Especially - freedom to pick any doctor as they are all in-network.
Family had experience with California PCIP insurance (bridge for pre-existing condition after ACA was voted in, but before it took effect). The PCIP was amazing - PPO-like benefits, using MediCare network (close to 100% doctors take it) and quality services. Of course, unfortunately, the ACA/exchange provided policies are nowhere close to how good PCIP was.
If we could get the PCIP-like option, it would truly change lives for the better.
Any doctor? Doctors can take so many patients. Though it may benefit a large number of people, some may end up worse. Those who have the best doctors currently (because they can pay) may no longer be able to have those doctors.
Second, you're at best arguing that we shouldn't go to a fair system of rationing because it would hurt the beneficiaries of an unfair system of rationing.
And to take this sideways... my favorite health care model is the Japanese system. It's actually quite similar to the American system (private employer-provided insurance, private providers), but with one key difference... a government commission fixes the prices for all medical goods and services. No more negotiating between providers and insurers. So no "networks".
It leads directly to the situation you described. It also leads to costing half as much as the US, for universal coverage and better outcomes. I'll take that trade, thank you.
It wouldn't, but if I needed to get a doctor, I might no longer be able to get a very good one.
Remember that cheaper prices for medical care means the smartest, best people may not become doctors.
> you're at best arguing that we shouldn't go to a fair system of rationing because it would hurt the beneficiaries of an unfair system of rationing.
I don't believe the current system is "unfair". Why is it? Most Americans like what they have; it is the bottom few percent who are unhappy. Is that "unfair"? At what percentage does that become the case? Must most of society change to accommodate a small, dissatisfied minority?
Without government regulation, health care would be much cheaper. Why must I purchase coverage for a hysterectomy or for birth control as part of a plan? I will never need these services. Wasted money.
What of experimental treatments? I know a person who is alive thanks to an experimental treatment that was reasonably priced. All it amounted to was an antibiotic regimen far outside the bounds of the CDC-recommended one, out-patient. The problem with single-payer is that I cannot do that, because there is a single payer - the feds. I may not pay for my own procedures (and my friend would not have been able to do so), even though this was quite affordable, because it was not on "the list".
Fixing prices is a possibility (albeit not one of which I am as fond), though we would need to allow procedures to be done out side of that (for those which were not approved, or for those who could not get availability and could pay). It is basic economics that price ceilings create shortages; who gets treatment? We are back at square one: I think it should be ordered by those who should pay. I trust dollars to be "fairer" than an opaque system, and would rather the coverage I can get be a known quantity than be at the mercy of the whims of a bureaucrat.
My biggest question: why do you want to force those who can pay onto the same plan? That is a part of single-payer that makes no sense. Why not let those who like their existing coverage keep it, as most Americans still do? [0]
There was an article that surfaced about an Indian hospital that had industrialized common health-care procedures. A four-year degree is not essential for these; why is it required? If we commoditize common and routine procedures via removal of barriers to entry, we can greatly increase the benefit without forcing those who like what they have to become worse off and without hurting more complicated situations.
Lastly, the problem with socialized medicine is that it cannot afford to spend beyond a certain amount per-person on average. End-of-life care is enormously expensive in America, but is better than in other places. [1]
Many of us may say it is foolish to spend upwards of a million dollars for a few more years of life, but having spoken to a few dying people, most say something to the effect of that they would give every thing they have for a few more weeks (the exception being those in exceptional pain, those with loss of senses, etc.).
EDIT: Downvoters care to comment?
[0] https://news.gallup.com/poll/245195/americans-rate-healthcar...
[1] https://www.forbes.com/sites/cjarlotta/2016/01/19/end-of-lif...
As for the "smartest, best" people becoming doctors... I don't think medicine is a path chosen simply because it's lucrative, in most cases. It's chosen because it's challenging (or sometimes, because it's expected). And those in it for the money are in paths of lucrative-but-socially-useless things like cosmetic surgery. High pay is incidental here.
Why pay coverage for things you'll never use? Same reason I'm paying for your broken arm. That's how insurance works. Spreading the risk.
Single payer systems - like Medicare, for example - are quite capable of covering experimental treatments. Why are you saying they can't? You're ignoring plain facts here. And it's possible that your experimental coverage might not be covered by your private insurer, either. I've been in that boat myself.
Fixed pricing is a far, far more transparent system than the current system of negotiating prices for the same things between different providers/insurers, so the same hospital charges $1.10 for aspirin here and $1.25 there. It also solves the problem of localized monopolies, such as rural hospitals, that can charge whatever they want because insurers have no alternative.
Why force people onto the same plan? Single payer doesn't do that, necessarily. Again, Medicare. There's a HUGE market for Medicare supplemental insurance (I work in that market). Wealthier people can afford additional coverage above and beyond single player. The single payer provides a guaranteed baseline, and covers basics so private insurers can focus on corner cases, extremes, and luxuries.
"End of life care is enormously expensive in America, but it is better than other places." Yeah, Medicare is single payer, right?
Insurance is supposed to hedge against risk. You might need a broken arm; I will never need a hysterectomy or birth control (especially not the type covered by insurance).
> localized monopolies, such as rural hospitals, that can charge whatever they want because insurers have no alternative.
And if the rural hospitals then shut down due to not being able to cover costs?
> Why force people onto the same plan? Single payer doesn't do that, necessarily. Again, Medicare. There's a HUGE market for Medicare supplemental insurance
The definition of single-payer is in the name - there is a single entity which pays for insurance. A single payer. That means, definitionally, no private/supplemental insurance, no cash payments, no nothing. Experimental treatment may not be covered by private insurance, but at least it can be purchased with cash. A single-payer system definitionally precludes a cash option.
> Yeah, Medicare is single payer, right?
Wrong; see above. Medicare is also subsidized in no small part by higher-paying patients; because it often reimburses at below-market rates, private coverage is necessary to pick up the slack.
Hedge against group risk. Why should I pay for your house burning down because it started on your deck? I don't have a deck. That's a terrible way of looking at it. The bigger the group/risk pool, the cheaper it is for everyone.
> And if the rural hospitals then shut down due to not being able to cover costs?
Sorry, that's not how socialized programs work. If there's particular need in communities they receive more funding. Or, the government flies people to nearby communities to seek treatment (see Northern Canada, Svalbard, etc).
> The definition of single-payer is in the name - there is a single entity which pays for insurance. A single payer. That means, definitionally, no private/supplemental insurance, no cash payments, no nothing. Experimental treatment may not be covered by private insurance, but at least it can be purchased with cash. A single-payer system definitionally precludes a cash option.
That's fine. Two tier is also fine. What's not fine is the status quo.
> Wrong; see above. Medicare is also subsidized in no small part by higher-paying patients; because it often reimburses at below-market rates, private coverage is necessary to pick up the slack.
Medicare subsidizes the private market by taking literally all the worst customers out of the risk pool. You've got this completely backwards. Without Medicare private cover would be astronomically expensive or have no margin.
Nope. I am also not okay with Medicare, Medicaid, Obamacare, and any sort of transfer payment from the feds.
> I'm guessing not, actually.
How remarkably prescient of you.
> you're using such a narrowly defined, pedantic definition of "single payer" as to make what you're railing against a total strawman. Not even the most socialist systems in the world, (Norway, Medicare, etc) come anywhere close to your extreme.
Gee whiz, I interpreted "single-payer" as meaning there was a single payer in the medical system? What sophistry!
I believe it was Senator Harris that recently said that "Medicare for All" included abolishing all private health insurance, and this has seemed to get traction among the far left. Senator Sanders has similar ideas; he would allow a small amount of private insurance, but only in addition to mandatory enrollment in his plan.
Reason Magazine corroborates the general definition: https://reason.com/2019/01/24/new-poll-shows-medicare-for-al...
Show me the part of the constitution where it says the government may sell health care. Show me the part that justifies transfer payments of any kind.
I proposed something of a solution above: remove the onerous regulations and allow industrialization of common procedures. This would cut out the bulk of health-care expense.
And how would you pay for such a plan? Even doubling taxes wouldn't do it: https://www.wsj.com/articles/even-doubling-taxes-wouldnt-pay...
We're in a hole, financially speaking. America has about ninety-five trillion dollars in about household value; the "one percent" hold about forty percent of that. Seizing all the money they have, thirty-eight trillion dollars, would just about cover the costs of this "medicare for all" thing for a decade. What do you do then? We're spending too much, not taking too little.
That's not an argument against the policy, it's an argument that if the policy is desirable it should be pursued by means which include a Constitutional Amendment.
Constitutional Amendments were designed to give each generation the power to decide both the specific content and the purpose of the Constitution; which was not ever intended to be a vehicle by which the long dead dictate the form of government to the living.
Not, of course, that national health insurance costs the original purpose of the Constitution, which is laid out in the preamble, however much one might argue it violates the details of the design.
> Why not allow states to do it for themselves? Broad-brush national solutions do not always work well.
Why not do it nationally? Isolated local solutions do not always work well.
> Labor costs are higher in certain places, conditions vary, etc. Why do it federally? My
National programs can, and do, account for local variations of the type you describe, and state-level programs aren't immune to having to deal with them, anyway.
No that's fine, you can tell grandma why she's not going to get that hip replacement or cancer treatment. It's because of your free market principals and she should have made more money when she was young. See, grammy, it says so right here in the constitution - and The Fountainhead!
If only there was a way to update or modernize or uh, what's the word, amend the constitution.
> I proposed something of a solution above: remove the onerous regulations and allow industrialization of common procedures. This would cut out the bulk of health-care expense.
Yes, it's the regulations, for sure. Like the ones that keep the air and water clean, and the rivers not-on-fire. And drugs safe. See if we just got rid of that, we'd be in great shape. You know what would make it really cheap? Let's get rid of medical licensing requirements. Now that's a money saver.
> And how would you pay for such a plan? Even doubling taxes wouldn't do it: https://www.wsj.com/articles/even-doubling-taxes-wouldnt-pay....
That's absurd. Even a Koch funded study showed MFA would be +/- 5% of what it costs right now, but would cover everyone, accidentally showing the unit economics to be much better. [1] You take all the money employers are currently spending on employee cover via a combination of payroll and personal taxes, direct it to the Medicare pool and enroll everyone. This isn't some sort of new wild plan. Other OECD member states do that right now.
By the way, the paper I link is the one the WSJ article cites (your link is broken) and if you read anything past the first page it clearly states that not only would everyone be covered it would cost less per capita and in total. Another study recently showed that Medicare and Medicaid do a better job of controlling costs than the private sector setting us up for success in the longer term, too. [2]
[1] https://www.mercatus.org/system/files/blahous-costs-medicare...
[2] https://www.modernhealthcare.com/article/20190211/NEWS/19021...
I'll ignore the flame-bait. I honestly believe that we could reduce regulation and make the poorest better off. I referenced above an example: an Indian hospital has essentially mass-produced procedures for low cost. Things like hip replacements do not take a brilliant surgeon with eight years of medical training; I think breaking the monopoly of the AMA and lowering regulation will allow cheap procedures at prices reasonable to almost all. For those last few, I believe Churches and states ought to shoulder the responsibility. I said nothing of "no health-care", I said that the feds shouldn't do it and that single-payer is a bad solution.
> amend the constitution.
Be careful with amending our founding document to push a policy agenda. This has been rarely done in the past, because if one side does it to suit one agenda, the other will reciprocate once re-elected. Maybe the far left could get socialized medicine, but the right might repeal the 14th amendment birthright citizenship next election.
> Yes, it's the regulations, for sure. Like the ones that keep the air and water clean, and the rivers not-on-fire. And drugs safe. See if we just got rid of that, we'd be in great shape.
What did I say of environmental regulations? We have them to protect the rights of others, and they are important.
With respect to drug safety, I do believe rules could be somewhat loosened, but I also believe some regulation is necessary.
> Even a Koch funded study showed MFA would be +/- 5% of what it costs right now
This is an "alternative fact" pushed by Senator Sanders and Congresswoman Ocasio. [0]
> You take all the money employers are currently spending on employee cover via a combination of payroll and personal taxes, direct it to the Medicare pool and enroll eveyrone.
Americans are generally leery of just "taking the money", "directing it", and "enrolling everyone". That's too heavy-handed an action for the feds to take. I would appreciate a different source for your cost, as the one you mentioned was not correctly represented.
With respect to unit economics, that does not account for quality. Note that the study you cited above mentions the outrageous cost in the abstract. It also mentions that Medicare reimbursement rates are roughly 40% lower than private insurance; where will the extra money come from? That doesn't make the unit economics cheaper, that means private health insurance costs are currently subsidizing low medicare reimbursement rates. The bulk of the "cost reduction" to which you are referring (over 85% thereof) came from provider payment cuts, which assumes the current 40%-below-market rate. That's not better unit economics, that's monopolizing an industry and fixing prices. The remaining <15% came from better drug prices. I will concede that a monopsony tends to lower prices for certain things, but this is not nearly what you claimed.
[0] https://www.factcheck.org/2018/08/the-cost-of-medicare-for-a...
I tried to downshift in 2017 but ended up having a $1400/mo health ins. payment for my family and me and that was more than my mortgage, which was about $650/mo. At least with the mortgage you know your future costs. I have since paid off the mortgage, so if we stay put, I have only property taxes to worry about.
Now, the last question is: What will taxpayers bearing the cost of everyone'se healthcare do to my taxes? The US is $21 Trillion in the hole and counting. I won't be paying much income tax, only taxes on capital gains and dividends.
My only other concern is that food prices keep rising like crazy, so do things like car insurance, homeowners' insurance, bills, etc.
I don't like private health ins--I work at a major provider and I know full well how billions get wasted. However, I think government taking it over is going to be the worst thing the US has seen since probably the Civil War. I'm certainly not paying for it all, you can go figure it out for yourselves.
Do it! We've got more people than jobs necessary anyways, certainly once automation enters full swing.
> I tried to downshift in 2017 but ended up having a $1400/mo health ins. payment for my family and me and that was more than my mortgage, which was about $650/mo. At least with the mortgage you know your future costs.
This sounds like single payer will provide you with freedom.
> Now, the last question is: What will taxpayers bearing the cost of everyone's healthcare do to my taxes? The US is $21 Trillion in the hole and counting. I won't be paying much income tax, only taxes on capital gains and dividends.
Even a Koch funded study found that the cost of providing cover is +/- 5%-ish the amount we're spending on medical cover right now, and other studies have shown Medicare does a better job of controlling costs than private insurers. The way the system would be executed is that the amount employers are currently paying private insurers would be redirected to the public purse, either via payroll tax or via personal income tax, or both. No new money needs to suddenly appear from thin air, it's just getting re-allocated.
You won't be paying much income tax, others will. Dividends are usually treated as ordinary income, FWIW.
> I don't like private health ins--I work at a major provider and I know full well how billions get wasted. However, I think government taking it over is going to be the worst thing the US has seen since probably the Civil War. I'm certainly not paying for it all, you can go figure it out for yourselves.
And yet you were planning to go on Medicare right? People in America seem to like Medicare. Why is it socialized medicine only becomes "good" once you hit 65? It's like parents trying to explain alcohol to children: It's really really bad until you turn 21 then suddenly its really really good.
Here's the study that showed Medicare and Medicaid control costs better than private insurers: https://www.modernhealthcare.com/article/20190211/NEWS/19021...
Do all other OECD countries cover nursing homes for free until death? That's the case when liens apply - not hospitalization.
https://www.aarp.org/health/medicare-insurance/info-1996/are...
I don't think it is entirely unreasonable that medicaid - a medical program for poor people - has the right to put a lien on someone's estate. Normally people on medicaid don't even have estates (or else they wouldn't meet the asset test), but for some reason we don't count house equity for the asset qualification criteria. Very unfair for renters - this at least somewhat equalizes things.
The NHS in the UK does, yeah [1]. In Ontario, end-of-life care is also provided and long-term care is provided for ~$1800CAD per month if you can afford it, and it may be free if not via a combination of CPP, social security and income-based subsidies. [2] In 2002, France introduced universal, income-adjusted, public long-term care coverage for adults 60 and older [3]. The Netherlands does too [4]. The rest of the OECD I'm not sure. Most developed systems do offer something.
The health system really is better pretty much everywhere else in the OECD. And remember! Every one of the systems I mentioned spends less per capita than the US. In some cases like Canada half.
> I don't think it is entirely unreasonable that medicaid - a medical program for poor people - has the right to put a lien on someone's estate. Normally people on medicaid don't even have estates (or else they wouldn't meet the asset test), but for some reason we don't count house equity for the asset qualification criteria. Very unfair for renters - this at least somewhat equalizes things.
While I don't believe in inter-generational wealth I'd argue this furthers the cycle of debt and poverty by taking an estate away from those who could most benefit - the poorest.
[1] https://www.nhs.uk/conditions/end-of-life-care/hospice-care/
[2] https://www.ontario.ca/page/get-help-paying-long-term-care
[3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4462881/
[4] https://www.researchgate.net/publication/304653227_Long-Term...
The insurance system is already bureaucratic as all get out. Creating one payer would actually streamline the experience.
The government has a monopoly on the national defense as well, a good that we all need. That works. Why wouldn't health care be the same.
Canadians and British folks seem pretty happy with their nationalized health care.
Sounds pretty efficient to me!
Of course what we have now with employers sponsored plans is the worst of both...
If you do have the money you can get your own supplementary health insurance that goes above and beyond. (This is common in Canada, not sure about England though.)
https://www.nbcnewyork.com/news/national-international/Ameri...
On the other hand, other first world governments adds strong government involvement in healthcare markets and average half the cost we do in the US. If you look at say the NHS in UK, it's pretty clear that government involvement results in a much smaller amount of bureaucracy from healthcare compared to the US.
Now turn the table, you are the one with cancer. There is an expensive treatment that might or might not work, but it is the only hope left. How much is this wroth to you?
With money. It's like insurance, except paid through an extra tax.
> Or more accurately, why.
I mean, are you really asking why someone sees human life to be roughly of equal value, regardless of said human's wealth? But let's look at it differently: I don't think public healthcare precludes people from access to private treatments and additional private medical insurance. Public healthcare is just another baseline service offered by the government, which happens to remove the need for most of the people to seek that service in private sector. Like many other government services, you could view it as a formalization of helping others in need.
> There is an expensive treatment that might or might not work, but it is the only hope left. How much is this wroth to you?
Obviously, all the wealth I can command at the moment - meaning what I have, + what debt I can get into. Which is precisely why healthcare needs to be regulated, and why public healthcare is useful - private providers know that true demand price for many medical issues is essentially "all that you have", and they will try to get all that money. Inserting the government between the healthcare provider and the patient means the provider doesn't get to "negotiate" with an individual under duress.
Employer sponsored health care is just one example of a government sponsored incentive, one that was supposed to help, that turned out to be a terrible idea. In fact, most of the problems we have with healthcare in the US are the result of well intentioned government interventions. Is the solution really to have more government involvement? No, not just that, an entire government takeover? Is there really confusion as to why people are nervous about this idea? Other countries that have succeeded with single payer have populations smaller than some of our cities, and near zero diversity with regard to race, religion, individual cultural upbringing, etc. How do we know it will scale up to over 300 million people with widely differing politics, religion, culture, geography, population density, etc.?
What's weird? That we have food stamps for those who are temporarily (at least that's how it's supposed to be) in a bind, yet not everyone uses food stamps? Why do you think that is?
Does everyone love medicare? Every doctor I've talked to hates it. It doesn't pay on time, it pays below market rates, it sometimes just doesn't pay at all, it doesn't let the doctors choose what care they think is best, etc. Doctors tell me that the rest of us are all subsidizing medicare patients right now, that if they could get away without seeing any medicare patients they would. How is that going to work out when we are all on medicare?
Because it's means-tested?
You're describing a two-tier health system, which many countries operating under a "socialized" model follow including Australia. That's fine, too. The government provides a safety net of basic coverage and then those who want more or whose employers want to lure them with the promise of better care can opt for private care. This would still work if Medicare were an open enrollment for anyone who wanted it.
> Does everyone love medicare? Every doctor I've talked to hates it. It doesn't pay on time, it pays below market rates, it sometimes just doesn't pay at all, it doesn't let the doctors choose what care they think is best, etc.
You can't on the one hand complain about the rising price of healthcare in the US, how it's moving further out of reach for everyone, and at the same time complain that the socialized program "pays below market rates." That's the definition of lowering costs, something the US has to do more than literally every other country in the world. That's a good thing. In fact, that's an argument for the system we're proposing.
> Doctors tell me that the rest of us are all subsidizing medicare patients right now, that if they could get away without seeing any medicare patients they would.
That's kinda hilarious. Medicare patients are the most expensive, worst customers for a medical program. They're all old, sick, dying or about to. That's facts. If the private system had to bear the burden of treating those patients their margins would implode or costs would balloon. The Medicare program as it exists right now is a huge subsidy to the private sector -- especially as it's forbidden from negotiating drug prices like any other sane system permits.
> How is that going to work out when we are all on medicare?
It's going to work fine like it does in every other country in the OECD. It's not like we're proposing something wildly outrageous and unheard of. Every other developed nation does this and has better health outcomes across the board with half the cost.
"You can't on the one hand complain about the rising price of healthcare in the US, how it's moving further out of reach for everyone, and at the same time complain that the socialized program 'pays below market rates.'"
I think that American people (probably more than any other country) value freedom of choice more than "cost cutting." Also, the idea of reducing costs by a government simply taking over the market really stinks of tyrannical authoritarianism in these here parts. It's distinctly un-American (like it or not).
Strangely enough, freedom of choice (i.e., increased supply along with low switching costs and price/value transparency) generally also leads to cheaper prices. I'm pretty sure that reforms in those types of areas are what would most easily get support from American people.
Yes, we could just go along with what other countries have done, but dang it, America is a leader. America champions freedom. If you want a better system (and I'm sure just about everyone in America does, I know I do) those are the things you have to sell.
That's a false choice because the vast majority can't afford the choice and never will. The rest the choice of physician is made for them by their employer.
> Strangely enough, freedom of choice (i.e., increased supply along with low switching costs and price/value transparency) generally also leads to cheaper prices. I'm pretty sure that reforms in those types of areas are what would most easily get support from American people.
No, it doesn't. Not when your life is on the line. That's what the OECD and WHO data shows.
> Yes, we could just go along with what other countries have done, but dang it, America is a leader. America champions freedom. If you want a better system (and I'm sure just about everyone in America does, I know I do) those are the things you have to sell.
Not in this case. It's an abject failure here. It's the world's most expensive per capita -- by a country mile. It costs twice as much as Canada, has the same level of health outcomes, covers far fewer people. It's a bad system. America has lots of positive things but it's by no means a world leader in everything. For instance, not being obese.
Just because you're in front doesn't mean you're going in the right direction.
But I'm not convinced that it's a total explanation, either. Necessary but not sufficient.
Like you said, small countries already do this. When 2/3 of the states can agree on a system then we make it federal. This is more like what Sweden does, their counties finance and administer health care according to agreed upon federal standards.
The U.S. government has already made a huge mess out of health care- the biggest in the world it appears. I don't trust them. We've already been screwed by industry lobbyists. They need to take a back seat and let the states run with this for now. As per our constitution.
I am 100% in favor of various plans at a state level. Vermont was going to do single payer before Obamacare. That's what I want to see. States will copy successful systems, and an amendment can eventually be passed once enough states agree on a federal system.
Besides the fact that is how it's supposed to work in this country. The constitution doesn't give the fed the power to regulate health care. That is supposed to require an amendment, which requires something more than a 51% majority because it is a big deal.
Just as abortions aren't outlawed federally, I think making sozalized healthcare equally available will perhaps be similarily difficult as it is to make abortion equally available.
And having one federal system creates corruption - a one-stop shop for lobbyists.
Do you really want congress and the president deciding on budgets for various illness, prescription costs, what is covered, etc?
I was pointing out that this is what makes America "varied" compared to other countries and it will introduce complications and variations in how a healthcare system is going to work for it's citizens if they do try to mimick Canada, UK, etc.
I would also hope that the hospitals have a bit more autonomy and they aren't hamstrung by congress deciding they aren't allowed to spend more than 5mn on sedatives or some other really narrow and specific budget.
Counter-argument... this isn't simply a question of "capitalism" vs "socialism". There are a wide variety of models in use out there, from the mostly-socialist (Sweden) to mostly-market (Japan). What they all have in common, though, is that all of them are producing better coverage and better outcomes at lower costs than the American system. We pay twice as much as the rest of the world, for the privilege of millions going without coverage, millions more trapped in jobs they hate for the sake of health insurance, and millions of families bankrupted by medical costs outside of what their insurance (or lack of insurance) covers.
In other words, the existing American model that you're defending is uniquely bad. It's more expensive and less efficient than any other system in the industrialized world. It's not about whether we can do better. It's about whether we could possibly do any worse, at this point.
Careful, those are fighting words! I am in no way defending the current American model. It sucks. Let's be clear here. I highly, highly doubt that anyone is arguing for status quo in America here.
I'm defending capitalism against single payer and medicare for all proposals that rely on magical thinking and trusting our government (that got us into this terrible status quo). If Japan has a mostly market-based solution then lets hear about that some more.
EDIT: "It's not about whether we can do better. It's about whether we could possibly do any worse, at this point." Yeah, that's the kind of cynicism that I'm also fighting against. "Yep, we are screwed, might as well try socialism" is not an attitude I'm inspired by.
Medicare is, in fact, the largest single payer system in the world, and it's a large chunk of the American system. Criticizing single payer would do well to start by criticizing the current Medicare system. But that means separating it logically from the privatized employer-based insurance model, and that's a very difficult knot.
Will do.
I have spoken with doctors and they hate medicare. It doesn't pay on time, it pays below market rates, it dictates what they can do with their patients, etc. These doctors still see medicare patients out of compassion, but they are losing money on each one. Think I'm making this up? I just did a quick web search and here's a quote from someone else:
"Yet, thanks to the federal program’s low reimbursement rates, stringent rules and grueling paperwork process, many doctors are refusing to accept Medicare’s payment for services. Case in point: In 2000, nearly 80% of the Texas Medical Association’s doctors were taking new Medicare patients. By 2012, that number dropped to less than 60%.
Why are more and more doctors turning down Medicare? The answer is simple: Medicare typically pays doctors only 80% of what private health insurance pays. While a gap always existed, many physicians feel that in the past several years, Medicare reimbursements haven't kept pace with inflation (especially the costs of running a medical practice), while the rules and regulations keep getting more onerous, as do penalties for not complying with them." --https://www.investopedia.com/articles/personal-finance/10021...
Here's another link a quick web search turned up: https://www.verywellhealth.com/doctors-accept-medicare-insur...
So, if we all go only-medicare, how many doctors decide to retire early? <edit>How many potential doctors will decide to do something else instead?</edit> What quality of doctors and care are we left with?
If by that you mean the entire OECD then yes, some tiny homogenous countries have tried it. And it works great. Also, diversity has nothing to do with medicine.
> I have spoken with doctors and they hate medicare. It doesn't pay on time, it pays below market rates, it dictates what they can do with their patients, etc. These doctors still see medicare patients out of compassion, but they are losing money on each one.
Lowering reimbursement rates reduces costs, that's how it's supposed to work. Did you think costs just go down while people get paid the same or more? Where did you think the money was to come from? Sorry, America's costs are 2X Canada's, those doctors do need to be paid less.
> Why are more and more doctors turning down Medicare? The answer is simple: Medicare typically pays doctors only 80% of what private health insurance pays.
Great, now all programs will pay the same, much less than today. You do know doctors in Canada make $200-500K/yr right, they're not exactly starving. They don't need to make more, they're public servants.
In the US the mean salary for a doctor is just shy of $300K (range $200-663K). In Canada the mean salary $225K, ranging from $232 to $676. I think they'll manage with the pay-cut.
> So, if we all go only-medicare, how many doctors decide to retire early?
Those who scrape by on $250-500K/yr and save, then retire, like the rest of the 1%.
Isn't the whole argument that our system is inefficient and therefore expensive? Get rid of the inefficiency and doctors should still get paid the same, no? Again (I think we are going back and forth in different threads here), free markets are great at doing that. We should try it with health care.
Doctors become public servants. They should get paid relatively comparably to other first-world countries but the fact is what they're getting paid right now is unsustainable for us as a society if our goal is to cover everyone at a reasonable price -- and it should be. Preserving doctors top-0.5% pay is strictly a non-goal. Building a functioning public health system is a goal.
That's pure tyranny. Stop it. People are paid what the market dictates, not what some government bureaucrat decides.
That's just partisan nonsense, platitudes disguised as criticism. You need to do a lot better than that. I could come back with plenty of failure modes for capitalism as well, but I very much doubt you'd call them proof that capitalism is a "proven failure", and I wouldn't make that argument myself. There are many cases where socialism has worked well and continues to work well.
What you are describing is not proposed.
This is obviously total and utter nonsense. Look at every other western country. Nobody is banning you (or your employer) from buying additional private health insurance. It's simply providing a basic level of service in this arena, just like roads, army, police, fire, health and safety, etc, etc, etc.
Comparing government provided healthcare to Venezuela is a straw man.
Oh??
https://www.nytimes.com/2019/03/23/health/private-health-ins...
(EDIT Formatting)
It is in fact illegal in Canada under federal law: private clinics are not legally allowed to provide services covered by the Canada Health Act. I'm still for it, though, and the rest of your point stands. It's just like roads, army, fire, etc.
> Comparing government provided healthcare to Venezuela is a straw man.
It 100% is a straw man.
The biggest downside to socialized care is stagnant innovation and a slow-moving bureacracy, and the major drawback to private care is unlimited catastrophic consequences for major health issues, and the fact that cost-comparison isn't possible for emergency care.
If I were decider for a day, I'd flip a coin for either option over what we have currently.
edit: Also, in the future, maybe we'll have AI doctors, and we're presently seeing remote health care through apps. I'm not talking specifically medical treatment technology, but so many other methods of health care which would greatly be encumbered by heavy-handed government regulations.
Kaiser isn’t much of an innovation it’s just a scaled down model of any socialized health system. It’s exactly what Canada has but smaller.
Also, in the US, Kaiser is an innovation. Comparing a voluntary, private organization to a forced, tax-funded system is a false comparison.
No, it isn't. It's the reason health insurance isn't insurance. Literally everyone will at some point come down with an emergency or life-threatening condition, and 100% of us will eventually die of one. It's not insurance if it's going to happen to you.
> Also, in the US, Kaiser is an innovation. Comparing a voluntary, private organization to a forced, tax-funded system is a false comparison.
That doesn't make it innovating. Cloning a system that works elsewhere isn't innovation. Get over the "forced tax funded" nonsense too, unless you want to relinquish all social services like education, fire, water, etc.
Most people are good, folks, otherwise no society is going to work!
None of which means it isn't true (it is), or that it isn't important (it is), but that's why it doesn't get used as an argument very much.
How can we know? Because if they were pro small business they would be pro universal healthcare, so that it would be easy to start your own business.
I suspect the "right" is actually sincere. But it so happens that ideas giving more power to private businesses tend to disproportionally benefit larger businesses over the smaller ones (this is a natural advantage of having scale and capital). The ideas surgically targeted to benefit smaller businesses? The "targeted" aspect tends to pattern-match to the "left", so they get rejected. The end result looks like the "right" was dishonest, but IMO it's just the ass-backwards stupid fixation on ideology over problem solving that causes this. And the same thing applies to the "left".
It should be like the green new deal - the economics of eg Medicare4All is similar in that it’d greatly improve life for small business as well as families.
http://fortune.com/2017/08/21/bernie-sanders-medicare-for-al...
Being trapped as the vassal of a giant corporation just to not-die is in direct opposition to the very concept of liberty. Being able to quit your job and create your own business is an essential freedom. But liberal politicians are unwilling to market that way, and so the neoliberal political class gets to argue for the preservation of a system that benefits the wealthy and the corporate at the expense of the liberty (and wallets!) of ordinary people as the "free market". Feh.
This argument has in fact been made by a great many liberals and moderates, many times, going back to Clinton's (failed) attempt to pass a single-payer health system.
I don't agree or disagree with the claims, but they're not easily refuted because they're not falsifiable. They amount to "we should do this because I think it's better". It's not persuasive. A better argument would be, "We all want to take care of poor people and improve our economy--we can do both and here is the data". Of course there will still be lots of friction and lobbying and so on, but at least it's a compelling argument.
I don't think it is too easy, to find such facts and figures. Can you give us some links to them?
Edit: it's true. If you are a democrat candidate and this is the angle you push, it's not going to work. But you already know that.