Healthy California Act: proposal to make findings about single-payer healthcare • Hacker News Board

Re: Healthy California Act: proposal to make findings about single-payer healthcare

#271

Post by TheSpiceIsLife » Thu, Mar 09, 2017, 1:49 AM UTC

dpc_pw wrote: post #257

Coming from a country with single-payer healthcare: If you have have 5 beds, and 10 people that need to use a bed every day, there is no pure finance management solution to solve it. If you have insurance-based system like in US, only people who can afford insurance will be able to use the beds. Rest will be priced-out. If you have single-payer system like in my country of origin (and what a lot of people in America…

If you have have 5 beds, and 10 people that need to use it every day, there is no financial solution to solve it.

One financial solution would be to fund construction of the infrastructure to house the beds and fund the operational expenditure to run them.

I would guess the reasons this doesn't happen are primarily political.

Re: Healthy California Act: proposal to make findings about single-payer healthcare

#272

Post by sanswork » Thu, Mar 09, 2017, 1:49 AM UTC

rdmcfee wrote: post #72

A single payer system is a step in the right direction, however, there are deeper issues with the American healthcare system. The unit cost of healthcare is so much higher than in other developed countries. In British Columbia, physicians bill at total of around $31 CAD ($23 USD) for a standard office visit. They pay all their overhead out of this fee. Typically doctors keep 65% of their billings and the offices take…

Private insurance is a big once since the Dr bills $xx with the expectation that insurance will only agree to pay a % of that amount(but different amounts from different insurers and clients). In BC doctors know up front what they'll get back so they don't have to play pricing games.

Re: Healthy California Act: proposal to make findings about single-payer healthcare

#273

Post by chimeracoder » Thu, Mar 09, 2017, 1:49 AM UTC

jahewson wrote: post #254

chimeracoder wrote: post #210

Earlier quoted context omitted.

> In the US there are a great many physicians who simply won't accept Medicare rates (they're viewed as too low by most) Right there is the big problem, though: Medicare reimbursement rates are already below sustainable levels for providers, which actually results in providers charging private insurers for the difference. If Medicare were expanded to everyone, either Medicare would have to increase its reimbursement…

Medicare reimbursement rates aren't necessarily too low if healthcare providers are currently overcharging. They could be perfectly be fair. But as long as healthcare providers can find someone else to overcharge then they'll do that rather than accepting Medicare patients.

> Medicare reimbursement rates aren't necessarily too low if healthcare providers are currently overcharging. They could be perfectly be fair.

No, Medicare reimbursement rates are about 7% lower (in the aggregate, not individually) than COGS - the marginal costs of providing care. That is, if a test costs a provider $100 to purchase wholesale, Medicare reimburses $93, which doesn't cover the cost of the supplies, let alone covering overhead (wages for staff, office rent, etc.)

Re: Healthy California Act: proposal to make findings about single-payer healthcare

#274

Post by maxerickson » Thu, Mar 09, 2017, 1:50 AM UTC

luckydata wrote: post #268

maxerickson wrote: post #220

Earlier quoted context omitted.

Several of those countries implement universal coverage using a private insurance model.

All the best systems are single payer. Italy, France, Spain, the UK. The countries with private insurance like Germany are middle of the pack. Clearly single payer is the superior option.

My primary contention is that Every other first world country? is a little too lacking in nuance, I wasn't trying to express an opinion about what works best.

Re: Healthy California Act: proposal to make findings about single-payer healthcare

#275

Post by pje » Thu, Mar 09, 2017, 1:50 AM UTC

gavman wrote: post #32

Vermont tried this a few years ago, they had to cancel it since in the end it wasn't financially feasible [1]. CA is already dealing with severe budget issues [2][3], so while it sounds nice in theory I'm hesitant to believe the finances actually work out. [1] http://www.politico.com/story/2014/12/single-payer-vermont-1... [2] http://www.latimes.com/projects/la-me-pension-crisis-davis-d... [3] http://www.cnbc.com/201…

It seems to be working pretty well in Canada.

Re: Healthy California Act: proposal to make findings about single-payer healthcare

#276

Post by joshpadnick » Thu, Mar 09, 2017, 1:50 AM UTC

dpc_pw wrote: post #257

Coming from a country with single-payer healthcare: If you have have 5 beds, and 10 people that need to use a bed every day, there is no pure finance management solution to solve it. If you have insurance-based system like in US, only people who can afford insurance will be able to use the beds. Rest will be priced-out. If you have single-payer system like in my country of origin (and what a lot of people in America…

> The real solution is to either have more beds, or to have less people who need to use them.

This is exactly the incentives we've wanted all along. Is healthcare too expensive to cover everyone's current level of need? Now it finally makes sense for government to get serious about investing in prevention.

Our current incentives of "the more sick-care you provide, the more you get paid" has exactly the opposite incentive. No solution is perfect, but this feels like a significant step in the right direction.

Re: Healthy California Act: proposal to make findings about single-payer healthcare

#277

Post by enraged_camel » Thu, Mar 09, 2017, 1:50 AM UTC

refurb wrote: post #231

enraged_camel wrote: post #169

Earlier quoted context omitted.

You would do well to start questioning the idea that the private sector does anything "better". After all, it was them that gave us Enron, Deepwater Horizon, and most recently, the subprime mortgage crisis, which brought the entire world economy to its knees. Those are only a few examples that spring to mind. In addition, comparing the government with the private sector is pretty silly. They have different goals. Pri…

After all, it was them that gave us Enron, Deepwater Horizon, and most recently, the subprime mortgage crisis, which brought the entire world economy to its knees. That's a pretty poor argument if you line it up against gov't waste, incompetence and corruption.

Can you provide any arguments (or, even better, empirical evidence) as to why the government has more waste, incompetence and corruption than the private sector?

Re: Healthy California Act: proposal to make findings about single-payer healthcare

#278

Post by refurb » Thu, Mar 09, 2017, 1:51 AM UTC

hackuser wrote: post #255

refurb wrote: post #209

Earlier quoted context omitted.

As a Canadian as well, I appreciate you being up front about the drawbacks of our system as well. I've heard so many American's say "oh, the Canadian system is so much better". Is it better in coverage? Obviously! However, when I ask if they'd be ok waiting over a year for joint replacement surgery, they get a weird look on their face. Or, if they have cancer, they aren't going to get to go to the best cancer center…

These situations are common in the U.S., unless you are well-connected and can pull strings. > waiting over a year for joint replacement surgery 1) Remember that many Americans have no access to healthcare outside of emergency rooms; they wait forever. I know plenty, including connected people, who wait months for simple appointments. A year before surgery wouldn't surprise me at all. > if they have cancer, they aren…

I'm not arguing that many people would be better off. I'm arguing that many people would have to lower their expectations around healthcare.

There is a very big chunk of the US that has very expensive (that they can afford) and very good healthcare.

Re: Healthy California Act: proposal to make findings about single-payer healthcare

#279

Post by ktRolster » Thu, Mar 09, 2017, 1:51 AM UTC

refurb wrote: post #209

tempestn wrote: post #137

Earlier quoted context omitted.

It seems like most of the complaints about healthcare now relate to unpredictable costs and complexity though. I'm not sure the simplicity and stress-reduction of a single-payer system really are appreciated. I'm Canadian, and our system is fair from perfect. That said, it's hard for me to comprehend the stories I regularly read about people's experiences in the American system, trying to decide on plans, sacrificing…

As a Canadian as well, I appreciate you being up front about the drawbacks of our system as well. I've heard so many American's say "oh, the Canadian system is so much better". Is it better in coverage? Obviously! However, when I ask if they'd be ok waiting over a year for joint replacement surgery, they get a weird look on their face. Or, if they have cancer, they aren't going to get to go to the best cancer center…

I like to remind myself of the complexity of the situation by remembering:

Sometimes Americans go to Canada for medical treatment, and sometimes Canadians come to America for treatment. It's not a simple better/worse situation.

Re: Healthy California Act: proposal to make findings about single-payer healthcare

#280

Post by alexqgb » Thu, Mar 09, 2017, 1:52 AM UTC

refurb wrote: post #214

alexqgb wrote: post #135

Earlier quoted context omitted.

The problem with this frame is that it assumes costs under a more socialized system wouldn't budge, making a single-payer system nothing more that simple wealth-transfer. The thing to recognize is that the every-person-for-themselves approach leads to outcomes that drive costs up extraordinarily. Avoiding the US model is why every other OECD country offers universal coverage and boasts longer lifespans, even though h…

the major advantage of single-payer is massively reducing the costs of health care It's cheaper because less is offered. Of course one can argue the extra you get under the US system doesn't really add value. Keep in mind that single payer systems are struggling with costs as well. It's just easier for them to say "no one gets this new treatment".

No, this is demonstrably wrong. Cutting $87,000 in markups from the price of $1,700 off-patent drugs does not mean "less is offered". To the contrary, far more people get access to the drug in question. It may mean that the system as a whole offers far less opportunity to predatory rent-seekers, but that's a feature, not a bug.

And yes, you can very easily argue that many other costs don't add value. That's why pointing to the superior overall life-expectancy in other countries is such an important part of the argument. On balance, every other system in the developed world does more, for more, with less. Our system offers bottom-of-the-pile rankings by every major measure.

Finally, "struggling with costs" is a non-starter as far as arguments against single-payer go since what things cost and how you come up with the money are clearly two different things. Saying "country X is having a hard time funding their health care system at 10% of GDP" in no way undermines the case for dumping a system here in the US that costs us closer to 18% of ours.

Seriously, we could make massive improvements to ours simply by picking the name of any other OECD country from a hat, and just implementing their system. Literally anything is better than what we've got here, and it's not even close.