority of Americans have favoured a single-payer system now for decades. This was the case under Reagan even, and still is today. This shows the degree to which the US is not in fact a true democracy, but more of an oligarchy. However things can change if there is enough public pressure. People just need to be organized.
- jonlucc 9y ago
  Pharma companies don't necessarily lose out with single payer. Consider that the vast majority of drugs prescribed are generics, and most generics (aside from those making headlines) are available pretty cheaply (you can check GoodRx to see real prices). Of course, you might shave a good amount of profit from big pharma by negotiation (if there's a single payer or a few payers, they have a lot of power), but you don't want to stop R&D. How we shift that R&D burden and to whom, I have no idea. Disclaimer: I work in big pharma research (nothing to do with pricing)
  - refurb 9y ago
    This is very true. Prices might go down under single payer, but more people are covered. Overall, prices may go down, but volume drives overall revenue up.
maxxxxx 9y ago
I have read that the US spends 18% of GDP vs. most other countries spending around 10%. That means the health industry is at risk of losing 8% of GDP which at 18 trillion GDP is around 1.5 trillion. People say this money is being wasted but it's going somewhere and these people will fight for keeping it.
- creaghpatr 9y ago
  Pretty much everyone with money in a 401k or any major index fund would suffer catastrophic losses as these are widely invested in various healthcare and pharma stocks. The downstream economic effects of an 8% contraction would be nuts.
  - davesque 9y ago
    Umm, no I don't think so. I regularly check my IRA and 401k's portfolio and I can't recall ever seeing a lopsided investment in healthcare or pharma like you're saying. And index funds track indices. Is the S&P 500 really dominated to that extent by big pharma?
    - whatok 9y ago
      Second largest sector at 14.7%. Click sector breakdown in the top right. http://us.spindices.com/indices/equity/sp-500 http://us.spindices.com/indices/equity/sp-500 There are a lot of middle men that would get absolutely crushed or go out of business if single payer were passed. Others would have to slash margins in order to meet whatever cost cutting is needed.
      - rkhleung 9y ago
        Yes, but the other 85% of the sectors would likely benefit a reduction in costs (i.e. insurance premiums for their employees) that would positively affect their bottom line.
  - deleted 9y ago
    [deleted]
mysterydip 9y ago
> Who exactly loses here? Rich people in the health industry? I don't get it. You forget lawmakers reaping various lobbyist benefits, which is one reason why not much changes. Two sides bicker for a while to satisfy their constituencies, then compromise by doing nothing.
- okreallywtf 9y ago
  Is this not a false equivalency though? I'm not saying either side is perfect, but wouldn't you say one side has done more to try to solve the problem? Can you point out a plan brought to the table by the republican party that hasn't been a total objective disaster that the democrats were unreasonably recalcitrant about? The ACA is/was a good faith attempt to fix some of the issues with our healthcare system. There was tons of negotiation even if the process wasn't perfect, but at least they tried to do something. The republicans only seem to care when they are railing against something else, they haven't (to my knowledge) brought anything useful to the table at a national level within my memory. I'm not trying to be partisan, and I accept that single payer is a huge leap from where we are politically, but the way the ACA has been demonized indicates that one side plays politics with healthcare more than the other.
  - whatok 9y ago
    ACA was shoehorned through without bi-partisan support. It's currently unsustainable from a cost perspective and was widely predicted to be upon passage. Having good intentions does not excuse you from the consequences of your actions. For something as fundamental to our country as healthcare, having a wide buy-in and costs that won't collapse under its own weight is crucial for cost and legislative sustainability.
    - okreallywtf 9y ago
      Those sound like talking points to me and I'm aware that my comments probably sound the same since I didn't present sources for my claims. As far as not having bipartisan support, the republicans did get concessions but really didn't seem to want to contribute and haven't really tried to do anything on their own while they were in charge (unless you can point to a reasonable proposal that was shot down by the left). On top of that, claims that the recent proposals were as secretive or anti-bipartisan as the ACA don't seem to hold up [0]. I can't present a truly objective truth that I think will convince you, but there are a few misleading things about the ACA that make it seem more unstable than it really is. Overall I think one basic failing is that the penalty for being uninsured is too low, causing to few healthy people to enter the market that essentially subsidize the unhealthy (which is pretty much how all insurance works at some level). Insurance companies were essentially promised tons of new customers who could offset the fact that they now have to offer plans that actually have coverage (and therefore cost them more). Because of this, they are largely still making money but less money than they were and want. This means they don't have much incentive to make the ACA work and might actively work to destroy it to continue making record profits in an unsustainable way [1]. Not only that, but some of the premium increases come from uncertainty around whether the ACA will continue [2], or whether the government will continue to make subsidy payments that were promised [3]. I don't expect any of this to convince you but hopefully it makes my arguments seem less opinionated. I think about it the same way I think about software, I cannot imagine having to design and build such a system with the adversarial system we have knowing that you have to do it in a couple years and the other party is going to work against you and then try to dismantle the system after you are gone. Expecting to not have to have to make changes over time to fix unforeseen problems seems totally unreasonable to me. [0] http://www.snopes.com/aca-versus-ahca/ http://www.snopes.com/aca-versus-ahca/ [1] http://www.latimes.com/business/hiltzik/la-fi-hiltzik-aetna-obamacare-20170123-story.html http://www.latimes.com/business/hiltzik/la-fi-hiltzik-aetna-... [2] https://www.nbcnews.com/health/health-care/obamacare-uncertainty-may-mean-higher-insurance-premiums-experts-say-n755756 https://www.nbcnews.com/health/health-care/obamacare-uncerta... [3] https://www.usnews.com/news/us/articles/2017-07-29/trump-threatens-to-end-insurance-payments-if-no-healthcare-bill https://www.usnews.com/news/us/articles/2017-07-29/trump-thr...
malandrew 9y ago
I lose here. I don't work in pharma, but I benefit from a drug developed in the US that is only available and approved for my condition in the US and one other country. Not only will I lose here, but the future you will lose here as will the future everyone on the planet. Healthcare needs don't just exist in the present. https://www.quora.com/Which-country-develops-the-most-effective-drugs https://www.quora.com/Which-country-develops-the-most-effect...
- tabeth 9y ago
  I don't quite understand the connection between single-payer and your implication that the drug you need wouldn't exist.
irq-1 9y ago
Rich people gain from research, new drugs, new equipment and new procedures. If the system spends more on poor people and common illnesses, it'll spend less on the things that benefit rich people. Billionaires from around the globe fly to the Mayo Clinic in the USA. Why seek medical care in the USA? It spends more on the things that are good for the rich.
RHSeeger 9y ago
There's a lot of people that see the government do an awful job in so many areas (over budget, over time, etc), and worry that the same would happen with healthcare; _"Have you seen how poorly the government handles 'abc'? I don't want them in charge of my health, too"_ I'm somewhat of the mind that the government couldn't possibly do it worse than it's being done now. However, looking at the constant issues with VA healthcare, I'm not sure of my opinion either.

by tabeth 9y ago

jerkstate 9y ago

My take is that any kind of fair renegotiation removing the regulatory capture and the anti-competitive behavior allowed (and in some cases, required) by decades of lobbying would improve the situation. Single payer would work, free(er) market would work, but we're currently reaping the fruits of generations of entrenched political class for sale.

ashark 9y ago
> Single payer would work, free(er) market would work, but we're currently reaping the fruits of generations of entrenched political class for sale. Single payer or similar universal coverage systems would be the safe (dare I say conservative?) bet, since we have tons of examples of systems like that working well in countries similar to ours while saving lots of money per-capita over our system. Looks like an easy win. Messing with our regulations and hoping the market fixes things might work, but it's more of a gamble.
- jerkstate 9y ago
  There are also examples of free market healthcare working very well, see Singapore.
  - tormeh 9y ago
    Singapore has multiple providers, like Germany, but it's not a Free Market (TM) by any means.

Synaesthesia 9y ago

Absolutely, except for the wealthy private interests like pharmaceutical companies and insurance. Polls show the majority of Americans have favoured a single-payer system now for decades. This was the case under Reagan even, and still is today. This shows the degree to which the US is not in fact a true democracy, but more of an oligarchy. However things can change if there is enough public pressure. People just need to be organized.

jonlucc 9y ago
Pharma companies don't necessarily lose out with single payer. Consider that the vast majority of drugs prescribed are generics, and most generics (aside from those making headlines) are available pretty cheaply (you can check GoodRx to see real prices). Of course, you might shave a good amount of profit from big pharma by negotiation (if there's a single payer or a few payers, they have a lot of power), but you don't want to stop R&D. How we shift that R&D burden and to whom, I have no idea. Disclaimer: I work in big pharma research (nothing to do with pricing)
- refurb 9y ago
  This is very true. Prices might go down under single payer, but more people are covered. Overall, prices may go down, but volume drives overall revenue up.

maxxxxx 9y ago

I have read that the US spends 18% of GDP vs. most other countries spending around 10%. That means the health industry is at risk of losing 8% of GDP which at 18 trillion GDP is around 1.5 trillion. People say this money is being wasted but it's going somewhere and these people will fight for keeping it.

creaghpatr 9y ago
Pretty much everyone with money in a 401k or any major index fund would suffer catastrophic losses as these are widely invested in various healthcare and pharma stocks. The downstream economic effects of an 8% contraction would be nuts.
- davesque 9y ago
  Umm, no I don't think so. I regularly check my IRA and 401k's portfolio and I can't recall ever seeing a lopsided investment in healthcare or pharma like you're saying. And index funds track indices. Is the S&P 500 really dominated to that extent by big pharma?
  - whatok 9y ago
    Second largest sector at 14.7%. Click sector breakdown in the top right. http://us.spindices.com/indices/equity/sp-500 http://us.spindices.com/indices/equity/sp-500 There are a lot of middle men that would get absolutely crushed or go out of business if single payer were passed. Others would have to slash margins in order to meet whatever cost cutting is needed.
    - rkhleung 9y ago
      Yes, but the other 85% of the sectors would likely benefit a reduction in costs (i.e. insurance premiums for their employees) that would positively affect their bottom line.
- deleted 9y ago
  [deleted]

mysterydip 9y ago

> Who exactly loses here? Rich people in the health industry? I don't get it. You forget lawmakers reaping various lobbyist benefits, which is one reason why not much changes. Two sides bicker for a while to satisfy their constituencies, then compromise by doing nothing.

okreallywtf 9y ago
Is this not a false equivalency though? I'm not saying either side is perfect, but wouldn't you say one side has done more to try to solve the problem? Can you point out a plan brought to the table by the republican party that hasn't been a total objective disaster that the democrats were unreasonably recalcitrant about? The ACA is/was a good faith attempt to fix some of the issues with our healthcare system. There was tons of negotiation even if the process wasn't perfect, but at least they tried to do something. The republicans only seem to care when they are railing against something else, they haven't (to my knowledge) brought anything useful to the table at a national level within my memory. I'm not trying to be partisan, and I accept that single payer is a huge leap from where we are politically, but the way the ACA has been demonized indicates that one side plays politics with healthcare more than the other.
- whatok 9y ago
  ACA was shoehorned through without bi-partisan support. It's currently unsustainable from a cost perspective and was widely predicted to be upon passage. Having good intentions does not excuse you from the consequences of your actions. For something as fundamental to our country as healthcare, having a wide buy-in and costs that won't collapse under its own weight is crucial for cost and legislative sustainability.
  - okreallywtf 9y ago
    Those sound like talking points to me and I'm aware that my comments probably sound the same since I didn't present sources for my claims. As far as not having bipartisan support, the republicans did get concessions but really didn't seem to want to contribute and haven't really tried to do anything on their own while they were in charge (unless you can point to a reasonable proposal that was shot down by the left). On top of that, claims that the recent proposals were as secretive or anti-bipartisan as the ACA don't seem to hold up [0]. I can't present a truly objective truth that I think will convince you, but there are a few misleading things about the ACA that make it seem more unstable than it really is. Overall I think one basic failing is that the penalty for being uninsured is too low, causing to few healthy people to enter the market that essentially subsidize the unhealthy (which is pretty much how all insurance works at some level). Insurance companies were essentially promised tons of new customers who could offset the fact that they now have to offer plans that actually have coverage (and therefore cost them more). Because of this, they are largely still making money but less money than they were and want. This means they don't have much incentive to make the ACA work and might actively work to destroy it to continue making record profits in an unsustainable way [1]. Not only that, but some of the premium increases come from uncertainty around whether the ACA will continue [2], or whether the government will continue to make subsidy payments that were promised [3]. I don't expect any of this to convince you but hopefully it makes my arguments seem less opinionated. I think about it the same way I think about software, I cannot imagine having to design and build such a system with the adversarial system we have knowing that you have to do it in a couple years and the other party is going to work against you and then try to dismantle the system after you are gone. Expecting to not have to have to make changes over time to fix unforeseen problems seems totally unreasonable to me. [0] http://www.snopes.com/aca-versus-ahca/ http://www.snopes.com/aca-versus-ahca/ [1] http://www.latimes.com/business/hiltzik/la-fi-hiltzik-aetna-obamacare-20170123-story.html http://www.latimes.com/business/hiltzik/la-fi-hiltzik-aetna-... [2] https://www.nbcnews.com/health/health-care/obamacare-uncertainty-may-mean-higher-insurance-premiums-experts-say-n755756 https://www.nbcnews.com/health/health-care/obamacare-uncerta... [3] https://www.usnews.com/news/us/articles/2017-07-29/trump-threatens-to-end-insurance-payments-if-no-healthcare-bill https://www.usnews.com/news/us/articles/2017-07-29/trump-thr...

malandrew 9y ago

I lose here. I don't work in pharma, but I benefit from a drug developed in the US that is only available and approved for my condition in the US and one other country. Not only will I lose here, but the future you will lose here as will the future everyone on the planet. Healthcare needs don't just exist in the present. https://www.quora.com/Which-country-develops-the-most-effective-drugs https://www.quora.com/Which-country-develops-the-most-effect...

tabeth 9y ago
I don't quite understand the connection between single-payer and your implication that the drug you need wouldn't exist.

irq-1 9y ago

Rich people gain from research, new drugs, new equipment and new procedures. If the system spends more on poor people and common illnesses, it'll spend less on the things that benefit rich people. Billionaires from around the globe fly to the Mayo Clinic in the USA. Why seek medical care in the USA? It spends more on the things that are good for the rich.

RHSeeger 9y ago

There's a lot of people that see the government do an awful job in so many areas (over budget, over time, etc), and worry that the same would happen with healthcare; _"Have you seen how poorly the government handles 'abc'? I don't want them in charge of my health, too"_ I'm somewhat of the mind that the government couldn't possibly do it worse than it's being done now. However, looking at the constant issues with VA healthcare, I'm not sure of my opinion either.