QuoteHalf of Americans said, in the abstract, that they would support single-payer. But 20 percent flipped and said they would oppose the idea if it meant many Americans would have to pay higher taxes.
https://www.vox.com/policy-and-politics/2017/5/22/15676782/california-single-payer-health-care-estimate
>> would oppose the idea if it meant many Americans would have to pay higher taxes
Here in Canada we pay higher taxes because of our Medicare but we escape the mess of insurance payments that our US friends face. Our net costs are less.
Our average life expectancy is two years longer than our US counterparts, yet medical costs are a significantly lower percentage of our GDP than in the US (something like 12% vs 18%).
Single payer has a lot to recommend it.
>Single payer has a lot to recommend it
I agree, sorta. In the long run, according to Brits here, single payer tends to crap out. A large percentage of doctors & nurses migrate away to the money elsewhere and these positions are filled by 2nd-world med staff who are also in the process of migrating to the money.
It seems to me, though, that the above Calif experiment has the pitfall of being stuck between two worlds; it's still having to contend with & pay the pricing of the US med-services oligarchy without full benefit of negotiating MUCH lower prices.
Quote20 percent flipped and said they would oppose the idea if it meant many Americans would have to pay higher taxes.
Oh my people.
For the 20% who shift, it's as if we had a 100% toll highway system and they were asked, would you support a toll-free highway system? And they answer yes. Then get told that a highway still costs money, so they would have to pay taxes, then said no.
Don't get me wrong. I can see saying no. Certainly a person who doesn't drive might have trouble seeing the benefit (though the benefit is there, since the person who doesn't drive is certainly getting deliveries). But the flipflop when you realize costs don't suddenly vanish is the part that astounds me.
Quote from: rcjordan on May 23, 2017, 02:37:15 PM
>Single payer has a lot to recommend it
I agree, sorta. In the long run, according to Brits here, single payer tends to crap out... stuck between two worlds.
As far as I can see, every system in the world is running into issues with cost containment and will continue to do so. I recently saw an interview with a guy who was high up in the Nixon administration and had something to do with health insurance under Nixon. He was commenting on the current fracas over ACA/AHCA and said that he saw no way to deal with healthcare in the US long-term other than single-payer. He personally said he didn't like single-payer, but that whatever solution he liked (he didn't go into it much) would never be politically viable (which is saying something if he thinks it's got less of a chance than single-payer).
But no matter what, we have to get costs down and that means among other things fewer service delivered by MDs. For several years now, self-learning diagnostic systems have had better track records than MDs, but both doctors and patients shy away from them. But generally speaking, diagnosis can be done *better* by someone with a smart system and a two-year training. That saves not only all the MD time on diagnosis, but saves all the time treating the wrong condition.
The current US system incentivizes doctors to be wrong. If a doctor is wrong, he gets repeat business. It's one of the few fields where that's true. We just had someone at our house who runs the wellness program for a hospital and she said there was this "Wait? What?" moment a few years into it when they realized it was working and patients weren't coming back and that was bad for revenue (anecdotal of course).
All of which gets me to this
QuoteCalifornians would not have any premiums, copays, or deductibles
This is bad. One of the problems in healthcare is that consumers have no clue how much things cost. There is a name for a market like this, but I can't recall it... It's similar to the college textbook market where the person making the buying decision (the professor) never pays for the product and the end user is commonly subsidized (parents or govt loans).
I would support a system with copays and deductibles based on income. Seriously, a $1000 deductible is not going to change my habits (not counting vision, I've only had 4 doctor visits in 20 years, two for an injured finger tendon and two for physicals).
I get that people on limited income will put off care if they have copays, and the long-term cost goes up. But frankly, the large number of people who are getting tested for every imaginable food and chemical sensitivity, the large number of people who go to the doc to seek antibiotics for their cold (which is viral people!) and so forth should have some skin in the game.
So... it turns out this will require $200b extra, and will shave $100b to $150b that get deducted from wages currently (as per the article). So there's $100b unaccounted for.
Let's say the median Californian spends $500/yr out of pocket - it has to be somewhere north of that because we average more than that and all we do is go to the dentist and the eye doctor. So with 40m people, that's $20b right there.
So we're down to $80-$130b shortfall.
There are 19 million workers in CA - https://www.bls.gov/eag/eag.ca.htm
Taking the middle: $105b/19m = $5500.
So that's $5500 extra if you're currently covered by insurance on average.
Now it gets too complicated for my brain though, because a progressive tax system means that people at the bottom end won't pay close to $5500/year.
And then there's the issue that "free" healthcare will increase consumption of services. Is the infrastructure there to deliver?
Then there are some obvious benefits
- preventative care to avoid hugely expensive emergency care (I bet ER admissions would go way down).
- preventative dental care, which has become a "rich" person's thing, as widely reported recently.
- address income inequality - as it is now, healthcare is shared evenly. At my company, the lowest wage earner and the CEO have the same contribution, and some analyses I've seen says that rising health insurance premiums account for almost all of the missing wage growth in the "anemic recovery" since 2008.
At then end of all that, I feel like I need a lot more info to decide whether this is actually good or bad.
Advances in AI / technology are probably the most realistic solutions. They should arrive just in time for my funeral.
To put it in perspective I've had to pay as much as $1.6k/month to insure my family so $5500/worker sounds like a pretty good deal to me.
>$1.6k/month
I used to manage a small company group policy and picked up a few billing tidbits related to BC/BS coverage. Most significant gotcha; there are age-brackets in healthcare policies, every 5 yrs of age ratchets up the cost. (Reasonable from an actuarial perspective.) At around 55, it'll kick into high gear. My brother, age 59, pays $1.6k/month for a low-deductible INDIVIDUAL policy.
<added>
Meanwhile, the new US budget proposal has surfaced.
The biggest savings would come from cuts to the Medicaid healthcare program... ...more than $800 billion
...and more than $192 billion from food stamps.
Ouch! That's going to leave a mark.
A big chunk of the population that voted for the current administration is going to get hit hard by that.
Quote from: littleman on May 23, 2017, 05:34:04 PM
To put it in perspective I've had to pay as much as $1.6k/month to insure my family so $5500/worker sounds like a pretty good deal to me.
The 1.6K is already factored in. That's how you save the first $100b. The *second* $100b is the part that you don't save by cutting premiums. So the relevant number is your out of pocket expenses.
>>Advances in AI
Watson. But non-AI systems were already outperforming MDs over a decade ago. My brother was in the industry and there was already ample evidence, but the cultural factors were the holdup. Consider how people are leery of self-driving cars, even when they outperform human drivers and add 100%. And doctors generally don't like it.
There are two models by which doctors get paid in the US
- fee for service, which drives cost up because the incentives are to offer more services, needed or not.
- fee per patient (doctors at HMOs), which drives quality down because the incentive is to push people through as fast as possible.
Advances in AI will help, but you have to get people using them. And part of that would be paying doctors salaries with perhaps some incentives based on outcomes. This is one of the more successful parts of Obamacare that people don't talk about much. Providers could opt in to be paid a flat fee to treat a given problem. The incentive then is to get the treatment right the first time and avoid readmissions. I read one article that said that readmissions in hospitals that opted in were down. Basically, that system incentivizes good care, not extra care or insufficient care.
I propose two ways to deal with this:
1. Single payer much like the Canadian system with tax increases, litigation and price controls. It will put the med insurance business out of business but they are already dying anyway.
2. Get all government (Feds and states) out of health care. Employers or self pay only. No Medicare no Medicaid the only exception would be the VA. The medical industry will collapse when they find people just can't pay the huge prices they are charging. They will have to cut prices or die. Private insurance costs will skyrocket. The die off of people will be massive: the poor, the sick and elderly first, infants and children, then into the middle class as they fall ill. The mega rich will be sheltered or even immune of course. Etc. Basically what is already happening right now in super slow motion, only accelerated to lightning speed.
I prefer #1 single payer. It has hidden costs too, like a slowing in medical research and innovation because of vastly reduced profits but I don't see another way.
From the article:
QuoteOf that, $200 billion of existing federal, state and local funds could be repurposed to go toward the single-payer system.
The $200/billion in savings is from the existing state run health plans (Covered California, Medical, etc.), not private insurance.
The state would have to come up with another $200 billion from taxes, but that would be offset by what people are currently paying the insurance companies. Doing quick math, if there are 19 million workers and they (and their employers) pay an average of $12 thousand a year then that's over $200 billion right there. So, it looks to basically be a wash, with the benefit of everybody having insurance and getting preventative care.
Quote from: littleman on May 23, 2017, 09:11:47 PM
The $200/billion in savings is from the existing state run health plans (Covered California, Medical, etc.), not private insurance.
The state would have to come up with another $200 billion from taxes, but that would be offset by what people are currently paying the insurance companies. Doing quick math, if there are 19 million workers and they (and their employers) pay an average of $12 thousand a year then that's over $200 billion right there. So, it looks to basically be a wash, with the benefit of everybody having insurance and getting preventative care.
From the article
Quoteemployers and employees would see reduced costs through the elimination of insurance premiums, which the Times reported range from $100 to $150 billion per year
So my numbers were off (I thought $100-$150b was the amount left, not the amount paid in premiums), but the concept is the same
$200b from existing programs
$100-$150B that people save in insurance premiums
That leaves $50b to $100b that needs to come from additional taxes *after* you include the premiums people pay already, but NOT counting out of pocket expenses. So that's where I was calculating from.
So that means that there is $2600/year to 5200/year in average expenses over and above what you pay now in taxes plus premiums.
But again, you're talking about progressive income tax, widely varying premiums and so forth, so you would need some pretty advanced analysis to find out where the breakeven points would be for a given family.
We LEFT California, in part, because of issues like this.
It makes me SAD to look back.
We still have family there.
PS: I prefer to purchase insurance for my family from a fiscally sound entity. Whatever that is...
> purchase insurance... ...from a fiscally sound entity.
Good point, and not just regarding California. If you'll dig into their finances, state & local govs are not exactly the epitome of sound money management. Mostly, they tend to kick the can down the road by layering on more debt AND/OR hide their failings because they are typically {A#1} not subject to business accounting standards & reporting and {B} considered 'too big to fail.'
Look at SSA, pensions, or existing gov-backed insurance pools. Odds are, any one of them you examine is underfunded. State-backed hurricane insurance would be a good place to start prying.
As funded levels have declined and overall fiscal pressure for states has increased in recent years, many
states have implemented some level of pension reforms in response. The majority of these changes
have been mandated increases or implementation of employee contributions, changes to formula calcula-
tions, and extending vesting periods. The details of these changes and the projected impact on the
state's liability, if available, will be addressed in the upcoming pension reports for the applicable states.
Pension reforms continue in the latter portion of calendar year 2012, including two of the most
populous states with sizeable liabilities: California and Ohio.
http://media.navigatored.com/documents/StateofStatePensionsReport.pdf
INTERESTING GRAPHS
QuoteThe flood insurance program was originally intended to be self sustaining — funded through policyholder premiums, not taxpayer dollars — and for much of its history, it was. But the catastrophic hurricanes Katrina in 2005 and Sandy in 2012 caused so much damage that the program could not pay for it all. After Hurricane Katrina, Congress increased FEMA's borrowing authority from $2 billion to more than $20 billion. They increased it again, to $30 billion, after Hurricane Sandy. The program's debt to the U.S. Treasury is now $23 billion.
In recent years, FEMA has been accused of inadequately supervising that money, as well as the private insurance companies that dispense it.
http://www.pbs.org/wgbh/frontline/article/can-femas-flood-insurance-program-afford-another-disaster/
I rest my case.
I've been looking for verification on the current cost of insurance premiums in California. That $100-$150 billion seems low to me. I would be interested in knowing what the total out of pocket and employer contributions are currently in California.
I do agree that a co-pay would be a good idea, even if it were a small one, say $25, or variable depending on income. This would help eliminate frivolous doctor visits.
"A sweeping measure that would establish government-run universal healthcare in California cleared its first legislative hurdle Wednesday as scores A of supporters crammed into the Capitol to advocate for a single-payer system. The Senate Health Committee approved the measure on a 5-2 vote after a nearly three-hour hearing, but Democrats and Republicans alike signaled unease with the major question still unanswered in the legislation: how the program would be paid for. The bill, SB 562, would establish a publicly run healthcare plan that would cover everyone living in California, including those without legal immigration status. The proposal would drastically reduce the role of insurance companies: The state would pay for all medical expenses, including inpatient, outpatient, emergency services, dental, vision, mental health and nursing home care. The measure says the program would be funded by "broad-based revenue," but does not specify where that money would come from."
https://townhall.com/tipsheet/guybenson/2017/05/23/surprise-californias-singlepayer-healthcare-plan-would-cost-400-billionper-year-n2330456
Universal health care is no doubt very expensive. In contrast, if AHCA goes through it looks like $330 billion would be reduced from the deficit in the next decade. I've also read that 23 million people will lose health insurance and 50 thousand people will die annually. So, that's 500 thousand lives for $330 billion dollars. Or, $660,000 a life.
The F-35 program is projected to cost $1.5 trillion. So that's the equivalent of 2,272,727 lives in taxes, but it sure is a sexy plane.
And thus my despairing comment at the beginning ("Oh my people.")
People are very poor at evaluating risk. If a mountain lion is loose in the city, it's a 911 situation. Get the SWAT teams out and take it out. Entire city blocks go into a lockdown. During which time, two people will die on the highways.
There are enough people who believe that the US military has become weak that you can build will for the F-35, but not for health insurance. Forget that by most accounts the largest three air forces in the world are all US (USAF, USN, and US Army). Some people say that the next three are the Marine Corp, the Air National Guard and the Air Force Reserve. We must protect the nation.
I remember when that plane crashed off Long Island and they had to pull the parts up from deep water at a some huge cost, like $125,000,000 for a projected savings of a couple of lives per decade. When asked if it was too expensive, the investigator said no, "Are you prepared to make that decision to let people die to save that money?"
Of course, littleman would say "Yes, that's 189 lives I can save if I spend that money on health insurance," and I would agree, but as my wife is always reminding me when I got on that particular broken record, people only pay attention to "interesting" ways to die.
Oh my people!
[BTW, "Oh my people!" is a refrain in Billy Lynn's Long Halftime Walk, an absolutely brilliant and funny book]
"if AHCA goes through it looks like $330 billion would be reduced from the deficit in the next decade. I've also read that 23 million people will lose health insurance and 50 thousand people will die annually."
That piece of $HIT is not doing anywhere.
The Senate will start over and something DIFFERENT will pass or Obamacare will implode and...
When the Patient Is a Gold Mine
http://www.neatorama.com/2017/05/26/When-the-Patient-Is-a-Gold-Mine/
I remember seeing charts showing how the cost of healthcare started rising with the start of Medicare. Seems to me we can't give any industry a direct feed into the US Treasury without it running wild over time. Medicare has to be able to control costs and use its buying power to negotiate lower prices. The VA can and does do this, but Medicare can't and the power for it to do so was removed from past legislation at the behest of the medical lobbyists.
All I can say is that the system was broken before ObamaCare. Obamacare is flawed in large part because it does not contain costs. The proposed "replacement" for Obamacare sounds worse, IMHO, and in the meantime the middle class, the people that provide the stability and backbone for the nation, are finding it more and more difficult to pay for the most basic medical needs and that inability to pay keeps spreading higher up the food chain.
"any industry a direct feed into the US Treasury without it running wild over time."
Take higher EDUCATION as an example >:(
Part of the inability to constrain costs in govt healthcare in the US is
1. medical/insurance lobbyists who got the laws crafted in such a way that the govt was not allowed to negotiate (basically Brad's point)
2. completely disconnecting those who receive services from the actual cost of those services
3. a complete unwillingness to recognize that as a society we are always rationing healthcare. The question is whether to do it based on ability to pay or based on projected outcomes. This is a main reason why US healthcare is so expensive. If you have the money, you can get prohibitively expensive care to add 6mos to a year to your life, while someone of lesser means is unable to access care that would add decades. This both drives costs up and life expectancy down, which is why we have the highest cost system and some of the worse outcomes on a population level.
Without dealing with those three things, the rest is window dressing and costs will never be contained in my opinion. Without dealing with those issues, you can't "tech" your way out of it.
QuoteMedicare has to be able to control costs and use its buying power to negotiate lower prices. The VA can and does do this, but Medicare can't and the power for it to do so was removed from past legislation at the behest of the medical lobbyists.
BAM. If there is only one change in our health system, this one would be the one that would do the most good.
Quote>2. completely disconnecting those who receive services from the actual cost of those services
Exactly. Republicans tell us that a free economy system will help contain costs. The problem with that is, nobody is going to compare costs of medical treatments when they need it.
IE
If you need medical treatment, you're not going to call different hospitals to see how much a bag of blood is going to cost or how much it will cost to get a bone set. You're just gonna go to the nearest hospital or go to the doctor you know to get treatment.
I remember on Oprah once, there was an insurance person saying that you could help contain costs by calling ahead to find what the prices were on bone marrow.
She yelled back at her guest,"IT'S BONE MARROW! You're not going to compare costs for bone marrow! You're just gonna get it."
And, how do you compare costs for medical procedures if you don't know what procedure you need?
There are a few procedures that you know about in advance: having a baby is one where you might be able to compare costs -- assuming there are no issues that come up -- but honestly, if I'm having a baby, I want to go to the doctor I know and trust even if the doctor isn't the cheapest one out there. I'm going to the one I feel the most comfortable with since, well, he/ she is gonna be deep up in my business.
Free economy just doesn't work for a lot of health care.
25 plus years ago, in a past life, I processed bankruptcy cases for a law firm for filing with the court. 9 out of 10 bankruptcies were because some unforeseen medical need came along and put them under. Most of these had good, employer funded health insurance.
>> some unforeseen medical need came along and put them under
That's a lot less common in Canada. I'm not saying it doesn't happen, but I've never heard of someone being bankrupted by medical expenses ... unless they got sick or hurt while travelling in the US!
>> completely disconnecting those who receive services from the actual cost of those services
There's often a big difference between the actual cost of a medical procedure and the cost that is charged after administrative bloat is factored in!
Canada spends a significantly smaller portion of its GDP on health care than the US does, yet on average we live longer. One big reason is that more of our costs go to actual medical care and less to administrative overhead. Another reason is that people can seek medical help while problems are still small, there's no incentive to wait until the thing is desperate.
>> good, employer funded health insurance
Canada's Medicare coverage doesn't depend on our employment status. There are many benefits to that, including removing a huge paperwork burden from employers.
-----
Years ago someone we knew was injured in a farming accident - his foot got caught in a grain auger. The doctor who looked after him said later that it would have been cheaper to just amputate the foot, but he truly valued not having to restrict his medical decisions on the basis of what the individual could afford at the time. Our friend was left with a limp, but the foot was saved and he was able to return to work. How to measure society's ROI on something like that?
"There's often a big difference between the actual cost of a medical procedure and the cost that is charged after administrative bloat is factored in!"
RIGHT
and part of the Admin costs are Government Regulations ie PAPERWORK
>paperwork
I have the original bill from the hospital for my birth in 1959. I've had restaurant checks longer. It's on a piece of paper the size of a half sheet of paper. About maybe 7 lines: room and board x days (no line items for $50 box of Kleenex), birthing room, etc. They kept new mothers and spawn in the hospital longer back in those days. Total around $3,000ish which was quite a sum back in those days. Dad was self employed professional so we had no health insurance, cash pay. Doctor billed separately, he was our local GP, no specialists back then. No Fathers in the delivery room, they were pacing the floors in the waiting room, smoking.
Today, that bill would be the size of a book.
But paperwork does not come just from the government, insurance companies demand paperwork and audit trails too. Computers and photocopiers spawn paper and line items and tracking. Hospitals track inventory. If you had to type up everything by typewriter with carbon copies you would learn how to summarize darn quick. National wealth also generates paperwork and jobs for shufflers because in times of plenty we can afford it, when times get lean we start complaining.
Just another point of view:
California's Single-Payer Health Care Plan Would Cost More Than the State's Whole Budget
Like in Colorado, New York, and Vermont, California is learning that a single-payer plan would be prohibitively expensive.
http://reason.com/blog/2017/05/23/california-single-payer-health-care-cost
Methinks that someone is dishing out phony numbers.
How is Canada able to provide pretty good universal coverage for so much less than those projections?
Our family has always had competent care when we needed it. Our needs over the years have ranged from travel vaccinations to, among other things, childbirths, kidney stones, fractures and miscellaneous infections to a grandchild nearly having part of her finger amputated in an accident. She got expert care, the finger was saved and now she sometimes wins piano classes in the local music festival. I had to pay for my own travel vaccinations but the other care mentioned did not result in bills for our family.
Our system isn't perfect, but we're clearly doing something right compared to the US. Tthe average life expectancy of Canadians is three years longer than their American counterparts. Specifically, women in Canada live an average of 83 years, compared to 80 in the US; men live more than 78 years on average compared to 75 in the US. Source: https://www.theglobeandmail.com/opinion/why-canadians-outlive-americans-and-why-we-shouldnt-be-so-satisfied/article16147153/
This is so even though our medical costs constitute roughly a one-third smaller percentage of our GDP. Source: http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS As mentioned earlier, one reason for the difference is that a better percentage of what we pay goes to actual care.
The average Canadian doesn't need to fear being bankrupted by medical bills. A Canadian who leaves or loses his/her job doesn't lose medical coverage along with it. The fact that our coverage doesn't depend on our job gives us more freedom to, among other things, look for a different position, go for more schooling, start their own business or bow out of the paid workforce to care for small children, than an American whose medical coverage is tied to their employment status. On the other side of the coin, businesses have fewer administrative costs, and in some cases will feel more flexibility to lay off employees if business requires it. (They know that Joe the pipefitter's daughter's disease will still get care regardless of Joe's job status.) The fact there's no incentive to delay getting help for problems can sometimes mean that big expenses are headed off. Those factors all have positive effects for our economy at large, and even more important, for the general well-being of our people.
What better investment could a country make than the health of its people?
Canada is able to negotiate lower drug costs and lower procedure costs. Basically.
As California liberals go, the Democratic Party often follows. So it's instructive, if not surprising, that Golden State Democrats are responding to the failure of ObamaCare by embracing single-payer health care. This proves the truism that the liberal solution to every government failure is always more government.
Many on the left championed single-payer in lieu of ObamaCare's regulations and subsidies, but in 2010 it lacked enough support among Democrats in Congress. But with premiums soaring and insurers fleeing the Affordable Care Act exchanges, progressives are now trying to pivot to achieve their longtime dream.
California Lieutenant Governor Gavin Newsom, the frontrunner to succeed Jerry Brown as Governor next year, is running on single-payer, which shows the idea is going mainstream. At the state Democratic convention last weekend, protesters shouted down speakers who dared to ask about paying for it. The state Senate Appropriations Committee passed a single-payer bill this week, and it has a fair chance of getting to Mr. Brown's desk.
The bill reflects the left's Platonic ideal, with the promise of free care for everyone for everything. Patients would be entitled to an essentially unlimited list of benefits including acupuncture and chiropractic care as well as "all medical care determined to be medically appropriate by the member's health care provider." They could see any specialist without a referral. Co-pays and deductibles and charging premiums would be prohibited.
There would thus be no restraint on health-care utilization and costs. Patients could get treated for virtually any malady by any physician at no cost. This is probably what kids educated at California's pre-eminent universities envision when politicians and professors promote single-payer: an efficient, free, munificent socialist paradise.
THE WALL STREET JOURNAL
Actually, I saw an interview with the person who was in charge of insurance programs for Nixon (I forget exactly if it was head of HHS, Medicare... I can't recall). But I was surprised to see him say that he thought long-term the US was going to have to adopt single-payer healthcare.
As Buckworks points out, the US system has the highest per-capita costs and some of the worst outcomes among major economies. Most countries have single-payer systems and better outcomes at lower cost.
That said, most countries (France in particular, but even the British NHS) face significant budgetary issues going forward. As with most complex issues, there is no simple solution. To be long-term sustainable, we have to change the way we pay for healthcare, but in both senses. That is, we probably need a single-payer system, but one in which the people who provide and receive healthcare have some skin in the game.
YES
http://www.mercurynews.com/2017/06/01/california-senate-passes-single-payer-health-care-plan/
"How do we possibly pay for this thing?" asked Sen. Tom Berryhill, R-Oakdale.
Quote
Americans, in general, support government-provided universal health care. A Pew Research Center survey taken in January found that 60 percent say that it's the responsibility of the federal government to make sure that all Americans have health coverage. A Morning Consult/Politico poll in April found that support for a single-payer health system outweighs opposition, by 44 percent to 36 percent (with 19 percent unsure).
https://www.bloomberg.com/view/articles/2017-06-01/americans-sure-seem-to-like-universal-health-care
(with 19 percent unsure)
I'm planning to wait & see what happens in Calif.
Quote from: littleman on June 03, 2017, 08:37:23 PM
Americans, in general, support government-provided universal health care.
One problem in America is that a lot of beneficiaries of entitlement programs, aka welfare, don't see themselves as such, namely the millions of Americans on Medicare. I remember my brother talking to my uncle who has publicly-funded healthcare twice over in the form of Medicare and the VA, who said that government-funded healthcare would be a terrible thing for the country. My brother said, "Well, don't you use Medicare and the VA?"
Uncle: "That's different."
It turns out that if you look at the history of support for entitlements, it tends to be quite strong when most voters feel like the benefits go to people "like me" but much less so as it goes to "the other" which is why Reagan's portrayal as black single mothers was so effective.
I had a similar conversation, but it went like this:
Friend (ex Marine): Government-funded healthcare would be a terrible thing for the country.
Me: Well, didn't you get govt. healthcare and the VA?
Friend: That's how I know.
Quote from: Travoli on June 05, 2017, 02:39:47 AM
Friend: That's how I know.
Ha ha! Yeah, the VA has had its challenges, that's for sure.
But I know a lot of vets who would be destitute and on the streets or in the grave if not for the VA. One friend of mine, a WWII vet, started getting dementia. He was a low-income guy living in basically a dorm room at the YMCA. Without the VA, he would have been completely screwed. The VA gave him a reasonably dignified end of life and there was no way he was getting private insurance for that.
No system is perfect, but I know a lot of vets that get really good healthcare through the VA.
All healthcare is rationed. Right now we ration on the basis of price, ability to pay, and ability to secure insurance. Single payer systems use a different set of criteria for rationing, things like: age, survival rate for given treatment, quality of life, etc.
As the US blunders around for the next 20 years, I expect medical tourism to explode both in country and out of country.
Example: a friend just priced out a yet another heart stent for her husband. $90K at a famous hospital in Chicago, where they had been referred, $45K at a local hospital 30 miles out of the city. Surgeon fees extra.
The Amish, who do not believe in insurance, travel to Mexico for surgery for things like cancer. I've heard of people traveling to India for hip replacements. Someday somebody will put together something like Travelocity with ratings for medical tourism and it will explode.
Why don't the Amish believe in insurance?
Best Answer: You are right. It is out of a Biblical sense of community providing for its own. Some may even consider insurance a form of gambling. You are betting you won't need to use it. Many Mennonites don't have insurance either. There is a general fund that communities can draw upon if needs exceed what the local group can provide. That's the closest to insurance they have. It seems to work well and fosters a better sense of interdependence between members.
Mennonites have several different varieties. There's Old Order that are horse and buggy like Amish. There's conservative or New Order which are what you describe. They drive, have electricity, and even cell phones but not TV, radio, movies, or use the internet (except limited business related). Then there is a more progressive, worldly group of Mennonites (mostly younger people) that aren't much different from mainstream society in dress or actions.
https://answers.yahoo.com/question/index?qid=20100804112904AAM2xdp
I learned about the Amish medical thing via an article about Amtrak. The train the author was on had a group of Amish men aboard traveling to the SW United States and ultimately to a trusted hospital/clinic in Mexico. They were helping one of their number who was going for cancer surgery.
The Amish know which hospitals in Mexico are good and take cash.
The Amish try to avoid entanglement or networking with the modern world, but exact interpretations are largely in the hands of the local bishops. So for instance, one bishop might ban all telephones, while another might allow a phone for emergencies but it is wired to a poll out in a pasture, not to a house, because wiring to the house would be an entanglement. Kind of the exact opposite of the Internet.
Certain exceptions are made for business purposes.
Quote from: Brad on June 05, 2017, 11:29:53 AM
All healthcare is rationed.
This is the piece that is generally lost on people. Or, perhaps, it is lost on them if they have good healthcare and someone proposing a different way of rationing.
And... in related news
https://www.nytimes.com/2017/06/03/business/economy/high-end-medical-care.html
And yes, the subject is *that* John Battelle
MORE READING Material:
https://www.policyed.org/intellections/single-payer-right-america/video?utm_source=facebook&utm_campaign=stripes&utm_content=060417
http://reason.com/blog/2017/06/06/state-run-single-payer-health-care-would
https://www.cato.org/publications/commentary/embracing-hard-realities-health-care-reform
The Cato report says that Sanders "Medicare for all" proposal would cost $13.8 trillion over the first decade. That sounds exhorbitant (it's over double the total military budget of about $600b per year), but in the context of current healthcare expenditures of $3.35 trillion and rising at 5% per year (so $40 trillion over the next decade), that sounds like a bargain.
http://www.pbs.org/newshour/rundown/new-peak-us-health-care-spending-10345-per-person/
Counter argument
Quote
The misleading figure of $404 billion that is often quoted is the cost under the existing fragmented, dysfunctional, for-profit insurance system. But a single payer plan like SB 562 has many cost-savings built in; among them hugely reducing the administrative costs involved in private insurance and bringing the weight of California to the table when negotiating with drug companies. Access to early and preventative care will cut down expensive emergency room visits. The real estimated cost of SB 562 is $331 billion, a savings of 18 percent over the $368.5 billion we are paying now to leave 2.7 million of our neighbors uninsured and another 12 million underinsured.
So where will that $331 billion come from? First, $225 billion of our total healthcare costs is already taxpayer financed through Medicare, Medi-Cal and subsidies to private insurers. With waivers we would shift these funds into the Healthy California system and according to the study, we could finance the remaining $106 billion with two new taxes. Yes, that dirty word "taxes." But under this plan all businesses that currently provide health insurance would actually save money and so would very nearly all households. Businesses would pay 2.3 percent on gross revenues, with the first $2 million exempted, which would mean that the smallest businesses would pay nothing. The projected net savings for small businesses that currently provide health benefits is 22 percent, 7-13 percent savings for medium-sized businesses, and 0.6 percent for larger employers. This tax is projected to raise $92 billion.
The remaining $14.3 billion would be funded by a sales tax of 2.3 percent that would exempt spending on housing, utilities, food at home and other necessities. Since all premiums, deductibles, co-pays and out-of-pocket expenses for services that will be newly covered under SB 562 will be eliminated, low-income families can expect to save 1.2-5.5 percent and middle-income families 2.6-9.1 percent over what they are paying now. Only higher-income families will see a small increase of 1.5-1.7 percent
http://www.santacruzsentinel.com/opinion/20170617/commentary-california-can-afford-universal-healthcare
http://eaglerising.com/45029/california-single-payer-plan-meets-reality-reality-wins/
http://www.dailywire.com/news/17743/shock-wapo-actually-acknowledges-single-payer-isnt-aaron-bandler