Single payer healthcare system discussion

So a large question in this is who should be making money?

Doctors?  For sure- they are the ones actually providing the care for you, as well as the research into improving treatments and outcomes.

Nurses?  For sure- they help doctors, as do the techs who help with the research.

Hospital Management?  Yes- doctors and nurses can not be expected to actually manage a hospital or treatment system.

The people who manage the money to pay for the above?  Depends.

For the people who actually process the payments- sure, it's paperwork.

For their managers- yes- they can't do it on their own.

Shareholders?  Wait- should we be making the system who just controls the payouts a profitable system, where shareholder value is the top goal???  When we have doctors who take a pledge to help people, should we have a profit center that decides whether you can get care or not?

IMHO, the honest discussion should be whether the group of people who just manage the money should be a profit center for our society.  If you get rid of the owners and shareholders, then you essentially have a single payer- as they would all have the same goal. 

The reason "medicare for all" keeps coming in is when you look at the overhead of medicare vs. nominal healthcare companies- you can quickly do some math and see that changing the system efficiency to be even close to Medicare- there is enough money being paid into traditional healthcare companies to cover every single person who isn't covered, and still have some money left over.

The next argument is how outcomes get paid- and right now, all systems pay on a procedure basis, as opposed to a success basis.  Which, for many people, has distorted the treatments to as much as possible instead of really looking at the problem and fixing it.

While it's easy to come up with various things that take longer to treat in the rest of the world than in the US- it's not as if the system we have is all that great- getting basic care is reasonably quick; but when you have to get a specialist involved, that can take weeks or months.  So it's not as if we don't have a wait for care.

infinitenexus said:

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.  

I hear this, but from what I have seen around the globe, the alternative seems to be that no new cures are researched, no new medicine is developed, and specialty doctors don't exist.

As was said earlier, our (the US) huge private spending in healthcare covers the rest of the world to a certain point. The only reason cheap generics can exist is because someone paid and risked a huge amount of money to develop and test the thing in the first place.

So while I'll eagerly concede that it sure seems expensive, I will not agree that centralizing it makes it better in any way, and in fact would make it far worse for my family. I probably would not have a wife today. My son would have likely died during delivery and none of his siblings would have been delivered, and my sister would be spiraling the drain right now instead of recovering from surgery from a specialty doctor that they found and paid for out of pocket.

(not) WilD (Matt) said:

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.

And society does, even though it can be tough to get- and it's not as if the food, shelter, and legal defense is all that great for the poor.  But it is provided.  

Robbie said:

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. 

As someone with experience with two non-American healthcare systems, I don't deny that the US has the world's best healthcare - but its expense is horrendous. It's a healthcare system best suited to people for whom money is no object, but at the same time it's the only option available to hundreds of millions of regular people.

From the mid-'90s to the mid-2000s, my mom, who used to be a nurse in Canada, worked as a medical rep. at a pharma distribution company in Barbados. She said the equipment and procedures in the public health care system at that time ranged from WW2-era to Cold War era. I often joke to other Bajans that if Americans knew about Barbados' health care system they'd use it as a cautionary tale to argue for maintaining their status quo, and sadly that might be true, but it's also true that it's saved a great number of alarmingly poor people from dying or being buried at the bottom of a Marianas trench of debt all while running on a relatively tiny budget, so maybe it's not so bad. The one big weak spot is that if you need some kind of advanced/unusual procedure that isn't available in the local public health care system (the local private health care system offers higher quality service but usually also doesn't offer these), the options are "scrape together 5~7 digits for treatment elsewhere (US if you're rich or South America if you're not)" or "receive end-of-life care locally."

As for Canada's health care system, which I have plenty of experience with through my family, I really can't complain, there have been only a few screwups, little waiting (none for anything urgent), and zero meaningful financial damage, I wouldn't trade it for anything else. It is nearly as good as the US' health care system at a cost everyone can afford. You can read more in the last paragraph of my last post on this page:

https://grassrootsmotorsports.com/forum/-topic-discussion/expatriotscurious-about-relocating-abroad-experien/144608/page1/

tuna55 said:

infinitenexus said:

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.  

I hear this, but from what I have seen around the globe, the alternative seems to be that no new cures are researched, no new medicine is developed, and specialty doctors don't exist.

 

As was said earlier, our (the US) huge private spending in healthcare covers the rest of the world to a certain point. The only reason cheap generics can exist is because someone paid and risked a huge amount of money to develop and test the thing in the first place.

 

So while I'll eagerly concede that it sure seems expensive, I will not agree that centralizing it makes it better in any way, and in fact would make it far worse for my family. I probably would not have a wife today. My son would have likely died during delivery and none of his siblings would have been delivered, and my sister would be spiraling the drain right now instead of recovering from surgery from a specialty doctor that they found and paid for out of pocket.

While that is all true, the problem with that is on a society basis, our healthcare does not lead to longer lives than many other places around the world.  We spend more, and as a population, we don't get the results that many other countries get.  Which is a tough conundrum to work out.

Still, we can STILL pay our doctors and researchers a lot of money outside of the companies that control what the healthcare payouts.  That can be baked into a single payer system if we so choose.  I'd much rather pay the highly skilled doctors and researchers than the CEO's and shareholders of HAP.

I'm seeing a lot of the same things often repeated.  First, there seems to be an assumption that if we change to a single payer (or whatever) system, all medical care will immediately turn to E36M3.  Another thing I see and hear fairly often (here and other places) is basically summed up as "how dare I pay for anyone else's health!"  And then there is the sentiment that if it's government run, it will suck.  I think that last one is spot on; most people that have worked for the government can tell you how they can't run anything right.  

Also, some financially successful people have commented on how great their care is.  So the real question is, how do we get that level of care at an affordable price to everyone, without letting the government berk everything?  If we want to be the best country then to my mind it makes sense that we should take the best care of our own people.  As in, that should be a top priority.

AAZCD, I live within driving distance to Walter Reed, so Tricare Prime makes sense for me now.  Once my wife and I move to south/central Florida, that won't work and I'll have to find something else because it won't work at all, as you alluded to.

alfadriver said:

tuna55 said:

infinitenexus said:

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.  

I hear this, but from what I have seen around the globe, the alternative seems to be that no new cures are researched, no new medicine is developed, and specialty doctors don't exist.

 

As was said earlier, our (the US) huge private spending in healthcare covers the rest of the world to a certain point. The only reason cheap generics can exist is because someone paid and risked a huge amount of money to develop and test the thing in the first place.

 

So while I'll eagerly concede that it sure seems expensive, I will not agree that centralizing it makes it better in any way, and in fact would make it far worse for my family. I probably would not have a wife today. My son would have likely died during delivery and none of his siblings would have been delivered, and my sister would be spiraling the drain right now instead of recovering from surgery from a specialty doctor that they found and paid for out of pocket.

While that is all true, the problem with that is on a society basis, our healthcare does not lead to longer lives than many other places around the world.  We spend more, and as a population, we don't get the results that many other countries get.  Which is a tough conundrum to work out.

Still, we can STILL pay our doctors and researchers a lot of money outside of the companies that control what the healthcare payouts.  That can be baked into a single payer system if we so choose.  I'd much rather pay the highly skilled doctors and researchers than the CEO's and shareholders of HAP.

And here is when it gets to politics. While undoubtedly waste and corruption is present, I'd rather that than the waste and corruption present in government.

So I'll fight tooth and nail to keep what we have before going to any alternative which exists in the real world. 

I'll keep the rest of my thoughts to myself, but do feel the need to share three stories: 

1. I occasionally feel guilty about getting a great deal on my house. The seller sold it to me cheap because they needed the money to pay for medical treatment. 

2. Because I had good insurance and money in savings, I was able to recover faster and more completely after breaking my clavicle. I received surgery that would have been skipped if I didn't have insurance and/or money for the operation. I would have still recovered, but with a mis-aligned shoulder for life, and a much longer healing process. 

3. My wife waited months to see a specialist this summer, then he walked out of the exam room before she could ask the questions she'd been waiting to ask. 

Anecdotes are not data, but I'm not sure those three are an indicator of a good system. And we're both 25, totally healthy, and have good jobs that provide good benefits. 

Also, as to America doing all the innovation, I searched a bit.  Kinda hard to with my filtered work internet, but other nations do much more than us on a per capita basis:
https://www.quora.com/What-countries-have-lead-the-world-in-medical-research-and-innovation-during-the-time-period-between-1995-and-2014

And then there's articles like this:
https://healthinformatics.uic.edu/blog/the-4-top-countries-for-health-tech-development/

and this:

https://www.healthsystemtracker.org/chart-collection/quality-u-s-healthcare-system-compare-countries/#item-start

Wow, this is expanding fast.  Anyone who recognizes my name will know I'm a strong proponent for a single payer system.  I'm probably one of the few here (BoxheadTim maybe another) who has lived under both a single payer and the US system.  I'm 50, I was born and raised in the UK and spent my first 25 years living there with the NHS.  I've spent the last 25 years living here with the American system.  Since moving here I obviously have an additional 25 years of friends and family who have continued to live with the NHS.

In a nutshell, nothing I've seen or experienced makes me think this system is better in any way.  No, a single payer system isn't perfect.  It has issues, but in my honest experience and opinion, it's far far better than here.  I'd also like to point out that there is nothing in a single payer system that prevents or outlaws a pay to play system as we have here.  That included private health insurance.  It exists in other countries that have single payer systems.  Through my parents we had BUPA, a private health insurance system.  Do you know how often we used it in the 10 plus years we had it?  Zero, not once.  Not one incident or illness needed us to fall back on it due to wait times, rules etc. of the NHS.  The NHS came through on time every time for zero out ofpocket expenses.  

If we listen to certain news outlets we are told that single payer systems are nothing but long wait times, poor service, and 'death lists' letting people die.  Nothing could be further from the truth.  Yes, for non critical or elective surgery etc. you can wait, at times too long, but they will get to you.  And the most important thing is no one daren't get treatment due to fear of costs, no one is ever bankrupted by costs etc.  Since I've lived here I've met people who lost their life savings with medical costs.  I've met people in their 20's who were bankrupted by medical costs.  It just doesn't happen over there.  I have a close friend who works for a nonprofit credit counseling company.  Much of what she did (moved onwards and upwards these days) day to day was counseling people facing and entering bankruptcy.  By far the biggest cause, even back in 08-09 when we were told all the bankruptcies were for too much debt and too much house, was, and still is medical bills.   Google it.  There are lot's of articles and studies, it's by far the leading cause of bankruptcy in this country.  I've had a friend who was killed due to an allergy to an anesthetic and had to be revived.  They then charged her for the privilege of resuscitating her.  They did it again  at the next surgery even though they were told about the allergy by both the patient and her sister who was there with her.  But they used it again and she had to be revived again, and guess who had to pay again?  Easy to say that's obvious malpractice, but when you're a single mother with not much income you can't afford to sue, let alone the emotianl effort it takes while fighting cancer even if you could find someone to take on the case.  She ended up passing away due to the illness with insurmountable debt meaning there was nothing to pass to her kids.  I've met someone who lost most of their retirement after an emergency tracheotomy was deemed not necessary retroactively by the insurance company and he tried to sue.  Bigger pockets means the truth doesn't matter. 

A few years ago my mother was here in the winter and just before going back she slipped and fell on ice and broke both wrists.  IT was close to her returnt so we splinted them up and she flew home.  The next day (a saturday) she went to the hospital inthe UK and was told yes,they're broken, but as they weren't set immidiatly the've started to set so we'll have to re-break them.  There will be a wait as it's no longer an emergency.  The wiat?  48 hours.  She was in surgery Monday.  Total cost ZERO.  One more personal anecdote.  When we were first married my wife got nasty grams and a summons for a supposedly unpaid bill from having a baby with her first husband several years before.  He didn't want to help, but after much digging through boxes in the basement and hours of calls we found that not only had the bill been paid by her prior insurance, it had been paid twice.  Again, imagine a young single mother on her own trying to sort out that, what extra stress would that have put on her?

While I feel for Tuna and his wife, they are lucky the treatment is available here.  Would it not be available here under a single payer system?  Even if not could they not get it with insurance or out of pocket under a single payer system?  What about a single payer system would make her situation worse?  I don't see it.  Also, there are many treatments, available on the NHS that US insurance wont cover, so Tuna's argument goes both ways for both systems.

I'm one of the lucky ones.  I've got great health coveage and I earn enough that even an aveage of $5k out of pocket annualy over and above insurance isnt' a problem for me.  But there are so many people who end up in emergency rooms in this country because they can't afford  basic preventative treatment.

As for paying for it.  We spend more for less over here.

I've heard all the arguments for 25 years and still nothing makes me believe this system is better unless you're wealthy.  But what about the other 70-90% of the population.  For them, this is a horrible situation.

LEt's not even start on prescriptions!!!!

On the topic of pharma research, it's true that US medication costs are sort of subsidizing the rest of the world in that area, but it's also true that the pharma companies are wasting immense amounts of money on marketing (generally spending more on it than research!) and executive pay and perks (even in comparison to other big companies). It doesn't have to be this way. Marketing prescription medications directly to the public is actually illegal in many places including Canada:

https://en.wikipedia.org/wiki/Direct-to-consumer_advertising#Legality

In reply to tuna55 :

Why do you assume that waste and corruption does not happen for the for profit payer system?  

Right now, the for profit system is supposed to be about making money #1- do you really think that is right?  It's ok for people to make a healthy profit by filtering MY money and how that gets paid to the actual providers?

Given the doctors take a moral oath to take care of people, I personally find it morally questionable that the healthcare industry is in place what so ever to make a huge amount of money.  Yes, a government system would likely have waste and corruption, but so does the private system we have right now.  Having worked in a massive corporation, I have little faith in large insurance companies.

My personal care has nothing really do to with HAP or The Blue company- it has to do with Michigan Medicine- who are the ones who actually do work on me.  The one who lauders my money for a profit does nothing besides restrict where I can go and who I can see.

Several people have mentioned that it's unfair they should pay tax to provide health care for others when they've already earned their medical insurance.  First, it can be argued that all taxes work like that.  Secondly, if it were part of payroll taxes you wouldn't pay them when retired.  We pay so much more for less coverage here than other countries, there's no reason a single payer system shouldn't be cheaper in the long run once it's a not for profit system.  Please don't raise the argument that government run systems are all bloated and inefficeint I dont' buy it.  Look how out of control outsourcing services has got in the military and with things like school busses in many cases.  We have no idea how many private contractors are overseas working on military bases and I've read so many articles where prisons, schools etc. outsourced meals, busses etc. and in the long run there is no cost save, all the happens is the workers get less and the new 'efficient' management company that wasn't' needed before is making massive profits.

So for the proponents of single payer - I'm hearing of a lot of issues with the current us system (and I don't disagree they are issues). What I'm not hearing is the logic behind how a single payer solves those problems. Can you lay it out for me?

Example: 

Problem 1 - US healthcare system sends too much profit to insurance company CEOs, single payer system solves that by annexing their jobs, therefore CEOs are out of work, and we assume the single payer can do the role while paying someone less, therefore we no longer have to pay their profit, problem solved. (obviously this is a shrill example). 

Problem 2 - etc. 

As often happens with discussions like this, the problems are many and easy to come by, and solutions are rarely simple and all-encompassing. I hear the problems. I see the problems. I agree they are problems. I don't see the link between single payer and the solutions. 

Americans would not stand for what a single payer system would entail.  

I have your where is all the waste laid out right here People are too far removed from what things actually cost.   Americans expect everything that can be done, will be done, without regard to expense, especially if they are not paying for it.  That is how you spend greater than 95% of the total lifetime expense on healthcare in the last 3 months of your life.  No way you get people to just accept the limitations that would be required for a single payer system.  In all single payer systems, there is rationing of care that Americans will not tolerate.  Leaving this aside, the only way you get to a single payer is to utterly destroy what we currently have.  ACA would have managed it, given more time, but a monkey wrench got tossed into that.  One of the big problems with the big problems with the ACA is none of the doctors would accept it, because it reimbursed so poorly.  In the end, it is like most things, it all comes down to money.

The story about the unfortunate woman who had several anaphylactic reaction to anesthesia above, one call to a plaintiff's attorney and that situation would have been taken care of at no cost to her for a large settlement.  Not all US government programs are bloated and inefficient, there are just none you can point to that are not.

Adrian_Thompson said:

 Please don't raise the argument that government run systems are all bloated and inefficeint I dont' buy it.  Look how out of control outsourcing services has got in the military and with things like school busses in many cases.  We have no idea how many private contractors are overseas working on military bases and I've read so many articles where prisons, schools etc. outsourced meals, busses etc. and in the long run there is no cost save, all the happens is the workers get less and the new 'efficient' management company that wasn't' needed before is making massive profits.

That sounds exactly like a government-run system being bloated and inefficient.

See: DoD.

If government-run healthcare would be bloated and inefficient, and the current system is bloated and inefficient, what's left? Nothing. We're berked. Guess we'll just have to suffer and die.

I have nothing useful to add. The system is berked. Watching and following the conversation for sure. Here's to hoping the thread stays on it's rails. Play nice everyone.

nutherjrfan said:

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.

After reading through the thread more. I definitely spoke too quick. I'll sit back and listen now.

FuzzWuzzy said:

Adrian_Thompson said:

 Please don't raise the argument that government run systems are all bloated and inefficeint I dont' buy it.  Look how out of control outsourcing services has got in the military and with things like school busses in many cases.  We have no idea how many private contractors are overseas working on military bases and I've read so many articles where prisons, schools etc. outsourced meals, busses etc. and in the long run there is no cost save, all the happens is the workers get less and the new 'efficient' management company that wasn't' needed before is making massive profits.

That sounds exactly like a government-run system being bloated and inefficient.

See: DoD.

Why?  Local school district spends say $2,000,000 on busses, drivers earn say $20/hr.  Private company comes in and say's they'll do it for $1,900,000.  Bingo $100k savings.  But now the new Manager earns $150k, several new supervisors and billing people earn $80k and the drivers are cut too $15/hr.  Then over the next X years the cost goes up X% a year and it ends up costing the same or more.  How is that inefficiancy on the governement part other than falling for the 'privatization is always better'argument?  Note, privatization isn't necessarily better or worse.  In the case of health care, I'd say we've got 70 years of data from the US, Canada, and Europe that says Government run single payer systems are more efficient in terms of cost and provide better service.    

Adrian_Thompson said:

She was in surgery Monday.  Total cost ZERO.

Did the doctors work for free??

In reply to alfadriver :

Not happy with your insurance company? You can choose a different one, but wherever you go your costs and choices will be limited by state and federal laws and regulations. Not happy with insurance? You can choose to not participate. You will still be able to receive healthcare if you walk into an emergency room or are in a situation where an emergency medical response has been requested.

Working for a private air medical provider, we respond when requested, and care is provided. Some people pay, some people don't. Some are insured, some aren't. They all get the same care. Billing will happen, but nobody is going to prison for not paying.

I have landed a helicopter in someone's back yard when they were having a heart attack. Within 30 minutes they are in the city getting a heart catheter, regardless of insurance or ability to pay. Even they have the choice to opt out unless they are not alert and oriented.

I have also been called to a place where a person was thought to be having a stroke. After arriving on scene it was determined that they just had low blood sugar. They were treated on scene and recovered from the condition. Medically they did not need to be flown to a hospital, but EMTs had called us and treatment was provided. The patient refused to be released and we were obliged to transport.

There are problems with the US healthcare system, but everyone can get access to a level of care. Read Toebra's "War and Peace" thread.

As long as there is so much money in private-ish healthcare and “private” globocorp hospitals, nothing will change. 

My wife works with specialty pharmaceuticals. She hasnt even really seen the real numbers but its hard to wrap your head around the $$ that moves around in that industry. 

TopNoodles said:

Adrian_Thompson said:

She was in surgery Monday.  Total cost ZERO.

Did the doctors work for free??

OK, OK, you know what I mean.  Zero out of pocket costs to her.  It's all covered.  No bill, no co-pay, no insurance, no hassle for a 79 year old woman living alone.  Even Medicare doesn't do that.  To me that's how it should be.  

IT's been stated and there are thousands of articles out there that show all other developed first world countries spend less per capita for better coverage than here.  So the statement should have been.  If I wanted to be a pedant I could have said 'It cost way less than here and was zero out of pocket for her'  But I feel 'total cost zero' got the same message across.  

In reply to Adrian_Thompson :

The government is the deciding factor in each situation. They don't fall for anything. They know exactly how it works and couldn't care less what the contract company does, as long as work is done. The contracts are set  for 3-5 years until they hold new bidding and chances are, the current contract company gets underbid by a smaller contract company. Cycle repeats. 

The VA is a government-run system and it is absolute trash. I don't know of anyone that has a choice between the VA and private, choose the VA willingly.