Single payer does not "remove the profit motive" from health care. That's a ridiculous claim.

[Recursion]

Single payer does not disallow for-profit hospitals or physicians' practices. (Or pharma and device manufacturers.)

If the AMA ever got its hands onto a single payer bill, we'd see a legal guarantee for current doctors' salaries and hospitals' fees. But those are what have to come down if we want healthcare as cheap as Europe has it.

There are efficiencies single payer offers, but the threat of regulatory capture like that is real. That's in fact one of the chief arguments for keeping private insurance in existence: it offers a competitor to providers for regulatory capture.

[SunSeeker]

1. Yes, American doctors and hospitals are very different from what is found in, say, Europe.

U.S hospitals expect to make money and U.S. doctors expect to be wealthy, or at least upper middle class. To get to where France or England are in terms of cost savings, there needs to be a major culture chance among U.S. health care providers.

[jfern]

13. Canada has a more similar culture to the US and has single payer

[SunSeeker]

48. No, Canadian doctors don't make as much. If they want big bucks they come to the US.

Canada also provides generous "bursaries" to cover medical school costs, so doctors can afford to live on those more modest salaries. People in Canada who enter the medical profession mostly do it because they want to help people, not because they want an affluent lifestyle. The ones who want to make the big bucks move to the US. About 1 in 10 do.

http://www.northernlife.ca/mobile/displayarticle.aspx?id=9565


Fortunately for Canada, which is experiencing a doctor shortage, many Canadian doctors are returning home, after giving up on the hell (for a person who cares about their patients) that is practicing medicine in the US for profit health industry.

Remember that scene in Sicko where Moore is interviewing the French doctor who lives in a modest home and drives an Audi and says he has all he needs? That's not how most American doctors think. It is a very different culture here.

[ViseGrip]

26. NO, but there are cost controls, especially for BIG PHARMA. THEY WOULD STILL BE RICH!

So, why not?

[Warren DeMontague]

2. No, it does not. It does, however, remove the rather substantial overhead that for-profit insurance

adds to the mix.

People agree- most progressives and Democrats, at least- that medicare works pretty damn well.. hell, even the teabaggers famously have wanted "gummint to keep its hands offa mah medicare" in a classic case of being unclear on the concept

Why extending something like medicare to the whole population is so radical a proposal, escapes me. If we didn't already have a good chunk of our people- people who need disproportionately more in terms of health care, by the way- under such a system already, maybe those arguments would make more sense. But we do.

[Recursion]

3. That overhead is currently 4% of spending

Why extending something like medicare to the whole population is so radical a proposal, escapes me.

Because doctors and hospitals have lobbyists.

[Warren DeMontague]

4. I guess, but there are more of us than there are of them, and it affects us as well.

As for the 4% figure, if you say so. Still it seems pretty obvious that a single pool, single payer system would reduce costs somewhere along the line.

I also think that having a SPHC able to negotiate drug prices, in particular, would bring some rather egregious costs down. Yes big pharma would complain, but we pay exorbitant prices compared to some other countries. Having one system, and one entity negotiating costs across the board would DEFINITELY bring some of the excesses of the system in line.

http://www.npr.org/sections/health-shots/2015/01/05/375024427/americas-bitter-pill-makes-case-for-why-health-care-law-wont-work

[Recursion]

5. It *might* reduce costs. Or it might greatly increase them.

Still it seems pretty obvious that a single pool, single payer system would reduce costs somewhere along the line.

I'm not sure why that's obvious to you. It isn't to me.

There are two "forces" (for lack of a better word) at play here:

1. Single payer avoids private insurance overhead (which is about 3 times what public overhead is) and in generally pays providers somewhat less. That drives cost down.

2. Single payer allows universal access to healthcare, including to the currently 30 million uninsured and 60 million underinsured (defined by Kaiser as people who have skipped treatments in the past year because of costs).

I realize this really pisses people off, but this seems like a fair question:

If we are treating individuals more cheaply thanks to Single Payer, but also treating 90 million more individuals than we were before because of Single Payer, can you at least see it's not immediately obvious that this will save money?

Universal healthcare is the right and moral thing to do, but without provider reform, I'm not convinced it's the cheaper thing to do.

[Warren DeMontague]

6. You don't really think that having underinsured people means less total health care costs, do you?

Poor, uninsured and underinsured people avoid preventative care and then end up really sick, needing catastrophic care at the ER. And I'm sure you can figure out who ends up paying for that.

[Recursion]

7. I absolutely do. Early and preventable death is often cheaper than prevention.

Time and again other countries have found this: preventive care saves lives, not money. It's cheaper to let people die.

Which, again, is why this is the *right* thing to do, not the cheap thing to do.

Health care is cheaper in other countries not because it's universal, but because the governments have the political will to actually fix prices from providers. I'll add, since we're in GDP, O'Malley's "all-payer" capitation budgeting model is the only one that addresses this, and it's why Maryland is the only state to have seen hospital costs go down over the past half-decade.

[Warren DeMontague]

8. Sure, but aside from the pretty obvious moral considerations of your point, just in terms of money

what we have been doing, up to the ACA in particular, hasn't exactly been saving us money either. So either the uninsured people haven't been effectively dying in a timely fashion before running up those ER bills, or something else.

So it's a fallacy to imagine that an Ayn Rand "fuck em" system would be cheaper (aside from being morally abhorrent) certainly not unless we were also willing to let every health care provider demand that, say, the person with a gushing head wound prove they were able to pay via submitting themselves to a credit score check, before the ER doctor could stop the bleeding.

You are right about costs and prices, I do not believe that you are right that "it's cheaper to let people die" because such a policy doesn't actually exist anywhere in the civilized world, nor should it.

[PATRICK]

10. Money has no value, people do

People decide to value money in the first place, never mind that moral diseases(affecting rich doctors as well) come from exposure to an extra supply of value symbols. Our biggest killing disease comes from valuing the accretion of money numbers over real value. What has value in a desert? A glass of water. What makes Earth more than a rock? Life forms. What makes man so special? His intelligence, such as reducing life to a set of numbers, paper or metal locked in a bank vault.

Universal health care is another step toward becoming an intelligent moral species. Real values follow even as debt-betting, value inhibiting hedge funds shrivel along with their cultural fan base. Scarily, we have even more critical issues to get our act together on that will leave billions more shattered lives and carcasses across the future horizon, other than the tens of millions whose premature death and misery we prefer to subsidize with taxpayer charity care when its too late.

Because greed is incurable?

[Warren DeMontague]

14. Yes to all you say. Still, even arguing on a far more grubby plane

People accept the idea of insurance, a single payer system is arguably the best coverage and the biggest pool.

People who say "I dont want to pay for other people"-- if you have insurance, that's what you are doing.

I strongly support a SPHC system for both the ethical and financial reasons, btw.

[jberryhill]

29. If you want to argue on a far more grubby plane

Then you should try living near an airport dominated by American Airlines.

[Warren DeMontague]

47. heh

I hear that.

[elleng]

9. 'O'Malley's "all-payer" capitation budgeting model is the only one that addresses this,

and it's why Maryland is the only state to have seen hospital costs go down over the past half-decade.'

[Warren DeMontague]

15. It's a good point.

GDP could use more issues-based facts and less hyperbolic bullshit, i think we can all agree here.

[Armstead]

43. Then add that

"Universal healthcare is the right and moral thing to do, but without provider reform, I'm not convinced it's the cheaper thing to do."

Then add it to the mix.

It''s possible to come up with all kinds of obstacles (theoretical or real) and justifications NOT TO DO ANYTHING MEANINGFUL. The problem is, to often those single issues are used to dismiss even an exploration and commitment to universal coverage.

[Hoyt]

60. Drug costs make up 10% of Healthcare expenditures. Most expensive drugs here

are maybe 15% or so more than England or Canada. It's definitely a savings, but not that big.

[Orsino]

32. I don't mind so much the profiting by those who actually provide care.

It's the ransom extracted by those who profit from the deni a lot of care who should be cut out of the loop.

[delrem]

11. There are many working models of single payer now flourishing in the world.

One thing is consistent across all models: the populations that benefit strongly support it across the board, across most political divisions, and wish only to make their systems better, and even the right wing dare not *directly* attack, threaten to remove it.

There are more than just economic reasons for a country establishing a single payer universal health care system. To be sure, the economic reasons are well understood! The elimination of a middle-man that has no other purpose than private profit, which has no other connection with health care than being a blood-sucking profiteering leech on the system, makes for huge savings. Further, the single non-profit insurance model allows for economies of scale, and economies of power that rest in the hands of the population at large.

But the most important effect of an universal health care system, in my eyes, is a moral one. Not only does a truly universal system serve ALL citizens, even the most desperate of the homeless, giving them access to one-on-one health counseling, but it gives the health care system as a whole access to the most in need as well. It not only FEELS BETTER, when care for those in most need isn't a matter of "charity", of depending on the whim of some "philanthropist", but it generates a better overall culture, a more uplifting community feeling. No such system solves all such problems, not ever, and certainly not instantly, but single payer universal systems give a lever to do better -- the best such lever that civilized countries have yet to come up with.

I'm so sad to see that O'Malley's supporters on DU have joined with Clinton's supporters in disparaging the idea of a single payer universal health care systrem. Have joined in turning even this into a cheap throwaway electoral matter. Unfortunately, I've come to expect it, now.

[Recursion]

12. No, there aren't

I can think of 2: Canada and Austria, and Austria has a buy-out option, so really just one.

What countries are you thinking of?

[delrem]

16. Use "the google".

Since you're denigrating universal health care, have some care about what you're denigrating.
Start here maybe
https://en.wikipedia.org/wiki/Universal_health_coverage_by_country

[Recursion]

17. We were talking about single payer; why are you bringing up universal health care?

Those are two very different questions. You really, really need to understand that.

If you actually think "Single Payer" and "Universal Health Care" are synonymous, we've already lost.

[delrem]

18. oh fer chrysake

https://en.wikipedia.org/wiki/Single-payer_healthcare

http://feelthebern.org/bernie-sanders-on-healthcare/

Now come back when you have something besides semantic quibbles.

[Recursion]

19. No, seriously, this is appalling: you really have to learn about this

Do you think "single payer" and "universal health care" mean the same thing!?!?!

[delrem]

20. A universal single payer health care program is the best and most logical.

Period.

http://healthinsurance.about.com/od/faqs/f/universalsp.htm

"In most cases, "universal coverage" and a "single-payer system" go hand-in-hand, because a country's federal government is the most likely candidate to administer and pay for a health care system covering millions of people. It is very difficult to imagine a private entity like an insurance company having the resources, or even the overall inclination, to establish a nationwide health care coverage system."

You are quibbling about semantics to score cheap political points.
You are denigrating Sanders' platform without understanding it in the least:
"Universal Healthcare: Many countries have proven that a single-payer system can work—it’s time for the U.S. to join that list."

[Recursion]

21. Gah! Those are two separate questions

[delrem]

24. No, the concepts go together like 'pea' and 'pod'.

As the article at
http://healthinsurance.about.com/od/faqs/f/universalsp.htm
explains.

And as Sanders' web page outlines.
http://feelthebern.org/bernie-sanders-on-healthcare/
http://feelthebern.org/bernie-sanders-on-healthcare/#universal-health-care

"Everyone should have access to universal healthcare through a single-payer system.
Bernie believes that we need to expand a Medicare-for-All, single-payer system. Though he voted for Affordable Care Act, he believes that the measure hasn’t gone far enough to provide adequate healthcare for all."

Or are you talking about some other primary campaign in some other country?

[Recursion]

25. No. They. Don't.

Last edited Thu Jan 21, 2016, 10:52 AM - Edit history (1)

France doesn't have single payer
Germany doesn't have single payer
Norway doesn't have single payer
Japan doesn't have single payer

Really, only Canada does.

We want universal health care. Single payer is one of many ways to achieve it .

[delrem]

35. bullshit

Country Start Date of Universal Health Care System Type

Norway 1912 Single Payer
New Zealand 1938 Two Tier
Japan 1938 Single Payer
Germany 1941 Insurance Mandate
Belgium 1945 Insurance Mandate
United Kingdom 1948 Single Payer
Kuwait 1950 Single Payer
Sweden 1955 Single Payer
Bahrain 1957 Single Payer
Brunei 1958 Single Payer
Canada 1966 Single Payer
Netherlands 1966 Two-Tier
Austria 1967 Insurance Mandate
United Arab Emirates 1971 Single Payer
Finland 1972 Single Payer
Slovenia 1972 Single Payer
Denmark 1973 Two-Tier
Luxembourg 1973 Insurance Mandate
France 1974 Two-Tier
Australia 1975 Two Tier
Ireland 1977 Two-Tier
Italy 1978 Single Payer
Portugal 1979 Single Payer
Cyprus 1980 Single Payer
Greece 1983 Insurance Mandate
Spain 1986 Single Payer
South Korea 1988 Insurance Mandate
Iceland 1990 Single Payer
Hong Kong 1993 Two-Tier
Singapore 1993 Two-Tier
Switzerland 1994 Insurance Mandate
Israel 1995 Two-Tier

Definitions:
Single Payer: The government provides insurance for all residents (or citizens) and pays all health care expenses except for copays and coinsurance. Providers may be public, private, or a combination of both.

Two-Tier: The government provides or mandates catrastrophic or minimum insurance coverage for all residents (or citizens), while allowing the purchase of additional voluntary insurance or fee-for service care when desired. In Singapore all residents receive a catastrophic policy from the government coupled with a health savings account that they use to pay for routine care. In other countries like Ireland and Israel, the government provides a core policy which the majority of the population supplement with private insurance.

Insurance Mandate: The government mandates that all citizens purchase insurance, whether from private, public, or non-profit insurers. In some cases the insurer list is quite restrictive, while in others a healthy private market for insurance is simply regulated and standardized by the government. In this kind of system insurers are barred from rejecting sick individuals, and individuals are required to purchase insurance, in order to prevent typical health care market failures from arising.

[Recursion]

36. That's not what single payer means

If you actually care about this, you should learn about it.

[delrem]

40. "single payer" doesn't mean "single payer" now?

Even after all this info I've given you, you continue to insist that Canada is the only country in the world with a single payer universal health care program?

Pshaw!

The hell if I'll try to educate you on what two-tier means, as implemented in countries like France.

I've finished with this discussion.

[Recursion]

41. No, there's also Austria

Seriously. You're confusing single payer and universal coverage.

The former is one (of many) ways to achieve the latter.

[delrem]

44. offs.

another for ignore.

[DanTex]

39. Yes, it is appalling. Hence my OP. I don't think it will help though.

It doesn't seem very complicated.

Single payer: the government pays for everything.
Universal coverage: everyone has coverage.

How have these become synonymous? I have no idea.

[DemocratSinceBirth]

22. What should be the minimum salary for a physician?

Thank you in advance.

[Recursion]

23. Minimum? Maybe $45K or so.

That's roughly in line with Europe.

[TexasBushwhacker]

27. You can't pay back student loans with $45K

But Canadian doctors may not graduate with $200K in student loan debt.

The median salary for entry level doctors in Canada is $119K.

http://www.payscale.com/research/CA/Job=Family_Physician_%2f_Doctor/Salary/dedb3e40/Entry-Level

Another article:

http://economix.blogs.nytimes.com/2009/07/15/how-much-do-doctors-in-other-countries-make/

[Recursion]

30. Oh, look at that: are you saying it's more complicated than our financing system?

Imagine that.

[DemocratSinceBirth]

31. Do you think there are a lot of Americans who will stay

Do you think there are a lot of Americans who will stay in school until they are twenty six and take responsibility for the lives of others for what would come out to $15.73 per hour, per your estimate?

[Recursion]

33. Plenty of teachers do (nt)

[DemocratSinceBirth]

34. Teaching requires a Bachelor's Degree. To practice medicine one needs a graduate degree.

In any case, the median salary for a teacher in the United States is around $57,000.00 which is also the median salary for a staff accountant.

And if the minimum wage is raised to $15.00 per hour, a physician working 55 hours a week which is the norm, will literally be making less than minimum wage if we use your $45,000.00 minimum.

[jberryhill]

28. There's a perverse incentive built into the ACA, though

Given the expense ratio imposed on private insurance, I'm confused as to what that does to pressure on things like drug prices or other medical expenses.

Figure, if my profit depends on keeping expenses down, then I'm going to use my market power as a buyer to negotiate lower expenses.

But if you tell me that I am limited to 10% of total revenue, then as far as I'm concerned, drugs can be priced out the wazoo, since I'd rather have 10% of a higher number than a lower one. In other words, high expenses simply raise the percentage of what I can keep. Ultimately, I can see how that is reflected in premium differences among insurers, but when they act more like a cartel than a competitive market, then collectively they are going to squeeze as much juice as they can out of the insured.

[Nanjeanne]

37. For heavens sake

It takes the profit out of insurance companies. It's never supposed to remove profit from doctors. Even countries like Switzerland that have just private insurance have it regulated where it is illegal to make profit on basic healthcare. They make their profit on alternative and additional services. Most thinking people understand what it's supposed to do.

[Recursion]

38. THANK YOU

The insurance industry is not "health care". And insurance profits are 4% of our national expenditures.

Good to cut out? Sure! A silver bullet? Not even slightly.

[Nanjeanne]

42. plenty of data from other countries

That shows we spend much more for healthcare for not as good results covering much less of the population than every other industrialized nation with universal healthcare. So somehow it works. I have such a hard time understanding why Democrats apparently all of a sudden believe it makes sense to keep a system that costs so much more for so much less. While the things like no caps on yearly expenditures, no discrimination against pre existing conditions, etc are wonderful -- we are basically subsidizing the insurance companies through the ACA subsidies -- and aren't they already doing well enough? I, for one, see no reason for the government to be giving large amounts of money to very profitable corporations. That democrats are suddenly in favor of this instead of Medicare for All is very hard for me to wrap my head around.

[Recursion]

45. And almost none of those countries have single payer (nt)

[Nanjeanne]

46. Oh please

Most have some form of single payer and then private insurance for add ins or alternatives. Germany has single payer for people earning under 50000 euros and private for those above or who opt out. Canada, france, Austria, Australia etc. it's disingenuous to say because Sanders calls for single payer, his vision isn't identical to other countries therefore it's better to have no vision. I'm quite sure the Sanders plan can be worked on to include a statement that insurance co will coexist to offer additional services. And wealthy people will always find ways to go to the head of a line. But it's strange to me as a Democrat to see people arguing that our present system is preferable.

Had Hillary ever uttered the words public option? Has she explained how she is going to make the ACA better?

[Recursion]

49. Gah! "Single payer" does not mean "universal health care"!!!!

I'm quite sure the Sanders plan can be worked on to include a statement that insurance co will coexist to offer additional services.

At which point it wouldn't be single payer. Which is what I'm saying. There are plenty of ways to get there.

Had Hillary ever uttered the words public option?

I don't know or care.

[TubbersUK]

54. Am I understanding you correctly ?

Are you saying that the coexistence of insurance cover automatically renders any core delivery system "non-single payer" - no matter how dominant that core system is?

If so, even the UK wouldn't meet your definition of single payer - given that private health insurance is available in the UK for those who wish to take it up.

[Recursion]

56. Now you're getting it. If the government entirely pays for all covered treatments, it's single payer

If that cost is shared in some way, it's not single payer.

So, Canada: single payer, in that the private insurance market is for non-covered procedures, and it is illegal for a doctor to provide a covered treatment outside of the provincial Medicare system.

That is what single payer means, and it's not very popular worldwide, and I still have no idea who convinced American Democrats that it's somehow the only way to achieve universal health care.

Yes, you are right: the UK is not Single Payer, in that there is a parallel private health care system. As some of us keep pointing out, Single Payer is one particular and not very popular way to achieve the goal of universal health care. Why are people so hung up on this particular means rather than the end?

France is not Single Payer: the government covers IIRC 70% of health care costs and people pay the rest out of pocket or through insurance. Great system; not Single Payer.

Germany is not Single Payer: the government mandates participation in regional insurance co-ops. Great system; not Single Payer.

Etc.

[TubbersUK]

63. I am indeed getting it,

Last edited Fri Jan 22, 2016, 01:40 AM - Edit history (2)

getting the fact that your definition of 'single payer' is risibly narrow and serves no purpose as far as productive discussion goes.

It clearly serves your purposes but really it renders any debate a total waste of time

[Nanjeanne]

50. This argument is specious

I refuse to believe people are seriously arguing over the fact that a single payer system for basic healthcare is not single payer if private insurance offers cosmetic surgery or upgraded hospital rooms. just because a chart calls something tiered, it's pretty easy to delve deeper and see that the majority of real healthcare is paid under a government single payer system.

By that logic I guess Medicare isn't single payer either because Some people buy gap insurance through private insurance to cover some items. So Sanders Medicare 4 All is not single payer under this incredibly strict word play.

[TubbersUK]

64. I know

Even the UK/NHS doesn't qualify as single payer apparently.

It's ludicrous.

But presumably it muddies the water nicely for those that see benefit in that.

[Recursion]

67. Sigh. No.

You should really learn what single payer is.

In Canada, the government will pay for 100% of a heart bypass surgery, and it is illegal to get payed for that surgery except by the government.

That is single payer. Nothing else is single payer.

It has nothing to do with discretionary treatments being coveref by private insurance.

[Motown_Johnny]

51. From the insurance companies it does. n/t

[Recursion]

57. Now you're getting it. It removes the 4% of our healthcare spending that goes to insurance profits

That's a good thing. But the much, much larger profit margins of providers stay.

[Motown_Johnny]

61. It isn't just that 4%

it is also the salaries and bonuses going to the top executives as well as marketing costs to compete against the other insurance companies.

Medicare overhead is 6% or lower. The 80/20 rule in the ACA has forced private insurance companies to keep overhead to 20%. That leaves us 14% of all the premiums paid now as potential savings.

The billing would also be less expensive since you would only need to bill one entity for all services.

Of course private hospitals and medical practices will still make profits. This is still a Capitalist system.

That doesn't mean that there are not real savings that can be had while COVERING EVERYONE!!!!!

[Recursion]

62. Right: that 14% of all premiums paid is 4% of all health care spending, like I said

Removing the excess overhead from private insurance cuts our annual healthcare spending by 4%, which takes us down from 18% of our GDP to about 17.2% of our GDP.

OTOH, if we cut physicians' fees in half, bringing them in line with Europe, we would cut 25% from our annual health care spending, bringing us down from 18% of GDP to 13% of our GDP, about equivalent to Switzerland

If we cut hospital fees in half, bringing them in line with Europe, we would cut 33% from our annual health care spending, bringing us down from 18% of GDP to 12% of GDP, about like the Netherlands.

If we did both, we'd be down at 7% of GDP, about like France.

The problem being, we don't have the political will to tell doctors and hospitals that they need to do a lot more work for half of the money they are currently making.

[Kelvin Mace]

52. No, but the single payer has a HELL of a lot of clout

on the subject of prices.

[Recursion]

58. Yup. And the providers have a whole lot of lobbying clout with those price setters

The AMA can lobby Congress, which would set doctors' fees under single payer.

[Kelvin Mace]

65. Unlikely that Congress would get down in the weeds

on setting price, but if they did, any drug negotiation is going to start with, "So what are Canada, France and the UK paying for this?"

[Recursion]

66. Really? You think so? Why doesn't Medicare do that now?

What's stopping them?

[Kelvin Mace]

68. A Bush era law,

which, point taken, but I don't see that law surviving future review. But in that area I am an optimist.

[Ferd Berfel]

53. It eliminates the 20% to 35% scraped and pocketed off the top by the Insurance Banksters

FUck 'em

[Recursion]

59. That 4% of our annual spending? Yeah, it does. Awesome.

We go from spending 18% of our GDP on health care to 17%. This isn't fixing the problem.