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infinitenexus
infinitenexus Reader
10/9/19 12:38 p.m.

As requested in another thread, this is for (non political) discussion of a single payer healthcare system.  Let's keep the right and left out of this and try to focus more on hard facts and statistics, so we can all learn a bit.

frenchyd
frenchyd UberDork
10/9/19 12:44 p.m.

Most of the world pays less for health care Than America.  

But we don’t have the best health by any quantifiable means.  

When you are failing it seems logical to look at who is successful and try to emulate them. 

I hope this can continue because I suspect I can learn a lot. 

Toyman01
Toyman01 MegaDork
10/9/19 12:46 p.m.

I don't think you can have this discussion without getting political because it is largely a political discussion. I can promise you the powers that be will be watching it like a hawk. 

Have fun. 

 

1988RedT2
1988RedT2 UltimaDork
10/9/19 12:47 p.m.

Single payer?  You mean, if you go to the doc and get healthcare, you pay for it?  What about if you're married?

tuna55
tuna55 MegaDork
10/9/19 12:48 p.m.

My wife has a lot to say on this subject. She has a rare disease, for which much research is being done in emerging medicines. She has friends through various groups all over the world. The rest of the world (outside the US) has zero access or long waiting times for much of the treatment options we've already gotten. This is aside from the fact that every single advance in treatment happened here because there is money to do so.

 

The healthcare costs for my family likely eclipse all but a few on here, and yet I would not trade it for a single payer system.

nutherjrfan
nutherjrfan UberDork
10/9/19 12:50 p.m.

Ask yourselves?  Is a simple phrase like 'single payer' appropriate for an immensely complicated subject?

I don't want 'universal healthcare'.  Pretty certain I'm not universal.  My failures might be on that scale.  Heck maybe even my cholesterol or prostate if I was worried enough to check.  I also don't want 'insert here' for all.  I'd rather not have some more if the gruel is thin and watered down.

I'll let nature take it's course.  It will at some point after all.  

My contribution to the facts of the matter. smiley

Robbie
Robbie GRM+ Memberand UltimaDork
10/9/19 12:55 p.m.
tuna55 said:

My wife has a lot to say on this subject. She has a rare disease, for which much research is being done in emerging medicines. She has friends through various groups all over the world. The rest of the world (outside the US) has zero access or long waiting times for much of the treatment options we've already gotten. This is aside from the fact that every single advance in treatment happened here because there is money to do so.

 

The healthcare costs for my family likely eclipse all but a few on here, and yet I would not trade it for a single payer system.

This. Whenever someone tries to tell me the US doesn't have the best healthcare, I have a forehead slap moment. Yes, it can be improved, but in general you get what you pay for (and we PAY for our health care). 

Single payer is something I just don't really see the advantage of. What if we just said cars cost too much and therefore we should switch to a single manufacturer system? For efficiency sake. 

aircooled
aircooled MegaDork
10/9/19 12:57 p.m.

Obviously a very complex topic, LOTS of misunderstandings around this.  A helpful starting point is a very good Frontline documentary on world healthcare systems, Sick Around the World:

https://www.pbs.org/wgbh/frontline/film/sickaroundtheworld/

The very important overview of this is that what most people think of when they think of single payer is not what most countries use.  The UK style is likely what they think of.

Anything approaching single payer in the US is VERY much likely to be more of a hybrid like Germany.

A small additional note (from my time in the Pharma industry): One of the reasons the rest of the world pays less is BECAUSE the US pays more.

ProDarwin
ProDarwin UltimaDork
10/9/19 12:59 p.m.
Robbie said:

What if we just said cars cost too much and therefore we should switch to a single manufacturer system? For efficiency sake. 

1)  Cars are a tool we use, not a basic need like healthcare is.

2)  With single payer or similar, you can still pay more for more healthcare.  It just establishes a baseline minimum provided to all.

infinitenexus
infinitenexus Reader
10/9/19 1:00 p.m.

Here's a quick backstory on a situation of mine:

My wife has asthma and one day her inhaler ran out when the counter on it was on 25 or 26.  She started having an asthma attack and called me, scared.  She picked me up and we sat down and had a conversation about what to do.  Her breathing was getting very rough and we needed help, but we were worried about money, so our option was to drive 2 hours in morning traffic down to Walter Reed, where it would be free (I'm a disabled veteran) but she might die, or to head to a local emergency room and cross our fingers, because tricare can suck sometimes.

Here's where healthcare comes in: Back in March I called tricare and signed up for Tricare Prime.  They said it would be something like $55/month and it would be taken out of my Army retirement.  They took out three months' worth in advance, and we enjoyed having insurance for those 3 months.  Then we later learned that the person that signed us up had made a big mistake:  I get my retirement from the VA, not directly from the Army.  They can take money from an Army retirement, but not if it comes from the VA.  So after that first three months that I paid in advance wore off, I had no healthcare.  No one called and let us know, we had to learn this the hard way. 

We went to John's Hopkins because it was closest and my wife felt like she was dying.  5 minutes on a nebulizer and a brief conversation with the doctor and a month later we get a bill for $1,000.  That's when I called tricare and learned of their error.  Not to long after that I hear on the news that Johns Hopkins is garnering a reputation for suing people that don't pay their bills on time, especially poorer people.  So we're scrambling to pay this off as soon as we can, while trying to pay for other things as well.

 

Hopefully that gives a bit of understanding.  I'm not sure what the solution to our healthcare shenanigans is.  I do believe doctors perform a vital service and deserve to be paid well.  At the same time I don't think people should be concerned about life-threatening injuries, illnesses, or whatever because they don't want to go into debt.  Prices are absolutely ridiculous.  I think something such as a single payer healthcare system could be a viable option - perhaps everyone could have the option of the single payer system, and they could opt out if their job offered something better?  In terms of paying for it, I think there's lots of room in the budget to pay for it, if we stop blowing money on other things.  Our deficit right now is more than $1 trillion, and military spending is extremely high as well.  As a former military member I'll say that the military is very wasteful overall, and we could probably stand to be causing less problems than we do - fixing both of those could save billions.  So maybe save some money in there, stop giving politicians raises and the best benefits ever and make them live on the healthcare system they implement for "regular" citizens.

infinitenexus
infinitenexus Reader
10/9/19 1:02 p.m.

Quick breakdown of the US budget for 2019 in case anyone wants that data for their argument:

https://www.thebalance.com/u-s-federal-budget-breakdown-3305789

infinitenexus
infinitenexus Reader
10/9/19 1:05 p.m.

I think we can keep this non-political.  People's health shouldn't be political, anyways.  Instead of talking about what party is doing what or not doing what, let's focus on what the actual issues are in our healthcare system are, and possible ways to fix it.  

 

I think frenchyd hit the nail on it's head with his comment up there.

Robbie
Robbie GRM+ Memberand UltimaDork
10/9/19 1:06 p.m.
ProDarwin said:
Robbie said:

What if we just said cars cost too much and therefore we should switch to a single manufacturer system? For efficiency sake. 

1)  Cars are a tool we use, not a basic need like healthcare is.

2)  With single payer or similar, you can still pay more for more healthcare.  It just establishes a baseline minimum provided to all.

It absolutely does not (in my mind). Say medicare or UHC suddenly becomes the one payer. Who says they have to cover everyone? Just like you say folks can pay more also insinuates that people can pay less (or nothing). 

Let's not confuse a 'single payer' with 'universal minimum coverage' or even WHO (govt vs individual vs employer - remember it all is paid for by the individual) "pays" the single payer. 

infinitenexus
infinitenexus Reader
10/9/19 1:10 p.m.
tuna55 said:

The healthcare costs for my family likely eclipse all but a few on here, and yet I would not trade it for a single payer system.

I think the ultimate goal is, or should be, what if you could have the same great care for your wife but at a more reasonable price?  And then what if everyone had access to care that good, even if they couldn't afford it?  

I feel like there's a price tag on our health.  If you can afford it, you're good.  

Daylan C
Daylan C GRM+ Memberand PowerDork
10/9/19 1:10 p.m.

I think we could greatly benefit from a single payer system. No clue how we'd actually pay for it though. And it's a topic where no one can seem to discuss it without resorting to logical fallacies and scare tactics before jumping track and belittling somebody for even considering it. So I don't know if we'll ever really know if this country could make it work or not.

infinitenexus
infinitenexus Reader
10/9/19 1:16 p.m.

I think there would have to be multiple caveats for a successful system.  For me personally, I don't think it would work too well.  At least once November rolls around and I can enroll in Tricare again, I'll have full coverage for a very cheap price.  If a single payer system is rolled out and I'm suddenly forced to pay 4 times that for the same level of care, obviously that's problematic.  

 

Here's the real question:  Where is all the waste in the system?  I know it's a very inefficient system, so where could things be made more efficient without harming anyone?

FuzzWuzzy
FuzzWuzzy Reader
10/9/19 1:17 p.m.

Which single player route are we going?

The, pay a lot in extra taxes for "free" healthcare, to only be forced to wait ludicrous amount of time to be seen or pay more out of pocket to see a private doctor, thereby increasing your original cost to be seen.

or

The, government runs everything like a mass VA.

Because I was in the military and still get to go to the VA.

much prefer my private doctor, dentist, and optometrist.

nutherjrfan
nutherjrfan UberDork
10/9/19 1:17 p.m.

In reply to Daylan C :

I've sort of scanned through the comments.  Not really sure what a logical fallacy is. Pretty certain I don't want to hear a sophisticated explanation of sophistry anyways.

I don't think there has been too much scare mongering so far in the thread and several of us have provided outside links to further peruse.  There are a couple admittedly I won't due to time constraints and my thoughts on the source of those links but I won't attack them without reading them.  I'm sure others will feel the same about my link.

Come back to us if you have some points rather than telling us how pointless the discussion is.  Being shiny happy people to each other doesn't mean we don't have a point.

At end of the day I hope to be long dead by the time it's 'figured' out.  Safer that way.

Robbie
Robbie GRM+ Memberand UltimaDork
10/9/19 1:31 p.m.

Maybe it's useful to think about 'universal minimum healthcare' similarly to all other basic human needs:

1. Air to breathe - the nat govt does have a single system to protect it (there are more at state and local levels)

2. Water to drink - there are multiple utilities as well as protections similar to air, small amounts of water is required to be provided free in many public places

3. Food to eat - a minimum is generally provided, but the majority of food does not go through that system, govt protections also in place

4. Shelter - no national minimum I'm aware of, but many local places do provide a minimum

5. Physical defense - multiple providers, police, army, fire, national, state, local, etc paid for by taxes

6. Property defense - national laws provided, it is up to the individual to make sure they are enforced (maybe some minimum is provided)

7. Legal equality - national laws provided, it is up to the individual to make sure they are enforced (maybe some minimum is provided)

8. Dignity and respect - national laws provided, it is up to the individual to make sure they are enforced (maybe some minimum is provided)

9 Healthcare - a minimum is provided (in ERs), but the majority is purchased by the individual

 

There are others I may be missing. But from this quick list, it does look to me like healthcare is already treated pretty similarly to most other basic human needs... Admittedly most of these systems can probably be improved.

ProDarwin
ProDarwin UltimaDork
10/9/19 1:33 p.m.
Robbie said:

Let's not confuse a 'single payer' with 'universal minimum coverage' or even WHO (govt vs individual vs employer - remember it all is paid for by the individual) "pays" the single payer. 

Fair enough.  Single payer can be done with or without minimum coverage.

There are several plans in circulation I've heard of that involve the above and you certainly have the option of going above and beyond by paying stuff out of pocket, but you have no option of having less coverage.

This seems like a logical solution to me but I am no expert.

 

I generally support large social programs like this but I will admit my hesitation with a system like this hinges on the efficiency of the govt. doing stuff and not adding unnecessary complication.  I have worked for govt. contractors before and the inefficiencies there are staggering.

 

(not) WilD (Matt)
(not) WilD (Matt) Dork
10/9/19 1:35 p.m.

I deleted my earlier anecdote to remove what was essentially an emotional reaction.  I have some strong feelings about this based on experiences of my extended family.  I do not think it's right that the standard of care one receives is greatly related to how wealthy a person is (the ability to pay).  If healthcare is a necessary public service, it should be treated as one.  It should not be treated as a luxury for the relatively fortunate.  Nobody should have to choose between life saving treatment and avoiding bankruptcy for their survivors. 

For this reason alone, I am of the opinion that we should be moving toward a universal healthcare system.

mtn
mtn MegaDork
10/9/19 1:38 p.m.

My background, as it is biased and probably much more steeped in this than most peoples:

  • I work for a company that provides good health benefits
  • My wife is an RD who has worked for highly rated hospitals for her career that have provided better benefits
  • Between the two of us we make good money and our parents have provided a financial backstop when it was necessary. 
  • My parents are a nurse, and a retired marketing executive for Big Pharma (think setting prices for drugs)
  • My in-laws are a nurse who works in billing, and a health insurance salesman (small group)
  • In my extended family (cousins, aunts, uncles) there are 3 MD's, 1 NP, 1 RD, and at least 4 RN's in hospital settings
  • I have seen a hospital bill for my daughter that included a $125 bag of saline. The total for this was over $1.6M; the total due to us after insurance was about $7,000. Our daughter only lived 2 weeks, but she almost made it, and if we didn't have the healthcare options available to us she wouldn't have lived 2 days.

 

I haven't seen a single universal or single-payer healthcare system plan that really makes sense to me as an improvement over what I have now. The one that I would be ok with, although not real happy with when I have forecasted out what it would do to my overall paycheck, is the British system where there is universal healthcare but there are private hospitals and private insurance plans. 

Ultimately what happens is that the US funds a significant portion of medical innovation. The profits are here, so the innovation occurs here. I don't have the numbers anymore, and they'd be dated anyways, but I know around 2014 or so it was well over 50% of all medical innovations came from the US. Would that stop, or slow if we went away from our system now? (I don't know, honest question, and I don't have data to back this up anymore).

Similarly, if we have single-payer, we should be innovating for the greater good. Right? So, we should be focussing our efforts on the problems that impact more people rather than less, and the problems that we are making progress to solving. For those of you with MS, ALS, rare genetic defects, etc., sorry, you're out of luck. If you've got heart disease though, we'll get that figured out! (Spoiler: We have figured it out. Stop eating meat, start eating plants, but no one wants to do that)

These are the things that scare me the most. Would the government step up and make up the (guessing) 75% of RD that is made up by companies? (ignoring tax breaks and all that). 

 

That being said, the current system is broken. If we didn't work for the company and hospital we do work for, I'd probably have a much different view. If our situation was slightly different, we probably would have entered bankruptcy after our daughters death instead of being able to pay for it with little effort. That is a problem. But on the other hand, our daughter had round the clock care from extremely qualified individuals who were consulting with doctors around the world to try to figure out what was wrong with her. So something is working right that we could have a problem that we have no clue what it was, and we have people in 3 countries, 7 states, 24 hour around the clock care with 2 at least 2 people attending our daughter the entire time for 2 entire weeks... And it only cost $7,500 to us. I'm not complaining. Really, that isn't bad. That would be roughly $11 an hour, without benefits, for the ECMO specialist and the RN that was with her 24/7, without the drugs, without the cardiac intesivists, without the neonatologists, Cat scan, neurologists, respitory techs, infectious disease speciast, ambulance, and probably some others that I'm forgetting...

 

So, I don't know an answer, I think the current system is broken for many, but for my financially fortunate self it is working. 

Robbie
Robbie GRM+ Memberand UltimaDork
10/9/19 1:41 p.m.

In reply to (not) WilD (Matt) :

I don't disagree with you. But out of curiosity do you feel similarly about the standard of shelter, food, property defense and legal equity (and all other necessary public services)?

AAZCD
AAZCD HalfDork
10/9/19 1:46 p.m.
infinitenexus said:

Here's a quick backstory on a situation of mine:

...

Here's where healthcare comes in: Back in March I called tricare and signed up for Tricare Prime.  They said it would be something like $55/month and it would be taken out of my Army retirement.  They took out three months' worth in advance, and we enjoyed having insurance for those 3 months.  Then we later learned that the person that signed us up had made a big mistake:  I get my retirement from the VA, not directly from the Army.  They can take money from an Army retirement, but not if it comes from the VA.  So after that first three months that I paid in advance wore off, I had no healthcare.  No one called and let us know, ...

This is a great example of of what happens with a large government run program. Bigger program, more problems, layers of incompetence, and waste. And VA healthcare is still broken and resistant to fixes after all the news in recent years. Typically I'll have an appointment a couple months ahead and get a notice that they decided to cancel. "Please call us at your convenience to reschedule." The new appointment is a month or more later. The only fix that has worked if you NEED healthcare is to go outside the VA to a private provider.

I used to have (and pay for) Tricare Prime. At some point the government said that I couldn't have it anymore because I didn't live close enough to a military base and I had to revert to Tricare Standard for my family.  I just don't see turning more healthcare decisions over to the Federal Government as a good idea.

(not) WilD (Matt)
(not) WilD (Matt) Dork
10/9/19 1:56 p.m.
Robbie said:

In reply to (not) WilD (Matt) :

I don't disagree with you. But out of curiosity do you feel similarly about the standard of shelter, food, property defense and legal equity (and all other necessary public services)?

Similarly, yes. Society should provide for a basic standard of all of the above.  Food and shelter are an interesting category because there is quite obviously a need of basic shelter from the elements and nutrition, but both categories can also clearly be luxuries.  Healthcare might be similar in that there could be a standard of care for the prevention/treatment of disease and injury but some services currently lumped in as healthcare are luxuries.  I'm not sure exatly where those lines get drawn though.

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