8 ms·

I've read that a single-payer system is very unlikely in the USA, due to political forces. The tremendous inefficiency of the American medical system increases

by wrp 4y ago

I've read that a single-payer system is very unlikely in the USA, due to political forces. The tremendous inefficiency of the American medical system increases costs, but also provides more jobs, and those job-holders vote.

bruce511 4y ago
In the USA its all about the money. Those "political forces" are not a grassroots movement, people in the street demanding insurance-based healthcare. No, it's well organizes, very well paid, lobbying on behalf of a profit-based health system. A system that generates lots of profits for nice big companies. And make no mistake, they're not going to roll over. And sure, doctors are depressed because they're finally coming to realise that medical care (in the US) is not about "helping sick people" (despite their good intentions.) Doctors and nurses set out with the noblest goals, then find themselves inside a system where the one true goal is to separate people from their money. They rile against "adminustrators" while at the same time failing to note that those administrators are the _reason_ for yhd business, and actual doctoring is just medical janitoring. Yay free markets!
- dmitrygr 4y ago
  > are not a grassroots movement, people in the street demanding insurance-based healthcare. > No, it's well organizes, very well paid, lobbying on behalf of a profit-based health system. A system that generates lots of profits for nice big companies. I am not a lobbyist or an owner of an insurance company. I am a "person on the street". I do not want single payer.
  - asdff 4y ago
    Can I ask why? Even right wing think tanks agree that medicare for all would save 2 billion a year in healthcare costs at least https://thehill.com/blogs/congress-blog/healthcare/484301-22-studies-agree-medicare-for-all-saves-money/ https://thehill.com/blogs/congress-blog/healthcare/484301-22...
    - dmitrygr 4y ago
      It is simple, calculating, and heartless. When there is a fixed amount of X available, a fair division of X across Y people gives everyone X / Y. When you need more than X / Y, you are screwed (ask anyone in england who's needed cataract surgery on their second eye and was told that QoL improvement was not there, like it was for the first, so GTFO) Since I can afford to buy a lot more than X / Y of healthcare for me and my family, should it be needed, the outcome for that limited and, to be honest, complete set of people whose well-being i care about is better in the current system.
      - maxerickson 4y ago
        X isn't fixed though. New technology, new knowledge and training all increase X. It's relatively fixed at a given moment in time (where your point is very true), but society shouldn't be making a major structural decision one moment at a time.
      - bruce511 4y ago
        I appreciate your honesty. I completely agree that the current system is excellent for those who can afford it, and queuing-based-on-worth certainly appeals to those with worth. In the US this worth translates into money, which translates into lobbying. You are not marching in the streets because you don't need to. Your money speaks for you. I say this not to patronise you, since you clearly understand this is the case. I say it merely to point out that this system works for the few, not the many. And yes it works well for the few. Regarding your cateract example, if the queue is need based, and you have two patients, then one with 2 cateracts is ahead of someone with 1. That's another system, a system I agree which would be most distressing to someone with 1 careact and lots of spare cash. I get that any system other than the current one will make you worse off. Equally I hope you see that any system at all will be a massive step forward for huge numbers of people. Sure, I get it. I prefer systems that favor me. The seething masses aren't "real" to me. I don't know them like I know me and the people I care about. I care about my medical needs now, not some hypothetical "other person". Like you, I can pay for my medical, and I appreciate that I can. But I also wonder if this is the best way. It works for me, but maybe there's something better for us all.
  - Gibbon1 4y ago
    Lobbyists have been successful convincing you of something in their paymasters interest and not at all in yours.
    - freedomben 4y ago
      I despise the current system, but arguments like this do a lot of damage to the reform cause. Aside from the incredible arrogance of assuming that GP is just so much stupider and more manipulable than you, it's also factually wrong in enough cases that it instantly discredits you. For example, many people who are upper-middle-class and above are better off in the current system.
  - CogitoCogito 4y ago
    The US could have medicare for all and additional private insurance simultaneously.
- jackieomk 4y ago
  [flagged]
- jackieomk 4y ago
  [flagged]
noobermin 4y ago
That is far too simple, as if citizens voting made a difference. Today, single-payer systems are overwhelmingly popular in the US, but one has yet to be implemented. The political corruption (known as "campaign contributions" which is "free speech" in the US after the citizens united decision) ensures that it won't happen, despite it being overwhelmingly positive in polling year after year on both sides of the aisle.
Der_Einzige 4y ago
It will also massively hurt global drug and medical research. We are the leader in it partly because we pay these exhortation prices when the rest of the developed world simply won't play that kind of game. I'm okay with biting that bullet, and taking a global reduction of health research by some double digit percent for awhile, but that's a serious unintended consequence of single payer. I'm a Bernie voter who supports single payer, but it's not sunshine and roses everywhere, and crooked capitalism really does do some "not bad" things for us.
- cudgy 4y ago
  > It will also massively hurt global drug and medical research. This may not be the case, since much research is subsidized by the government and educational funding providing labs that train the scientists the pharmaceutical companies utilize. Single-payer may result in lower costs and therefore more money for support of research and laboratories. Also, pharmaceutical companies would not need to spend vast amounts for marketing their drugs direct to consumers.
  - nradov 4y ago
    The government subsidizes much of the basic research needed to identify candidate drugs. However, private companies usually pay for the human trials necessary to bring new drugs to market. A stage-3 clinical trial can cost >$1B with no guarantee of success. It's a huge financial risk. In theory we could nationalize the whole industry, and let government bureaucrats decide which clinical trials to fund. I'm skeptical whether that would produce better results. Government employees with no skin in the game have a poor record of picking winners.
- EVa5I7bHFq9mnYK 4y ago
  I don't know, many of the major drugs, like penicillin, insulin, thorazine, birth control etc were developed without those hurdles, and not in the USA. But US gave us Viagra)
- amf12 4y ago
  > It will also massively hurt global drug and medical research. I doubt it would. Private drug companies would still exist and charge the same money regardless of whether the insurance is paying for it or "the single payer system".
cudgy 4y ago
Not sure I agree with this. Lower cost of care via single-payer would seem to create more jobs not less. Would be nice to find out though.
red-iron-pine 4y ago
Pull up a list of the Fortune 500. Look how many US healthcare companies are in the top 100. Many in the top 20. That, plus the loosening of donation rules aka "corporations are people", is all you need to know about the state of American healthcare.

by wrp 4y ago

bruce511 4y ago

In the USA its all about the money. Those "political forces" are not a grassroots movement, people in the street demanding insurance-based healthcare. No, it's well organizes, very well paid, lobbying on behalf of a profit-based health system. A system that generates lots of profits for nice big companies. And make no mistake, they're not going to roll over. And sure, doctors are depressed because they're finally coming to realise that medical care (in the US) is not about "helping sick people" (despite their good intentions.) Doctors and nurses set out with the noblest goals, then find themselves inside a system where the one true goal is to separate people from their money. They rile against "adminustrators" while at the same time failing to note that those administrators are the _reason_ for yhd business, and actual doctoring is just medical janitoring. Yay free markets!

dmitrygr 4y ago
> are not a grassroots movement, people in the street demanding insurance-based healthcare. > No, it's well organizes, very well paid, lobbying on behalf of a profit-based health system. A system that generates lots of profits for nice big companies. I am not a lobbyist or an owner of an insurance company. I am a "person on the street". I do not want single payer.
- asdff 4y ago
  Can I ask why? Even right wing think tanks agree that medicare for all would save 2 billion a year in healthcare costs at least https://thehill.com/blogs/congress-blog/healthcare/484301-22-studies-agree-medicare-for-all-saves-money/ https://thehill.com/blogs/congress-blog/healthcare/484301-22...
  - dmitrygr 4y ago
    It is simple, calculating, and heartless. When there is a fixed amount of X available, a fair division of X across Y people gives everyone X / Y. When you need more than X / Y, you are screwed (ask anyone in england who's needed cataract surgery on their second eye and was told that QoL improvement was not there, like it was for the first, so GTFO) Since I can afford to buy a lot more than X / Y of healthcare for me and my family, should it be needed, the outcome for that limited and, to be honest, complete set of people whose well-being i care about is better in the current system.
    - maxerickson 4y ago
      X isn't fixed though. New technology, new knowledge and training all increase X. It's relatively fixed at a given moment in time (where your point is very true), but society shouldn't be making a major structural decision one moment at a time.
    - bruce511 4y ago
      I appreciate your honesty. I completely agree that the current system is excellent for those who can afford it, and queuing-based-on-worth certainly appeals to those with worth. In the US this worth translates into money, which translates into lobbying. You are not marching in the streets because you don't need to. Your money speaks for you. I say this not to patronise you, since you clearly understand this is the case. I say it merely to point out that this system works for the few, not the many. And yes it works well for the few. Regarding your cateract example, if the queue is need based, and you have two patients, then one with 2 cateracts is ahead of someone with 1. That's another system, a system I agree which would be most distressing to someone with 1 careact and lots of spare cash. I get that any system other than the current one will make you worse off. Equally I hope you see that any system at all will be a massive step forward for huge numbers of people. Sure, I get it. I prefer systems that favor me. The seething masses aren't "real" to me. I don't know them like I know me and the people I care about. I care about my medical needs now, not some hypothetical "other person". Like you, I can pay for my medical, and I appreciate that I can. But I also wonder if this is the best way. It works for me, but maybe there's something better for us all.
- Gibbon1 4y ago
  Lobbyists have been successful convincing you of something in their paymasters interest and not at all in yours.
  - freedomben 4y ago
    I despise the current system, but arguments like this do a lot of damage to the reform cause. Aside from the incredible arrogance of assuming that GP is just so much stupider and more manipulable than you, it's also factually wrong in enough cases that it instantly discredits you. For example, many people who are upper-middle-class and above are better off in the current system.
- CogitoCogito 4y ago
  The US could have medicare for all and additional private insurance simultaneously.
jackieomk 4y ago
[flagged]
jackieomk 4y ago
[flagged]

noobermin 4y ago

That is far too simple, as if citizens voting made a difference. Today, single-payer systems are overwhelmingly popular in the US, but one has yet to be implemented. The political corruption (known as "campaign contributions" which is "free speech" in the US after the citizens united decision) ensures that it won't happen, despite it being overwhelmingly positive in polling year after year on both sides of the aisle.

Der_Einzige 4y ago

It will also massively hurt global drug and medical research. We are the leader in it partly because we pay these exhortation prices when the rest of the developed world simply won't play that kind of game. I'm okay with biting that bullet, and taking a global reduction of health research by some double digit percent for awhile, but that's a serious unintended consequence of single payer. I'm a Bernie voter who supports single payer, but it's not sunshine and roses everywhere, and crooked capitalism really does do some "not bad" things for us.

cudgy 4y ago
> It will also massively hurt global drug and medical research. This may not be the case, since much research is subsidized by the government and educational funding providing labs that train the scientists the pharmaceutical companies utilize. Single-payer may result in lower costs and therefore more money for support of research and laboratories. Also, pharmaceutical companies would not need to spend vast amounts for marketing their drugs direct to consumers.
- nradov 4y ago
  The government subsidizes much of the basic research needed to identify candidate drugs. However, private companies usually pay for the human trials necessary to bring new drugs to market. A stage-3 clinical trial can cost >$1B with no guarantee of success. It's a huge financial risk. In theory we could nationalize the whole industry, and let government bureaucrats decide which clinical trials to fund. I'm skeptical whether that would produce better results. Government employees with no skin in the game have a poor record of picking winners.
EVa5I7bHFq9mnYK 4y ago
I don't know, many of the major drugs, like penicillin, insulin, thorazine, birth control etc were developed without those hurdles, and not in the USA. But US gave us Viagra)
amf12 4y ago
> It will also massively hurt global drug and medical research. I doubt it would. Private drug companies would still exist and charge the same money regardless of whether the insurance is paying for it or "the single payer system".

cudgy 4y ago

Not sure I agree with this. Lower cost of care via single-payer would seem to create more jobs not less. Would be nice to find out though.

red-iron-pine 4y ago

Pull up a list of the Fortune 500. Look how many US healthcare companies are in the top 100. Many in the top 20. That, plus the loosening of donation rules aka "corporations are people", is all you need to know about the state of American healthcare.