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Single-payer healthcare is the answer. Period. If all Americans were in a single pool negotiating for drugs and healthcare, prices would plummet. It worked in E

Single-payer healthcare is the answer. Period. If all Americans were in a single pool negotiating for drugs and healthcare, prices would plummet. It worked in Europe and it’ll work here. We are spending somewhere between 150% and 200% of what we should be on healthcare on a national level. We don’t get better outcomes either. So the harsh truth is that the whole industry needs to take a pay cut. That includes doctors, who actually make more than they should be in a well-lubricated market economy. Make no mistake, the healthcare market is colossally broken. Zero price transparency combined with high price insensitivity (due to extremely high value of life) and no practical substitute services (“protest” healthcare and go uninsured....at your peril) is a toxic combination. It guarantees that people are fleeced for every penny they could pay. Almost no other industry in America works in that way. Imagine a grocery store with no listed prices. When you roll up to the register and ask for the price, the employees are baffled. How dare you question the value of those who provide you sustenance. Do you even know how many years it took to optimize our supply chain so that you can have organic chicken and avocados? Our executives have to pay off their MBA debt somehow. They then inform you that the price of your basket is probably somewhere between $100-$1000, and that it’s really up to your grocery insurance provider. You call the insurance company, which then ask for the chicken code, avocado code, toilet paper code, etc... 2 hours later, they say they can give you an answer on how much your groceries will take from your deductible, but it’s going to take a week. They can quote the same prices for a couple other in-network grocery stores too, but you have a choice to make. Leave your groceries for today and wait a week for an answer, or buy your damn groceries like 99.9% of other people and get on with your life. You decide to wait. You find out that all the prices are exorbitant, but the grocery store that’s 2 hours away would only charge $300 as opposed to $500. Alas, it’s not even worth taking off work for that. If that sounds utterly dystopian, that’s healthcare in America today. It’s a game of name-your-price for providers. Insurance companies are in on it too. They want prices to be higher because high total spending results in higher insurance premiums. Businesses mostly shrug at the problem because of tax subsidies and because they want employees to fear losing their insurance along with their job. Americans must be unapologetic to medical organizations complaining about single-payer (“We’ll literally go out of business! We’ll close rural hospitals! Insurance workers will lose their jobs! Long socialist wait times! Government death panels!”). They want to keep the status quo at the expense of American families. For that reason, I assign close to no value to what healthcare insiders have to say about solving the spending problem. Lastly, consider this: American employees take home less of their paycheck than employees in all other developed nations except Netherlands. Note that this takes into consideration the portion of your premiums paid by your employer, which otherwise would have been paid to you in income. That’s why tax increases seem so unfathomable in the U.S. The healthcare industry is parasitically sucking out all the slack. Imagine if all that economic rent went to education and infrastructure instead.

throwaway34241 7y ago
I agree with you on the insanity of the current system, but I have two problems that prevent me from believing that single payer is the simple answer to our health care cost problem: 1) "Europe" is not single payer, England is while the two largest EU countries, Germany and France, are not. 2) Medicare is already an enormous single payer system, covering the demographic that consumes the most health care services, and does not have costs anywhere in line with Europe. So, I think copying Europe would be reasonable, but that maybe it would be better to draw inspiration from one of the non-single-payer systems instead. The results don't seem to be any worse and it seems a bit safer to have more choices.
- keenmaster 7y ago
  Medicare sets reimbursement rates at around 80% of what insurance companies pay. The government couldn’t go lower because Medicare patients are elderly. Doctors simply would not take Medicare patients if they got significantly less than 80% per procedure (on average) because they take more time and resources than the average patient. If the pool included younger and healthier patients (most of the rest of America) its cost basis would be lower than Medicare. Additionally, I’m aware that there are different gradations of government healthcare in Europe. All of them would be better than the current system, though I’m a fan of single-payer. I was just simplifying.
  - throwaway34241 7y ago
    Even if you can save 20% on younger people (by paying doctors/hospitals 20% less) that's still a long way away from bringing costs in line with Europe. Single payer doesn't sound like a crazy idea to me, I'm just skeptical that it will necessarily solve the cost problem. A single payer system that is very expensive and continually increasing seems like a real possibility to me. I guess you could achieve cost savings by cutting reimbursement rates even further if you prohibit any alternatives. Hospitals can and do go bankrupt but it seems likely that physician salaries could also be cut. I'm sure this will drive many doctors that were borderline into retirement but I guess we're facing a physician shortage anyway. I think there's a number of other things we could do to contain health care costs. We could expand the role of nurses and physician assistants (possibly with the aid of computer diagnostic systems). We could increase the number of doctors produced (which will in general lower salaries). We could subsidize medical education more, so doctors graduate with less debt, in exchange for accepting a lower salary later. We could have better conversations around end-of-life care, since many patients choose treatment plans that doctors would not chose for themselves, but might not if things were explained better. We could have official guidelines to establish when certain tests are necessary using evidence-based medicine, to limit thoughtless CYA testing for liability purposes if it isn't medically warranted. So, my feelings on single payer are tied to whether it will make it more or less likely that we can explore these things. Given the current state of our political discourse I'm not encouraged.

throwaway34241 7y ago

I agree with you on the insanity of the current system, but I have two problems that prevent me from believing that single payer is the simple answer to our health care cost problem: 1) "Europe" is not single payer, England is while the two largest EU countries, Germany and France, are not. 2) Medicare is already an enormous single payer system, covering the demographic that consumes the most health care services, and does not have costs anywhere in line with Europe. So, I think copying Europe would be reasonable, but that maybe it would be better to draw inspiration from one of the non-single-payer systems instead. The results don't seem to be any worse and it seems a bit safer to have more choices.

keenmaster 7y ago
Medicare sets reimbursement rates at around 80% of what insurance companies pay. The government couldn’t go lower because Medicare patients are elderly. Doctors simply would not take Medicare patients if they got significantly less than 80% per procedure (on average) because they take more time and resources than the average patient. If the pool included younger and healthier patients (most of the rest of America) its cost basis would be lower than Medicare. Additionally, I’m aware that there are different gradations of government healthcare in Europe. All of them would be better than the current system, though I’m a fan of single-payer. I was just simplifying.
- throwaway34241 7y ago
  Even if you can save 20% on younger people (by paying doctors/hospitals 20% less) that's still a long way away from bringing costs in line with Europe. Single payer doesn't sound like a crazy idea to me, I'm just skeptical that it will necessarily solve the cost problem. A single payer system that is very expensive and continually increasing seems like a real possibility to me. I guess you could achieve cost savings by cutting reimbursement rates even further if you prohibit any alternatives. Hospitals can and do go bankrupt but it seems likely that physician salaries could also be cut. I'm sure this will drive many doctors that were borderline into retirement but I guess we're facing a physician shortage anyway. I think there's a number of other things we could do to contain health care costs. We could expand the role of nurses and physician assistants (possibly with the aid of computer diagnostic systems). We could increase the number of doctors produced (which will in general lower salaries). We could subsidize medical education more, so doctors graduate with less debt, in exchange for accepting a lower salary later. We could have better conversations around end-of-life care, since many patients choose treatment plans that doctors would not chose for themselves, but might not if things were explained better. We could have official guidelines to establish when certain tests are necessary using evidence-based medicine, to limit thoughtless CYA testing for liability purposes if it isn't medically warranted. So, my feelings on single payer are tied to whether it will make it more or less likely that we can explore these things. Given the current state of our political discourse I'm not encouraged.