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I think you may be misunderstanding “single-payer”. That term refers to there being a single entity paying for the care (generally speaking, this is the governm
by akerl_ 8y ago
I think you may be misunderstanding “single-payer”. That term refers to there being a single entity paying for the care (generally speaking, this is the government), vs the US system which is multi-payer (you pay part of it, public or private health insurance pays another).
In a single-payer system, there can still be many healthcare providers, and the single entity doing the paying is incentivized to push aggressively for low prices from providers, because that keeps their own overhead low. Likewise, they’re incentivized to keep their premiums low, because when you’re the government, if people think you’re screwing up their healthcare they vote you out of office.
As an example of this in the US, take the Medicare system, which can negotiation super aggressively on pricing from healthcare providers because a provider who lands a contract for Medicare knows they have a massive pool of humans to provide care (and thus receive payment) for/from.
- atemerev 8y agoI believe understand it right. What _motivation_ this single entity will have to always have the best customers interests in mind? What will prevent it from being sloppy, or even corrupted and colluding with healthcare providers?
- akerl_ 8y agoWhat stops any group of people from being sloppy or corrupted? I called out the things that keep single-payer systems in check in my original comment, which you’ve replied to: pressure from constituents keeps premiums low (in the same way that the government is pressured to keep taxes low by their electorate), and they’re incentivized to negotiate low rates with providers because it improves their ability to keep premiums low without having them be lower than expenses. That said: the US’s current privatized system is sloppy and corrupt in a multitude of ways, because their incentive structure includes turning a profit, and they can’t negotiate costs as hard as a single-payer system can, because their pool of customers is smaller. So we’ve got the worst combination of traits.
- kgwgk 8y agoYou seem to misunderstand what “there are many insurance companies“ means. There are multiple entities doing the paying. A person contracts health insurance with one among several insurers (at least one, different companies can be chosen for the compulsory insurance and the optional plans offering additional coverage). In the end healthcare is paid directly by the individuals (deductibles, contribution up to some threshold, non-covered charges), by their insurer(s) and by the state (public hospital budgets are not completely covered by the amounts they charge, a large share of the costs is paid from taxes).