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Why should healthcare be tied to employment? "Quit fucking around" and institute a national, single-payer plan that covers everyone, like every other modern in
by luma 2y ago
Why should healthcare be tied to employment?
"Quit fucking around" and institute a national, single-payer plan that covers everyone, like every other modern industrialized country.
- bumby 2y ago>"Quit fucking around" and institute a national, single-payer plan that covers everyone, like every other modern industrialized country. Except we're not starting from a blank slate. So short of heavy-handed, dictatorial decisions how would you propose to get to a single-payer plan that covers everyone? You'll have to work with the existing hospital infrastructure, insurance companies, and citizens who don't want a single-payer system. They all get a say, too. People who act like its a straightforward solution don't really understand the problem. But to avoid sounding overly cynical, I'll throw out a couple of recommendations. 1) Expand the VA system to cover all vets, regardless of whether it's a service-connected health issue or not, without insurance. This is politically possibly the easiest step because its hard for a politician to stand up and say they aren't an advocate for better care for the troops. However, the VA is entwined with medical schools and you'd have ensure you expand the funding proportionately to avoid pissing off that constituency. 2) Gradually ratchet down the age for medicare, over decades. (I'd also argue you'd have to get money out of politics first for any really change to have a chance)
- luma 2y ago3) Medicare for all, starting today. Stroke of a pen I just fixed everything. > existing hospital infrastructure Hospitals already deal with medicare. > insurance companies Oh no the vultures in the system will go hungry whatever shall we do > citizens who don't want a single-payer system Buy premium insurance above and beyond the public option, same as every other modern industrialized country. If you don't like the offering for free, the market can cover whatever gap exists.
- bumby 2y agoIgnoring that a “stroke of the pen” is a dictatorial solution almost by definition… Considering Medicare/Medicaid are currently approaching $1T annually to serve less than 20% of the population how dues your stroke of the pen plan pay for the increase when everyone is enrolled? Hospitals are forced to accept Medicare, but in many cases this is at a loss, subsidized by private charges elsewhere. So you’ll need to find out how to shore up that cost, too. These types of naive solutions assume everyone else is very very stupid or very very corrupt (or else why didn’t such a simple solution get implemented already?)
- ryandrake 2y agoCome on--obviously OP meant a "stroke of the pen, held by duly elected representatives". Nothing dictatorial about that. We currently can almost get enough of those representatives in office to do it (and a president to sign it), if it weren't for things like the electoral college, gerrymandering, and grossly unequal representation in the Senate, things that currently give disproportionate power to the "team" that happens to oppose single-payer.
- bumby 2y agoI meant it as an executive order, which is really the only stroke of a pen that would work. Otherwise you’d have to build the political capital to get enough representatives to sign on, and that’s exactly the non-simple task I was alluding to. Those are the same reps who make the rules you’re complaining about, and the same ones who can’t agree on a budget when we don’t have a massive increase in Medicare entitlements. Maybe I’m too cynical, but pretending like there’s the political capital to do it just in the horizon feels like a pipe dream to me. I’m old enough to remember politicians talking about a single payer system in the 1990s and yet here we are.
- ceejayoz 2y agoMedicare covers the most expensive part of the population. The US spends 2-3x what the rest of the OECD spends per-capita, with about the same outcomes. Our system is the least cost efficient system in the entire developed world. It’s hard to see how Medicare-for-all could manage to do worse.
- candiddevmike 2y agoRemove employer healthcare plans and allow everyone to enroll in Medicare or private insurance directly.
- bumby 2y agoDo the employers then pay for Medicare?
- scroy 2y agoWhy would they? I think their point is this would help solve the principal agent problem so consumers can shop for service.
- bumby 2y agoI see. Except Medicare isn’t currently an option for most people employed. I think there are some benefits to employer sponsered healthcare, particularly with large employers who can negotiate lower prices. But I’m not sure it’s better on balance.
- BrenBarn 2y agoThere are many heavy-handed, dictatorial decisions I could imagine which would be immensely superior to the current situation.
- bumby 2y agoNo doubt, but then all we have to make sure is we have a benevolent dictator...forever. That pretty much pushes the long-term probability to zero.
- deleted 2y ago[deleted]
- philwelch 2y agoNot every modern industrialized country has a single payer system.
- throwaway5959 2y ago[flagged]
- dang 2y agoAs you certainly can't post like this to HN, I've had to ban the account again. https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html
- throwaway5959 2y ago[dead]
- robertlagrant 2y ago> institute a national, single-payer plan that covers everyone, like every other modern industrialized country The two (real, non-politicians are corrupt) downsides to contend with: - countries do this by limiting what they will spend; in the US you have access to unlimited treatment. E.g. in the UK the NHS will spend £30k for each good year it buys you - this one isn't fair, but the US is where health innovation happens. Companies sell into it to make money to survive. They then sell into the other countries to make much less margin, and if those countries were all they had as customers, they wouldn't exist. The US is why we have the advancements we have, and all us non-US countries have silly smug citizens who think our countries are better at negotiating deals. If the US didn't do what it did, we'd be a lot worse off.
- ceejayoz 2y ago> in the US you have access to unlimited treatment This is a ludicrous claim.
- dghlsakjg 2y agoI live in Canada and there isn’t a spending limit. The decision of how to treat is made by the doctor. The doctor is then paid. In my experience living on both sides of the border, you get far more care up here since there is no bullshit with finding a facility that accepts your insurance, and cost isn’t a consideration for doctors or patients. People will occasionally travel to the states for drug/therapy trials not available in Canada, or for treatments that are not proven effective. These people will then loudly bitch about Canadian healthcare. If you want the proof of it, remember that a huge majority of Canadians live close enough to drive to the US for health care, but don’t.
- rayiner 2y agoMost developed countries don’t have single payer healthcare. Obamacare is actually modeled on the system used in the Netherlands. And why is “national” a criteria? California doesn’t get single payer unless Montana also gets it? Neither Californians nor Montanans want that. It’s just political games.
- stackskipton 2y ago>Most developed countries don’t have single payer healthcare. Obamacare is actually modeled on the system used in the Netherlands. No it's not. Most European countries that run private health insurance keep pretty strong regulatory regime where pricing and coverage is tightly controlled. In America, there is some basic regulatory scheme but pricing, coverage, limits and such is extremely open.
- shiroiushi 2y agoYou're not contradicting the OP. He's right: most developed countries don't have single-payer healthcare. Their systems are more similar to Obamacare than to the UK's NHS. You're correct too: these countries have strong regulations where pricing and coverage is tightly controlled, though they do use private health insurance.
- hollerith 2y agoBefore Obamacare, if California's taxpayers became the single payer behind medical care in California, then millions of poor chronically ill people would have moved to California from the other 49 states for the free medical care --unless I am wrong in my belief that there is nothing California voters can do to prevent US citizens from moving to California.
- JamesBarney 2y agoWhy couldn't they put in restrictions such as a having worked in California for x years or lived there for y years.
- deleted 2y ago[deleted]
- dang 2y agoPlease don't take HN threads on tedious generic flamewar tangents, let alone nationalistic ones. They're repetitive and nasty and we're trying for something else here. We detached this subthread from https://news.ycombinator.com/item?id=40566761 https://news.ycombinator.com/item?id=40566761.