5 ms·

> Why don't you change it? What are the reasons why moving to a single payer system is so bad? The best way I can describe our healthcare is that it's freakish

> Why don't you change it? What are the reasons why moving to a single payer system is so bad? The best way I can describe our healthcare is that it's freakishly complicated, so complicated that pretty much every argument made by any side at any given time is both correct and incorrect. For your example about single payer, with that scheme costs will likely be much lower but on the flip side, we also would not get immediate access to care (that is you can't attend a doctors appt within 72 hrs of scheduling) and we also would not get access to the latest and greatest drugs and therapies because those are always expensive and SP schemes typically do not cover that. Now with that said is single payer good or bad? Well it all depends on who you ask. If you ask a 20 something that just visits the doctor once a year for a checkup and maybe calls into urgent care once every few years when the get the flu or food poisoning, that person will be all over the moon about a single payer system. Now contrast that with someone in their 50's or 60's that has pre-existing conditions, sometimes chronic conditions, and needs constant care and access to the latest drugs. Well for that person single payer is dogshit and won't cover half their needs. And that is the essence of the problem, two sides with vastly different needs from the healthcare system and a government that has to make one decision that will somehow satisfy both parties, even though that could really never happen. You're either going to pick the 20 year old and screw over grandma or you're gonna pick the grandma and screw the 20 year old.

tomrod 2y ago
I mean, call a spade a spade. Single Payor can have programs set up to specifically address specific issues, like turnaround time to see a GP when sick (e.g virtual visits to clear up demand that can be routed that way). Whereas the disjointed system the US currently "enjoys" STILL has GP rationing -- and worse, whole specialties disappearing or otherwise rejecting a payor because it sucks. It's bogus that "single payor won't cover people in 60s/70s with chronic needs." That is 100% a policy decision. Versus the entrenched broken system we have now, where often needs are covered despite urgency.
quasse 2y ago
> For your example about single payer, with that scheme costs will likely be much lower but on the flip side, we also would not get immediate access to care (that is you can't attend a doctors appt within 72 hrs of scheduling) I am curious, why is this accepted as a "given" of single payer health care? I know it's a a problem in Canada and Britain, but those systems seem to be victims of something between neglect and outright political sabotage. As a side note, my partner is currently about half way through a two month wait to see her GP in the good old US of A (on United Health Care). I would love to only have to wait a few days.
- kaikai 2y ago
  Right? It took me a year and a half to find a GP accepting new patients and get my first appointment. I’m in the US. Getting pre approvals and appealing denials has delayed my care multiple times in other situations.
- HDThoreaun 2y ago
  Incentives matter. If theres no downside to using a service people will use the service more. Single payer removes much of the downside to using medical care so people will look for medical care where they wouldnt before. To solve this single payer systems need ways to stop people from receiving care they dont need, and heuristics are imperfect so that will stop some people who actually do need care too.
  - DangitBobby 2y ago
    We can use a designed system of allocation instead of defaulting to the class system.
- AngryData 2y ago
  What he said is true, if you have a lot of money, which is the part people always seem to miss. But people get sucked into the propaganda because they personally haven't had to deal with it, or themselves or their family have the money to bypass such problems. Every time someone complains, people with money will dispute it because they themselves have not had or seen that experience and deny there is a problem at all because they personally don't have that problem. And HN itself is full of people doing way better financially than the average American with better insurance than the majority of people, so even here many people will have a much better impression of and access to the US healthcare system than the average person in the US actually does.
mindslight 2y ago
"someone in their 50's or 60's that has pre-existing conditions" should not be naive enough to believe your nonsense about seeing doctors right away. No matter what you need, it's always a referral to a specialist, and they are generally booking out months in advance. One or two months is a good wait time here. Also "grandma" is on Medicare, if not completely then as the primary payer (supplement) or at least benefiting from the negotiating/regulations (medicare advantage). (and just for perspective here, I'm actually not a big proponent of single payer as the main reform. the problem is that discussing any type of reform has been absolutely paralyzed by nonsense talking points to entrench the status quo)
Aromasin 2y ago
But that second argument of "saving grandma" isn't an issue in Europe either. You think we just abandoned old people with difficult health care needs to the dogs? They get first class care in most European countries - if anything, the issue is the reverse of what you describe. Most young people resent how much they pay in tax for a system they rarely use, while the elderly spend much of their geriatric life bed bound in hospital getting 24/7 care, all for free on the working person's dime despite them being long retired with no private health coverage. I'm typing this right now from a general practice surgery in the UK. The place is full the brim with older people getting local treatment, fast. I booked this morning and they're seeing me the same day. Much of what Americans get fed on the news about waiting lines is exaggerated from the days of Covid. For most services you get seen in a few weeks. My local allergy checks happened within a week. I broke my ankle playing rugby a few months ago and was seen, xrayed, got surgery, and was out the door within 48 hours. Some specialisms are still struggling to get through the backlog of patients, but it's just that - a backlog from when all the surgeries were closed and running on no funding because everything went into Covid-19 treatment. If you're so concerned about not getting the latest and greatest treatment, in the UK private and public health care have started to work progressively more hand in hand. My family are all covered by my private insurance through work. We get consultations online through an app, and they refer us to either and NHS surgery or a private one, depending on which is fastest and has the best health outcomes. That's a privilege not everyone has, but everyone gets the next best thing which is free universal health care covered by all tax payers - corporate and individual. This "decision" that you seems to think exists isn't one. We get the best of both worlds - a society where the poor don't fight tooth and nail for health care with the risk of becoming forever indebted and subjected to poverty, and the rich get whatever level of service they're willing to pay for. Personally, I think you're all fed a lot of propoganda by folks that make a lot of money out of the misery of your healthcare system.
alistairSH 2y ago
on the flip side, we also would not get immediate access to care (that is you can't attend a doctors appt within 72 hrs of scheduling) Not true today in the US. It took me ~7 days to get an MRI of my hip. And have you tried getting into see an endocrinologist lately?
- HDThoreaun 2y ago
  Where I live there are mri strip mall spots where you can just walk in. Same with dialysis.
  - alistairSH 2y ago
    Not here, gotta get a CON, which the existing facilities will fight tooth and nail to prevent. We seem to have the worst of all options. Not a free/open market. Not a socialized or single payer. Instead it’s all rent seeking, regulatory capture, and the rich getting richer.
    - HDThoreaun 2y ago
      Oof, CONs strike again. We really do have the absolute worst of both worlds, neither free market nor gov run. Just some fucking government locked in monopolies.
- nickff 2y ago
  Here's a link to a story where a Canadian woman waited three years: https://www.cbc.ca/news/canada/nova-scotia/halifax-woman-3-years-mri-that-showed-she-had-brain-tumour-1.7398080 https://www.cbc.ca/news/canada/nova-scotia/halifax-woman-3-y... Apparently the average in her province is about 14 months, about sixty times longer than you experienced.
  - DangitBobby 2y ago
    We should probably not continue to wring our hands and allow our entire system to be the worst in the world based on FOMO anecdotes.

tomrod 2y ago

I mean, call a spade a spade. Single Payor can have programs set up to specifically address specific issues, like turnaround time to see a GP when sick (e.g virtual visits to clear up demand that can be routed that way). Whereas the disjointed system the US currently "enjoys" STILL has GP rationing -- and worse, whole specialties disappearing or otherwise rejecting a payor because it sucks. It's bogus that "single payor won't cover people in 60s/70s with chronic needs." That is 100% a policy decision. Versus the entrenched broken system we have now, where often needs are covered despite urgency.

quasse 2y ago

> For your example about single payer, with that scheme costs will likely be much lower but on the flip side, we also would not get immediate access to care (that is you can't attend a doctors appt within 72 hrs of scheduling) I am curious, why is this accepted as a "given" of single payer health care? I know it's a a problem in Canada and Britain, but those systems seem to be victims of something between neglect and outright political sabotage. As a side note, my partner is currently about half way through a two month wait to see her GP in the good old US of A (on United Health Care). I would love to only have to wait a few days.

kaikai 2y ago
Right? It took me a year and a half to find a GP accepting new patients and get my first appointment. I’m in the US. Getting pre approvals and appealing denials has delayed my care multiple times in other situations.
HDThoreaun 2y ago
Incentives matter. If theres no downside to using a service people will use the service more. Single payer removes much of the downside to using medical care so people will look for medical care where they wouldnt before. To solve this single payer systems need ways to stop people from receiving care they dont need, and heuristics are imperfect so that will stop some people who actually do need care too.
- DangitBobby 2y ago
  We can use a designed system of allocation instead of defaulting to the class system.
AngryData 2y ago
What he said is true, if you have a lot of money, which is the part people always seem to miss. But people get sucked into the propaganda because they personally haven't had to deal with it, or themselves or their family have the money to bypass such problems. Every time someone complains, people with money will dispute it because they themselves have not had or seen that experience and deny there is a problem at all because they personally don't have that problem. And HN itself is full of people doing way better financially than the average American with better insurance than the majority of people, so even here many people will have a much better impression of and access to the US healthcare system than the average person in the US actually does.

mindslight 2y ago

"someone in their 50's or 60's that has pre-existing conditions" should not be naive enough to believe your nonsense about seeing doctors right away. No matter what you need, it's always a referral to a specialist, and they are generally booking out months in advance. One or two months is a good wait time here. Also "grandma" is on Medicare, if not completely then as the primary payer (supplement) or at least benefiting from the negotiating/regulations (medicare advantage). (and just for perspective here, I'm actually not a big proponent of single payer as the main reform. the problem is that discussing any type of reform has been absolutely paralyzed by nonsense talking points to entrench the status quo)

Aromasin 2y ago

But that second argument of "saving grandma" isn't an issue in Europe either. You think we just abandoned old people with difficult health care needs to the dogs? They get first class care in most European countries - if anything, the issue is the reverse of what you describe. Most young people resent how much they pay in tax for a system they rarely use, while the elderly spend much of their geriatric life bed bound in hospital getting 24/7 care, all for free on the working person's dime despite them being long retired with no private health coverage. I'm typing this right now from a general practice surgery in the UK. The place is full the brim with older people getting local treatment, fast. I booked this morning and they're seeing me the same day. Much of what Americans get fed on the news about waiting lines is exaggerated from the days of Covid. For most services you get seen in a few weeks. My local allergy checks happened within a week. I broke my ankle playing rugby a few months ago and was seen, xrayed, got surgery, and was out the door within 48 hours. Some specialisms are still struggling to get through the backlog of patients, but it's just that - a backlog from when all the surgeries were closed and running on no funding because everything went into Covid-19 treatment. If you're so concerned about not getting the latest and greatest treatment, in the UK private and public health care have started to work progressively more hand in hand. My family are all covered by my private insurance through work. We get consultations online through an app, and they refer us to either and NHS surgery or a private one, depending on which is fastest and has the best health outcomes. That's a privilege not everyone has, but everyone gets the next best thing which is free universal health care covered by all tax payers - corporate and individual. This "decision" that you seems to think exists isn't one. We get the best of both worlds - a society where the poor don't fight tooth and nail for health care with the risk of becoming forever indebted and subjected to poverty, and the rich get whatever level of service they're willing to pay for. Personally, I think you're all fed a lot of propoganda by folks that make a lot of money out of the misery of your healthcare system.

alistairSH 2y ago

on the flip side, we also would not get immediate access to care (that is you can't attend a doctors appt within 72 hrs of scheduling) Not true today in the US. It took me ~7 days to get an MRI of my hip. And have you tried getting into see an endocrinologist lately?

HDThoreaun 2y ago
Where I live there are mri strip mall spots where you can just walk in. Same with dialysis.
- alistairSH 2y ago
  Not here, gotta get a CON, which the existing facilities will fight tooth and nail to prevent. We seem to have the worst of all options. Not a free/open market. Not a socialized or single payer. Instead it’s all rent seeking, regulatory capture, and the rich getting richer.
  - HDThoreaun 2y ago
    Oof, CONs strike again. We really do have the absolute worst of both worlds, neither free market nor gov run. Just some fucking government locked in monopolies.
nickff 2y ago
Here's a link to a story where a Canadian woman waited three years: https://www.cbc.ca/news/canada/nova-scotia/halifax-woman-3-years-mri-that-showed-she-had-brain-tumour-1.7398080 https://www.cbc.ca/news/canada/nova-scotia/halifax-woman-3-y... Apparently the average in her province is about 14 months, about sixty times longer than you experienced.
- DangitBobby 2y ago
  We should probably not continue to wring our hands and allow our entire system to be the worst in the world based on FOMO anecdotes.