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Did you read it? Also, are you familiar with any modern nations where a single-payer healthcare system has been tried? Perhaps we could use them to predict the

Did you read it? Also, are you familiar with any modern nations where a single-payer healthcare system has been tried? Perhaps we could use them to predict the effects. > Is waste, fraud, and abuse taken into account at all in this study? From the paper: "In addition to savings on overheads, a comprehensive database of health-care charges would facilitate detection of fraud, which extracts $85·7 billion every year. Following the transition to a single-payer system in Taiwan, an 8% reduction in overall national expenditure was attributed to the reduction in fraud. By moving from a fragmented health-care payment system to a unified system, irregularities in provider claims can be more easily detected. For example, under the fragmented system excessive claims for physician time can be spread across patients with several different insurance providers. However, acknowledging that improvements have been made in fraud detection since Taiwan's transition, we conservatively assume that the improved fraud detection would garner savings amounting to half that observed in Taiwan, corresponding to 4% of total health-care expenditure." https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)33019-3/fulltext#seccestitle50 https://www.thelancet.com/journals/lancet/article/PIIS0140-6... > People who have a proclivity to go to the doctor too much will go even more when its 'free'. Younger people who eschew doctors because it interferes with their current lifestyle will feel even safer continuing bad health habits because free care will be there for them later in life. Is this a significant problem in countries with single-payer systems? > Why should I subsidize other people's bad decision making? You already are? That's how health insurance works. What this study is showing is that you'll have to subsidize other people less, because the whole system will be less expensive.

macinjosh 7y ago
> You already are? That's how health insurance works. I am not a defender of the insurance system. It blows. But single-payer is not the only other choice. I want a freer healthcare market where prices are known before consuming services. Real market competition could actually occur to bring down prices. For drugs, research and development for less profitable cases could be a very worthy target of government funding. I don't have all the answers but neither does single-payer.
- burkaman 7y ago
  Healthcare is not and cannot ever be a free market. You cannot have price transparency when a buyer may be unconscious at the time of "purchase". You cannot have price competition when buyers are frequently forced to immediately purchase a good or service if they don't want to die. Hospitals are chosen by proximity, not price. These are the consequences of being mortal human beings. If we were all immortal, and "healthcare" was nothing more than voluntary cosmetic surgery, a free market might make sense.
  - macinjosh 7y ago
    > You cannot have price competition when buyers are frequently forced to immediately purchase a good or service if they don't want to die. The number of instances where this dire case occurs is minimal compared to every other instance. Sure, when its life and death its not practical. Perhaps those sorts of situations is where single payer or insurance makes sense. For humdrum things like physicals, wellness visits, cold and flu checks, vaccinations, routine labs and imaging, etc. a free market could work very well.
    - burkaman 7y ago
      Hospital care is the largest spending category by far: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/highlights.pdf https://www.cms.gov/Research-Statistics-Data-and-Systems/Sta... While the other things you list are technically not immediate life-or-death decisions, they still are not voluntary purchases. The presence of any kind of coercion distorts a free market. Also, I don't want to live in a society where individuals must decide between vaccinating their newborn children or paying their electricity bill that month. Or between getting a flu shot and buying groceries for the week. The externalities of these "individual" decisions are obvious, and a free market has no answer. Finally, let's imagine a system where emergency care is covered by a national single payer, but "humdrum things" are available in a free market. Now the poor can't afford basic physicals and flu shots, so we all end up paying more into the single payer system to cover such people being hospitalized for conditions that could have been prevented by regular medical checkups.
senordevnyc 7y ago
It doesn’t matter if it’s better. It’s fundamentally impossible to get to there from here directly. You can’t do it politically or economically, and honestly, given how much of our economy is built on healthcare spending, it’s pretty stupid to try. But again, it doesn’t matter, you can’t do it in a democracy. Just like a carbon tax, if you make too much of the population hurt in the short term, they’ll just replace you with someone who won’t. The public option is the only thing that has a snowballs chance in hell of working.
- burkaman 7y ago
  How did FDR accomplish the New Deal in a democracy? How did the UK implement the NHS in 1948? How did Canada pass the Canada Health Act in 1984? How did Taiwan institute National Health Insurance in 1995?

macinjosh 7y ago

> You already are? That's how health insurance works. I am not a defender of the insurance system. It blows. But single-payer is not the only other choice. I want a freer healthcare market where prices are known before consuming services. Real market competition could actually occur to bring down prices. For drugs, research and development for less profitable cases could be a very worthy target of government funding. I don't have all the answers but neither does single-payer.

burkaman 7y ago
Healthcare is not and cannot ever be a free market. You cannot have price transparency when a buyer may be unconscious at the time of "purchase". You cannot have price competition when buyers are frequently forced to immediately purchase a good or service if they don't want to die. Hospitals are chosen by proximity, not price. These are the consequences of being mortal human beings. If we were all immortal, and "healthcare" was nothing more than voluntary cosmetic surgery, a free market might make sense.
- macinjosh 7y ago
  > You cannot have price competition when buyers are frequently forced to immediately purchase a good or service if they don't want to die. The number of instances where this dire case occurs is minimal compared to every other instance. Sure, when its life and death its not practical. Perhaps those sorts of situations is where single payer or insurance makes sense. For humdrum things like physicals, wellness visits, cold and flu checks, vaccinations, routine labs and imaging, etc. a free market could work very well.
  - burkaman 7y ago
    Hospital care is the largest spending category by far: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/highlights.pdf https://www.cms.gov/Research-Statistics-Data-and-Systems/Sta... While the other things you list are technically not immediate life-or-death decisions, they still are not voluntary purchases. The presence of any kind of coercion distorts a free market. Also, I don't want to live in a society where individuals must decide between vaccinating their newborn children or paying their electricity bill that month. Or between getting a flu shot and buying groceries for the week. The externalities of these "individual" decisions are obvious, and a free market has no answer. Finally, let's imagine a system where emergency care is covered by a national single payer, but "humdrum things" are available in a free market. Now the poor can't afford basic physicals and flu shots, so we all end up paying more into the single payer system to cover such people being hospitalized for conditions that could have been prevented by regular medical checkups.

senordevnyc 7y ago

It doesn’t matter if it’s better. It’s fundamentally impossible to get to there from here directly. You can’t do it politically or economically, and honestly, given how much of our economy is built on healthcare spending, it’s pretty stupid to try. But again, it doesn’t matter, you can’t do it in a democracy. Just like a carbon tax, if you make too much of the population hurt in the short term, they’ll just replace you with someone who won’t. The public option is the only thing that has a snowballs chance in hell of working.

burkaman 7y ago
How did FDR accomplish the New Deal in a democracy? How did the UK implement the NHS in 1948? How did Canada pass the Canada Health Act in 1984? How did Taiwan institute National Health Insurance in 1995?