You need single payer because you can overcharge anyone who can't negotiate lower rates (i.e. individuals who's personal business with the healthcare system doesn't have much if any effect on it).

Compare that to a state bargaining on behalf of 10+ million customers.

I'm not sure the government can do a good job negotiating on behalf of its citizens. It doesn't work well for student loans (blind checks that increases tuition) [1], California's power cost (rate set with gov cooperation) [2], or even Medicare [3].

I think we need to fix several more issues before single payer would be a suitable option.

[1] https://www.forbes.com/sites/prestoncooper2/2017/02/22/how-u... [2] http://www.cpuc.ca.gov/electricrates/ [3] https://www.reuters.com/article/us-column-miller-medicare/re...

How is this, from your link, the government bargaining on medical costs?

> but the plan bypasses an obvious remedy - one that President Donald Trump embraced as a candidate: allowing Medicare to negotiate drug prices directly with pharmaceutical companies.

To me (non-english native speaker) it reads as if though they are literally not allowed to negotiate.

When it comes to schools, here (Sweden) the government negotiates how much money the schools get per student, not just the interest rates of loans. Lowering interest rates means students can afford a higher loan. None of this is comparable to negotiating costs.

The points I posted are a few examples of the government doing a poor job at dealing with the public's money. With medicare they past laws preventing their ability to negotiate. For schools in the US, the federal government has no limit on the amount of loans they can give it. I think these are relevant to the government's negotiation ability as in both cases they're allowing the counter party to abuse them to the detriment of the public. I don't trust that if the government is the single payer for healthcare that they won't let the pharmaceutical companies and hospitals take advantage of them.

>>I'm not sure the government can do a good job negotiating on behalf of its citizens.

Of course it can. For examples, please see: Medicare, Veterans Affairs, etc.

You just need more competition and regulations to make prices public and stated before the procedure. I live in a country with single payer healthcare. It sucks tremendously. Instead of paying there is waiting, sometimes for long months for absolutely crucial procedures. Fortunately I also live in a country with reasonable regulations and sizeable private healthcare facilities. I pay reasonable prices (which means often 5x-20x less than in US) if I need treatment and I can get it in timely manner.

It's not single payer that makes our system better. It's competition and reasonable regulation that makes it possible to have cheap services available.

Those prices are likely low because their "competition" is single payer.

The single payer solution assumes the status quo is the only possible way healthcare can be priced. However prices for the same procedure can vary wildly depending on the provider in the same area in US. In all other areas of commerce, prices tend to be comparable among competitors especially within the same geographic area. So why is healthcare the only industry that doesn't act like that?

I honestly don't know, but I think part of the problem is a lack of price transparency. People cannot shop for the best prices for non-urgent procedures, etc. I bet price transparency would at least help stabilize the prices across providers. Is that enough to solve the problem completely? Doubtful, but it would be a start.

There's a difference between single payer and universal coverage.There are many other systems. For example, France and Germany do not have single payer. Single payer is just well known in the US due to the proximity with Canada.

Cf. the insurance company negotiating on the above poster's behalf, and my curiosity about the result of those negotiations.

Well. A for profit entity can hardly be regarded as bargaining on your behalf. They are bargaining on behalf of their revenue. The difference between what they negotiate and what they charge you is their entire business.

That's if you have insurance, which - surprise - is only reasonably priced if you are part of a group (e.g. employer) which can negotiate on your behalf.

Ah, so then that's what this boils down to? The high cost of health care is a symptom of capitalism run a muck? We're being charged these exorbitant rates simply because they can get away with it? If only we had a single payer that was able to negotiate, these costs would evaporate over night? Not sure it's that simple...

Although, in a way it does kind of make sense. Unlike consumer goods (television, cars, etc.), one's health is something they're likely willing to break-the-bank for. So without any kind of restraint, I could see costs getting out of control. The hospital is focused on making as much money as they can, and the consumer is focused on preserving their health. If one doesn't have their health after all, what do they have?

Add an ever increasing demand (baby boomers are aging rapidly) and suddenly, things begin to look much worse for the demand side of the equation.

> Not sure it's that simple...

There aren't that many countries that pay as much as the us from public funds (two, see my previous link) or out of pocket (none).

The problem is localized to the US.

Consider: - The US is much fatter, on average - Medicare's standards for reimbursement are often not based on cost effectivenes - The US government will pay around $150K/QALY vs. e.g. the UK's c. $40K/QALY.

More expensive healthcare per capita is what I'd expect given those attributes and "single payer is the only solution" does not seem to be logically linked to the problem and facts.

You are paying much more than anyone else[0]. I really doubt that's because of you being the 17th fattest country by BMI[1].

[0] https://en.wikipedia.org/wiki/List_of_countries_by_total_hea...

[1] https://en.wikipedia.org/wiki/List_of_countries_by_body_mass...

Please note that the data you link does not address obesity and health costs simultaneously! Obesity is indeed a contributing factor, around 5% of total.[ξ] And from your references, the US has substantially more obeses and overweights per capita than the countries against which it is compared for health costs

[ξ]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1449869/

I think the final amount I had to pay was around $1,150.

Thanks! That seems high, although I suspect the pricing has something to do with opportunity cost for the hospital. ER docs are limited, and he wasn't available to assist with [serious life-threatening trauma] while he was gluing your finger up.

I had something similar (knife slip, a few stitches) come out to like $350 at urgent care. I paid with (literal) cash.

Any other system is going to be written by lobbyist relying on complexity for cover.

If consumers had as much political strength on capitol hill as the medical industry, another system could be worked out. But they don't. The window was closed on that option with Citizens United.