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re: Single payer as a model in other industries not related to healthcare.
Posted on 7/20/17 at 4:10 pm to bonhoeffer45
Posted on 7/20/17 at 4:10 pm to bonhoeffer45
quote:I'm sure your arguments were in good faith.
Like I told the other person, I have litigated this with people that have actually tried to make good faith arguments and it hasn't worked.
That doesn't make them less wrong.
0
Posted on 7/20/17 at 4:11 pm to HailHailtoMichigan!
I am a strident opponent of single payer, but industry economics are critical in understanding pricing, service, and profitability. Healthcare isn't exactly like every other industry, just like, for example, the airline manufacturing industry is a lot different than every other industry and why three companies have dominated cereal production for seventy-five years.
The biggest problem, in my opinion and by far, is information asymmetry and lack of price transparency in healthcare. If someone could realistically solve that problem, they'd become the richest person in America.
I don't buy the captive audience argument unless in relatively extreme circumstances, as we've managed to figure out how to keep our two other major quality of life/life-sustaining industries - real estate and food - in quality shape and cheaper than our counterparts in most of the rest of the developed world without massive, wholesale intervention by the state and federal government.
I surmise that we'd still have the most expensive healthcare system in the world given our cultural and political context even if we skipped over a Bismarck model and went straight to an NHS or Beveridge model, and it probably still wouldn't be close.
The biggest problem, in my opinion and by far, is information asymmetry and lack of price transparency in healthcare. If someone could realistically solve that problem, they'd become the richest person in America.
I don't buy the captive audience argument unless in relatively extreme circumstances, as we've managed to figure out how to keep our two other major quality of life/life-sustaining industries - real estate and food - in quality shape and cheaper than our counterparts in most of the rest of the developed world without massive, wholesale intervention by the state and federal government.
I surmise that we'd still have the most expensive healthcare system in the world given our cultural and political context even if we skipped over a Bismarck model and went straight to an NHS or Beveridge model, and it probably still wouldn't be close.
Posted on 7/20/17 at 4:12 pm to HailHailtoMichigan!
We're talking about reducing prices in an industry already subsidized by government dollars.
Obviously another industry free of subsidies like TVs or something is not going to benefit from single payer.
Think about it. We already have single payer for old people (Medicare), poor people (Medicaid), plus additional single payer subsidies for others (Obamacare). What's the harm in replacing all of those with one single payer system to cover the same groups of people?
Obviously another industry free of subsidies like TVs or something is not going to benefit from single payer.
Think about it. We already have single payer for old people (Medicare), poor people (Medicaid), plus additional single payer subsidies for others (Obamacare). What's the harm in replacing all of those with one single payer system to cover the same groups of people?
Posted on 7/20/17 at 4:12 pm to HailHailtoMichigan!
quote:
Bonny, my point is this:
Why would single payer reduced prices in Medicaid but not in other industries?
I think I have mentioned several reasons now.
For one, administration is not free, there is little cost effectiveness for that type of bureaucracy(let alone even a need) for a commodity that is essentially relatively cheap and not critical to a person and societies core needs. So if you tried to implement single payer for cell phones, determined it was something all citizens had to have, I am not sure how that even works the same way but more importantly the costs far outweigh the benefits for that commodity and the social need make the argument in a world of scarcity kinda stupid.
The starting points, as mentioned above, are also vastly different.
This post was edited on 7/20/17 at 4:14 pm
Posted on 7/20/17 at 4:13 pm to HailHailtoMichigan!
quote:
If single payer lowers costs because of the huge bargaining position of the government having every citizen under its wing, when it enters into negotiation with the medical sector, why wouldn't that work in other industries as well? If everyone paid in and the government became a single buyer of cell phones and cell phone plans, wouldn't that massively reduce the price of both? The companies would have little alternative besides accepting the conditions of the single payer government, which all citizens are buying into.
the argument is going to be "healthcare is a right" or "healthcare shouldn't be determined by economic forces" to avoid the dilemma presented
Posted on 7/20/17 at 4:14 pm to bonhoeffer45
quote:
I have litigated this with people that have actually tried to make good faith arguments and it hasn't worked.
they spend less because they have less healthcare availability and certain aspects are less robust (like shared rooms)
as long as you're honest that single payer countries reduce spending by rationing care, i'll agree with your argument
Posted on 7/20/17 at 4:17 pm to cahoots
quote:
Think about it. We already have single payer for old people (Medicare), poor people (Medicaid), plus additional single payer subsidies for others (Obamacare). What's the harm in replacing all of those with one single payer system to cover the same groups of people?
the biggest issue is going to be treating them like actual single payer systems, which we don't
just look at those recent articles about how obscene our spending is for the elderly and how this isn't the case in Europe. why is our spending insane and so skewed to the end of lives of our citizens? b/c Medicare is not restricted by rationing like a real single payer system
go propose turning Medicare into a system like Europe and the AARP will revolt
Posted on 7/20/17 at 4:18 pm to AbuTheMonkey
quote:
I don't buy the captive audience argument unless in relatively extreme circumstances, as we've managed to figure out how to keep our two other major quality of life/life-sustaining industries - real estate and food - in quality shape and cheaper than our counterparts in most of the rest of the developed world without massive, wholesale intervention by the state and federal government.
Food and housing is heavily government subsidized just FYI. But by its nature, food and shelter is a cheaper product then cancer treatment.
Technology, like in any other sector, is ultimately the most disruptive force that can enter a space. It will be interesting to see what ultimately comes out with the emergence of supercomputers and AI with the healthcare industry. Like is happening with IBM's super computer.
The level of Asymmetry will probably never be solved, but technology and automation could make a pretty big impact on operating costs in the future.
Posted on 7/20/17 at 4:21 pm to bonhoeffer45
quote:
Food and housing is heavily government subsidized just FYI. But by its nature, food and shelter is a cheaper product then cancer treatment.
Not anywhere close to what healthcare is and with nowhere near the regulatory bodies surrounding it. Yea, there are mortgage subsidies and sugar protection and so forth, but it's peanuts compared to healthcare.
Posted on 7/20/17 at 4:22 pm to SlowFlowPro
quote:
they spend less because they have less healthcare availability and certain aspects are less robust (like shared rooms)
as long as you're honest that single payer countries reduce spending by rationing care, i'll agree with your argument
They spend less for a litany of reasons.
What is frustrating is for people to attempt a discussion as if it is the US vs. this caricature model that exists elsewhere.
We spend more for every unit of healthcare in the system by and large. That is the core difference. Why that is the case is often much more complex then the 2-3 bullet points people like to give. Just look at the drug industry for instance. Legal and industry protections, structural issues, industry power dynamics and a number of middlemen issues drive up the per unit cost enormously. Every system rations care, even Medicare. Healthcare is not an infinite resource, which means rationing has to take place. So I just don't accept the premise you are making.
This post was edited on 7/20/17 at 4:24 pm
Posted on 7/20/17 at 4:24 pm to bonhoeffer45
quote:Why?
but healthcare is expensive
Why is healthcare so much more expensive in the US than abroad?
Why are Medicare and Medicaid (both socialized single-payer models) so much more expensive in the US than comparable systems abroad?
Posted on 7/20/17 at 4:24 pm to HailHailtoMichigan!
You are describing communism. Single payer would move us closer to actual communism. You think the left stops after single payer? Please.
Posted on 7/20/17 at 4:27 pm to AbuTheMonkey
quote:
Not anywhere close to what healthcare is and with nowhere near the regulatory bodies surrounding it. Yea, there are mortgage subsidies and sugar protection and so forth, but it's peanuts compared to healthcare.
I didn't say they are on equal spending ground, but the government is heavily involved in subsidizing food and shelter.
But the reason for the discrepancy in part goes back to what I am saying. Feeding a person, giving them public housing, is a lot cheaper then fixing their occupants bodies after car wrecks, treating/preventing a pandemic, treating someone with cancer. So of course the amount of spending will be disproportionate.
I think what people are all rallying around though is that what is in place could and should be made more efficient over the long-term.
This post was edited on 7/20/17 at 4:28 pm
Posted on 7/20/17 at 4:28 pm to cahoots
quote:
Medicaid
Medicare
Military
VA
ER rooms with non-payers
Obamacare subsidies
Replace all of that with a single payer system with strict controls. Idealistic, I know, but you could theoretically spend money more efficiently that way.
Also Preexisting conditions so that those who don't fall into those categories should have the best insurance premiums & deductibles we have seen in decades. Dump all the shite into one pile while giving the healthy to moderate healthy great rates.
I would then pass a national sales tax to offset the cost of the single payer where everybody has skin in the game. That's a lot fairer system that what we have at the moment.
Posted on 7/20/17 at 4:31 pm to ShortyRob
quote:
Hence, they simply pretend that their economic assertion on health care is UNIQUE to health care.
Somehow, HC is an industry that lives outside of economic reality.
Some people are humane enough to see that healthcareis a necessity when many other industries are not.
I know you want to make it so easy and just put it all in a nice little box but sometimes you just can't.
Posted on 7/20/17 at 4:35 pm to HailHailtoMichigan!
quote:I assume you are talking about some other government negotiating for our government. Anything our government negotiates costs more than it should.
If the government can lower the prices of medical delivery by having everyone under its wing and massively expanding its bargaining power, then that could be a model for an entire economic system
Posted on 7/20/17 at 4:36 pm to NC_Tigah
quote:
Why?
Why is healthcare so much more expensive in the US than abroad?
Why are Medicare and Medicaid (both socialized single-payer models) so much more expensive in the US than comparable systems abroad?
You could write a 500 page book and not answer all the questions NC(and there have been many) LINK 1
LINK 2
And we have had multiple discussions on this. So, yeah.
And I think you know some of the reasons, at least in one splinter sector. I remember that one time I was one of the few defenders of you when you made a good faith effort to analyze and prescribe some positive changes to the US tort system?
This post was edited on 7/20/17 at 4:36 pm
Posted on 7/20/17 at 4:39 pm to cahoots
quote:
I think the argument is more that a single payer system can consolidate the already ridiculous set of subsidies that we have right now.
Medicaid
Medicare
Military
VA
ER rooms with non-payers
Obamacare subsidies
i've been arguing this for a bit as a compromise position
take all the spending on medicare, medicade, VA and ACA and create a single fund. cut spending by 10-25% and that's the "public option" fund. all you have to do is apply and you're apart of the fund. it is to be run like European/Canadian single payer systems
then allow a private market and repeal all sorts of regs like EMTALA and draconinan regs on doctors who accept public monies
that covers everything except people who want single payer coverage without single care rationing (but even then, they can still opt out and by private insurance)
Posted on 7/20/17 at 4:41 pm to bonhoeffer45
quote:
What is frustrating is for people to attempt a discussion as if it is the US vs. this caricature model that exists elsewhere.
so you won't even admit that rationing is a major part of single payer systems?
this is the exact dishonesty that i was trying to address
quote:
We spend more for every unit of healthcare in the system by and large.
1. underclass population
2. robust care for covered (including government coverage)
3. being the leader in developing new medicines and having strong patents on new formulas
3 huge drivers of our costs that other countries don't have to face. how do we deal with those costs?
Posted on 7/20/17 at 4:43 pm to bonhoeffer45
quote:
I didn't say they are on equal spending ground, but the government is heavily involved in subsidizing food and shelter.
Massive, massive differences in scope, and they still largely operate in a free market.
quote:
But the reason for the discrepancy in part goes back to what I am saying. Feeding a person, giving them public housing, is a lot cheaper then fixing their occupants bodies after car wrecks, treating/preventing a pandemic, treating someone with cancer. So of course the amount of spending will be disproportionate.
You think housing a person is cheaper than healthcare? Check out overall housing spend vis a vis healthcare per person and overall in the U.S.
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