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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

#141

Post by warcher »

krupan wrote: post #135
warcher wrote: post #95

Earlier quoted context omitted.

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.

It's not as if we don't have experimental data on both the ability to run a government that is more or less functional with a bunch of self-interested actors in general, or the relative merits of the free market vs socialized healthcare in specific. We ran the numbers. It isn't working. The arguments around doubling down on the free market I find intellectually spurious, and the most convenient explanation from my perspective is the fact that we are thus far wealthy and powerful enough to afford the application of a one-size-fits-all ideology to avoid the emotional strain of admitting we were wrong all these years.

Re: Why Single-Payer Health Care Saves Money

#142

Post by buckbova »

magicalist wrote: post #76
buckbova wrote: post #22

Earlier quoted context omitted.

> Americans will die needless deaths First off everyone dies. Who's not receiving healthcare right now that would be ultimately saved by the government? Secondly let's cut the hyperbole and have a rational conversation about this.

> Who's not receiving healthcare right now that would be ultimately saved by the government? People not receiving basic preventative care with problems that are only going to snowball until emergency services can try to treat a much more complex situation in the future? > Secondly let's cut the hyperbole and have a rational conversation about this. You could have maybe had a point by quoting "but the market will win"…

"Americans will die needless deaths"

when they're on long wait lists for procedures because of a glut on resources

when they no longer have access to the high quality care they once had

when there's a greater shortage of quality nurses and doctors because of diminished pay

when innovation is stifled because R&D is funded by the government

Re: Why Single-Payer Health Care Saves Money

#143

Post by ClassyJacket »

luxuryballs wrote: post #69
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…

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.

You're proposing that the massive wealth inequality in the USA is a good reason to continue creating more wealth inequality?

The old "America is just different to everywhere else" argument... we see this from the gun nuts too.

Re: Why Single-Payer Health Care Saves Money

#144

Post by [deleted] »

buckbova wrote: post #22
typomatic wrote: post #17

Earlier quoted context omitted.

In the meantime, Americans will die needless deaths from not receiving basic healthcare, but the market will win, so their sacrifice will be worth it.

> Americans will die needless deaths First off everyone dies. Who's not receiving healthcare right now that would be ultimately saved by the government? Secondly let's cut the hyperbole and have a rational conversation about this.

[deleted]

Re: Why Single-Payer Health Care Saves Money

#145

Post by ClassyJacket »

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 don't even understand your question. Countries with single payer handle this by making everyone pay with taxes and having immigration controls.

Re: Why Single-Payer Health Care Saves Money

#146

Post by exelius »

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…

Pricing in health care is currently not a negotiation. The customer often doesn't know the price before services are rendered -- they're left to negotiate the bill after the fact. And in the case of life-saving care like chemotherapy, your choice is "pay or die". That's not a negotiation; that's an ultimatum.

Re: Why Single-Payer Health Care Saves Money

#147

Post by esturk »

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.

Re: Why Single-Payer Health Care Saves Money

#148

Post by camiller »

makomk wrote: post #97
frgtpsswrdlame wrote: post #37

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…

> 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.

This.

And lets put it in concrete terms.

If you are 40 and get cancer you get treatment.

If you are 82 and get cancer you get pain meds.

And there is no US politician that is going to fall on that grenade.

Re: Why Single-Payer Health Care Saves Money

#149

Post by peterhadlaw »

lb1lf wrote: post #65
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…

I don't think I ever made a claim that "doctors would be sleeping in boxes".

Re: Why Single-Payer Health Care Saves Money

#150

Post by peterhadlaw »

lb1lf wrote: post #65
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…

I said that the government would be dictating what a doctor's time and efforts would be worth instead of letting it figure itself out without any artificial restrictions
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