It's starting to seem as if ACA was a universal for all single payer system, the state of our health care system would be a whole lot better. But the question I have is, why is there so much more opposition to it when it was introduced, compared to when such proposal was introduced in next door Canada?
Do you think America would have been in a better condition, had ACA was a universal single payer system for all Americans compared to it now?
- Thread starter Amol S.
- Start date
nakedfrog
No Lifer
- Apr 3, 2001
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Think of all the profits! Why do you hate money, commie?
WelshBloke
Lifer
- Jan 12, 2005
- 30,449
- 8,111
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Starting to seem!?
Your health care system isn't, and isn't designed to be, about health care. It's a business, and businesses are about profit.
So I guess it depends what you want out of a health care system, yours is working as designed.
nickqt
Diamond Member
- Jan 15, 2015
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Had the Supreme Court decided that Medicaid Expansion was Constitutional because it was 2012 and not 1784 under the Articles of Confederation, Republican governors wouldn't have been able to decide not to accept FREE MONEY! for Medicaid Expansion to help the poors and browns.
Many rural and urban hospitals would still be operating as they would have received FREE MONEY! from poors and browns for their hospital stays.
Also, many more people would be alive as it would have allowed poors and browns to get access to primary care coverage because of the FREE MONEY!
But alas, Republican Governors, intent on hurting poors and browns, decided to fight against FREE MONEY! and the welfare (small w) of their citizens, because it would hurt poors and browns, and would jab communist fascist terrorist Barack HUSSEIN Obama right in the eye...and again, hurt poors and browns, which is always the goal of Republicans.
Next easily answerable question.
Many rural and urban hospitals would still be operating as they would have received FREE MONEY! from poors and browns for their hospital stays.
Also, many more people would be alive as it would have allowed poors and browns to get access to primary care coverage because of the FREE MONEY!
But alas, Republican Governors, intent on hurting poors and browns, decided to fight against FREE MONEY! and the welfare (small w) of their citizens, because it would hurt poors and browns, and would jab communist fascist terrorist Barack HUSSEIN Obama right in the eye...and again, hurt poors and browns, which is always the goal of Republicans.
Next easily answerable question.
Jaskalas
Lifer
- Jun 23, 2004
- 33,446
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Of course we'd be far better off.
Your question is asking... why America is... more right wing than Canada?
Cause that's how it is. The folklore of the All American Bootstrap, of each man a mythical island unto himself pulled up by his own bootstraps. Don't need no stinking government stealing his money and using it for the poors. If they wanted healthcare then they would work harder! Why... back in my day...... etc... etc...
Because humans are tribal, fervent, and delusional. And America carries a rugged individualist narrative and eschews government aid. (Except when it has already been given)
Americans, trapped by this dogma, must be dragged kicking and screaming into the 21st century and the notion that we are all in this together. That WE together are stronger than I alone.
We have an entire political party dedicated to stopping any and all progress on this front, and so many other issues.
And when you really examine our politics, they've controlled our government my entire life. Despite some faint vestiges of Democrat control, those moments were middling at best, soured by the moderate plea to not "do" too much, or by our utterly dysfunctional system that favors a "do nothing" attitude.
As a Canadian, I'm a fan of our universal healthcare system. It isn't perfect, but it's a far sight better than whatever the hell you guys are doing south of the border.
But I'm also highly skeptical that the US could pull off any kind of even semi decent universal health care system if it tried, in the same way that democracy is generally a good thing, but you can't force democracy onto a country like Afghanistan. The Afghan population isn't amenable to democracy, and I think the same may be true for Americans and proper universal healthcare, or anything really where there's an enormous profit motive to make something crappy, as patronizing as that sounds.
A combination of the enumerable rent seeking interests with their grubby hands over the existing byzantine system, plus a congress that is so corrupt they brazenly flaunt the revolving door between regulator and lobbyist while shamelessly engaging in insider trading leaves little hope that whatever system they come up with doesn't end up an embarrassingly corrupted farce. I have some faith that someone could come up with promising proposal, but little faith that by the time something is actually passed the good parts get defenestrated while corrupt politicians tack on a bunch of crud for all of their politically connected interests to whet their beaks.
Making congress accountable needs to be the first step.
But I'm also highly skeptical that the US could pull off any kind of even semi decent universal health care system if it tried, in the same way that democracy is generally a good thing, but you can't force democracy onto a country like Afghanistan. The Afghan population isn't amenable to democracy, and I think the same may be true for Americans and proper universal healthcare, or anything really where there's an enormous profit motive to make something crappy, as patronizing as that sounds.
A combination of the enumerable rent seeking interests with their grubby hands over the existing byzantine system, plus a congress that is so corrupt they brazenly flaunt the revolving door between regulator and lobbyist while shamelessly engaging in insider trading leaves little hope that whatever system they come up with doesn't end up an embarrassingly corrupted farce. I have some faith that someone could come up with promising proposal, but little faith that by the time something is actually passed the good parts get defenestrated while corrupt politicians tack on a bunch of crud for all of their politically connected interests to whet their beaks.
Making congress accountable needs to be the first step.
yottabit
Golden Member
- Jun 5, 2008
- 1,365
- 229
- 116
Yes it likely would be far better as a single payer system. it was conceived as such and only when it was clear that it had no chance of passing in that form, compromised into what it is today. Which still had some very good benefits such as inability to completely deny for pre-existing conditions, formalizing plan tiers with standard levels of coverage, limiting out of pocket maximums, and subsidized premiums from a federal marketplace for those that are income-limited. Also employer mandate for employers over a certain size, and a more toothless individual mandate which Trump later repealed.
Many of the things people dislike about it are precisely because of the compromises made and because it is not single payer. the whole concept sort of hinged on single payer.
Forcing extra coverage and limiting out-of-pocket maximums without any other regulation/control over private healthcare insurance industry naturally leads to premium rate hikes. Subsidizing insurance premium costs for lower income by having the federal government cover some portion of the bill naturally leads to premium rate hikes. Repealing even the individual mandate means less people in the healthcare system to pool risk which naturally leads to premium rate hikes.
About the only way to fix these fundamental issues is something like much more intense govt control and regulation over health care industries, such as widespread price controls like what medicare uses. This would probably leave not much purpose for most of the health insurance industry. It would be a difficult and disruptive transition to be honest no matter how much I support the concept. I think this is what proponents in the past have failed to acknowledge. There would need to be some wide reaching support plan for everyone displaced and not "maybe they can become coders"
On the other end, detractors of single payer say things like "I don't want to pay for somebody else's illness" without perhaps realizing that that is exactly what they are doing with private health insurance now. Private health insurance is pooled risk - your premium is paying for other sick people, and if you ever get sick other people will be paying for you. Private health insurance is just a less efficient method than single player because the pool is smaller and lacks any power price regulation.
America has a real problem with accepting direct subsidies that help literally everyone. People falsely assume it is a zero sum game and our great grandchildren will have to bear the cost or something. Myths when things can be paid for largely by cost reduction
The populus is willing to let subsidizies for the poor, such as the Federal Student Loan program and the federal ACA healthcare marketplace slide. But these are implemented in the worst possible way and benefit the private companies more than the end user, with the govt picking up the portion of the tab that essentially the free market couldn't naturally support. In both cases it leads to spiralling increased prices. I'm of the opinion now that such subsidies should only come with some form of price controls, since it isn't really free market anymore. Or just don't do the subsidies this way.
The two issues I bring up are somewhat interlinked, with medical professionals taking out exorbinant amounts of debt due to the extremely high cost of education. This leads to them demanding higher salaries to pay back their quarter million dollars or more of student loan debt, which trickles back in some form to healthcare cost. The high tuitions being propped up again by a federal subsidy program that encourages colleges and universities to raise rates.
America is also a very litigous society and doctors and providers need to deal with potential malpractice suits, and pay hefty fees for malpractice insurance from what I understand. I'm not sure what the ACA did to address this aspect if anything, but it would be something else to look at in a single payer system.
I think the most feasible idea I've heard so far was Bernie's plan for "Medicare for all" which involved gradually lowering the age of eligibility of the Medicare program (which people seem to know and love) over some period of years. Medicare also has limits in place for what they will pay for certain services and prescription drugs etc.
For complete clarity, even private health insurance has limits on what they pay too. You'll see this discrepancy on any medical bill between what the provider billed and what the agreed rate the health insurer will pay is, often several times lower. And the provider just accepts this lower agreed amount and says, "Mmmkay, I guess this is the bill now" So both private health insurance and Medicare do use some form of "price control" already.
The difference being, if you happen to be uninsured and get the same bill, you have little bargaining power to negotiate that same "agreed rate"
So again I support an idea like "Medicare for all". But it comes with some uncomfortable truths that I think need to be acknowledged and planned around if such a transition were ever to occur, and if it is attempted it is very important not to go "halfway" and compromise again or we might end up in an even worse mess.
If there remains some small very pool of private health insurance as someone's sole primary coverage, it will likely become unstable and have skyrocketing rates. I think though that the age reduced "Medicare for all" rollout would safeguard against this, since the last age group to be included would be the youngest and healthiest. But it would be difficult to guarantee in todays political climate that the rollout could even continue unhindered, as it would likely span presidential administrations and certainly midterm elections in terms of length.
There can still be a place for private insurance with a single payer system, and that would be supplemental insurance. This would be an option for coverage of more optional procedures, or potentially reduce wait times etc. I believe several european countries have supplemental private plans on top of the public option.
I'm not a professional in any healthcare industry, but I have had people close to me die due to health complications while being either uninsured or underinsured. I really think something like "Medicare for all" or other single payer system would have greatly extended their lives. As it was they would put off visits to the doctor unless it was an emergency due to the bills, despite having ongoing health issues that should have been carefully monitored.
Many of the things people dislike about it are precisely because of the compromises made and because it is not single payer. the whole concept sort of hinged on single payer.
Forcing extra coverage and limiting out-of-pocket maximums without any other regulation/control over private healthcare insurance industry naturally leads to premium rate hikes. Subsidizing insurance premium costs for lower income by having the federal government cover some portion of the bill naturally leads to premium rate hikes. Repealing even the individual mandate means less people in the healthcare system to pool risk which naturally leads to premium rate hikes.
About the only way to fix these fundamental issues is something like much more intense govt control and regulation over health care industries, such as widespread price controls like what medicare uses. This would probably leave not much purpose for most of the health insurance industry. It would be a difficult and disruptive transition to be honest no matter how much I support the concept. I think this is what proponents in the past have failed to acknowledge. There would need to be some wide reaching support plan for everyone displaced and not "maybe they can become coders"
On the other end, detractors of single payer say things like "I don't want to pay for somebody else's illness" without perhaps realizing that that is exactly what they are doing with private health insurance now. Private health insurance is pooled risk - your premium is paying for other sick people, and if you ever get sick other people will be paying for you. Private health insurance is just a less efficient method than single player because the pool is smaller and lacks any power price regulation.
America has a real problem with accepting direct subsidies that help literally everyone. People falsely assume it is a zero sum game and our great grandchildren will have to bear the cost or something. Myths when things can be paid for largely by cost reduction
The populus is willing to let subsidizies for the poor, such as the Federal Student Loan program and the federal ACA healthcare marketplace slide. But these are implemented in the worst possible way and benefit the private companies more than the end user, with the govt picking up the portion of the tab that essentially the free market couldn't naturally support. In both cases it leads to spiralling increased prices. I'm of the opinion now that such subsidies should only come with some form of price controls, since it isn't really free market anymore. Or just don't do the subsidies this way.
The two issues I bring up are somewhat interlinked, with medical professionals taking out exorbinant amounts of debt due to the extremely high cost of education. This leads to them demanding higher salaries to pay back their quarter million dollars or more of student loan debt, which trickles back in some form to healthcare cost. The high tuitions being propped up again by a federal subsidy program that encourages colleges and universities to raise rates.
America is also a very litigous society and doctors and providers need to deal with potential malpractice suits, and pay hefty fees for malpractice insurance from what I understand. I'm not sure what the ACA did to address this aspect if anything, but it would be something else to look at in a single payer system.
I think the most feasible idea I've heard so far was Bernie's plan for "Medicare for all" which involved gradually lowering the age of eligibility of the Medicare program (which people seem to know and love) over some period of years. Medicare also has limits in place for what they will pay for certain services and prescription drugs etc.
For complete clarity, even private health insurance has limits on what they pay too. You'll see this discrepancy on any medical bill between what the provider billed and what the agreed rate the health insurer will pay is, often several times lower. And the provider just accepts this lower agreed amount and says, "Mmmkay, I guess this is the bill now" So both private health insurance and Medicare do use some form of "price control" already.
The difference being, if you happen to be uninsured and get the same bill, you have little bargaining power to negotiate that same "agreed rate"
So again I support an idea like "Medicare for all". But it comes with some uncomfortable truths that I think need to be acknowledged and planned around if such a transition were ever to occur, and if it is attempted it is very important not to go "halfway" and compromise again or we might end up in an even worse mess.
If there remains some small very pool of private health insurance as someone's sole primary coverage, it will likely become unstable and have skyrocketing rates. I think though that the age reduced "Medicare for all" rollout would safeguard against this, since the last age group to be included would be the youngest and healthiest. But it would be difficult to guarantee in todays political climate that the rollout could even continue unhindered, as it would likely span presidential administrations and certainly midterm elections in terms of length.
There can still be a place for private insurance with a single payer system, and that would be supplemental insurance. This would be an option for coverage of more optional procedures, or potentially reduce wait times etc. I believe several european countries have supplemental private plans on top of the public option.
I'm not a professional in any healthcare industry, but I have had people close to me die due to health complications while being either uninsured or underinsured. I really think something like "Medicare for all" or other single payer system would have greatly extended their lives. As it was they would put off visits to the doctor unless it was an emergency due to the bills, despite having ongoing health issues that should have been carefully monitored.
Pens1566
Lifer
- Oct 11, 2005
- 11,592
- 8,044
- 136
sdifox
No Lifer
- Sep 30, 2005
- 95,027
- 15,139
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I am surprised the owner class is not pushing for this, they would save a lot on employee medical insurance.
Single payer never passes Congress, so no the U.S. would not have been better off if that proposal had been the core of ACA. This is specifically addressed by Paul Krugman in his NYT columns.
The reason it's so ingrained is that it's a healthy tax break for employers and they've been shifting a significant portion of the premiums to employees since approx. 2005. Large corps don't exactly hate the status quo. As the U.S. employment "system" is designed, if employer-sponsored health insurance were to disappear, corps would have to pay higher salaries and/or perhaps higher taxes to fund a single payer system.
I was in the military, and have used the VA health care system, government run health care. It is NOT something i would recommend at all. All you who believe government run health care is the answer, obviouslt havent used the VA health care system. Some places are good, majority are not. careful, you may get what you ask for. grass is not greener on the other side!
there are multiple places around me that have discounted rates if you dont have insurance, and also use a sliding scale based on your income if you dont have insurance. in some cases its cheaper than what they charge some insurance plans
sdifox
No Lifer
- Sep 30, 2005
- 95,027
- 15,139
- 126
Employer sponsored health care does not go away in the single payer system. It just gets cheaper since the public option covers the basics.
For example, hospital stay is free if you are in the ward, semi private and private room cost extra. Your employer health coverage would pay for the private room if you want a private room. The coverage percentage varies of course but there is no different rate.
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MtnMan
Diamond Member
- Jul 27, 2004
- 8,751
- 7,867
- 136
These are successful and what many consider wealthy, earned through hard work and business savvy to create and manage a growing company.
They trouble is they are powerless as they are NOT 11 or 12 digit "rich" ($10 Billion and up), and as such hold no sway in Washington. That right has been bought and paid for by the people that only see 99%+ of citizens as disposable fools they can bleed dry then discard. (Oil, energy, big pharma, health care, etc.)
The VA system has certainly had its issues over the years, including the well known scandals. Nonetheless, the VA system has consistently scored as good, if not better that private health care systems in the US in safety and effectiveness in healthcare outcomes. Quality in care is also typically better in VA hospitals compared to non-VA hospitals. Even more recent studies have demonstrated that individuals were more likely to die after a ER visit if they were treated at a non-VA hospital compared to VA hospitals. Surveys of patients demonstrate higher satisfaction amongst VA patients compared to private/employer based insurance systems.
And let's not forget, private insurance systems add 30% of administrative overhead to healthcare costs, something that public systems do not struggle with. It is not surprising. Insurance CEO's getting million dollar paychecks. They employ armies of people to deny coverage and deny payment to the insured and to the medical providers. Health care insurance companies are nothing but middle-men, adding very little of significant value to healthcare. Yet here is the US, paying nearly double the costs for healthcare despite getting outcomes similar or worse compared to most other developed countries.
PowerEngineer
Diamond Member
- Oct 22, 2001
- 3,552
- 726
- 136
Yes, I can believe that health care provided through government run facilities might be terrible. And certainly everything that I have read about the VA system supports what you are telling us.
On the other hand, my personal experience with Medicare (being the old fart that I am) has been very good. I am using all the same medical providers I did while on private insurance, having lower out-of-pocket expenses for co-pays, and have a much more transparent process for coverage decisions. (Although my monthly Medicare premium is over $500/month, but still cheaper than private insurance). So perhaps a single payer system can be better than a single provider system?
My understanding is that our current handling of health care comes out of employer efforts to recruit employees during World War II. War time legislation prevented them from competing with one another on wages, and so they competed on the basis of benefits. If you sit back and think about it, having employers responsible for providing healthcare for the nation is pretty strange. And I gather that Medicare comes into the picture as a patch to provide health care for those too sick or too old to be employed.
See no reason why only old people should get health coverage from our government.
Jaskalas
Lifer
- Jun 23, 2004
- 33,446
- 7,508
- 136
Or #Bootstraps , the American way. You know, from an absentee employer who wants nothing to do with you. And will avoid paying benefits at every opportunity.
In the face of that !@#$, we stand united. Medicare For All.
MtnMan
Diamond Member
- Jul 27, 2004
- 8,751
- 7,867
- 136
You won't have to file for bankruptcy, or spend your retirement and life savings to pay off medical bills if you happen to receive the wrong diagnosis. The majority of bankruptcies filed in the US are due to health care costs.
The only thing I’d change is that the “rugged individualist” part of turning down benefits basically never happens. A lot of farmers and rural people consider themselves to be that sort that don’t want the gooberment meddling in their affairs, yet they consume much more in services than their economic output could ever support. Farmers in particular never saw a farm subsidy they didn’t like.
MrSquished
Lifer
- Jan 14, 2013
- 21,271
- 19,763
- 136
Lets see, small U.S. farmers only average about $10,000 per farmer in direct cash payments from the government for being a farmer (not counting indirect subsidies)
And, U.S. farm sole proprietors, as a tax group, have had negative reported income when looked at on a 10-year basis, over at least the past 40 years - thus net paying no income taxes, and further deducting the losses to reduce taxes on other non-farm income.
Do Most U.S. Farms Really Lose Money? Taxation and Farm Income Underreporting | Journal of Agricultural and Applied Economics | Cambridge Core
Do Most U.S. Farms Really Lose Money? Taxation and Farm Income Underreporting - Volume 51 Issue 4
Gardener
Senior member
- Nov 22, 1999
- 758
- 540
- 136
MrSquished
Lifer
- Jan 14, 2013
- 21,271
- 19,763
- 136
Sorry I meant to say Medicare as a public option for anybody to buy into. That would have been a step that could have been sold to the American people. I think they had 59 senators willing to pass Medicare for everyone 55 and over, but Joe Lieberman stop that from happening
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