THIS is the problem with healthcare

[fskimospy]

To be fair, we've seen presidents come and go. House and Senate controlled by either GOP or DNC come and go. We still have money in politics. There is no difference in the level of greed for corporate monies between parties. You apparently buy into the rhetoric that the dems are for changing it... They aren't.

As long as congress both writes and approves campaign finance law we are never going to get big money out of politics.

That said, as long as campaign finance remains an issue, we won't have meaningful reform of healthcare, gun control, immigration etc. Campaign finance should be our number one priority on the path to managing our other issues.

You may want to look at the landmark SCOTUS decisions on campaign finance law and look at which party appointed the justices on each side.

Before we can tackle campaign finance we need to cut the cancer of #bothsides out of our discourse. They are not the same.

 

[uclaLabrat]

Yes, the argument that prices need to be this high because research is expensive falls apart when you realize that drug companies spend between 50% and about 90% more money on advertisements than they do on developing drugs.

This is a common argument, but not the only one. Like any good business, they charge what the market will bear. The issue with healthcare (and drugs in particular) is demand is pretty inelastic. If you have a life threatening (or even mildly inconvenient) indication, you'll spend a lot of money to treat it because most people value their life quite highly.

Drug prices aren't the same in the US as they are in Somalia because the market will not bear that price. As a result, the US subsidizes a lot of the rest of the worlds' drug costs.

Single payer will go a long way towards price reduction because having a unified formulary in the US will distort the market in favor of the buyer, unlike the fragmented system we have now.

 

[fskimospy]

This is a common argument, but not the only one. Like any good business, they charge what the market will bear. The issue with healthcare (and drugs in particular) is demand is pretty inelastic. If you have a life threatening (or even mildly inconvenient) indication, you'll spend a lot of money to treat it because most people value their life quite highly.

While I agree with this statement 100% it would seem the inevitable conclusion from that is we need to be regulating drug manufacturers a lot more heavily. If demand is inelastic and there's virtually zero competition you end up with sky-high monopolist pricing. There isn't a functioning market so it's just basically rent seeking behavior at this point.

 

[Cerb]

I guess the two glaring things *I see* are 1. The elimination of the private health insurance market, and 2. how exactly price controls would pass constitutional muster. For the latter point, Ive already acknowledged we have price controls in the banking market, so theres that.

The U.S. Constitution does not preclude price controls anywhere, and the federal government is tasked with commerce regulation and providing for the general welfare. It does not even preclude genuine Socialist control of businesses and property, so long as the methods do not violate one's rights. Given that health insurance companies are riding on the back of government regulations just to exist as they do, I doubt there would be any legal problems at all. They already do it, even through Medicare, but the results can be that it costs more than what can be charged, much less what is reimbursed. Legally, price controls should be fine, but they are often a way of trying to fix a problem at the wrong end.

On the former, to address a point made by another poster, Im sure some people wouldnt mind working for the federal government, but I suspect many wouldnt. Admittedly, this opinion is biased on my own discussions with coworkers through he decades of discussions with others in my profession (due to the fact private jobs in general pay much more than public positions).

Private care is not going to go away any time soon, in the U.S.. But, it also doesn't need to, and could be detrimental if attempted. Private care providers would mostly love to have less red tape to deal with, and lower their costs. Insurance (yours and theirs both) and regulatory compliance are huge financial burdens for them.

They don't like the price opacity, or having different providers in different networks in the same office, any more than you do, and don't usually charge an arm, a leg, and your firstborn, for the sake of greed. If they can lower prices a bit, and serve more people better, they will. It doesn't make sense to intentionally, and unnecessarily, price themselves out of customers. Most of them would find an equilibrium of affordable costs and healthy profit for their neck of the woods, for all but catastrophic needs (like cancer).

Of course, there are bad actors, and that will have to be dealt with, somehow. Some will always find a way to game a system designed by good actors for good actors, won't have to even try with a system designed by bad actors for bad actors, and I don't pretend to know ideal ways to prevent any of that. But, for non-emergency care, cost transparency would go a long way, as would simplifying a lot of regulations that require massive administrative burdens, today.

 

[blackangst1]

So, I thought about starting a new thread, but I honestly dont think any one gives a shit about my opinion, just like I dont give a shit about most of yours. But so many of you have pushed me into a "Trump corner" I feel I need to prove Im actually middle of the road.

For the last several months, Ive been reading quite a bit about single payer healthcare. Both the pros and the cons. In my reading Ive discovered most of the pro stances AND the against stances are based on emotion, and lack any real depth of thinking. Ive found a few good pieces, however, and these have made me change my stance.

I am pro-single payer.

Now, with that said, I think those that claim "it works in Canada...it works in the Netherlands...etc etc etc" are complete idiots, and lack depth of their opinion. When single payer is implemented, and it WILL be implemented, I dont think it will look anything like those countries, but rather will have nuances of each of them. None of those were implemented well, and have SERIOUS cons. I have faith that those who get it passed here in the US will tend to avoid alot of those cons, of which are PLENTY. With that said, no system is perfect, and every health care system has its flaws, including ours. The most significant, IMHO, is:

1. Exorbitant and continued rising care and drug costs, fueled by patents, advertising, excessive support needed by health care providers (thanks, Obama), and no price controls.
2. Consumers are left making insurance (NOT health care) decisions relying on for-profit companies that will say anything to "earn" business, and not understanding well enough the ins and out of an extremely complicated system (I know I dont completely understand, and I doubt any of you do either).
3. Complete lack of competition. In some cases, as with Pinal County here in AZ, IA, and TN are left with ZERO or ONE choice for coverage. (thanks again, Obama. Good try but beware unintended consequences).

Those are the top 3 for me. Obamacare was good on some points, but it certainly backfired in many others. I say this as one who benefits from some provisions of it. It goes back to, Obamacare did not FIX anything. Sure, there are more insured, but for fucks sake...at what cost? Theres more to a healthy health care system than simply having insurance.

There are still some niggling issues that tug at me accepting that single payer is the right way to go, but with time I think they could get worked out.


Now, in closing, Id like to share that my opinion is not exclusive among conservatives OR Republicans (of which Im not one). I know you lefties think otherwise, but as usual you make emotional opinions and do the same as die-hard Trump supporters-believe every talking point you hear. For evidence, Ill share a very persuading report: http://www.pnhp.org/gop

So thats it. I think we're a decade away, at least, and believe the first passing single payer bill could be brought either party. But its inevitable, I think.

 

[ivwshane]

So, I thought about starting a new thread, but I honestly dont think any one gives a shit about my opinion, just like I dont give a shit about most of yours. But so many of you have pushed me into a "Trump corner" I feel I need to prove Im actually middle of the road.

For the last several months, Ive been reading quite a bit about single payer healthcare. Both the pros and the cons. In my reading Ive discovered most of the pro stances AND the against stances are based on emotion, and lack any real depth of thinking. Ive found a few good pieces, however, and these have made me change my stance.

I am pro-single payer.

Now, with that said, I think those that claim "it works in Canada...it works in the Netherlands...etc etc etc" are complete idiots, and lack depth of their opinion. When single payer is implemented, and it WILL be implemented, I dont think it will look anything like those countries, but rather will have nuances of each of them. None of those were implemented well, and have SERIOUS cons. I have faith that those who get it passed here in the US will tend to avoid alot of those cons, of which are PLENTY. With that said, no system is perfect, and every health care system has its flaws, including ours. The most significant, IMHO, is:

1. Exorbitant and continued rising care and drug costs, fueled by patents, advertising, excessive support needed by health care providers (thanks, Obama), and no price controls.
2. Consumers are left making insurance (NOT health care) decisions relying on for-profit companies that will say anything to "earn" business, and not understanding well enough the ins and out of an extremely complicated system (I know I dont completely understand, and I doubt any of you do either).
3. Complete lack of competition. In some cases, as with Pinal County here in AZ, IA, and TN are left with ZERO or ONE choice for coverage. (thanks again, Obama. Good try but beware unintended consequences).

Those are the top 3 for me. Obamacare was good on some points, but it certainly backfired in many others. I say this as one who benefits from some provisions of it. It goes back to, Obamacare did not FIX anything. Sure, there are more insured, but for fucks sake...at what cost? Theres more to a healthy health care system than simply having insurance.

There are still some niggling issues that tug at me accepting that single payer is the right way to go, but with time I think they could get worked out.


Now, in closing, Id like to share that my opinion is not exclusive among conservatives OR Republicans (of which Im not one). I know you lefties think otherwise, but as usual you make emotional opinions and do the same as die-hard Trump supporters-believe every talking point you hear. For evidence, Ill share a very persuading report: http://www.pnhp.org/gop

So thats it. I think we're a decade away, at least, and believe the first passing single payer bill could be brought either party. But its inevitable, I think.

I'm sure the Republicans have a draft of a single player health care system ready to go. Idiot.

 

[brycejones]

So, I thought about starting a new thread, but I honestly dont think any one gives a shit about my opinion, just like I dont give a shit about most of yours. But so many of you have pushed me into a "Trump corner" I feel I need to prove Im actually middle of the road.

For the last several months, Ive been reading quite a bit about single payer healthcare. Both the pros and the cons. In my reading Ive discovered most of the pro stances AND the against stances are based on emotion, and lack any real depth of thinking. Ive found a few good pieces, however, and these have made me change my stance.

I am pro-single payer.

Now, with that said, I think those that claim "it works in Canada...it works in the Netherlands...etc etc etc" are complete idiots, and lack depth of their opinion. When single payer is implemented, and it WILL be implemented, I dont think it will look anything like those countries, but rather will have nuances of each of them. None of those were implemented well, and have SERIOUS cons. I have faith that those who get it passed here in the US will tend to avoid alot of those cons, of which are PLENTY. With that said, no system is perfect, and every health care system has its flaws, including ours. The most significant, IMHO, is:

1. Exorbitant and continued rising care and drug costs, fueled by patents, advertising, excessive support needed by health care providers (thanks, Obama), and no price controls.
2. Consumers are left making insurance (NOT health care) decisions relying on for-profit companies that will say anything to "earn" business, and not understanding well enough the ins and out of an extremely complicated system (I know I dont completely understand, and I doubt any of you do either).
3. Complete lack of competition. In some cases, as with Pinal County here in AZ, IA, and TN are left with ZERO or ONE choice for coverage. (thanks again, Obama. Good try but beware unintended consequences).

Those are the top 3 for me. Obamacare was good on some points, but it certainly backfired in many others. I say this as one who benefits from some provisions of it. It goes back to, Obamacare did not FIX anything. Sure, there are more insured, but for fucks sake...at what cost? Theres more to a healthy health care system than simply having insurance.

There are still some niggling issues that tug at me accepting that single payer is the right way to go, but with time I think they could get worked out.


Now, in closing, Id like to share that my opinion is not exclusive among conservatives OR Republicans (of which Im not one). I know you lefties think otherwise, but as usual you make emotional opinions and do the same as die-hard Trump supporters-believe every talking point you hear. For evidence, Ill share a very persuading report: http://www.pnhp.org/gop

So thats it. I think we're a decade away, at least, and believe the first passing single payer bill could be brought either party. But its inevitable, I think.

Name one significant Republican politician who is pro single payer.

 

[SMOGZINN]

You gave a reasonable post, so I'll give you a reasonable response.

Now, with that said, I think those that claim "it works in Canada...it works in the Netherlands...etc etc etc" are complete idiots, and lack depth of their opinion.

I think you are misunderstanding what we are saying when we say that. Few people think we can simply lift any of those systems from their respective country and apply it here. What we are saying is that it is proof that a single payer system can work and be more efficient, and produce better customer satisfaction, than our current system. We are saying that we should look at those systems to see what works and what does not. They paid the price of working out a system that works, at least for them, we would be stupid not to learn from the triumphs and mistakes they made along the way.

With that said, no system is perfect, and every health care system has its flaws, including ours.

That is something to keep in mind. No system is perfect. All we are trying to do is find a system that works better than our current one, not one that is perfect. Any system we come up with is going to fail some people. It is going to have some tradeoffs. It will have some annoyances, and some flat out hardships to some people. All we need to do is make it better than what we have now, and then work on improving it incrementally.

It goes back to, Obamacare did not FIX anything. Sure, there are more insured, but for fucks sake...at what cost? Theres more to a healthy health care system than simply having insurance.

I disagree. The problems that the ACA tried to fix was to get more people insured, and to get the insurance companies to cover needed procedures, while controlling premiums. Because in the end that is what our system is. We do not really have a health care system, we have a insurance system. Unless you are very wealthy you don't get to make practically any of your own medical decisions, your insurance company makes them for you. Don't have insurance? Then you are basically a charity case and you get the minimum medical care that is required by law.

I agree that the ACA did not go far enough. That was it's main problem. To get it passed they had to compromise with people that didn't want it at all and was working to undermine it. Those same people have worked constantly to keep undermining it. The main flaws in the ACA is that from the beginning it was never worked in good faith. It became a tool for partisan politics.

The Republicans linked the ACA to Democrats in the minds of Americans, and Obama in specific, so as it fails it hurts the Democrats, so Republican have taken up a extended campaign to literally sabotage your healthcare to harm their political rivals. It is despicable. It is nothing short of evil. People are literally dying so they can win political arguments. It should be unforgiveable.

 

[Atreus21]

It’s almost like he doesn’t know that single payer is cheaper.

Cheaper for who?

Certainly not taxpayers.

 

[Jaskalas]

Many, many other countries are based on a free market. If you think there is a meaningful distinction between the freedom of US markets and the freedom of other developed nations' markets that is relevant to the distribution of health care you will have to describe it.

Sure, our market has the freedom to price gouge helpless consumers.

 

[sdifox]

Cheaper for who?

Certainly not taxpayers.

There is only ever one payer, the taxpayer.

 

[fskimospy]

Cheaper for who?

Certainly not taxpayers.

Yes, cheaper for the taxpayers. Remember, you already pay a health care 'tax' in everything you buy, you just don't see the line item.

 

[Atreus21]

Yes, cheaper for the taxpayers. Remember, you already pay a health care 'tax' in everything you buy, you just don't see the line item.

You don't think adding $3 trillion a year in government spending is going to involve significant added expense to taxpayers?

 

[MomentsofSanity]

Cheaper for who?

Certainly not taxpayers.

Certainly for taxpayers. The average household income in the US is slightly above 59K a year. The average health insurance expenses out of pocket for premiums alone is $5,227. That doesn't include co-pays and deductibles. That's just under 9%. The average tax rate between the US and Canada (for example) is not much different. It certainly doesn't come close to closing the gap once you factor in your health care costs which we dimply don't have.

Then you have to look at what you get for those taxes. Paid parental leave. High quality education at affordable prices. Overall you pay more and get less. Your health care results are worse than ours.

 

[Atreus21]

Certainly for taxpayers. The average household income in the US is slightly above 59K a year. The average health insurance expenses out of pocket for premiums alone is $5,227. That doesn't include co-pays and deductibles. That's just under 9%. The average tax rate between the US and Canada (for example) is not much different. It certainly doesn't come close to closing the gap once you factor in your health care costs which we dimply don't have.

Then you have to look at what you get for those taxes. Paid parental leave. High quality education at affordable prices. Overall you pay more and get less. Your health care results are worse than ours.

Is Sanders' single-payer plan comparable to Canada's?

 

[SMOGZINN]

You don't think adding $3 trillion a year in government spending is going to involve significant added expense to taxpayers?

No, because they will be saving that money elsewhere. The taxpayers are already spending that money on healthcare, it is just currently has to pass through several layers of for profit companies first.

 

[MomentsofSanity]

You don't think adding $3 trillion a year in government spending is going to involve significant added expense to taxpayers?

Of course it wouldn't. Right now you have a difference in costs for procedures that can be as much as as much as 2-3 times depending on the state or even region within the state the procedure is performed. You don't think those costs would be greatly reduced when there is only one payer saying "no we aren't paying those ridiculously inflated prices"? You don't think the redundancy and paper pushers could be greatly reduced?

 

[MomentsofSanity]

Is Sanders' single-payer plan comparable to Canada's?

Why is that the only option that can exist? Who gives a shit what his plan compares to?

 

[fskimospy]

You don't think adding $3 trillion a year in government spending is going to involve significant added expense to taxpayers?

Why would it? Genuinely confused. Remember, every dollar we're spending on single payer health insurance is one we aren't spending on private insurance and public insurance is generally more efficient so it's really a dollar and change less.

Your wallet doesn't care if you pay $1 more in taxes but $1 less for that iphone you bought, a dollar is a dollar either way.

 

[Atreus21]

Why is that the only option that can exist? Who gives a shit what his plan compares to?

Democrats, I think.

 

[Atreus21]

Why would it? Genuinely confused. Remember, every dollar we're spending on single payer health insurance is one we aren't spending on private insurance and public insurance is generally more efficient so it's really a dollar and change less.

Your wallet doesn't care if you pay $1 more in taxes but $1 less for that iphone you bought, a dollar is a dollar either way.

From the urban institute analysis I linked:

"In total, federal spending would increase by about $2.5 trillion (257.6 percent) in 2017. Federal expenditures would increase by about $32.0 trillion (232.7 percent) between 2017 and 2026. The increase in federal spending is so large because the federal government would absorb a substantial amount of current spending by state and local governments, employers, and households. In addition, federal spending would be needed for newly covered individuals, expanded benefits and the elimination of cost sharing for those insured under current law, and the new long-term support and services program.

State and local governments could save $319.8 billion in 2017 and $4.1 trillion between 2017 and 2026 as the federal government absorbs these costs under the Sanders plan (not shown in table 1). A maintenance-of-effort requirement could make state and local funds available to help pay for the plan, but the legality of such a requirement is in question.

Private health care spending by households and employers would drop as the federal government would absorb their spending under current law. Private sector expenditures for these groups would decrease by $1.7 trillion in 2017 and by $21.9 trillion between 2017 and 2026. These considerable savings would partially offset the impact on the private sector of new taxes required to pay for the Sanders plan.

Analysis by the Tax Policy Center indicates that Sanders’s revenue proposals, intended to finance all new health and nonhealth spending, would raise $15.3 trillion in revenue over 2017 to 2026. This amount is approximately $16.6 trillion less than the increased federal cost of his health care plan estimated here. The discrepancy suggests that to fully finance the Sanders approach, additional sources of revenue would have to be identified; that is, the proposed taxes are much too low to fully finance the plan."

 

[fskimospy]

From the urban institute analysis I linked:

"In total, federal spending would increase by about $2.5 trillion (257.6 percent) in 2017. Federal expenditures would increase by about $32.0 trillion (232.7 percent) between 2017 and 2026. The increase in federal spending is so large because the federal government would absorb a substantial amount of current spending by state and local governments, employers, and households. In addition, federal spending would be needed for newly covered individuals, expanded benefits and the elimination of cost sharing for those insured under current law, and the new long-term support and services program.

State and local governments could save $319.8 billion in 2017 and $4.1 trillion between 2017 and 2026 as the federal government absorbs these costs under the Sanders plan (not shown in table 1). A maintenance-of-effort requirement could make state and local funds available to help pay for the plan, but the legality of such a requirement is in question.

Private health care spending by households and employers would drop as the federal government would absorb their spending under current law. Private sector expenditures for these groups would decrease by $1.7 trillion in 2017 and by $21.9 trillion between 2017 and 2026. These considerable savings would partially offset the impact on the private sector of new taxes required to pay for the Sanders plan.

Analysis by the Tax Policy Center indicates that Sanders’s revenue proposals, intended to finance all new health and nonhealth spending, would raise $15.3 trillion in revenue over 2017 to 2026. This amount is approximately $16.6 trillion less than the increased federal cost of his health care plan estimated here. The discrepancy suggests that to fully finance the Sanders approach, additional sources of revenue would have to be identified; that is, the proposed taxes are much too low to fully finance the plan."

Not sure as to the relevance of the bolded or what you're really trying to argue. The relevant question is if net spending by America both public, private, whatever, is lower per person than it would be under our current system. The answer to that is most likely yes.

You like more efficient things, right?

 

[sdifox]

US is already spending more than 3T a year on healthcare...17% of your GDP...

 

[interchange]

Disclaimer: I haven't really read through this whole thread.

Prescription drugs account for about 10% of healthcare spending. It is certainly a problem but it is by no means the problem. Neither is it as simple as saying the rest of medicine costs too much from the standpoint of the consumer. Healthcare costs are not simply a function of providers charging exorbitant fees. While you can investigate and find numerous instances of fraud or things along the lines of racketeering, the vast majority of dollars are spent earnestly to provide care. The problems are systemic in nature. One systemic solution is single payer, and it is likely the easiest for the American healthcare system to move toward (e.g. gradual expansion of Medicaid/Medicare until universal, likely with private insurance moving toward a role as supplement). That said, although many businesses are operating earnestly, they are still businesses. None of them are going to lie down and let you make them obsolete because it's for the common good.

 

[Atreus21]

Not sure as to the relevance of the bolded or what you're really trying to argue. The relevant question is if net spending by America both public, private, whatever, is lower per person than it would be under our current system. The answer to that is most likely yes.

You like more efficient things, right?

How do you know the answer to that is yes? It certainly wasn't when California flirted with the idea last year.