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As a Canadian, I am constantly flabbergasted when American friends tell me "Yeah, but a single-payer system would be way too expensive! Taxes would go up!". It

• tashoecraft 5y ago
  There has been a massive disinformation campaign pushed on the American people saying “socialism medicine” would be much more expensive and you’d have to let grandma die. That Canada hates their system and you have to wait for days to get seen. Any evidence to the contrary is met with “but my freedom”, idk how to fight back against this
  • Vaslo 5y ago
    Just buy insurance if you are worried about it.
    • RedShift1 5y ago
      Even those who have insurance end up paying a lot out of pocket and if the insurance provider decides to not pay the bill it gets chucked onto you and that can easily run in the 100000's of dollars.
  • FpUser 5y ago
    >"That Canada hates their system and you have to wait for days to get seen." I would not call that I hate the whole Canadian system, but parts of it for sure. Especially the ones when they let you wait for months for some things. Some people died because of it. All because the guvvamint only allows for so many procedures per period allowed. The rest does not fit into budget. However you will find enough of deaths in the US that can be attributed to a lack of money as well. Depending on how one gets sick the may hate Canadian system or the one in the US.
  • rayiner 5y ago
    What disinformation campaign? Elizabeth Warren’s proposed healthcare plan would cost $52 trillion over 10 years, with $20 trillion in new federal spending: https://www.cnbc.com/2019/11/01/elizabeth-warren-releases-plan-to-pay-for-medicare-for-all.html https://www.cnbc.com/2019/11/01/elizabeth-warren-releases-pl.... Warren estimates that $52 trillion is about what Americans would spend on healthcare over that time frame anyway. When the candidate “with a plan” estimates that single payer wouldn’t reduce costs, does it take a “massive disinformation campaign” to convince people that, by the time all is said and done, costs would go up significantly?
  • antiterra 5y ago
    I do know people in Canada who have to wait days to be seen for certain things or who pay for supplemental healthcare plans to fill in the gaps. That doesn’t mean they’d rather be in our system, which seems to get more broken every day.
• dominotw 5y ago
  > the incentive on everyone is to find ways to lower the cost of healthcare why is this? Here in Chicago all govt run institutions are out of money with out of control budget overruns. eg: public transport( CTA) , usps ect. Not to mention pensions/pension debts which have spiraled out of control.
• victor106 5y ago
  From the outside the Canadian healthcare system looks good. But I have friends in Canada who complain that it’s very very hard to get an appointment for a basic check up. They have to wait anywhere from 2 to 6 months. Also, they just end up going to emergency for anything. Your experience might vary. The same with UK also I hear. I am no big fan of the American healthcare system but I don’t think any country (don’t bring up Switzerland and Singapore as examples, they are too small and don’t have the diversity, size and complexity of the US) has demonstrated an ideal healthcare model.
  • dominotw 5y ago
    My indian friends travel to india to get routine medical procedures. My understanding is that you get priority if you have a pressing concern but long wait times for procedures that can wait.
    • FpUser 5y ago
      What is considered as "can wait" can be pretty insane sometimes.
  • 1helloworld1 5y ago
    Lot of the anecdotes like yours probably stems from a deliberate propaganda campaign started by US Health Insurance companies. This is quick npr podcast about it- https://www.npr.org/2020/11/06/931990578/why-americans-have-been-deceived-about-canadas-health-care-system https://www.npr.org/2020/11/06/931990578/why-americans-have-...
    • dominotw 5y ago
      > Canadians might wait several weeks or a few months to get a knee replacement Hard to tell from this what else falls under "knee replacement" category of urgency. I personally know ppl who traveled to india to get a root canal. Weird to dismiss it as " deliberate propaganda campaign " and link to npr article with no actual statistics.
  • FpUser 5y ago
• rayiner 5y ago
  People say taxes would go up because every plan for single payer would involve taxes going up. Pretty much no one things you can squeeze major cost efficiencies out of the system.
  • ceejayoz 5y ago
    I pay over $25k in insurance premiums a year for a family of four. If raising my taxes by $10k eliminates that, I’m extremely ok with it. The cost of US healthcare is 2-3x the cost of healthcare in the rest of the developed world - counting both public and private spend - and with very similar outcomes.
    • giantg2 5y ago
      "If raising my taxes by $10k eliminates that, I’m extremely ok with it." As would I, if there's a $15k savings. Is there any data to support that? You mention costs in other countries. How do salaries, taxes, and cost of living compare as well? It seems that many places have lower cost of living, which seems to influence prices for any number of services.
      • pomian 5y ago
        Canada had a slightly higher cost of living than US. But we are a very very big country with low population density, so logistics are expensive. Health care costs about 50/month if you have income. Simple. Cost never enters into medical decisions. .(Some pharmaceuticals are a problem - expensive, if you have special needs.)
        • giantg2 5y ago
          "Cost never enters into medical decisions." From a patient perspective or system perspective? "Health care costs about 50/month if you have income." That's what is billed. What do the systems actually cost on a per patient basis adjusted for population risks (like obesity)?
      • andreskytt 5y ago
• RHSeeger 5y ago
  Of course, you also have to contend with things like "medicare is not allowed to negotiate drug prices"... except now there's even _more_ motivation for drug companies to bribe politicians to get things like that encoded into law. While I'm a proponent of universal healthcare, it does have some negatives.
  • ceejayoz 5y ago
    Is this an actual problem in the various real-world examples of single payer and universal healthcare out there?
    • RHSeeger 5y ago
      No, but it's already a problem in the US. I would expect moving to a single payer system would make that particular type of issue worse.
      • ceejayoz 5y ago
        So, the problems brought on by the uniquely weird and shitty US health insurance system will persist when we transition to the tried-and-tested alternatives the rest of the developed world use without those problems?
  • rayiner 5y ago
    Medicare isn’t allowed to negotiate drug prices because it mostly doesn’t cover or pay for drugs. Drugs are covered under Medicare Part D plans through private insurers. It’s their job to negotiate drug prices.
• 1helloworld1 5y ago
  This is a great 3 minute podcast about how US health insurance companies started a propaganda campaign to scare Americans about Canadian Health Insurance system - https://www.npr.org/2020/11/06/931990578/why-americans-have-been-deceived-about-canadas-health-care-system https://www.npr.org/2020/11/06/931990578/why-americans-have-...
• giantg2 5y ago
  "It does not occur to them that in a single-payer system, the incentive on everyone is to find ways to lower the cost of healthcare, while in a privatized healthcare system the incentives are reversed." I don't think this is completely true. That greatly depends on the population. Regardless of single payer or private insurance, it's the underlying mentality of the people, or restrictions placed by the plan (which people then complain about). Many people think they have coverage, so they might as well use it. This can happen extremely often and for minor things. Think people going into the doctor or urgent care because they have cold symptoms (for less than a week) and want antibiotics. Most people want the easiest, most beneficial thing, like why diet and exercise when you can just take a pill for your type 2 diabetes, cholesterol, or blood pressure? People don't think about costs during the most costly parts of life - end of life care. People want doctors to do "everything" to extend a person's existence, even if the outcome isn't likely to result in extended life. When the system does make choices about who to treat or how to treat, there is generally some public backlash (like NY letting many elderly die because they thought they needed to save the ventilators/beds for younger covid patients). It's the views and intelligence of society that dictate behavior-based costs. This includes what restrictions are placed on both supply and demand sides.
  • threatofrain 5y ago
    How does that translate into the costs of stitches at Stanford Health Care?
    • giantg2 5y ago
      What does the parent comment have to so with the cost of stitches at Stanford? I was responding to their generalized comment about costs, which also has very little to do with the cost of stitches at Stanford. For one, people are using Stanford for the name and presumed quality of care (see tweet about price being much higher than other hospitals). That's shows patients are willing to spend more for treatment there. If you want to dig deeper into the cost, then we would need to know why the price is listed that high, as it is likely a mistake (also speculated in the tweets). It's not really a good idea to compare anecdote that is suspected to be a mistake against an unspecified cost in another system (implied by parent).
• Amezarak 5y ago
  I weakly support single-payer because it would at least hopefully save me from spending hours dealing with the vagaries of medical provider billing and free people from worrying about health insurance when job-searching, but I don't see much reason to believe it would lower prices in America. There's some kind of horrific cost disease going on in America. Sure, the insurance doesn't help, but it's not the main problem. The cash price - with a discount - for me to get the five-minute opinion of a nurse practitioner is $125-$150. Self-insured companies are paying 20k+ in premiums for an employee's family health insurance plan. This is reflected in the fact that a lot of hospital systems in the US are already publicly owned! Taxpayers in much of the US are already paying directly to built facilities and pay doctors and nurses for anything their billing doesn't cover. (Not even counting the VA system.) 64 million Americans are on Medicaid, about 20% of the population; [1] 18% of Americans are on Medicare. [2] (There's some overlap, so those aren't strictly additive.) More Americans than Canadians are already the beneficiaries of public health care! And Medicare/Medicaid is already the one of the biggest US government expenditures. [3] Whatever natural incentives are in place are already there. It may be the case that specific government policies are partly responsible for hamstringing cost-cutting, but I see no reason to believe those policies and worse ones wouldn't perpetuate themselves. There's a lot of factors driving the crazy costs in the US. Unfortunately, I don't see a reason to believe single payer would do anything but mildly slow the rise, unless combined with a lot of very unpopular policies. [1] https://www.cms.gov/newsroom/fact-sheets/medicaid-facts-and-figures https://www.cms.gov/newsroom/fact-sheets/medicaid-facts-and-... [2] https://www.statista.com/statistics/200962/percentage-of-americans-covered-by-medicare/#:~:text=Percentage%20of%20people%20covered%20by%20Medicare%20in%20the,%2016.7%20%25%20%209%20more%20rows%20 https://www.statista.com/statistics/200962/percentage-of-ame... [3] https://datalab.usaspending.gov/americas-finance-guide/spending/categories/ https://datalab.usaspending.gov/americas-finance-guide/spend...
  • giantg2 5y ago
    "Not even counting the VA system" Personally, I would like to see the government use the VA to demonstrate what level of care and overall experience the public can expect if switching to a single payer or other government involved system. Most of us that have any knowledge of their workings would not be too optimistic about US government expanding their role in the general system. It's such an embarrassment.
• browningstreet 5y ago
  The discussion needs to separate cost and bill rate.
• deleted 5y ago
  [deleted]
• closeparen 5y ago
  The interesting part of socialized healthcare isn’t that it’s run by the government but that the cost burden is borne by the highest wage earners, i.e. the California and New York knowledge workers who make up a large part of this community. If your friend is part of this cohort then his concern is probably founded. Less so if he’s a line cook or even an IT admin in Wisconsin.
• pyuser583 5y ago
  When I say things like that to my Canadian friends, what I mean is: “I am not confident in the ability of the government to implement a reasonable single payer system. I am concerned that regulatory capture, small government politics, and special interest groups will result in system that is worse than what we currently have.” You had mentioned hospitals being incentivized to reduce costs. They could do that by avoiding sick patients. Or not treating sick patients. Some “providers” already have this business model. Also, it’s all but guaranteed hospitals would seek to increase revenue by providing non medical services at high expense. $2000/meal. $500/night parking. $500 for a hospital gown. America needs to address its weak administrative state, underfunded and under-qualified civil service, and overall shitty public sector before taking on a massive project like this.
  • ajnin 5y ago
    > I am not confident in the ability of the government to implement a reasonable single payer system. I am concerned that regulatory capture, small government politics, and special interest groups will result in system that is worse than what we currently have. It takes a special kind of delusion to believe that when every single country in the world that has a public health system is in fact not worse than the US system. I think a large part of the problem is that Americans are brainwashed from birth to believe that the "Free Market" will solve all problems, and that it is superior to public systems 100% of the time.
    • pyuser583 5y ago
      America is dealing with some very serious problems that “every other country” is not. As an America this is a very sad thing for me to say. But the basic mechanisms of government are failing.