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I'm really surprised to see this downvoted instead of rationally argued with. What is the disagreement here? We don't have universal single payer food, clothi

by krupan 7y ago

I'm really surprised to see this downvoted instead of rationally argued with. What is the disagreement here? We don't have universal single payer food, clothing, housing, etc. all because we know how inefficient and disastrous those things have turned out every time they've been attempted. Why do we expect medicine, especially in a country as large and varied as the United States to be any different? Employer sponsored health care is just one example of a government sponsored incentive, one that was supposed to help, that turned out to be a terrible idea. In fact, most of the problems we have with healthcare in the US are the result of well intentioned government interventions. Is the solution really to have more government involvement? No, not just that, an entire government takeover? Is there really confusion as to why people are nervous about this idea? Other countries that have succeeded with single payer have populations smaller than some of our cities, and near zero diversity with regard to race, religion, individual cultural upbringing, etc. How do we know it will scale up to over 300 million people with widely differing politics, religion, culture, geography, population density, etc.?

namdnay 7y ago
Let’s turn that question around: It scales relatively well from countries with less than 1 million to countries with more than 80 million people, with the same variations in population and geography (although to be honest I don’t understand why race or culture would make a difference to a healthcare system). So why wouldn’t it scale further? Is there some fundamental limit at 100 or 200 million that would make it impossible?
- TeMPOraL 7y ago
  Note that as long as you keep the bureaucracy mostly at state level, the argument of scale doesn't apply to the US - seen from the state level, the US is really just 50 small countries in a federation.
  - beat 7y ago
    That's a far, far better statement of the problem. We have a system that is subject to both federal and state law. But I'm not convinced that it's a total explanation, either. Necessary but not sufficient.
    - arcticbull 7y ago
      It’s how Canada works too. Federal minimum requirements (the Canada Health Act) implemented at the provincial level.
- simongr3dal 7y ago
  Race and culture being varied shouldn't be a propblem neither should having a big population size. I think having differing regulation in each and every state is the thing that will create complications. Just as abortions aren't outlawed federally, I think making sozalized healthcare equally available will perhaps be similarily difficult as it is to make abortion equally available.
  - mikem170 7y ago
    >I think having differing regulation in each and every state is the thing that will create complications. And having one federal system creates corruption - a one-stop shop for lobbyists. Do you really want congress and the president deciding on budgets for various illness, prescription costs, what is covered, etc?
    - simongr3dal 7y ago
      I'm not arguing that having more things regulated federally or having a completely federally regulated America is going to be better. It seems like you think of lawmakers and lobbyists as adversarial, not necesarily untrue, but it it is hard to argue in any direction since they will always be working against you to their benefit. I was pointing out that this is what makes America "varied" compared to other countries and it will introduce complications and variations in how a healthcare system is going to work for it's citizens if they do try to mimick Canada, UK, etc. I would also hope that the hospitals have a bit more autonomy and they aren't hamstrung by congress deciding they aren't allowed to spend more than 5mn on sedatives or some other really narrow and specific budget.
- arcticbull 7y ago
  And further you needn’t scale it beyond 30 million if you leave it to each state to build a system that meets federal minimum requirements, which is what Canada does.
- mikem170 7y ago
  I'm 100% opposed to federal health care, but would be in favor of letting the states do whatever they want. How about that? Like you said, small countries already do this. When 2/3 of the states can agree on a system then we make it federal. This is more like what Sweden does, their counties finance and administer health care according to agreed upon federal standards. The U.S. government has already made a huge mess out of health care- the biggest in the world it appears. I don't trust them. We've already been screwed by industry lobbyists. They need to take a back seat and let the states run with this for now. As per our constitution. I am 100% in favor of various plans at a state level. Vermont was going to do single payer before Obamacare. That's what I want to see. States will copy successful systems, and an amendment can eventually be passed once enough states agree on a federal system.
  - krupan 7y ago
    So if one state offers free health care for all, how do they avoid the freeload problem? When I lived in Washington near the Oregon border, we Washingtonions loved shopping sales tax free in Oregon. What prevents us all from going to Vermont as soon as we get cancer and overwhelming their system?
    - mikem170 7y ago
      That would seem to be a concern, but it didn't stop Massachusetts from implementing Romneycare, nor Vermont from passing a single payer system, nor NY and California making plans for the same. It was happening before the feds got involved. Besides the fact that is how it's supposed to work in this country. The constitution doesn't give the fed the power to regulate health care. That is supposed to require an amendment, which requires something more than a 51% majority because it is a big deal.
beat 7y ago
Your argument is grounded in the idea that the US is somehow an exception to the economic behavior of other first world nations, due to size or diversity or whatever. But is that actually the case? Counter-argument... this isn't simply a question of "capitalism" vs "socialism". There are a wide variety of models in use out there, from the mostly-socialist (Sweden) to mostly-market (Japan). What they all have in common, though, is that all of them are producing better coverage and better outcomes at lower costs than the American system. We pay twice as much as the rest of the world, for the privilege of millions going without coverage, millions more trapped in jobs they hate for the sake of health insurance, and millions of families bankrupted by medical costs outside of what their insurance (or lack of insurance) covers. In other words, the existing American model that you're defending is uniquely bad. It's more expensive and less efficient than any other system in the industrialized world. It's not about whether we can do better. It's about whether we could possibly do any worse, at this point.
- krupan 7y ago
  "In other words, the existing American model that you're defending" Careful, those are fighting words! I am in no way defending the current American model. It sucks. Let's be clear here. I highly, highly doubt that anyone is arguing for status quo in America here. I'm defending capitalism against single payer and medicare for all proposals that rely on magical thinking and trusting our government (that got us into this terrible status quo). If Japan has a mostly market-based solution then lets hear about that some more. EDIT: "It's not about whether we can do better. It's about whether we could possibly do any worse, at this point." Yeah, that's the kind of cynicism that I'm also fighting against. "Yep, we are screwed, might as well try socialism" is not an attitude I'm inspired by.
  - beat 7y ago
    Yes, but. Highly socialist systems are working well in other countries. Interestingly, they seem about as effective as highly capitalist systems in other countries (except, of course, for the American system). So I don't think "socialism" is the problem here, and I worry about the magical thinking of reactionary politics when I see that used as the argument against. Medicare is, in fact, the largest single payer system in the world, and it's a large chunk of the American system. Criticizing single payer would do well to start by criticizing the current Medicare system. But that means separating it logically from the privatized employer-based insurance model, and that's a very difficult knot.
arcticbull 7y ago
It’s weird because the US does have socialized food options (SNAP/food stamps), socialized housing - albeit limited (shelters, BMR housing), clothing I’m not sure. It also has socialized medicine for the old which everyone loves, but if it’s so great once you turn 65 why does it suddenly stop working when you’re 64? 60? 50? 20? It doesn’t. It works great. It controls costs better, it’s more efficient and doesn’t leave anyone out.
- krupan 7y ago
  "It’s weird because..." What's weird? That we have food stamps for those who are temporarily (at least that's how it's supposed to be) in a bind, yet not everyone uses food stamps? Why do you think that is? Does everyone love medicare? Every doctor I've talked to hates it. It doesn't pay on time, it pays below market rates, it sometimes just doesn't pay at all, it doesn't let the doctors choose what care they think is best, etc. Doctors tell me that the rest of us are all subsidizing medicare patients right now, that if they could get away without seeing any medicare patients they would. How is that going to work out when we are all on medicare?
  - arcticbull 7y ago
    > What's weird? That we have food stamps for those who are temporarily (at least that's how it's supposed to be) in a bind, yet not everyone uses food stamps? Why do you think that is? Because it's means-tested? You're describing a two-tier health system, which many countries operating under a "socialized" model follow including Australia. That's fine, too. The government provides a safety net of basic coverage and then those who want more or whose employers want to lure them with the promise of better care can opt for private care. This would still work if Medicare were an open enrollment for anyone who wanted it. > Does everyone love medicare? Every doctor I've talked to hates it. It doesn't pay on time, it pays below market rates, it sometimes just doesn't pay at all, it doesn't let the doctors choose what care they think is best, etc. You can't on the one hand complain about the rising price of healthcare in the US, how it's moving further out of reach for everyone, and at the same time complain that the socialized program "pays below market rates." That's the definition of lowering costs, something the US has to do more than literally every other country in the world. That's a good thing. In fact, that's an argument for the system we're proposing. > Doctors tell me that the rest of us are all subsidizing medicare patients right now, that if they could get away without seeing any medicare patients they would. That's kinda hilarious. Medicare patients are the most expensive, worst customers for a medical program. They're all old, sick, dying or about to. That's facts. If the private system had to bear the burden of treating those patients their margins would implode or costs would balloon. The Medicare program as it exists right now is a huge subsidy to the private sector -- especially as it's forbidden from negotiating drug prices like any other sane system permits. > How is that going to work out when we are all on medicare? It's going to work fine like it does in every other country in the OECD. It's not like we're proposing something wildly outrageous and unheard of. Every other developed nation does this and has better health outcomes across the board with half the cost.

by krupan 7y ago

namdnay 7y ago

Let’s turn that question around: It scales relatively well from countries with less than 1 million to countries with more than 80 million people, with the same variations in population and geography (although to be honest I don’t understand why race or culture would make a difference to a healthcare system). So why wouldn’t it scale further? Is there some fundamental limit at 100 or 200 million that would make it impossible?

TeMPOraL 7y ago
Note that as long as you keep the bureaucracy mostly at state level, the argument of scale doesn't apply to the US - seen from the state level, the US is really just 50 small countries in a federation.
- beat 7y ago
  That's a far, far better statement of the problem. We have a system that is subject to both federal and state law. But I'm not convinced that it's a total explanation, either. Necessary but not sufficient.
  - arcticbull 7y ago
    It’s how Canada works too. Federal minimum requirements (the Canada Health Act) implemented at the provincial level.
simongr3dal 7y ago
Race and culture being varied shouldn't be a propblem neither should having a big population size. I think having differing regulation in each and every state is the thing that will create complications. Just as abortions aren't outlawed federally, I think making sozalized healthcare equally available will perhaps be similarily difficult as it is to make abortion equally available.
- mikem170 7y ago
  >I think having differing regulation in each and every state is the thing that will create complications. And having one federal system creates corruption - a one-stop shop for lobbyists. Do you really want congress and the president deciding on budgets for various illness, prescription costs, what is covered, etc?
  - simongr3dal 7y ago
    I'm not arguing that having more things regulated federally or having a completely federally regulated America is going to be better. It seems like you think of lawmakers and lobbyists as adversarial, not necesarily untrue, but it it is hard to argue in any direction since they will always be working against you to their benefit. I was pointing out that this is what makes America "varied" compared to other countries and it will introduce complications and variations in how a healthcare system is going to work for it's citizens if they do try to mimick Canada, UK, etc. I would also hope that the hospitals have a bit more autonomy and they aren't hamstrung by congress deciding they aren't allowed to spend more than 5mn on sedatives or some other really narrow and specific budget.
arcticbull 7y ago
And further you needn’t scale it beyond 30 million if you leave it to each state to build a system that meets federal minimum requirements, which is what Canada does.
mikem170 7y ago
I'm 100% opposed to federal health care, but would be in favor of letting the states do whatever they want. How about that? Like you said, small countries already do this. When 2/3 of the states can agree on a system then we make it federal. This is more like what Sweden does, their counties finance and administer health care according to agreed upon federal standards. The U.S. government has already made a huge mess out of health care- the biggest in the world it appears. I don't trust them. We've already been screwed by industry lobbyists. They need to take a back seat and let the states run with this for now. As per our constitution. I am 100% in favor of various plans at a state level. Vermont was going to do single payer before Obamacare. That's what I want to see. States will copy successful systems, and an amendment can eventually be passed once enough states agree on a federal system.
- krupan 7y ago
  So if one state offers free health care for all, how do they avoid the freeload problem? When I lived in Washington near the Oregon border, we Washingtonions loved shopping sales tax free in Oregon. What prevents us all from going to Vermont as soon as we get cancer and overwhelming their system?
  - mikem170 7y ago
    That would seem to be a concern, but it didn't stop Massachusetts from implementing Romneycare, nor Vermont from passing a single payer system, nor NY and California making plans for the same. It was happening before the feds got involved. Besides the fact that is how it's supposed to work in this country. The constitution doesn't give the fed the power to regulate health care. That is supposed to require an amendment, which requires something more than a 51% majority because it is a big deal.

beat 7y ago

Your argument is grounded in the idea that the US is somehow an exception to the economic behavior of other first world nations, due to size or diversity or whatever. But is that actually the case? Counter-argument... this isn't simply a question of "capitalism" vs "socialism". There are a wide variety of models in use out there, from the mostly-socialist (Sweden) to mostly-market (Japan). What they all have in common, though, is that all of them are producing better coverage and better outcomes at lower costs than the American system. We pay twice as much as the rest of the world, for the privilege of millions going without coverage, millions more trapped in jobs they hate for the sake of health insurance, and millions of families bankrupted by medical costs outside of what their insurance (or lack of insurance) covers. In other words, the existing American model that you're defending is uniquely bad. It's more expensive and less efficient than any other system in the industrialized world. It's not about whether we can do better. It's about whether we could possibly do any worse, at this point.

krupan 7y ago
"In other words, the existing American model that you're defending" Careful, those are fighting words! I am in no way defending the current American model. It sucks. Let's be clear here. I highly, highly doubt that anyone is arguing for status quo in America here. I'm defending capitalism against single payer and medicare for all proposals that rely on magical thinking and trusting our government (that got us into this terrible status quo). If Japan has a mostly market-based solution then lets hear about that some more. EDIT: "It's not about whether we can do better. It's about whether we could possibly do any worse, at this point." Yeah, that's the kind of cynicism that I'm also fighting against. "Yep, we are screwed, might as well try socialism" is not an attitude I'm inspired by.
- beat 7y ago
  Yes, but. Highly socialist systems are working well in other countries. Interestingly, they seem about as effective as highly capitalist systems in other countries (except, of course, for the American system). So I don't think "socialism" is the problem here, and I worry about the magical thinking of reactionary politics when I see that used as the argument against. Medicare is, in fact, the largest single payer system in the world, and it's a large chunk of the American system. Criticizing single payer would do well to start by criticizing the current Medicare system. But that means separating it logically from the privatized employer-based insurance model, and that's a very difficult knot.

arcticbull 7y ago

It’s weird because the US does have socialized food options (SNAP/food stamps), socialized housing - albeit limited (shelters, BMR housing), clothing I’m not sure. It also has socialized medicine for the old which everyone loves, but if it’s so great once you turn 65 why does it suddenly stop working when you’re 64? 60? 50? 20? It doesn’t. It works great. It controls costs better, it’s more efficient and doesn’t leave anyone out.

krupan 7y ago
"It’s weird because..." What's weird? That we have food stamps for those who are temporarily (at least that's how it's supposed to be) in a bind, yet not everyone uses food stamps? Why do you think that is? Does everyone love medicare? Every doctor I've talked to hates it. It doesn't pay on time, it pays below market rates, it sometimes just doesn't pay at all, it doesn't let the doctors choose what care they think is best, etc. Doctors tell me that the rest of us are all subsidizing medicare patients right now, that if they could get away without seeing any medicare patients they would. How is that going to work out when we are all on medicare?
- arcticbull 7y ago
  > What's weird? That we have food stamps for those who are temporarily (at least that's how it's supposed to be) in a bind, yet not everyone uses food stamps? Why do you think that is? Because it's means-tested? You're describing a two-tier health system, which many countries operating under a "socialized" model follow including Australia. That's fine, too. The government provides a safety net of basic coverage and then those who want more or whose employers want to lure them with the promise of better care can opt for private care. This would still work if Medicare were an open enrollment for anyone who wanted it. > Does everyone love medicare? Every doctor I've talked to hates it. It doesn't pay on time, it pays below market rates, it sometimes just doesn't pay at all, it doesn't let the doctors choose what care they think is best, etc. You can't on the one hand complain about the rising price of healthcare in the US, how it's moving further out of reach for everyone, and at the same time complain that the socialized program "pays below market rates." That's the definition of lowering costs, something the US has to do more than literally every other country in the world. That's a good thing. In fact, that's an argument for the system we're proposing. > Doctors tell me that the rest of us are all subsidizing medicare patients right now, that if they could get away without seeing any medicare patients they would. That's kinda hilarious. Medicare patients are the most expensive, worst customers for a medical program. They're all old, sick, dying or about to. That's facts. If the private system had to bear the burden of treating those patients their margins would implode or costs would balloon. The Medicare program as it exists right now is a huge subsidy to the private sector -- especially as it's forbidden from negotiating drug prices like any other sane system permits. > How is that going to work out when we are all on medicare? It's going to work fine like it does in every other country in the OECD. It's not like we're proposing something wildly outrageous and unheard of. Every other developed nation does this and has better health outcomes across the board with half the cost.