Single-Payer Health Care

[Frodo]

Since it appears that Obamacare is at death's door with Trump's latest threat to withdraw all subsidies (and I strongly doubt that the Republican-dominated Congress will come to the rescue...), it seems that single-payer is increasingly becoming an inevitability the next time Democrats regain control of the trifecta.

With that said, what will single-payer look like?  Everyone keeps talking about it being essentially 'Medicare for all', but what about other programs like Medicaid and SCHIP (state children's health insurance programs)?  Do they all get subsumed within it?  I would very much like to take Medicaid out of the hands of the states (especially Republican-dominated states), so they can't play at social engineering at the expense of the poor and vulnerable. 

[Kingpoleon]

It depends. The only major universal healthcare proposal post-2004 was Wyden-Bennett.

[NeverAgain]

I have no clue, and that is what annoyed me about Bernie's healthcare platform. There were no specifics other than "Medicare For All". My assumption is that it will follow HR 676, but I don't know what will be done about other programs (included within Medicare, Medicaid abolished?). I don't know. Here is 676, but it's just a symoblic measure that Conyers does every session. Yet, still has 110 Co-Sponsors. Anyways. It'll all depend on what happens in the next couple of months and years.

[Frodo]

I have no clue, and that is what annoyed me about Bernie's healthcare platform. There were no specifics other than "Medicare For All". My assumption is that it will follow HR 676, but I don't know what will be done about other programs (included within Medicare, Medicaid abolished?). I don't know. Here is 676, but it's just a symoblic measure that Conyers does every session. Yet, still has 110 Co-Sponsors. Anyways. It'll all depend on what happens in the next couple of months and years.

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The language here suggests that these programs would indeed be absorbed immediately into this new Medicare-for-all system.

And as for the Veterans' Health Administration and the Indian Health Service (both of which are single-payer, BTW):

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[Person Man]

it seems that single-payer is increasingly becoming an inevitability the next time Democrats regain control of the trifecta

What country are you posting from?

I like to say that Fee For Service HC is basically the Roe v. Wade for the left. It's basically the #1 justice issue they have. They campaign and win elections on the issue, and may threaten ancillary action or might even unsuccessfully push it at the state level every now in then in the most partisan states, but they need to keep running on it. They also fear that there won't be a new issue and that they secretly fear that if we do overturn Roe v. Wade or pass Single Payer, it will be very unpopular and unsuccessful.

[DC Al Fine]

With that said, what will single-payer look like? 

One things for certain. Spending will have to go down. There's no way the government can afford all that healthcare spending plus all the additional usage that will happen when people pay out of pocket. Some of the cuts will be popular (insurance company profits, all those jobs related to managing billing, selling health insurance etc), but a lot of it will have to be from actual healthcare. If the Canadian experience is any indicator, most of the cuts will be on chronic, non life threatening conditions.

The Canadian healthcare system is excellent if you broke your leg or are having a baby or lung cancer, but it's stinks if you need a knee replacement (two year waiting list in my province), or need a family doctor (chronic shortages in many parts of the country). Now, I like the Canadian system and see it as a major improvement over the American one, but you guys ought to know what you are getting into. A large segment of Americans will see a decline in their quality of care.

[Person Man]

With that said, what will single-payer look like?

One things for certain. Spending will have to go down. There's no way the government can afford all that healthcare spending plus all the additional usage that will happen when people pay out of pocket. Some of the cuts will be popular (insurance company profits, all those jobs related to managing billing, selling health insurance etc), but a lot of it will have to be from actual healthcare. If the Canadian experience is any indicator, most of the cuts will be on chronic, non life threatening conditions.

The Canadian healthcare system is excellent if you broke your leg or are having a baby or lung cancer, but it's stinks if you need a knee replacement (two year waiting list in my province), or need a family doctor (chronic shortages in many parts of the country). Now, I like the Canadian system and see it as a major improvement over the American one, but you guys ought to know what you are getting into. A large segment of Americans will see a decline in their quality of care.

Can't we just allow more paraprofessionals, like nurses, and high skilled subprofessionals (PRNs and PAs) handle
more routine care?

[parochial boy]

With that said, what will single-payer look like? 

One things for certain. Spending will have to go down. There's no way the government can afford all that healthcare spending plus all the additional usage that will happen when people pay out of pocket. Some of the cuts will be popular (insurance company profits, all those jobs related to managing billing, selling health insurance etc), but a lot of it will have to be from actual healthcare. If the Canadian experience is any indicator, most of the cuts will be on chronic, non life threatening conditions.

The Canadian healthcare system is excellent if you broke your leg or are having a baby or lung cancer, but it's stinks if you need a knee replacement (two year waiting list in my province), or need a family doctor (chronic shortages in many parts of the country). Now, I like the Canadian system and see it as a major improvement over the American one, but you guys ought to know what you are getting into. A large segment of Americans will see a decline in their quality of care.

Completely irrelevant bit of trivia here, but I actually work for a company that makes knee replacements, and part of the reason for long waiting times in Canda is the move to a new procurement model, where hospitals, or even provinces, are making final procurement decisions instead of surgeons. Which has been excellent for cost control, but lead to longer waiting times for surgeries.

In the US however, surgeons still mae the final procurement decisions, which is great for our profit margins, but, dare I say it, not so great for patients at the end of the day.

[MasterJedi]

We could possibly try instituting a profit cap to keep expenses down first.

[Santander]

We could possibly try instituting a profit cap to keep expenses down first.

You can't be serious... before we even get into how immoral and impractical the idea of profit caps are in general, the only thing this would do consolidate healthcare providers since they are the ones who are really making money, and greatly reduce healthcare product development. The healthcare capital market would collapse, and one failed blockbuster would take down most innovative drug manufacturers.

The best way to lower prices in a market is to put more power into the hands of consumers. Insurance companies are currently acting as a shield for healthcare providers against consumers - that needs to end, whether we are talking about private insurance or public universal insurance.

[Storebought]

It will likely take a constitutional amendment to institute a Republican and insurance-company proof single payer system.

[tschandler]

We simply can't afford it with the scale and complexity of the US healthcare system. 

[Cory]

We simply can't afford it with the scale and complexity of the US healthcare system. 

Because reasons.

[hueylong]

According to the BLS, employment in insurance industry as of April 2017 was 2629.3 thousand, or about 2.6 million. Let's say that health insurance administrators account for roughly 25% of that. That's ~650,000 people who would stand to become unemployed if we adopted single-payer. Why is this treated as such a non-issue? Oftentimes it's not even a part of the conversation, which is bewildering.
 
You can quite easily make the argument that from a utilitarian perspective, 650,000 jobs lost is a small price to pay in order to ensure that everybody has coverage, but that only speaks to the moral component of this question, and does nothing to resolve the political consequences or address the very real instability and uncertainty these people would face.
 
It is true that, from a policy perspective, dealing with the resulting unemployment would likely be fairly straightforward. Many of those displaced could find employment in the expanded Medicare system which would arise, and practically speaking many could be retrained to eventually occupy positions in separate, unrelated fields. I also don't doubt that the type of reform we're discussing is needed and likely the morally correct thing to do. So that's all well and good. Mitigating the political consequences, however, would be anything but straightforward. Progressives would rejoice in their victory, but Democrats would get absolutely clobbered because they would in the eyes of many have basically confirmed the common Republican critique, namely that they don't care all that much about Americans having jobs/don't regard it as a priority. Add in the fact that healthcare is a true political third rail and the electoral consequences look horrifying. The Republican ads, speeches, and campaign slogans would craft themselves. And while it's noble to say that morality should trump politics, many will not share that view.
 
With the implementation of the Affordable Care Act, there has been a corresponding increase in the amount of jobs in the health insurance industry. The reason is obvious--more claims, applications, and purchases, so more employees. And yet instead of this being a reversal of past trends, it's probably more accurate to describe it as an acceleration: This is a sector that has seen consistent growth for decades. So another element of this healthcare debate is that if the Senate GOP does decide to go through with repeal and replace, it will be interesting to see the impact that legislative activity has on employment trends in the health insurance industry both in the immediate short-term and over the coming years.
 
I don't know. Just some thoughts.

[Kingpoleon]

We simply can't afford it with the scale and complexity of the US healthcare system. 

Because reasons.

It's not really realistic, especially compared to universal healthcare systems that are revenue neutral fairly soon, such as Wyden-Bennett.

[The_Doctor]

Don't do single payer. It's an asinine idea. What's better is managed premiums into a managed market system with well regulated insurance markets. Basically, a streamlined version of the ACA with more competition, coverage of all beyond a certain percentage of income, adjustments based on obesity, smoking, and drug history, and different community coverage ratings than the ACA.

The ACA demonstrates with fixes, we don't need single payer. We need a better market system. (It would also help if we took on drug makers).

This plan would be more affordable, would work for the United States better, and maintain our capitalistic system. It's also been tried in Switzerland and is one of the most conservative plans in Europe.

[parochial boy]

Yeah, don't take Switzerland as some example to follow on healthcare. Having to blow 300-400 francs a month in insurance is one of the biggest political issues at the moment, it is second to only the US in terms of how expensive it is.

To add to that, the world class treatment that people get mostly occurs in public hospitals.

[The_Doctor]

Yeah, don't take Switzerland as some example to follow on healthcare. Having to blow 300-400 francs a month in insurance is one of the biggest political issues at the moment, it is second to only the US in terms of how expensive it is.

To add to that, the world class treatment that people get mostly occurs in public hospitals.

For one, Switzerland's system is still highly rated in Europe. I think your answer might be a result of your general expectations no? Compared to the American system, Switzerland is a world class system.

The reason I favor continued insurance premiums is that they, by definition, price risk appropriately. They assess each person appropriately and assess how much of a general risk they are. For a lot of reasons, we shouldn't penalize people with genetic diseases and diseases unrelated to lifestyle choices but for again, a lot of reasons, we SHOULD price in premiums for people who have horrible lifestyle choices.

There is still no such thing as a free lunch. We can reduce costs, shift costs around, and create a managed pool but still, no such thing as a free lunch and we should be cognizant of that when offering people benefits. Human nature being what it is, they will maximise their benefits accordingly with the least adjustment to their personal lives. This, to me, presents one of the biggest reasons with socializing medicine.

Also, the American system rewards healthcare innovations which are used by other universal healthcare systems around the world. Socialized systems are not conducive to innovation to reduce costs, and not conducive to creating an incentive to further the technological advancement that we have seen in the American capitalistic healthcare system.

For note: the NHS is experiencing considerable costs related to this issue (not as much as it has been said, but still).

[Kingpoleon]

TD/SilentCal1924: Would you support something like Collins-Cassidy(with adjustments) temporarily, in order to ease in something like Wyden-Bennett?

[parochial boy]

Yeah, don't take Switzerland as some example to follow on healthcare. Having to blow 300-400 francs a month in insurance is one of the biggest political issues at the moment, it is second to only the US in terms of how expensive it is.

To add to that, the world class treatment that people get mostly occurs in public hospitals.

For one, Switzerland's system is still highly rated in Europe. I think your answer might be a result of your general expectations no? Compared to the American system, Switzerland is a world class system.

The reason I favor continued insurance premiums is that they, by definition, price risk appropriately. They assess each person appropriately and assess how much of a general risk they are. For a lot of reasons, we shouldn't penalize people with genetic diseases and diseases unrelated to lifestyle choices but for again, a lot of reasons, we SHOULD price in premiums for people who have horrible lifestyle choices.

There is still no such thing as a free lunch. We can reduce costs, shift costs around, and create a managed pool but still, no such thing as a free lunch and we should be cognizant of that when offering people benefits. Human nature being what it is, they will maximise their benefits accordingly with the least adjustment to their personal lives. This, to me, presents one of the biggest reasons with socializing medicine.

Also, the American system rewards healthcare innovations which are used by other universal healthcare systems around the world. Socialized systems are not conducive to innovation to reduce costs, and not conducive to creating an incentive to further the technological advancement that we have seen in the American capitalistic healthcare system.

For note: the NHS is experiencing considerable costs related to this issue (not as much as it has been said, but still).

That sounds more like an argument that a free market solution is better because it is the free market, rather than because it is more effective to be honest.

Healthcare in Switzerland is excellent, not because of the insurance model, but because it is an exceptionally wealthy country that directs a lot of resources towards healthcare. It is absolutely not an effective model, and when it comes down to it, the quality of care isn't any higher than it is in France, which does have a single payer model, and which is much (almost 40%) cheaper at that.

The difference is, cap or no, healthcare costs for people on lower or middle incomes, especially with chronic conditions, can still be crippling. When it comes down to it, passing funding of healthcare on to patients through an insurance system provides a much less cost efficient solution, for many reasons (case in point - the US or Swiss models provide significantly less stringency or procurement than alternatives, as costs can be passed directly on to the "consumer").

I would also add that public funding has not stopped other countries (the NHS especially) from innovation. Innovation in the US is really not all that spectacular when you consider that it accounts for virtually 50% of global healthcare expenditure.

[MasterJedi]

We could possibly try instituting a profit cap to keep expenses down first.

You can't be serious... before we even get into how immoral and impractical the idea of profit caps are in general, the only thing this would do consolidate healthcare providers since they are the ones who are really making money, and greatly reduce healthcare product development. The healthcare capital market would collapse, and one failed blockbuster would take down most innovative drug manufacturers.

The best way to lower prices in a market is to put more power into the hands of consumers. Insurance companies are currently acting as a shield for healthcare providers against consumers - that needs to end, whether we are talking about private insurance or public universal insurance.

Lol, child, it's immoral to charge people exorbitant amounts of money for a life giving/sustaining service to the point they can't afford it and die or live substandard lives. It's not like we're talking about large flat screen TVs, luxury cars or jewelry here that is not a necessity.

[Person Man]

We could possibly try instituting a profit cap to keep expenses down first.

You can't be serious... before we even get into how immoral and impractical the idea of profit caps are in general, the only thing this would do consolidate healthcare providers since they are the ones who are really making money, and greatly reduce healthcare product development. The healthcare capital market would collapse, and one failed blockbuster would take down most innovative drug manufacturers.

The best way to lower prices in a market is to put more power into the hands of consumers. Insurance companies are currently acting as a shield for healthcare providers against consumers - that needs to end, whether we are talking about private insurance or public universal insurance.

Lol, child, it's immoral to charge people exorbitant amounts of money for a life giving/sustaining service to the point they can't afford it and die or live substandard lives. It's not like we're talking about large flat screen TVs, luxury cars or jewelry here that is not a necessity.

You should be able to make a living delivering or arranging Health Care, but not to seek rent over it.

[Potus]

I've written here before about the crisis that would follow single payer if the federal adopted reimbursement rates similar to existing health insurance programs. You're looking at a total depopulation of rural areas, huge paycuts and layoffs in the industry, and a growing call for nationalization. Nationalization is another problem entirely, but probably the end goal of most in the know about single payer.

[MasterJedi]

I've written here before about the crisis that would follow single payer if the federal adopted reimbursement rates similar to existing health insurance programs. You're looking at a total depopulation of rural areas, huge paycuts and layoffs in the industry, and a growing call for nationalization. Nationalization is another problem entirely, but probably the end goal of most in the know about single payer.

Well you sold me with "total depopulation of rural areas".

[○∙◄☻¥tπ[╪AV┼cVê└]

it seems that single-payer is increasingly becoming an inevitability the next time Democrats regain control of the trifecta

What country are you posting from?

What's funny is that this is from someone who supported the candidate in the primary who said "single payer will never ever happen".