Single payer healthcare, would it work?

In reply to Toyman01:

I can partially see why pricing isn't totally posted because the treatment might not be not all cases are the same, especially in healthcare.

The part I take issue with is when you need care immediately you don't even have an inkling what it'll cost. Add to that the initial bill situation where it looks like the healthcare provider is just throwing E36 M3 at the wall to see what sticks, and yea, it shows what a mess healthcare is.

There's pricing tools on most insurance company's websites (Capital Blue Cross buries it good and deep though) but when it comes to an unexpected hospital visit you can't even guess.

tuna55 wrote: No. The VA is a great example of single payer not working.

The VA actually works very well in some locations, and overall have been making improvements in both patient care and facilities. FWIW my wife gets all her healthcare through the VA(though they do outsource many services) and is also a former VA employee, so we've seen it from both sides.

The single worst thing about the VA IMO is the same problem you see frequently in civil-service: the "I'm gonna' get me a cush government job and sit on my ass until I retire" syndrome. We've not encountered that among the medical staff though, it's always been on the admin/leadership side.

The point I think is often missed in these single-payer discussions is the wide range in the quality of healthcare available presently. If a single-payer system is enacted, how will quality be judged and monitored? And regardless of the level of quality achieved, I expect the top 1% will still go elsewhere for better care on their own dime - and that's where the top providers will end up: outside of the program.

Personally, I believe as a global society we need equal healthcare for everyone, along with food/shelter/basic education, or we're doomed as a civilization. But I definitely don't have a solution to achieving it, nor do I expect to see it within my lifetime.

Medicare drives a lot of the quality initiatives in healthcare today- at least in hospitals - if you want to get paid by medicare you have to be accredited. The accreditation process is very detailed and involved - from specifics in medical practice, record-keeping, facility management... then again, we already have the most expensive healthcare in the world, but not the best health outcomes so there's room for improvement on the quality/value front.

It seems in the countries that it works the best in - the people tend to trust their governments - and the government folks have worked to earn it.

Having worked in both union and non-union government and in unionized utilities, Unions in the USA tend to be incredibly protectionist and inefficient, due in part to a lack of metrics. I've worked with so many people who are great in some "simple" respects to their job. They show up early. Woop dee doo. They complete the basics of their job. Hurray! They play golf with their boss! Great!

What annoys me in every profession, every workplace, including government and healthcare, there is a lot more than just simply showing up early and doing the very least to satisfy requirements of the job.

It's hard to measure enthusiasm and interest in the position. It's hard to measure an employee's ability to notice efficiency or improvements that can be made, and the ability or leadership to implement those improvements. In government, not every outcome makes everyone happy, and the same came be said for healthcare. When you cut back on military spending, defense contractors cut jobs. When you tell patients that spending a few hundred thousand on treatment will likely not extend their life and is inefficient, you get angry patients. Some angry patients are rich enough to spend themselves broke trying to save their lives, and other patients are not. You couldn't force everyone into that same level of efficiency.

Healthcare within Veterans Affairs probably struggles with identifying legitimate concerns from patients and the public as well gaining enough information about unionized positions due to people (highly paid people) worrying about someone looking over their shoulder.

What worries me about our current system and a subsequent shift to single payer healthcare is a few things: 1) Insurance companies employ lots of people and don't like the idea of their jobs being cut as a single payer system takes over. 2) Cost of entry into anything healthcare related is prohibitive due to aforementioned tort laws, and this reduces competition or innovation within healthcare. 3) Even the best data gathering can be corrupted by politics, so even if we knew how to make the system better, there are people actively trying to distort the results so as to keep money in their pockets. Recent developments about Pharmacuetical companies contracted with British National Health Service trying to block generic drugs for cancer treatment is a perfect example.

We're not playing (or paying for) healthcare with the books open. Too much is hidden from patients and the public and there is so much money in it I'm not sure we'll ever be able to correct things without a President issuing an Executive Order to so. Obamacare has proven one thing at least partially right: once you give the majority something, even something kinda crappy, it's really hard to take it away.

racerdave600 wrote: The amount of lawsuits flying in health care is stunning.

Johnson and Johnson for Talc... REALLY who thinks its a good idea to put inside your body????

tuna55 wrote:

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.

Well, I've had company supplied healthcare for 25 years. And in that time, the choices I have were changed quite a few times. Thankfully, the doctors I've been seeing have been part of that, but my office mate had to change when our options changed. Which turned into a bad thing when new doctor didn't keep up like old doctor.

Still, single payer means all doctors get paid from the same source. So if you want to be a doctor, you must accept the payer.

So then doctors would be in competition with each other trying to provide you with the best care.

ACA is just letting you choose between different money laundering companies.

This is all I have to say, if nothing else a more socialized system should be cheaper.

I'm not even going to touch the bureaucratic aspect because I suspect it will go off on a tangent.

What I would like to see happen is how things were setup pre ACA, where my mom or another adult who opted for early retirement but isn't at the medicare age yet can take their own money from their own investment accounts to say, repair their house, and not lose such a huge chunk to the government because it's then counted as income and healthcare fees and taxes attack it. Or, as a consenting adult, could opt to NOT have coverage and not be penalized for it.

To pull $50k out of mutual funds to keep the house from falling down, it would cost my mom $18k in taxes, fees, and healthcare premium increases because it puts her yearly income at the top level of healthcare paying. The same healthcare that has tripled her copays in the last 4 years, taken her preferred doctors away from her, and doesn't cover vision or hearing aids, the two big expensive things she actually needs in day to day life.

For every "ACA miracle" I see 10 more horror stories of people losing everything just trying to stay covered to avoid a fine. Of course all that are ever publicized are the "miracle" fixes that had Jimmy Bob worked somewhere other than McWendy's their standard company insurance would have covered anyway, we're not seeing the people in their late 50s early 60's that are losing their entire nest egg because of company changes or restructuring putting them out of work just before retirement age. Or positions being eliminated right before the pension package would kick in, you know, standard business practices.

It seems with people my age and younger, they were never taught there is no such thing as a free lunch. They just hear "free healthcare" or "free college" and think it's magically free, never seeing where the funding is coming from or how quickly quality dies when profits are slashed.

Growing up in and out of hospitals with my dad, and seeing how things worked and how they didn't work, I'd rather die of tetanus than check in to a hospital or go to a doctor. Period. I don't see why I need to be financially penalized for a service or program I have absolutely zero desire to take part in.

curtis73 wrote: 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. H

My father just got diagnosed with cancer in Ontario. He has been treated with good speed, it's pretty tough to come up with any sort of examples of how he could have been treated much faster. My mother had the same situation when she had a similar run-in or needed her knees replaced. So while I keep getting told the Canadian system is in disarray, I've seen the exact opposite.

I view healthcare as a right, and it's much better dealt with by government than by individual for-profits. Yes, some people need a lot more health care than others. So the many pay for the needs of the few. But is it right that someone should lose their home because they got the bad luck to be hit with the cancer stick? Heck, this is how insurance works too, it's just that the insurance companies make sure there's a big pile of money left in the pot after the payout.

Keith Tanner wrote:

curtis73 wrote: 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. H

My father just got diagnosed with cancer in Ontario. He has been treated with good speed, it's pretty tough to come up with any sort of examples of how he could have been treated much faster. My mother had the same situation when she had a similar run-in or needed her knees replaced. So while I keep getting told the Canadian system is in disarray, I've seen the exact opposite. I view healthcare as a right, and it's much better dealt with by government than by individual for-profits. Yes, some people need a lot more health care than others. So the many pay for the needs of the few. But is it right that someone should lose their home because they got the bad luck to be hit with the cancer stick? Heck, this is how insurance works too, it's just that the insurance companies make sure there's a big pile of money left in the pot after the payout.

I had an MRI a couple of weeks ago. My family Doc put the request in on Tuesday and I had the scan on Friday. Sorry to disagree with the 9-14 month wait times but I haven't seen it. I understand that if we lived in a remote area it can be tougher to get an appointment.

PLease show me one thing the US gov't has run efficiently, under budget and not made worse. When you can provide me with something I'll consider this idea. Until then, I'll wait over here in the corner bitching about how unaffordable the ACA really is and how it's only caused our deductibles and co-pays to triple.

What are the alternatives?

We get government out of health care, but tort law remains, keeping prices high due to potential liability. If we do get tort reform passed, will the consumer really see reduced costs?

We can buy across state lines, but will that reduce costs?

We don't force people to have insurance, but what happens when they need medical care they can't afford? Who foots that bill?

I'm all about trial and error, so lets get on with the next trial.

In reply to Bobzilla:

Thank you!

In reply to 1988RedT2:

I mean that. I'm willing to consider an option such as this once you can show me that the .gov can actually run, operate and manage something without huge cost overruns, poor quality and never getting rid of them when it doesn't work.

Look, I don't know what the answer is. I think, like a lot of things, there are more than one option that could actually work instead of hte one magic bullet they try to shove down our collective throats every time (Hybrid! no... SOLAR! no.... WIND! no.... ETHANOL! no....CLEAN COAL! No.....). Unfortunately our gov't doesn't understand that there are usually more than one option for different things and different locales and try to use a broad brush approach that doesn't work for anyone worth a crap. Think: one size fits all clothing. Sure, it works for most people, but is far from ideal. And healthcare is the LAST thing we should have a binary gov't entity in control of IMO.

I was about to point out that pretty much every other country makes it work - until you mentioned binary government. And yeah, that's a problem.

Something the government does do pretty well: roads. And that's very much an area where the many subsidize the few. There are definitely areas of the country where the infrastructure is crumbling, but that's due to a lack of funding instead of incompetence. When given the choice between spending on infrastructure or schools, the public will choose the children every time...

Keith Tanner wrote: I was about to point out that pretty much every other country makes it work - until you mentioned binary government. And yeah, that's a problem. Something the government does do pretty well: roads. And that's very much an area where the many subsidize the few. There are definitely areas of the country where the infrastructure is crumbling, but that's due to a lack of funding instead of incompetence. When given the choice between spending on infrastructure or schools, the public will choose the children every time...

But it's not done well, efficiently or economically. Every road project is over budget, over time and the finished product is terrible. I know this is anectdotal evidence, but the last 3 major local projects that were on fed road have had to be redone withing 6 months because the quality was beyond poor and they were all over budget.

That is NOT how I want my healthcare run. You can disagree, and that is what makes both this site and country great. We can have different opinions and it's ok.

I wonder how China handles road construction. Do they use contractors?

We all pay for all of the healthcare that happens in this country right now. Some is taxes, some is private expenditure, but it all gets paid for. If someone doesn't pay, someone else pays more.
It doesn't matter to me which pile of money I'm paying into for health care, but what I DO care about is my ability to access care when something happens. I don't want people cutting their pills in half. I don't want people to not afford insulin and end up with amputations. I don't want pregnant women to not get the prenatal care they need to deliver healthy babies and then develop a relationship with their pediatrician to learn to care for those babies.
Unregulated private insurance doesn't work because insurance companies drop people with conditions that cost money. We know this, that's why the pre-existing condition part of the ACA is one of it's most popular and meaningful parts. However, you CAN'T support that system with voluntary private purchases. There is no incentive to have insurance until you get sick otherwise.

I just want to say thanks for the considered conversation. I've been thinking recently about how we (society, broadly) argue about specifics without trying to sort out our basic assumptions about what our society is and how we should make these things work. I should have known GRM would be the place to see better.

Bobzilla wrote:

Keith Tanner wrote: I was about to point out that pretty much every other country makes it work - until you mentioned binary government. And yeah, that's a problem. Something the government does do pretty well: roads. And that's very much an area where the many subsidize the few. There are definitely areas of the country where the infrastructure is crumbling, but that's due to a lack of funding instead of incompetence. When given the choice between spending on infrastructure or schools, the public will choose the children every time...

But it's not done well, efficiently or economically. Every road project is over budget, over time and the finished product is terrible. I know this is anectdotal evidence, but the last 3 major local projects that were on fed road have had to be redone withing 6 months because the quality was beyond poor and they were all over budget. That is NOT how I want my healthcare run. You can disagree, and that is what makes both this site and country great. We can have different opinions and it's ok.

I chose road construction because I'm married to someone who does heavy highway estimation and project management This is a common topic of conversation around our place.

Usually, if a project is "over budget", it's because it's not actually possible to do it for the price the DOT engineer imagined. There are mechanisms in place to deal with that. The contractors get heavy penalties if things are late, so they work their asses off to get done on time. Besides, that equipment needs to be somewhere else. The finished product is held to very specific, strict quality standards with financial penalties for missing them. The margins on government jobs are much lower than the margins on private jobs, too, so the government gets much better value for their money than the guys who are building subdivisions and parking lots. A lot of this is due to the pain in the ass aspect of dealing with private builders, who are always up to a wide range of shenanigans.

If I was the one to wave a magic wand, this is what I would propose:

Expanding of Medicare/Medicade to cover those that are below the poverty level. Along with this, I would also push for more welfare reform with a graded reduction in benefits as the income level increases. Help people "learn to fish" rather than give them a fish if they sit at home and procreate.

Tort reform. Too many lawsuits. Too many people looking for an unjustified payday.

Open options country-wide for insurance providers. Let the market determine the price. In the process, enforce many of the laws we have already on the books to eliminate one company creating a monopoly of the market. Ensure a FAIR market.

Lastly, Once a pharmaceutical has recouped the cost of development and earned a profit, it become elligible for generics to reduce costs. Look, I don't think a company should be forced to cover all the costs of developing products and not make a profit... but there needs to be a limit on how hard we screw the consumer and for how long.

Maybe it's because I'm older and have worked my ass off all my life and been smart and had insurance even when I didn't "need" it in my younger years. Maybe it's because I'm tired of the "but think of the children" whining for EVERYTHING. But if you have the ability to be pro-active with your health and CHOOSE not to, it's no longer my responsibility to pay for your mistakes. Choices have consequences (not as much anymore sadly) and stupid should hurt. I know this makes me an evil person and I don't give a E36 M3.

I'll be one of the few to say, it's not a right, it's a privilege. It's one of the advantages of living in a country with great opportunity, where anyone can work hard and better themselves. Being able to live in a place with access to great doctors and great medicine is something many take for granted, because they think it is a "right".

That being said, it is way too expensive for the average guy to afford, but that is a different argument. Why is it so expensive? Mainly because so many have to pay for so few, the ones that do pay, get screwed. Guess what happens if insurance companies are taken out of the middle and the treatment is paid by the consumer? The price goes down. If no one is able to pay $400 a month for your magic pill, you either lower the price or go out of business.

It's like college cost that keeps skyrocketing. College used to be a goal, something people worked to make happen. As soon as it became a "right" and loans became easy to get, the tuition tripled

Our healthcare system has some major problems. It is horribly inefficient, leaves people without care, and ruins people financially who get major illnesses. Other countries have issues, but don't seem to compound both the inefficiency and lack of care that we do. There's got to be a way to improve our system.

I don't really know what that way is.

I suspect our government has some role to help make it better. I think some single payer system is part of that.

As someone who has a key role in a small company, I would love to see something that takes the burden of paying for health care off of small businesses and the individuals who work for them. I want the people I work with to not have to worry about getting sick or injured and I don't what the company I work for to struggle to provide that.

Beer Baron wrote: I suspect our government has some role to help make it better. I think some single payer system is part of that.

I am 100% opposite. Take the government out. Make it a commodity and the market price will correct itself. The reason an MRI cost so much is because "someone else" is paying for it. Take that someone else out of the picture.

Of course the problem with that is that insurance industry fills pockets on both sides of the isle. It also employs a tremendous number of people.

If we do go the route towards making medical expenses more of a commodity, then healthcare providers need to be more transparent with their pricing.

I guess I don't understand how the President couldn't make that happen today. He could just call it the "Healthcare Price Transparency Law" that forces providers to give us a freaking menu, is all.

But no, the industry doesn't want that because that might allow people to shop around, and heaven forbid you give the consumer any ability to make decisions themselves.

Of course this would also do nothing for people who can't afford medical costs, and they'd still be bankrupt trying to pay for expensive treatment.