Americans - would you support single-payer?

[AliHajiSheik]

As they should, considering the US has higher infant mortality rates than many other developed countries. Why do you think that is? Could it have to do with the expectant mothers not having proper medical care?



I’ve been on it for years. I’ve been on Tricare Prime for probably 20 years, and Medicare for 8.

I have absolutely no issue with either. They both work as designed.

Since you asked, it does appear to be the definitions used is a major factor:

Upon examination, however, the discrepancy between the U.S. and other countries appears largely due to country-to-country differences in the way infant mortality statistics are compiled. Infant mortality is defined differently in different countries, and the U.S. definition is notably broader than that of most other countries.

Infant Mortality Rate by Country 2025

Discover population, economy, health, and more with the most comprehensive global statistics at your fingertips.

worldpopulationreview.com

The death of a live-born child before his or her first birthday. Age at death may be further classified as neonatal or postneonatal. Neonatal deaths are those that occur before the 28th day of life; postneonatal deaths are those that occur between 28 days and 364 days of life.

Infant death - Health, United States

Health, United States provides a wide array of trends in health statistics to policymakers, public health professionals, and the public. It presents statistics in four overarching areas: health status and determinants, health care utilization, health care resources, and health expenditures and...

www.cdc.gov

 

[WorldWatcher]

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?).

Understood, but that is a single sector. We're talking about UHC which will not be a "perk" of taking a specific job (Military, UAW Union Worker, etc.) we are talking about eliminating those system and going to UHC.

So totally agree, that VA benefits are NOT unfair based on their (my service).

The injection is looking at the future and pointing out that with the implementation of UHC (in it's most common model) means there wouldn't be different retirement health care systems based on employer. UHC by it's very nature means everyone (working, retiree, private sector, government sector, etc.) are all in the same system.

WW

 

[Bergslagstroll]

I don't have an opinion one way or the other. I've rarely had need of medical assistance, mostly (IMO) because I don't have a lot of "vices" that lead to poor health.

1. I don't smoke. (Nothing, so don't ask if that includes "preferred drugs").

2. I don't drink alcohol of any kind. To be honest it all tastes terrible, and if it tastes bad I figured it's not that good for you.

3. I avoid foods that are full of processed sugars (no candy, no confections, and no soft drinks).

4. I don't do any "recreational drugs."

I have annual physicals at the V.A. and pass them all with flying colors. That is literally the only "medical visits" I've had in decades.

I am not sure I support massive government programs of most kinds, but especially those that give people a false sense of security allowing them to think they can "party on," and someone will come take care of them.

Isn't it better to tax unhealthy choices directly than having people forced to pay a massive health bill 20 years after they mad those unhealthy choices. Especially you have also the dumb luck factor. That some thanks to good genetics can be healthier in old age even if they made more unhealthy choices.

 

[WorldWatcher]

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.
.
.
.
.

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.

.
.
.
.
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.
.
.
.
.
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

As was pointed out to me, I used "Adjusted Gross Income" in the example, which I probably shouldn't have. The intent was as an example, so I should have said Gross Income so that the UHC tax would be independent of gross. Meaning is would work like the SS/Medicare model where the tax applies regardless of whether Federal Income Tax is owed.

Hope that helps.

WW

 

[ttwtt78640]

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.

OK, but I have yet to see UHC (M4A) bill which advocates an increase in the FICA ‘payroll’ tax rate(s). The sales pitch is typically that corporations and “the rich” will pay higher FIT rates to fund “free” UHC (MFA).

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

Again, the sales pitch used to get the electorate to support a new government policy (or program) doesn’t necessarily mean that it will actually happen. It’s like the prediction that CA’s MW increase to $20/hour would help (all?) low income workers, yet reality indicates otherwise.

The layoffs are expected to go into effect as soon as February, just weeks before the state’s $20 minimum wage for fast-food workers is set to go into effect.

The pay increase is the result of Assembly Bill 1228, which applies to California workers employed by any fast-food chain that has more than 60 locations in the United States. California’s minimum wage is currently $15.50 for all workers. Statewide, the increase is estimated to affect more than 500,000 workers.

California Pizza Hut franchises to lay off more than 1,100 delivery drivers ahead of wage hike

Ahead of minimum wage increases, hundreds of California Pizza Huts are cutting delivery services and laying off drivers.

www.latimes.com

 

[MrNiceGuy]

Just a temperature check on how Americans feel about single-payer universal health care.

I traditionally have been against it, but the system has been so screwed up for so long now, that I think we are left with no choice.

 

[WorldWatcher]

OK, but I have yet to see UHC (M4A) bill which advocates an increase in the FICA ‘payroll’ tax rate(s). The sales pitch is typically that corporations and “the rich” will pay higher FIT rates to fund “free” UHC (MFA).



Again, the sales pitch used to get the electorate to support a new government policy (or program) doesn’t necessarily mean that it will actually happen. It’s like the prediction that CA’s MW increase to $20/hour would help (all?) low income workers, yet reality indicates otherwise.

California Pizza Hut franchises to lay off more than 1,100 delivery drivers ahead of wage hike

Ahead of minimum wage increases, hundreds of California Pizza Huts are cutting delivery services and laying off drivers.

www.latimes.com

Yep, there is a saying about the road to hell…

Which to me has always been about the law of unintended consequences.

WW

 

[Geoist]

I don't have an opinion one way or the other. I've rarely had need of medical assistance, mostly (IMO) because I don't have a lot of "vices" that lead to poor health.

You don't need 'vices' to have poor health. And you can take care of your body as well as anyone and still end up with cancer or some other debilitating disease that leads to bankruptcy.

 

[ttwtt78640]

Understood, but that is a single sector. We're talking about UHC which will not be a "perk" of taking a specific job (Military, UAW Union Worker, etc.) we are talking about eliminating those system and going to UHC.

So totally agree, that VA benefits are NOT unfair based on their (my service).

The injection is looking at the future and pointing out that with the implementation of UHC (in it's most common model) means there wouldn't be different retirement health care systems based on employer. UHC by it's very nature means everyone (working, retiree, private sector, government sector, etc.) are all in the same system.

WW

Maybe, but maybe not - that’s why we need to see the details of any US UHC plan (preferably in the form of a House bill). Germany, Canada and the UK each have different health care systems, yet all are said to have UHC.

 

[Geoist]

This forum is maybe not the best of gauges.

True. It is occupied by people who know more of their stuff when it comes to politics/policy than the average American. Interestingly, the forum leans more left than the average American. But I'm sure that's just a coincidence.

 

[ttwtt78640]

Yep, there is a saying about the road to hell…

Which to me has always been about the law of unintended consequences.

WW

Often, those consequences aren’t “unintended” (or unexpected), they’re simply not expressed (advertised?) in advance.

 

[eohrnberger]

Been over this ground before.

Yes, a 3 legged stool, but not in the terms that you elaborated on.

If you are proposing a government run health care system which returns everyone back to full health, regardless of cost, regardless of ability to pay, regardless of what health calamities, a really bad wreck or shooting, it is a sure road to national bankruptcy, after consuming everyone's income in form of taxation to support such a foolish idea.

As I've posted before, there are 3 aspects of this.

• Affordability
• Universal access
• Quality

You can dictate 2 the third will be a variable based on where you set the other 2.

You can have an affordable HC insurance system, with universal access, but the quality would suck.
You can have a universal access HC insurance system, with good quality, but it would be affordable to only some.
You can have an affordable, high quality HC system, but you wouldn't be able to provide it to everyone.

Just as in business and project management, there are three resources, and you can only control two at any one time, the third will adjust itself to what the other 2 dictate.

 

[Greenbeard]

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's really the crux of the problem, how to do it in a way the maximizes the number of winners and minimizes the number of losers. Those who view single-payer as coming with a magic dial we get to spin to reduce costs are in for a rude awakening, as I imagine if the question were ever called it would become apparent very quickly that the nurses unions supporting SP don't want to get busted and see their wages reduced, patients don't want to see their convenient local facility closed, people are not going to be willing to experience the capacity reductions that other cheaper systems just grin and bear, etc. We like getting fast access to cutting edge technology and treatments and it seems unlikely that we're going to be willing to give that up in the name of cost savings.

Which leads to the other part of the winners/losers conundrum: financing it. For all its faults, the bloated employer-based system has gotten a lot of middle class families used to having good access to world class care. We don't reserve access to great care just for the uber rich, we've made it part of the middle class experience. And we've done it by hiding the costs behind the employer portion of the premium. So you need to find a way to give people access to coverage that feels as good as what they have now (so, something better than traditional Medicare, which would feel like a step down to most people with employer-based coverage) without making it feel like they're paying more for it. A challenge that gets compounded if we're not really willing to pare back our system in the name of finding cost savings.

This is exactly the problem Vermont ran into a few years ago: they couldn't figure out how to design a plan and financing mechanism that didn't leave large swaths of their population feeling like they were paying more and getting less. Even if you can make the argument that on paper the opposite is true, what matters is how people experience the transition.

 

[Geoist]

1) Not all illnesses are based on bad choices

2) It’s not all about you.

Some of these posts truly reveal the conservative mindset:

1. How does it affect me?
2. Anything bad that happens to OTHERS is the result of poor life choices.

 

[Lovebug]

Emotional appeal...denied.

I will choose what to do with my resources as I see fit. If I can help a person I can see in real need, I will. That is real, it is in front of me, and I can act as needed.

But when it comes to the great mass of humanity and creating social safety nets, all I have seen is people in power using those funds for their own purposes and goals.

Buying power with giveaways using other people's money.

That's my last word on the subject. Feel free to have yours...

Having others pay for your annual check ups but denying others the same is what, exactly?

 

[Geoist]

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.

Not gonna pry on your health care coverage, but for the record, if you have Medicare Advantage you don't have actual Medicare.

 

[Greenbeard]

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.

I know, I was commenting on the idea that business would convert an decreased costs to increased employee wages.

Both excellent/important points. I think there's basically zero chance that "single-payer" in the United States would involve removing private insurers from the equation. As a practical matter, the SCOTUS is going to have an extremely rightwing majority for the foreseeable future and I don't see how they would allow that to happen. Nor is it clear the voters would allow that to happen. The majority of people in both Medicaid and Medicare right now are enrolled in private insurance plans, so it's hard to imagine that expanding access to "public" health insurance would really mean eliminating private insurers. (Somewhere above I mentioned the pile up of recent examples of bad behavior by private insurers is a good argument in favor of single-payer, which in the abstract I think it is--but in real life, I don't actually think "American single-payer" would be a solution to that problem because it wouldn't get rid of them.)

And as for converting employer health care contributions to wages, that's one where the economists will say that ought to happen in the long run and the average employee/voter is going to be justifiably skeptical. Which just underscores the point that even if you can figure out a decent financing model on paper, the politics of it are likely to be brutal beyond anything we've seen in our lifetimes.

 

[ttwtt78640]

That's really the crux of the problem, how to do it in a way the maximizes the number of winners and minimizes the number of losers. Those who view single-payer as coming with a magic dial we get to spin to reduce costs are in for a rude awakening, as I imagine if the question were ever called it would become apparent very quickly that the nurses unions supporting SP don't want to get busted and see their wages reduced, patients don't want to see their convenient local facility closed, people are not going to be willing to experience the capacity reductions that other cheaper systems just grin and bear, etc. We like getting fast access to cutting edge technology and treatments and it seems unlikely that we're going to be willing to give that up in the name of cost savings.

Which leads to the other part of the winners/losers conundrum: financing it. For all its faults, the bloated employer-based system has gotten a lot of middle class families used to having good access to world class care. We don't reserve access to great care just for the uber rich, we've made it part of the middle class experience. And we've done it by hiding the costs behind the employer portion of the premium. So you need to find a way to give people access to coverage that feels as good as what they have now (so, something better than traditional Medicare, which would feel like a step down to most people with employer-based coverage) without making it feel like they're paying more for it. A challenge that gets compounded if we're not really willing to pare back our system in the name of finding cost savings.

This is exactly the problem Vermont ran into a few years ago: they couldn't figure out how to design a plan and financing mechanism that didn't leave large swaths of their population feeling like they were paying more and getting less. Even if you can make the argument that on paper the opposite is true, what matters is how people experience the transition.

IMHO, the biggest problem with UHC is that the wonderful cost savings, advertised by switching to UHC, are largely obtained simply by paying medical care providers less. That likely means the cost of educating (training?) medical care provider personnel must also become publicly funded, as is the case in many (if not most) UHC nations.

 

[Greenbeard]

IMHO, the biggest problem with UHC is that the wonderful cost savings, advertised by switching to UHC, are largely obtained simply by paying medical care providers less. That likely means the cost of educating (training?) medical care provider personnel must also become publicly funded, as is the case in many (if not most) UHC nations.

The cost savings argument for single-payer seems weak to me, as I think the actual immediate cost savings potential is pretty modest. The opposite line of thinking is more persuasive to me: that, barring some drastic change in the nature of what health care is, it's inevitably and unavoidably going to swell as a portion of the economy and household budgets (past 20% of GDP to 30%, 40%, 50%, who knows?) and it's just hard to picture how that's going to work down the line without a standardized, rationalized way of extracting and transferring the money for the health care system in a fair and equitable way.

 

[jpevans]

YES, absolutely! I am one of those people who very rarely even go to a doctor and am on no prescription medications, but I see the value of having Universal Healthcare in the USA and I was glad when President Obama promoted the Affordable Care Act.

I was didapointed that Obama didn't lead with Universal Healthcare & be negotiated down to the vastly inferior ACA. At least give it a shot, so folks could have been more exposed to the concept. Bernie Sanders as the best advocate for it. There are those who feel that the sudden shift of all candidates to backing Joe Biden was basically to block Bernie & Medicare for All.

 

[Geoist]

Americans - would you support single-payer?​

Well, it IS about single payer (the title says so ) - apparently some think single payer the silver-bullet solution to all those layers of parasites between patient and doctor. But understand that much of the "system" as it is now, which is heavily, heavily influenced and regulated by the federal government at virtually every level, is the very system that spawns and breeds all those parasites.

It sucks now, but I can guarantee you if we put the federal government in complete charge and control of healthcare it'll only get worse, far worse.

And fwiw, I was in a "single payer" federal government controlled and regulated healthcare system - in the Navy. And I've seen how the government treats its veterans. Does anyone honestly think the government will treat its citizens any better than it does its veterans?

Why is it the citizens who are happiest with their health care are the ones who get it through a single payer/universal healthcare system?


Iceland came forward as the best with a staggering score of 93.6 on the healthcare access and quality index, reflected back into a 7.5 happiness score. Following suit is for Switzerland with a score of 91.8 and 7.6 respectively. Third place is for another Nordic country, Sweden, with a score of 90.5 and 7.4.

Global Health vs. Happiness Index | Lenstore

In our latest study, we've analysed how health correlates with happiness to reveal the importance wellbeing has on a nation's life satisfaction

www.lenstore.co.uk

 

[eohrnberger]

IMHO, the biggest problem with UHC is that the wonderful cost savings, advertised by switching to UHC, are largely obtained simply by paying medical care providers less. That likely means the cost of educating (training?) medical care provider personnel must also become publicly funded, as is the case in many (if not most) UHC nations.

This very much highlighting the realities as described in #287.

 

[jpevans]

It depends on who the single payer is that is going to pay for everyone's healthcare

The Taxpayer. It will raise taxes significantly, yet eliminate Insurances premiums, co-pays, medication charges etc. Most taxpayers will save.

 

[ttwtt78640]

The cost savings argument for single-payer seems weak to me, as I think the actual immediate cost savings potential is pretty modest.

I agree, since having a single-payer DoD and MIC system managed by congress critters is, by far, the most expensive on the planet.

The opposite line of thinking is more persuasive to me: that, barring some drastic change in the nature of what health care is, it's inevitably and unavoidably going to swell as a portion of the economy and household budgets (past 20% of GDP to 30%, 40%, 50%, who knows?) and it's just hard to picture how that's going to work down the line without a standardized, rationalized way of extracting and transferring the money for the health care system in a fair and equitable way.

That’s also likely to become true for housing (combined with utility) costs, as they seem to be rising far faster than general inflation or wage increases.

 

[ttwtt78640]

The Taxpayer. It will raise taxes significantly, yet eliminate Insurances premiums, co-pays, medication charges etc. Most taxpayers will save.

Progressives say that about every proposed (new or expanded) government program.