Why do you believe single-payer is a bad idea? The model works very well in most European countries.
NHS in the UK has 6M folks on waiting lists for things like cataract surgery, knee replacements etc. The wait time is in range of 18 weeks for many and for 300K+ > 52 weeks.
Private providers in the US will see you MUCH more quickly than one year (!!).
Some place like Europe are not really single systems. They do work well though in a lot of ways.
They will have statutory mandated and the private coverage. Even the mandated coverage will be delivered by 100-200 nonprofit funds. "Government has virtually no role in the direct delivery of health care."
So these systems work by a) requiring that everyone be covered and b) staying out of the way of the actual service. Interestingly in germany patient representatives have no vote on the main body handling this (insurance companies and physicians do).
And for anyone privileged to be able to afford good insurance in the US, you can presumably pay for better private insurance/service in Europe, right?
Places like Germany have taken a very different approach. Govt stays out of delivery of care entirely, but everyone has coverage basically (80% public/20% private maybe).
Public care is pretty good with low waits. But govt not delivering it.
The obvious question here (and I legitimately don't know the answer) is if there are a bunch of people who want knee surgery in the US but can't afford it, and so demand at the offered price is lower.
Fewer people being able to afford a procedure would generally mean less demand and shorter wait times, but its not clear that that's a preferred outcome at a population level.
Switching to a single-payer will be too costly for any political party to tolerate. The US spends $3.8T on health care per year. That's $11,500 for every single person in the United States.
In order to fund (raise taxes) to a single-payer system that number will need to drop dramatically. We'll have to cut out middlemen, reduce bureaucracy, negotiate domestically, etc. That $11.5k needs to drop to about $6k to be on the upper quintile of health spending per capita compared to other, successful, single-payer systems. That brings the total from $3.8T down to $1.98T.
...but therein lies the problem. The health sector is 18% of the economy and employs 14% of all US workers. You can't quickly pull $1.8T out of a single sector of the economy. Would it stabilize to 9% of the economy and 7% of all US workers? What do all those people (7% of all workers) who previously worked in health care go do? Where does that $1.8T that we used to spent show up?
So it's a conundrum. You need to slowly reshape the industry over 10-20 years and carefully manage the outcomes or it's an economic and political disaster. However, the only way for that gradual plan to work is if you raise taxes to fund the $5T that it would take to maintain status quo. ...and good luck with that. The total net worth of all the billionaires in the US is $5T. There isn't a tax rate in the world that could raise that kind of revenue.
Vermont tried to implement a single-payer system, did their own analysis of what it would take, and decided not to move forward.[0]
So it's not that I oppose single-payer in theory, I just oppose it as policy in the US because I see it as a political impossibility that is in the way of realistic reform. To me it's chasing a perfect outcome when there are good outcomes available.
[0]:https://www.vox.com/2014/12/22/7427117/single-payer-vermont-...
But I agree in general: healthcare reform should do something about costs, and healthcare is so much apart of our economy that any attempted cost reduction will be painful.
Presumably the entire industry isn't going to magically become less complicated when a single payer option begins. There will still be a need for many of those roles, but they will be employed by the state instead of private companies siphoning profit.
I have not seen, and I am not sure it would be possible to generate, evidence in the number of jobs that would be lost (or created) by a single payer system.
People complain all the time. The military budget is $700 billion. Healthcare expenses would be $5T to cover everyone in our current situation.
For reference, the total federal tax revenue is $3.86T. That’s individual, corporate, payroll, everything.
> Presumably the entire industry isn't going to magically become less complicated when a single payer option begins. There will still be a need for many of those roles, but they will be employed by the state instead of private companies siphoning profit.
Yes that’s the exact problem. How to not destroy millions of lives and the economy. You’re suggesting these people will go work for the state? We will literally have to, at minimum, double the effective tax at every single level. Double the federal income tax, double the payroll tax, etc.
Would you personally vote to double your total effective taxes? I would not.
Single payer just isn’t going to happen in the US anytime soon. Democrats can’t even corral the votes to fund an infrastructure bill that is a fraction of the cost an single player health plan would cost.
…and Democrats are going to get thrown out of Congress this year. So it’s time to move on to reforms that might actually happen.
Or we can keep endlessly chasing the perfect outcome and endlessly achieve nothing.
European countries (including the UK - actually one of the best examples of single payer health care) figured out that having a healthy population is a matter of national security, so it gets funded the same way.
Do you have any knowledge of what the typical waiting periods are in the US? How many are postponing care due to inability to cover the costs?
I happen to think the UK is not close to the best example.
These are for what in the US are considered relatively routine and available services - things like a pacemaker. Or knee and joint work.
“The pain is so bad now I don’t want to live much longer,” she explained. “I get up in the morning [and fear] making it to the bathroom without wetting myself as the pain and stiffness overwhelms me. Then, after losing my dignity, I attempt to make it down the stairs."
So we need to begin with just the basics - can you even get care at all - period.
Your employer can't "take away" your health insurance in the US in most cases. If they will stop paying for it in most cases they will send you a letter giving you the option to pay for it. This will cover you for up to 36 months.
What you would do is after being laid off is to take advantage of the downtime to get LOTS of care. That's actually pretty common approach, folks max out benefits for 1-3 months then let COBRA coverage drop. I've seen some folks take advantage of the 60 day period to decide to basically go get tons of testing, if nothing comes up they let it drop after 30 days. If they expect lots of costs they keep coverage.
Alternatively, a layoff is a qualifying event. You can sign up for subsidized coverage on the obamacare exchanges. For an individual this helps with incomes < $51K, and households of 4 < $106K. For example, if you still have SOME income coming in (let's say $20K per year) you'd do something like a Silver 87 plan. That runs about $3/month.
Alternatively, if you fall below certain thresholds in income (ie, laid off with nothing) you would be eligible for medicaid for adults. For an individual this kicks in for incomes below $17,000.
I can tell you it's pretty grim looking at a crippling illness and trying to juggle employment so that you might have a hope of managing that illness. So yes, I hope I'm wrong but so far it isn't looking so good.
Single nondisabled male adult - not in mandatory medicaid coverage groups unfortunately. That said, many of these types of states are are aggressive about offloading to disability. Depending on your circumstances than can be a route to medicaid as well.
Regardless of its effectiveness, single-payer is not the norm in "most European countries". Americans naturally get exposed most to the UK and Canada and so think that their single-payer systems with zero/minimal cost on delivery are what "everyone else" uses, but it's not true. Germany, Austria, Switzerland, and the Netherlands are among those that mandate getting one of dozens/hundreds of private plans (basically Obamacare without exemptions). Australia has a government-run plan, but *strongly* encourages people to move to private plans. France has three big nonprofit plans for the entire country, with 30% copayments (akin to a US high-deducctible plan, without the corresponding HSA). Etc., etc.
Also, coverage is rationed more in these systems, they would never approve these the $20,000 per bill with limited evidence type treatments.
It's a huge step up for everyone that is unemployed or on crappy minimum-wage insurance. Even if it's "only" on par with the worst of the US system, it still grants you the freedom to switch jobs and a better negotiating position for other benefits. And everyone that has better insurance can presumably just pay out of pocket to get better-than-minimum.
https://turbotax.intuit.com/tax-tips/college-and-education/t...