The only way to control soaring healthcare costs is to have single payer

[Yavin4]

However, Republicans, some Dems, and a lot of people who get employer covered insurance won't support it.

[pbmus]

1. The only way to control healthcare costs is to get insurance companies

Completely out of the equation. ... .... ..... ......

[uponit7771]

11. This is only 10% of the cost, the rest of it is doctors, pharma and hospital corps...

... that need to take half of what they're charging now.

The majority of HC cost is not HCI's

Last week I was being charged 450 for sleep medicine ... I am requesting generic if there are any but that amount is stupid on its face....

[Foggyhill]

29. They charge so much because

There was no pushback from insurance company, they just the pass the cost along and if you couldn't pay you dropped out or your deductibles were ever increasing. They're still using this business model except people can't drop out anymore.
Do Medicare costs explode 20% a year, i don't think so

Also, medical costs have exploded for 20 years straight, before though the sickest weren't even covered so the real cost, their death and becoming destitute and winding up in emergency rooms or on the street was hidden

[uponit7771]

30. Good point and prolly why my HCI wouldn't pay for this medicine... if the HCI's pushed back on the

... doctors and hospital groups like they did the sleep medicine then we'd prolly have lower cost.

I was disgusted when I saw the price of that medicine... everyone was shaking their heads

[Skittles]

99. the word is PROBABLY

[ehrnst]

28. Without taking the whole system down? How do you propose do that?

It's not like we can just shut down and reboot a massively complicated system without harming people - usually the most vulnerable.

Incremental change is frustrating, but thinking that any administration can wave a wand and make it all single payer in 10 years is not realistic, no matter what a politician says.

http://khn.org/news/democrats-unite-but-what-happened-to-medicare-for-all/

[ellennelle]

84. ooh ooh let's think small

it's ever so much safer.

sigh. sorry, not to pick on you, but ferchrissake, what is it with this godforsaken incrementalism obsession??

here's the deal. you settle for that, and you don't even get the puny increment you offer up in the first place.

moreover, the whole moral high ground gets lost in the shuffle.

this will be negotiated. one would hope with individuals who have different but nonetheless principled ideas. to go into negotiations like this, with so much at stake, saying ooh ooh, i know i won't get much so do let me suggest even less... WTF?? we watched obama do this very thing and were gobsmacked, forehead to desk. this not only deflates anything resembling inspiration, it never gets the job done, as it operates more like zeno's paradox than a negotiating strategy, and does not even resemble anything principled. in fact, it smacks of precisely what it is, acknowledging the brakes put on your position by the various big money campaign contributors what brung ya.

because this will be negotiated, of course whatever you offer up will be cut in half, or less. such is the nature of compromise. but knowing all this, why the hell would one not start out by shooting for the principled moon?? at least then you get somewhere closer to where you really want to be.

[ehrnst]

112. It's called realistic goals, and acknowledging what is and is not likely.

When you have limited time and resources to legislate, you want to spend time doing what could work.

Moral high ground is nothing without concrete results. The GOP has already laid the groundwork for demonizing "socialized medicine," with 8 years of practice, and some successful chipping away at the ACA.

Expanding Medicare and SCHIP will work much better, and be far more likely to pass - uncut.

Oooooh, lets shoot for the impossible. That's so much more moral.... meanwhile people die for want of medical care. Sorry, not to pick o you, but what is with the litmus test for any progressive being Single Payer or nothing?

I will listen to people who know what they are talking about. I'm glad that Hillary is listening to those same people, as she did when she was a Senator.

[Doremus]

154. "Realistic goals" is why we're in the mess we're in. "Single payer is off the table," remember that?

[lumberjack_jeff]

97. Insurance companies don't charge $141,300 for dual knee replacement. Doctors and hospitals do.

And yes, that's an actual number, I have the receipts.

[Act_of_Reparation]

113. Not really.

Your insurance company sets a reimbursement rate for drugs or procedures, a portion of which you, the patient, are responsible for paying (copay). When a doctor or pharmacist agrees to accept your insurance, they agree to accept your insurance's reimbursement rates.

A doctor, hospital, or pharmacy can't just charge you whatever the hell they feel like... unless you have no insurance.

[lumberjack_jeff]

118. The poster to whom I'm replying was arguing that ins. companies should be removed from the equation

... in which case doctors, hospitals and pharmacies could "just charge you whatever the hell they feel like" subject only to the limitation provided by your net worth.

Insurance companies aren't the problem, the medical industry is. What we need is a stronger insurance company i.e. Medicare.

[Act_of_Reparation]

138. I'm not sure I follow.

You said it wasn't the insurance company charging a hundred thousand dollars for your knees, but the doctor and the hospital. This is fundamentally incorrect. Your insurance company absolutely did set the cost.

Insurance is almost certainly a part of the problem, and here's why:

There are procedures that reimburse high, and procedures that reimburse low. Hospitals and doctors' offices are able to provide low-reimbursement services because they redirect money generated from high-reimbursement services to cover the losses. This has two implications: first, that lowering reimbursement rates across board will make certain procedures cost-prohibitive and thus less available for people who need them; and second, doctors and hospitals are incentivized to prescribe high-reimbursement services as a means of keeping certain divisions afloat.

The system doesn't work because it is inefficient, and insurance companies play a significant part in that.

[lumberjack_jeff]

141. The $140k was the billed amount

The insurance company paid something like $70k and we paid about $5k.

If everyone was insured, by a single entity, there would be no purpose for the $140k bill because the insurance company would set the rate.

Getting the insurance (entity) out of the picture removes the only cost control mechanism.

[Act_of_Reparation]

144. Tthe insurance companies already set the rates.

Most hospitals are non-profit. Most physicians want a single-payer system. I realize this might be difficult to believe, but in general, healthcare workers are not looking to fleece you.

Healthcare is expensive because the overheads are expensive. There is virtually no price control in the United States, so hospitals have to pay out the nose for drugs, equipment, and to stay staffed, and they have little option but to pass the cost right along to you, the customer. Single payer systems are effective at keeping costs down not because they limit what they'll reimburse, but because the governments that have single payer systems exercise the authority to control the costs of essential healthcare resources.

[upaloopa]

129. I have been saying what you posted for years having been a controller

of a medical clinic.

Most people who want single payer think it is a magic wan that wil solve everything.

[annabanana]

2. Get the insurance companies out of there..

Their primary obligation is to shareholders, not patients.

[Yavin4]

3. Health insurance should be viewed similar to a fire department.

The public collectively pays for a fire department, their training, their uniforms, their equipment, fire houses, etc. Because we all pay for it, the costs to each of us individually is minimal.

Now, we do use healthcare more than we call the fire department, but the soaring premiums are not due increased care. Rather, it's due to the insurance companies need to show a profit to their shareholders, something a fire department does not need to do.

[Travis_0004]

7. I used to volunteer with a fire department

If we got a call, and it was outside of our small town, we sent a bill. Not all fire services are "free".

A house fire bill would be thousands of dollars. Homeowners insurance paid it though.

[Yavin4]

9. Understood, but that model is not pratical in most urban areas in America n/t

[mythology]

135. I'm getting tired of pointing out the obvious on this, but I'll do it again

With the ACA insurance companies have to pay 80% of premiums on member care. That leaves 20% for overhead and/or profit. If the company only spends 70% on member care, they don't get to pass the extra 10% on to shareholders. They have to pay it back. So there isn't the same ability to show any significant profit, much less the rapid quarterly growth shareholders as there is a limit to how much they can make and how much they have to spend on overhead.

The primary drivers of cost of medical care are drugs and the increasing consolidation of providers who can then bargain for higher payments from insurers. Drug companies game the patent system by making small changes to a drug that then renews the patent for another term rather than letting it be open to generic manufacturing. Medical care is a largely inelastic good. Most of us want to continue living and if the latest cancer treatment or Hep C treatment costs $150,000, well we're going to want it.

And for a country with such lousy insurance companies, we do rank 1st in 5 year life expectancy for people who develop breast, prostate and colorectal cancer over all those other countries.

The way to lower health care costs is to go after drug costs. The reason drug companies can charge so much less in other countries is that we are effectively subsidizing that cost by paying more. We bar Medicare from negotiating drug prices, instead it is done by individual insurance companies which have less leverage.

It's easy and simple to blame insurance companies, but when you actually bother to drill down into facts, your argument fails.

[pnwmom]

59. That's not the only issue. Medicare costs are rising, too,

and that's a single payer plan.

The problem is rising health care costs, and that affects everybody's costs, no matter what kind of insurance we have, single payer or private.

[ellennelle]

78. no no no

with all due respect, it is precisely the other way 'round; you have it entirely backward.

it is because the healthcare industry markets - inclusive of hospitals, doctors, and insurance and pharm companies - have essentially zero regulations controlling their pricing, they are motivated by nothing but profit. THAT is what is driving up healthcare costs; they are not simply floating up of their own accord with nothing causing it!

this is why we have to get the market out of healthcare, get profit out of the basic human need for healthcare. the thought of that is simply obscene. like moneychangers in the temple.

but surely you know that part.

every economic model out there worth salt shows single payer is far more efficient and would drive costs down. this explains the fact that the US healthcare costs are astronomical compared to other countries where there is some form of government single payer system regulating pricing.

i mean, the math - as i've noted elsewhere here - really is simple. are you aware of the profits raked in by these monsters? unitedhealthgroup alone enjoyed last year profits over $11billion! talk about astronomical!! take those profits out of the equation but keep the money for actually delivering healthcare, and think of what that would mean!!

please be sure you get very clear on this point, i beg you.

[pnwmom]

83. Both Canada and Switzerland have a mixture of public and private plans

but they do far better than we do in cost control.

And we have Medicare and Medicaid, single payer plans, but we're still facing much larger costs than other countries.

So going to single payer won't magically control costs.

[ellennelle]

90. um, yes; it will

i'm not sure how better to spell this out for you:

'other countries' do not suffer our medical costs precisely BECAUSE we rely on private for profit insurance companies to suck all the premium revenues for shareholder profits instead of using them to, you know, treat people's illnesses!

so, YES: SINGLE PAYER WILL MOST DEFINITELY CONTROL HEALTHCARE COSTS.

period. not magical; very. simple. math.

[TexasBushwhacker]

95. Drug prices are regulated in other countries too

Get bitten by a rattlesnake in Mexico, the antivenom is $100-$200 per vial. Get bitten in the US and it can be as much as $14K and you may need more than one vial. It's the exact same antivenom. Same name, strength and manufacturer.

[pnwmom]

96. Right. And Medicare's rising costs are largely due to high drug prices here. n/t

[TexasBushwhacker]

102. And Congress decided Medicare can't negotiate drug prices

Stupid stupid stupid

[pnwmom]

104. Worse than stupid. n/t

[OKNancy]

6. I wonder though. Insurance companies are rotten, but so are some healthcare providers

My latest story:
First, Blue Cross has paid over 185,000 this year for my husband. We have a shitty bronze policy.

One thing that Blue Cross would not cover is some feeding tube formula. This is like unflavored Boost or Ensure.
It is used for my husbands nutrition until he can swallow ( he can now!) or he feels like eating food.
He can eat if he wants, but chemo and radiation makes everything tasteless, so he refuses to eat "real" food.

The doctor ordered this formula for us but I said that I didn't want it unless insurance paid for it.
On the invoice we got in the hospital before checking out, it said "paid by insurance"
So a day or two later we got 8 cases of the stuff delivered to our door.

Two months later we get a bill for the stuff. $722.00!! I call up the Medical supply company and said I want to return half of it and get a credit as he hadn't needed it and.... IT SELLS AT AMAZON FOR almost one quarter the price. They refused to take it back. They said they couldn't guarantee it was stored correctly, blah blah.

So per unit the stuff with the Medical Supply Company was $3.98. Ordered on amazon.com it was $1.04 per unit.

I'm leaving out the name of the company, but if anyone in Tulsa wants to know, PM me.

[ellennelle]

81. that is NOT the provider

that is the medical supplier.

please be careful here. as most providers i know - and i know a lot, being one myself - are good folks who are in the business of helping folks (save those inevitable blowhard moneybags docs with god complexes).

medical suppliers and devices operate a lot like the pharm industry; always a new gadget to make you feel better. then they send the bill that ruins all that.



good luck to you and your hubby.

[safeinOhio]

8. I would think it would be easy

to look at all the single payer systems in other countries and copy the best one. Least cost and best service. Germany, Japan, to name a few to look at.

[Yavin4]

10. If only it was that easy

The biggest political obstacle are the majority of people who get insured through their jobs. Their employer pays the premiums and they have a good relationship with their doctor. A single payer system would add to their taxes and may break up their relationship with their doctor.

That's a powerful political hurdle to overcome, and few Dems want to take that on.

[B2G]

12. And there's a lot of distrust

The average person won't trust any more major overhauls given the results that are happening from last one.

[Yavin4]

15. The only path for single payer is for employers to stop offering health insurance as a benefit.

That day may soon come.

[ehrnst]

23. And then what happens to people when they lose their insurance?

Before the massive change that would be required to offer single payer?

Any thoughts?

[Yavin4]

26. Creating a Public Option today would be the first step

to Single Payer.

[ehrnst]

31. I agree. Incremental steps are going to be the best way - but tell that to people

who see only single payer, and think anything less is 'selling out."

[ellennelle]

82. it's not about selling out

it's about simply cutting to the chase. everyone knows single payer is THE most efficient way to deliver healthcare to citizens, no contest. any hint of profit motive injected into the process takes it out of the hands of those in need. so it's not just economically superior, it's morally imperative.

so help me understand how baby steps is better? all that does is drag out profit making days for the insurance companies.

please, tell me you're not serious.

[Yavin4]

108. Because the majority of Americans get their health care through their employers

You would have to break that relationship in order to enact Single Payer, and that would create fertile ground for political opponents to scare the American people into opposing it. Politicians, both Dems and Republicans, would see the handwriting on the wall and go with the flow.

A Public Option is a good first step because not only would it insure people struggling with premium increases, but it ease fears about the "horrors" of national health insurance.

[ehrnst]

115. Agreed. There is so much more involved than people think. (nt)

[CanSocDem]

18. It is easy....

...if the intention is to take the profit motive out of public health. THIS is the biggest hurdle to overcome.

What is it with Americans that you have to make a profit on everything. Have you no basic human rights? Things like public safety or freedom from discrimination for example.

Oh right...you have "insurance". Which, to be honest, probably sounds a lot better than "no insurance". And you have a staggering array of fancy Cure-All potions available on every block. What's to worry about....??!!

Somebody up thread said 'take the money out...' !! This would be a good place to start.

.

[Yavin4]

22. Since 1980, Americans have been opened to being preyed upon economically

We've allowed banks, higher education, healthcare, housing, the food industry, the media, you name it to literally economically enslave us for profit. My theory is that this is due to ending legal racial and gender discrimination. Americans feel more threatened by African Americans and women than by financial predators.

[CanSocDem]

36. My theory....

...is that Americans were born and raised in a highly organized and tightly controlled class society. All the institutions you mentioned could be nationalized, like Cuba did after they got rid of the American gangsters. Cuba survived very well.

As a student of sociology, I find this interesting.

"Americans feel more threatened by African Americans and women than by financial predators."

I've always felt the strongest influence on American Culture was the peculiar brand of evangelical Christianity that pervades the nation with various interpretations. If you're looking for someone to blame, there's always God. AA's and women are an easy first choice...

.

[ehrnst]

32. A hurdle that big means that it's *not* easy, and it's not the only hurdle.

Just as Libertarians think that "removing regulations" is the simple way to fix the economy.

It's the all or nothing, there is only one solution thinking that will shoot us in the foot.

[DemInND]

46. America's heath care theme song

"If you've got the money, we've got the time".

[ehrnst]

21. Thank you - if it was that easy, it would have been done a long time ago. (nt)

[colorado_ufo]

41. Medicare already has this worked out.

My husband continued to work at his job long after he was eligible for Medicare, and he continued under his employer's policy, because he was grandfathered into the company program and had his premium covered completely. I went onto Medicare, since he would have had to pay for my insurance under the company policy.

When he retired, he simply switched to Medicare and a supplemental insurance, along with a Part D drug policy, since his former insurance had met all the qualifications.

We do NOT have to reinvent the wheel; we already have the system in place. We just need to study what is done in other countries to determine if there are ways the system can be improved and if there are pitfalls that can be avoided.

[ehrnst]

64. Medicare was launched for a limited part of the population, with the costs hidden

LBJ lied about how much it would cost, because he knew that it would not pass.

You cannot lie about that because of the Congressional Budget Office.

And there are some real problems with physicians getting payment in Medicare, and many physicians are not accepting new medicare patients.

Combine that with the VA scandals, and you won't have the public or the political will to switch the entire system over.

Not all other countries use single payer to achieve universal health care. Some use regulated not for profit companies as the payers.

[colorado_ufo]

145. We have one of those right here.

We were members of one of those companies for years, from its inception. In fact, it was the one President Obama praised and held up as a model. The premiums and deductibles rose and rose until ir was unaffordable for many people, who were forced to go to policies in other companies that only offered catastrophic coverage or just went uninsured. Medicare for all brings in a younger healthier population that changes the actuarials. Any time private companies are involved, costs rise out of sight. Nonprofit doesn't mean they don't make money; it means the Board is not paid, and stock is not sold.

[ehrnst]

146. Medicare is not 'single payer' - it involves private payers for Rx and things like hearing aids

"Medicare for all" as was proposed in 2016 would cover all those things that medicare does not currently cover, which is why the costs would be more than simply expanding actual medicare to all people.

The not-for-profit private payers that are a part of many European systems are heavily regulated.

[subterranean]

48. Single payer would NOT break up people's relationship with their doctors.

Precisely the opposite, in fact. In countries with universal healthcare (single or multi-payer), virtually all doctors participate in the system, so people can go to any doctor they choose. Ours is the only system that has restrictive networks of providers.

[lumberjack_jeff]

98. I'm at a loss as to how a single payer system might jeopardize one's doctor choice.

If your doctor refuses to accept the single payer insurance company, they're unemployed.

[IronLionZion]

44. Taiwan did exactly that. Guess who they chose to copy?

America's Medicare

[JCMach1]

14. Single Payer with strong price controls built in...

[ehrnst]

24. So, how do we do that? (nt)

[Auggie]

38. I guess we begin by MAKING NOISE

Call, write, e-mail ... basically, hound our reps

[uponit7771]

45. +1, the HC community would take a huge hit at first ... doctors, pharma and Hospital groups would ..

... have to take a nice pay cut or no pay raises but its better than what we have now

[Roland99]

17. Hear! Hear! Revive H.R. 676!

[Chathamization]

19. There should be a push for this at the state level. No good reason why blue states don't have it.

With 50% of the population supporting single-payer, we should be making a big push for this. It's crazy to see a light-blue state like Colorado lead on this (and marijuana) while dark blue states are twiddling their thumbs. It's time for people to put their money where their mouth is.

[ehrnst]

20. But it's not that simple, unfortunately. If it was, then it would have been done a long time ago.

Most health policy analysts — including those who are sympathetic to the idea — say moving from the current U.S. public-private hybrid health system to one fully funded by the government in one step is basically impossible. And that’s making a huge assumption that it could get through Congress.

“To try to do it in one fell swoop would be massively disruptive,” said Paul Starr, a professor at Princeton who was a health policy adviser to President Bill Clinton.

The U.S. health care system, said Jeff Goldsmith, a health care consultant and health futurist, is “the size of a country — it’s bigger than France — and it employs 16 million people.”

In moving to a single-payer system, he said, “you’re talking about reallocating $3 trillion, reducing people’s incomes and creating” in effect a single entity that would set prices for all medical services. Single-payer supporters dispute the idea that getting from here to there could not be done.

.....................................................................


But while a single-payer system would undoubtedly produce efficiencies, it would also bring huge disruptions. Said Starr, single-payer supporters “haven’t worked through the consequences.”

One of the biggest is exactly how to redistribute literally trillions of dollars. The problem, said Harold Pollack, a professor at the University of Chicago, is that the change will create losers as well as winners.

“Precisely the thing that is a feature for single-payer proponents is a bug for everyone who provides goods and services for the medical economy,” he said, since their profits — and possibly their incomes — could be cut.

And it’s not just the private insurance industry (which would effectively be put out of business) that could feel the impact to the bottom line. Parts of the health care industry that lawmakers want to help, like rural hospitals, could inadvertently get hurt, too. Many rural hospitals get paid so little by Medicare that they only survive on higher private insurance payments. Yet under single-payer, those payments would go away and some could not make it financially. “You would not want to wipe out a third of the hospitals in Minnesota by accident,” Pollack said. “And you could,” if payments to hospitals end up too low.

http://khn.org/news/democrats-unite-but-what-happened-to-medicare-for-all/

[Yavin4]

25. You are correct. The more practical solution is to offer a Public Plan to folks who cannot afford

private insurance and don't get insurance from their employers. Build it on the model of higher education.

[ehrnst]

33. The fact that we could not get it with a dem house, senate and white house

shows that it's not going to be easy or fast at all.

In the meantime, people get sick, people get old, kids get born.

[ellennelle]

43. it's not up to congress

IT IS UP TO US!!!

the louder we shout, the more relentlessly we demand, the more this will get done. not just healthcare, but ...(see below; you know the list).

we cannot let up.

put the WH and your congress critters on speed dial and call, EVERY SINGLE DAY!

[uponit7771]

53. Congress DOES NOT have to care how loud we shout right now and the president is the least powerful

... of the 2 entities.

Getting a non gerrymandered congress is paramount ... Obama is right, get rid of a non representative congress and we get what we want in the end

[ehrnst]

66. Congress has to make it law, so yes, it is up to them.

To ignore that is to be no better than a Trump supporter who thinks he will be able to make them do what he wants.

[ellennelle]

85. say what?

them's fighting words, my friend, and totally uncalled for.

sheez, all i said was it is not up to congress, IT IS UP TO US!!!

we have to make very loud noise about this.

do help me grasp just how that makes me no better than a trump supporter?

was your comment in line with our civility rules here?

sorry; i think they're a bit over the top, but this comment was a bit out of hand.

[ehrnst]

147. Trump's supporters believe that he can do things without congress that he can't actually do

That is something that many people forget in a presidential election year.

And yes, legislation is up to congress. We don't get a direct vote on federal laws.

We have to vote for candidates, who then vote for those laws.

Them's not fighting words, them's facts.

[uponit7771]

49. We did not have a super controlling majority in either houses in congress... we get one then that

... battle is over quick and in a hurry

[ehrnst]

67. The ACA has been challenged constantly, and sometimes successfully.

Last edited Fri Oct 28, 2016, 01:40 PM - Edit history (1)

The battle is never over.

[uponit7771]

47. “To try to do it in one fell swoop would be massively disruptive" I agree, then do it piece meal in

... small progressive steps over 20 years so when I retire HC cost would be relatively low...

cool...

[ehrnst]

68. But there are those who say that's a cop out. Single Payer or nothing.... (nt)

[ellennelle]

88. for the record

i know of no one who says this! NO ONE!!

what i say, and i hear most other healthcare providers and practitioners say, is for the love of gawd, at least try for the moral and economic RIGHT THING! trying for crumbs is not trying at all, but merely accepting what the other side will give without putting up a fight.

[ehrnst]

106. I have been told that Single Payer is "the only way" to bring down costs, not to mention "simple."

by many here on DU.

I'm sure that the medical community, which has a much firmer grasp on the situation than those that are not in that community would agree with you and me.

[ellennelle]

50. always a glitch

do you see what starr is doing there? he's more worried about the 'industry' and the 'economy' (translation: wall st.) than he is the american citizens this should be helping.

sure, there will be a lot of workers out of jobs in that industry, but hey howdy, a single payer system will need a lot of workers familiar with the healthcare system, so that is not so hard to fit.

as for the others that have starr's sympathy, those are shareholders and the huge chunk of wall street that is invested in profits from the industry. i don't know about you, but i have a bit of trouble working up concern for them. they've been profiteering off this criminal system for too long already. somehow i suspect most if not all have a nice cushion in place to soften their fall.

meanwhile, i lose no sleep over starr's concerns, but wonder how he and the rest of the market based mental cases can.

[ehrnst]

71. Did you read about the rural hospitals?

Yeah, they would close if they got less in the form of payments.

I see what Starr is doing - he's going through all the consequences. And no, insurance company desk jobs don't translate to the health care industry as magically as you think.

It's about as realistic as 'building a wall to keep out the immigrants" is - sounds simple enough to someone without the knowledge of the situation.

We need to stop demonizing anyone who points out the problems and breaks our bubble of a simple solution as some sort of corporate shill.

[ellennelle]

75. excuse me

but i've been IN the system as a provider for decades. worked in hospitals, the VA, clinics, private practice, and i suggest it might be your perception that is without knowledge of the situation.

desk jobs are ALL the insurance companies have! they are a bunch of folks on phones, essentially confusing customers and denying payment to providers for a living. but i digress....

running a national health service would most certainly require abundant people at desks, and they do; do you think the doctors and hospitals would just run it themselves? you are aware that medicare employs thousands only for servicing seniors, right?

but of course, part of the beauty of the system is that it is more efficient, so there will not likely be any need for all this superfluous mid-level management level jobs that serve no one but them.

which raises the question, you do realize this service is about healthcare for the citizenry, right? not keeping the insurance industry afloat or those jobs in tact.

[ellennelle]

76. rural hospitals

oops, forgot to reply to that part.

it seems you are missing the fact that those hospitals were forced to close due to competition from the larger hospitals, which have been swallowing them up (essentially violating anti-trust laws, imho; but i digress again). this would NOT happen in a single payer system that exists solely to see that all citizens are provided healthcare, with NO concerns for profit or shareholders.

folks compulsively underestimate the rapacious power of that profit motive, esp. in healthcare, and how much revenue it sucks out of the system. take the market OUT of healthcare, and it would work far far better for everyone concerned, including - if not esp. - rural hospitals. doctors in it for the big bucks might not want to stay in the profession. but, having worked with tons of them, i can tell you, the profession would be better off without their kind.

but you'll not find me pitying the poor shareholders who have been sucking at this trough for decades. they make my skin crawl, frankly.

[ellennelle]

35. THE MATH IS SO SIMPLE!

and the msg should be.

bernie tried to get this across, but his plan was, grossly misrepresented.

here is the deal. yes, taxes would increase. not by much for the middle class, but they would increase.

however - and this is the part that was always left out -

NO COPAYS!
NO DEDUCTIBLES!
NO PREMIUMS!!

ya got all that?

every single family, including kids and parents and grandparents - EVERYONE! - would be covered. period.

AND NO ONE WOULD BE MAKING A PROFIT! because the system is the only game in town so it sets all the pricing. period.

each and every family would have all the healthcare they require, without a worry, no one would be profiting, and each and every family would be saving more money. more money in the pockets of the citizenry, the better the economy.

what we have to do now is expose all the naysayers as immoral money grubbers, profiting at the expense of those in need - WHICH WE ALL KNOW ALREADY - and force it through congress with the shame factor.

seriously, people; this is where we need to be working; shaming the life out of these death corps! and not just with healthcare; we have to shame the moneychangers on climate change, rapacious banking, wars, injustice and discrimination, and all the rest. they've relied on their "moral" pseudo-superiority way beyond the shelf life; time to pitch them into the dumpster. along with the trumpster. heh.

and don't tell me it can't be done; this is what democracy looks like!!! and the only way these things are ever achieved!

[ellennelle]

40. ps to all that

and don't even settle for medicare for all! that is just more of the same, sadly. as a senior, i can tell you; there is just as much limitation, out of pocket expense, and shameful profiteering as there is with obamacare.

we have to kill health insurance, once and for all, forever!!

and this is not just coming from a senior, but a healthcare provider!! i deal with the insanity from both sides; it is truly beyond shameful.

[CanSocDem]

42. Well said!! (eom)

[Hoyt]

55. Love Sanders, but Vermont ran from single payer as soon as they looked at the cost and figured out

taxpayers would crucify them. Even though we can argue you will be better off paying taxes than premiums, people are too stupid to get it.

The only way we will get close to single payer is to have a public option that people will gravitate to quickly if it is as good as we think.

[ellennelle]

74. not so on any point

VT did not run from it, the governor nixed it, 'inexplicably.' rumor has it the insurance companies got to him. big surprise there.

the public option will not cut it, but it might ultimately starve the insurance companies out of business.

but as long as they're allowed to contribute to the plan at all, they'll sabotage it.

single payer is the only way. hell, if nothing else, check out what's happening to obamacare right now. all the carriers are hiking up prices because they can, and swallowing up all the smaller companies, which will ultimately prove that SINGLE PAYER is the most efficient way to do this.

and would folks stop assuming the public is so stupid?? damn, they/we elected obama twice and are about to reject trump in spectacular fashion. get real, please.

[Hoyt]

77. They nixed it because of the taxes required. The carriers can only hike premiums if

medical costs go up because of the cap on administrative costs. Part B Medicarer premiums will increase 20+% next year too (subject to COLA cap), and that has nothing to do with ACA.

People have been telling us how the ACA was a gift to insurance companies, yet they are dropping out and many non-profit co-ops have gone bankrupt as well.

We need single payer, but it is not going to happen by cramming it down the throats of the 45+% who are adamantly opposed, and yes they are stupid.

[ellennelle]

89. just, no

medical costs go up because the gawd dam insurance companies have to have their gawd dam profit! what part of this equation do you not grasp??

medicare has NO profit motive, and runs extremely efficiently on a very low percentage for admin costs.

people are profiting here when those revenues should be totally directed to healthcare. period.

and insurance companies are not 'dropping' out but getting swallowed up by two companies, BC/BS and kaiser. proving quite intriguingly the fact that healthcare runs most efficiently with a single - or close to it - payer.

just think how much more efficient it will be without the shareholders sucking up all those revenues as profits!!

those opposed have been propagandized; they're not beyond being educated.

[Hoyt]

100. Uncapped Medicare Part B premiums are increasing over 22% in 2017. That's a fact.

Kaiser is non-profit. I actually like Kaiser, but it'shows not cheap. The large companies like United are dropping out of ACA individual plans. Medicare is administered by insurance companies. ACA limits overhead to 15 or 20% depending on plan size. Much of that is unavoidable under Medicare. I don't like insurance companies, but at least they negotiate drug costs and say no to useless procedures,.

Point is, simply getting rid of insurance companies is not going to be enough.

[world wide wally]

37. You would think that these people would be thrilled with the price for health insurance going up!

Weren't they the ones saying we wouldn't be a free country anymore if Obamacare passed? I would say that Insurance companies are just expressing their God given American right to raise the prices again.
Am I missing something?

[pnwmom]

39. Switzerland controls costs with a combination of gov. and private plans

and so does Canada.

[IronLionZion]

51. Employers don't like paying for health insurance

Get employers on board with single payer. Most large American companies operating in Canada have publicly supported medicare for all.

Single payer is the pro-business, pro-jobs plan. Because it reduces costs for job creators.

Tie in a way for purchasing prescription drugs at affordable prices and you'll have a winner. Most everyone can empathize with the out of control price of drugs.

[DemInND]

52. Big Pharma likes it the way it is

They don't want a "cure" for what ails you. Just take our expensive over-priced pill to lessen the effects! Then they spend 75% of their commercial time going through all the potential dangerous side effects while images of happy people fill your screen. Oh that newfound freedom from what it ailing me! Oops, time to take another pill.

[Mr.Bill]

54. What I don't get is this:

Politicians (especially Republicans) constantly say that our jobs are going overseas because of high labor costs (unions), environmental regulations and high taxes. Why does no one mention the elephant in the room? That is providing health insurance for their employees, which they do not have to do in most other countries. it would be a huge benefit to all employers to be relieved of this burden.

Actually, I do get it. The insurance companies bought the politicians a long time ago.

[Delmette]

56. How about if we start with the small population states.

Convert people to the single payer plan based on the names, address and tax ID's on their state income tax return. Doctors and hospitals can verify the individual information and have what they need to file a claims just like they do for Medicare or Medicaid. There would be very few people who do not have medicare, medicaid or file a state tax return. Yes I know homeless people may not be included but someone knows how we provide services for them at emergency rooms.

If we start with the small population states then any kinks can be worked out before we tackle the large population states.

[IronLionZion]

61. Vermont tried and failed badly

California actually had a solid chance years ago. There's an attempt in Colorado, it's on their ballot this year. ColoradoCare.

Some states have public options that people can buy into.

http://www.foxnews.com/politics/2016/06/23/colorado-considers-replacing-obamacare-with-state-single-payer-plan.html

[Delmette]

63. Are these public options federally funded or state funded?

[IronLionZion]

65. Minnesota is state funded

Don't remember the other states that have it. There are also the non-profit co-ops that are federally funded. Those are working well in some states.

[Delmette]

70. I like the term Non-profit.

There are ideas and plans that work, we have to identify them and push to start implementing them in more states. Eventually for profit health insurance will go away.

[ellennelle]

91. romneycare

worked extremely well here in MA. template for obamacare.

just not enough; rich don't need it, so it essentially covered the very poor, and the middle class coverage was highly dependent on where you fall in the spectrum. such as, between the cracks.

which is why we need single payer; UNIVERSAL HEALTHCARE COVERAGE.

all these programs are INSURANCE programs. we simply need to jettison the insurance feature altogether, and concentrate on HEALTHCARE.

[ellennelle]

93. actually works better the larger the population to pool from

[PoliticAverse]

101. The federal government controls so much of health care in the US...

including Medicare and Medicaid that it's rather difficult for an individual state
to implement something like single payer. Note that the states that try to implement
some alternative to the ACA must get permission from the federal government to do so
if they want to continue to receive their current level of federal health care transfer payments.

[AllyCat]

58. I get employer covered insurance and I support single-payer

[zentrum]

60. Go Elizabeth! Go Bernie!

Our progressives in congress are going to have to fight hard for this. Once it's explained, the majority of people do want it.

[ehrnst]

69. That's not all there is to it - there is the implementation of it which is a huge

There is no turning it around quickly. Anything that big isn't going to change directions quickly without falling over.

Just because people think it's simple doesn't make it simple. People were completely mislead about Obamacare, and very easily at that.

This is what actual, non-partisan health policy analysts - many who really want Single Payer - have to say about the feasibility:

Most health policy analysts — including those who are sympathetic to the idea — say moving from the current U.S. public-private hybrid health system to one fully funded by the government in one step is basically impossible. And that’s making a huge assumption that it could get through Congress.

“To try to do it in one fell swoop would be massively disruptive,” said Paul Starr, a professor at Princeton who was a health policy adviser to President Bill Clinton.

The U.S. health care system, said Jeff Goldsmith, a health care consultant and health futurist, is “the size of a country — it’s bigger than France — and it employs 16 million people.”

In moving to a single-payer system, he said, “you’re talking about reallocating $3 trillion, reducing people’s incomes and creating” in effect a single entity that would set prices for all medical services. Single-payer supporters dispute the idea that getting from here to there could not be done.

“We’re so used to such a complicated system in the U.S. that we envisage any change would be incredibly complicated as well,” said Steffie Woolhandler, a physician and one of the founders of the single-payer advocacy organization Physicians for a National Health Program. “But what you’re doing with single-payer is actually simplifying the system.”

For example, said Woolhandler, “the latest data is U.S. hospitals are spending 25 percent of their total budget on billing and administration, and hospitals in single-payer nations like Canada and Scotland are spending 12 percent.”

But while a single-payer system would undoubtedly produce efficiencies, it would also bring huge disruptions. Said Starr, single-payer supporters “haven’t worked through the consequences.”

One of the biggest is exactly how to redistribute literally trillions of dollars. The problem, said Harold Pollack, a professor at the University of Chicago, is that the change will create losers as well as winners.

“Precisely the thing that is a feature for single-payer proponents is a bug for everyone who provides goods and services for the medical economy,” he said, since their profits — and possibly their incomes — could be cut.

And it’s not just the private insurance industry (which would effectively be put out of business) that could feel the impact to the bottom line. Parts of the health care industry that lawmakers want to help, like rural hospitals, could inadvertently get hurt, too. Many rural hospitals get paid so little by Medicare that they only survive on higher private insurance payments. Yet under single-payer, those payments would go away and some could not make it financially. “You would not want to wipe out a third of the hospitals in Minnesota by accident,” Pollack said. “And you could,” if payments to hospitals end up too low.

There are also questions about how feasible it would be to have the federal government run the entire health care system. “It’s hard to be nimble” when a system gets that big, said Ezekiel Emanuel, a former health adviser in the Obama administration now at the University of Pennsylvania. “No organization in the world does anything for 300 million people and does it efficiently.”

http://khn.org/news/democrats-unite-but-what-happened-to-medicare-for-all/

[area51]

73. The claim of

“But while a single-payer system would undoubtedly produce efficiencies, it would also bring huge disruptions. Said Starr, single-payer supporters 'haven’t worked through the consequences'.”

I think they have worked through the consequences.

[Hulk]

62. Let's get it done this time!!

Occupy Wall Street, or The Revolution Party, or some group needs to get behind the Congress and burn their butts if they try to sit this one out this next time.

Single Payer is the ONLY answer. Always was, and always will be.

[dflprincess]

86. Single payer isn't feasible unless it regulates pharma

and other medical device makers.

The other thing that might help is to subsidize education for MDs and RNs. Having doctors come out of med school $300k or more in debt doesn't help us.

[ellennelle]

92. single payer would correct all of that

it of course regulate pharma and device makers.

and because the providers will no longer be making the obscene big bucks, they'll not be able to afford the big medical school costs, so that will have to come down.

and they will. so much of this is interlocked, but ultimately driven by the profits of pharma and insurance. esp. insurance; they're total fat. we do NOT need them at all, and in fact they're a leech, pure and simple. i'd say the same for drugs, but some are necessary. they're totally lost sight of that distinction, tho.

[ehrnst]

151. So much is interlocked - you said it.

Something as huge as the health care system in this country, along with the system that manufactures drugs and medical devices will not be rebooted quickly or easily.

You can't turn a huge ship too quickly without it falling over.

[roamer65]

87. It's pretty simple.

You charge companies a percentage of payroll and expand Medicare to everyone. If need be levy a tax on any income over 100,000 as well.

[1939]

127. Which Senator said it in 1986?

Don't tax you, don't tax me, tax that other fellow behind the tree!

When they were negotiating the Roth-Gephardt Tax Bill.

[InAbLuEsTaTe]

94. No question!

[napi21]

103. I agree with you but, there is something that concerns me about single payer in the US.

We keep referencing the rest of the civilized world has single payer, but AFAIK all of their programs are Government programs; meaning the employees, doctors, nurses, etc., all work for their Government. I asked my DIL, who is from Romania, if there were problems with crazy medical expenses in the EU. She said not really because costs are capped. There are some private doctors who are allowed to charge whatever they want, but all others simply treat the patient and their pay comes from the Gov't. Same thing with drugs. There are private pharmacies, but the majority are gov't owned and med costs are controlled.

Americans would never accept a system like that, not to mention the doctors who are used to setting their own prices. I'm not sure a single payer system would work without being able to control the dr. fees, hospital charges, rehab facility costs, etc. The only reason the Veterans Administration works as well as it does is because it's set up just like the EU programs.

I wonder if we are pushing for something that can't work.

[Lee-Lee]

105. Single payer won't fix anything. We need to NATIONALIZE ALL HEALTHCARE

It's not a problem of insurance company profits. Insurance companies typically post less than 10%, often less than 5% profits compared to peeve all revenue. If you removed 100% of insurance company profits and replaced them with a much larger single government entity the effect on the cost of health care would be negligible at best, and that is if you could get a government agency to be as efficient at the job. Having just spent the last 2 months dealing with the VA not paying a bill and having to spend over 5 hours of my time fighting with them to get it paid I question if that will happen.

The problem isn't profit from insurance companies. Add up all the insurance profits and then subtract it from the entire healthcare economy over 3 trillion and you will see it's a tiny part. The problem is profit at every step. The drug makers want a profit, the people who made your IV kit want a profit, the hospital wants a profit, your doctors practice wants to make a profit- and on and on and on. At every step someone is profiting off your illness and you can't avoid feeding that greed of you want treatment.

The only way to control the out of control costs is wipe that out at every stage by nationalizing every step of health cafe from the making of gowns to the making of drugs to ownership of hospitals to making every healthcare worker a government employee.

If we just do single payer it won't make anything along the way cost less, it will just mask the cost because we won't see it but the burden on the treasury will grow and eventually become untenable. Then because a half assed solution was tried that left too much profit in the system they will scream it's a government failure.

Nationalize all of it. It's the only way.

[MineralMan]

107. You're right, of course. But no Presidential candidate is

going to say that during the campaign. Not going to happen.

[ellennelle]

110. um, with all due respect

a candidate DID in fact say it could happen, and it was bernie sanders.

and, a candidate said "ain't gonna happen!"

and it was hillary saying single payer would NEVER happen.

such vision, such courage, such a tell.

'nuff said.

[MineralMan]

111. The primaries no longer matter. Truly they do not.

The candidates for each party are now known. Others are no longer candidates.

I support a single payer healthcare system, but realize that we are no closer to it than we were in 2009. It might be conceivably possible to begin allowing people who are 50+ in age to buy into Medicare. That would be a reasonable start toward single payer. However, a nationwide single-payer system is not going to happen until we elect powerful Democratic majorities in both houses of Congress who will work with a Democratic President to push a single payer program through.

You are correct. Bernie Sanders supported such a system, but would not have been able to make it happen. The reality is that no President right now could make it happen.

In any case, Sanders is not the candidate now. He is a Senator from Vermont, just as he has been for some time. His opinion on this matter is no longer relevant to the current election.

The primaries are over.

[ehrnst]

116. Not a candidate in the presidential election.

That is Hillary. And she gave her own health care reform policies, which are based in a world where we had a dem house, senate and white house, and a public OPTION wasn't passed.

I don't recall a "IT AIN'T GONNA HAPPEN" coming out of the Democratic nominee's mouth, even in the primary.

If you want to diss her for something, it ain't gonna be lack of vision, courage and a 'tell.'

I think you have said 'nuff.

[HughBeaumont]

126. Er . . .

[ehrnst]

130. To be fair, I googled "Ain't never gonna happen."

And she's right, according to the non-partisan, self funded policy think tanks. And only two developed countries have Single Payer, Canada and Taiwan.

"Which Countries Have Single-Payer Health Systems?

There are fewer than many people might think. Most European countries either never had or no longer have single-payer systems. "Most are basically what we call social insurance systems," says Gerard Anderson, a professor at Johns Hopkins Bloomberg School of Public Health who has studied international health systems. Social insurance programs ensure that almost everyone is covered. They are taxpayer-funded but aren't necessarily run by the government.

Germany, for example, has 135 "sickness funds," which are essentially private, nonprofit insurance plans that negotiate prices with health care providers. "So you have 135 funds to choose from," said Anderson.

Nearby, Switzerland and the Netherlands require their residents to have private insurance (just like the Affordable Care Act does), with subsidies to help those who cannot otherwise afford coverage.

And while conservatives in the United States often use Great Britain's National Health Service as the poster child for a socialized system, there are many private insurance options available to residents there, too.

As far as countries that have true single-payer systems, Anderson lists only two: Canada and Taiwan."

http://www.npr.org/sections/health-shots/2016/01/22/463976098/debate-sharpens-over-single-payer-health-care-but-what-is-it-exactly

[HughBeaumont]

131. So, multi-payer systems. Public driving the market FOR Private, not the other way around.

What you all don't seem to get is that's still eons better than what we have here and America's politicians and corporations DON'T EVEN WANT THAT.

Private insurance, Pharma and Medicine dictated nearly everything about the PPACA. Holy Joe Lieberturd, the Senator from Big Insurance-fattened Connecticut, made absolute sure his friends wouldn't have their stock prices (or profit$) driven down by some silly tree-hugging "public option".

They're driving the car and not giving up the steering wheel, all because America thinks inconveniencing rich people even an atom speck is Satan's path to a Warsaw Pact Police State. Or something.

[ehrnst]

132. Yes - and incremental change. What I've been saying all along. (nt)

[HughBeaumont]

109. Yay status quo.

Yay barbarism.
Yay bake-sale-to-bankruptcy.
SOMEone has to pay for this sensibly sensible system, and it isn't going to be us rich/wealthy people. Think of our POOLS. Think of our yachts.
It's too fucking hard to change. Might as well just accept that we cannot. Ever.

Want to get better? COUGH up, say the "Democrats".

Gee, color ME inspired.

[ehrnst]

117. You don't sound like you have much respect for Democrats. (nt)

[HughBeaumont]

124. Not asswipes like Lieberturd or Baucus.

Anyone who makes any person's health care more difficult and expensive to attain . . . anyone who's political career is funded by Big Pharma and Insurance lobbies to keep for-profit wealthcare in place for ruining people's livelihoods . . . that person isn't anyone's friend or worthwhile public servant. They're a disgrace.

Quisling "Democrats" who won't give a single INCH on even incremental changes are actually WORSE than "all about Number ONE" Republicans or Libertarians . . . because selfish bullshit is what I EXPECT from THEM.

Tell me something . . . WHAT INTEREST is it of ANY rich, corporate-fattened wealth hoarder whether or not a lowly impoverished citizen even has one BREAK thrown their way . . . one BONE? ONE CRUMB???

Signed - a citizen whose kid has a pre-existing condition. "Qualify" does not mean "can afford".

[Blue_Tires]

114. The only chance of getting single-payer is flipping the senate...

[StevieM]

119. Flipping the Senate won't get single-payer.

Actually, neither will flipping the House.

For better or worse, the votes aren't even close to being there.

[moondust]

121. Like common sense gun control,

90% of the population can want it but Congress still won't pass it.

[Blue_Tires]

123. but it will crack the door open a bit...

I do know what will happen if the GOP keeps the senate, though...

[Grey Lemercier]

120. This is the single most depressing, enraging, disheartening

thread I have ever read on here. I fucking swear I am SO FUCKING GLAD I do not live in my country of birth.

America is FUCKED because people's health is the most important aspect of life and your system is PROFOUNDLY enslaved to the profit motive and over half of the population is delusional about even basic truths of the system itself.

I want to slam my head against the wall and I am not even remotely affected by any of this. ARRRRRF

[Yavin4]

122. America was built on racial and social stratification

In order to prevent the White working class from revolting against the upper class, they use racial phobia. That's why we don't have the social safety net system that Europe has.

European governments use their social safety net to prevent their working classes from revolting against the upper classes.

[The2ndWheel]

136. It was also built on people that left European countries

How many countries in Europe have the same ratio of whites to minorities that the US does? Not too many. How many have the same sort of history? Not too many. How many countries in Europe are paying for a global military? Not too many, but both the US and European countries are somewhat cool with that. It allows nobody to be able to tell the US no, and countries in Europe can spend their money on social programs. Countries in Europe used to have to pay for their own empires, but by the end of the 20th century, there was basically only one government standing in the winner's circle.

[Yavin4]

137. Europe does has a high degree of racial diversification.

Go to Germany, and you'll see more racial diversity than Vermont or Utah. Europe has a long and violent history of class rebellions. Germans used ethno-hatred of the Jews to rise to power. Following WWII, the European nations learned that the best way to stop class revolts is to provide strong social safety nets.

[The2ndWheel]

139. Not as much as the US though, and it's different

The US also has 4 times as many people as Germany. The US is also like 30 times the size of Germany. Vermont and Utah are different than Germany. Yeah, so are Mississippi and Georgia. Germany also lost WWII, had their country split up for a time, and can't escape having what many consider to be the worst bad guy in history.

Europe can pay for those social safety nets because they all lost their empires, and the US eventually outlasted the Soviet Union. The US is the world police by default, and the US taxpayer is the only one paying for it. Europe benefits from that.

[Yavin4]

140. Have you been to Europe?

Please go. You will see racial and ethnic diversity there. It's not as monolithic as you think.

On your other point, yes, we provide military protect, but at the same time, the world trades in our currency for oil, and that allows us to have zero percent interest rates.

[The2ndWheel]

143. I'm not saying there isn't any

There's just less than the US. How many countries in Europe are considered to be nations of immigrants, as is the popular way to describe the US? It's all just different.

On your other point, yes, we provide military protect, but at the same time, the world trades in our currency for oil, and that allows us to have zero percent interest rates.

Exactly, the US won the 20th century. The US government set up the rules. That's why our currency is used, or why we don't get economically sanctioned, or bombed by another state.

1. US
2. UN
3. Everyone else

[ehrnst]

148. That is correct. More importantly

Our vision of 'tribe' is much smaller. Other countries consider their family to include 20-30 people instead of the 5-10 that Americans do.

The idea of a large group of people being responsible for each other's health and well being is not something our society has accepted, if if ever did.

[ehrnst]

149. Germany also has a very strong anti-immigrant right wing right now.

There is a sense of German nationalism that has always been there.

Most other European countries have a much narrower national identity than we do in the US - they are much more homogeneous in religion, race, and cultural strata than the US. At least before Trump...

[HughBeaumont]

125. It's disgraceful.

American citizens asserting that there is no way to make people's lives better and there's no point in trying. So hey, let's just continue the bake-sale-to-bankruptcy plan, the gofundme-so-I-won't-die racket, because it's just working out SO well.

It's defeatism, and we seem to be great at it.

[upaloopa]

128. I have Medicare and need private insurance

to pay what Medicare doesn't pay.

I think single payer if Medicare for all would be the same.

So prices for additional coverage could go up.

[ehrnst]

133. Medicare recipients still pay an average of 14% of their income on health care coverage and costs.

Sanders' single payer plan was much more generous than medicare, and would have cost much more to implement.

[ehrnst]

134. Only two countries have single payer: Canada and Taiwan

Which Countries Have Single-Payer Health Systems?

There are fewer than many people might think. Most European countries either never had or no longer have single-payer systems. "Most are basically what we call social insurance systems," says Gerard Anderson, a professor at Johns Hopkins Bloomberg School of Public Health who has studied international health systems. Social insurance programs ensure that almost everyone is covered. They are taxpayer-funded but aren't necessarily run by the government.

Germany, for example, has 135 "sickness funds," which are essentially private, nonprofit insurance plans that negotiate prices with health care providers. "So you have 135 funds to choose from," said Anderson.

Nearby, Switzerland and the Netherlands require their residents to have private insurance (just like the Affordable Care Act does), with subsidies to help those who cannot otherwise afford coverage.

And while conservatives in the United States often use Great Britain's National Health Service as the poster child for a socialized system, there are many private insurance options available to residents there, too.

As far as countries that have true single-payer systems, Anderson lists only two: Canada and Taiwan.

Are Single-Payer Plans Less Expensive Than Other Health Coverage Systems?

Not necessarily. True, eliminating the profits and duplicative administrative costs associated with hundreds of different private insurance plans would reduce spending, perhaps as much as 10 percent of the nation's $3 trillion annual health care bill, says Anderson. But, he notes, once those savings are achieved, there wouldn't be further reductions afterward.

More important, as many analysts have noted, is how much health services cost and how those prices are determined. In most other developed countries, even those with private insurance, writes Princeton health economist Uwe Reinhardt, prices "either are set by government or negotiated between associations of insurers and providers of care on a regional, state or national basis." By contrast, in the U.S., "the payment side of the health care market in the private sector is fragmented, weakening the bargaining power of individual insurers."

http://www.npr.org/sections/health-shots/2016/01/22/463976098/debate-sharpens-over-single-payer-health-care-but-what-is-it-exactly

[Peaches999]

142. Price discrimination needs to be banned in health care

Meaning that à healthcare provider or drug provider cannot charge more to anyone than the median price of what they charge. That will stop a lot of health care inflation. Then we can have a dual system of private healthcare and Medicare for All. Also, subsidies must be provided for the middle class as Bill Clinton has talked about.

Obamacare is better than the old status quo but much needs to be improved.

[tonyt53]

152. Part of it, but not the entire means to fix our mess of high costs for healthcare.