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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

#151

Post by cortesoft »

rayiner wrote: post #86
flavor8 wrote: post #53

Earlier quoted context omitted.

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 would be unconstitutional for a U.S. state to treat newly-established residents differently than long-established ones with regard to a welfare benefit: http://www.washingtonpost.com/wp-srv/national/longterm/supco... . Countries like Germany don't have this problem because they have the power to control their borders. Accessing Germany's healthcare system requires being a German resident. That, in general, require…

Interesting... I wonder how places like California are allowed to still offer different rates for in-state vs out-of-state tuition at the UCs?

Re: Why Single-Payer Health Care Saves Money

#153

Post by makomk »

inopinatus wrote: post #134
makomk wrote: post #97

Earlier quoted context omitted.

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 t…

Part of running an "efficient" healthcare system is that cost constraints are always a factor. Sure, NHS trusts are legally allowed to offer treatments that aren't approved by NICE, but they have piles of money lying around to do expensive things beyond the basics that are required of them at the best of time, and this isn't the best of times - like many countries the UK has a healthcare funding crisis right now.

At best, requiring a treatment rejected by NICE leaves your fate up to a postcode lottery where your location determines whether you have access to it. At worst, nowhere will cover it. Also, cost per QALY is one of the main factors NICE uses, and the ACA means it and similar measures cannot be used as any kind of factor at all in the US.

Re: Why Single-Payer Health Care Saves Money

#154

Post by ryandrake »

galeaspablo wrote: post #88
bradleyjg wrote: post #71

Earlier quoted context omitted.

"And now to quote the original article... 'It is a bedrock economic principle that if we can find a way to do something more efficiently, it’s possible for everyone to come out ahead.'" That's a really important "possible" though. It is a near certainty that if were to transition to single payer healthcare we would not do the transfers to hold everyone profiting from the current system harmless (e.g. health insurance…

That's a matter of policy. You can set a cap of how much tax someone pays for healthcare, such that rich people don't get screwed. The question here is what's more efficient... And the numbers are there. Single payer + Healthcare transparency = Efficiency. (see sources and explanation in original comment)

Why do rich people need a cap in order to not "get screwed?"

Re: Why Single-Payer Health Care Saves Money

#155

Post by makomk »

esturk wrote: post #147
methodover wrote: post #120

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…

You rip NYT for not openly discussing the downsides, yet after reading your comment about the 'risks', you haven't talked about the downsides either. Aside from "negotiation is not negotiation in the private sector", you aren't adding much to the discussion. Yes, government negotiation is still negotiation and yes it is not like in the private sector but it doesn't make it any less legitimate.

One of the risks is that the doctors and nurses you need to actually provide the healthcare will find work elsewhere that actually pays them well. This seems to be happening to a certain extent in the UK right now.

Re: Why Single-Payer Health Care Saves Money

#156

Post by nolepointer »

krath94 wrote: post #94
donmatito wrote: post #73

Earlier quoted context omitted.

If by "truly free market" you mean that healthy people can opt out of being insured, no, that would drive the costs up. Risk selection is a very driver of prices in health insurance. If you can spread the risk between healthy and sick people, the price goes down. If you can't, the price goes up. Secondly, having a population that has no health insurance means less prevention, i.e. worse health problems down the road,…

No the point of free market is that insurance is cheap enough that even healthy people buy it. Or even better, that healthcare costs are low enough that you don't even need insurance (that won't happen though because of the healthcare monopolies).

>Or even better, that healthcare costs are low enough that you don't even need insurance

See, this is what I don't get. I'm fairly inexperienced with this stuff, but it's starting to become relevant in my life. Despite my new employer offering insurance, I'm staying on my parents' until I'm 26 (this was part of their policy even before Obamacare).

However, this is the question I've been asking ... why do I even need health insurance? Why can't the money I pay in the form of premiums just be used to pay for my health care? The answer: well, it can be really expensive, so this way the cost is shared. But why is it expensive? Why don't I ask how much something is versus whether my insurance will cover it?

Again, like I said, I don't have a lot of experience, so go easy on me. But I think my questions are valid.

Re: Why Single-Payer Health Care Saves Money

#157

Post by inopinatus »

makomk wrote: post #153
inopinatus wrote: post #134

Earlier quoted context omitted.

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 t…

Part of running an "efficient" healthcare system is that cost constraints are always a factor. Sure, NHS trusts are legally allowed to offer treatments that aren't approved by NICE, but they have piles of money lying around to do expensive things beyond the basics that are required of them at the best of time, and this isn't the best of times - like many countries the UK has a healthcare funding crisis right now. At…

NICE was founded to reduce that postcode lottery by creating a base set of what is nationally achievable. Over time, that set grows. It's grossly unfair to misrepresent it as some kind of net-negative body, or to suggest that doctors won't treat a patient. Indeed one of the effects is to encourage research into more affordable treatments. This is in antithesis to the US system where, for example, the drug companies are incentivized to R&D long-term treatments for symptoms, not cures for diseases.

I like the incentives that NICE creates instead. Over time, it's a strong net national benefit.

The failure to include such a mechanism in the ACA seems more to do with US politics than any intrinsic characteristic of single-payer systems.

The NHS has apparently been under-funded for decades, far too long a period to call it a "crisis". I would maintain it is simply grossly inefficient at spending the money it does receive, due to horrible management. Again, this is not an intrinsic characteristic of such systems.

Re: Why Single-Payer Health Care Saves Money

#158

Post by tptacek »

cortesoft wrote: post #151
rayiner wrote: post #86

Earlier quoted context omitted.

It would be unconstitutional for a U.S. state to treat newly-established residents differently than long-established ones with regard to a welfare benefit: http://www.washingtonpost.com/wp-srv/national/longterm/supco... . Countries like Germany don't have this problem because they have the power to control their borders. Accessing Germany's healthcare system requires being a German resident. That, in general, require…

Interesting... I wonder how places like California are allowed to still offer different rates for in-state vs out-of-state tuition at the UCs?

This is a really good question. The most recent case I could find here is the one Rayiner cited, Saenz v. Roe. If you read it, both the opinion and the dissent grapple explicitly with college tuition.

The reasoning goes, it seems, that only bona fide citizens of (say) California will consume welfare in California (you don't move to California to consume California welfare benefits in Ohio). But college education benefits are "portable"; you could conceivably move to California solely for the purpose of accumulating the benefits of a UC education, then take it back with you to Ohio.

Further, the way in-state tuition benefits are structured, the residency requirement is (supposedly) carefully tailored to address just that scenario, by imposing relatively short durational requirements on residency, rather than evidence of permanent residency.

It's tricky to piece out how health care would fit into this rubric. Depending on the condition, you might move to California to benefit from their health care and return to Ohio when you're cured, or you might need to stay in California indefinitely to treat a manageable illness.

Re: Why Single-Payer Health Care Saves Money

#159

Post by galeaspablo »

ryandrake wrote: post #154
galeaspablo wrote: post #88

Earlier quoted context omitted.

That's a matter of policy. You can set a cap of how much tax someone pays for healthcare, such that rich people don't get screwed. The question here is what's more efficient... And the numbers are there. Single payer + Healthcare transparency = Efficiency. (see sources and explanation in original comment)

Why do rich people need a cap in order to not "get screwed?"

Like I said, that's a matter of policy. I.e. should rich people pay more tax?

But I'm not here to answer that question.

Re: Why Single-Payer Health Care Saves Money

#160

Post by camiller »

jellicle wrote: post #137
methodover wrote: post #120

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?

I suppose the hospital will lay off a pharmacist, increasing the workload for the rest of the pharmacy team, and instead of your Tylenol showing up in 15 min it will show up in 45 min.
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