Single payer healthcare, would it work?

1. For anyone who thinks healthcare is a right I ask you if you are for or against slavery.

If you have a right to another's labor then they must be a slave. Of course no one has a right to healthcare unless doctors, nurses and all the other people that make the system function are slaves.

1. I think the question whether or not we should have a single payer system nationally is silly unless it starts off with a Constitutional amendment that allows such a thing to exist. It is just not in the powers of the Federal government as it stands now (Of course, I think that a lot of things the Federal government does is not per the Constitution, but they do it anyway. I realize if they wanted to implement it, they would and wouldn't worry about what gives them the power to do so.)

2. I would love to see a state implement a single payer system. Not sure how they would fund it and how they would wrest control away from the insurance companies and private medicine, but I think it makes the most sense.

Datsun1500 wrote:

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.

+100,000,000,000,000,000,000,000

Can it work?

Sure

Would it work in California?

Ha,ha, hilarious, no

racerdave600 wrote: 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.

Payout amounts are chump change. The big money is in ALL the tests done as pre-emptive CYA with the lawsuits in mind.

alfadriver wrote: 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.

This is a great plan, just don't pay the healthcare providers anything over and above what it costs them to provide service. Where is the sarcasm button on this thing?

Huge expansion of Medicaid is what the "Affordable" Care Act did. It also pushed a lot of people into health insurance plans that are essentially catastrophic plans, with huge deductibles, at premiums on par with zero deductible, gold plated insurance from prior to it being imposed. In California, most doctors opted out of the exchange plans, not only because the reimbursement was 70 cents on the dollar, but it would make all your other contracts default to the lower reimbursement rate. In California, about 80% of the people that were newly insured following its imposition were due to the massive expansion of Medi-Cal, California's version of Medicaid. It has a different name here, because, California. There are practically no doctors at all that accept Medi-Cal, because if you lose money on every patient, you can't make it up in volume. They pay you substantially less than the $30 you get to see a patient in the ER if you see them in your office. This has resulted in the Emergency Rooms being over run by Medi-Cal patients, because no one will see them unless they are forced to do so, which is what happens when you are on call. Generally, these are patients that CHOOSE not to take care of themselves, or do anything the doctor advises them to do. They are also the most likely to sue you.

WRT the VA. I am not a VA provider. I see a LOT of Tricare(active and retired military) patients in my office, did surgery on one this morning. It was a GD nightmare to get authorization to do the surgery, and I am still not sure the facility will get paid, because, VA. They refer them out because they have nowhere near the staff to handle the load, and a bunch of people got famous for faking like they were doing something to mitigate the problem, but just pretended like they did.

Canadian system works for a few reasons. They don't have a problem with illegal, I mean undocumented immigrants. They have a relatively homogeneous society, and there are not that many of them. They also don't have to spend much on defense, because, USA. Finally, when it comes down to it, they can come to the US to get care if they can't get it there. For every story like Mr Tanner's where someone got prompt care, I can give you a number of examples to the contrary.

One thing I don't hear mentioned much is that most medication and medical device development is driven by the demand from the USA.

In California, because the place is run by idiots, about 10 years ago they dropped Dental, Optometry and Podiatry from the services that Medi-Cal would pay for, to save money. They have put a lot of it back, but podiatry is still out. They claim that they will pay for podiatry services provided in hospitals, but they are liars. A few years ago, I went to the Capitol, met with my Assembly and Senate representatives, and them gave copies of studies, done in Virginia and Arizona, that show what happened when they dropped podiatry from Medicaid. Turns out, for every dollar spent on podiatry services, it saved $40. I told them before they quit paying for those services before they dropped them, but they did it anyway. People that make stupid, politically driven decisions, should probably not be in charge of this stuff.

I am sorry this comment has some political content, but in the US, healthcare and politics are inextricably linked.

In reply to Toebra:

You seem very knowledgable on this subject. What do you think would be improvements over our current system? Things that might actually work, not just pie in the sky stuff.

This is just a whimsical thought about an alternative. It's not perfect or well thought out, just a spitball idea.

As much as I despise the way cable and internet services are handled in this country, I like the example they allow me to provide.

You buy channels in bundles, sports pack, movie pack, basic pack, everything..

Why couldn't we do insurance that way? A basic, lowish fee, emergency plan, that would cover things like broken bones or injuries, things that randomly happen. Your family has a high history of cancer or heart disease? buy a treatment package made up of doctors and specialists, with related costs and activities, for lack of a better word, included. PLanning a family? prenatal and pediatrics package. Allow vision, dental, or chiropractor type things as a fee for each or packaged.

While I know the whole sorting and cross coverage of a lot of things would make this beyond difficult, I think it could be packaged as a ala carte style service.

So I could get emergency, vision, and kid package and pay my monthly rate for it, then when I need glasses every few years, or I break a bone or bury a tool in my hand, go and it's covered, but things like doctor visits for a cold or mileage checkups would have to be out of pocket.

I was first thinking car insurance, like liability and comprehensive, a basic emergency room plan, then a full doctors, checkups, body maintenance style plan, but I think you need more than just two options for something as variable as health.

I think a big part of why we wind up with "one size fits all" options is just the level of bullE36 M3 that needs to happen to get things actually done. It can take years to get approval to change things or build things through government, so throwing like 8 different options out for approval could make things even slower and more annoying. John Q Public seem to think officials have magic wands to wave and make things happen, when just putting the ink to the paper can take an entire term in office.

T.J. wrote: 1. For anyone who thinks healthcare is a right I ask you if you are for or against slavery. If you have a right to another's labor then they must be a slave. Of course no one has a right to healthcare unless doctors, nurses and all the other people that make the system function are slaves.

Is clean water a right? Because people work in that industry.

In reply to Keith Tanner:

No. But I'm also only billed for how much I use. Not a share of everyone in the cities use.

Medicare exists because there is no way to price insurance for the elderly. People in their twilight years CANNOT afford to pay for their medicine via private insurance. As a country we accept this.
If you are poor enough, we have Medicaid, it used to be smaller, but it's been there for a while. For the most part we're ok with this. Suffering sucks.
If you're a veteran you have care through the VA (a sweeping generalization, yes) and many (most?) Americans think we need to do MORE for them.
So the only people we think don't deserve healthcare are working age people and their families? The very people who make healthcare available for everyone else are the people who are told to suck it up? Really?

In reply to Keith Tanner:

Of course not. If clean water was a right then a homeless guy could walk into any store and grab a bottle of dasani out of the cooler and just walk out. That is called stealing. That doesn't mean polluting water is not a crime however. If clean water was a right and my pipe broke I could demand a plumber come an fix it for me at no cost to me because it is my right to have that water. That is silly.

I'm for it, but I'm also okay with paying more for roads, schools, and national parks the more I earn. We say that a single payer healthcare system will get less efficient, but don't we currently have 50 individual marketplaces that require management, a separate VA, and Medicare? What if we get rid of all of these parallel entities and just have a singular approach to keeping people alive and (hopefully) well?

In reply to T.J.:

If there is a drinking fountain, water is free.

IMHO, some of you are mixing up the people who actually supply a service and those who bundle a lot of people's money together to pay for it.

Nobody is suggesting that doctors and nurses or drugs are free. That part, I'm fine with paying the skilled and talented more money. Doctors who cure cancer deserve compensation.

It's the companies who take our money and then tell us how to spend it after taking a healthy profit that is in question here. They provide no real service, they also restrict where I can go to get service. For the most part, they launder my money, and that is it.

It's fair that people worry about lost jobs from them, but they are also filled with the skill to make sure payments are made. So many can be part of the single payer system, too.

I'm just leery of an industry who makes money filtering my healthcare dollars for profit and add nothing to my heath at all. Health should not be divvied up between the haves and have nots. We don't have a military that protects the rich but not the poor. In other words, killing foes goes across the entire population. Why can't just taking care of people's health be the same thing?

I used to be completely on the never side of this argument. I'm not as resolute about that now. While part of me agrees with Bobzilla part of me also agrees with Alfadriver. I don't know who I am anymore.

Health should not be divvied up between the haves and have nots. We don't have a military that protects the rich but not the poor. In other words, killing foes goes across the entire population. Why can't just taking care of people's health be the same thing?

Insurance and healthcare are two different things. At least they used to be. Insurance is a gamble on the insurance company's part. They bet that overall, the amount paid out for claims will be less than they take in. And people buying insurance understand that they will likely never get back what they paid in. And they are okay with that, because they can sleep easier knowing that everything that they have worked for won't be gone if they get sick. But now we are adding people to that risk pool who are not paying their share. It has to come from somewhere, so those paying now pay more. The problem is, many of the added people that now have "insurance," don't need it. No one requiring medical attention is turned away in this country. You can get healthcare without insurance. So why are we pushing to insure people that don't have much to lose financially? Why add them to the risk pool of people that need actually need insurance? We already have MediCal, Medicade, etc.. We also live in the most generous country on the planet. Why is it that private charity is never part of this discussion? It's still alive and well, stronger than ever judging by "Go Fund Me" stories. It was also there long before any government programs. Can't we just keep the government out of it? I'd argue that regulations that stifle competition are one of the biggest obstacles of lowering both health care and insurance costs. Add in tort reform, and we are most of the way there. Then insurance would be affordable to those who actually need it. And if you can afford insurance but choose not to buy it- why should we shed a tear when you go broke? If you don't buy insurance on your home and it burns down, should we pay for that too?

As for the Military, I don't think that is a very good comparison. First, the Military is pretty much the only true responsiblity of the federal government. And they do an absolute horrible job on a cost basis. Any guesses on what the cost per bad guy killed amount would be? And I'm okay with that, because everything that we are talking about would be moot without our strong military. I'm also okay with spending crazy dollars to give our soldiers the best chances of survival. But I'd never call our military efficient. It's overkill at it's best. I don't think that approach to health care is the answer. Heck, that approach to health care is not even the military's answer- see the VA.

Mr Heller, I do have some thoughts on the matter.

I think it is instructive to have a better understanding how we came to be where we are today. The fact that healthcare and healthcare insurance are routinely conflated muddies the waters, so to speak, but setting that aside for the moment, let's dive in.

After WW2, there were controls placed on wages, limits on how much workers could be paid. There was a great demand for labor in the United States, because it was essentially the only place in the world with an intact manufacturing capability. Wage controls were instituted to prevent a precipitous rise in wages. This led to companies offering non-salary remuneration, retirement packages, college scholarships for children of employees, coverage for healthcare services, and so on. This, and the creation of Medicare in the 1960's, has served to insulate the person receiving the services from the actual cost of these services. This has resulted in a steady rise in spending on these services, not unlike what we have seen happen with the cost of higher education.

A big piece is tort reform. The cost of malpractice premiums is easy to quantify. For example, when I practiced in Texas, I had 200/600 coverage, which is to say, $200,000 per occurrence, $600,000 per year, because the hospitals required that level of coverage. When I moved to California, I had to have a $1,000,000/$3,000,000, policy, again, because the hospitals required it. You would think my premiums would have been significantly higher, but they went down about 30%. California instituted limitations an malpractice liability prior to my moving here. The hospitals still required that level of coverage, because California. The liability insurance companies know they are never going to pay out a million bucks, so the policy costs less than it otherwise would. The lion's share of the expense does not come from malpractice premiums though. The big money is in the defensive practice of medicine. Everybody who bumps their head gets a CT scan or MRI, full on workup, just in case. That stuff adds up.

The immigration situation is also a part of this. If you assume that Americans deserve healthcare, can we afford to import people and take care of all their healthcare needs? People in this country illegally are getting medical care they can't pay for, this expense is absorbed by those that can and do pay.

Another subject that will have to be addressed is end of life care. For most people, the vast majority of the medical expenses they generate during the course of there lives are in the last year or two of their lives. It sounds callous, but a frank discussion about this will eventually need to happen. How do you balance expense against quality of life? Who makes the decision that the cost outweighs the benefit? Does a person who was unfortunate in the genetic lottery and turns up with some chronic disease "deserve" more care than someone who engages in self destructive behavior, such as smoking, taking drugs or being morbidly obese? Do they get less care than an active, non smoker who eats a healthy diet? Do we devote more resources to someone who makes a significant contribution to society? Do you base this on ability to pay, on need? Who is the arbiter of these choices? I think this part of it will be a very tough nut to crack.

I am of the opinion that there can be no resolution to this conundrum unless the separation between the people getting the care and cost of the care is addressed. It seems to me that a single payer makes this part of it worse, not better. If single payer is determined to be the way to go, who administers it? Large bureaucracies do not have good track record for efficiency.

Wayslow wrote:

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.

Also came here to point out how wrong Curtis is.

Have had to wait a few weeks for an MRI for an ongoing (not critical) condition. When I needed one, I had it within the hour.

Unfortunately, our family has had to use the system quite a bit over the years. We have been very happy with the prompt service and results.

Zomby Woof wrote:

Wayslow wrote:

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.

Also came here to point out how wrong Curtis is. Have had to wait a few weeks for an MRI for an ongoing (not critical) condition. When I needed one, I had it within the hour.

I find this interesting.

The only non GRM Canadian I know, recently had to wait 8 weeks for bypass surgery. The more worrisome incident was the stroke he had while visiting my parents several years ago. According to the local doctors, it was brought on by a particular drug cocktail, that had been prescribed by his Canadian doctor for back pain. He already had high blood pressure and the drugs they gave him drove it through the roof.

Obviously this is anecdotal, but still troubling.

T.J. wrote: 1. For anyone who thinks healthcare is a right I ask you if you are for or against slavery. If you have a right to another's labor then they must be a slave. Of course no one has a right to healthcare unless doctors, nurses and all the other people that make the system function are slaves.

People in the US have plenty of rights (enumerated in the Bill of Rights) that are dependent on others' labor to make possible. The sixth one is the most visible, as it mandates that accused are provided defense in court.

I find it amazing to me that anyone who has had experience with the bureaucracy, waste and incompetence, that is Government in this country, would ever be willing to subject themselves to a government run healthcare system.

The ACA is a disaster. Just imaging what a single payer system will look like after the blithering idiots in DC get done with it. To think they will have your best interest at heart is foolish.

Knurled wrote:

T.J. wrote: 1. For anyone who thinks healthcare is a right I ask you if you are for or against slavery. If you have a right to another's labor then they must be a slave. Of course no one has a right to healthcare unless doctors, nurses and all the other people that make the system function are slaves.

People in the US have plenty of rights (enumerated in the Bill of Rights) that are dependent on others' labor to make possible. The sixth one is the most visible, as it mandates that accused are provided defense in court.

And everyone knows the quality of the Public Defenders Office.

Boost_Crazy wrote: But now we are adding people to that risk pool who are not paying their share. It has to come from somewhere, so those paying now pay more. The problem is, many of the added people that now have "insurance," don't need it. No one requiring medical attention is turned away in this country. You can get healthcare without insurance. So why are we pushing to insure people that don't have much to lose financially? Why add them to the risk pool of people that need actually need insurance?

How do you think it worked pre-ACA? Those that didn't have insurance just showed up at an emergency room or urgent care when they had a cold and racked up a bill they never planned to pay. This led to hospitals raising costs to cover the unpaid bills. Those that had insurance ended up paying higher premiums because the insurance companies won't cover the extra costs. Those without insurance were seen as a burden on the system that caused overall costs to go up. The ACA was supposed to combat that by making insurance cheaper than the fees of not having it. It removed the preexisting clauses of insurance policies to make sure everyone could get it, and then it made it mandatory. Unfortunately it backfired in many ways. I've personally seen my costs quadruple because of it.

The ACA was more reactionary to current problems in the system and sought to correct those problems through compulsory insurance but decided not to correct the already mentioned biggest issue currently, which is the transparency of costs. I should be able to go to my PCP and have him tell me what procedure I need, then I should be able to shop the costs of that through different providers and choose the most cost effective. The only situation where I wouldn't have a choice is an emergency situation.

As for gov't involvement, who knows. The prison system is a wreck because of private corporate greed, while the school systems are a wreck because of gov't standardized testing. Obviously the private healthcare system had flaws, while the gov't "dip our toes into the water" ACA has issues of it's own.

Toyman01 wrote: I find it amazing to me that anyone who has had experience with the bureaucracy, waste and incompetence, that is Government in this country, would ever be willing to subject themselves to a government run healthcare system.

I'm in healthcare, I've been a practitioner since the early 1990s. Part of my graduate degree was in Public Health, so let me address this statement.

When I studied it 15 year ago, non-healthcare related costs (anything not related to patient care) across the private health insurance industry was 23%. Medicare was 2% .

I doubt that will shift any paradigms. There are people who think the government can do nothing right, but at least in efficiency of service delivery, the Federal government is king.

Regarding what can change: a greater focus on primary care and prevention would be great. Medicare (the world's largest health care provider by dollar amount, by the way) needs to shift it's system of preferential payments away from the medical specialists. It currently reimburses the medical specialties (orthopedics, oncologists etc.) at a far higher rate than primary care physicians, to the point that many family practice GPs tell me they lose money on Medicare patients.

We are moving to a single payer system by default. Up until the mid-2000s, the majority of medical school graduates went into private practice. The majority now work for larger health care systems. Lower reimbursement rates are forcing industry consolidation.

Toyman01 wrote: The only non GRM Canadian I know, recently had to wait 8 weeks for bypass surgery. The more worrisome incident was the stroke he had while visiting my parents several years ago. According to the local doctors, it was brought on by a particular drug cocktail, that had been prescribed by his Canadian doctor for back pain. He already had high blood pressure and the drugs they gave him drove it through the roof. Obviously this is anecdotal, but still troubling.

Uh huh. And I could provide anecdotes about the US system taking too long, or making mistakes, like my grandmother who presented with a UTI the day before Thansgiving, but since all of the doctors were on vacation, we couldn't get a prescription for the medicine she needed until the following week. Then one of the prescriptions (a new one, by a new doctor's advice) gave her screaming pain and we couldn't tell which medication was causing it and she began to refuse to take any of them. Then her kidneys failed, and we buried her a short time later.

This the week after her oldest daughter had the misfortune of having a heart attack on a Friday. And the leg they harvested the artery from didn't heat right and she had to be in a nursing home for six months while they kept debrideing (sp?) the graft site so it could heal. And then, after six months, long after we laid her mother to rest (and did I mention that she lived her entire life at home with her parents?) the insurance company said "Oh, by the way, your coverage runs out tomorrow, you go home now, whatever problems you have are your own now"

NB: Most of my family is in the healthcare biz. I hear lots of horror stories with respect to the billing systems, from the ones that are exposed to it. The doctors and nurses are not.

In reply to Knurled:

The system is broken. I get that.

Do any of us truly expect the government to fix it? Or are we so desperate for some kind of change, that we will take a chance that they can, even after all the proof, that they can't even tie a shoe successfully.

This is going to be a one way decision. If single payer happens, it will never be undone. We will then be stuck with whatever the fools in DC decide to give us.

Personally, I wouldn't trust any of them to walk my dog.

Toyman01 wrote:

Knurled wrote:

T.J. wrote: 1. For anyone who thinks healthcare is a right I ask you if you are for or against slavery. If you have a right to another's labor then they must be a slave. Of course no one has a right to healthcare unless doctors, nurses and all the other people that make the system function are slaves.

People in the US have plenty of rights (enumerated in the Bill of Rights) that are dependent on others' labor to make possible. The sixth one is the most visible, as it mandates that accused are provided defense in court.

And everyone knows the quality of the Public Defenders Office.

And that is an interesting one, because politicians who want to be Tough On Crime (who wouldn't be?) would cut public defense to the bone, since that gets conviction rates up.

Keeping people healthy is a benefit to society and could be a politician's talking point.

IMO we spend a lot of money on healthcare in the US in all the wrong places. I have a knee problem that I bitch about sometimes here (especially in auto vs. manual threads, since it's my left knee and clutch extensions are exactly the kind of motion that gives me fits) and I won't get it looked at for two reasons. First, I have a huge concern that I'd just be seen as a pill-seeker and shoved off. Or worse, I'd just get a prescription for some painkillers and moved on my way. Painkillers don't work on me, and if they did, that is how addictions start, since the brain is so adaptable that there is no such thing as a non-addictive painkiller. So if my options are "suck it up and deal with it", or "take a bunch of drugs, feel okay for six months to a year, then it gets REALLY bad and you end up sucking it up and dealing with it anyway after your life becomes 10x worse", I'll take the first one.

Second, I can't afford it, even with health insurance.

The point is, it seems like going to a doctor for joint/back pain result in a lot of money spent in rehab clinics. Heroin/other opiods is a huge problem in this part of the country and most of those addictions start in hospitals.

Datsun1500 wrote: 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.

Health care economics are unique for a couple of reasons:

1. The patient isn't always in a position to shop around, such as in the case of an emergency and

2. Sometimes it's hard to predict whether the outcome of a procedure is going to require follow-up care. An example: going in for a tonsillectomy and getting a hospital acquired infection (such as MRSA). Or, you have appendicitis but during the procedure it turns out you have sepsis. No price guarantees