4 ms·

A cato link isn't convincing. Its an extremely biased source. Cato can't stand that the single payer works in the rest of the world.

gojomo 13y ago
Your glib bias-accusation is unimpressive and unresponsive: Cato cites verifiable details about the particular point I was making, that single-payer systems often do "prevent any doctor and patient from doing whatever they wanted, at their own expense". Similar to the claim that under ACA, no one would lose a plan they liked [1], the claim that single-payer will still allow full freedom to work outside the system is a pre-implementation falsehood used to build support. Hell, it's even in the name: "single-payer". You have to crack down on competing payers, or your price leverage slips away, and voters stuck in the single-payer system get angry that they're facing the political cost-benefit rationing that others aren't. None of the other-country "single-payer"-ish systems cover even 1/4th the population size of the US. If single-payer can work so well for cost-control in the US political reality, why doesn't it work for Medicare, and the Defense Department? [1] http://networkedblogs.com/Qy7JI http://networkedblogs.com/Qy7JI
- drzaiusapelord 13y ago
  >None of the other-country "single-payer"-ish systems cover even 1/4th the population size of the US. That is 100% meaningless. Cost per patient is the only metric that matters. Its the same old right-wing canards that get pulled around here by the same ultra-conservative libertarains. I am so glad you are on the losing side of history. Imagine if I said "Whoa whoa, you can't open a giant factory in the US! No one has ever made one so big!" and you said "But my cost per item and cost per worker works out." Its madness that this kind of thinking is artificially applied to healthcare, like its some special industry immune to all the rules and can never, ever be regulated or be made in single payer like the Europeans have been doing for decades.
  - gojomo 13y ago
    A nationalized service industry does not benefit from the same economies of scale as a factory. Also, health care isn't primarily delivered as standardized mass-produced widgets. If what you say about the ease of running an efficient nationwide federal program were true, Medicare and the DoD would be known for their cost-controls. Instead, they're known for the opposite.
    - patmcc 13y ago
      Fine, it's impossible to run at a national level because there's some magic cutoff population point past which single-payer can't be done. Let's take your word for it. Why can't the feds force each state to figure out a single-payer system? No state is bigger than the UK or Canada (ok, California has a few more people than Canada), and they have it figured out. Look, if you like the private system for some reason, give that reason. Don't spout bullshit about "it's impossible to manage because the US is 4X larger than the UK".
      - gojomo 13y ago
        Why can't the feds force each state to figure out a single-payer system? Our constitution, politics, and culture don't let "the feds" easily dictate such things. The federal government can nudge with some mandates and grants (as with the ACA itself), but forced nationalization of industries is hard, especially so when most states (by count) would prefer otherwise. It's also especially hard, if those in favor of single-payer takeover only barely or temporarily have the legislative majorities necessary (again, as with the ACA itself). That much larger and more diverse populations, economies, geographies, and institutions are harder to govern via a working consensus isn't "bullshit", it's a political and historical reality. (How many government shutdowns has the UK had recently?) You can stomp your feet over this, and perhaps wish that some more-powerful central government could just "force" everyone to enthusiastically implement your preferred policy... but that's not the US way. Maybe you could get a single-payer constitutional amendment passed. That'd establish clear legal authority, and prove a broad consensus that would help with implementation. Why don't you try that? I dislike national single-payer (and the baby-step of the ACA) because I don't think it can work well here. It'll have the cost-efficiency of the pentagon, the compassion of the INS, the simplicity of the tax code, and the innovative pace of the FDA. What would be a good decentralizing alternative to this current forced-march towards unprecedented-scale nationalization? Leave more details to the states. Use national action mainly to undo existing distortions, like medical cartels/protectionism and the tax-preference for non-portable employer coverage. And, provide direct payment assistance to the neediest/sickest, rather than new regulations on the shape and cost of policies for everyone.
- desas 13y ago
  I live in a single payer country. I can absolutely go to a private hospital and do what I want at my own expense (assuming it's passed the equivalent of FDA). My wife has limited private health insurance. I can buy private health insurance.
  - gojomo 13y ago
    Your country might have a more liberal system than others. Which country?
    - desas 13y ago
      The poster child for socialised medicine, the UK.
      - gojomo 13y ago
        Interesting. This doctor reports that some UK private insurance options, which have coexisted with the NHS since its inception, are banned in Canada: http://thehealthcareblog.com/blog/2012/01/16/the-awkward-world-of-private-insurance-in-the-uk/ http://thehealthcareblog.com/blog/2012/01/16/the-awkward-wor... My point is that "single-payer" doesn't mean one specific thing, and the implementation details in different political systems matter.
  - novalis78 13y ago
    I lived in a single payer country. I still remember how depressing it was at the end of each month looking at my paycheck. The amount of overhead and false incentives such a nationalized or semi-nationalized health care system generates truly paralyzes - not just the economy at large. You can get pretty decent prices for medical treatments in the US, but you always have to ask and price shop. Certain things seem more expensive then elsewhere. It's interesting to note how the great quality and extreme competition of dental care providers in former Eastern European countries have driven price down. Many people living in the neighboring socialized welfare funded health care systems take a bus/plane and get their teeth fixed in the "capitalist" alternative in the former communist countries. Oh the irony.

gojomo 13y ago

Your glib bias-accusation is unimpressive and unresponsive: Cato cites verifiable details about the particular point I was making, that single-payer systems often do "prevent any doctor and patient from doing whatever they wanted, at their own expense". Similar to the claim that under ACA, no one would lose a plan they liked [1], the claim that single-payer will still allow full freedom to work outside the system is a pre-implementation falsehood used to build support. Hell, it's even in the name: "single-payer". You have to crack down on competing payers, or your price leverage slips away, and voters stuck in the single-payer system get angry that they're facing the political cost-benefit rationing that others aren't. None of the other-country "single-payer"-ish systems cover even 1/4th the population size of the US. If single-payer can work so well for cost-control in the US political reality, why doesn't it work for Medicare, and the Defense Department? [1] http://networkedblogs.com/Qy7JI http://networkedblogs.com/Qy7JI

drzaiusapelord 13y ago
>None of the other-country "single-payer"-ish systems cover even 1/4th the population size of the US. That is 100% meaningless. Cost per patient is the only metric that matters. Its the same old right-wing canards that get pulled around here by the same ultra-conservative libertarains. I am so glad you are on the losing side of history. Imagine if I said "Whoa whoa, you can't open a giant factory in the US! No one has ever made one so big!" and you said "But my cost per item and cost per worker works out." Its madness that this kind of thinking is artificially applied to healthcare, like its some special industry immune to all the rules and can never, ever be regulated or be made in single payer like the Europeans have been doing for decades.
- gojomo 13y ago
  A nationalized service industry does not benefit from the same economies of scale as a factory. Also, health care isn't primarily delivered as standardized mass-produced widgets. If what you say about the ease of running an efficient nationwide federal program were true, Medicare and the DoD would be known for their cost-controls. Instead, they're known for the opposite.
  - patmcc 13y ago
    Fine, it's impossible to run at a national level because there's some magic cutoff population point past which single-payer can't be done. Let's take your word for it. Why can't the feds force each state to figure out a single-payer system? No state is bigger than the UK or Canada (ok, California has a few more people than Canada), and they have it figured out. Look, if you like the private system for some reason, give that reason. Don't spout bullshit about "it's impossible to manage because the US is 4X larger than the UK".
    - gojomo 13y ago
      Why can't the feds force each state to figure out a single-payer system? Our constitution, politics, and culture don't let "the feds" easily dictate such things. The federal government can nudge with some mandates and grants (as with the ACA itself), but forced nationalization of industries is hard, especially so when most states (by count) would prefer otherwise. It's also especially hard, if those in favor of single-payer takeover only barely or temporarily have the legislative majorities necessary (again, as with the ACA itself). That much larger and more diverse populations, economies, geographies, and institutions are harder to govern via a working consensus isn't "bullshit", it's a political and historical reality. (How many government shutdowns has the UK had recently?) You can stomp your feet over this, and perhaps wish that some more-powerful central government could just "force" everyone to enthusiastically implement your preferred policy... but that's not the US way. Maybe you could get a single-payer constitutional amendment passed. That'd establish clear legal authority, and prove a broad consensus that would help with implementation. Why don't you try that? I dislike national single-payer (and the baby-step of the ACA) because I don't think it can work well here. It'll have the cost-efficiency of the pentagon, the compassion of the INS, the simplicity of the tax code, and the innovative pace of the FDA. What would be a good decentralizing alternative to this current forced-march towards unprecedented-scale nationalization? Leave more details to the states. Use national action mainly to undo existing distortions, like medical cartels/protectionism and the tax-preference for non-portable employer coverage. And, provide direct payment assistance to the neediest/sickest, rather than new regulations on the shape and cost of policies for everyone.
desas 13y ago
I live in a single payer country. I can absolutely go to a private hospital and do what I want at my own expense (assuming it's passed the equivalent of FDA). My wife has limited private health insurance. I can buy private health insurance.
- gojomo 13y ago
  Your country might have a more liberal system than others. Which country?
  - desas 13y ago
    The poster child for socialised medicine, the UK.
    - gojomo 13y ago
      Interesting. This doctor reports that some UK private insurance options, which have coexisted with the NHS since its inception, are banned in Canada: http://thehealthcareblog.com/blog/2012/01/16/the-awkward-world-of-private-insurance-in-the-uk/ http://thehealthcareblog.com/blog/2012/01/16/the-awkward-wor... My point is that "single-payer" doesn't mean one specific thing, and the implementation details in different political systems matter.
- novalis78 13y ago
  I lived in a single payer country. I still remember how depressing it was at the end of each month looking at my paycheck. The amount of overhead and false incentives such a nationalized or semi-nationalized health care system generates truly paralyzes - not just the economy at large. You can get pretty decent prices for medical treatments in the US, but you always have to ask and price shop. Certain things seem more expensive then elsewhere. It's interesting to note how the great quality and extreme competition of dental care providers in former Eastern European countries have driven price down. Many people living in the neighboring socialized welfare funded health care systems take a bus/plane and get their teeth fixed in the "capitalist" alternative in the former communist countries. Oh the irony.