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>"Quit fucking around" and institute a national, single-payer plan that covers everyone, like every other modern industrialized country. Except we're not start
by 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.
- bumby 2y agoI agree with the population part. But more nuance is that a huge part is the last few weeks of life because of cultural aspects regarding protecting life by all means necessary. However, they’re a saying in healthcare that you can optimize for quality, access, or cost but you only get two. The US system is largely focused on optimizing for quality and access (although I admit the latter isn’t necessarily done well and generally relies on reactive care). So to open up access further, you’d probably need to address the other two levers, and I’m not seeing anyone discuss that. There’s also the disproportionate amount of R&D done by the US which effectively subsidizes the rest of the world to help keep their costs down. All that to say, none of the simple solutions bandied about really talk about those effects, let alone how to manage them.
- 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.