Since it looks like Clinton is going to win the 2016 election, and it is no secret that s pro-single-payer healthcare, I would like to dedicate a thread to the possibility of having it implemented in this country.

It's no secret that I've been a fairly staunch conservative on this board, but over the years I've mellowed out some - I don't really care about abortion, definition of marriage...most of the social issues I couldn't care less now. I still consider myself fiscally conservative though, so in the past I've not been a big fan of the ACA or single-payer systems.

Having said that, for the folks here that want single payer, could you explain why you think it would be better for us - mostly middle or upper middle class thirty-somethings. I get that single payer would be great for those unemployed or underemployed who don't have access to employers insurance plans, and yes I agree that it is great that they can get it now, but I fear that single payer, more than the ACA, will be built upon the backs of those in the middle class.

This year, my individual deductible has gone up by 1100, while my premiums are now almost 1000/month. On top of that, i've lost my access to a prescription plan, which means until I meet my 40% higher deductible, I have to pay full price for prescriptions. I was paying approx. $550 for my family plan this year. Needless to say, this is a huge chunk of my paycheck that I will lose.

I'm thinking now that things can't be much worse than that, so if single payer can help reverse all of this, by having me pay more in taxes, I might be open to the idea.

So is it possible to debunk the clutter that comes from partisan politics surrounding single payer and come up with an actual scenario of what it would look like in this country? I can read about how it works in Canada and in the UK and other European countries, but I don't see that we could compare apples to apples here given our massive economy.

I guess my questions boil down to basically:

1. How much of a percentage of my paycheck could I expect to lose in taxes and

2. What kind of care could I realistically get for said increase in taxes.

Also, let this be just a general discussion for the pros and cons of single payer.

10/21/2016 11:00:53 AM

Clinton isn't pro single payer, so you can delay this thread at least 4 years.

But to answer your question, you should stop basing your politics on what benefits you personally and start basing it on humanity as a whole.

[Edited on October 21, 2016 at 11:33 AM. Reason : .]

10/21/2016 11:29:12 AM

https://en.wikipedia.org/wiki/Veil_of_ignorance

10/21/2016 11:36:12 AM

Quote :

"But to answer your question, you should stop basing your politics on what benefits you personally and start basing it on humanity as a whole. "

I ask for a logical discussion about how we would implement single payer, an this is all I get, typical.

10/21/2016 11:49:38 AM

I am curious about this as well. The impact to my family has been pretty drastic from a monetary perspective, so I would welcome a change that would make it more affordable.

[Edited on October 21, 2016 at 11:53 AM. Reason : ed]

10/21/2016 11:52:05 AM

http://www.citizen.org/Page.aspx?pid=577

10/21/2016 12:00:26 PM

I, too, highly doubt that Clinton is gonna dive head first into single payer, especially when she is going to be dealing with congress.

Instead we will see "pragmatic incrementalism" (that's assuming we see any movement at all).

There have been various "fixes" proposed for the ACA, some good, some bad, some probably meaningless, but those will take priority.

After that we will see Medicare and Medicaid expanded to cover more people. Reducing the age people become eligible for Medicare and raising the income level for Medicaid. This actually could go a long way toward reducing costs for those of us that wouldn't be covered.

After that I'd like to see certain expensive to cover segments of the population get coverage. Like people with chronic conditions, or all children or something. Or it could be the opposite, the federal government could cover all "catastrophic" type events, since that would be cheaper to do than the chronic conditions.

The wildcard will be the states. We are going to start seeing state level attempts at single payer or universal healthcare. This trend is just beginning and I expect we will see many more attempts in the coming years. If any of the states find success we will see other states follow suit, and eventually we could see the federal government offer the same system or we would have a network of state systems.

10/21/2016 12:12:41 PM

Ok ok ok. Let's stop harping on what Clinton will do. Let's just assume that at some point, after we're done with the incremental steps toward a single payer system, that we'll be there eventually.

That link that adultswim posted was good, but there are going to be some negatives that it ignores, like the inevitable higher taxes.

So how would it impact the middle class - the teat of which is currently being milked for as much as it can.

I care about all of humanity, but I care about putting food on the table more.

10/21/2016 12:25:51 PM

Your employer wouldn't be paying for insurance anymore, so your salary should be offset based on that. Smaller benefits package = higher salary.

10/21/2016 12:37:40 PM

In theory. But likely these companies will just pocket the change.

How would we pay for it though? Say my employer no longer has to provide me with insurance, so instead of putting $15k towards my insurance, they give me a $15k/year raise. Now I'm bumped into a higher tax bracket, so I'll be paying a little more in taxes that way, but that bump couldn't possibly fund a national healthcare system.

10/21/2016 12:40:30 PM

One way to pay for it:

https://berniesanders.com/issues/medicare-for-all/

And tax brackets are incremental. For example, if you are right under the next tax bracket and you get a $5k raise, you only pay extra taxes on that $5k.

10/21/2016 12:46:34 PM

that money and more will just be redirected towards taxes. While single payer in theory should reduce the cost of medical care through bulk price negotiations, those effects may take years to settle out. We still haven't seen prices fluctuations from ACA settle out, and it's been years now.

10/21/2016 12:47:30 PM

ACA isn't at all comparable to single payer and there are no substantial price restrictions to keep those "fluctuations" in check. Consumer cost will continue to rise every year.

Single payer of course would take time to settle into the intended price point. But if other countries can do it, I think the most powerful country on earth can do it as well.

10/21/2016 12:53:10 PM

Yeah I don't know a lot about this type of stuff but I can see why most people hate the ACA other than those who get insurance now who didnt before. I am not sure who those people are who they said would pay less but my premiums went up about 85% this year and I think nearly everyones went up. With a lot of the insurance companies getting ready to bail on it soon is there any reason to assume the price isnt going to continue to rise until most of us just can't actually afford insurance?

10/21/2016 12:56:29 PM

Hard to say exactly how much money would need to be raised, but I thought there were some analysis floating around that used VA costs to estimate single payer costs. I'll have to look around for that.

Another thing to consider are the economic benefits that could result from single payer. How many potential entrepreneurs sit at their crummy, below them, corporate job because they want/need access to company provided healthcare? How many companies hold off years in investing in Improving their company because of volatile healthcare prices? Same for individuals putting off purchasing some need they've been looking at.

[Edited on October 21, 2016 at 1:01 PM. Reason : Too slow]

10/21/2016 1:01:22 PM

Quote :

"And tax brackets are incremental. For example, if you are right under the next tax bracket and you get a $5k raise, you only pay extra taxes on that $5k."

This is how taxes have worked for the history of taxes.

10/21/2016 1:05:58 PM

Yes, it's surprising how many people are never taught that. I've had to explain it a lot when talking about Bernie's tax plan and medicare for all.

[Edited on October 21, 2016 at 1:08 PM. Reason : .]

10/21/2016 1:07:43 PM

I had to explain how taxes work the other day to several people who get paid more than I do.

10/21/2016 1:36:57 PM

Gonna be honest I didn't actually know that either. Had always heard people talk about stories of getting a raise and making less money because they went up tax brackets, guess those were just stories indeed haha.

10/21/2016 1:48:03 PM

Quote :

"Or it could be the opposite, the federal government could cover all "catastrophic" type events, since that would be cheaper to do than the chronic conditions."

I say we dip our toe in the water with this being the single payer coverage. If that's good enough for you (it's enough for me) then great you have free healthcare. If not, buy supplemental insurance.

If that goes well then we look at expanding.

10/21/2016 1:52:14 PM

^ I think it's the low hanging fruit too, and would benefit me personally the most, unfortunately I'm not sure it would do much for costs since the chronic conditions are such a significant portion of healthcare spending.

[Edited on October 21, 2016 at 2:15 PM. Reason : Assuming you needed coverage beyond the single payer, it'd prob be more expensive ]

10/21/2016 2:14:22 PM

Anything would be an improvement over the current system. Even single payer.

10/21/2016 4:24:51 PM

Regardless, why can't we call it what it is instead of a ridiculous euphemism?

10/21/2016 4:48:39 PM

Single-payer health insurance?

10/21/2016 5:19:41 PM

In principle I favor a single payer health system. Ideologically it looks like it should be a terrible idea, but in practical terms, countries with single payer have better health for less money. You can quibble about the details, and whine about lifestyle differences, and all that, but at the end of the day the facts are inescapable: Canucks, Limeys, Frogs, Krauts, and Crocodile Dundee all spend less per person and live longer for it.

In the face of cold hard reality I am willing to let go of my ideas.

Unfortunately, the reality doesn't stop there. This country is enormously invested into its current health care system. 17.2% of our GDP is tied up in it. Half a million people (at least - the estimates I'm finding are pretty conservative) work in health insurance. The entire structure of our medical system, from folksy country doctor to sprawling urban hospital, is designed around private health insurance. Extricating it is probably a pipe dream.

Obama has said as much - that if he had been able to design the system from the ground up, he would have wanted single-payer. But he knew going into the healthcare debate that it wasn't in the cards.

Two realities -- single payer works better, and we can't have it -- have to meet somewhere, I guess. My hope is for something a little more to the American end of the spectrum than what the British have: the single payer for everybody, with the option for private providers and supplemental private insurance.

This would keep the private insurers in play, diminishing rather than eradicating them. It would allow people with money to receive care a little faster, maybe a little better, if they wanted to pay for it. But it would also make sure that people without money still get what they need. They key pitfall is that it would require some intelligent management and real public support, or else we'd just have the public hospitals be disgusting "free clinic" nightmares while every white-collar person just spends a bundle to go to the private institution. This can be done, of course. The Brits are generally quite fond of their system. But it does require a set of circumstances we don't have just yet.

---

How much would this cost? A lot, though a comparison with other countries suggests that in the end it would cost less than we as a country currently pay.

How much would your taxes go up? Obviously we have no idea. I don't know what bracket you're in, and I don't know how the costs would be distributed.

How would the middle class be impacted? Well, hard to say. But our middle class is shrinking, and Canada's is holding steady. So evidently a single payer plan isn't an automatic middle class killer.

10/22/2016 11:07:21 AM

^
Can you talk to my dad please

10/22/2016 12:16:05 PM

Well of course we would allow private providers and private whatever. This is America, not Britain or old-timey Canada. Enslaving our doctors is not something we would do (making it illegal for them to work anywhere but for the government). That said, there is a structure issue. Just because the government is paying, it would be ruinous to have the government run it. The government seems horrible at managing its own employees.

So, what we need is a system where the vast majority of the employees and business decisions are made by private industry. We also need a system where patients and doctors are somehow discouraged from wasteful behavior. We also need the system to devise and enforce best practices that are actually in the national interest, not necessarily in the interest of avoiding lawsuits.

First things first, the AMA needs to be nationalized or a replacement created on the national level and managed by direct appointees by the president and approved by the Senate. Preferably NOT doctors. This organization will write regulations on best practices, investigate malpractice, and license providers.

That should fix the AMA monopoly which is driving up costs. That still leaves the actual provision of care. A plan I like is the Japanese system where a government bureau sets price caps by region absurdly low and pays all comers. The actual provision of healthcare is otherwise a free market. Of course, in Japan, it is illegal to accept a price different from that set by the government. This seems a bit restrictive, so if the Bureau sets prices too low somewhere, patients will be trapped without any legal care. So what I like is allowing doctors to charge above the price caps, with the difference to be paid by the patient. This will allow the Bureau to set prices lower than they otherwise would, because there is more political pull from people dying without care than people merely having to pay something out of pocket. This will also manage one of the big problems in Japan, which is abuse of the system by excessive care (people get bored and see their doctor for weekly checkups) because I suspect only the most cost averse among us would limit ourselves to care providers that stuck to the price cap.

I also like the French system. What about my proposal would anyone change and why?

10/22/2016 3:24:17 PM

I don't reject it out of hand, but I'm not sure I see what prevents providers from exploiting it.

The bureau says an X-ray costs $100 and will pay up to that point. Bob's radiology charges $125, so patients (or their supplemental insurance) pay $25. Nobody is too upset by this. But it occurs to Bob that if people were willing to pay $125 before, they'd probably be fine with paying $50 now. Maybe $75. So he raises the rate, people keep paying because it's still cheaper than it used to be, but now Bob is gaming the system and suddenly there's very poor people that can't get an x-ray.

Another problem is that any system which allows for personal costs still leaves out the poorest people. The reason I prefer outright single payer with private supplements is that even someone who is completely destitute will get their care. It might not be the fastest or the best, but it will be care. Whereas someone with no money who lives in a world where care costs a little money is still basically just as screwed.

If I'm missing something that fixes these problems, then I'm intrigued.

10/22/2016 6:18:46 PM

govt regulation fucked up healthcare so bad nobody can afford it anymore so the solution must be more govt regulation. ok





[Edited on October 23, 2016 at 9:35 AM. Reason : y]

10/23/2016 9:31:10 AM

Because Adam's radiology nearby will do it for free.

10/23/2016 5:15:32 PM

What reason do we have to think that? What guarantee?

Even in fields without the government handing out money, price collusion is rampant.

10/23/2016 8:45:35 PM

I would likely lose my current job if we went to a single payer system but it's still my #1 most wanted change for the US. I can find another job, small price to pay for all Americans to have access to decent healthcare.

And even if I can't find another job, at least I'll have healthcare

10/24/2016 12:02:11 AM

Quote :

"What reason do we have to think that? What guarantee? Even in fields without the government handing out money, price collusion is rampant"

Without barriers to entry, phantom competition alone can handle it. But most cities already have numerous suppliers. When a 50% price cut for the consumer only costs 10% of revenue, it will be impossible for any cartel to prevent cheating.

That said, the current system is rampant with barriers to entry (proof of need requirements in north Carolina, for example). A government regulation of prices would lessen the destruction being wrought by the existing government regulation of supply. Fair point.

[Edited on October 25, 2016 at 10:23 AM. Reason : ]]

10/25/2016 10:21:35 AM

Quote :

"Well of course we would allow private providers and private whatever. This is America, not Britain or old-timey Canada. Enslaving our doctors is not something we would do (making it illegal for them to work anywhere but for the government). That said, there is a structure issue. Just because the government is paying, it would be ruinous to have the government run it. The government seems horrible at managing its own employees. So, what we need is a system where the vast majority of the employees and business decisions are made by private industry. We also need a system where patients and doctors are somehow discouraged from wasteful behavior. We also need the system to devise and enforce best practices that are actually in the national interest, not necessarily in the interest of avoiding lawsuits. "

This! Government run programs never seem to work and are just a waste of tax dollars. We need less government employees, not more. From what I have heard, single payer isn't as great as its supporters make it out to be. You have to wait in line for quite a while sometimes and by then it may be too late. The one big problem is people with pre-existing conditions/major medical problem. I don't know what the cure is to the problem. Somehow a system has to be developed to help them without the government being involved though. The problem is a lot of people have that attitude of, "I'm young and healthy, so I don't need insurance." The insurance industry needs their money to help the sick though.

10/31/2016 7:39:25 PM

Quote :

" The insurance industry needs their money to help the sick though."

Hahahaha

10/31/2016 7:42:02 PM

Corrections Corp of America needs our money to help reform the criminals. Donate today.

10/31/2016 7:51:53 PM

Quote :

"Hahahaha"

It's the truth. A friend of mine had a heart attack a year ago. The final bill was over $200,000. That bill was covered by the monthly premiums he pays along with the monthly premiums a lot of healthy people pay. The money doesn't just magically appear. Under the current system the monthly rates are going up because people with preexisting conditions can no longer be denied. Plus the fine is way cheaper than paying for insurance.

10/31/2016 7:52:44 PM

You do realize those bills aren't ever really "real", right? They are super inflated and then negotiated down.

10/31/2016 7:54:35 PM

^^
most countries with single payer healthcare pay less than we do and have a longer average lifespan. might be every country but i don't care to do the research atm

[Edited on October 31, 2016 at 10:41 PM. Reason : .]

10/31/2016 10:40:31 PM

the longer lifespan isn't because of their healthcare system though. I'm all for single payer but that won't make us healthy. We do have the best quality system for treating the sick even though it doesn't reach everyone. Our main problem is that society makes people sick in the first place with poor diet and education.

[Edited on November 1, 2016 at 1:18 AM. Reason : but the moderators don't want that discussed on this board. i guess its bad for advertisers.]

11/1/2016 1:05:33 AM

the understanding I got from my research was that other countries, all of them, single payer and otherwise, pay a fraction of what we Americans pay. However, in terms of outcomes, America's system is better, although only barely. The issue is that America consists of lots of various peoples, some of which naturally suffer worse health outcomes. Recent immigrants are the worst group, and America has more of them as a percentage of the population. Also, our young people are more likely to drive and therefore more likely to find themselves in the hospital from a fatal car accident. After adjusting for all these, (comparing white immigrants from Norway with white Norwegians still in Norway) the American healthcare system just performs slightly better than all. Not by much, but just enough to measure consistently in the statistics. We actually do get something for all the wasted effort and expense we throw at our sick patients.

But, a 5% improvement in outcomes is not worth spending 500% percent more. No way, no how. Sheer stupidity. Single-payer, please.

11/1/2016 1:09:17 AM

^So you are cool with that 5% dying, or remaining sick? Our system has its problems, but getting the government involved even more than it is now is not the answer. Just look at the VA.

11/1/2016 7:14:48 PM

Sure, dying is fine. Had you asked them before they got sick, they would not have chosen to spend the money saving their lives, so why should we want to spend it?

I'll ask you right now: would you take $200k right now in exchange for shortening your expected life-span by a month? I know I would, and I'm sure nearly everyone would.

11/2/2016 12:45:10 PM

would you take $200K right now knowing there was a 1.7% chance you would die a hell of a lot sooner from a treatable condition? because that's one estimate of how many people were dying in 2009 due to a lack of medical coverage.

http://news.harvard.edu/gazette/story/2009/09/new-study-finds-45000-deaths-annually-linked-to-lack-of-health-coverage/

it's easy as shit to say you want to live to 78 and a half instead of 78 and three quarters. but that's not what that cash is really preventing, is it?

[Edited on November 2, 2016 at 3:41 PM. Reason : ,]

11/2/2016 3:40:15 PM

This 5% shit is pointless when that 5% only helps a portion of the population.

11/2/2016 5:51:34 PM

^^ There is a lot going on here. We spend the $200k and yet still that 1.7% you're talking about died without having their illness dealt with. The vast majority of our ridiculous level of spending goes to keeping doctors rich and old people alive a little longer, not curing the young with easily treatable illness...and yet, our outcomes are still a little better overall. Which is bullshit: implement my plan, slash spending, treat the young, and let the old hit their expenditure caps and die.

11/3/2016 10:39:30 AM

So you want a cap put on someone who has a minor problem at age 80, but is otherwise in perfect health? My Grandpa had a heart attack in his 70s and then died 3 months before his 100th birthday.

11/3/2016 1:39:46 PM

Quote :

"I'll ask you right now: would you take $200k right now in exchange for shortening your expected life-span by a month?"

FUCK no

11/3/2016 1:54:06 PM

i would, if that was the only thing involved

but it was a stupid point because its not

11/3/2016 2:08:35 PM

eat the rich old but slightly unhealthy amirite

[Edited on November 3, 2016 at 2:32 PM. Reason : .]

11/3/2016 2:30:52 PM