3 ms·

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 peo

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.
- pyuser583 5y ago
  Could you be more specific about the problems at the VA? I’ve heard both very good and very bad things about it.
  - giantg2 5y ago
    Long waits for care, like waiting months for appointments, and can be very difficult to reschedule. Substandard care is pretty common. They try to cut costs and don't pay very well. They even have looser restrictions on physician testing than states, so sometimes you end up with lower quality people that couldn't hack it under the state requirements. Oftentimes you're seeing a PA or nurse practitioner rather than a physician. For basic things that could be ok, but usually the people in need of care at the VA have complex needs. Long waits for approval of benefits which can take years, require multiple applications as they almost blanket deny some claims, and sometimes require legal assistance with third party medical evaluations. Limited facilities means long drives for some people, and even makes it a near impossibility for some. I honestly haven't heard anything good about the VA other than it's free (but was really earned through service). The good care tends to be at what I would call the active duty facilities, like Walter Reed and Bethesda.

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.

pyuser583 5y ago
Could you be more specific about the problems at the VA? I’ve heard both very good and very bad things about it.
- giantg2 5y ago
  Long waits for care, like waiting months for appointments, and can be very difficult to reschedule. Substandard care is pretty common. They try to cut costs and don't pay very well. They even have looser restrictions on physician testing than states, so sometimes you end up with lower quality people that couldn't hack it under the state requirements. Oftentimes you're seeing a PA or nurse practitioner rather than a physician. For basic things that could be ok, but usually the people in need of care at the VA have complex needs. Long waits for approval of benefits which can take years, require multiple applications as they almost blanket deny some claims, and sometimes require legal assistance with third party medical evaluations. Limited facilities means long drives for some people, and even makes it a near impossibility for some. I honestly haven't heard anything good about the VA other than it's free (but was really earned through service). The good care tends to be at what I would call the active duty facilities, like Walter Reed and Bethesda.