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The problem with single payer is that it results in shortages. Look at waiting lists for the NHS, especially for mental health or routine surgery. That is a dir

The problem with single payer is that it results in shortages. Look at waiting lists for the NHS, especially for mental health or routine surgery. That is a direct consequence of single payer. An unpopular view, but it is a fact.

rootusrootus 8y ago
I am skeptical of a causal relationship there. In the United States, approximately 2/3 of healthcare costs are already borne by the government. My parents are both enrolled in Medicare and they are very satisfied. Why would it not work if we just dropped the eligible age for Medicare to zero? Hasn't this been extensively studied recently?
- dragonwriter 8y ago
  > In the United States, approximately 2/3 of healthcare costs are already borne by the government. Less than half; US healthcare spending was around 8.5% GDP public, 8.8% GDP private in 2016. https://www.healthsystemtracker.org/chart-collection/health-spending-u-s-compare-countries/#item-u-s-similar-public-spending-private-sector-spending-triple-comparable-countries https://www.healthsystemtracker.org/chart-collection/health-...
  - rootusrootus 8y ago
    I've heard the 2/3 number (sometimes a little less, most recently slightly over, 68%) from a few reputable sources recently. At the same time, I generally consider Kaiser pretty reliable. I think the discrepancy comes from what is being included in the total -- all costs, direct payments only, tax subsidies, etc. At least from what research I've done. Even if we take the value to be 50%, my point stands -- the gov't is already heavily involved in funding healthcare in this country. Implementing single payer at this point would simplify quite a lot of bureaucracy.
    - conanbatt 8y ago
      You should look into what Kaiser does to its providers. Its pretty grim.
      - dragonwriter 8y ago
        Henry J. Kaiser Family Foundation, not the Kaiser Permanente managed care consortium. Same founder, but very different organizations.
- CWuestefeld 8y ago
  In many cases, Medicare doesn't even cover the actual cost to provide the service. The providers make up the shortfall by charging other patients more - including charging uninsured patients a LOT more. So if everybody was covered by Medicare, either the providers would be going bankrupt left and right, or the Medicare reimbursements would have to rise - i.e., the price to the government would increase, and the only thing to do about that is to pass it on to the taxpayers. It's a common misconceptions that Medicare is more efficient than commercial insurance, because on paper it looks that way. But in fact they're hiding their administrative expenses by forcing the providers to do much of their bookkeeping. (Source: my wife used to manage the department in the hospital that did that Medicare financial stuff)
  - krupan 8y ago
    This should be a highlighted comment in this discussion. My dad just retired and shut down his medical practice. He hated Medicare as a doctor (OK, my words, not exactly his), but now that he's using it as a patient he can see why people like it so much. It really isn't going to work like it does now if it becomes the only option for everyone.
  - rootusrootus 8y ago
    That is a pretty bold claim, can you cite someone more authoritative than your wife? Kaiser, who has a plausible claim to expertise in this field, puts the overhead cost of Medicare at 2%. The raw number is more like 1.4% but Medicare does get to piggyback a lot of the administrative workload on Social Security so perhaps that is why Kaiser's number is higher. Insurance industry advocates, who are incentivized to provide the lowest number that can be defended, put private insurance overhead at 17%. The rest of your suggestion -- that Medicare doesn't even pay for the actual cost of service -- is hard to really reason about accurately. Prices and costs are so completely distorted now that I am very skeptical of anybody's estimates of 'actual value.' Things will change dramatically if we eliminate the insurance industry and medical billing field. Having just experienced first world level healthcare in another country and paying for it out of pocket at 1/20th or less of what it runs in the US, I am certain we are getting shafted.
- conanbatt 8y ago
  Medicare has 30 million patients and costs about 3% of gdp. Multiply by 10, and you would need to almost double the tax-base to pay for medicare. I propose the other thought experiment: why doesnt medicare just compete in the market with other insurance plans: it charges X and provides the service. If its truly more efficient it will beat all the rest.
Symbiote 8y ago
Depending which side you want to believe, NHS waiting times are a direct result of Conservative government austerity, or excessive immigration.
- tialaramex 8y ago
  To really hammer home the point here, that Conservative government, in an effort to make immigration numbers go down set immigration rules to impose a minimum income for jobs that could recruit outside the EU. That minimum was lower than the government austerity cut maximum pay for nurses. Result: can't hire non-EU nurses, shortage worsens. Waiting times increase. Eventually, as this started to be more widely known the Conservative government "fixed" it. Not by paying nurses more, not by lowering the immigration income requirement to match what they pay skilled workers like nurses, but by specifically exempting nurses.
  - tialaramex 8y ago
    Ugh. Should say the minimum income for immigration was set "higher" not "lower" than nurses are paid. Sorry wasn't awake enough when I first wrote this.
NeoBasilisk 8y ago
There are shortages in a private healthcare system. If you can't pay, you don't get treatment.
wizzard 8y ago
Do you think a single-payer system creates more sick people? If not, what do you think is currently happening to those people who need mental health care or routine surgery in a non-single-payer system?
XorNot 8y ago
I live in a country with single payer (Australia). I've never had to wait for an elective procedure because I can choose to privately pay for care on a schedule more convenient to me. I have private health cover which tries to compete on this basis. But if I had any emergency needs, then I'd be treated immediately at any hospital by the public system, which I pay into with taxes. And the waiting list for those elective procedures, if I couldn't afford private care, is a priority list - based on need. The idea that shortages don't exist in the US is absurd - sure they do, you can't afford critical care then you just don't get it. The US waiting list is infinite.

rootusrootus 8y ago

I am skeptical of a causal relationship there. In the United States, approximately 2/3 of healthcare costs are already borne by the government. My parents are both enrolled in Medicare and they are very satisfied. Why would it not work if we just dropped the eligible age for Medicare to zero? Hasn't this been extensively studied recently?

dragonwriter 8y ago
> In the United States, approximately 2/3 of healthcare costs are already borne by the government. Less than half; US healthcare spending was around 8.5% GDP public, 8.8% GDP private in 2016. https://www.healthsystemtracker.org/chart-collection/health-spending-u-s-compare-countries/#item-u-s-similar-public-spending-private-sector-spending-triple-comparable-countries https://www.healthsystemtracker.org/chart-collection/health-...
- rootusrootus 8y ago
  I've heard the 2/3 number (sometimes a little less, most recently slightly over, 68%) from a few reputable sources recently. At the same time, I generally consider Kaiser pretty reliable. I think the discrepancy comes from what is being included in the total -- all costs, direct payments only, tax subsidies, etc. At least from what research I've done. Even if we take the value to be 50%, my point stands -- the gov't is already heavily involved in funding healthcare in this country. Implementing single payer at this point would simplify quite a lot of bureaucracy.
  - conanbatt 8y ago
    You should look into what Kaiser does to its providers. Its pretty grim.
    - dragonwriter 8y ago
      Henry J. Kaiser Family Foundation, not the Kaiser Permanente managed care consortium. Same founder, but very different organizations.
CWuestefeld 8y ago
In many cases, Medicare doesn't even cover the actual cost to provide the service. The providers make up the shortfall by charging other patients more - including charging uninsured patients a LOT more. So if everybody was covered by Medicare, either the providers would be going bankrupt left and right, or the Medicare reimbursements would have to rise - i.e., the price to the government would increase, and the only thing to do about that is to pass it on to the taxpayers. It's a common misconceptions that Medicare is more efficient than commercial insurance, because on paper it looks that way. But in fact they're hiding their administrative expenses by forcing the providers to do much of their bookkeeping. (Source: my wife used to manage the department in the hospital that did that Medicare financial stuff)
- krupan 8y ago
  This should be a highlighted comment in this discussion. My dad just retired and shut down his medical practice. He hated Medicare as a doctor (OK, my words, not exactly his), but now that he's using it as a patient he can see why people like it so much. It really isn't going to work like it does now if it becomes the only option for everyone.
- rootusrootus 8y ago
  That is a pretty bold claim, can you cite someone more authoritative than your wife? Kaiser, who has a plausible claim to expertise in this field, puts the overhead cost of Medicare at 2%. The raw number is more like 1.4% but Medicare does get to piggyback a lot of the administrative workload on Social Security so perhaps that is why Kaiser's number is higher. Insurance industry advocates, who are incentivized to provide the lowest number that can be defended, put private insurance overhead at 17%. The rest of your suggestion -- that Medicare doesn't even pay for the actual cost of service -- is hard to really reason about accurately. Prices and costs are so completely distorted now that I am very skeptical of anybody's estimates of 'actual value.' Things will change dramatically if we eliminate the insurance industry and medical billing field. Having just experienced first world level healthcare in another country and paying for it out of pocket at 1/20th or less of what it runs in the US, I am certain we are getting shafted.
conanbatt 8y ago
Medicare has 30 million patients and costs about 3% of gdp. Multiply by 10, and you would need to almost double the tax-base to pay for medicare. I propose the other thought experiment: why doesnt medicare just compete in the market with other insurance plans: it charges X and provides the service. If its truly more efficient it will beat all the rest.

Symbiote 8y ago

Depending which side you want to believe, NHS waiting times are a direct result of Conservative government austerity, or excessive immigration.

tialaramex 8y ago
To really hammer home the point here, that Conservative government, in an effort to make immigration numbers go down set immigration rules to impose a minimum income for jobs that could recruit outside the EU. That minimum was lower than the government austerity cut maximum pay for nurses. Result: can't hire non-EU nurses, shortage worsens. Waiting times increase. Eventually, as this started to be more widely known the Conservative government "fixed" it. Not by paying nurses more, not by lowering the immigration income requirement to match what they pay skilled workers like nurses, but by specifically exempting nurses.
- tialaramex 8y ago
  Ugh. Should say the minimum income for immigration was set "higher" not "lower" than nurses are paid. Sorry wasn't awake enough when I first wrote this.

NeoBasilisk 8y ago

There are shortages in a private healthcare system. If you can't pay, you don't get treatment.

wizzard 8y ago

Do you think a single-payer system creates more sick people? If not, what do you think is currently happening to those people who need mental health care or routine surgery in a non-single-payer system?

XorNot 8y ago

I live in a country with single payer (Australia). I've never had to wait for an elective procedure because I can choose to privately pay for care on a schedule more convenient to me. I have private health cover which tries to compete on this basis. But if I had any emergency needs, then I'd be treated immediately at any hospital by the public system, which I pay into with taxes. And the waiting list for those elective procedures, if I couldn't afford private care, is a priority list - based on need. The idea that shortages don't exist in the US is absurd - sure they do, you can't afford critical care then you just don't get it. The US waiting list is infinite.