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gearheadmb
gearheadmb Dork
4/14/17 12:07 p.m.

I heard on the radio about a push in california to go to single payer, funded by a payroll tax. A good chunk of my paycheck is already going out for health insurance and to medicare/medicaid, so if those were traded for a different withholding doesn't seem like a big deal to me.

But here is a model I have in my head for this, put the entire hospital facility on a salary based on their job. Surgeon gets $x, radiologist gets $y, etc. it doesn't matter if you have two patients that day or ten. So there is no incentive to put people through unnecessary procedures to line pockets. You are already paying someone to be there to man the mri, or someone to be there to take out the appendix, so it seems like the cost to run the place should pretty predictable.

It seems like something should be done. A normal person can scrimp and save, do all the right things, and be financially wiped out by one illness or accident.

So what do you guys think?

1988RedT2
1988RedT2 UltimaDork
4/14/17 12:15 p.m.

Dum-de-dum, dum-de-dum-de-dum. Hey, who left this unexploded mine laying here? I better leave this alone....

Knurled
Knurled MegaDork
4/14/17 12:22 p.m.

The biggest thing in favor of single payer, even bigger than the obvious health benefits, and economic benefits of not having to file bankruptcy because you broke your leg, is that decoupling employment from healthcare would greatly increase flexibility both for employers and workers. Employers wouldn't have to deal with the expenses, or screw their workers by only hiring part-time help, and workers are not only more likely to not get screwed by employers trying to save a buck, but it would be easier for them to hang out their own shingle and start up their own small business.

aircooled
aircooled MegaDork
4/14/17 12:24 p.m.

Aw come one. This is a topic that can be discussed without E36 M3 throwing.

It certainly can work. It does work in most other countries. How well, is heavily shrouded in many self-interested / slanted opinions on both sides.

Having it in ONE state? Well, that's kind of defeating a lot of the "spreading the cost" aspect. If you had an expensive illness, and one state offered single payer, where would you move? Adding it to a state that has a lot of non-citizen type people in it... oh boy.

aircooled
aircooled MegaDork
4/14/17 12:26 p.m.
Knurled wrote: ...but it would be easier for them to hang out their own shingle and start up their own small business.

This is an aspect that I think a lot of people miss.

Health insurance is a HUGE issue when thinking about being self-employed or having a small business.

oldtin
oldtin PowerDork
4/14/17 12:28 p.m.

Medicare seems to work pretty well - even with a bunch of inefficiencies built in. It could be ramped up. I think one of the biggest issues is that heavy healthcare users are about 5% of the population. The other 95% are reluctant to pay even though eventually they will age into the 5%. No one wants to believe they'll get old and sick or have a debilitating accident - it's hardwired in humans to underestimate our own risk - we would have never left the caves if we knew the risks out there so - I'll be ok, it won't happen to me.

One of the bigger questions that nobody is asking - do you believe healthcare is a right or a privilege? Or is it access to healthcare (insurance) that is a right/privilege or is it all a privilege? Once you address those questions I think the path becomes a lot clearer on what actions to take. Without some clarity on what it is we want to accomplish it seems to just be an endless debate and cost-shifting game.

tuna55
tuna55 MegaDork
4/14/17 12:32 p.m.

No. The VA is a great example of single payer not working.

Robbie
Robbie GRM+ Memberand UberDork
4/14/17 12:39 p.m.

oldtin - yes. that is exactly the right question. Is healthcare a right or a privilege? Hard question certainly.

tuna - I agree about the VA but it is significantly faulty logic to show one example of not-working and extrapolate that to say the idea cannot work.

racerdave600
racerdave600 SuperDork
4/14/17 12:40 p.m.

I don't disagree with decoupling health insurance from employment, it was never a great idea. But I do not believe single payer is the way to go either. Usually when you get a government monopoly in anything, eventually it turns into a snake pit. From talking to my friends in the UK, theirs is far from perfect. They have come to the US several times just to get timely care.

What I believe is that you need combinations of both. You need a total free market health care with no state monopolies like we have now, more or less, and you also need a state run version too that will need to compete (Medicare now does not, we have to pick up the tab for those that use it. For example, my wife's office has to average $95 per patient just to break even, Medicare pays $25. Where does the rest come from? The rest of us of course.). I think anyone on unemployment for example should automatically get Medicaid, or something like it.

My wife's side of the family are either doctors, nurses or paramedics, so I get a "family debriefing" non-stop. Right now there are so many issues with healthcare, single payer simply will make matters worse. And yes, insurance companies are big part of the problem.

But also part of the problem is the need for tort reform. The amount of lawsuits flying in health care is stunning. And the amount of payouts also stunning. Health care is complicated problem, and so far, I haven't seen anything from either party that makes it better. I also think very strongly that health care should not be used as a political issue. It's something everyone needs to work on to get is as right as possible.

gearheadmb
gearheadmb Dork
4/14/17 12:40 p.m.
1988RedT2 wrote: Dum-de-dum, dum-de-dum-de-dum. Hey, who left this unexploded mine laying here? I better leave this alone....

Theres really no reason it would have to be that way. Just looking for an intelligent, unbiased conversation about a system we are all effected by. Thats why I asked here.

D2W
D2W Reader
4/14/17 12:42 p.m.

So you are basically suggesting government regulated health care, where a bureaucrat decides the pay scale for each position regardless of talent? No incentive whether you are the best doctor or the worst. Isn't that communism?

I'm not saying the whole load doesn't need to be changed, but I don't see that working.

alfadriver
alfadriver GRM+ Memberand MegaDork
4/14/17 12:46 p.m.
tuna55 wrote: No. The VA is a great example of single payer not working.

All that illustrates is that it's political. And for that specific example, in a very poor taste way. Not that you brought it up, but we spend so much time thanking our Vets, calling them heros, and leaving most of them out to dry. Regardless of who is running whatever part of the government.

It can work, take the best payment manage from the for profit industry, take away the need for profit, and there is quite a bit of money left over for more people.

gearheadmb
gearheadmb Dork
4/14/17 12:47 p.m.

In reply to D2W:

I wouldn't call that communism. Isn't that pretty much how it works for faculty in a public school? You get paid a certain amount to start, increases a certain amount every year, and so on.

oldtin
oldtin PowerDork
4/14/17 12:49 p.m.
tuna55 wrote: No. The VA is a great example of single payer not working.

The VA has surprisingly good IT infrastructure. They struggle a bit on resources and admin folks are rewarded for the wrong things that tend to slow the works down. I suspect they aren't big enough to meet the needs. I doubt they were planning on 15-20 years of non-stop war.

alfadriver
alfadriver GRM+ Memberand MegaDork
4/14/17 12:49 p.m.
D2W wrote: So you are basically suggesting government regulated health care, where a bureaucrat decides the pay scale for each position regardless of talent? No incentive whether you are the best doctor or the worst. Isn't that communism? I'm not saying the whole load doesn't need to be changed, but I don't see that working.

How is that realistically different than any healthcare company? Honestly?

Right now, you have people who's best interest is them making money instead of taking care of you. Just a different bureaucrat.

Think less of who is running it, and think more black boxes.

Toyman01
Toyman01 GRM+ Memberand MegaDork
4/14/17 12:56 p.m.

Having worked in and around the VA for 15 years, I wouldn't want to depend on government employees for healthcare. I have seen the lackadaisical employees and the nastiness of the buildings.

Having listened to some of the stories from friends in Canada, their system isn't all it's cracked up to be either.

I would much rather see a regulation that required pricing to be posted, rather than the shell game we have now. If people could actually find the prices they are paying for stuff, prices would come down on their own.

Something like this would be nice. Need a hip replacement? $25K. Having a baby? $11,900. A pacemaker will set you back $11,400.

https://surgerycenterok.com/pricing/

tuna55
tuna55 MegaDork
4/14/17 1:00 p.m.
Robbie wrote: oldtin - yes. that is exactly the right question. Is healthcare a right or a privilege? Hard question certainly. tuna - I agree about the VA but it is significantly faulty logic to show one example of not-working and extrapolate that to say the idea cannot work.

Fair enough. It's the only single payer health care system run by the US federal government, though, and one would think it has a higher degree of financial support than could be expected for non vets, and it's terrible by most measures.

Examples on far smaller scales, or in countries with far different economies and personal autonomy situations may be far less relevant.

tuna55
tuna55 MegaDork
4/14/17 1:02 p.m.
alfadriver wrote:
D2W wrote: So you are basically suggesting government regulated health care, where a bureaucrat decides the pay scale for each position regardless of talent? No incentive whether you are the best doctor or the worst. Isn't that communism? I'm not saying the whole load doesn't need to be changed, but I don't see that working.
How is that realistically different than any healthcare company? Honestly? Right now, you have people who's best interest is them making money instead of taking care of you. Just a different bureaucrat. Think less of who is running it, and think more black boxes.

I think the basic issue here is the choice. With a 'capitalist' healthcare setup, assuming anti-trust situations were handled appropriately, would allow competition and constant review and improvements in the name of making money. Government has no such incentives nor method for competition.

I'm not saying it's the magical answer, but it is the "realistic difference" that you're asking about.

trucke
trucke SuperDork
4/14/17 1:11 p.m.

The automotive equivalent of single healthcare provider - no competition.

Just picture all of us driving around in one of these.

alfadriver
alfadriver GRM+ Memberand MegaDork
4/14/17 1:18 p.m.

In reply to tuna55:

Choice is relative.

You can have choice which company controls the money that you put into healthcare. But once you do that, your choice for who actually supplies your car is limited to who they choose.

With single payer, the choice of doctor is up to you. And THAT part of the economy now has real competition again.

tuna55
tuna55 MegaDork
4/14/17 1:22 p.m.
alfadriver wrote: With single payer, the choice of doctor is up to you. And THAT part of the economy now has real competition again.

I have yet to see that be true. I have the same broad choice of doctors I had before ACA as I do now. Many folks post ACA cannot choose their preferred doctor anymore.

In fact I would say that a bad implementation of either option (thinking early HMOs) can lead down the path of limited choice in providers, and I agree that is a bad thing.

curtis73
curtis73 GRM+ Memberand PowerDork
4/14/17 1:35 p.m.

Single payer doesn't have to mean no competition. Doctors can still negotiate salaries based on resume and performance.

Here are the issues as I see it. If you use Canada as a paradigm, it likely won't work well except for one caveat (to be discussed below.) Canada's system relies on a lot of government waste and the end result is lower pay for caregivers. That resulting lower pay means fewer healthcare workers and a large backlog of waiting for care. The typical wait period for an MRI in Ontario right now is 9-14 months. Sorry you are paralyzed and in crippling pain, we can't do anything for a year. Have some free vicodin.

The caveat I mentioned before may have a benefit, however. One of the dynamics happening up north is that education is cheap. Canadian med students get their license up there and then promptly come to the states for the triple salary. Adopting a canadian-esque system here would likely reduce that incentive and possibly benefit all involved.

As long as it is done well, single payer is by far the best paradigm for health economics; as proven by the dozens of countries that are doing it very successfully.

The one thing I do NOT want to see is healthcare providers being government employees. I want the financial side of healthcare to be single payer. In some countries with socialized medicine the doctor is pretty much untouchable, legally. If you become damaged due to a doctor's negligence and wish to sue, you're suing your own country's government. Good luck with that.

Beer Baron
Beer Baron MegaDork
4/14/17 1:37 p.m.

I would like to see a single-payer system.

There are different ways of enacting one that work differently in different countries. In the U.S. it seems like it would make sense to have public funding that people then can use like a voucher to buy insurance and care from a private market.

Biggest advantage I see is leveling things a lot for small businesses. Makes it easier for owners and employees. No big hurdle when crossing the line of employees you can have before the employer has to provide insurance.

It could also simplify the overall healthcare system. We wouldn't need separate health care models for things like Medicare/Medicaid. No need for people to apply for those programs and wait to get on them. No need for the extra administration to determine who actually qualifies for what benefits.

Removes barriers that prevent some people from being able to work. E.g. my mother has mental health issues. She relies on government funded health care. If she works a job that provides health insurance, she loses the government run health benefits. If she loses that job (which she could, due to the mental health issues) or has a period of unemployment, she would be without health care for the length of time it takes to re-enroll. Basically, she wants to be able to work part time, but she can't. She needs the stability of government provided care, but can only get it if she never works again.

slefain
slefain PowerDork
4/14/17 1:40 p.m.

I'll start digging my own hole under the patio now.

I'm all for single payer. When I found out my Dad about died because he was cutting his blood pressure pills in half because he didn't have insurance, and couldn't afford refills, I knew our country was screwed up. And don't give me that "don't buy an iPhone" crap that rat face Chaffetz tried to spew. My Dad was working a retail job in his 60s because nobody else would hire him (too old). No cable TV, no cell phone, and rarely used A/C. Driving a $1000 car. He didn't qualify for company insurance for a year, so he was on his own.

Health care is a racket, and we are all screwed by it.

Beer Baron
Beer Baron MegaDork
4/14/17 1:46 p.m.

Single Payer =/= Single Provider

Think of it like school systems. Single payer just means there is a single pot of money that is used to pay for all of the primary schools. It doesn't say who gets the power to spend that money.

Single payer can operate like a voucher system where you get to decide what school you want to send your kid to, and that school gets the money for that student. If you are told what school you have to send your kids to, that's single payer and single provider. VA is an example of single Provider. If you want better service, you have to move.

Single payer could mean that everyone gets something like a $5,000/year voucher for health insurance. It can only be spent on health insurance. You can use it to buy insurance from any company you want. If you want better care, you are welcome to purchase an insurance plan that costs >$5,000, but the extra will have to come out of your own pocket.

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