20 ms·
I do not believe single-payer is a good idea, but then lots of people DO seem to think it is, and the state is probably the best level at which to conduct an ex
by mdavis6890 5y ago
I do not believe single-payer is a good idea, but then lots of people DO seem to think it is, and the state is probably the best level at which to conduct an experiment this way. As a Californian, I'll be happy to see the experiment conducted, sad that it happens in my state, and excited to be a guinea pig.
My only hope if we do this is that the federal govt or other states do not leap quickly into this and give it a good 10 years to see how things work out for us.
- Maxion 5y agoWhy do you believe single-payer is a bad idea? The model works very well in most European countries.
- oa2022 5y agoIt works in the sense that I go to a private clinic when I have an issue. Likewise with the great public school system, where families pay 30k per year so they can avoid a public school
- baq 5y agoMe too, but only because my employer pays for that extra, and on multiple occasions it was easier and quicker to get an appointment in the public health care system - which shouldn't be too surprising, since there's a personnel shortage in healthcare full stop.
- dillondoyle 5y agoIn most countries that have public care you can still do this, just like opting for private schools. Britain people buy private insurance for any additional services they want. But I don't think they usually get a tax incentives like private school does can in the US? https://turbotax.intuit.com/tax-tips/college-and-education/tax-tips-when-sending-kids-to-private-or-public-schools/L8TJdgFAH https://turbotax.intuit.com/tax-tips/college-and-education/t...
- oa2022 5y agoIf I get private healthcare and private education, and private pensions, I don't want to pay social security, thanks!
- labawi 5y agoI don't know the state of your welfare services, but I suggest you consider it a tax. A tax you pay for those who cannot pay for private healthcare, retirement, etc. Additionally, you are covered in case you get into a bad accident, or you are down on your fortune.
- baq 5y agoSocial security is a tax, you pay that for the privilege of living somewhere. It’s called social because humans are social animals.
- baq 5y agonot sure why you're getting downvoted, came here to say exactly that. European countries (including the UK - actually one of the best examples of single payer health care) figured out that having a healthy population is a matter of national security, so it gets funded the same way.
- onphonenow 5y agoExcept UK is a disaster, 6M people waiting for service. Some longer than a year. Heartbreaking stories if you are paying attention.
- hotpotamus 5y agoHow many millions are waiting in the US because they can't afford care?
- thrill 5y agoThe solution to a problem that is not working as well as you'd like is not to jump into a system that's working even worse.
- wbsss4412 5y agoDo you have any proof of that? (That it is worse) Do you have any knowledge of what the typical waiting periods are in the US? How many are postponing care due to inability to cover the costs?
- c0nducktr 5y agoExactly what I'd say to anyone from the UK thinking of moving to an USA-style healthcare system.
- TrueGeek 5y agoOr going into debt because they are paying for care with loans / credit cards?
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- sneak 5y agoMost european countries have fewer poor people by percentage than the USA. Single payer "works" in europe in the sense that you still end up having to pay out of pocket if you want not-crap (private) care.
- onphonenow 5y agoNot true really. Germany has had pretty good success. Wait times even on the public side are reasonable. But govt is actually not very involved in providing care - they are more of a market administrator. 100+ nonprofits compete for patients in various ways. And everyone has to have coverage. Also, coverage is rationed more in these systems, they would never approve these the $20,000 per bill with limited evidence type treatments.
- sneak 5y agoThe average quality of healthcare in Germany versus the US is crap, as someone who lives in both places. It's cheaper but you get what you pay for.
- handoflixue 5y agoI don't see how anyone is worse off in that system? It's a huge step up for everyone that is unemployed or on crappy minimum-wage insurance. Even if it's "only" on par with the worst of the US system, it still grants you the freedom to switch jobs and a better negotiating position for other benefits. And everyone that has better insurance can presumably just pay out of pocket to get better-than-minimum.
- onphonenow 5y agoI suppose you are joking. NHS in the UK has 6M folks on waiting lists for things like cataract surgery, knee replacements etc. The wait time is in range of 18 weeks for many and for 300K+ > 52 weeks. Private providers in the US will see you MUCH more quickly than one year (!!). Some place like Europe are not really single systems. They do work well though in a lot of ways. They will have statutory mandated and the private coverage. Even the mandated coverage will be delivered by 100-200 nonprofit funds. "Government has virtually no role in the direct delivery of health care." So these systems work by a) requiring that everyone be covered and b) staying out of the way of the actual service. Interestingly in germany patient representatives have no vote on the main body handling this (insurance companies and physicians do).
- handoflixue 5y agoI don't follow. "The minimum insurance that they get is inadequate to my needs" seems like a poor argument when the alternative is "absolutely nothing, which is inadequate for everyone". In the US, instead of wait times, we have people who just go without entirely. I know if I was unemployed, I'd much prefer an 18 week wait time to a "no". And for anyone privileged to be able to afford good insurance in the US, you can presumably pay for better private insurance/service in Europe, right?
- onphonenow 5y agoIf you don't mind long waits, then a UK style system may be a good option for you. Places like Germany have taken a very different approach. Govt stays out of delivery of care entirely, but everyone has coverage basically (80% public/20% private maybe). Public care is pretty good with low waits. But govt not delivering it.
- joshuamorton 5y ago> NHS in the UK has 6M folks on waiting lists for things like cataract surgery, knee replacements etc. The wait time is in range of 18 weeks for many and for 300K+ > 52 weeks. The obvious question here (and I legitimately don't know the answer) is if there are a bunch of people who want knee surgery in the US but can't afford it, and so demand at the offered price is lower. Fewer people being able to afford a procedure would generally mean less demand and shorter wait times, but its not clear that that's a preferred outcome at a population level.
- reghtlkjlkj 5y ago
- parkingrift 5y agoNot OP, but I'll answer. Switching to a single-payer will be too costly for any political party to tolerate. The US spends $3.8T on health care per year. That's $11,500 for every single person in the United States. In order to fund (raise taxes) to a single-payer system that number will need to drop dramatically. We'll have to cut out middlemen, reduce bureaucracy, negotiate domestically, etc. That $11.5k needs to drop to about $6k to be on the upper quintile of health spending per capita compared to other, successful, single-payer systems. That brings the total from $3.8T down to $1.98T. ...but therein lies the problem. The health sector is 18% of the economy and employs 14% of all US workers. You can't quickly pull $1.8T out of a single sector of the economy. Would it stabilize to 9% of the economy and 7% of all US workers? What do all those people (7% of all workers) who previously worked in health care go do? Where does that $1.8T that we used to spent show up? So it's a conundrum. You need to slowly reshape the industry over 10-20 years and carefully manage the outcomes or it's an economic and political disaster. However, the only way for that gradual plan to work is if you raise taxes to fund the $5T that it would take to maintain status quo. ...and good luck with that. The total net worth of all the billionaires in the US is $5T. There isn't a tax rate in the world that could raise that kind of revenue. Vermont tried to implement a single-payer system, did their own analysis of what it would take, and decided not to move forward.[0] So it's not that I oppose single-payer in theory, I just oppose it as policy in the US because I see it as a political impossibility that is in the way of realistic reform. To me it's chasing a perfect outcome when there are good outcomes available. [0]:https://www.vox.com/2014/12/22/7427117/single-payer-vermont-shumlin https://www.vox.com/2014/12/22/7427117/single-payer-vermont-...
- seanmcdirmid 5y agoOddly enough, the USA already publicly funds about 40-50% of all healthcare already via medicare, health insurance for federal employees (and military), the VA, etc... So they aren't going from 0 to 100%. But I agree in general: healthcare reform should do something about costs, and healthcare is so much apart of our economy that any attempted cost reduction will be painful.
- beeboop 5y agoHow much of the $3.8T is profits that don't need to exist? Why should public medicine be for-profit when public education isn't? Why does no one complain that the military doesn't turn a profit yet also costs nearly a trillion a year? Presumably the entire industry isn't going to magically become less complicated when a single payer option begins. There will still be a need for many of those roles, but they will be employed by the state instead of private companies siphoning profit. I have not seen, and I am not sure it would be possible to generate, evidence in the number of jobs that would be lost (or created) by a single payer system.
- TMWNN 5y ago>The model works very well in most European countries. Regardless of its effectiveness, single-payer is not the norm in "most European countries". Americans naturally get exposed most to the UK and Canada and so think that their single-payer systems with zero/minimal cost on delivery are what "everyone else" uses, but it's not true. Germany, Austria, Switzerland, and the Netherlands are among those that mandate getting one of dozens/hundreds of private plans (basically Obamacare without exemptions). Australia has a government-run plan, but *strongly* encourages people to move to private plans. France has three big nonprofit plans for the entire country, with 30% copayments (akin to a US high-deducctible plan, without the corresponding HSA). Etc., etc.
- epmatsw 5y agoSeems like every other first-world country in the world should be sufficient experimentation.
- Kye 5y agoI expect "that won't work in the US" to become "the rest of the country isn't like California" after it's a resounding success.
- Maxion 5y agoIt is an odd argument for many reasons, but it seems to be the one that is given more often. Yet I've never seen any specific reasons why a single-payer system can work in e.g. Finland and Sweden and not in the US. Healthcare benefits from having a larger population, and it is harder to provide quality care for a smaller population (read more expensive). Yet Finland spends less per capita and has better outcomes.
- rrrrrrrrrrrryan 5y agoImagine trying to roll out one giant healthcare system across the EU. The challenges of rolling out single-payer healthcare across the U.S. would be more similar to this than to one individual European nation, both in terms of scale (~330m vs ~450m population) and in complexity: it would require a ton of political coordination between different entities, as the individual states have a great deal of power.
- yongjik 5y agoIt's honestly sad. Back in the 60s, "America is different" meant "We can put astronauts on the Moon, never mind no other country has done it, for this is America!" Nowadays it means "We can't have a single-payer system, never mind all other first-world countries have it, because this is America!"