"Universal healthcare now!" must be the Democratic motto in 2018

[Torie]

Is universal health care the same thing as single payer? I support the former, but resist the latter, unless there is no other way to do it, that will not cost a lot more money (other than money which funds drug research).

[Torie]

Is universal health care the same thing as single payer? I support the former, but resist the latter, unless there is no other way to do it, that will not cost a lot more money (other than money which funds drug research).

They do not need to be the same, and universal health care can be operated with a multi-payer system. In Germany there are over 100 funds that insure most of the population, paid for by a combination of employer, employee and government contributions. The premium is fixed for individuals in these funds independent of risk. There is also an opt-out provision for qualified individuals to pay a tax and buy insurance independently of the regulated funds, but those individuals can be charged based on risk.

Thank you. Do you think the German model has merit to consider for the US?

[Torie]

Is universal health care the same thing as single payer? I support the former, but resist the latter, unless there is no other way to do it, that will not cost a lot more money (other than money which funds drug research).

They do not need to be the same, and universal health care can be operated with a multi-payer system. In Germany there are over 100 funds that insure most of the population, paid for by a combination of employer, employee and government contributions. The premium is fixed for individuals in these funds independent of risk. There is also an opt-out provision for qualified individuals to pay a tax and buy insurance independently of the regulated funds, but those individuals can be charged based on risk.

Thank you. Do you think the German model has merit to consider for the US?

There is no reason to condemn the German model as less likely to work well here than single payer, but neither necessarily helps when the underlying costs of delivering health care in the United State are around twice as much per capita compared to Germany, which itself is fairly expensive compared to many other rich countries. "Universal health care" is a wonderful and high-minded commitment, but it's far from a direct answer to our health care affordability problem.

The ACA has been good mostly at moving costs around to keep hospitals open, individuals out of bankruptcy, state and local governments solvent, and businesses able to afford insurance for their employees. But the costs are still there, and still growing. They are probably a major factor behind increasingly toxic politics on an issue that has always been politically toxic. Unfortunately, no one in power appears to have much interest in addressing - except maybe by cutting off some of the most basic forms of health care for the most vulnerable and powerless people.

As difficult as it to talk about health care coverage, it's much more difficult to talk about health care delivery.

Part of the problem is that the US funds drug research for the planet, because drug companies charge less to rich foreign countries than in the US due to their being a single purchaser in government run health care systems. That is why I keep harping on that the US should pass a law that drug companies should be prohibited from charging more for drugs in the US than in rich countries abroad, other than for whatever cost savings attend having just one purchaser (the volume discount concept). Doing that will reduce costs for health care in the US by a fairly large number, unless government run health systems abroad refuse to pay higher prices for expensive drugs that work better, then cheaper generic drugs, and force their citizens to do without. I tend to doubt that will happen. In the end, the idea is that rich countries abroad will pay more for drugs, and the US less.

One other thing. The health care industry private sector needs a profit to pay for the cost of capital. When the government spends money, it too has a cost of capital. It is just not on the books. It's implicit because the more the government spends, the higher the debt service. Thus the cost savings from an economic perspective from single payer are less than advertised.