4 ms·

Why wouldn't a single-payer solution work? The margin that the insurance companies take for themselves seems like a good place to start. From there it would spi

by throwway120385 3mo ago

Why wouldn't a single-payer solution work? The margin that the insurance companies take for themselves seems like a good place to start. From there it would spiral out to the third to half of time that all of the clinical staff spend just dealing with insurance issues and insurance billing.

dominotw 3mo ago
insurance issues are provider and insurer going back and forth detrmining if doctors assessment of necessity is agreed upon. i am not familiar with universal system. In that system if your doctor thinks something is medically necessary then thats the end of it and its gets done?
- nradov 3mo ago
  All healthcare systems have some form of rationing. Even if your doctor thinks something is medically necessary it can only get done if the system actually has capacity. In most countries where there is universal coverage with a single payer, certain expensive treatments have long waiting lists or are simply unavailable at any price. Thus we see wealthy Canadians coming to the USA as medical tourists and paying cash for procedures like MRI scans or joint replacements in order to avoid the queue back home. There are always trade-offs, it's just a matter of what we want to prioritize.
  - dominotw 3mo ago
    yea queue is fine . i was wondering about gp's claim that universal would be more efficient because there is no more back and forth about approving. i wasnt sure if it simply takes a different form or gets eliminated completly.
- throwway120385 3mo ago
  In my experience, insurance issues are usually insurer and patient going back and forth and then patient getting 6 different answers from 6 different representatives, then reviewing the 3000 page plan document, finding the single line that properly describes what should have happened, calling the insurance company, explaining to the rep how your plan works, and demanding that it be reprocessed. Like my wife has to do this frequently and spends several hours per month dealing with this but she has saved us probably tens of thousands of dollars in mis-processed claims that the insurance companies can't even properly handle. I usually am the person carefully reading plan docs, finding the proper billing codes, and explaining things like that to the insurance company. Sometimes we have to get the doctor's billing people to code things, like once they coded something that was an outpatient appointment as a minor surgery which could have cost us a lot of money. So in my book since we get to speculate about what the system should look like, it should absolutely result in people getting care without all of this run-around. It's about eliminating as much misery as possible from the system and letting people just get treated and providers just get paid. We can talk about efficiency once the misery is gone.
  - dominotw 3mo ago
    you think there is scope for a non profit here that can advocate on behalf of patients and read the contracts. perhaps with ais help.
  - nradov 3mo ago
    Yes, part of the overall solution needs to be health plan transparency on clinical guidelines and coverage rules. Currently much of that is concealed, or applied unevenly. But we're not going to eliminate misery from the healthcare system. Demand is effectively infinite, mainly from patients with complex conditions, and supply is finite. Developed countries with more socialized healthcare systems typically do a pretty good job of delivering basic primary care but things often fall apart when more complex or specialized care is needed. Those systems also ration and deny care but it tends to be through forcing patients to wait in long queues, or simply not offering expensive treatments at all. Like under the UK NHS, some prescription cancer drugs just aren't available. So that's a different form of misery.
nradov 3mo ago
I'm not necessarily opposed to a single-payer system but the margin that for-profit insurance companies take is a tiny fraction of overall healthcare spending. You could zero it out and it would barely move the needle. And many of the largest commercial health plans such as most Blue Cross Blue Shield Association members are non-profit. There is literally no margin. Provider organizations spend a huge amount of effort dealing with Medicare and Medicaid, which are pretty close to being a "single-payer solution" already in many cases. From an administrative overhead perspective they aren't always easier to work with than commercial health plans. Plus they have enormous problems with fraud, waste, and abuse.
- ambicapter 3mo ago
  The mandated low margin is part of the problem. When your margins are regulated, the only way to increase profits is to just make everything more expensive. More revenue, same margin, more profits. Humane health care is incompatible with free market economics.
  - wqaatwt 3mo ago
    Perhaps its not compatible. But that’s tangential to the situation in the US, at the very minimum you need to have price transparency in any ‘free market’ system.
    - saghm 3mo ago
      I think the point is that we might as well just give up the pretense of a free market healthcare solution and just focus on what's humane.
      - nradov 3mo ago
        Is it humane to leave a patient to die in an ambulance when a single-payer nationalized healthcare system is over capacity? https://www.theguardian.com/society/2025/apr/06/englands-nhs-crews-watching-patients-die-in-back-of-ambulances-due-to-ae-delays https://www.theguardian.com/society/2025/apr/06/englands-nhs... I'm not trying to be snarky here, the point is that there is no easy solution and optimizing based on what politicians subjectively consider "humane" isn't going to get us anywhere. If we want to actually fix the problem then we need to focus on what's economically feasible rather than low-effort hot takes and sound bites. Free markets, with reasonable limits, can be part of that solution by revealing consumer preferences and allowing for efficient allocation of limited resources.
wqaatwt 3mo ago
There are countries in Europe which have entirely privatized healthcare systems (not even medicare/medicaid equivalents). US tried adopting some of their practices with Obamacare and even that didn’t work out. Singlepayer isn’t really necessary to have a reasonably affordable and accessible healthcare system proper regulation is.
- autoexec 3mo ago
  As successful as Obamacare has been it didn't really do much to lower the cost of healthcare or claw back the billions wasted to insurance company profits. There might be some kind of regulation just as effective as single payer, but we've never seen it anywhere in the US.
  - jmye 3mo ago
    > As successful as Obamacare has been it didn't really do much to lower the cost of healthcare It dramatically lowered the cost to consumers. Further, conflating overall healthcare spend with the portion of spend tied to a significantly lower-cost population is apples and oranges at best and represents a fundamental misunderstanding of healthcare cost in general. It's ok to not have opinions about things you know you don't understand.
    - autoexec 3mo ago
      "lowered" hasn't made much difference. Before the affordable care act Americans spent more and got less for their money and that hasn't changed. Insurance companies are still stuffing their pockets with billions and denying coverage. Americans struggled to afford the care that they needed before the affordable care act, and they still struggle to afford the care that they need today. The affordable care act was a very small improvement, but it didn't move the needle compared to other nations
  - wqaatwt 3mo ago
    > but we've never seen it anywhere in the US. Well just copy paste the Swiss system (of course that’s not feasible both the “free market” and pro “socialized” single payer supporters would hate it). However they have a heavily regulated, reasonably affordable fully private healthcare system.

dominotw 3mo ago

insurance issues are provider and insurer going back and forth detrmining if doctors assessment of necessity is agreed upon. i am not familiar with universal system. In that system if your doctor thinks something is medically necessary then thats the end of it and its gets done?

nradov 3mo ago
All healthcare systems have some form of rationing. Even if your doctor thinks something is medically necessary it can only get done if the system actually has capacity. In most countries where there is universal coverage with a single payer, certain expensive treatments have long waiting lists or are simply unavailable at any price. Thus we see wealthy Canadians coming to the USA as medical tourists and paying cash for procedures like MRI scans or joint replacements in order to avoid the queue back home. There are always trade-offs, it's just a matter of what we want to prioritize.
- dominotw 3mo ago
  yea queue is fine . i was wondering about gp's claim that universal would be more efficient because there is no more back and forth about approving. i wasnt sure if it simply takes a different form or gets eliminated completly.
throwway120385 3mo ago
In my experience, insurance issues are usually insurer and patient going back and forth and then patient getting 6 different answers from 6 different representatives, then reviewing the 3000 page plan document, finding the single line that properly describes what should have happened, calling the insurance company, explaining to the rep how your plan works, and demanding that it be reprocessed. Like my wife has to do this frequently and spends several hours per month dealing with this but she has saved us probably tens of thousands of dollars in mis-processed claims that the insurance companies can't even properly handle. I usually am the person carefully reading plan docs, finding the proper billing codes, and explaining things like that to the insurance company. Sometimes we have to get the doctor's billing people to code things, like once they coded something that was an outpatient appointment as a minor surgery which could have cost us a lot of money. So in my book since we get to speculate about what the system should look like, it should absolutely result in people getting care without all of this run-around. It's about eliminating as much misery as possible from the system and letting people just get treated and providers just get paid. We can talk about efficiency once the misery is gone.
- dominotw 3mo ago
  you think there is scope for a non profit here that can advocate on behalf of patients and read the contracts. perhaps with ais help.
- nradov 3mo ago
  Yes, part of the overall solution needs to be health plan transparency on clinical guidelines and coverage rules. Currently much of that is concealed, or applied unevenly. But we're not going to eliminate misery from the healthcare system. Demand is effectively infinite, mainly from patients with complex conditions, and supply is finite. Developed countries with more socialized healthcare systems typically do a pretty good job of delivering basic primary care but things often fall apart when more complex or specialized care is needed. Those systems also ration and deny care but it tends to be through forcing patients to wait in long queues, or simply not offering expensive treatments at all. Like under the UK NHS, some prescription cancer drugs just aren't available. So that's a different form of misery.

nradov 3mo ago

I'm not necessarily opposed to a single-payer system but the margin that for-profit insurance companies take is a tiny fraction of overall healthcare spending. You could zero it out and it would barely move the needle. And many of the largest commercial health plans such as most Blue Cross Blue Shield Association members are non-profit. There is literally no margin. Provider organizations spend a huge amount of effort dealing with Medicare and Medicaid, which are pretty close to being a "single-payer solution" already in many cases. From an administrative overhead perspective they aren't always easier to work with than commercial health plans. Plus they have enormous problems with fraud, waste, and abuse.

ambicapter 3mo ago
The mandated low margin is part of the problem. When your margins are regulated, the only way to increase profits is to just make everything more expensive. More revenue, same margin, more profits. Humane health care is incompatible with free market economics.
- wqaatwt 3mo ago
  Perhaps its not compatible. But that’s tangential to the situation in the US, at the very minimum you need to have price transparency in any ‘free market’ system.
  - saghm 3mo ago
    I think the point is that we might as well just give up the pretense of a free market healthcare solution and just focus on what's humane.
    - nradov 3mo ago
      Is it humane to leave a patient to die in an ambulance when a single-payer nationalized healthcare system is over capacity? https://www.theguardian.com/society/2025/apr/06/englands-nhs-crews-watching-patients-die-in-back-of-ambulances-due-to-ae-delays https://www.theguardian.com/society/2025/apr/06/englands-nhs... I'm not trying to be snarky here, the point is that there is no easy solution and optimizing based on what politicians subjectively consider "humane" isn't going to get us anywhere. If we want to actually fix the problem then we need to focus on what's economically feasible rather than low-effort hot takes and sound bites. Free markets, with reasonable limits, can be part of that solution by revealing consumer preferences and allowing for efficient allocation of limited resources.

wqaatwt 3mo ago

There are countries in Europe which have entirely privatized healthcare systems (not even medicare/medicaid equivalents). US tried adopting some of their practices with Obamacare and even that didn’t work out. Singlepayer isn’t really necessary to have a reasonably affordable and accessible healthcare system proper regulation is.

autoexec 3mo ago
As successful as Obamacare has been it didn't really do much to lower the cost of healthcare or claw back the billions wasted to insurance company profits. There might be some kind of regulation just as effective as single payer, but we've never seen it anywhere in the US.
- jmye 3mo ago
  > As successful as Obamacare has been it didn't really do much to lower the cost of healthcare It dramatically lowered the cost to consumers. Further, conflating overall healthcare spend with the portion of spend tied to a significantly lower-cost population is apples and oranges at best and represents a fundamental misunderstanding of healthcare cost in general. It's ok to not have opinions about things you know you don't understand.
  - autoexec 3mo ago
    "lowered" hasn't made much difference. Before the affordable care act Americans spent more and got less for their money and that hasn't changed. Insurance companies are still stuffing their pockets with billions and denying coverage. Americans struggled to afford the care that they needed before the affordable care act, and they still struggle to afford the care that they need today. The affordable care act was a very small improvement, but it didn't move the needle compared to other nations
- wqaatwt 3mo ago
  > but we've never seen it anywhere in the US. Well just copy paste the Swiss system (of course that’s not feasible both the “free market” and pro “socialized” single payer supporters would hate it). However they have a heavily regulated, reasonably affordable fully private healthcare system.