What can we agree on regarding health care?

[ivwshane]

Another poster in another thread said they supported single payer health care which surprised me and at least one other poster and it left me wondering; how many people support a universal, single payer health care system?

In order to gauge the support of such a plan we first need to agree on what universal, single payer means. For the purpose of this poll, universal means health care access to all US citizens. There is debate about whether it makes sense to cover other people as well and in other countries non citizens are indeed able to access some health care benefits but for the purpose of this discussion and to get as broad as an agreement as possible, I'll narrow the scope of the definition.

Single payer, again, for the purposes of this discussion means that everyone pays something. "Everyone" means anyone receiving an income, so employees and employers.

Based on how every country (as far as I know) implements health care, universal/single payer also means price controls of some sort. This means price controls for both suppliers, providers, doctors and anything else.

Access to health care is defined as access to both preventive care and treatment for basic health related items up to and including catastrophic care. Voluntary procedures/care such as cosmetic surgery are not covered.

Of course all the above can be debated and the degrees to which they apply can be debated as well but for the purpose of this poll, these are the base definitions we are using.

So, who supports universal/single payer health care?

 

[Hayabusa Rider]

What are you willing to give up? Will you wait for 3 years to have hernia surgery? How do you implement a system without harming people by breaking care? This is an infinitely harder thing than the ACA, probably more than any other project in US history.

How do you implement, who controls it, who makes the decisions about your health? Look carefully at the UK where their system has led to a large portion of sex workers coming from care and education because of better pay and working conditions. Is that acceptable?

Before I sign on for anything the crucial details must be given.

 

[woolfe9998]

What are you willing to give up? Will you wait for 3 years to have hernia surgery? How do you implement a system without harming people by breaking care? This is an infinitely harder thing than the ACA, probably more than any other project in US history.

How do you implement, who controls it, who makes the decisions about your health? Look carefully at the UK where their system has led to a large portion of sex workers coming from care and education because of better pay and working conditions. Is that acceptable?

Before I sign on for anything the crucial details must be given.

I don't think a poll can capture such nuance. The underlying premise of this sort of poll is that it's asking you whether you would support something in theory, meaning under the right conditions. I think it's a given assumption that if you say "yes," it means that you would support something that satisfies the OP's definition but also is implemented in a way you would deem to be correct. It's not asking if you support a poor implementation of the idea.

 

[Hayabusa Rider]

I don't think a poll can capture such nuance. The underlying premise of this sort of poll is that it's asking you whether you would support something in theory, meaning under the right conditions. I think it's a given assumption that if you say "yes," it means that you would support something that satisfies the OP's definition but also is implemented in a way you would deem to be correct. It's not asking if you support a poor implementation of the idea.

I'd support some form of universal coverage, maybe. Having been a practitioner and seeing the good, the bad, and the ugly of it all my position is highly dependent on what it ultimately is.

This is like one of those crappy genie horror movies where one must be careful lest you get what you ask for.


So, conditional yes would be my answer.

 

[deathBOB]

What are you willing to give up? Will you wait for 3 years to have hernia surgery? How do you implement a system without harming people by breaking care? This is an infinitely harder thing than the ACA, probably more than any other project in US history.

How do you implement, who controls it, who makes the decisions about your health? Look carefully at the UK where their system has led to a large portion of sex workers coming from care and education because of better pay and working conditions. Is that acceptable?

Before I sign on for anything the crucial details must be given.

Is it that much harder? Medicaid and Medicare already function like single payer systems. They may not be perfect but about a hundred million people in America currently rely on them. Scaling up from there doesn't seem so bad.

 

[vi edit]

I don't think *TRUE* single payer is the answer. I think ultimately it will be some sort of hybrid model where key wellness and basic healthcare is "single payer". Everyone should have access to basic primary care, preventative dental and non-emergent/urgent care treatment. I do think we can move towards that and relieve some burden from the more acute, and high cost settings. Move that to a government operated/funded clinic by staff that are subsidized by the feds (student loan forgiveness in exchange for years of commitment) where they can control costs and the administrative overhead that exists in the current disaster of a model created by insurance and government procedures. If people have access to preventative care maybe we can catch some things before they are bigger. Especially if cost is no longer a barrier.

Where things get very messy is once you go beyond basic and into the realm of trauma, cancer, cardiac interventions, stroke, ect. That is where the bills start to spiral out of control. There's some yet to be defined/compromised middle ground that we have to reach here. This is where the high deductible & health savings plans models start to make more sense. They can be used for that gap coverage that isn't provided by the basic care described in my first paragraph.

But in addition to just a change up in model, is a change up in philosophy too. We throw billions of dollars at the wall in treatment and care to only extend the inevitable. America needs to take a deep look at how we treat our elderly and family members and drag them out on life support and throwing them into the OR for a high risk procedure at the age of 80. People like to sling the term "death panels" around, but we need to understand that health care resources are finite and not a bottomless bucket of money, staff, hospital beds and available procedures. There are some times when those are better put to improving prevention and saving others.

 

[Hayabusa Rider]

Is it that much harder? Medicaid and Medicare already function like single payer systems. They may not be perfect but about a hundred million people in America currently rely on them. Scaling up from there doesn't seem so bad.

Single payer would run all of health care. This won't be an expanded ACA but the dictation of every single interaction between your provider and you. It will tell him or her what he can medically do for you or cannot and this will be based on cost. Medicaid itself is a timesink and money pit for providers. Needless bureaucratic requirements offloaded by Medicaid "to keep costs down". Well no, to shift costs to others which ultimately someone pays for.

No, this isn't easy at all. Your life and the life of those you care for hang in the balance of how wisely this is done.

 

[fskimospy]

I don't think *TRUE* single payer is the answer. I think ultimately it will be some sort of hybrid model where key wellness and basic healthcare is "single payer". Everyone should have access to basic primary care, preventative dental and non-emergent/urgent care treatment. I do think we can move towards that and relieve some burden from the more acute, and high cost settings. Move that to a government operated/funded clinic by staff that are subsidized by the feds (student loan forgiveness in exchange for years of commitment) where they can control costs and the administrative overhead that exists in the current disaster of a model created by insurance and government procedures. If people have access to preventative care maybe we can catch some things before they are bigger. Especially if cost is no longer a barrier.

Where things get very messy is once you go beyond basic and into the realm of trauma, cancer, cardiac interventions, stroke, ect. That is where the bills start to spiral out of control. There's some yet to be defined/compromised middle ground that we have to reach here. This is where the high deductible & health savings plans models start to make more sense. They can be used for that gap coverage that isn't provided by the basic care described in my first paragraph.

But in addition to just a change up in model, is a change up in philosophy too. We throw billions of dollars at the wall in treatment and care to only extend the inevitable. America needs to take a deep look at how we treat our elderly and family members and drag them out on life support and throwing them into the OR for a high risk procedure at the age of 80. People like to sling the term "death panels" around, but we need to understand that health care resources are finite and not a bottomless bucket of money, staff, hospital beds and available procedures. There are some times when those are better put to improving prevention and saving others.

I would actually go the opposite way, where everyone has universal catastrophic coverage to cover things like cancer and then everything else is paid for by HSAs or whatever. The primary cost driver in US health care is not the routine stuff, it's the end of life care, the cancer care, etc. This is where single payer can really shine if we let it.

 

[Hayabusa Rider]

I don't think *TRUE* single payer is the answer. I think ultimately it will be some sort of hybrid model where key wellness and basic healthcare is "single payer". Everyone should have access to basic primary care, preventative dental and non-emergent/urgent care treatment. I do think we can move towards that and relieve some burden from the more acute, and high cost settings. Move that to a government operated/funded clinic by staff that are subsidized by the feds (student loan forgiveness in exchange for years of commitment) where they can control costs and the administrative overhead that exists in the current disaster of a model created by insurance and government procedures. If people have access to preventative care maybe we can catch some things before they are bigger. Especially if cost is no longer a barrier.

Where things get very messy is once you go beyond basic and into the realm of trauma, cancer, cardiac interventions, stroke, ect. That is where the bills start to spiral out of control. There's some yet to be defined/compromised middle ground that we have to reach here. This is where the high deductible & health savings plans models start to make more sense. They can be used for that gap coverage that isn't provided by the basic care described in my first paragraph.

But in addition to just a change up in model, is a change up in philosophy too. We throw billions of dollars at the wall in treatment and care to only extend the inevitable. America needs to take a deep look at how we treat our elderly and family members and drag them out on life support and throwing them into the OR for a high risk procedure at the age of 80. People like to sling the term "death panels" around, but we need to understand that health care resources are finite and not a bottomless bucket of money, staff, hospital beds and available procedures. There are some times when those are better put to improving prevention and saving others.

Had a heart attack and later a bypass. I had a 1% chance of survival any my excellent cardiologist who gave treatment immediately said he's mystified as to how I am still alive.

I could have been triaged out of life for cost sake, or resources reduced such that there was no one to help me in time.

Serious question- Should I and others like me die to save money? This is not an abstraction. Who ultimately decides, bean counters? The answer to that is yes, the people with the purse.

Change is needed but if the focus is on money instead of care this won't work out well. That does not mean unlimited funds are required but things could be done much smarter than they are if smart people are allowed to do a good job.

Ah well, let's cut nursing staff. They sit around all day anyway. Look at the money!

 

[Fanatical Meat]

I'll throw my broad expectations in, please keep in mind these are broad goals don't nit pick.

Nobody should "die in the street", I'll allow an exception for the addicted or mentally ill not caring for themselves
The above should have some kind of realistic treatment path and maybe bring back institutionalization provided its respectful
Insurance shouldn't be run 100% for profit like buying a new internet service. There needs to be an expectation that Insurers aren't going to manipulate coverage to make an extra ten cents per customer
Drug prices need to be reasonable. Something that is a true break thru I'll accept there is more cost but the BS about changing the pills shape or color then getting a patent extension is crap
Insurance should be for everyone, I'll accept a opt out process but the starting point needs to be having insurance.
People shouldn't have to choose between home/shelter and treatment....ever!
We shouldn't have an expectation that we'll all get the maximum benefit
Hospitals should be required to give you at least an 80% accurate cost figure before any procedure happens (obviously barring an emergency procedure)
Maybe some kind of out of pocket yearly expense limit based upon income

 

[Hayabusa Rider]

I would actually go the opposite way, where everyone has universal catastrophic coverage to cover things like cancer and then everything else is paid for by HSAs or whatever. The primary cost driver in US health care is not the routine stuff, it's the end of life care, the cancer care, etc. This is where single payer can really shine if we let it.

I'm sure people like Trump will have the BEST care for you.

 

[vi edit]

I would actually go the opposite way, where everyone has universal catastrophic coverage to cover things like cancer and then everything else is paid for by HSAs or whatever. The primary cost driver in US health care is not the routine stuff, it's the end of life care, the cancer care, etc. This is where single payer can really shine if we let it.

I don't disagree that those types of health issues are the ones that are the family crushers and and bankrupters. It's not a fix that will notice changes over something like a presidential term. It's something that takes time to implement and actually notice the benefits of. Americans are fucking horrible when it comes to personal responsibility and health choices. Better access, continuous reinforcement and early corrections can help prevent huge expensive issues later in their life. Take away the premium costs and copays associated with that and move towards a model where people start saving for things earlier and those catastrophic plans are funded earlier, with more accessible cash to fund the larger deductibles and in a generation or so we may see a more stabilized model.

Just leaving it for the government to pick up the tab isn't going to work. That's a risk pool you are jumping into without knowing how deep it is.

On top of everything else...one of the biggest obstructions is that people want the impossible. They want some revolutionary change in coverage/access, want it to cost less and expect it to happen within some defined election model time frame. Most of our lifestyle choices that got us to where we are health wise did not happen over the 4-6 years of an election cycle, and they aren't going to be fixed in that same time frame either.

Things take time to stabilize and for the data to drilled long enough to understand the impact. If we choose some model, it has to be given the appropriate time to stabilize and not turned into a partisan election topic.

 

[fskimospy]

Had a heart attack and later a bypass. I had a 1% chance of survival any my excellent cardiologist who gave treatment immediately said he's mystified as to how I am still alive.

I could have been triaged out of life for cost sake, or resources reduced such that there was no one to help me in time.

Serious question- Should I and others like me die to save money? This is not an abstraction.

I feel you, when I was diagnosed with cancer I had a 1 kilogram tumor in my chest that had grown around my heart. The initial thought was that I had stage 4 non-Hodgkins lymphoma would would have meant almost certain death. Thankfully it was something much easier to treat but if it had been non-Hodgkins should I have been left to die? Probably, as there wasn't much that could have saved me. (well maybe not left to die, but had the scope of treatment constricted.)

Who ultimately decides, bean counters? The answer to that is yes, the people with the purse.

Change is needed but if the focus is on money instead of care this won't work out well. That does not mean unlimited funds are required but things could be done much smarter than they are if smart people are allowed to do a good job.

Ah well, let's cut nursing staff. They sit around all day anyway. Look at the money!

Yes in the end we have to make those hard choices and let some people die to save money. Presumably all of us agree that if we had to spend a million dollars to keep someone alive for 5 more minutes we should let them die. Once that basic principle is established all we're really discussing is where the line is. End of life care is enormously expensive and often yields little improvement and so it's something we have to look at.

 

[Thebobo]

As long as it includes dental care. Who the fuck ever thought your teeth were not a vital part to your health?

 

[vi edit]

Had a heart attack and later a bypass. I had a 1% chance of survival any my excellent cardiologist who gave treatment immediately said he's mystified as to how I am still alive.

I could have been triaged out of life for cost sake, or resources reduced such that there was no one to help me in time.

Serious question- Should I and others like me die to save money? This is not an abstraction. Who ultimately decides, bean counters? The answer to that is yes, the people with the purse.

Change is needed but if the focus is on money instead of care this won't work out well. That does not mean unlimited funds are required but things could be done much smarter than they are if smart people are allowed to do a good job.

Ah well, let's cut nursing staff. They sit around all day anyway. Look at the money!

It's a question that doesn't have a right answer. There rarely is when it comes to something as significant as a life impacting decision. But at some point we are going to have to do some deep reflecting on how much care we demand and where those dollars are going to come from.

 

[Hayabusa Rider]

I feel you, when I was diagnosed with cancer I had a 1 kilogram tumor in my chest that had grown around my heart. The initial thought was that I had stage 4 non-Hodgkins lymphoma would would have meant almost certain death. Thankfully it was something much easier to treat but if it had been non-Hodgkins should I have been left to die? Probably, as there wasn't much that could have saved me. (well maybe not left to die, but had the scope of treatment constricted.)



Yes in the end we have to make those hard choices and let some people die to save money. Presumably all of us agree that if we had to spend a million dollars to keep someone alive for 5 more minutes we should let them die. Once that basic principle is established all we're really discussing is where the line is. End of life care is enormously expensive and often yields little improvement and so it's something we have to look at.

At some point we will have to say "sorry" and I accept that. Perhaps I can explain my objection to the automatic acceptance of UHC.

I've explained in that past that I object to Congress doing the formulation of a changeover, and that a select group of individuals take charge instead. This is not some blue ribbon panel advising, but doing the actual work free of Trump or whomever is in office. In fact members who are qualified could craft law and regulation in order to limit adverse unintended consequences. Congress funds an autonomous group to take time and do things right. I've suggested one thing, a nationwide system with access to medical history for all americans everywhere. The value of this cannot be overstated. But, we're looking for one thing above all, not spending money and I find that troubling.

Care is about the patient. There may be limitations on what we can do, but systems where punishment is the "solution" is a terrible idea. Note how improvements in care really didn't come about in outcomes as a whole because the entire premise was that people were irresponsible and negligent. Yes that happens, but you and I have spent enough time in hospital to see how nurses may spend 16 hours on a shift under constant pressure because care is expensive and it's financially simpler to burn them out. Unfortunately that means care is affected and removing support isn't going to make things better. Instead ask the nurses what they need, what they see, and solicit their input, not to some committee who will shuffle them to the back of ten thousand pieces of paper so they can move on to fracking.

Government is not a solution because it cannot be divorced from partisanship and the people in Congress have neither the time nor knowledge to do this right. EDIT- It can be a facilitator so others can do a proper job. Government isn't an evil entity but it is not all wise.

Naturally Congress has the final say and it should, but this is not really something new. Legislation has been written by other parties and approved, often with less than honorable intent. We don't want that. We want an open and expertly implemented system that takes into account the person in need. Is it fact that the better the treatment, the better the outcome, the lower the total cost will be. That approach makes sense to me as a professional and a person interested in care. If we need to make cuts? Then do so with understanding.

Is it really to much to ask for us and those we love?

 

[senseamp]

Can we all agree, that for a party that had 7 years of promising to replace Obamacare with something better, billions of dollars in think tank funding, and control of Congress, the bill they have finally came up with is pretty pathetic? The Republican mountain gave birth to a mouse.

 

[echo4747]

I too would like to see some sort of single payer catastrophic plan.. and then have different optional packages one can add on. In Order to see any real significant savings,prescription drug prices need to be reduced as well. Trial lawyers and malpractice suits need to be eliminated or capped at a certain $$ amount. I would even consider the right to refuse treatment for those without insurance ( this would depend on ultimately how much can actually be saved by doing so) I think travelers and tourists should be required to purchase a temporary plan/policy based on intended length of stay in USA. This policy would only cover medical conditions/emergencies that occur during their stay. It won't cover anything pre-existing conditions

 

[Hayabusa Rider]

I too would like to see some sort of single payer catastrophic plan.. and then have different optional packages one can add on. In Order to see any real significant savings,prescription drug prices need to be reduced as well. Trial lawyers and malpractice suits need to be eliminated or capped at a certain $$ amount. I would even consider the right to refuse treatment for those without insurance ( this would depend on ultimately how much can actually be saved by doing so) I think travelers and tourists should be required to purchase a temporary plan/policy based on intended length of stay in USA. This policy would only cover medical conditions/emergencies that occur during their stay. It won't cover anything pre-existing conditions

What about things like mortgage assistance for those with serious problems perhaps? Some sort of comprehensive catastrophic coverage?

 

[interchange]

People here are misrepresenting single payer and socialized medicine.

While single payer may put limits on access to interventions, it is not obligated, and generally Medicare is a good model. As a provider, it is generally much easier to get something covered under Medicare than private insurances who put up administrative hurdles to limit spending (unfortunately driving up costs).

My personal general ideal would be expansion of Medicaid to all for free, Medicare to all who pay premium, and private supplemental insurance.

 

[ivwshane]

I'd support some form of universal coverage, maybe. Having been a practitioner and seeing the good, the bad, and the ugly of it all my position is highly dependent on what it ultimately is.

This is like one of those crappy genie horror movies where one must be careful lest you get what you ask for.


So, conditional yes would be my answer.

It is assumed that a yes answer is conditional.

The question really is; do you think a universal/single payer system is the best way forward to better health care in terms of coverage and costs.

The details, while important, are way beyond the scope of this thread.

 

[Hayabusa Rider]

It is assumed that a yes answer is conditional.

The question really is; do you think a universal/single payer system is the best way forward to better health care in terms of coverage and costs.

The details, while important, are way beyond the scope of this thread.

I'd certainly to see everyone who needs care get it. So the answer is yes. I just want it done right, as I'm sure you understand.

 

[ivwshane]

I'd certainly to see everyone who needs care get it. So the answer is yes. I just want it done right, as I'm sure you understand.

I can almost guarantee everyone who supports it wants it done right. I don't think anyone's motives are being questioned here.

 

[woolfe9998]

I would actually go the opposite way, where everyone has universal catastrophic coverage to cover things like cancer and then everything else is paid for by HSAs or whatever. The primary cost driver in US health care is not the routine stuff, it's the end of life care, the cancer care, etc. This is where single payer can really shine if we let it.

In order to implement this, there would have to be strict price controls on all the "ordinary care" that consumers pay for with their HSA's or whatever. If all the expensive catastrophic care is paid for by the government, the reimbursement rates will naturally be low as they are right now with Medicare and Medicaid. Without price controls, providers will jack up the price on everything that consumers have to pay for in order to compensate. Either way, we're looking at government regulation of the entire system, not just a part of it.

 

[Pulsar]

What are you willing to give up? Will you wait for 3 years to have hernia surgery? How do you implement a system without harming people by breaking care? This is an infinitely harder thing than the ACA, probably more than any other project in US history.

How do you implement, who controls it, who makes the decisions about your health? Look carefully at the UK where their system has led to a large portion of sex workers coming from care and education because of better pay and working conditions. Is that acceptable?

Before I sign on for anything the crucial details must be given.

Good to see you didn't leave the site.

The government has actually done a fairly good job with medicare and medicaid. Yes, there are definitely problems with both. They aren't perfect. But nothing is. Just like the prices of utilities (electricity specifically) the government has to manage this because the free market system cannot. And will not. The opportunistic profit-taking we've seen recently by tycoons who buy up critical single-suppliers of medications like epipens and jack the prices up by 800 to 1000% is a perfect example. The giant health conglomerates and the clear price fixing going on between medical companies and insurance companies is another example. $120,000 to have a child. I can't buy replacement pieces for my cpap with my OWN MONEY because the medical companies have insisted you must have prescription.

I would normally say I'm a republican. But their conduct over the last 10 years - the obstructionism, the ignoring of women's medical rights, the disregard of the wage gap, the tax cuts on the wealthy, have pretty much turned me off entirely. Their total failure to present something even slightly feasible to replace the ACA after 8 years of saying they were going to is unforgiveable. I think they were just as surprised trump won as hillary was, and they have no plan at all.