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...