Question for Single Payer fans...

[Deuce]

Getting pretty close. The tax cuts are designed to create a deficit, then the deficit will be used as an excuse to cut Medicare.

So we shouldn’t have Medicare because someone might cut Medicare? Alllriiight. Now, can you tell me what is so wonderful about Blue Cross’ management that I should love?

 

[MrWonka]

So we shouldn’t have Medicare because someone might cut Medicare?

No, but if someone cuts medicare at least we'll have private insurance even if it is insanely expensive, and we can always pay with cash if needs are.

Alllriiight. Now, can you tell me what is so wonderful about Blue Cross’ management that I should love?

Is it possible that Blue Cross doesn't actually want to screw people they just have to because the alternative would be to go out of business? Maybe we could just try taking some of the most expensive patients off their hands, and let them handle more standard-issue day to day stuff.

Think about it like homeowners insurance. For the most part, your homeowner's insurance protects your house in case of emergency, but in the case of huge natural disasters that wipe out entire cities or towns the federal government steps in and declares it a disaster area. Fema and other federal agencies step in to help in that situation.

So everybody doesn't always have to rely on the government, but it should be there to help in the worst case scenario.

 

[JasperL]

This also seems like a false choice. At the very least I would expect this problem could be minimized in other ways.

Car insurance and dental insurance is fairly standard in large part because the amount of money they end up paying out is smaller and more specific.

It's hard to minimize because the way insurers make money is by offering a bunch of different products with different coverage, which allows them to charge many different premiums, from good coverage like most of us have at work, to catastrophic policies that don't pay until huge deductibles are met. The ACA eliminated some of that with the minimum coverage and community rating stuff, but in a 'free market' regime, the only way to lower premiums is to deny coverage...somehow. Either by outright denying the coverage or by making the insured pay, through deductibles and copays. So you have a single insurer in a market with a dozen different "plans" and each has different rules and copays, etc.

So if a gold plated plan like Cruz had through his wife and Goldman Sachs costs nearly $50k/year (about right as I recall) then a plan that costs $15k per year has to have a bunch of points where the coverage Cruz gets under his plan is denied for that other guy working at Walmart. So how do you minimize the admin costs when you have 5 insurers with 14 plans each?

I've billed this stuff a few years back. It's a nightmare, and most of the clients I billed were Medicare with pretty standard rules - generally if Medicare paid, the secondary paid some fixed percentage of the remainder. Pretty easy. For private plans (non-Medicare) we had no idea what to expect - often flat rejections, then appeals, then getting a fraction of the bill, then you bill the client 3 months later... I'm convinced some private insurers had a policy to just reject nearly every claim, and make us file an appeal, because when I'd call and ask why the rejection, often there was no reason, and we just refiled the same claim and got paid the 2nd or 3rd try.

 

[JasperL]

No, but if someone cuts medicare at least we'll have private insurance even if it is insanely expensive, and we can always pay with cash if needs are.


Is it possible that Blue Cross doesn't actually want to screw people they just have to because the alternative would be to go out of business? Maybe we could just try taking some of the most expensive patients off their hands, and let them handle more standard-issue day to day stuff.

Think about it like homeowners insurance. For the most part, your homeowner's insurance protects your house in case of emergency, but in the case of huge natural disasters that wipe out entire cities or towns the federal government steps in and declares it a disaster area. Fema and other federal agencies step in to help in that situation.

So everybody doesn't always have to rely on the government, but it should be there to help in the worst case scenario.

We've tried high risk pools and they have failed everywhere. In Tennessee it was kind of a joke - people at high risk had to call in once a quarter (as I recall) and it was like a lottery. Some number of callers were randomly chosen to get to enroll, after that the pool was full and everyone else was f'd at least until the next quarter.

Plus when you give BCBS the ability to offload their high risk/high cost patients, and let taxpayers take the sick and expensive, that's a dream come true for a private insurer, and employers, but now there is a huge incentive to get the sick offloaded onto taxpayers, and they'll find a way to do it. Plus, what have we accomplished there? The vast majority of patients driving healthcare costs - those who are sick and need lots of expensive treatment - are in the government plan, and the rest of us have insurance for checkups and a cut at the lake or broken arm. That's not hard for BCBS to manage, but it's a nightmare for taxpayers.

People who like to blame ACA don't realize that the provisions in it were there to address, for example, the absolute failure of state high risk pools. There isn't any doubt they'd failed - the question is how best to address it. It's one thing to say ACA was a bad answer, but quite different to suggest we go back to a regime we KNOW HAD FAILED.

 

[Greenbeard]

I see no evidence that nurse unions have any desire to prevent policies to lower Healthcare cost as it is to everyone's benefits including nurses and Healthcare professionals. We're talking about policies with substantially contribute to health care cost. everyone is entitled to more pay corresponding to increased inflation so that argument will be false. Pay follows inflation it doesn't cause it.

To the extent SP is to use ”negotiating power” to lower spending, the idea is that it will function in the opposite manner of a union: it’s supposed to use its power as a monopsony buyer of labor to drive down wages (the primary component of health costs and the one most amenable to being squeezed this way). So if it were to actually function like that there would absolutely be a political conflict with labor at some point. Which is why there’s a limit to how much squeezing/saving in this way is actually realistic.

 

[Deuce]

No, but if someone cuts medicare at least we'll have private insurance even if it is insanely expensive, and we can always pay with cash if needs are.


Is it possible that Blue Cross doesn't actually want to screw people they just have to because the alternative would be to go out of business? Maybe we could just try taking some of the most expensive patients off their hands, and let them handle more standard-issue day to day stuff.

Think about it like homeowners insurance. For the most part, your homeowner's insurance protects your house in case of emergency, but in the case of huge natural disasters that wipe out entire cities or towns the federal government steps in and declares it a disaster area. Fema and other federal agencies step in to help in that situation.

So everybody doesn't always have to rely on the government, but it should be there to help in the worst case scenario.

Privatize the profits, socialize the losses? Hmm, nah. Sounds like a recipe for higher deficits.

 

[Bullseye]

What happens when the next Trump gets elected and appoints Scott Pruit or Betsy DeVos to run your single payer system?

What happens when a Dr and Nurse Union arise to prevent you from using the negotiating power of the Federal Government to lower health care costs? Will they be allowed to go on strike?

How about WTF are you going to get the money? Last I heard Bernie's plan would cost around 32 trillion or about six times our current budget outlay.

 

[Hypothetical]

What happens when the next Trump gets elected and appoints Scott Pruit or Betsy DeVos to run your single payer system?

What happens when a Dr and Nurse Union arise to prevent you from using the negotiating power of the Federal Government to lower health care costs? Will they be allowed to go on strike?

what do other countries with single payer do in these situations?

 

[Barnacle]

What happens when the next Trump gets elected and appoints Scott Pruit or Betsy DeVos to run your single payer system?

What happens when a Dr and Nurse Union arise to prevent you from using the negotiating power of the Federal Government to lower health care costs? Will they be allowed to go on strike?

That depends on what type of single-payer system.

 

[ataraxia]

Doesn't change whether or not they'll need a Union. Most Teachers favor public school, they still have a union.

I remember reading somewhere that doctors tried forming unions. The courts said it was not legal. I don’t know what it was about the business of medicine that made it illegal.

 

[lurchadams]

What happens when the next Trump gets elected and appoints Scott Pruit or Betsy DeVos to run your single payer system?

What happens when a Dr and Nurse Union arise to prevent you from using the negotiating power of the Federal Government to lower health care costs? Will they be allowed to go on strike?

Economies of scale under single payer will reduce other costs, medical supplies, prescription drugs, etc. which would allow more room for payroll expense. Surveys show most doctors support single-payer care. What causes inefficiencies is the profit-driven private insurance companies.
Another thing reducing costs will be the premiums spread over the entire population, including younger, healthier people. One of the things that drives the costs up is, people with no or poor coverage don't seek medical help until something really catastrophic happens. People will seek preventative care because they can afford it. We're the only civilized country that doesn't have some form of universal healthcare. That says something - it's the right thing to do.

 

[Finch]

How about WTF are you going to get the money? Last I heard Bernie's plan would cost around 32 trillion or about six times our current budget outlay.

The Sanders plan is just one possible version of a single-payer plan, and a "quite generous" one at that...I suspect, if anything, we could go to a Medicaid for all program or we adopt a unique system that would work for our country. Obama tried that by using the conservative Heritage Foundation plan, which was formed back in the 90's, as its foundation. However, it was flawed and everyone including Sanders and Clinton agreed to that during the 2016 campaigns. But Sanders, Clinton, and Trump all had different solutions for that flaw. Sanders wanted to first fix the ACA and then obviously move to single payer, Clinton wanted to just fix the ACA, and Trump just wanted to get rid of it. Singapore has a unique system in which we could learn a lot from, I encourage people to research it....I believe we should have at the very least a system that would subsidize expensive procedures like chemo, transplants, and other life saving procedures and to not deny anyone access to those procedures because of money. Our current system is not good and we need to figure out a better way.

 

[OscarLevant]

You know they paid to do their jobs right? Did teachers have a desire to prevent policies to lower education costs?


Which would include the high salaries that doctors and nurses make?


How is that working out for teachers?



Well, actually that's just not true. Pay does contribute to inflation to a degree.

It doesn't. It only seems like it does. Factors cause prices to fluctuate, but aggregate swelling of money supply that is actually put to circulation that swells ahead of production, over time, is what causes inflation. It's complicated, and you will find temporal exceptions, but over time, this is what causes inflation and the erosion of the purchasing power of the dollar. All other seemoing causes are not causes, but cause only fluctuation. Inflation is the increasing trend beyond the fluctuations.

 

[ataraxia]

How about WTF are you going to get the money? Last I heard Bernie's plan would cost around 32 trillion or about six times our current budget outlay.

One of the most recent countries to adapt a system of nationalized healthcare has been Thailand. The result: improvements in just about every metric used to measure public health, and big gains in the national GDP because you have a healthier population. But there was also one very unexpected result: almost entirely eliminating extreme poverty in the country. It turned out that the biggest reason for extreme poverty in the country was unexpected catastrophic illness in an uninsured person. People and their entire families were going under trying to pay for it. So there was a triple success: improvement of public health, improvement in GDP, and elimination of extreme poverty. Not bad, I would say.

https://www.google.com/amp/s/amp.th...-healthcare-ucs-patients-government-political

Interestingly enough, the top reason for declarations of bankruptcy in this country is the same: unexpected illness in uninsured or under-insured people.

Difference is, they did something about it, and it’s working. We have Paul Ryan.

 

[Bullseye]

One of the most recent countries to adapt a system of nationalized healthcare has been Thailand. The result: improvements in just about every metric used to measure public health, and big gains in the national GDP because you have a healthier population. But there was also one very unexpected result: almost entirely eliminating extreme poverty in the country. It turned out that the biggest reason for extreme poverty in the country was unexpected catastrophic illness in an uninsured person. People and their entire families were going under trying to pay for it. So there was a triple success: improvement of public health, improvement in GDP, and elimination of extreme poverty. Not bad, I would say.

https://www.google.com/amp/s/amp.th...-healthcare-ucs-patients-government-political

Interestingly enough, the top reason for declarations of bankruptcy in this country is the same: unexpected illness in uninsured or under-insured people.

Difference is, they did something about it, and it’s working. We have Paul Ryan.

Yeah, and our society and culture is so much like Thailand it would be a turnkey operation to change over our system. Oh, and coming up with the 32 tril it would take to do so.

 

[Bullseye]

The Sanders plan is just one possible version of a single-payer plan, and a "quite generous" one at that...I suspect, if anything, we could go to a Medicaid for all program or we adopt a unique system that would work for our country. Obama tried that by using the conservative Heritage Foundation plan, which was formed back in the 90's, as its foundation. However, it was flawed and everyone including Sanders and Clinton agreed to that during the 2016 campaigns. But Sanders, Clinton, and Trump all had different solutions for that flaw. Sanders wanted to first fix the ACA and then obviously move to single payer, Clinton wanted to just fix the ACA, and Trump just wanted to get rid of it. Singapore has a unique system in which we could learn a lot from, I encourage people to research it....I believe we should have at the very least a system that would subsidize expensive procedures like chemo, transplants, and other life saving procedures and to not deny anyone access to those procedures because of money. Our current system is not good and we need to figure out a better way.

Here in California the Democrats in the Legislature floated a single payer proposal but when some people penciled it out the annual cost was estimated to be as large as all the current budget spending.

I think some people over look that fact that programs like Medicare and Medicaid squeezing by because they have a large pool of taxpayers footing the bill and a smaller number of recipients using it. IF everyone had Medicare or Medicaid that wouldn't be the case. Medicare funding just for retirees is on shaky ground according to the Medicare Trustees adding more recipients without significantly boosting income would be disastrous.

 

[ataraxia]

Here in California the Democrats in the Legislature floated a single payer proposal but when some people penciled it out the annual cost was estimated to be as large as all the current budget spending.

I think some people over look that fact that programs like Medicare and Medicaid squeezing by because they have a large pool of taxpayers footing the bill and a smaller number of recipients using it. IF everyone had Medicare or Medicaid that wouldn't be the case. Medicare funding just for retirees is on shaky ground according to the Medicare Trustees adding more recipients without significantly boosting income would be disastrous.

You make it sound like it’s something new that has never been done before. But every single other developed nation on the planet already has it. Not just Thailand. Not just Scandinavian and other European countries, not jus Japan. Everybody. Except us. And they have lower healthcare costs and better public health by almost any parameter you want to measure, unless you want to include quality of nose jobs and boob jobs for the wealthy. Why is it that we keep acting like it’s such a weird, novel, and impossible thing? No one lives like this in the modern world. It’s barbaric and inhumane.

 

[Bullseye]

You make it sound like it’s something new that has never been done before. But every single other developed nation on the planet already has it. Not just Thailand. Not just Scandinavian and other European countries, not jus Japan. Everybody. Except us. And they have lower healthcare costs and better public health by almost any parameter you want to measure, unless you want to include quality of nose jobs and boob jobs for the wealthy. Why is it that we keep acting like it’s such a weird, novel, and impossible thing? No one lives like this in the modern world. It’s barbaric and inhumane.

With all due respect arguments based on the "But, mommy, all the other countries are doing it" carry little weight. They frequently overlook that fact that those countries are not Utopia, and face many problems with their systems, just as we do. Compare costs, wait times, and availability of services and the trades off appear. IMHO, those trade offs aren't worth it. I believe we can develop an economically sound quality healthcare system based on market principles rather than bureaucratic snafus. National exchanges offering a wide variety of plans at a wide range of prices, offering plans consumers want rather than one dictated by a faceless bureaucrat deciding what he/she thinks you need. Some form of pre-existing condition pool, premiums based on actuarial calculations, government subsidies when required.

 

[ataraxia]

Maybe so. Maybe not. Interesting ideas.

Whatever the case, I would like to see a conservative base more interested in positive, constructive ideas like those above, discussion, brainstorming, negotiation, compromise, and deal making, rather than just one in a chronic state of outrage and stubborn obstructionism like a 2 year old in a meltdown at the grocery store aisle. Whatever we do, the status quo is unacceptable and intolerable. It’s a system that puts too many people in situations no human being should ever have to face. Let’s shape it up and get our act together!

 

[Deuce]

With all due respect arguments based on the "But, mommy, all the other countries are doing it" carry little weight. They frequently overlook that fact that those countries are not Utopia, and face many problems with their systems, just as we do. Compare costs, wait times, and availability of services and the trades off appear. IMHO, those trade offs aren't worth it. I believe we can develop an economically sound quality healthcare system based on market principles rather than bureaucratic snafus. National exchanges offering a wide variety of plans at a wide range of prices, offering plans consumers want rather than one dictated by a faceless bureaucrat deciding what he/she thinks you need. Some form of pre-existing condition pool, premiums based on actuarial calculations, government subsidies when required.

Are you really sure you want to compare costs? Because ours is, by a large margin, the most expensive system on the planet.

Now, you talk about market principles. Let’s look at those. Would you agree that choice and competition are fundamental principles necessary for a functional free market?

 

[Helix]

Question for Single Payer fans...

q : do you want to be a serious illness or injury away from bankruptcy?

a: no, because the rest of the first world solved that decades ago.

 

[Greenbeard]

q : do you want to be a serious illness or injury away from bankruptcy?

a: no, because the rest of the first world solved that decades ago.

SP has benefits, no doubt.

But to what I assume the OP's point is, there is a legitimate conversation to be had about the potential downsides of moving economic and/or personal decisions into the political space. Particularly given how poisonous, immature, and destructive our politics are.

 

[Bullseye]

Are you really sure you want to compare costs? Because ours is, by a large margin, the most expensive system on the planet.

Which is why I proposed a market based exchange with a wide variety of policy choices made by the customer instead of bureaucrats. I'm NOT comparing CURRENT costs I'm suggesting that a national menu-driven market would provide more competition and pricing. Also the ready availability of treatment and advanced technologies here does make our system more expensive. When it comes to quality of care there are a damn sight more folks coming here than going overseas.

Now, you talk about market principles. Let’s look at those. Would you agree that choice and competition are fundamental principles necessary for a functional free market?

And single payer provides that HOW?

 

[Moderate Right]

What happens when the next Trump gets elected and appoints Scott Pruit or Betsy DeVos to run your single payer system?

What happens when a Dr and Nurse Union arise to prevent you from using the negotiating power of the Federal Government to lower health care costs? Will they be allowed to go on strike?

Exactly why we should have a bipartisan health care system. Obama and the left were arrogant to think they could cram through Obamacare and expect that they would be in power forever. And, Trump & Co, while they didn't really succeed in their own partisan health care program, would have been arrogant to think they could cram through their own health care system and be in power forever. The only working solution is to have a truly bipartisan health care system.

 

[Deuce]

Which is why I proposed a market based exchange with a wide variety of policy choices made by the customer instead of bureaucrats. I'm NOT comparing CURRENT costs I'm suggesting that a national menu-driven market would provide more competition and pricing. Also the ready availability of treatment and advanced technologies here does make our system more expensive. When it comes to quality of care there are a damn sight more folks coming here than going overseas.

And single payer provides that HOW?

It’s a simple question, is there a reason you didn’t answer?