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Hopefully they figure out how to stop it. Single payer is a horrible idea and generally lowers the standard of care for everyone.
by bifrost 13y ago
Hopefully they figure out how to stop it. Single payer is a horrible idea and generally lowers the standard of care for everyone.
- toomuchtodo 13y ago....which would explain why every first world country uses it except the US? I'd much prefer we don't devolve into a political argument. My question, I thought, was relevant due to ACA kicking in, which is the first step towards universal healthcare/single payer in the US (which would eliminate the business model in question). In closing, here is healthcare spending as a percentage of GDP by country (almost all first world countries): http://upload.wikimedia.org/wikipedia/commons/a/a1/International_Comparison_-_Healthcare_spending_as_%25_GDP.png http://upload.wikimedia.org/wikipedia/commons/a/a1/Internati... The US leads in spending, and only spending.
- kenrikm 13y agoI would like to point out we're also significantly more overweight, have higher rates of heart disease, have a quickly aging population of baby boomers etc.. Your argument is not logical as there are plenty of other reasons we have higher healthcare costs other then that we're not single payer.
- daguar 13y agoActually, the reason real reason US health costs are much higher is that the unit-cost is much higher. Check out the unit cost differences here: http://voices.washingtonpost.com/ezra-klein/2009/11/an_insurance_industry_ceo_expl.html http://voices.washingtonpost.com/ezra-klein/2009/11/an_insur...
- toomuchtodo 13y agohttp://www.pbs.org/newshour/bb/health/july-dec12/medicine_09-24.html http://www.pbs.org/newshour/bb/health/july-dec12/medicine_09... "But I think the biggest single driver is our fee-for-service system that rewards volume instead of value and quantity of medical services instead of quality. And as a result, we end up doing a lot of things that cause more harm than benefit for patients." Also: "What that dramatic variation tells us is that there's a lot unnecessary medical care that's being delivered and a lot of room to eliminate some of that wasteful spending."
- dragonwriter 13y ago> I would like to point out we're also significantly more overweight, have higher rates of heart disease, have a quickly aging population of baby boomers etc.. Those are all, arguably, consequences of the poor access to health care in this country and the short-term incentives in this country to delay care. IOW, they are products of the system that we pay more for (per capita or even per GDP -- or even either way only considering public expenditures and excluding the private costs) than first world countries that provide universal coverage through government single-payer systems.
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- ams6110 13y agoI see this argument a lot: people go without care, or delay early treatments that would be cheaper, because they can't afford to go to the doctor. I'm sure this is true to a degree, but making terrible diet choices, being sedentary, and being 100 lbs overweight is not a consequence of not having health insurance. And I really don't see the avoidance of primary care being primarily financial either. A yearly routine physical is not very expensive, and is often free at many public health clinics. Likewise common preventive care like flu shots, pap smears, and prostate exams. A big reason a lot of people don't go to the doctor is that they don't like going to the doctor. I'm in that group. Having insurance doesn't change that.
- zanny 13y agoThere is a huge cultural difference between almost every single payer nation and the US. For example, I haven't seen a regular doctor in 3 years for any kind of check up, because I'm uninsured. Meanwhile, I have friends in Canada that get quarterly or even monthly checkups. It isn't even a cost thing, they say it is cultural - their parents and peers expect them to regularly see a doctor to make sure nothing is wrong with them, and if they sneeze wrong they see the doctor. I dislocated my knee this spring and reset it and just stayed in bed for 2 weeks. Never saw a medical professional, because they would want to x-ray (it might have broke, it was much more painful than a normal dislocation to me, and swelled huge for a while) and I'd be stuck with a $3 - 5k bill minimum just for that, combined with any treatment, and I'd laugh if they'd want me in physical therapy for it. So it isn't just about not haivng a doctor to say 3 bic macs a day is bad for you, it is that in most other places people do see their doctors, regularly, and for most issues, beucase it doesn't bankrupt them. That adds up over a lifetime.
- dragonwriter 13y ago> ....which would explain why every first world country uses it except the US? Every first world country except the US has something approximating universal coverage, but not all of them use single-payer (or even a single basic coverage insurer with supplemental coverage from other payers.) Compulsory-purchase insurance models similar to those in the ACA (but, you know, actually universal) with private insurers are not unheard of (e.g., Switzerland uses that model)
- mjn 13y agoSwitzerland's is interesting in that it goes a step further than Obamacare and really makes it compulsory, rather than simply fining you for not having insurance. A colleague was a postdoc there for a while and didn't understand the system, and after ignoring a few letters telling him he needed to buy insurance, he got a follow-up letter telling him that, as he had not yet enrolled in a plan, a default one had been chosen and he was now enrolled in it.
- gojomo 13y agoThe US is 5-10x larger in population than the other single-payer-ish systems usually cited. (And, more culturally/politically/geographically varied.) Also, we in the US tend to have bigger problems running giant federal bureaucracies, compared to these other smaller, more-unified nations. (How many government shutdowns have they had in the past 40 years?) Our existing single-payer-ish health bureacracies, like Medicare, suffer more fraud and cost-problems, and have a harder time enforcing steely-eyed rationing (aka "death panels") than elsewhere. These smaller systems also benefit as free-riders from positive externalities thrown off by the United States' eccentric overexpenditures - like drug and new-treatment beta-testing. (If we become more like them, their own medical indicators could get worse.) So the argument can't just be, "make it work like over there", when nothing here works quite like there, and our challenges of scale, culture, and politics are larger.
- ceejayoz 13y ago> The US is 5-10x larger in population than the other single-payer-ish systems usually cited. (And, more culturally/politically/geographically varied.) I see this argument all the time, and never an elaboration. I understand going from 1,000 to 1,000,000 people incurring growing pains, but I have a hard time understanding why people seem to think a system that works for 80,000,000 people in Germany wouldn't be scalable to 300,000,000.
- gojomo 13y agoGermany… …isn't quite single-payer, more like a "public option". …has far more labor-business-government cooperation than the US. …has the oldest tradition of social insurance, but still their current system was the result of gradual expansions over many years. …runs lots of government services better than the US. …is only half the area of Texas, but that area is as population-dense as Maryland (our 5th densest state). Why can't any 300 million people in Africa just adopt US-levels of public services by willpower and legal fiat? Why can't the US make our 50-million-member Medicare as efficient as the German system? These structural, historical, cultural, and political path-dependencies matter. "Make it work because I don't understand how it couldn't" isn't a good basis for the largest nationalization experiment ever.
- bifrost 13y ago> ....which would explain why every first world country uses it except the US? Which is why almost every country outside of the US has a lower standard of care than we do. I'd be fine if we had a "minimum safety net" which covered catastrophic care, but thats not what was put into law. I also think a government mandated requirement to purchase a commercial product is probably not a good thing.
- gnaritas 13y ago> Which is why almost every country outside of the US has a lower standard of care than we do. You just like to make up shit I see. Every country that provides public healthcare has a higher standard of care than we do because for 10's of millions of American's there is no care at all beyond emergency care. People die daily for lack of health care in this country, to call that a higher standard than countries with public healthcare is beyond absurd. Our system has a fantastic standard of care for those with money, it has shit for care for the rest.
- tghw 13y ago> Which is why almost every country outside of the US has a lower standard of care than we do. Uh, where do you get that from? The JAMA study, one of the most comprehensive such studies done, concluded that the US health care outcomes are far worse than comparable nations, yet we pay significantly more for it. The biggest reason we pay more is that provider costs are much higher than the GDP-adjusted average. $500,000,000,000 more. (And before you say it, that's factoring out defensive medicine and the results of tort reform.) A lot of that has to do with insurance companies inability to negotiate reasonable rates with the providers. And of all the insurers in the US, which is the only one that can and does negotiate reasonable rates? Medicare.
- pbreit 13y agoI think many/most would disagree with your contention that other countries have a lower standard of care. It's particularly annoying that your so matter of fact about it.
- gnaritas 13y ago> Hopefully they figure out how to stop it. Single payer is a horrible idea and generally lowers the standard of care for everyone. Maybe if you live in opposite world; in this world, it does exactly the opposite.