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Why Single-Payer Health Care Saves Money

nytimes.com

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Re: Why Single-Payer Health Care Saves Money

#61

Post by learc83 »

kansface wrote: post #51
ravitation wrote: post #13

Earlier quoted context omitted.

> a truly free market health care system would be substantially cheaper Why would you imagine that? Regardless... You must also then ask the question, whether a "truly free market health care system" would be ethical.

> Why would you imagine that? Why do you imagine it wouldn't!? The portions of health care universally not covered by insurance are not subject to the same cost disease of the industry as a whole. Lo and behold, the real cost of eg. breast augmentation is declining (total cost of about 4K)! The cost of lasik has decreased ~50% over the last 15 years, current results are better, and the surgery has the highest rating…

>Why do you imagine it wouldn't!? The portions of health care universally not covered by insurance are not subject to the same cost disease of the industry as a whole. Lo and behold, the real cost of eg. breast augmentation is declining (total cost of about 4K)! The cost of lasik has decreased ~50% over the last 15 years, current results are better, and the surgery has the highest rating of patient satisfaction in the entire industry! A similar result anywhere else in medicine in the US is completely unimaginable.

In addition to not being covered by insurance those procedures are all elective. For elective procedures a free market is more likely to produce better results.

There is no way to make money insuring or treating poor, sick patients. The free market just can't do it.

The inherent problem here is that the math behind traditional free market economics breaks down when it comes to life saving goods and services. There is no equilibrium to be had, because of a combination of issues.

First the answer to how much will you pay to access this live saving drug is "anything" for 99% of the population. Second, life saving services are time sensitive--customers often can't choose a different supplier except the closest one. Third patent law ensures that there often isn't an alternative supplier.

Re: Why Single-Payer Health Care Saves Money

#62

Post by jefurii »

vowelless wrote: post #31

I personally think Medicare for all could potentially be a good system. But this article doesn't make a good argument at all. > Voters need to understand that this cost objection is specious. That’s because, as experience in many countries has demonstrated, the total cost of providing health coverage under the single-payer approach is actually substantially lower than under the current system in the United States. No…

> Ah this is infuriating. The link compares USA to other countries. Why not given evidence of Medicare compared to private insurers?

If Medicare covered the same set of people as private insurers it might be a good comparison. However in the U.S. Medicare currently covers certain groups (elderly, disabled) that have very different profiles from most private insurance customers.

Re: Why Single-Payer Health Care Saves Money

#63

Post by donmatito »

I would like to understand better what is meant by "single payer". I think I know what it should mean, but then I see France as an example of single-payer system. France has a complex system of insurance bodies (public entities, privates companies, some weird stuff in between)...

If I understand correctly the biggest savings come from the mandatory nature of the coverage - everybody is covered at least partially by the State, + employees by their employers, + private offers for the others + universal coverage for immigrants and the most destitute. Risk is shared between the healthy and sick people, and prevention can be maximized.

Re: Why Single-Payer Health Care Saves Money

#64

Post by specialist »

galeaspablo wrote: post #20

How do we compare apples to apples (between countries)? Compare health expenditure per capita (public and private) with multiple health indexes. I.e. get the bang for buck . In the list of nations with the best bang for buck healthcare programs, you will notice that top 20 healthcare programs are mostly single payer. http://www.who.int/healthinfo/paper30.pdf But there are single payer healthcare systems with bad heal…

I advocate single payer, vs single provider. What Canada has, more or less, vs Britain's NHS.

http://www.pnhp.org/single_payer_resources/health_care_syste...

Plus a good dash of capitation, to incentivise wellness thru prevention, vs fee-for-service.

Re: Why Single-Payer Health Care Saves Money

#65

Post by lb1lf »

peterhadlaw wrote: post #12

The word "negotiation" is a euphemism here: > The most important source of cost savings under single-payer is that large government entities are able to negotiate much more favorable terms with service providers. If there are no other options for clients, it's essentially the government telling doctors how much their services are worth.

Living in what is essentially a single-payer health care system (Norway), I assure you we don't see many MDs sleeping in cardboard boxes under freeway overpasses.

On a more serious note - education and skills tend to pay off.

Around here, doctors with their own practice are reimbursed by the state via several mechanisms, the two most significant ones are probably a fixed sum for each patient they are responsible for (they get this regardless of whether the patient sees them or not) and a fixed sum for each treatment, prescription filled &c.

Anecdotally, an MD with his own practice earns approx. $100k-$150k annually before taxes; this is 2-2,5 times the national average. (Very roughly speaking, but in the right ballpark)

Re: Why Single-Payer Health Care Saves Money

#66

Post by anotherfounder »

nostromo wrote: post #9

I imagine both single-payer and a truly free market health care system would be substantially cheaper than the current system -- which has none of the benefits of either approach. With the federal government unable to act, turning healthcare back to the states to test a number of different solutions seems entirely reasonable. Let California try single-payer and Texas try something different -- after a few years see i…

Also, healthcare isn't truly a free market since there are no free agent buyers. So, you'd have to define that phrase 'truly free market health care'.

Re: Why Single-Payer Health Care Saves Money

#67

Post by Analemma_ »

flavor8 wrote: post #53
cortesoft wrote: post #19

Earlier quoted context omitted.

The problem with a 'each state do their own thing' solution is the very problem with health care in this country in general - the freeloader problem. If California implements a single payer system, it would make people in other states more likely to choose not to get healthcare; if they get sick, they can just move to California. This is the reason the ACA has the 'individual mandate' to go along with preventing the…

I'm not convinced this is insurmountable. How do countries with single payer handle this? Surely you could require an newly established resident who wants treatment to pay a portion since they hadn't been funding it directly via taxes, and then add a further penalty if they move back out of state within a certain period of time (to discourage moving in-state just for treatment).

> I'm not convinced this is insurmountable. How do countries with single payer handle this?

I'm confused by your question. Countries with single-payer have the same policy everywhere in the country, so there is no freeloading involved.

Unless you're talking about people coming from other countries, in which case it's handled by their immigration policy.

Re: Why Single-Payer Health Care Saves Money

#68

Post by rednerrus »

nostromo wrote: post #9

I imagine both single-payer and a truly free market health care system would be substantially cheaper than the current system -- which has none of the benefits of either approach. With the federal government unable to act, turning healthcare back to the states to test a number of different solutions seems entirely reasonable. Let California try single-payer and Texas try something different -- after a few years see i…

You can't have a truly free market health care system: https://krugman.blogs.nytimes.com/2009/07/25/why-markets-can... http://www.who.int/bulletin/volumes/82/2/PHCBP.pdf

The federal government already pays for 64.3% of healthcare costs http://www.pnhp.org/news/2016/january/government-funds-nearl.... In a centralized managed system this would likely cover the cost of all healthcare. It's roughly what other industrialized nations pay, per person, for single-payer.

Re: Why Single-Payer Health Care Saves Money

#69

Post by luxuryballs »

cortesoft wrote: post #19
nostromo wrote: post #9

I imagine both single-payer and a truly free market health care system would be substantially cheaper than the current system -- which has none of the benefits of either approach. With the federal government unable to act, turning healthcare back to the states to test a number of different solutions seems entirely reasonable. Let California try single-payer and Texas try something different -- after a few years see i…

The problem with a 'each state do their own thing' solution is the very problem with health care in this country in general - the freeloader problem. If California implements a single payer system, it would make people in other states more likely to choose not to get healthcare; if they get sick, they can just move to California. This is the reason the ACA has the 'individual mandate' to go along with preventing the…

This problem is exactly why a single payer system would fail entirely, imagine if you could easily be a freeloader without having to move at all?

I don't think the US has the same demographics as the other countries where this currently appears to succeed. There are way more people who can't pay in the US, we're far too big for this.

Re: Why Single-Payer Health Care Saves Money

#70

Post by cortesoft »

flavor8 wrote: post #53
cortesoft wrote: post #19

Earlier quoted context omitted.

The problem with a 'each state do their own thing' solution is the very problem with health care in this country in general - the freeloader problem. If California implements a single payer system, it would make people in other states more likely to choose not to get healthcare; if they get sick, they can just move to California. This is the reason the ACA has the 'individual mandate' to go along with preventing the…

I'm not convinced this is insurmountable. How do countries with single payer handle this? Surely you could require an newly established resident who wants treatment to pay a portion since they hadn't been funding it directly via taxes, and then add a further penalty if they move back out of state within a certain period of time (to discourage moving in-state just for treatment).

It isn't insurmountable, it basically comes down to having to choose to deny care to someone.

However, it is really hard to do it in a fair and humane way; to deny care to people trying to freeload but not deny care to people who aren't.

The whole point of universal, single payer, healthcare is to avoid having to make this determination.

This isn't an issue for a country because the number of new residents (immigrants) is not a large percentage of the total number of citizens. If it was a state, though, that ratio might not work out; there is a VERY large pool of possible 'freeloaders' who are legally allowed to move to the state whenever they want.

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