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Yet we're not going to see a big raise because we switch over to a single payer system. It's not unreasonable for people to be skeptical of such a massive chang

Yet we're not going to see a big raise because we switch over to a single payer system. It's not unreasonable for people to be skeptical of such a massive change when their current situation works fine (for them.) A change like this would be far more beneficial to the under/uninsured than those of us with existing, comprehensive plans. I'm not making an argument either way. Personally I'm for single payer, but that's largely due to the issues my mother had when she became ill.

wahern 7y ago
> Yet we're not going to see a big raise because we switch over to a single payer system. Californian legislators released a study last year about the costs of moving to single-payer healthcare in the state. In total it would be $400 billion, requiring $200 billion in new tax revenues after accounting for the existing $200 billion in federal, state, and local expenditures. Diverting existing employer and individual premium payments would still leave anywhere from a $50 billion to $150 billion gap. California's existing budget is ~$200 billion, so covering that gap would require significant new taxes. Anybody telling you that you can get single-payer for free is lying to you. That would only be possible if we could significantly reduce costs, but we don't know how to reduce costs. Any suggestion you've heard is almost certainly part of the ACA/Obamacare in some form or fashion, and the strategies aren't working as well as originally believed. But this was predicted. The ACA was always intended to be a process of experimenting with cost reducing strategies, which is why there were supposed to be panels that could rewrite the rules as new information came in. But nobody is interested in the hard work of figuring out what those solutions are; all the electorate on both sides is interested in voting for are feel-good solutions. And they'll believe whatever they need to believe in order to support their political tribe.
- sitkack 7y ago
  > we don't know how to reduce costs I am pretty sure administrators of health systems that are cheaper could tell us. Like just directly to our face.
  - wahern 7y ago
    If you could magically wave a wand and instantly replace a multi-trillion industry, maybe. But you can't. And so even the most radical of possible reforms will necessarily be incremental. The other part of it is that Americans want mutually exclusive things--low prices and end-of-life services that will spare no expense. In the end any equitable system will have to choose the former, just as every other national system has. However, the people in those systems were never given the choice; their healthcare systems just evolved in that direction decades before modern revolutions in incomprehensibly expensive medical care. So Americans are being forced (by partisan politics) to make a decision no democracy can be reasonably expected to make. The ACA was largely based on Hillary Clinton's 15+ years of footwork. The ACA is based on extensive examinations of foreign healthcare systems. If Democrats can't make the ACA work--because they can't overcome Republican opposition, because they're fickle and have turned their backs on it--then what hope is there of even more radical reforms? I'm not saying single-payer isn't possible in the U.S. It's just not possible now. We'd have to wind our way there. But that's too much of an ask from our modern politics. The ACA could have been a stepping stone, instead leftist and populist Democrats just want to chuck it and start over, ignoring the fact that they'd be facing all the same impediments and problems of the ACA and a whole lot more, yet without any better answers. "Other people do it" isn't an answer. Can I expect you to become a Warren Buffet or Bill Gates merely because they and you both exist? It's a non sequitur. You can't simply ignore path dependencies.
    - sitkack 7y ago
      A young man is walking down a dusty country road, putting out his thumb for each passing vehicle. None stop. An hour goes by and a old red truck rolls past him, ineffectually coming to a soft halt, front brakes obviously worn out years ago. The old guy in the truck asks him where he is going. The kid points to a location on the map. And the old guy says, "oh they blew the bridge up years ago. You can't get there from here, at least not anymore."

wahern 7y ago

> Yet we're not going to see a big raise because we switch over to a single payer system. Californian legislators released a study last year about the costs of moving to single-payer healthcare in the state. In total it would be $400 billion, requiring $200 billion in new tax revenues after accounting for the existing $200 billion in federal, state, and local expenditures. Diverting existing employer and individual premium payments would still leave anywhere from a $50 billion to $150 billion gap. California's existing budget is ~$200 billion, so covering that gap would require significant new taxes. Anybody telling you that you can get single-payer for free is lying to you. That would only be possible if we could significantly reduce costs, but we don't know how to reduce costs. Any suggestion you've heard is almost certainly part of the ACA/Obamacare in some form or fashion, and the strategies aren't working as well as originally believed. But this was predicted. The ACA was always intended to be a process of experimenting with cost reducing strategies, which is why there were supposed to be panels that could rewrite the rules as new information came in. But nobody is interested in the hard work of figuring out what those solutions are; all the electorate on both sides is interested in voting for are feel-good solutions. And they'll believe whatever they need to believe in order to support their political tribe.

sitkack 7y ago
> we don't know how to reduce costs I am pretty sure administrators of health systems that are cheaper could tell us. Like just directly to our face.
- wahern 7y ago
  If you could magically wave a wand and instantly replace a multi-trillion industry, maybe. But you can't. And so even the most radical of possible reforms will necessarily be incremental. The other part of it is that Americans want mutually exclusive things--low prices and end-of-life services that will spare no expense. In the end any equitable system will have to choose the former, just as every other national system has. However, the people in those systems were never given the choice; their healthcare systems just evolved in that direction decades before modern revolutions in incomprehensibly expensive medical care. So Americans are being forced (by partisan politics) to make a decision no democracy can be reasonably expected to make. The ACA was largely based on Hillary Clinton's 15+ years of footwork. The ACA is based on extensive examinations of foreign healthcare systems. If Democrats can't make the ACA work--because they can't overcome Republican opposition, because they're fickle and have turned their backs on it--then what hope is there of even more radical reforms? I'm not saying single-payer isn't possible in the U.S. It's just not possible now. We'd have to wind our way there. But that's too much of an ask from our modern politics. The ACA could have been a stepping stone, instead leftist and populist Democrats just want to chuck it and start over, ignoring the fact that they'd be facing all the same impediments and problems of the ACA and a whole lot more, yet without any better answers. "Other people do it" isn't an answer. Can I expect you to become a Warren Buffet or Bill Gates merely because they and you both exist? It's a non sequitur. You can't simply ignore path dependencies.
  - sitkack 7y ago
    A young man is walking down a dusty country road, putting out his thumb for each passing vehicle. None stop. An hour goes by and a old red truck rolls past him, ineffectually coming to a soft halt, front brakes obviously worn out years ago. The old guy in the truck asks him where he is going. The kid points to a location on the map. And the old guy says, "oh they blew the bridge up years ago. You can't get there from here, at least not anymore."