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.
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.?