How do we compare apples to apples (between countries)? Compare health expenditure per capita (public and private) with multiple health indexes. I.e. get the bang for buck.
In the list of nations with the best bang for buck healthcare programs, you will notice that top 20 healthcare programs are mostly single payer.
But there are single payer healthcare systems with bad health indexes, you might say... Well, combine single payer healthcare systems and add some transparency in healthcare and you now have an unmissable correlation.
The top 20 bang for buck healthcare programs (mostly single payer systems), have an average ranking in terms of healthcare transparency of 18.7.
Are you from the USA? Notice the countries with universal healthcare, who have a similar healthcare transparency ranking to that of the USA: Luxembourg, Canada, Germany, France, Belgium, Ireland, and Chile. Their bang for buck rankings are 16, 30, 25, 1, 21, 19, 33 respectively. All of these countries have a better bang for buck ranking than the USA's 37.
In one sentence... Universal and transparently managed healthcare consistently gives more bang for buck.
And now to quote the original article... "It is a bedrock economic principle that if we can find a way to do something more efficiently, it’s possible for everyone to come out ahead."
EDIT: Check page 18 in the first source. Check chapter 11 in the second source.
It's still absurd to me that we make the false differentiation between taxes and insurance premiums. If you've got a family, neither is negotiable. If you have a job that pays, I promise you it affects your check in nearly identically the same way as payroll taxes do. There's a tradition in America where the price isn't actually the real price, we artificially advertise fake prices to get you in the door and stuff a bunch of surcharges on the back end. I wish we'd cut it out-- our taxes aren't crazy, but the way they're presented make people flip their shit.
I imagine both single-payer and a truly free market health care system would be substantially cheaper than the current system -- which has none of the benefits of either approach.
With the federal government unable to act, turning healthcare back to the states to test a number of different solutions seems entirely reasonable. Let California try single-payer and Texas try something different -- after a few years see if we've found a solution that could work for the whole country.
The problem with a 'each state do their own thing' solution is the very problem with health care in this country in general - the freeloader problem.
If California implements a single payer system, it would make people in other states more likely to choose not to get healthcare; if they get sick, they can just move to California.
This is the reason the ACA has the 'individual mandate' to go along with preventing the denial of care because of pre-existing conditions - without some coercive force, there is no reason to buy health care until you get sick.
This is why a national single payer system is the solution.
If by "truly free market" you mean that healthy people can opt out of being insured, no, that would drive the costs up.
Risk selection is a very driver of prices in health insurance. If you can spread the risk between healthy and sick people, the price goes down. If you can't, the price goes up.
Secondly, having a population that has no health insurance means less prevention, i.e. worse health problems down the road, again driving the costs up
Which would mark the second time in 241 years those states agreed upon something...
In all seriousness, state run healthcare is a great idea, but the government is just such a big stakeholder in having a healthy population that I do not see a good reason for it [at some level] to stay out of that line of business. Single payer works, so much better than the current setup...why not start there and try iterate?
That would require both ideological sides to agree on objectives, agree on what counts as successful, agree on metrics. Something I doubt will ever happen at this point.
The federal government already pays for 64.3% of healthcare costs http://www.pnhp.org/news/2016/january/government-funds-nearl.... In a centralized managed system this would likely cover the cost of all healthcare. It's roughly what other industrialized nations pay, per person, for single-payer.
> One is that administrative costs average only about 2 percent of total expenses under a single-payer program like Medicare, less than one-sixth the corresponding percentage for many private insurers.
Anti-fraud enforcement is a tiny nit compared to the overall poor performance of US healthcare compared to other single payer nations. We pay roughly double per capita, cover fewer people (which means the people who do pay in our system are paying more than double), and have lagging health measures such as life expectancy and infant mortality rates (2-3x higher in the US!).
Anti-fraud measures can be evaluated for cost-benefit in isolation, but when the fundamental cost structures are so completely out of whack then we should prioritize discussion of the fundamental problems - which is lack of single payer universal healthcare in America.
Switching to a single payer would reduce fraud. Because simplified rules are easier to adult. A cynic might even say the USA's healthcare system is purpose built to maxmize fraud.
Here's the other thing about administrative costs: Medicare's patients cost a lot more per person than private insurance.
In other words, if it costs you $500 in administration costs and one patient has care that totals $5,000 and another has care that totals $10,000, then their administrative costs are 10% and 20%.
And yet we think that if we shifted more people onto a Medicare-like system, we'd save money.
Further it is not a good argument by itself. One could imagine a program with no administrative overhead that because of that lack of administration ended up costing far more than a program with higher administrative overhead. I'm not saying that's the case here, but the argument needs to be made that it isn't.
> The most important source of cost savings under single-payer is that large government entities are able to negotiate much more favorable terms with service providers.
If there are no other options for clients, it's essentially the government telling doctors how much their services are worth.
Living in what is essentially a single-payer health care system (Norway), I assure you we don't see many MDs sleeping in cardboard boxes under freeway overpasses.
On a more serious note - education and skills tend to pay off.
Around here, doctors with their own practice are reimbursed by the state via several mechanisms, the two most significant ones are probably a fixed sum for each patient they are responsible for (they get this regardless of whether the patient sees them or not) and a fixed sum for each treatment, prescription filled &c.
Anecdotally, an MD with his own practice earns approx. $100k-$150k annually before taxes; this is 2-2,5 times the national average. (Very roughly speaking, but in the right ballpark)
It's not just doctors, its drug and health insurance companies, etc... but really? Is the argument is that we as a nation should pay double what other modern nations pay so doctors can be well paid?
Edit: Here's a deal, lets pay for doctor's educations, implement universal healthcare and call it even.
Yes, it's a euphemism for price controls. Which may or may not be a no-go depending on your political bent.
Another issue here is termination shock - if a provider comes up under the current system, getting into massive student debt in anticipation of a highly remunerative medical career, how will price controls effect him?
This doesn't stop lobbyists and special interests from moving the goalposts for how much a thing is worth or whether a new procedure should be covered. It does solve a medical office having to hire X administrators to cover his own health care just to negotiate with all of the insurance providers so they can get paid at all.
To me what we have already doesn't feel like a market. It's not like I feel doctors are being paid net/15 and that is why they get a discount. Or that they invest in their health care networks so costs are reduced for them in the long run. Insurance company hedges their bets so that they have the money to pay, but then when you get to a certain age you are chucked to the curb and then society has to pay for it. I just don't see where insurance companies are being fantastic middlemen or support networks for medical professionals or linking those who need care and appropriate medical professionals and producing value above and beyond what a single-payer system provides elsewhere. They just seem to complicate the costs significantly and do not create a market where resources feel distributed efficiently.
To me the biggest weirdness of health insurance is why they are a for-profit industry or largely for profit in the non-competing model they have right now. I want the employees of a insurance company to be smart, paid well and distribute all the resources in a smart way, but instead the goal is making money. If the market was competitive like it is for car insurance and other insurances that is fine because there are actual competitors but the whole equation doesn't work because most individuals making health insurance purchasing decisions have effectively the same amount of choice as whether or not you have Comcast.
> "The most important source of cost savings under single-payer is that large government entities are able to negotiate much more favorable terms with service providers. In 2012, for example, the average cost of coronary bypass surgery was more than $73,000 in the United States but less than $23,000 in France."
A more useful comparison would be the average cost of coronary bypass surgery for someone with a employer-provided health plan versus the cost that Medicare, Medicaid, or the VA pays. And then compare the average wait times of each along with recovery time/effectiveness.
Yes, a single-payer system would save money, but you have to be honest about the downsides. It's unfortunate that they are not honestly discussed in the article. Or, for that matter, almost anywhere.
The vast majority of the savings come from government price fixing. This is what the article means by "large government entities are able to negotiate much more favorable terms with service providers." It's not really a negotiation; at least not like it is in the private sector. When the government controls an entire market, they set prices. They can (and should) take input from providers and drug/device developers, but at the end of the day, whatever they say goes.
There are incredible risks when the government sets prices for a good/service. We should not take on those risks lightly.
Pricing in health care is currently not a negotiation. The customer often doesn't know the price before services are rendered -- they're left to negotiate the bill after the fact. And in the case of life-saving care like chemotherapy, your choice is "pay or die". That's not a negotiation; that's an ultimatum.
You rip NYT for not openly discussing the downsides, yet after reading your comment about the 'risks', you haven't talked about the downsides either.
Aside from "negotiation is not negotiation in the private sector", you aren't adding much to the discussion. Yes, government negotiation is still negotiation and yes it is not like in the private sector but it doesn't make it any less legitimate.
Suppose the current price for "two tylenol handed to a patient in a paper cup" is $50, and a giant insurer^W^W EVIL GOVERNMENT says it will only pay $40 next year. What do you suppose will happen? Societal collapse?
The article makes the assumption that the goal is to save money. Perhaps the way things are keeps the status-quo alive for those who make the rules, and that's why we don't have single payer.
I hate to be the conspiracy theorist, but I can't help but think that's the truth.
Anytime one person saves money, it is also costing someone else money (the person or people that money was going to). Saving money on healthcare will cost money for people who are currently making money from the excessive costs of healthcare.
This is not a secret, and not really a conspiracy; the groups that make money from the current system are always the ones opposed to change. It just sucks because there aren't nearly as many of them as the rest of us, but they just have more to lose than the rest of us have to gain - a classic example of concentrated benefits and diffuse costs.
> "Of course, having to pay taxes is itself a mandate of a sort, but it’s one the electorate has largely come to terms with."
Some taxes maybe? The whole "mandate vs. tax" argument was at the core of the opposition to the Affordable Care Act. I would argue that this issue is not decided by a long shot and a great deal of people are still upset by this.
Further, this article addresses aggregate costs but doesn't acknowledge that costs of the change to single payer will impact people in much different ways. Some folks will be asked to pay a lot MORE, and some will be asked to pay LESS, and it may settle out to be cheaper in aggregate, but cheaper to whom? These impacts (especially felt in the short term) need to be considered and mitigated.
Agency costs. Fools (& idealistic Americans) be thinking of "administrative costs" as able to be managed like the phone center that books your appointment, mail shop that sends your test results or janitors that clean the floor. Yes, these kinds of costs are basically in proportion to medical services provided, and yes, economies of scale apply. But if you have worked for a giant corporation or government, you might understand the danger of agency costs: not only can't be controlled, but in time, you get a worse product. Sad!
No, there's no perfect solution, but there must be a balance of market forces and semi-trustworthy regulators to make it work.
I would like to understand better what is meant by "single payer". I think I know what it should mean, but then I see France as an example of single-payer system. France has a complex system of insurance bodies (public entities, privates companies, some weird stuff in between)...
If I understand correctly the biggest savings come from the mandatory nature of the coverage - everybody is covered at least partially by the State, + employees by their employers, + private offers for the others + universal coverage for immigrants and the most destitute. Risk is shared between the healthy and sick people, and prevention can be maximized.
In France when you work you have to pay a percentage of your salary for the national healthcare to cover you and your family. This national healthcare reimburse you about 60 to 80% of the bills depending on the type of treatment. The remainder is paid by a private healthcare that your employer is chosing and paying for you. The difference between the many private healthcare is usually the amount reimbursed for dental treatment and eyeglasses.
If you have no work, there is an universal healthcare to cover you, but you cannot get fancy glasses or good tooth implant.
The prices are regulated by deciding the amount reimbursed by the national healthcare for each medical act. The private healthcare reimbursement are based on these prices. Doctors are free to ask more money, but you are going to pay the delta.
Savings are mainly achieved by having both sick and healthy people paying. Also, the fact that any medical treatment is basically free encourages you to see your doctor everytime you are beginning to be sick, preventing complications leading to a stay in hospital.
Note also that many private healthcare are mutual insurance which are lowering the rates if there is a profit.
I find it hilarious that this article uses state government taking over road maintenance as an analogy and claim it will save money, while it's known that California has a bad reputation in road repair, due to funding problem.
Yeah plus what a terrible analogy. The road is shared equally by everyone for the most part, my car tools along in a single lane. However if I smoke cigarettes and get cancer or eat myself into heart disease, this still doesn't cost any more for the road. It's something that can be mostly shared in a fair way. Healthcare cannot be shared in a fair way.
Plus if I don't play well with others the government will take away my license so I can't drive anymore. I don't want the government standing between me and healthcare in any sense of the term. If they are the ones in charge of a limited resource that means they are also the ones that have to say 'no' when there isn't enough to go around.
>“I think the missing element in this is Republican votes and identified Republican support,” said Brian Kelly, secretary of the California State Transportation Agency.
>California’s reliance on gas taxes to repair its transportation network is becoming less and less tenable. Increased fuel economy standards have led to less spending on gasoline
Why stop at saying it's a funding problem? (Allegedly) Obstructionist Republicans won't allow the government to react to changing conditions to update laws needed to fix the funding problem.
> It thus makes no sense to reject single-payer on the grounds that it would require higher tax revenues. That’s true, of course, but it’s an irrelevant objection.
> The most important source of cost savings under single-payer is that large government entities are able to negotiate much more favorable terms with service providers.
I agree these objections are not relevant for the overall system. But certain individuals and groups within the current system will get screwed.
The wealthy and upper middle-class will oppose any tax increases, as it will decrease their take-home income. Plus the resentment of having to pay for someone else (the moochers).
Providers will oppose any haircut that comes with single-payer rates and price controls. No more millionaire doctors, specialists, or dentists.
And of course the overhead of health insurance middle-men and the huge administrative bureaucracy costs.
This is the crux of the problem. We could have a reasonably good system for everyone. But it requires a lot of people with heavily vested interests into a less ideal situation.
Yeah, and we ban people from public roads for bad behavior. Will we ban people from public healthcare for bad health choices? Do we really want to give the government that kind of exclusive control over a service while giving up control of our bodies?
"An underappreciated advantage of the single-payer approach is that it sidesteps the mandate objection by paying to cover everyone out of tax revenue.
Of course, having to pay taxes is itself a mandate of a sort, but it’s one the electorate has largely come to terms with. Apart from fringe groups that denounce all taxation as theft, most people understand that our entire system would collapse if tax payments were purely voluntary."
Seriously? This is the argumentation from someone that has absolutely no idea what the other side is thinking.
What is more likely, insurance companies beat more than 50% more care per dollar out of doctors/hospitals etc, or people would be better of getting rid of the giant middleman? Insurance companies don't heal you. Medicine does. Get rid of the 33% overhead of insurance and gain the free 50% extra money for healthcare. Then all the people in that industry can move on to better gainful employment.
The government (county, state, or federal) pays for infrastructure, safety, defense, (public) schools, and a lot of other things. All out of tax revenue. With the help of _private_ contractors. Through a bidding process for contracts and work - thereby getting the lowest price (even if not necessarily value).
It blows my mind that health is treated differently. It seems to me a lot of middle-America mistakenly assumes it's socialist, which single provider is. Single-payer is similar to most systems we already enjoy. It's the only way prices will come down. You need negotiating leverage and a single-payer system that a majority of your population uses is the only way to have that kind of leverage over drug companies and healthcare providers.
Single payer universal healthcare with more expensive private plans (for those who can afford) is the only system that can come close to fixing the broken healthcare system in this country.
I personally think Medicare for all could potentially be a good system. But this article doesn't make a good argument at all.
> Voters need to understand that this cost objection is specious. That’s because, as experience in many countries has demonstrated, the total cost of providing health coverage under the single-payer approach is actually substantially lower than under the current system in the United States.
Not a valid comparison. They literally give examples of three liberal states where there were cost concerns. And the response? It is not to compare to states where single payer actually worked, bit compare it to different countries with widely different budgets and levels of centralization from medical research, medical school to employment of doctors. Just not a valid comparison at all.
> It is a bedrock economic principle that if we can find a way to do something more efficiently, it’s possible for everyone to come out ahead.
Useless fluff statement
> By analogy, suppose that your state’s government took over road maintenance from the county governments within it, in the process reducing total maintenance costs by 30 percent. Your state taxes would obviously have to go up under this arrangement
How is this an "obvious " point? Need some justification for this very important point !
Hence this statement doesn't follow as the premise is not established
> Likewise, it makes no sense to oppose single-payer on the grounds that it would require additional tax revenue.
.
> One is that administrative costs average only about 2 percent of total expenses under a single-payer program like Medicare, less than one-sixth the corresponding percentage for many private insurers. Single-payer systems also spend virtually nothing on competitive advertising, which can account for more than 15 percent of total expenses for private insurers.
Finally, some relevant fact and justified points. These are good points in favor of single payer.
> The most important source of cost savings under single-payer is that large government entities are able to negotiate much more favorable terms with service providers
Ah this is infuriating. The link compares USA to other countries. Why not given evidence of Medicare compared to private insurers? That would be such a strong point in favor of Medicare. I just don't think you can compare the entirety of the American healthcare system to other countries without controlling for the wide disparity in the systems as mentioned above.
> In 2012, for example, the average cost of coronary bypass surgery was more than $73,000 in the United States but less than $23,000 in France
Sad reality but again this comparison is meaningless without controlling. Why not compare states with single payer with states that don't have it? Or why not compare Medicare bypass surgeries with those of private? If none of those support the argument for single payer, then at least control for the variables when comparing countries... Otherwise the comparison is just lazy (or worse, just narrative building ).
> In short, the evidence is clear that single-payer delivers quality care at significantly lower cost than the current American hybrid system. It thus makes no sense to reject single-payer on the grounds that it would require higher tax revenues. That’s true, of course, but it’s an irrelevant objection.
I agree with this point, I am willing to take a higher tax hit to support single payer but the tax question is not an irrelevant object at all!
Anyway, sorry if I sound bitter. I really want to see the US have a robust single payer system that respects it's ability to innovate with drugs and provide great healthcare to everyone. I just hope defenders of single payer (especially economics professors like the author ) can build a better case for it. I hope.
> Ah this is infuriating. The link compares USA to other countries. Why not given evidence of Medicare compared to private insurers?
If Medicare covered the same set of people as private insurers it might be a good comparison. However in the U.S. Medicare currently covers certain groups (elderly, disabled) that have very different profiles from most private insurance customers.
I'm still wondering if it's possible to little by little add single-payer. If we could agree for basic 6-month checks at a doctor for preventive heads-up, basic immunizations, a single child delivery, and potentially a few other things; I wonder whom would get on-board. If at least very basic healthcare is guaranteed, why couldn't we as a nation at least provide that?
Interested to see what someone more knowledgable would say is wrong with trying that.
[+] [-] galeaspablo|8 years ago|reply
In the list of nations with the best bang for buck healthcare programs, you will notice that top 20 healthcare programs are mostly single payer.
http://www.who.int/healthinfo/paper30.pdf
But there are single payer healthcare systems with bad health indexes, you might say... Well, combine single payer healthcare systems and add some transparency in healthcare and you now have an unmissable correlation.
https://www.transparency.org/whatwedo/publication/global_cor...
The top 20 bang for buck healthcare programs (mostly single payer systems), have an average ranking in terms of healthcare transparency of 18.7.
Are you from the USA? Notice the countries with universal healthcare, who have a similar healthcare transparency ranking to that of the USA: Luxembourg, Canada, Germany, France, Belgium, Ireland, and Chile. Their bang for buck rankings are 16, 30, 25, 1, 21, 19, 33 respectively. All of these countries have a better bang for buck ranking than the USA's 37.
In one sentence... Universal and transparently managed healthcare consistently gives more bang for buck.
And now to quote the original article... "It is a bedrock economic principle that if we can find a way to do something more efficiently, it’s possible for everyone to come out ahead."
EDIT: Check page 18 in the first source. Check chapter 11 in the second source.
[+] [-] warcher|8 years ago|reply
[+] [-] nostromo|8 years ago|reply
With the federal government unable to act, turning healthcare back to the states to test a number of different solutions seems entirely reasonable. Let California try single-payer and Texas try something different -- after a few years see if we've found a solution that could work for the whole country.
[+] [-] cortesoft|8 years ago|reply
If California implements a single payer system, it would make people in other states more likely to choose not to get healthcare; if they get sick, they can just move to California.
This is the reason the ACA has the 'individual mandate' to go along with preventing the denial of care because of pre-existing conditions - without some coercive force, there is no reason to buy health care until you get sick.
This is why a national single payer system is the solution.
[+] [-] donmatito|8 years ago|reply
Risk selection is a very driver of prices in health insurance. If you can spread the risk between healthy and sick people, the price goes down. If you can't, the price goes up.
Secondly, having a population that has no health insurance means less prevention, i.e. worse health problems down the road, again driving the costs up
[+] [-] ravitation|8 years ago|reply
Why would you imagine that?
Regardless... You must also then ask the question, whether a "truly free market health care system" would be ethical.
[+] [-] anotherfounder|8 years ago|reply
[+] [-] verelo|8 years ago|reply
In all seriousness, state run healthcare is a great idea, but the government is just such a big stakeholder in having a healthy population that I do not see a good reason for it [at some level] to stay out of that line of business. Single payer works, so much better than the current setup...why not start there and try iterate?
[+] [-] rhcom2|8 years ago|reply
[+] [-] typomatic|8 years ago|reply
[deleted]
[+] [-] rednerrus|8 years ago|reply
The federal government already pays for 64.3% of healthcare costs http://www.pnhp.org/news/2016/january/government-funds-nearl.... In a centralized managed system this would likely cover the cost of all healthcare. It's roughly what other industrialized nations pay, per person, for single-payer.
[+] [-] prostoalex|8 years ago|reply
That story needs to come with a caveat that Medicare's anti-fraud efforts are covered by law enforcement budgets, namely FBI https://news.google.com/news/search/section/q/medicare%20fra...
[+] [-] dv_dt|8 years ago|reply
https://ourworldindata.org/the-link-between-life-expectancy-...
Anti-fraud measures can be evaluated for cost-benefit in isolation, but when the fundamental cost structures are so completely out of whack then we should prioritize discussion of the fundamental problems - which is lack of single payer universal healthcare in America.
[+] [-] martinald|8 years ago|reply
[+] [-] specialist|8 years ago|reply
https://www.amazon.com/Healthcare-Fraud-Auditing-Detection-G...
[+] [-] tvchurch|8 years ago|reply
In other words, if it costs you $500 in administration costs and one patient has care that totals $5,000 and another has care that totals $10,000, then their administrative costs are 10% and 20%.
And yet we think that if we shifted more people onto a Medicare-like system, we'd save money.
[+] [-] bradleyjg|8 years ago|reply
[+] [-] peterhadlaw|8 years ago|reply
> The most important source of cost savings under single-payer is that large government entities are able to negotiate much more favorable terms with service providers.
If there are no other options for clients, it's essentially the government telling doctors how much their services are worth.
[+] [-] lb1lf|8 years ago|reply
On a more serious note - education and skills tend to pay off.
Around here, doctors with their own practice are reimbursed by the state via several mechanisms, the two most significant ones are probably a fixed sum for each patient they are responsible for (they get this regardless of whether the patient sees them or not) and a fixed sum for each treatment, prescription filled &c.
Anecdotally, an MD with his own practice earns approx. $100k-$150k annually before taxes; this is 2-2,5 times the national average. (Very roughly speaking, but in the right ballpark)
[+] [-] dv_dt|8 years ago|reply
Edit: Here's a deal, lets pay for doctor's educations, implement universal healthcare and call it even.
[+] [-] leepowers|8 years ago|reply
Another issue here is termination shock - if a provider comes up under the current system, getting into massive student debt in anticipation of a highly remunerative medical career, how will price controls effect him?
[+] [-] xemdetia|8 years ago|reply
To me what we have already doesn't feel like a market. It's not like I feel doctors are being paid net/15 and that is why they get a discount. Or that they invest in their health care networks so costs are reduced for them in the long run. Insurance company hedges their bets so that they have the money to pay, but then when you get to a certain age you are chucked to the curb and then society has to pay for it. I just don't see where insurance companies are being fantastic middlemen or support networks for medical professionals or linking those who need care and appropriate medical professionals and producing value above and beyond what a single-payer system provides elsewhere. They just seem to complicate the costs significantly and do not create a market where resources feel distributed efficiently.
To me the biggest weirdness of health insurance is why they are a for-profit industry or largely for profit in the non-competing model they have right now. I want the employees of a insurance company to be smart, paid well and distribute all the resources in a smart way, but instead the goal is making money. If the market was competitive like it is for car insurance and other insurances that is fine because there are actual competitors but the whole equation doesn't work because most individuals making health insurance purchasing decisions have effectively the same amount of choice as whether or not you have Comcast.
[+] [-] caseysoftware|8 years ago|reply
A more useful comparison would be the average cost of coronary bypass surgery for someone with a employer-provided health plan versus the cost that Medicare, Medicaid, or the VA pays. And then compare the average wait times of each along with recovery time/effectiveness.
Out of pocket is only one "cost" in this picture.
[+] [-] methodover|8 years ago|reply
The vast majority of the savings come from government price fixing. This is what the article means by "large government entities are able to negotiate much more favorable terms with service providers." It's not really a negotiation; at least not like it is in the private sector. When the government controls an entire market, they set prices. They can (and should) take input from providers and drug/device developers, but at the end of the day, whatever they say goes.
There are incredible risks when the government sets prices for a good/service. We should not take on those risks lightly.
[+] [-] exelius|8 years ago|reply
[+] [-] esturk|8 years ago|reply
Aside from "negotiation is not negotiation in the private sector", you aren't adding much to the discussion. Yes, government negotiation is still negotiation and yes it is not like in the private sector but it doesn't make it any less legitimate.
[+] [-] ClassyJacket|8 years ago|reply
[+] [-] jellicle|8 years ago|reply
[+] [-] _m8fo|8 years ago|reply
I hate to be the conspiracy theorist, but I can't help but think that's the truth.
[+] [-] cortesoft|8 years ago|reply
This is not a secret, and not really a conspiracy; the groups that make money from the current system are always the ones opposed to change. It just sucks because there aren't nearly as many of them as the rest of us, but they just have more to lose than the rest of us have to gain - a classic example of concentrated benefits and diffuse costs.
[+] [-] sailfast|8 years ago|reply
Some taxes maybe? The whole "mandate vs. tax" argument was at the core of the opposition to the Affordable Care Act. I would argue that this issue is not decided by a long shot and a great deal of people are still upset by this.
Further, this article addresses aggregate costs but doesn't acknowledge that costs of the change to single payer will impact people in much different ways. Some folks will be asked to pay a lot MORE, and some will be asked to pay LESS, and it may settle out to be cheaper in aggregate, but cheaper to whom? These impacts (especially felt in the short term) need to be considered and mitigated.
[+] [-] DrScump|8 years ago|reply
[+] [-] mcrad|8 years ago|reply
No, there's no perfect solution, but there must be a balance of market forces and semi-trustworthy regulators to make it work.
[+] [-] donmatito|8 years ago|reply
If I understand correctly the biggest savings come from the mandatory nature of the coverage - everybody is covered at least partially by the State, + employees by their employers, + private offers for the others + universal coverage for immigrants and the most destitute. Risk is shared between the healthy and sick people, and prevention can be maximized.
[+] [-] LensLarque|8 years ago|reply
If you have no work, there is an universal healthcare to cover you, but you cannot get fancy glasses or good tooth implant.
The prices are regulated by deciding the amount reimbursed by the national healthcare for each medical act. The private healthcare reimbursement are based on these prices. Doctors are free to ask more money, but you are going to pay the delta.
Savings are mainly achieved by having both sick and healthy people paying. Also, the fact that any medical treatment is basically free encourages you to see your doctor everytime you are beginning to be sick, preventing complications leading to a stay in hospital.
Note also that many private healthcare are mutual insurance which are lowering the rates if there is a profit.
[+] [-] yegle|8 years ago|reply
http://www.latimes.com/politics/la-pol-sac-road-funding-prob...
[+] [-] luxuryballs|8 years ago|reply
Plus if I don't play well with others the government will take away my license so I can't drive anymore. I don't want the government standing between me and healthcare in any sense of the term. If they are the ones in charge of a limited resource that means they are also the ones that have to say 'no' when there isn't enough to go around.
[+] [-] undersuit|8 years ago|reply
>California’s reliance on gas taxes to repair its transportation network is becoming less and less tenable. Increased fuel economy standards have led to less spending on gasoline
Why stop at saying it's a funding problem? (Allegedly) Obstructionist Republicans won't allow the government to react to changing conditions to update laws needed to fix the funding problem.
[+] [-] erentz|8 years ago|reply
https://itunes.apple.com/us/podcast/common-sense-with-dan-ca...
[+] [-] leepowers|8 years ago|reply
> The most important source of cost savings under single-payer is that large government entities are able to negotiate much more favorable terms with service providers.
I agree these objections are not relevant for the overall system. But certain individuals and groups within the current system will get screwed.
The wealthy and upper middle-class will oppose any tax increases, as it will decrease their take-home income. Plus the resentment of having to pay for someone else (the moochers).
Providers will oppose any haircut that comes with single-payer rates and price controls. No more millionaire doctors, specialists, or dentists.
And of course the overhead of health insurance middle-men and the huge administrative bureaucracy costs.
This is the crux of the problem. We could have a reasonably good system for everyone. But it requires a lot of people with heavily vested interests into a less ideal situation.
[+] [-] luxuryballs|8 years ago|reply
[+] [-] ML_God|8 years ago|reply
[deleted]
[+] [-] Aron|8 years ago|reply
Of course, having to pay taxes is itself a mandate of a sort, but it’s one the electorate has largely come to terms with. Apart from fringe groups that denounce all taxation as theft, most people understand that our entire system would collapse if tax payments were purely voluntary."
Seriously? This is the argumentation from someone that has absolutely no idea what the other side is thinking.
[+] [-] RichardHeart|8 years ago|reply
[+] [-] kbutler|8 years ago|reply
Highways? Defense? Education? National parks?
Why would single payer health care be the exception?
[+] [-] blizkreeg|8 years ago|reply
It blows my mind that health is treated differently. It seems to me a lot of middle-America mistakenly assumes it's socialist, which single provider is. Single-payer is similar to most systems we already enjoy. It's the only way prices will come down. You need negotiating leverage and a single-payer system that a majority of your population uses is the only way to have that kind of leverage over drug companies and healthcare providers.
Single payer universal healthcare with more expensive private plans (for those who can afford) is the only system that can come close to fixing the broken healthcare system in this country.
[+] [-] vowelless|8 years ago|reply
> Voters need to understand that this cost objection is specious. That’s because, as experience in many countries has demonstrated, the total cost of providing health coverage under the single-payer approach is actually substantially lower than under the current system in the United States.
Not a valid comparison. They literally give examples of three liberal states where there were cost concerns. And the response? It is not to compare to states where single payer actually worked, bit compare it to different countries with widely different budgets and levels of centralization from medical research, medical school to employment of doctors. Just not a valid comparison at all.
> It is a bedrock economic principle that if we can find a way to do something more efficiently, it’s possible for everyone to come out ahead.
Useless fluff statement
> By analogy, suppose that your state’s government took over road maintenance from the county governments within it, in the process reducing total maintenance costs by 30 percent. Your state taxes would obviously have to go up under this arrangement
How is this an "obvious " point? Need some justification for this very important point !
Hence this statement doesn't follow as the premise is not established
> Likewise, it makes no sense to oppose single-payer on the grounds that it would require additional tax revenue.
.
> One is that administrative costs average only about 2 percent of total expenses under a single-payer program like Medicare, less than one-sixth the corresponding percentage for many private insurers. Single-payer systems also spend virtually nothing on competitive advertising, which can account for more than 15 percent of total expenses for private insurers.
Finally, some relevant fact and justified points. These are good points in favor of single payer.
> The most important source of cost savings under single-payer is that large government entities are able to negotiate much more favorable terms with service providers
Ah this is infuriating. The link compares USA to other countries. Why not given evidence of Medicare compared to private insurers? That would be such a strong point in favor of Medicare. I just don't think you can compare the entirety of the American healthcare system to other countries without controlling for the wide disparity in the systems as mentioned above.
> In 2012, for example, the average cost of coronary bypass surgery was more than $73,000 in the United States but less than $23,000 in France
Sad reality but again this comparison is meaningless without controlling. Why not compare states with single payer with states that don't have it? Or why not compare Medicare bypass surgeries with those of private? If none of those support the argument for single payer, then at least control for the variables when comparing countries... Otherwise the comparison is just lazy (or worse, just narrative building ).
> In short, the evidence is clear that single-payer delivers quality care at significantly lower cost than the current American hybrid system. It thus makes no sense to reject single-payer on the grounds that it would require higher tax revenues. That’s true, of course, but it’s an irrelevant objection.
I agree with this point, I am willing to take a higher tax hit to support single payer but the tax question is not an irrelevant object at all!
Anyway, sorry if I sound bitter. I really want to see the US have a robust single payer system that respects it's ability to innovate with drugs and provide great healthcare to everyone. I just hope defenders of single payer (especially economics professors like the author ) can build a better case for it. I hope.
[+] [-] jefurii|8 years ago|reply
If Medicare covered the same set of people as private insurers it might be a good comparison. However in the U.S. Medicare currently covers certain groups (elderly, disabled) that have very different profiles from most private insurance customers.
[+] [-] al3xnull|8 years ago|reply