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Why Single-Payer Health Care Saves Money

nytimes.com

131–140 of 206 posts

Re: Why Single-Payer Health Care Saves Money

#131
post #25

Earlier quoted context omitted.

It's not just doctors, its drug and health insurance companies, etc... but really? Is the argument is that we as a nation should pay double what other modern nations pay so doctors can be well paid? Edit: Here's a deal, lets pay for doctor's educations, implement universal healthcare and call it even.

You're still telling people what their time and efforts are worth rather than if there were no artificial restrictions.

No, if we're implementing universal healthcare, they're negotiating in a labor market which has decided to collectively bargain for the purchase of services.

Consider it the physcians version of labor globalization. Or workers labor negotiations vs ever larger corporations. Only this time its for a public good.

Re: Why Single-Payer Health Care Saves Money

#132
What is more likely, insurance companies beat more than 50% more care per dollar out of doctors/hospitals etc, or people would be better of getting rid of the giant middleman? Insurance companies don't heal you. Medicine does. Get rid of the 33% overhead of insurance and gain the free 50% extra money for healthcare. Then all the people in that industry can move on to better gainful employment.

Re: Why Single-Payer Health Care Saves Money

#133
post #122
post #54

It's still absurd to me that we make the false differentiation between taxes and insurance premiums. If you've got a family, neither is negotiable. If you have a job that pays, I promise you it affects your check in nearly identically the same way as payroll taxes do. There's a tradition in America where the price isn't actually the real price, we artificially advertise fake prices to get you in the door and stuff a…

Whenever I've visited the U.S. this drives me crazy. I always wonder how people shop for anything, given that the only time you find out the actual price of things is when you're about to pay for them. Do you just in your head have to tack on 10 to 20 percent (depending on the context)?

>Do you just in your head have to tack on 10 to 20 percent (depending on the context)?

Yes - and I actually prefer shopping at places that don't use manipulative ($x.99) pricing or if they do, at least tax has already been included in the price (a local card shop does that). If something is $0.99 I should be able to buy it if I only have $1.00 with me, but after tax it comes out to $1.08. Infuriating.

I just tack 10% onto everything mentally, actual rate is 8.25% but 10% is easier to do mentally.

Re: Why Single-Payer Health Care Saves Money

#134
post #97

Earlier quoted context omitted.

This is a really good point. One problem I think though is that not everyone will come out ahead in a single payer system. Our system is explicitly organized around the fact that you must pay for care and we have the best and most expensive care in the world. Our system is setup so that those at the top of the economic ladder can buy a level of care they could not get anywhere else. They will undoubtedly receive wors…

Indeed. One of the core ways single payer systems achieve such great results in terms of bang-for-buck is by not covering treatments that offer bad value for money, and this is almost certainly not politically viable in the US. For example, I understand the ACA specifically forbids assessing the cost-effectiveness of treatment based on dollars per QALY, which is how the NHS in the UK rations care to reduce costs. It…

This is flat wrong mis-statement of both the facts and the outcomes.

The NHS does not assess cost-effectiveness of treatment in the UK in that fashion, and does not deny it on that basis.

Cost-effectiveness by QALY is one factor included in assessments by a separate body, NICE, which a) is not part of the NHS and b) does not inhibit NHS bodies from offering any particular treatment. If NICE gives a treatment option the green light, then the NHS trusts are obliged to offer it in applicable circumstances. If NICE does not, then individual (local) NHS trusts can make their own assessment. If there is a local cost constraint, that is considered as a matter of simple necessity.

It is a common falsehood often repeated by opponents of single-payer systems that doctors in such systems are directly prevented from offering treatments by faceless beancounters. It simply isn't so. Quite the opposite. The assessors may say "you must offer this treatment". They do not say "you must not".

However, QALY itself is IMO a terrible metric mainly because it is sufficiently describable to non-practitioners to become a political football.

Re: Why Single-Payer Health Care Saves Money

#135
post #95
post #56

Earlier quoted context omitted.

"2) if you can't pay, you die in the gutter." No. It is simply false. Even a 100% free market does not exclude charity.

Somebody pays, or you die in the gutter. Lotta people talk about charity as a replacement for government services, but folks give around 3% of their income to charity (tax deductible) in the US. That ain't gonna get it done. Not even close. People would have you believe they would give more if they didn't pay as much in taxes, but there is not one shred of evidence that is the case based on variations in local tax ra…

And so we should put government in control of health care. But who runs government? Oh, it's people, who you just argued are all hopelessly greedy and self-centered.

Re: Why Single-Payer Health Care Saves Money

#136
post #84

Earlier quoted context omitted.

"Or is the US government not a leading force in fighting corruption anymore?" Um...

Put it in perspective (compared with every country on Earth). https://www.transparency.org/news/feature/corruption_percept...

0xffff2 - that's correct. Personally I am more lenient, given that my country of birth struggles.

But in the context of the conversation, I think #18 is good enough to make the cutoff for single payer. After all, other countries with lower healthcare transparency are still more efficient with their universal systems.

krupan - I don't have the data for what has happened with transparency when countries implemented universal healthcare. So I don't have the answer for that.

Re: Why Single-Payer Health Care Saves Money

#137

Yes, a single-payer system would save money, but you have to be honest about the downsides. It's unfortunate that they are not honestly discussed in the article. Or, for that matter, almost anywhere. The vast majority of the savings come from government price fixing. This is what the article means by "large government entities are able to negotiate much more favorable terms with service providers." It's not really a…

Suppose the current price for "two tylenol handed to a patient in a paper cup" is $50, and a giant insurer^W^W EVIL GOVERNMENT says it will only pay $40 next year. What do you suppose will happen? Societal collapse?

Re: Why Single-Payer Health Care Saves Money

#138
post #122
post #54

It's still absurd to me that we make the false differentiation between taxes and insurance premiums. If you've got a family, neither is negotiable. If you have a job that pays, I promise you it affects your check in nearly identically the same way as payroll taxes do. There's a tradition in America where the price isn't actually the real price, we artificially advertise fake prices to get you in the door and stuff a…

Whenever I've visited the U.S. this drives me crazy. I always wonder how people shop for anything, given that the only time you find out the actual price of things is when you're about to pay for them. Do you just in your head have to tack on 10 to 20 percent (depending on the context)?

Do you just in your head have to tack on 10 to 20 percent (depending on the context)?

Most people do that. They just assume that it will be some multiplier above the advertised price.

Re: Why Single-Payer Health Care Saves Money

#139

Earlier quoted context omitted.

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 industrial…

This is what I don't understand. The feds are paying a bunch of money via Medicare/Medicaid/VA but clearly aren't covering everyone. What is the mechanism whereby more people are covered but no additional funds are required? Yes, there's some profit in private insurance companies, but it's not _that_ much.

PROFIT is not the only economic factor.

Let's say I'm in the business of selling normal goods (say, backpacks). Now, instead of just people going to my website or looking at crowdsourced backpack reviews, there's some cartel that has figured out how to dominate search engines and other sources so that almost all the customers see their middle-man stuff and buy through them instead of directly (even more extreme, maybe they spend massively on lobbying to achieve real rent-seeking via outlawing direct purchases by consumers, although that's not necessary for my argument).

These middle-men charge much higher prices than we'd see if everyone bought directly. But dominating the search-engines while the algorithms constantly change is ENORMOUS work, so these cartel companies pay almost all their revenue to a huge number of employees who work constantly to update their systems and maintain their middle-man dominance. You could say they "barely make a profit!"

So, in that scenario above, it's painfully obvious that the system is horribly wasteful and all-around negative for the economy aside from all the bullshit work of the cartel employees directly providing them income. The room for efficiency improvements are, in this case, nearly the entire REVENUE of the middle-men, minus only the costs of the goods themselves, not just their profits!!

Insurance companies do TONS of bullshit economic waste that is both necessary to the system as it is today yet unnecessary in a single-payer system. All of that waste is NOT profit but IS available margin for efficiency improvements.

But really, insurers are just one aspect. There's also total craziness in the core pricing that providers set and lots of other complete insanity in the status quo.

P.S. the middle-man issues described above are potential market-failures for any market system and just one of many reasons that dogmatic "free market" ideology is bullshit. That said, there's cases where actions to fix market failures only make things worse. Recognizing that free-market dogma is bullshit does NOT mean the opposing dogma is correct.

Re: Why Single-Payer Health Care Saves Money

#140

Yes, a single-payer system would save money, but you have to be honest about the downsides. It's unfortunate that they are not honestly discussed in the article. Or, for that matter, almost anywhere. The vast majority of the savings come from government price fixing. This is what the article means by "large government entities are able to negotiate much more favorable terms with service providers." It's not really a…

How does a government control an entire market when private health insurance is still available?
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