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Americans - would you support single-payer?

Would you support a single payer system in the US?

  • Total voters
    108
aociswundumho said:
What has changed to move you into the maybe camp?
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Given the experience of the last decade and a half, I find four arguments increasingly persuasive.

1. The administrative complexity of the current multi-payer system is untenable. Navigating varying coverages, and provider networks, and payment policies is maddening for everyone involved, sapping not only energy and resources better directed elsewhere but also contributing to a dehumanizing experience for anyone unfortunate enough to have to navigate the health care system. Americans spend infuriating time trying to track down answers to questions that arguably shouldn't even have to be asked. As I noted somewhere above, it’s very evident at this point that people much prefer simplicity and paternalism to the responsibility and burden of the decision-making required of people navigating the marketplace on their own (even when the choice architecture is deliberately simplified for them).

2. The juice isn't worth the squeeze when it comes to the multi-payer landscape of private insurers. Whatever benefits theoretically ought to accrue from choice and competition are outweighed by a rash of well-documented bad behavior on the part of private payers, including but not limited to: failing to adequately inform their beneficiaries of the services to which they're entitled; using technology to deny claims without medical review; bilking employers out of the funds they're putting up to pay their employees' health expenses; negotiating substantially higher prices for their (or their employer clients') privately insured patients than for their Medicare business; denying care for Medicaid-insured patients at higher rates than others; inflating the federal payments they get to insure Medicare beneficiaries; and straight up tricking old folks during the Medicare sign-up process.

3. There are no obviously easier ways than something like single-payer to tackle one of the primary challenges we have, which is how to distribute the costs of health care in a fair, rational, equitable way. Health care hasn't gotten more expensive for society since the Affordable Care Act passed thirteen years ago--today it comprises roughly the same shares of GDP and per capita income that it did just before the ACA passed. Yet if people feel like health care has gotten relatively more expensive since then, it suggests income inequality and the way we distribute health care costs across the population may be a bigger problem than actual health care cost growth, at least recently. I underestimated how much the cost curve would bend post-ACA, and yet overestimated how much achieving that would be felt by people. That suggests that a larger system-wide approach to spreading the load equitably is going to be needed.

4. As long as we continue to use people to deliver care, a continuously rising cost burden is likely inevitable. Long-term, if you believe the cost disease hypothesis then (notwithstanding the pause over the past thirteen years in the wake of the ACA) we're destined for health care to take up an ever-greater share of our economy and it's a little hard to envision how we reasonably distribute health care costs using our multi-payer premium-based system when health care takes up 40, 50, 60 percent or more of GDP. This is essentially a longer-term version of point 3.
 
If you are a Medicare recipient, all of that is irrelevant. If you had four grandparents, you are a mixture of who they were, with all associated genetic predispositions that lifestyle choices cannot overcome if the luck of the draw serves up other health disorders. Only a tiny number of households can weather three years of long term in patient care without exhausting assets and becoming "wards of the state". Are you setting yourself up to go out, "that way" because whatever ends up confining you to a nursing home because of incapacitation may not shorten your life to the extent it does patients with chronic negative habits to their health lifestyles, destines you to live on as a longterm financial drain to taxpayers?

A recent statement by one VA long term care facility was that the average patient lived 832 day at the veterans' long term care facility,
 
Bullseye said:
Perhaps you should grasp that I'm not advising Exxon to take over helathcere. Try to grasp the context before you spew an irrational brain fart.
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Suggesting that Exxon is more trustworthy than Congress is the real brain fart.
 
cpwill said:
those numbers are not apples to apples. The U.S., for example, counts premie deaths.

Also, having been on it, I can attest that our government-run Healthcare is qualitatively worse than our private system.
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My mother-in law, in a span of just under three years, had two different, successful transplant surgeries via government run healthcare (military). And due to her husband being a retired Army officer, TRICARE (double check, but I believe that is still the military medical insurance) prevents them from paying that much for it. As in, a few hundred dollars a year...whereas civilians would be paying hundreds of thousands.

While military personnel will pay for it out of their paycheck, it is a fraction of what we have to pay for on private insurance per paycheck. The rest is paid for by the American taxpayers to take care of our folks in the military. This is a example of why I don't mind paying taxes: it takes care of those who take care of us. And it's a program that isn't too different from single-payer healthcare.

I don't know what your experience was, not trying to minimize it, but my experience personally and through family members are different than yours.
 
Every time I read through the pros and cons of a single payer system, I come away more doubtful of the system ever working here in the US. The United States government is on par with third world countries when it comes to incompetence, waste, fraud, and abuse and nobody is held accountable for it for the most part.

Every single time that I have used Tri-Care since I retired from the Navy I got stuck with a stack of bills from doctors and hospitals........ because the bills got kicked back to them. The DEERS program ( Defence Enrollment Eligibility Reporting) system has been ****ing up my DOB & middle name since Jan 11, 1977. I had to resubmit/update DEERS info at every new command on active duty. I had to go back to the PSD offices at Oceana Air Base, Little Creek JEB, NOB, Portsmouth and Naval Hospital no less than 6 times to resubmit/update my DEERS enrollment since I retired in 1997.

The funny part is ..................if there is one............. the incompetence within DEERS never affected my wife or and kids medical billings while they were still eligible.

Try getting a retired military ID card when your DEERS information is all ****ed up. My wife could get hers with the correct DEERS info but I couldn't.................and I was her sponsor?

My credit score was down in the 500 range a few times instead of being in the 800 range where it should have been because of DEERS **** ups.

I ended up seeing doctors under my wife's private insurance for non emergency visits just to avoid the nightmare right up until my 65th birthday.



If it weren't for the good people over at the Amphibious Base Credit Union here in my area, I would never have received a single small business loan. They looked past the medical on my credit reports.

Portsmouth Naval was a god send as well....... they knew about my DEERS situation while I was active duty and kept it in my records which really saved me couple times after I retired.


On top of my own issues, I lost two old shipmates to suicide because of the Hampton Virginia VA. The VA kept them dugged up for years instead of fixing their hips, arms, and shoulders.

Hampton VA hospital admits more than 800 vets may not have received timely care

Internal emails from the Hampton VA uncovered by a NewsChannel 3 investigation show schedulers at the hospital are working overtime on what’s known as the NEAR (New Enrollee Appointment Request) call list. They are contacting 836 veterans who have been waiting for an appointment to try and get them
www.wtkr.com

The VA Fueled The National Opioid Crisis, Killing Vets

The VA killed thousands of vets and fueled the national opioid addiction crisis by recklessly throwing pills at a problem.
www.newsweek.com

So until things get fixed.......................................a Big ****ing NO!
 
Better late than never, but these have all been glaring problems since health care costs exploded in the 80s, and ACA wasn't nearly about to fix them.
 
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Depends on the implementation. Some versions I would, some I wouldn't. I'd prefer a hybrid system like Germany's over a fully government owned and run system like the NHS.
 

While I also object to the federal government having the ability to automagically (without need for amendment) give itself new powers, it’s far too late for any hope that the SCOTUS will decide providing healthcare (only as it sees fit) isn’t a constitutional federal government power.

Keep in mind that congress critters currently have the power to tax your income (from all sources) in order to give funds to (any?) other individuals who they deem ‘qualified’ (entitled?) to spend those funds as they see fit.
 
I would support it IF its quality of care was better.

The problem is it’s a staple of single payer health care that for everyday stuff it’s great. If you need specialty care that increases with age the lines get long.

If I need a hip I want it yesterday. I don’t want to wait six months till they get around to me. If I need cardiac surgery I don’t want single payer’s lack of cardiac surgeons to cause me to die while I’m waiting for a table and a cutter.

This nation sucks for health care if you aren’t rich or have great insurance. If you are rich or have great insurance it’s better than nations with single payer. I have great health insurance.

I get it if you have lousy or no insurance and I wish you better. Our system is broken and needs restructuring. It’s better for me personally though than a single payer alternative with my current situation.
 

That depends on how the “free” (federal?) universal healthcare system is funded. As it stands now, employers deduct the (direct labor) costs of fringe benefits (e.g. medical care insurance) from their net (taxable) income. If (when?) that fringe benefit cost is no longer provided and is converted to increased worker pay, it’s likely that corporate federal income tax rates would be increased.
 
IOW, you would prefer not to be governed in a federal republic, but instead all or all major legislation would require passage of
constitutional amendments instead of legislative bills and then be signed by the POTUS and then proceed through the state legislature ratification process....

Can you not recognize that the present tyranny of the minority does not slake your thirst for it, you want Wyoming, Alaska, and perhaps an additional handful of other states with populations too small for two fully populated congressional districts to overrule settled law of
85 years as to the definition of "the general welfare"?
 
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It’s also important to look at how government (publicly funded) insurance saves money compared to private insurance - they pay medical care providers less.


How Differences in Medicaid, Medicare, and Commercial Health Insurance Payment Rates Impact Access, Health Equity, and Cost

Medicaid fee-for-service payments for physician services are nearly 30 percent below Medicare payments, which in turn are well below commercial rates
www.commonwealthfund.org
 

How is that any different than if a private employer’s pension (retirement?) plan included medical care benefits?
 
ttwtt78640 said:
How is that any different than if a private employer’s pension (retirement?) plan included medical care benefits?
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How long must one serve in order to collect full healthcare benefits? An honest question as I have no idea.
 
bomberfox said:
That too. Our ambulatory services are getting gutted by private equity as well. It just needs to be a public service like the fire department.
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I was charged $750 for a 6 mile ride to the hospital ER in a fire truck (all their ambulances were tied up on other calls).
 

(Not commenting on UHC)

My friend, I'm surprised at you thinking that companies can deduct fringe benefits as a cost of doing business and that under UHC those costs will be eliminated and converted into "increased worker pay".

In my job my insurance costs (EE+Spouse) runs about $3500 per year and my employer pays about $14,000 for a total premium of $17,500 per year.

Under UHC that $14,000 (some or all) my employer pays will be converted to the funding mechanism for UHC.

WW
 

The footnotes in the Commonwealth page you linked to, in addition to the text in the page the footnotes support, scream out for a reform such as single payer, unless reform determines that provision of healthcare is not a business.

Here are the footnotes, consider them along with the desire of RWE governed states for federal eimbursement in the form of block grants that are not earmarked for reimbursing any state expense in particular..... Brett Favre, are you listening?
  1. Federal law directs state Medicaid programs to ensure provider payments “. . . are sufficient to enlist enough providers so that care and services are available . . . at least to the extent that such care and services are available to the general population in the geographic area.” Title XIX Section 1902(a)(30)(A). This statutory requirement sets the standard for fee-for-service payments; for managed care, Medicaid rules require states that contract with a managed care organization to deliver services must establish and enforce standards to ensure an adequate network of providers; see, 42 CFR 438.68.
  2. Relatively high commercial rates are sometimes justified as needed to make up for lower Medicaid and Medicare rates. However, studies show that the same facilities that rely heavily on Medicaid not only have fewer patients with commercial coverage but are often paid lower commercial rates than facilities where commercial coverage is dominant.

Block grants are the heart of GOP's Medicaid plans. Here's ...​


PBS
https://www.pbs.org › newshour › nation › b-gran...
Jan 25, 2017 — Republican plans to transform Medicaid could help set debate on the role of government and entitlements. Here's an explanation of how it ...It’s called “block granting.” Right now, Medicaid, which was expanded under the 2010 health reform to insure more people, covers almost 75 million adults and children. Because it is an entitlement, everyone who qualifies is guaranteed coverage and states and the federal government combine funds to cover the costs. Conservatives have long argued the program would be more efficient if states got a lump sum from the federal government and then managed the program as they saw fit. But others say that would mean less funding for the program —...
..Currently, states share the cost of Medicaid with the federal government. Poorer states pay less: In Mississippi, for instance, the federal government pays about three-fourths the cost of the program, compared to 50 percent in Massachusetts.

The federal funding is open-ended, but in return, states must cover certain services and people — for instance, children, pregnant women who meet income criteria and parents with dependent children. Under a block grant, states would have more freedom to decide who qualifies, and for what services.
 
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Regarding UHC, I don't know.

Is it doable and provide a more efficient and cost effective health care delivery system? Absolutely as a philosophical mental exercise.

Can it be done? That is a whole other question.

Most people don't realize (in the real word, not on a political discussion board) that if they have group health insurance through their employer, what they "see" coming out of their paychecks is not the cost of the premium. Typically employers cover 75-80% of the premium cost and the employee deduction therefore is 20-25%. Most people in the real world don't understand the cost of their employer provided health insurance.
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While I think a UHC system * CAN * work, it depends on the funding stream that allows it to work. If the funding stream is equitable and consistent, that is the starting point. As such here are some suggestion (based on a modern economy):
  • All people pay a fixed percentage based on their 1040 Adjusted Gross Income. Current SS and Medicare taxes are based on only wages/salaries which was the norm decades ago. I think it much more equitable to realize that the workforce has changed and healthcare is supplied independent of income source. By using Income Tax Adjusted Gross as the basis it would include wages and salaries, but also include such things as capital gains, dividends, interest, and people that work the "gig" economy. This would be the individual fixed rate. UHC Individual Premium Cost.
  • Business would still pay into the health care system just as they do now in two ways. One, they are already responsible for paying Medicare Tax (1.45%) on wages and salaries. In addition employers are paying most of the actual premium costs for health insurance (employee portion + employer portion = actual premium). Under UHC most of the costs currently paid by employers for their group plan would be converted to the UHC Employer Premium Cost.
  • UHC Individual Premium Cost would be equal to UHC Employer Premium Cost.
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So at this point I can't say would I support UHC v. the current For Profit Model, it really depends on the UHC model and the funding.

Then there is the concept of a hybrid system similar to Medicare. Where there is a baseline coverage under UHC, this is available to all. For those that can afford it then there is available in the private sector "Gap Insurance" to handle uncover percentage costs.
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But lets be real, the For Profit Insurance mega-Corporations (Health Care and Pharmaceuticals) have very deep pockets because UHC would wreck their profit model. They are never going to allow meaningful UHC and they will lobby and bribe politicians to ensure it never happens.

WW

[DISCLAIMER: I currently have employer sponsored Health Insurance + TRICARE Select and in a few years will be moving to Medicare + TRICARE For Life. So ya, one could say I'm already partially in a UHC type system with TRICARE and once I retire even more so.]

W
 
WorldWatcher said:
(Not commenting on UHC)

My friend, I'm surprised at you thinking that companies can deduct fringe benefits as a cost of doing business and that under UHC those costs will be eliminated and converted into "increased worker pay".
Click to expand...

That’s a common claim made by many on the left who advocate for higher corporate share of federal income taxation. It’s hard to refute, since about 50% of workers currently pay no FIT.


OK, but the argument (basis for my reply) was the claim that employers (the example was Canadian auto manufacturers) save money under the (Canadian) UHC system. The corporate federal income tax rate in Canada is 38% as opposed to 21% in the US.
 
ttwtt78640 said:
I was charged $750 for a 6 mile ride to the hospital ER in a fire truck (all their ambulances were tied up on other calls).
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My wife was charged $300 twenty two years ago for a 6 mile ride to the closest hospital by paramedics manning a unit housed
in the local professionally staffed firehouse. I pointed out that she was suffering symptoms of a severe stroke and asked them repeatedly to transport her to the larger but 12 miles distant university hospital where she was employed as a nurse. They insisted on adhering to policy of transport to the nearest hospital. Three hours later the neurologist called in to evaluate her informed me that the hospital did not perform clot dissolving TPA treatment and that the four hour window to administer it at low risk would be exceeded even if he arranged transport by helicopter to the university hospital, 18 miles distant from the hospital in the other direction the paramedics had delivered her to.
 
ttwtt78640 said:
How is that any different than if a private employer’s pension (retirement?) plan included medical care benefits?
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Retiree Health Benefits At the Crossroads - Overview of Health Benefits for Pre-65 and Medicare-Eligible Retirees - 8576 | KFF

Trends Among Employers Offering Retiree Health Benefits Over time, the share of large employers (with 200 or more employees) offering retiree health benefits has declined, and employers that continue to offer benefits have made changes to manage their costs, often by shifting costs directly or...
www.kff.org

Employers covering employee health care in a private pension (retirement) system has been declining. Not only are employers NOT providing defined benefit plans, moving in the private sector, to 401K systems - even those that do are not covering health insurance costs. That means more and more people left with Medicare as their retirement health insurance. The above link is from 2014, but I can pretty much guarantee the percentage of employers extending health insurance to retirees has continued to decline in the last 9 years.

Hell, I work in a local government job and even I have to shift to Medicare at 65 (if retired) and can't be on my employers plan. Where I work there are provisions that if you retire prior to 65, you can stay on the plan until 65, but you are responsible for 100% of the actual premium.

WW
 
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ttwtt78640 said:
That’s a common claim made by many on the left who advocate for higher corporate share of federal income taxation. It’s hard to refute, since about 50% of workers currently pay no FIT.
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Possibly I wasn't clear, my fault.

I didn't mean to imply that it would be based on FIT Gross, I was using that as an example of how the revenue sources would be expanded beyond wages/salaries. The actual model would be like SS/Medicare, where the taxes are based on the time of earning. Working poor who pay no FIT, are STILL paying SS/Medicare taxes because they come of gross wages and are independent of FIT. For those not involved in the wage/salary economy, they would have a transactional UHC Individual Cost at time of posting (dividends, capital gains sale, interest, stock transaction, etc.)

ttwtt78640 said:
OK, but the argument (basis for my reply) was the claim that employers (the example was Canadian auto manufacturers) save money under the (Canadian) UHC system. The corporate federal income tax rate in Canada is 38% as opposed to 21% in the US.
Click to expand...

I know, I was commenting on the idea that business would convert an decreased costs to increased employee wages. We say with COVID corporations got huge handout from the government and often used them to pay dividends to investors and for stock buybacks. Actual workers say very little in companies/corporations that did this.

WW
 

That has nothing to do with my point, which was that different jobs having different retirement benefits isn’t unfair. The fact that veterans get VA benefit’s isn’t some greedy “I got mine so FU” - it’s a perk used to justify putting up with the downsides of military employment (service?).
 
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