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Healthcare, in America, is broken. We need single payer healthcare for all emergency and 'standard' care (government gets a bid on rates from practitioners in

Healthcare, in America, is broken. We need single payer healthcare for all emergency and 'standard' care (government gets a bid on rates from practitioners in the area, and if it doesn't like the rate, supports patients via the military systems). That includes vision and dental; being able to see and being able to consume food properly tend to be requirements for workforce productivity. Cosmetic and luxury care (like cutting triage lines in non-emergencies) can be premium services.

chrisseaton 8y ago
> supports patients via the military systems Why should the military be involved?
- SolarNet 8y ago
  Author probably meant military health care systems.
  - deleted 8y ago
    [deleted]
- maxerickson 8y ago
  I think they are probably partly talking about VA hospitals, which aren't part of the Department of Defense (the VA is a cabinet level department all its own). There aren't enough military hospitals to meaningfully support civilians. There's not enough VA hospitals to do it either, but whatever.
- deleted 8y ago
  [deleted]
- mjevans 8y ago
  Provider of last resort / "I can do it better"; the argument is generally that private healthcare can do things better/faster/cheaper. So then why not let the infrastructure that serves the active military provide care? Or training for doctors beyond what civilian residency programs provide?
  - chrisseaton 8y ago
    Military healthcare is specialised for a young and healthy population of disciplined people who report problems early and do what they’re told in treatment. I’m not sure the results scale to civilians.
King-Aaron 8y ago
cough Universal healthcare
- batiudrami 8y ago
  In addition to being a more practical solution than what the US has now, it's also just the civilised thing to do. Letting people die or lose their life's savings because they can't afford medical care is some dystopian shit. The very least a government can do is provide its citizens with acceptable medical care. There is a lot of money in private practice and insurance who are prepared to campaign against reform, however.
koolba 8y ago
The problem is nobody has the balls to cut out the corporate tax perks for providing insurance coverage. It’s a local maxima that without a cataclysmic event will not be broken.
AnthonyMouse 8y ago
> We need single payer healthcare for all emergency and 'standard' care (government gets a bid on rates from practitioners in the area, and if it doesn't like the rate, supports patients via the military systems). Look at the other things the government bids on. Are they getting a good deal? The theory is that the government has a lot of purchasing power and can use it to get a discount, but that's not what happens in practice. Suppose there are two providers of a service in the area. There are 800 patients and each provider has to capacity to serve 500. If one bids a dollar and the other bids a million dollars, what happens? Both bids have to be accepted, because the first provider can't serve all the patients. Of course, the first provider knows this too, so they both bid a million dollars to begin with. Compare this with what happens to individuals if we had price transparency: Both providers would rather have 500 customers than fewer, so they try to underbid each other to be the one that gets to fill their capacity. Moreover, individual patients may decide that a significant discount is worth a two hour drive to a neighboring region, so you get inter-region price competition as well. The government can't exactly get away with telling you to drive to the next state or suffer any of the other inconveniences price sensitive customers may prefer over higher prices, so they have to suffer the high bids. Using the VA healthcare system as an escape hatch is little help because it's just trading one set of problems for another, e.g. the system is very bureaucratic and it can take months to get an appointment. If the government carries through on the threat then the voters would be unhappy and both the government politicians and the providers know that, so it's an idle threat.
- lostlogin 8y ago
  > Look at the other things the government bids on. Are they getting a good deal? New Zealand has been under a lot of pressure to weaken Pharmac, the national drug purchasing agency, as part of the TPP agreement. It hasn’t happened yet and hopefully never will. The current system is far from perfect but we pay a lot less for funded drugs here in NZ due to Pharmacs bargaining power.
  - AnthonyMouse 8y ago
    > New Zealand has been under a lot of pressure to weaken Pharmac, the national drug purchasing agency, as part of the TPP agreement. It hasn’t happened yet and hopefully never will. The current system is far from perfect but we pay a lot less for funded drugs here in NZ due to Pharmacs bargaining power. That's not bargaining power, it's price controls. You can have price controls even without single payer. But price controls are terrible -- if the price is too high you're paying too much, if it's too low you get shortages or providers have to cut corners to hit the price target. In the pharmaceutical market this falls squarely on the side of shortages, which are then invisible because nobody is aware of the drugs that don't exist because the developer estimated that the government wouldn't allow a high enough price to recoup the R&D cost and then didn't do the R&D. It's prisoners' dilemma at the national level -- if you defect by legislating drug prices, you pay less for drugs while other countries pay the higher rate required to fund their development. Then you say "look how great defecting is, why doesn't everybody defect?" Well, yes, that's the problem. Somebody has to pay somehow. It also makes no sense to have drug patents but then regulate prices, because the whole point of the patent system is for the market to set the price of the drug at its value over the status quo during the term of the patent. If you're just going to regulate prices then you might as well instead just get rid of drug patents and replace them with X prizes. Then drugs would be much cheaper even without price controls because they would all be generics. The problem then being that then the government would have to be good at choosing what to pay prizes for, and they probably wouldn't be very efficient at it even before corruption set in.

chrisseaton 8y ago

> supports patients via the military systems Why should the military be involved?

SolarNet 8y ago
Author probably meant military health care systems.
- deleted 8y ago
  [deleted]
maxerickson 8y ago
I think they are probably partly talking about VA hospitals, which aren't part of the Department of Defense (the VA is a cabinet level department all its own). There aren't enough military hospitals to meaningfully support civilians. There's not enough VA hospitals to do it either, but whatever.
deleted 8y ago
[deleted]
mjevans 8y ago
Provider of last resort / "I can do it better"; the argument is generally that private healthcare can do things better/faster/cheaper. So then why not let the infrastructure that serves the active military provide care? Or training for doctors beyond what civilian residency programs provide?
- chrisseaton 8y ago
  Military healthcare is specialised for a young and healthy population of disciplined people who report problems early and do what they’re told in treatment. I’m not sure the results scale to civilians.

King-Aaron 8y ago

cough Universal healthcare

batiudrami 8y ago
In addition to being a more practical solution than what the US has now, it's also just the civilised thing to do. Letting people die or lose their life's savings because they can't afford medical care is some dystopian shit. The very least a government can do is provide its citizens with acceptable medical care. There is a lot of money in private practice and insurance who are prepared to campaign against reform, however.

koolba 8y ago

The problem is nobody has the balls to cut out the corporate tax perks for providing insurance coverage. It’s a local maxima that without a cataclysmic event will not be broken.

AnthonyMouse 8y ago

> We need single payer healthcare for all emergency and 'standard' care (government gets a bid on rates from practitioners in the area, and if it doesn't like the rate, supports patients via the military systems). Look at the other things the government bids on. Are they getting a good deal? The theory is that the government has a lot of purchasing power and can use it to get a discount, but that's not what happens in practice. Suppose there are two providers of a service in the area. There are 800 patients and each provider has to capacity to serve 500. If one bids a dollar and the other bids a million dollars, what happens? Both bids have to be accepted, because the first provider can't serve all the patients. Of course, the first provider knows this too, so they both bid a million dollars to begin with. Compare this with what happens to individuals if we had price transparency: Both providers would rather have 500 customers than fewer, so they try to underbid each other to be the one that gets to fill their capacity. Moreover, individual patients may decide that a significant discount is worth a two hour drive to a neighboring region, so you get inter-region price competition as well. The government can't exactly get away with telling you to drive to the next state or suffer any of the other inconveniences price sensitive customers may prefer over higher prices, so they have to suffer the high bids. Using the VA healthcare system as an escape hatch is little help because it's just trading one set of problems for another, e.g. the system is very bureaucratic and it can take months to get an appointment. If the government carries through on the threat then the voters would be unhappy and both the government politicians and the providers know that, so it's an idle threat.

lostlogin 8y ago
> Look at the other things the government bids on. Are they getting a good deal? New Zealand has been under a lot of pressure to weaken Pharmac, the national drug purchasing agency, as part of the TPP agreement. It hasn’t happened yet and hopefully never will. The current system is far from perfect but we pay a lot less for funded drugs here in NZ due to Pharmacs bargaining power.
- AnthonyMouse 8y ago
  > New Zealand has been under a lot of pressure to weaken Pharmac, the national drug purchasing agency, as part of the TPP agreement. It hasn’t happened yet and hopefully never will. The current system is far from perfect but we pay a lot less for funded drugs here in NZ due to Pharmacs bargaining power. That's not bargaining power, it's price controls. You can have price controls even without single payer. But price controls are terrible -- if the price is too high you're paying too much, if it's too low you get shortages or providers have to cut corners to hit the price target. In the pharmaceutical market this falls squarely on the side of shortages, which are then invisible because nobody is aware of the drugs that don't exist because the developer estimated that the government wouldn't allow a high enough price to recoup the R&D cost and then didn't do the R&D. It's prisoners' dilemma at the national level -- if you defect by legislating drug prices, you pay less for drugs while other countries pay the higher rate required to fund their development. Then you say "look how great defecting is, why doesn't everybody defect?" Well, yes, that's the problem. Somebody has to pay somehow. It also makes no sense to have drug patents but then regulate prices, because the whole point of the patent system is for the market to set the price of the drug at its value over the status quo during the term of the patent. If you're just going to regulate prices then you might as well instead just get rid of drug patents and replace them with X prizes. Then drugs would be much cheaper even without price controls because they would all be generics. The problem then being that then the government would have to be good at choosing what to pay prizes for, and they probably wouldn't be very efficient at it even before corruption set in.