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I don't think Democrats (or Republicans when they take power) are clever/smart/kind/honest enough to offer universal single-payer healthcare without rationing.
by EdSharkey 7y ago
I don't think Democrats (or Republicans when they take power) are clever/smart/kind/honest enough to offer universal single-payer healthcare without rationing. Is there an intent to take my health care choices away, and is that intent benevolent or malicious?
You paint a very abstractly wonderful picture, so let's assume yes and benevolent if rationing is to be expected given the finite tax base. I still need more details before I get on board with your plan.
First of all, my employer and I pay through the nose for my decent healthcare right now. Under your universal single-payer healthcare system, will I still be able to pay quadruple-through-the-nose to buy supplemental insurance such that I can still continue to get halfway decent service when I want it? Or, am I going to be stuck with everyone else waiting for rationed care out of fairness?
Also, are you planning to cap salaries of doctors and profits of hospitals and insurance companies out of fairness? (You think it's hard to get quality specialist care now??)
A different opinion from yours goes something like this: US health care is so expensive and inaccessible to 10% of the population because government got involved. The federal government twisted the HC system into a bureaucratic pretzel with no market forces to control costs. The absurd system we have now is a consequence of letting busybody crusaders and insurance company cronies write the laws.
I am not saying that viewpoint is accurate, but it's worth getting diverse voices into the discussion so that we don't wind up with an unhealthy progressive monoculture here on HN.
If we talk to each other like friends that have differing opinions, then we can find lots of little improvements that a majority of us can agree on, like maybe up-front pricing in hospitals or tort reform. If we can bring costs down and make health care more accessible to more people, then maybe we won't feel forced to take risky steps like forcing everyone to cede their personal health care choices to indifferent government pencil pushers.
Reaching out to you as a friend, I feel we both want the same thing - to have the maximum number of people possible receive quality care. I feel we're both frustrated that the current system is so unfair in so many ways.
I'm not opposed to setting up a safety net, as long as it doesn't get out of hand cost-wise or turn into a racket for the cronies. I'm thinking like mending broken bones, treating infections, vaccinations, most generics, and addiction treatment all should be abundant, cheap and/or free. Panacea it would not be with a fixed budget so that as a program it cannot grow to crony levels. You could sell me on providing basic health services like that because it just makes sense economically and public health-wise.
And I hope you're not opposed to weeding out waste, fraud, and abuse as one approach (of many) to fix a broken system. If we can get costs demonstrably down, maybe you'd even be open to deep cuts in existing nondiscretionary programs like medicare that have insane unfunded liabilities and will eventually crush us.
Maybe there is a middle ground that satisfies between us politically such that we can move forward together rather than lurching crazily right and left every 8 years.
- marcus_holmes 7y agocheck out Australia's healthcare system as a middle ground then. I've lived in the UK (free, single-payer, government-run) and Australia's, and I prefer Australia's because it has a mix of both government and market. The basic principle is that the Australian Federal Government subsidises healthcare by a fixed amount for each procedure. So iirc, it was AUD$45 for a visit to the GP. That's enough for some GP practices to be able to offer a free service (referred to as "bulk billed" because they only billed the government). Obviously those services become popular, so to get a free appointment you have to wait a while. Or, you can pay a bit yourself to get an appointment with a doctor who charges more than the government rate and are therefore less in demand. In Australia I could usually get an appointment next day if I paid $25-50 or so. In the UK it was usually a 1-2 week wait, but free. This goes for everything (except dental care for some reason, I don't know what's up with that). So an X-Ray costs $200, or nothing if you can wait until next week. And so on. Health insurance covers the additional costs, and I paid $25/month for a plan that meant if anything serious happened I'd be liable for the first $250. And it also gave me dental cover, so I could claim some (but not all) of my dental care from my health insurance - a net gain for me most years.
- disordinary 7y agoThe NZ system is similar. GPs are subsidised (your primary health provider) but hospitals are run by the government and are free. The unfortunate thing is you have to go through the GP to get a referral to the Hospital (unless you go into A&E). The other interesting system that NZ has is something called ACC which also pays for rehabilitation and loss of income when someone has an accident. If you are paralysed and can no longer work then ACC will pay you something like 80% of your income until you manage to find another job. That could be for the rest of your life.
- michaelt 7y agomy employer and I pay through the nose for my decent healthcare right now [...] Under your universal single-payer healthcare system, will I still be able to pay quadruple-through-the-nose to buy supplemental insurance Here in the UK, the private health insurance arranged by my employer costs them $450 per year. I don't know how much US insurance costs your employer, but I assume it's several times more, rather than several times less, than mine pays! After all, in the UK private medical insurance doesn't have to cover ambulances or emergency surgery or pre-existing conditions or chronic illnesses or old age or organ transplants or childbirth.