Single payer debate no so easy

Slavister · Oct 9, 2018

jaeger19 said:
Look I have already debunked every one of your points so far..

Exactly what I did to yours

jaeger19 said:
Yes... I already explained your statistic. Lets say you have 2 people in the US that go in to see the doctor for an arthritic knee and need a total knee. You have 4 people in Europe go in for the same.

Wow.. only two people saw the doctor.. so costs must be less. Ooops.. no.. because those two people in the US are obese, diabetic and have copd. Because of those comorbidities.. they need MORE SERVICES.. than do the other 4 people combined. thus they create more demand for services.. despite being fewer people.
Understand?

Now you are arguing that the rest of obese, diabetic people with copd do NOT go to the doctor? Give me a break. After all, US has less people going to the doctor but per your stats it has all those issues...

jaeger19 · Oct 9, 2018

Slavister said:
On a side note, let's forget for the moment that a major chunk of debt is actually owed for foreigners. Let's concentrate just on that part that is owed to US people.

Your statement / insinuation that we can disregard somehow that part of national debt is completely idiotic. If it were true, you just magically found the unlimited source of funds for US government. All we need to do is issue US bonds; and might as well pay a high rate too(!)... you know, to collect more taxes that you mentioned!... and just require for these bonds to be owned only by US citizens.

There you go - unlimited source of funds for anything our Government ever wishes to fund! This National Debt does not matter according to you! Good job, Mr. CEO.

Actually.. largely yes. The national debt does not matter.. and not just according to me.. but to most economists. The reality is that the National debt doesn;t really matter that much except for how we PERCIEVE that debt.. that actually could be a problem.. if people begin to perceive that the dollar has no value because.. our currency is based on basically faith (unless its based on gold or other commodity)..
Well.. that public debt.. going back in to pay for healthcare, social security, education, .. goes right into peoples salaries and so forth.. which of course boosts the economy. And when you consider that the baby boomers will eventually die off.. and healthcare costs and social security will be less stressed..

Just not that big of an issue.

jaeger19 · Oct 9, 2018

Slavister said:
Exactly what I did to yours
...

Man thanks for that.. I needed a laugh.

Now you are arguing that the rest of obese, diabetic people with copd do NOT go to the doctor? Give me a break. After all, US has less people going to the doctor but per your stats it has all those issues...

See above.. look man..this has become a habit of yours... either you are purposely being obtuse.. or you have to spend a lot more time researching things. Okay.. I will go slow.

1. Yes.. fewer people going to the doctor. That DOES NOT MEAN THAT DEMAND IS LOWER. because demand for healthcare.. isn;t solely determined by just how many go to the doctor.. but HOW MANY AND HOW MUCH SERVICES.. they need when they get there.

As I linked to.. 5%.. just 5% of the population.. takes up over half the demand for healthcare.

That means.. the US can have higher demand for services.. because though fewer people go to the doctor than other countries.. the ones that go.. are far sicker because of their comorbidities..

Slavister · Oct 9, 2018

jaeger19 said:
You claim that because the US spends more in healthcare.. than other countries... like the UK.. it MUST MEAN.. that its fat.

You have to take this in context. It's not just plain simple literal comparison.

In case of UK vs US, cost of living difference is 5%. You claim salary difference is 20% (I won't bother checking). In that context,
- we pay 150% more for healthcare for capita than UK
- we spend a ton of extra TIME on dealing with unnecessary complexities and being middlement between insurance companies and provider offices (and sometimes HR of our companies)
- we get WORSE health care (on ALL parameters you had listed)

jaeger19 said:
Right.. so you plan in addition to radically change the education system for physicians. got it. Just create a law that orders universities to change their programs? How specifically do you plan to do this?

I don't think it's as complicated as you think. Once you have 1 reasonable program established, others will follow because students will flock to it.

Main point is that this should be part of the solution. How is the secondary question. First people have to agree on where to go before figuting out best way to get there.

jaeger19 said:
but then again.. you are not going to get the savings you claim. You claim that you are going to get the savings like other countries.. which get their savings from BOTH lowering administration AND lowering physician pay. So when you say.."its going to make up for it"... no.. it can't make up for it. You are going to drop their pay by 40kto 110k or more .. to get the savings you say you are going to get.

No, our savings can come from other ways. E.g. instead of lowering physician pay by much we can tax corporations more; i.e. what we might already be doing in current system effectively. In other words, redirecting all the spending that corporations do toward employee healthcare to single player system would be a big source of savings that other countries may not be doing.

jaeger19 said:
And thus you are not going to get the savings you claim we will because labor costs are the major way other countries get their savings.

That's your repeated, yet never substantiated claim.

jaeger19 said:
Sure.. Canada may pay their physicians well.. but as I linked to.. they have fewer physicians than other countries..and thus score worse on wait times (). you say.. well we will pay like Canada? Well.. are we going to decrease providers.. like they have?

So you are saying that even though Canada pays GREAT to their providers, they have FEWER of them... That goes against all your talk about how number of providers would increase or decrease based on pay.

jaeger19 said:
Uhhh..no you say.. we are going to get them from India. Okay.. why doesn;t Canada just go get a bunch of doctors from india.. why do THEY have a shortage? Its so easy right? And since they pay more.. they should be hauling doctors in from India left and right.. and have more physicians per population than any other country that pays less. Ooops.. they don't.

Maybe they have laws making it exceedingly hard for Indian [wanna-be] doctors to immigrate to Canada? Here is one link to talk about this. Here is another.

In short, Canada has been (due to incorrect predictions) reducing number of available training spots while at the same time shutting out foreign doctors and making it very hard for them to practice in Canada.

jaeger19 · Oct 9, 2018

manofknowledge said:
Most folks posting on this thread tend to over simplify the concept of transition to a single-payer health care system. They focus on the cost, or where savings would come from, or what doctors are paid. Here are a few points I'd like to make and upfront I am strongly in favor of single-payer.

First, even with single-payer, no one is forced to use it. Anyone can still pay physicians directly or get health insurance or get supplemental health insurance because like Medicare, single-payer would only cover about 75% of costs (Silver Plan).

Next Medicare, Medicaid, VA health plans all go away. That cost gets rolled into Single-payer. Single-payer covers everyone birth to death. Also, there is no longer a need for employer based health insurance unless the employer wants to provide a supplemental plan. Consequently the $500-$1000 a month out of your paycheck goes away and the employer doesn't need to worry about the cost of health care. They are off the hook for the expense.

The flip side of that is single-payer will require premiums , likely based on income, that like Medicare, would be a payroll deductiion.

The majority of doctors favor such a plan. Already Medicare is a major source of income for health care providers since the sickest people tend to be old. Most people on Medicare are happy with it.

Regarding wait times. The long wait time argument has no merit because in single-payer there is a triage system. The sickest people get treated first, not the wealthiest. It is the correct way to manage delivery of care. People with money would still be perfectly able to go to a private physician and get their high cost care more promptly.

Lastly the cost. It's complicated. There are many variables. This is not a bad analysis. As you can see a lot depends on the details. However, one thing is clear. Overall it would cost less and every citizen would be covered.

https://www.politifact.com/truth-o-...1/how-expensive-would-single-payer-system-be/

Just to point out.. some countries do force you to use their single payer system.

About half of Canadians say they would like the option to buy a private health insurance plan. Currently, that’s not allowed.”
Canadians can purchase supplemental private coverage for services that are not covered by the public plan, but cannot purchase private insurance for basic services.

Next Medicare, Medicaid, VA health plans all go away. That cost gets rolled into Single-payer. Single-payer covers everyone birth to death. Also, there is no longer a need for employer based health insurance unless the employer wants to provide a supplemental plan. Consequently the $500-$1000 a month out of your paycheck goes away and the employer doesn't need to worry about the cost of health care. They are off the hook for the expense.

The flip side of that is single-payer will require premiums , likely based on income, that like Medicare, would be a payroll deductiion.

just to point out.. Employers pay HALF of the payroll deduction for medicare.. no limit on payroll. (unlike social security)... on all their employees. So employers definitely have to worry about the cost of healthcare.. especially troubling is the fact that the cost is tied to their payroll. Pay an employee MORE and you will be on the hook for more medicare dollars. Unlike the current plan.. which is finite.. and not tied to wages.

And the majority of doctors do not support single payer. Polling shows they are split on it.

Long wait times don't simply have to do with sickest getting treated first.. they have to do with availability of providers.

That being said.. it surprises me as a progressive that you would like to see a system in which the upper middle class and wealthy.. can take advantage of a private healthcare system and get speedy care.. while the poor and middle class languish in the public system waiting for the next available provider.

Slavister · Oct 9, 2018

jaeger19 said:
...because though fewer people go to the doctor than other countries.. the ones that go.. are far sicker because of their comorbidities..

Or maybe... just maybe.. fewer people using our healthcare while our healthcare costs a ton more is because of the super-complex, inefficient, prone-to-overpaying system that we have here... Oh no, that could not be!!!

Look, we've gone back and forth for way too long.

I offered to end our discussion back at post #203 when I summarized my position in response to your summary. We are close to #280 now.

It's tiring going around in circles.

The only thing I would add to my summary is that the other issue never talked about in these discussions is a huge waste of TIME that Americans spend dealing with their complex system. Other people in the world almost never have to think much about how to pay, who to pay, who is in the network, is anesthesiologist covered, EOBs, why do I get bills from facilities, separate from my doctor, separate from my radiologist, separate from my pathologist, and God forbid there is an error somewhere, it propagates out with further visits completely making a mess of everything.

I don't know how an MD and CEO of multiple businesses has the time that you have to post so much, but more power to you. I give up.

P.S. I am glad you found the gold mine of unlimited National Debt as the unlimited source of funds for whatever Government wants to do. Here is some intro for you. You can skip to "How the National Debt Affects Everyone" section at the end if you like.

jaeger19 · Oct 9, 2018

Slavister said:
You have to take this in context. It's not just plain simple literal comparison.

In case of UK vs US, cost of living difference is 5%. You claim salary difference is 20% (I won't bother checking). In that context,
- we pay 150% more for healthcare for capita than UK
- we spend a ton of extra TIME on dealing with unnecessary complexities and being middlement between insurance companies and provider offices (and sometimes HR of our companies)
- we get WORSE health care (on ALL parameters you had listed)
.

Yep;.. and YOU claim that's because its "waste and fat"..

Yet.. the UK also pays a lot less for wages.. so according to you.. since the US pays more in average weekly net salary.. (and I gave you the link that shows that)... that means that the US is paying too much for labor.. and we need to reduce the cost of labor in the US by artificially holding wages down.

I am countering your argument that just because the US pays more.. it means that its "fat and waste".. clearly you cannot make that assumption.. OR if you are.. then since the US pays more in salary on average (across the board).. that means that the US labor is "fat and waste"..

I don't think it's as complicated as you think

Right.. you plan to get medical schools that understand physician education.. to suddenly switch their programs to your "accelerated plan".. because "one got started and students will flock to it". And you don't realize that most medical schools that do an accelerated program.. only do so through their undergraduate program.. so that you are committing to two schools.. which also means that schools are going to have to change their undergraduate programs as well.

No, our savings can come from other ways. E.g. instead of lowering physician pay by much we can tax corporations more;

In other words.. no savings.. just cost shifting.

That's your repeated, yet never substantiated claim.

Stop lying.. heck even your own links showed that labor was one largest costs.. yet you choose to ignore it

So you are saying that even though Canada pays GREAT to their providers, they have FEWER of them... That goes against all your talk about how number of providers would increase or decrease based on pay.

Ummm no it doesn't. Because by controlling the number of providers.. or access to providers.. Canada can control the number of providers.. like specialists. Its a way some countries get savings. Remember our specialist vs generalist debate. AS I pointed out.. the more specialists.. the higher the costs to the system..

Say there is 100 people in a community that need a total knee. If there a three providers each with their own staff, nurse, building etc.. that means they have to charge more because they only are going to get 33 patients.

however, if there is one specialist.. he can survive on a lower per patient charge.. because he gets all 100 patients.... of course.. they have to wait.. (I,e, longer wait times).

In short, Canada has been (due to incorrect predictions) reducing number of available training spots while at the same time shutting out foreign doctors and making it very hard for them to practice in Canada

Which is what explains why they have higher pay than other countries.. but fewer physicians per population.. than other countries. Which is their trade off to keep costs lower.

jaeger19 · Oct 9, 2018

Slavister said:
Or maybe... just maybe.. fewer people using our healthcare while our healthcare costs a ton more is because of the super-complex, inefficient, prone-to-overpaying system that we have here... Oh no, that could not be!!!.

Right.. so you think that insurance companies are just paying that healthcare cost because they don't mind it being super complex and inefficient and they are paying more. Yep.. why they don't like those profits.. no way.. get those profits out of there.. they want an inefficient..overpaying system. Why the federal government.. that wants that as well.. hey.. despite the fact that the federal government has been reducing payments and controlling healthcare expenditures since the late 1990's. nope.. insurance companies and the government love overpaying.. ... yep.. it JUST HAS to be it.. right? I mean it couldn;t be that that the US has more comorbidities.. .(proven). It can't be that the US pays more in wages (proven). it can't be that the US doesn't cover everyone so that it loses in preventative medicine (proven)... and it can't be that other countries cost shift their healthcare costs.. physician education to public education., or repetitive injuries to a shorter work week.. or early retirement for those working in hard labor fields.. etc (proven).

Nope.. it we should ignore all the actual proven factors.. because it just HAS to be "super-complex, inefficient, prone-to-overpaying system" it just HAS to be.. cuz otherwise.. you feelings would be wrong.

Other people in the world almost never have to think much about how to pay, who to pay, who is in the network, is anesthesiologist covered, EOBs, why do I get bills from facilities, separate from my doctor, separate from my radiologist, separate from my pathologist, and God forbid there is an error somewhere, it propagates out with further visits completely making a mess of everything.

Yeah they do. People in france have to think whether their anesthesia is covered.. because their bowel surgery may be covered.. but not the anesthesia. and they have to know if their private insurance covers it. In Canada they have to deal with bills from their outpatient therapist, and their medications. In other countries.. they have to wait.. and jump through hoops and until those hoops are jumped through.. only then can they have say their knee surgery... etc...

manofknowledge · Oct 9, 2018

jaeger19 said:
Just to point out.. some countries do force you to use their single payer system.

There is a lot of variability in what other countries do, but many have much better systems. The UK is full government run, not single-payer. You hear a lot of bad press about it but the fact is it is excellent care. Steven Hawking lived to his 70s with ALS and never paid for health care.

just to point out.. Employers pay HALF of the payroll deduction for medicare.. no limit on payroll. (unlike social security)... on all their employees. So employers definitely have to worry about the cost of healthcare.. especially troubling is the fact that the cost is tied to their payroll. Pay an employee MORE and you will be on the hook for more medicare dollars. Unlike the current plan.. which is finite.. and not tied to wages.

They also pay a percentage of the cost of insurance and as group plans their cost is tied to the health of their employees so it is not as simple as you would make out. One of the reasons employers pay half the cost of Medicare is that those using the plan are usually not employees. The details have to be worked out. As I said up front it complex but worth the effort.

And the majority of doctors do not support single payer. Polling shows they are split on it.

It's a close split but the data I've seen still has the majority in favor and the younger they are the more they support it. Old guys don't like to change.

Long wait times don't simply have to do with sickest getting treated first.. they have to do with availability of providers.

Availability of providers has nothing to do with the payers. It has to do with population. Hospitals are not built where they can't make money. That is not an effect of the payment system.

That being said.. it surprises me as a progressive that you would like to see a system in which the upper middle class and wealthy.. can take advantage of a private healthcare system and get speedy care.. while the poor and middle class languish in the public system waiting for the next available provider.

I have no problem with people paying out of pocket for premium services. I have a problem with bankrupting people or denying them care. Besides since the cost of Single-payer would be higher for higher incomes they are pulling their own weight anyway.

jaeger19 · Oct 9, 2018

manofknowledge said:
There is a lot of variability in what other countries do, but many have much better systems.

Depends on what you term as better. We often score higher on several metrics like timeliness, effective care etc.. and if we had universal coverage.. we would probably score better on even more categories.

The UK is full government run, not single-payer. You hear a lot of bad press about it but the fact is it is excellent care

Depends on how you define "excellent care".. the UK does much worse on cancer survival rates than the US. but.. yes.. the do score better on many things.. on the other hand.. like you said. they are a full government run system. Do you want Donald Trump to be in charge of your healthcare? I don't. So there are other considerations here.

They also pay a percentage of the cost of insurance and as group plans their cost is tied to the health of their employees so it is not as simple as you would make out.

Sure.. but again.. its a finite amount.. If I give my employees a raise.. my healthcare costs do not go up.

One of the reasons employers pay half the cost of Medicare is that those using the plan are usually not employees. The details have to be worked out. As I said up front it complex but worth the effort.

Which is true.. but that's how medicare is economically feasible. So you have people and employers paying in for years without taking out.. and then in their last years.. when they need healthcare its there. And that system is already in some trouble. Now imagine if you dumped millions upon millions of americans onto the system.. who are taking out though they have not put in for years? That would put a huge strain on the system. And we would likely have to reduce medicare benefits to make it feasible.. which is why our medicare is better than most other countries single payer.

It's a close split but the data I've seen still has the majority in favor

A close split and ":majority favor".. don't equate.

Availability of providers has nothing to do with the payers.

Sure it can. It is financially problematic to have a lot of providers. Like you said.. hospitals are not build where they can't make money. Well.. a hospital in a rural community.. with fewer people.. needs to get paid MORE per sick person to make money. and if the payer does not want to pay more per sick people.. then the hospital won't be built or will close.. reducing access for that community. Which leads to longer wait times.

I have a problem with bankrupting people or denying them care

Well our current system really does neither.

manofknowledge · Oct 10, 2018

jaeger19 said:
Depends on what you term as better. We often score higher on several metrics like timeliness, effective care etc.. and if we had universal coverage.. we would probably score better on even more categories.

However good US health care performs it still leaves millions of people without adequate care.

jaeger19 said:
Depends on how you define "excellent care".. the UK does much worse on cancer survival rates than the US. but.. yes.. the do score better on many things.. on the other hand.. like you said. they are a full government run system. Do you want Donald Trump to be in charge of your healthcare? I don't. So there are other considerations here.

I'm not advocating full social system, although I wouldn't object to it, the transition to it would be too extreme. I don't have any problem with the Medicare covering everyone. It's not like Trump would decide if I get a flu shot or not.

jaeger19 said:
Sure.. but again.. its a finite amount.. If I give my employees a raise.. my healthcare costs do not go up.

It's finite by the year. You hire someone with diabetes and the following year your health care costs go up even more than the nominal yearly increase.

jaeger19 said:
Which is true.. but that's how medicare is economically feasible. So you have people and employers paying in for years without taking out.. and then in their last years.. when they need healthcare its there. And that system is already in some trouble. Now imagine if you dumped millions upon millions of americans onto the system.. who are taking out though they have not put in for years? That would put a huge strain on the system. And we would likely have to reduce medicare benefits to make it feasible.. which is why our medicare is better than most other countries single payer.

There are mulitiple trade offs with Medicare for all. Yes more patients mean more demand and we would need to expand the provider system. The Medicare tax deduction would have to go up significantly as well but people would not need to purchase comprehensive health insurance so they could afford the additional deduction. On the other hand hospitals would not have to cost of unreimbursed services which is significant for hospitals currently and Medicare for all would almost certainly lower the cost of hospitalization. Medicare for all can be made to work in this country but it can't be a stagnant system, it needs to be adaptable.

jaeger19 said:
A close split and ":majority favor".. don't equate.

The last survey I saw was 56% in favor. That is a majority. https://www.usnews.com/news/healthc...8-16/doctors-warm-to-single-payer-health-care

jaeger19 said:
Sure it can. It is financially problematic to have a lot of providers. Like you said.. hospitals are not build where they can't make money. Well.. a hospital in a rural community.. with fewer people.. needs to get paid MORE per sick person to make money. and if the payer does not want to pay more per sick people.. then the hospital won't be built or will close.. reducing access for that community. Which leads to longer wait times.

Only a national system managing the education of health care providers can solve the problems with access in rural communities. Incentives to practice in rural areas and to build hospitals in those communities could go a long way.

jaeger19 said:
Well our current system really does neither.

The current system does bankrupt some people but it is not a direct consequence in many cases, loss of income due to health issues is a big problem that single payer doesn't solve but at least people who lose their income can still get medicine.

jaeger19 · Oct 10, 2018

manofknowledge said:
However good US health care performs it still leaves millions of people without adequate care.
.

Yep.. which is why we need a universal system.. so that everyone or darn close to everyone is covered. Doesn;t have to be single payer though.. in fact.. we could get pretty darn close with just obamacare.

I don't have any problem with the Medicare covering everyone. It's not like Trump would decide if I get a flu shot or not.

Well actually he could. In fact.. Medicaid and medicare right now have prohibition on covering abortion services for women.. (unless somehow its deemed that the womans life is in danger). In todays political climate its scary to think of having a fellow like trump deciding what healthcare my wife and cousins can get.

It's finite by the year. You hire someone with diabetes and the following year your health care costs go up even more than the nominal yearly increase.

And the minute I give that guy a raise.. I just increase my healthcare cost if its based on payroll. immediately.

Medicare for all can be made to work in this country but it can't be a stagnant system, it needs to be adaptable.

Which pretty much means that its not going to be as good as prior medicare was.. so 85% of the population that has insurance and knows how good medicare was and was for their parents.. are going to be pissed that its not as good and as comprehensive as it was before.

The last survey I saw was 56% in favor. That is a majority

really? that's your "a majority". Cripes, I bet the error in the pole was at least 5%.

Only a national system managing the education of health care providers can solve the problems with access in rural communities. Incentives to practice in rural areas and to build hospitals in those communities could go a long way.

Well if you plan to go to a national system with the cost savings of other countries.. than you are going to have to decrease access to rural communities.. because its a major inefficiency in America and it drives our costs up.

Building a hospital system for a small community.. is inefficient and costly.

The current system does bankrupt some people but it is not a direct consequence in many cases, loss of income due to health issues is a big problem that single payer doesn't solve

Bingo..

doesn't solve but at least people who lose their income can still get medicine

Depends on the system.. in some countries.. like Canada.. medicine coverage is not a part of the basic government plan.. and so is covered by private plans either bought by the individual or by their employer.

manofknowledge · Oct 11, 2018

jaeger19 said:
Yep.. which is why we need a universal system.. so that everyone or darn close to everyone is covered. Doesn;t have to be single payer though.. in fact.. we could get pretty darn close with just obamacare..

I supported the ACA but it has been destroyed by Republicans. It cannot function as it was designed.

jaeger19 said:
Well actually he could. In fact.. Medicaid and medicare right now have prohibition on covering abortion services for women.. (unless somehow its deemed that the womans life is in danger). In todays political climate its scary to think of having a fellow like trump deciding what healthcare my wife and cousins can get..

The ban on paying for abortion services is not an executive decision. It is written into law by Congress. It's just a scare tactic like claiming the ACA had death squads.

jaeger19 said:
And the minute I give that guy a raise.. I just increase my healthcare cost if its based on payroll. immediately..

Yep, and you also increase your payroll cost. Health care is used as part of a pay package. It often outweighs direct salary in the minds of employees. Prior to the ACA, it was practically the only way to have insurance cover pre-existing conditions.

jaeger19 said:
Which pretty much means that its not going to be as good as prior medicare was.. so 85% of the population that has insurance and knows how good medicare was and was for their parents.. are going to be pissed that its not as good and as comprehensive as it was before..

Medicare is Medicare and it has been changed continuously since its passage.

jaeger19 said:
really? that's your "a majority". Cripes, I bet the error in the pole was at least 5%..

Maybe it is within the margin of error but it is still a majority and even 50% is a significant number given the claims that it will cost them dearly.

jaeger19 said:
Well if you plan to go to a national system with the cost savings of other countries.. than you are going to have to decrease access to rural communities.. because its a major inefficiency in America and it drives our costs up.

Building a hospital system for a small community.. is inefficient and costly.

Rural communities don't need full blown hospitals with intensive care units, and surgical theaters. They need an ER, basic radiology, a basic lab and basic family services. I agree a major hospital doesn't make sense in low population areas.

jaeger19 said:
Depends on the system.. in some countries.. like Canada.. medicine coverage is not a part of the basic government plan.. and so is covered by private plans either bought by the individual or by their employer.

Acutally the Canadian system does cover prescription medications but it's at a province level not national and also based on income and need.

https://www.canada.ca/en/health-can...nsurance-coverage-prescription-medicines.html

jaeger19 · Oct 11, 2018

manofknowledge said:
I supported the ACA but it has been destroyed by Republicans. It cannot function as it was designed.
]

Not completely destroyed. Hurt"? Yes.. but the reality is that it would not take much to add to obamacare and make it better. Heck.. I bet if the democrats wiin congress.. and add to obamacare.. but call it "trump care".. Trump would sign it.

The ban on paying for abortion services is not an executive decision. It is written into law by Congress. It's just a scare tactic like claiming the ACA had death squads.

Whoa their cowboy.. unlike the death panels.. which DID NOT EXIST. the ban on paying for abortion services certainly exists. You stated it.. it was written into law by Congress and has not been removed by either democrats or republicans. AND the executive branch has the power in how it administers that healthcare.. so sorry.. no "scare tactic".. because guess what? the ban EXISTS.

Yep, and you also increase your payroll cost. Health care is used as part of a pay package.

But currently its not based on pay.. my cost does not go up the minute I increase wages.. where in your system.. it will.

It often outweighs direct salary in the minds of employees

Yeah that's not true. The majority of workers don't even know what their benefits ARE because they are not sick.

Medicare is Medicare and it has been changed continuously since its passage

Actually not in its benefits other than it was added to when drug coverage was added.

To get the savings promised by single payer advocates.. in a medicare for all to be feasible.. medicare benefits would have to be DECREASED.. not increased. medicare is pretty much better than any other single payer government system.. it covers more.

Maybe it is within the margin of error but it is still a majority and even 50% is a significant number given the claims that it will cost them dearly.

No.. because its a reflection of the fact that more and more physicians are paid by salary. and not independent providers. Many of those folks that are in support? Would probably not be in support when you sat down and explained them the financials of single payer and the pay cut that they would experience. Not to mention the other issues when it comes to care delivery.
You start bringing up the realities. as I am discussing here.. and lot of those that support single payer.. yeah.. begin to question the idea.

Rural communities don't need full blown hospitals with intensive care units, and surgical theaters. They need an ER, basic radiology, a basic lab and basic family services. I agree a major hospital doesn't make sense in low population areas.

You might think they "don't need".. but folks in those rural areas.. they feel differently.. especially when that rural hospital system is a major employer in the area. One of the reasons that we have the cost to our system that we do.. is because we value that speedy access. That convenience. So.. single payer savings are only going to happen when people have to make a decisions of what is more important to them.. to pay what Europeans pay.. but close their local hospital and lose all those jobs... or whether they want to keep the convenience and the economy the way it is.

Acutally the Canadian system does cover prescription medications but it's at a province level not national and also based on income and need.

Exactly.. the Canadian BASIC government insurance.. their "single payer" does not cover medicines. So a number of working Canadians.. don't have coverage for prescriptions unless they pay for it or get it from their employer.. which means a number go without coverage.

James972 · Oct 16, 2018

manofknowledge said:
However good US health care performs it still leaves millions of people without adequate care.

I'm not advocating full social system, although I wouldn't object to it, the transition to it would be too extreme. I don't have any problem with the Medicare covering everyone. It's not like Trump would decide if I get a flu shot or not.

It's finite by the year. You hire someone with diabetes and the following year your health care costs go up even more than the nominal yearly increase.

There are mulitiple trade offs with Medicare for all. Yes more patients mean more demand and we would need to expand the provider system. The Medicare tax deduction would have to go up significantly as well but people would not need to purchase comprehensive health insurance so they could afford the additional deduction. On the other hand hospitals would not have to cost of unreimbursed services which is significant for hospitals currently and Medicare for all would almost certainly lower the cost of hospitalization. Medicare for all can be made to work in this country but it can't be a stagnant system, it needs to be adaptable.

The last survey I saw was 56% in favor. That is a majority. https://www.usnews.com/news/healthc...8-16/doctors-warm-to-single-payer-health-care

Only a national system managing the education of health care providers can solve the problems with access in rural communities. Incentives to practice in rural areas and to build hospitals in those communities could go a long way.

The current system does bankrupt some people but it is not a direct consequence in many cases, loss of income due to health issues is a big problem that single payer doesn't solve but at least people who lose their income can still get medicine.

The obvious solution is to switch from socialism to capitalism. Think Cuba/Florida. In Cuba and 132 other socialist countries nobody can afford anything, something like our socialist health care system. A switch to capitalism would lower prices 80% and add 10-20 years to our life spans. How can you beat that.

Single payer debate no so easy

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manofknowledge

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manofknowledge

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James972