4 ms·
The 20-30T is over 10 years. The US currently spends 3.5T annually. About half of that is private spending (employer-sponsored, out-of-pocket, etc) and the othe
by js2 7y ago
The 20-30T is over 10 years. The US currently spends 3.5T annually. About half of that is private spending (employer-sponsored, out-of-pocket, etc) and the other half is government spending (Medicare, Medicaid, VA, and government employees).
The only way we can possibly contain costs is to legislate it via negotiation between shareholders. There's simply no free market to control cost of health care.
I'm ambivalent if single-payer is the best option. On the one hand, the Federal government has shown it can supply it for those 65+ (Medicare). Satisfaction with Medicare is better than satisfaction with private insurance. And Medicare has 2% administration costs vs something like 14% for private insurance. OTOH, our existing system is much closer to a Bismarck-style multi-payer system like Germany, Japan, etc.
I'm also ambivalent about trying to convert to single-payer in one fell swoop, vs a slower transition like making Medicare a public option with subsidies.
Currently, 160M Americans are covered by employer sponsored coverage. I can imagine it's scary for many of them telling them they'll be put onto Medicare. Loss aversion and all that. Americans seem to like the illusion of choice and control.
I say illusion because what choice, really, do I have over provider if it's employer-sponsored? In my career, I've only ever been offered 2-3 choices picked by the employer that are varying degrees of suck.
Regardless, this will not be a simple transition:
https://www.cbo.gov/publication/55150 https://www.cbo.gov/publication/55150
- simonblack 7y agoThe greatest drawback, as I see it, to the US system is this: Currently, 160M Americans are covered by employer sponsored coverage. The people most in need of 'single-payer' are the unfortunates who don't have employer-sponsored health cover (160M is less than half the US population); those out of work, whether 'retired' or 'not employed just right now'; those who are physically unable to work because of bad health or past injuries; etc. Single-payer covers everybody, and removes the cause of bankruptcies because of tens (or hundreds) of thousands of dollar hospital debts. There's no way I could have afforded my triple bypass surgery including 2 days in ICU on my 22-hours-a-week employment classified as 'casual work' if I was under the US health scheme. That surgery came with a mere two-week warning, I went to have an angiogram 'just to check things' and was told "We're not sure if we'll let you go home today!"
- js2 7y agoThat 160M is vulnerable to having a health issue crop up which prevents them from working, then they lose their job, 18 months later lose their COBRA coverage (if they could afford it in the first place), then go bankrupt at which point they can qualify for Medicaid. It's terrible and it happens. BTW, a big point in favor of single-payer even for those 160M is that it increases consumer choice of provider since you no longer have to worry about provider networks. In theory anyway. There's just so much inertia and powerful vested interests behind the current system, it's really hard to change. This isn't a new fight: https://www.healthcare-now.org/legislation/national-timeline/ https://www.healthcare-now.org/legislation/national-timeline...