Do You Want a Single Payer System?
We are 13 days into the new year with Democrats controlling the House. And this already came out:
A U.S. representative has requested that the Congressional Budget Office provide a report on single-payer policy considerations.
House Budget Committee Chairman John Yarmuth, D-Ky., on Jan. 8 sent a letter to CBO Director Keith Hall requesting a report “on the design considerations that policymakers would confront in developing proposals to establish a single-payer system.”
The letter comes as Mr. Yarmuth’s panel prepares to consider ways to provide Americans with affordable, high quality healthcare coverage.
As his committee discusses this issue, it is crucial to begin with a qualitative assessment of how policy design choices could affect the federal budget, national healthcare spending and care access, Mr. Yarmuth said in a news release.
I don’t love the system we have now. I think we have great doctors and hospital systems but it is unaffordable. You know my thoughts on this. I believe the free market is the only way to fix it and DPC has been a living example of that. But that is only the primary care part. Dr. Keith Smith and his Surgery Center of Oklahoma has been a great example of the surgical part. That being said there are people who think a single-payer system is the answer. I am open to your thoughts on this.
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The VA is a classic example of “Single Payer” and is a debacle, to put it mildly. Expanding this will not improve anything.
The VA is an example of full on socialized medicine, like the military and UK.
The Improved Medicare for All crowd, growing fast, are not calling for this at all.
Single payer that allows balance billing should be considered (I think that’s the case in France and Australia).
First and foremost, Coverage≠Care. No matter what insurance is covering, commercial, government or Obamacare.
Secondly, I agree with Doug’s thoughts on DPC and services like SCOK as wonderful examples of how the free market can make a difference.
The missing piece is true catastrophic insurance, which the ACA deftly outlawed, thereby forcing us into the ACA.
True catastrophic insurance making a return + DPC + freestanding, independent ancillary services can be the solution to our problems. The issue there is that TPTB that have trillions invested will balk at the idea.
In the meantime, AHPs and STLDs, along with excepted benefit plans, and to some degree health sharing plans can bridge the gap until true catastrophic policies are once again available.
If we don’t do something, a universal, single-payer, first-dollar coverage plan will be the rule of the day. And I don’t want anything to do with that.
Yes, I agree that the DPC run by MDs and DOs will make the HCCs and ACA raise HELL despite the AHPs and STLDs crying BS about the TPTB no matter the wonderful SCOK says. LOL, ROFLMFAO, WTF.
Too bad you have nothing substantive to say. If just casting aspersions makes you feel better, then go for it.
If done right, a single payer system could work and I would have to answer the theoretical question “yes”.
The trouble is dealing with it and implementing it in a practical sense. I have no confidence that the US, either its leaders or its citizens, would be able to deal successfully with the changes necessitated by a single payer system.
I disagree. If we could implement Medicare, with so many in Congress against it in 1965, then we can implement Single Payer – maybe incrementally, but we can do it.
I am totally for single payer, or Medicare for All. I am on Medicare and it is fantastic. I cannot say enough about it and I think everyone in this country should have it. You do not have to cover everyone at once – stagger coverage, e.g., 54-64, etc. We already have single payer in Medicare and again, it is the greatest thing ever.
1. How much money do you pay for your fantastic Medicare?
2. How much money does Medicare pay out for your care (based on those Explanation of Benefits statements you receive in the mail)?
3. Where does the money come from to cover the difference between those two numbers?
4. Multiply the money in 3 by 380,000,000, the number of people in the US.
Now multiply that by 2, as everyone will be seeing the doctor twice as much once it’s “free.”
That’s how much basic care will cost, not counting unusual events, such as ICU stays and the end-of-life Medicare roll-up, for the entire country.
5. Where is that money going to come from?
I have heard the same argument about education and the police and the fire department and yet we cover the cost for them through our taxes. They are considered a right and not a privilege, as is our health care and which you seem to think is a privilege.
We are the only industrial country in the world without universal health care. Right now, we pay 30% of our premiums for administrative fees – unbelievable – and not health care. With Medicare for all, that 30% would go for health care. Payment would also come out of our taxes. Plus, there would not be any insurance companies – doctors spend so much time trying to figure out how to pay these companies – there are different rules for each one. And the CEO’s salaries – a disgrace!! Without those salaries, the cost of health care would be much lower.
And why do you assume that people will see their doctors more now that it is “free”? It is not free and would not be free, as I have said above. But your lack of respect for people is so obvious. People hate going to doctors – they put it off for as long as they can. Which is another issue that I shall not go into here.
I have been working for Single Payer since 1994 and you can learn more about me and my television series, Your Health Care:Choice or Chance” at http://www.tvyourhealthcare.org. And you can read my book, Ellen In Medicaland, on Kindle and you can watch my show, Just What The Doctor Ordered, on youtube, both about my wild and crazy experiences at a Harvard-teaching hospital. When you read and watch, you will see how “wonderful” our current system is and that it is must change to Single Payer.
The fact remains, we cannot afford Medicare for the retirees, much less everyone. Get RID of the Dept of Defense and the seniors will still bankrupt is.
Any care deemed a “right” leads to unrestrained demand, inflation, cost overrun, cost-containment attempts, shortages, then rationing.
And as Lance pointed out, the shuffleboard set isn’t even paying for their own care in large measure. This is a Ponzi-scheme ripoff of the younger generations and you know it. I’m mid-50’s, and resent the hell out of seniors for what they are willing to inflict on others for their own comfort. And yes, Granny and Gramps run to the ER all the time for minor stuff – just wait till you bring in the Medicaid crowd!
Ms. Kagan,
“I have heard the same argument about education and the police and the fire department and yet we cover the cost for them through our taxes.”
— Which argument? I re-read my post. I don’t see any argument that would fit your statement. Would you, perchance, be creating one so that you can oppose it?
“They are considered a right and not a privilege, as is our health care and which you seem to think is a privilege.”
— Absolutely false. Neither education, nor police protection, nor fire service is a right.
If they were, individuals would be able to sue in order to obtain them, and others would be forced to provide them.
If education were a right, then Americans would not be among the poorest educated citizens of developed nations. A child cannot be refused an education, and local government must provide some sort of educational facility, but there is absolutely no true standard for what an education actually entails. I could say “You have a right to health care” and hand you a Band-Aid, but that would not be the same as providing actual health care.
Police protection has been explicitly ruled by the Supreme Court not to be a right.
There is no requirement for a jurisdiction to provide police coverage (my own town in NY has no police force – if you call, the county sheriff or the state police will come, if and when they have a chance). If you are the victim of a crime that the police could have (and by evidence should have) prevented, you have no right to sue the police department for damages, because they explicitly have no obligation to protect you, personally, which is to say that you have no right to police protection.
If you live outside of an urban area, it is very likely that your fire services are provided by a volunteer fire department. There is no right to have a fire department, and in many rural areas, there is effectively no fire coverage.
Your statement that these are rights is pure fantasy.
Health care is also not a right. As in the above cases, things that require the actions of other people cannot be rights. The rights to freedom of speech, of religion, from illegal searches, and the right to arm oneself do not require action on the part of any other person (inaction, yes – they require the government to stay back) If health care were a right, then it could be enforced by an individual, which would mean that I could be dragooned into providing medical care without pay, which would violate the13th Amendment (ie: my right not to be a slave).
“We are the only industrial country in the world without universal health care. Right now, we pay 30% of our premiums for administrative fees – unbelievable – and not health care. With Medicare for all, that 30% would go for health care. Payment would also come out of our taxes. Plus, there would not be any insurance companies – doctors spend so much time trying to figure out how to pay these companies – there are different rules for each one. And the CEO’s salaries – a disgrace!! Without those salaries, the cost of health care would be much lower.”
— Yes, we know all that. That’s why we’re opposed to the profiteering of the insurance companies.
Have you been paying attention here, or did you just pop in to troll?
“And why do you assume that people will see their doctors more now that it is ‘free’?”
— Because every study has shown that that’s what happens.
“… your lack of respect for people is so obvious.”
— Thank you. I didn’t think you’d notice.
“People hate going to doctors – they put it off for as long as they can.”
— Exactly the opposite of what I’ve observed in practice.
People will come in, and they will wait three hours, to be told that their obvious cold is a cold, or that their minor scrape requires no care. I see them 13 hours a day. It is constant. Sometimes they bring the whole family, bring food, and make an outing of it.
“I have been working for Single Payer since 1994”
— Doesn’t look like you’ve done a very good job of it then, does it?
People are much worse off now than they were 25 years ago.
Don’t feel bad, though – I’ve been trying to cure pestilence and misery for even longer, and it doesn’t look like I’ve even made a dent, so I guess we’re in the same boat.
Well sonofabitch Lance, you knocked that way out of the park.
Thank you, Pat.
You’ll notice it’s been several days, and still no reply, too.
I mean, I’m happy to discuss this stuff, and I’m not even opposed to some sort of “universal coverage,” provided it’s done properly (which I don’t expect it would be), but this sort of “troll and run” post is just reprehensible as far as I’m concerned, especially on a board that is comprised almost entirely of medical professionals, who could provide enlightening information to the dedicated health care crusader.
Unfortunately I fear we are headed in this direction. There are more and more people in this country who want “free” stuff and less who are willing to work for it. Plus healthcare and health insurance have become so unaffordable that it is now more affordable NOT to use insurance (enter DPC) unless something catastrophic occurs. IF we are going to have some form of single payor, I would like to see a bipartisan plan that includes catastrophic coverage combined with HSA’s with incentives for being healthier, getting preventative care, etc. Allow patients to choose their doctor and use their HSA for DPC.
Healthcare Goals (listed alphabetically)
1) Affordable.
2) Quality
3) Universal Coverage:
Pick two. You can’t have all three.
Options:
1)Pure Free Market: Quality and Affordable. Universal coverage is lacking.
2)Single Payor/Nationalized Healthcare: Affordable (to the consumer) and Universal Coverage. Quality is lacking.
3)Our current third party payor system: Quality only. Both Affordability and Universal Coverage are lacking.
If we (as a nation) are going to have an honest discussion, we have to start with the knowledge that all three goals are not compatible with each other. There is no perfect system.
You can have free market and universal coverage, although it is not “coverage” in the traditional sense. Singapore has it. Every working individual has to deposit a certain percentage of their income into an HSA type of fund. When ill, the individual chooses the physician or hospital and uses the HSA to pay. No insurance to make a profit, no admins to feed.bGabi EyalWhen funds are exhausted, the government steps in, based on recommendations from physicians. Government completely subsidies the disabled only. It works, it works very well.
That may work in a sense, but with subsidies guaranteed hospitals by government, it is definitely not “free market,” and costs would either rise, or payments would be capped. Don’t know about Singapore, but this government doing things “based on recommendations from physicians” is laughable.
I posed this question to a friend just last week (he’s very pro universal single payer). He said he only needed one of the three for the US – quantity. I told him fine, with that you get WebMD and a handful of generic BP meds, aspirin, and do-it-yourself appendectomy videos on YouTube. Additionally, in order to provide that handful of generic meds to everybody, you’d have to do away with DOD and let Canada and Mexico provide for our security. His answer was he’d have to think about that one and never got back to me on it.
Have everyone work and pay 50% in taxes, allow physicians to unionize and strike, muzzle the lawyers, and tell patients if they have a problem they have to to take it up with their Congressperson, and socialized medicine has a slim chance working. Otherwise it is doomed to fail.
You are absolutely correct.
And society will have to embrace rationing.
As with Medicare/Medicaid presently, there is no disincentive to seeking immediate care for the most trivial complaints. Half my extremely busy ER shift yesterday was occupied with anxious seniors who’s complaints compelled huge work ups (thanks lawyers) with negative findings; and numerous Medicaid adults and children with (literally) runny noses or minor bumps, who come to the ER because “it’s free.”
We can’t even afford universal care for the retirees – can’t wait to hear how we’ll cover everyone.