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I’m concerned with anyone proposing “Medicare for all” in America, because they all state - for doctors who want to stay out of the system, they can be paid dir
by jmpman 10mo ago
I’m concerned with anyone proposing “Medicare for all” in America, because they all state - for doctors who want to stay out of the system, they can be paid directly… that immediately causes a slightly different 2 tier system. Right now our 2 tier system is the 90% with health insurance and the 10% without health insurance. In the new Medicare for all, it will be the 99.9% on government insurance, and the 0.1% - the ultra wealthy - who dominate tax policy and are heavily financially incentivized to reduce their tax contributions to the public system. They will influence politicians to spend less on healthcare, with no impact to their health outcomes. The only system which will work in the US is one in which the ultra wealthy have an incentive to provide funding to the public system, and that seems like you’d need to force them to be on the public system too.
- PieTime 10mo agoThis is precisely what allows for the NHS to be cannibalized. They underfunded one of the best systems of healthcare and replaced it with private care for ultra wealthy while reducing quality of care for vast majority of people.
- harvey9 10mo agoPrivate care has been available in Britain throughout the history of the NHS and is available to people far below the 'ultra wealthy' strata. Don't ruin a valid point with hyperbole.
- cj 10mo ago> The only system which will work in the US is one in which the ultra wealthy have an incentive to provide funding to the public system, and that seems like you’d need to force them to be on the public system too. In my state, I pay $15k/year in school taxes, yet I have no children. I pay $1000/year in property taxes to support my city's library, yet I don't have a library card. People are taxed for lots of things they don't actually benefit from. I don't think we would need to force rich people to use the plans. If they want to buy medical services from private doctors, sure we can let them. The issue then becomes more about allocation of resources (how many doctors are available to be seen on the public system vs. only available to self-pay customers) rather than the issue being about how to collect taxes.
- teachrdan 10mo agoThis may be small potatoes, but I've heard it said that people like you benefit "by not living in a state full of dumbasses." There's definitely an indirect benefit from these payments.
- cj 10mo agoExactly, same with health insurance! I'm less likely to get sick if everyone around me has access to doctors when they get sick. (I personally don't mind subsidizing my library + local school district... good schools and libraries are good for the community)
- smileysteve 10mo agoNot only are you less likely to get sick, You're less likely to see sick people. Healthy people are more productive (you'll have better businesses) Healthy people are nicer (especially if we consider mental health, and then violence) Healthy people use the ER less.
- nradov 10mo agoBe careful what you wish for. Having health insurance doesn't equate to having access to care. Especially in the mental health space, fewer and fewer providers will even accept new patients on government-sponsored health plans due to low rates. https://www.wsj.com/health/healthcare/medicaid-insurers-doctor-networks-appointments-72f9c11f https://www.wsj.com/health/healthcare/medicaid-insurers-doct...
- peterangular 10mo ago> (I personally don't mind subsidizing my library + local school district... good schools and libraries are good for the community) Just sharing random coffee break thoughts... it always blows my mind is how many people _don't_ think like this. When base conditions improve for society, the conditions improve for _everyone_ regardless if they directly benefit you. I'm also in the boat where I don't have kids, but I'd also like to live in a place that has educated people - so schools make perfect sense to me. Heck, even if I didn't benefit from it, providing children education is just the gosh-darn right thing to do.
- apercu 10mo agoEvery western country that has a single payer system as far as I know allows for private clinics, doctors and labs. I spent 18 years in Canada. The healthcare I got was as good as anything I received in America (in both cases it depends on where you live, unfortunately) and looking ahead to 2026 was cheaper (comparing my tax burden in Ontario to the terrible insurance I can afford for 2026 in America).
- nradov 10mo agoHealthcare quality and access varies widely between Canadian provinces. It's common for affluent Canadians to come to the USA as medical tourists and pay out of pocket for elective procedures like MRI scans or joint replacement surgeries due to excessive waiting times at home. There are advantages to the Canadian system but some clear downsides as well.
- apercu 10mo agoThe point is that saying you have no "choice" in these systems is a lie.
- jjtheblunt 10mo ago> is the 90% with health insurance and the 10% without health insurance it's even more complicated, because you can have insurance fully accepted at one clinic and "not contracted" with a different clinic. it's a total mess.
- rr808 10mo agoThat's the same as most countries then.
- matthewdgreen 10mo agoYou're never going to make a system that prevents the ultra-wealthy from augmenting it with private services. You might, however, reduce the power of the ultra-wealthy.
- jmpman 10mo agoNot after citizens united.
- sharts 10mo agoAll of that applies to military spending, highways, schools, etc. Does that mean we can’t have these things unless the wealthy want them?
- jmpman 10mo agoThe wealthy benefit from military spending as it keeps their resources secure. The ultra wealthy are also business owners who benefit from increased commerce made possible from the highways. They don’t benefit from paying for my father’s cancer treatment.