It takes one state to fully implement a working single-payer plan. That's it. Then over the next few years, the news stories start coming out. About the mom who didn't go bankrupt from breast cancer. About the kid who was born with an expensive heart defect and their family was still able to afford the college that he absolutely lived to go to, and he STILL gets insured after all that.
Once the majority of Americans have seen a working single-payer system, that integrates well with our existing insurance and medical industries, they are going to start asking questions. Specifically, they are going to start calling up their Governors and Congresspeople and demanding to know why THEY don't have this as well.
Drastic changes to healthcare scare people and it's easy to fan those fears into terror. That is literally why we have this AHCA shit to deal with. It took how long for people to understand how good Obamacare was? Six years? Six years of virulent messaging from the right about how it needed to be repealed. It was only when people stood on the verge of losing it they started to realize what they had done. (and they very well may still lose it).
We're not going to get it nationally for a long time, the GOP has seen to that. But every state that implements their own system can drastically improve quality of life for their people, save a lot of lives, and provide immense pressure to the rest of the country to finally get their shit together.
I disagree. The state most likely to be able to not only pass it, but actually afford it, is Cali. And large segments of Republicans (as well as some Dem's and unaffiliated) look at that state as being full of "liberal hippies and whack jobs" along with the whole "Hollywood elite" thing.
You would also need to get over the false impression that others are paying for it. I guarantee that any state run single payer system will have more than a few Republicans insinuating that it's being paid for by the broader US taxpayers, and contributing to the poor economy in deep red states. "All those libruls are on the dole with YOUR money".
Now, I still think they should do it. Because we're not getting it on a federal level in my lifetime at this point. So the more states that actually do right by the people living there the better. It'll just further the divide, but maybe the red states will actually get on board eventually once they get bad enough.
But leading by example would only work if the people (at least somewhat) objectively look at it... which we've unfortunately already proven they do not.
It takes one state to fully implement a working single-payer plan. That's it. Then over the next few years, the news stories start coming out. About the mom who didn't go bankrupt from breast cancer. About the kid who was born with an expensive heart defect and their family was still able to afford the college that he absolutely lived to go to, and he STILL gets insured after all that.
Once the majority of Americans have seen a working single-payer system, that integrates well with our existing insurance and medical industries, they are going to start asking questions. Specifically, they are going to start calling up their Governors and Congresspeople and demanding to know why THEY don't have this as well.
Drastic changes to healthcare scare people and it's easy to fan those fears into terror. That is literally why we have this AHCA shit to deal with. It took how long for people to understand how good Obamacare was? Six years? Six years of virulent messaging from the right about how it needed to be repealed. It was only when people stood on the verge of losing it they started to realize what they had done. (and they very well may still lose it).
We're not going to get it nationally for a long time, the GOP has seen to that. But every state that implements their own system can drastically improve quality of life for their people, save a lot of lives, and provide immense pressure to the rest of the country to finally get their shit together.
No state is going to be willing to to do it though. The states that might be open to it have expanded Medicaid under ACA and have uninsured rates of ~5%. And its a massive undertaking and one that by definition can't integrate well with our existing insurance and medical structures because it is a drastic change to go single payer. Vermont tried a few years ago and they couldn't make it work when they made an honest look at the costs involved. Colorado voters rejected it very strongly last year as well.
But putting that aside there was a successful implementation of universal coverage before Obamacare that worke well with existing insurance and medical industries. Massachusetts had basically the same framework before the ACA went national. It has gone very well and the uninsured rate is very low and premium growth slowed. It hasn't convinced conservatives and it is far less drastic than a single payer and it hasn't been a model for six years, but 10. Yeah approval for ACA is up, but its still right around 50%. Its not like its wildly popular to this day and that seems unrelated to its overall success.
Christ, they should be wishing for apathy. Gratitude is a unicorn to them at this point.
They're throwing shit at the wall and seeing what sticks at this point. They know they've cooked their goose and are looking for any out. If that means convincing Americans that they should be thankful for the all the crap of the past year and a half, then that's exactly what they're going to do as a party.
All opinions are my own and in no way reflect that of my employer.
I'd think right now would be a great time for dems to build up the case for single payer. Since they're out of power, there's no risk associated with having to produce legislation, but they can still work on crafting the basics so that when they retake power, they can roll with it if it looks like the people are receptive. And if the people aren't receptive, no big. Work on smaller scale tweaks to the existing law.
I'd very much like them to--desperately, even, as I'm personally the somewhat person who statistically makes the least use of healthcare on an individual-basis, and also have experienced both the Republican-local-interference bullshit failings of the ACA and the distinct and separate bad-plannings-in-design failings of the ACA (in fact, I complained about them at the Healthcare.gov thread in D&D), which has not left me terribly cheery on the program, but I understand how desperate many less fortunate people (from a health aspect) are, and don't want them dying.
What I wonder is if they can overcome their own institutional opposition (among some portion of the party staff and leadership) to what is, by American standards, a radical idea. Nevermind that some Democrats do oppose it--you'll find other Democrats who'll oppose it because of how important it is to present a united front as the minority party across multiple branches of government. It's the whole, "Well of course I want (insert non-stupid healthplan here), but not everyone feels that way--and if we let them realize it, the Republicans will eat us alive." It's not like the Republicans aren't embarrassing themselves with their own discord.
It's not a radical idea, it's an idea that generally doesn't work - that's why politics is mainly compromise.
The Dems have to 1) get it past the conservative Dems first (which can be a huge task all in itself, God help us if we get another Liebermann) then 2) the GOP - who are even more difficult, and this is where the whole thing tends to fall apart usually. Obama was lucky to get the ACA passed as it was, and repeating that today would be greater challenge.
What's what makes it a "radical" notion, I would argue--I don't think it's radical, but I can certainly think of quite a few significant Democratic legislators who are sickened by the idea for a few different reasons. Across the general, non-member-of-congress population, it seems to poll well, but I'm always pessimistic on that.
$400 B per year, compared to the about $200 B a year that they'd be able to fold in currently, from existing outlays, leaving the other half needing to be funded by additional taxes. The analysis softens it a bit, saying that nationalizing it would add in a bit more savings, making the actual cost closer to $50-100 B, but that's still a lot given that the annual budget for the whole state is $180B
Ooof. That's gonna make it hard. I'm interested to see if they can come up with something to pay for it.
It's going to be a hard sell.
The idea is that you take money that folks are already spending on health care and just divert it to the government. A $10,000/year tax hike sounds obscene before you get reminded that it's going to save you $15,000/year in medical expenses (premiums and deductibles), which is actually $5,000 in your pocket instead.
$400 B per year, compared to the about $200 B a year that they'd be able to fold in currently, from existing outlays, leaving the other half needing to be funded by additional taxes. The analysis softens it a bit, saying that nationalizing it would add in a bit more savings, making the actual cost closer to $50-100 B, but that's still a lot given that the annual budget for the whole state is $180B
Ooof. That's gonna make it hard. I'm interested to see if they can come up with something to pay for it.
It's going to be a hard sell.
The idea is that you take money that folks are already spending on health care and just divert it to the government. A $10,000/year tax hike sounds obscene before you get reminded that it's going to save you $15,000/year in medical expenses (premiums and deductibles), which is actually $5,000 in your pocket instead.
But this isn't how it works. One of the things people just have to find a way to get the fuck over is, "some of you are going to pay money that you don't get a benefit from other than the intangible concept that if you were unlucky, like that guy over there, you'd get the benefit he's getting."
$400 B per year, compared to the about $200 B a year that they'd be able to fold in currently, from existing outlays, leaving the other half needing to be funded by additional taxes. The analysis softens it a bit, saying that nationalizing it would add in a bit more savings, making the actual cost closer to $50-100 B, but that's still a lot given that the annual budget for the whole state is $180B
Ooof. That's gonna make it hard. I'm interested to see if they can come up with something to pay for it.
It's going to be a hard sell.
The idea is that you take money that folks are already spending on health care and just divert it to the government. A $10,000/year tax hike sounds obscene before you get reminded that it's going to save you $15,000/year in medical expenses (premiums and deductibles), which is actually $5,000 in your pocket instead.
Right but that's a huge assumption and completely untrue. More specifically 1/3 of of healthcare spending is not stuff that would get eliminated by single payer. Healthcare might cost say 10-20% less (that's generous) but that doesn't mean people would pay less because most healthcare spending isn't by the recipient, but by who pays for their health insurance. Generally that isn't an individual.
A large majority of people would end up paying more for healthcare even with substantial efficiency improvements because a very large percentage of people have employer provided health insurance or socialized health coverage, at least under most funding methods currently proposed. Theoretically wages should go up to compensate but that's theoretical and wouldn't be immediate. Most funding proposals also seems to be from payroll taxes like the way SS and Medicare is paid for, which are regressive. If you could get corporate taxes to pay for it, that'd be great but we haven't been able to effectively crack that nut for anything else either. In the short term its a huge transfer of financial burden from private employers to the public with massive transitional costs in order to address a problem that is largely addressed in states with Medicaid expansion. And if you're going that far, you could much more easily institute a public option that eliminates almost all the transitional costs while providing a bulwark against the added costs of private profit seeking
$400 B per year, compared to the about $200 B a year that they'd be able to fold in currently, from existing outlays, leaving the other half needing to be funded by additional taxes. The analysis softens it a bit, saying that nationalizing it would add in a bit more savings, making the actual cost closer to $50-100 B, but that's still a lot given that the annual budget for the whole state is $180B
Ooof. That's gonna make it hard. I'm interested to see if they can come up with something to pay for it.
It's going to be a hard sell.
The idea is that you take money that folks are already spending on health care and just divert it to the government. A $10,000/year tax hike sounds obscene before you get reminded that it's going to save you $15,000/year in medical expenses (premiums and deductibles), which is actually $5,000 in your pocket instead.
But this isn't how it works. One of the things people just have to find a way to get the fuck over is, "some of you are going to pay money that you don't get a benefit from other than the intangible concept that if you were unlucky, like that guy over there, you'd get the benefit he's getting."
Right, i way over-simplified and that scenario would only apply to some people, the higher end of the income spectrum would see absolute increases in their healthcare outlays, but the big point is that "they're gonna raise taxes!" is reductionist thinking because folks will assume that they have to eat the tax hike in its entirety, rather than only eating the portion of the tax hike that exceeds their current healthcare expenditures.
So the example is maybe a $20,000 tax hike which is 3/4ths offset by $15,000/year in medical savings.
And that's before you get into the voodoo economics part of it where single payer has net benefits due to overall healthcare costs decreasing in the long run (as universal preventative medicine access decreases the development of costly chronic diseases) and the decoupling of healthcare to employment leads to some extra entrepreneurship and labor mobility.
$400 B per year, compared to the about $200 B a year that they'd be able to fold in currently, from existing outlays, leaving the other half needing to be funded by additional taxes. The analysis softens it a bit, saying that nationalizing it would add in a bit more savings, making the actual cost closer to $50-100 B, but that's still a lot given that the annual budget for the whole state is $180B
Ooof. That's gonna make it hard. I'm interested to see if they can come up with something to pay for it.
It's going to be a hard sell.
The idea is that you take money that folks are already spending on health care and just divert it to the government. A $10,000/year tax hike sounds obscene before you get reminded that it's going to save you $15,000/year in medical expenses (premiums and deductibles), which is actually $5,000 in your pocket instead.
But this isn't how it works. One of the things people just have to find a way to get the fuck over is, "some of you are going to pay money that you don't get a benefit from other than the intangible concept that if you were unlucky, like that guy over there, you'd get the benefit he's getting."
Right, i way over-simplified and that scenario would only apply to some people, the higher end of the income spectrum would see absolute increases in their healthcare outlays, but the big point is that "they're gonna raise taxes!" is reductionist thinking because folks will assume that they have to eat the tax hike in its entirety, rather than only eating the portion of the tax hike that exceeds their current healthcare expenditures.
So the example is maybe a $20,000 tax hike which is 3/4ths offset by $15,000/year in medical savings.
And that's before you get into the voodoo economics part of it where single payer has net benefits due to overall healthcare costs decreasing in the long run (as universal preventative medicine access decreases the development of costly chronic diseases) and the decoupling of healthcare to employment leads to some extra entrepreneurship and labor mobility.
Yes, but my mortgage payment is due next week not in the long run. Transition costs are a thing, and that needs to be acknowledged and/or addressed rather than just hand waived away. I mean, the Feds could just eat it with deficit spending for some length of time like, say, a war or two by giving everybody a $5k shifting healthcare tax credit. But that addresses the transition. If you don't, a lot of people will be worse off for long enough that the status quo looks better for now.
I wonder if you could just mandate that employers include money that would have been paid to insurance in the employees check. Then refund the employers on the back end.
There are some problems with that that, and it would be very difficult to implement, but it at least reduces the immediate shocks to the market. I think.
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ButtersA glass of some milksRegistered Userregular
Our system is such a god damn spiderweb I don't see any way you get single payer without a massive and immediate shock to the market.
I wonder if you could just mandate that employers include money that would have been paid to insurance in the employees check. Then refund the employers on the back end.
There are some problems with that that, and it would be very difficult to implement, but it at least reduces the immediate shocks to the market. I think.
I've covered this quandary before: you have the tax hikes be both on individual income, and on payroll, splitting the cost of healthcare as it is already split: employer pays most, individual pays some, so you hike income taxes on all brackets a little, and hike payroll tax a more significant amount, but neither party has to worry about paying for insurance any longer.
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EncA Fool with CompassionPronouns: He, Him, HisRegistered Userregular
Yeah its gonna take collapse to get there. And a lot of innocent lives lost for stupid reasons.
Our system is such a god damn spiderweb I don't see any way you get single payer without a massive and immediate shock to the market.
Yes, and it would probably suck, but let's not go all sunk cost fallacy on this. The ACA was good but it's a band-aid on a gaping wound. Healthcare costs are still spiraling out of control and until we make some fundamental changes to how we get healthcare it will continue to get worse.
The ACA is better than what we had. We were seriously just completely fucked up until it passed. We've still got a long way to go though.
Other countries had for profit healthcare just like we did before they went UHC. It'll suck for some insurance companies and employees of those companies, but oh well, at least they'll have health care while they look for a job.
We don't have to get rid of private insurance entirely, those can still theoretically coexist with single payer.
not a doctor, not a lawyer, examples I use may not be fully researched so don't take out of context plz, don't @ me
Other countries had for profit healthcare just like we did before they went UHC. It'll suck for some insurance companies and employees of those companies, but oh well, at least they'll have health care while they look for a job.
We don't have to get rid of private insurance entirely, those can still theoretically coexist with single payer.
England, at least, established theirs after WW2. I am gonna guess at least some of Europe did the same. It was probably a lot easier to establish sweeping changes at that point.
There's no plan, there's no race to be run
The harder the rain, honey, the sweeter the sun.
Other countries had for profit healthcare just like we did before they went UHC. It'll suck for some insurance companies and employees of those companies, but oh well, at least they'll have health care while they look for a job.
We don't have to get rid of private insurance entirely, those can still theoretically coexist with single payer.
England, at least, established theirs after WW2. I am gonna guess at least some of Europe did the same. It was probably a lot easier to establish sweeping changes at that point.
Yeah, realistically, it'd take something catastrophic for there to be enough political will to push it through. Maybe the ACHA passing would qualify.
Other countries had for profit healthcare just like we did before they went UHC. It'll suck for some insurance companies and employees of those companies, but oh well, at least they'll have health care while they look for a job.
We don't have to get rid of private insurance entirely, those can still theoretically coexist with single payer.
England, at least, established theirs after WW2. I am gonna guess at least some of Europe did the same. It was probably a lot easier to establish sweeping changes at that point.
Canada's was established much later, in the late 60s/early 70s. In a similar parallel to the state-first method Pelosi suggested, it was proven in Saskatchewan first, fighting against doctor and insurance groups, then once proven to be A Very Good Thing, spread to the rest of the provinces shortly after. Insurance is mostly a provincial deal, even now.
So not all single payer systems in use now were established right after a nation went through a system shock, basically.
$400 B per year, compared to the about $200 B a year that they'd be able to fold in currently, from existing outlays, leaving the other half needing to be funded by additional taxes. The analysis softens it a bit, saying that nationalizing it would add in a bit more savings, making the actual cost closer to $50-100 B, but that's still a lot given that the annual budget for the whole state is $180B
Ooof. That's gonna make it hard. I'm interested to see if they can come up with something to pay for it.
It's going to be a hard sell.
The idea is that you take money that folks are already spending on health care and just divert it to the government. A $10,000/year tax hike sounds obscene before you get reminded that it's going to save you $15,000/year in medical expenses (premiums and deductibles), which is actually $5,000 in your pocket instead.
But this isn't how it works. One of the things people just have to find a way to get the fuck over is, "some of you are going to pay money that you don't get a benefit from other than the intangible concept that if you were unlucky, like that guy over there, you'd get the benefit he's getting."
Right, i way over-simplified and that scenario would only apply to some people, the higher end of the income spectrum would see absolute increases in their healthcare outlays, but the big point is that "they're gonna raise taxes!" is reductionist thinking because folks will assume that they have to eat the tax hike in its entirety, rather than only eating the portion of the tax hike that exceeds their current healthcare expenditures.
So the example is maybe a $20,000 tax hike which is 3/4ths offset by $15,000/year in medical savings.
And that's before you get into the voodoo economics part of it where single payer has net benefits due to overall healthcare costs decreasing in the long run (as universal preventative medicine access decreases the development of costly chronic diseases) and the decoupling of healthcare to employment leads to some extra entrepreneurship and labor mobility.
Any analysis which says that single payer healthcare is more expensive than the total costs of current healthcare in the US is wrong. Simple as that. Every other nation shows that they make it work better with single payer (either government provision, government minimum quality assurance, government is source of funding etc).
Introducing any new system, even in the smallest state, would save money for the people in that state since it does everywhere else in the world.
edit - If you read the article effectively what it says is that if they assume that the new single payer system can remove absolutely NONE of the inefficiencies of the current system and is obliged to continue paying for all of them at the current rates, and is also forced to pay for an entire new level of bureaucracy ABOVE the current system then it will be more expensive.
So yes, clearly if you insist that single payer healthcare must cost AT LEAST current costs + $1 then clearly the costs will rise by introducing single payer.
However, thats not how it works, and you can see clearly how this is just partisan nonsense. ALL single payer systems are cheaper. You are buying the same thing, but transitioning to a system where rather than the supplier having ALL negotiating power and the purchaser buying out of fear and terror, you are instead transitioning all power to the purchaser. It is literally impossible for this system to not save money by the 'rules' of economics.
Other countries had for profit healthcare just like we did before they went UHC. It'll suck for some insurance companies and employees of those companies, but oh well, at least they'll have health care while they look for a job.
We don't have to get rid of private insurance entirely, those can still theoretically coexist with single payer.
Off the top of my head I don't actually know any where it doesn't.
Other countries had for profit healthcare just like we did before they went UHC. It'll suck for some insurance companies and employees of those companies, but oh well, at least they'll have health care while they look for a job.
We don't have to get rid of private insurance entirely, those can still theoretically coexist with single payer.
England, at least, established theirs after WW2. I am gonna guess at least some of Europe did the same. It was probably a lot easier to establish sweeping changes at that point.
Canada's was established much later, in the late 60s/early 70s. In a similar parallel to the state-first method Pelosi suggested, it was proven in Saskatchewan first, fighting against doctor and insurance groups, then once proven to be A Very Good Thing, spread to the rest of the provinces shortly after. Insurance is mostly a provincial deal, even now.
So not all single payer systems in use now were established right after a nation went through a system shock, basically.
And it was done by one charismatic guy on a mission.
"it's too hard right now " is only true because you keep making it true.
Insert quote about thinking you'll win or thinking you'll lose blah blah here.
The states that might be open to it have expanded Medicaid under ACA and have uninsured rates of ~5%.
5% uninsured sounds low until you remember that health insurance is a basic necessity, not a luxury. Most first world countries have an uninsured rate of 0. (I almost said "most other" first world countries, but really, I don't know if the U.S. qualifies as a member of the first world.)
Yeah the West Coast could probably all agree to work together on a single payer system, but it'd be three identical systems, not one collective system.
I'd think right now would be a great time for dems to build up the case for single payer. Since they're out of power, there's no risk associated with having to produce legislation, but they can still work on crafting the basics so that when they retake power, they can roll with it if it looks like the people are receptive. And if the people aren't receptive, no big. Work on smaller scale tweaks to the existing law.
Meanwhile, they can still work the message of "the pubs have terrible ideas that will literally kill you."
Basically, they should mimic the pubs during the last decade, except actually come up with viable alternatives.
Two things terrify me.
One is the Republicans in power now, who seem like they're more or less on track to make massive cuts to Medicaid. They want to wage a massive assault on the poor. It is a humanitarian disaster in the making. And it's not just a moral failing -- it's dangerous. Nations that neglect the poor tend to end up in very bad situations, historically speaking.
However.
@ElJeffe's suggestion, a single-payer healthcare system, scares me too. We ought to be extremely reluctant to go that far. For the United States, it's the nuclear option. It carries massive risk.
You all are correct that a single payer system would reduce costs. A single payer system would do so by fixing prices -- the government would have the ability to say how much it'll pay for a particular device or treatment, and that would be that. Sander said his Medicare-for-all plan would cut healthcare costs by $8 trillion over ten years, and that sounds great, right?
But what effect would that have on innovation? $8 trillion is a massive amount of money. It seems almost self-evident that of course we would see less innovation. You can't cut $8 trillion dollars from an industry and expect to see no effect. The magnitude of the effect seems to be a matter of considerable disagreement, however. But it could be massive. The development of life-saving (or simply life-enhancing, which ought to be considered too) treatments might be delayed by years or decades if we collectively decide to fix prices. And typically speaking, a stifling of innovation is precisely what happens when a monopoly takes over a market.
And then there are the political consequences. A single payer system is a massive, MASSIVE political risk. Look at Obamacare. Look at the massive backlash it caused. The worst midterm election for the Democrats in modern history, and the party still hasn't recovered from it. And that was just philosophical opposition! No one was actually, personally injured by Obamacare in 2010, and yet the reaction was huge and terrible.
When a real single-payer plan kicks people off the insurance plans they've been used to, they'll be mad. When things go wrong -- and they will go wrong -- they'll be mad. The backlash will almost certainly be worse. The legislation might be able to survive until the benefits fully kick in and people get used to the new system, but that to me seems highly unlikely. What will likely happen is another Republican president will get himself elected with another Republican congress, and we'll see the pendulum swing towards the same kind of irresponsible leadership we're watching right now.
There's a number of other criticism to be made, but I'll stop there. It's a scary move, and an ill-advised one. Every time it came up in the Democratic primary, I cringed. And besides, there are smaller, incremental steps you can take that are much better -- like expanding Medicaid. Give the poor the help they need, but leave the rest of us free to participate in the market as we see fit.
I'd think right now would be a great time for dems to build up the case for single payer. Since they're out of power, there's no risk associated with having to produce legislation, but they can still work on crafting the basics so that when they retake power, they can roll with it if it looks like the people are receptive. And if the people aren't receptive, no big. Work on smaller scale tweaks to the existing law.
Meanwhile, they can still work the message of "the pubs have terrible ideas that will literally kill you."
Basically, they should mimic the pubs during the last decade, except actually come up with viable alternatives.
Two things terrify me.
One is the Republicans in power now, who seem like they're more or less on track to make massive cuts to Medicaid. They want to wage a massive assault on the poor. It is a humanitarian disaster in the making. And it's not just a moral failing -- it's dangerous. Nations that neglect the poor tend to end up in very bad situations, historically speaking.
However.
@ElJeffe's suggestion, a single-payer healthcare system, scares me too. We ought to be extremely reluctant to go that far. For the United States, it's the nuclear option. It carries massive risk.
You all are correct that a single payer system would reduce costs. A single payer system would do so by fixing prices -- the government would have the ability to say how much it'll pay for a particular device or treatment, and that would be that. Sander said his Medicare-for-all plan would cut healthcare costs by $8 trillion over ten years, and that sounds great, right?
But what effect would that have on innovation? $8 trillion is a massive amount of money. It seems almost self-evident that of course we would see less innovation. You can't cut $8 trillion dollars from an industry and expect to see no effect. The magnitude of the effect seems to be a matter of considerable disagreement, however. But it could be massive. The development of life-saving (or simply life-enhancing, which ought to be considered too) treatments might be delayed by years or decades if we collectively decide to fix prices. And typically speaking, a stifling of innovation is precisely what happens when a monopoly takes over a market.
And then there are the political consequences. A single payer system is a massive, MASSIVE political risk. Look at Obamacare. Look at the massive backlash it caused. The worst midterm election for the Democrats in modern history, and the party still hasn't recovered from it. And that was just philosophical opposition! No one was actually, personally injured by Obamacare in 2010, and yet the reaction was huge and terrible.
When a real single-payer plan kicks people off the insurance plans they've been used to, they'll be mad. When things go wrong -- and they will go wrong -- they'll be mad. The backlash will almost certainly be worse. The legislation might be able to survive until the benefits fully kick in and people get used to the new system, but that to me seems highly unlikely. What will likely happen is another Republican president will get himself elected with another Republican congress, and we'll see the pendulum swing towards the same kind of irresponsible leadership we're watching right now.
There's a number of other criticism to be made, but I'll stop there. It's a scary move, and an ill-advised one. Every time it came up in the Democratic primary, I cringed. And besides, there are smaller, incremental steps you can take that are much better -- like expanding Medicaid. Give the poor the help they need, but leave the rest of us free to participate in the market as we see fit.
Furthermore, the goal isn't single payer, it's universal health care coverage. We're better positioned to move to a European style hybrid system than single payer.
I'd think right now would be a great time for dems to build up the case for single payer. Since they're out of power, there's no risk associated with having to produce legislation, but they can still work on crafting the basics so that when they retake power, they can roll with it if it looks like the people are receptive. And if the people aren't receptive, no big. Work on smaller scale tweaks to the existing law.
Meanwhile, they can still work the message of "the pubs have terrible ideas that will literally kill you."
Basically, they should mimic the pubs during the last decade, except actually come up with viable alternatives.
Two things terrify me.
One is the Republicans in power now, who seem like they're more or less on track to make massive cuts to Medicaid. They want to wage a massive assault on the poor. It is a humanitarian disaster in the making. And it's not just a moral failing -- it's dangerous. Nations that neglect the poor tend to end up in very bad situations, historically speaking.
However.
ElJeffe's suggestion, a single-payer healthcare system, scares me too. We ought to be extremely reluctant to go that far. For the United States, it's the nuclear option. It carries massive risk.
You all are correct that a single payer system would reduce costs. A single payer system would do so by fixing prices -- the government would have the ability to say how much it'll pay for a particular device or treatment, and that would be that. Sander said his Medicare-for-all plan would cut healthcare costs by $8 trillion over ten years, and that sounds great, right?
But what effect would that have on innovation? $8 trillion is a massive amount of money. It seems almost self-evident that of course we would see less innovation. You can't cut $8 trillion dollars from an industry and expect to see no effect. The magnitude of the effect seems to be a matter of considerable disagreement, however. But it could be massive. The development of life-saving (or simply life-enhancing, which ought to be considered too) treatments might be delayed by years or decades if we collectively decide to fix prices. And typically speaking, a stifling of innovation is precisely what happens when a monopoly takes over a market.
And then there are the political consequences. A single payer system is a massive, MASSIVE political risk. Look at Obamacare. Look at the massive backlash it caused. The worst midterm election for the Democrats in modern history, and the party still hasn't recovered from it. And that was just philosophical opposition! No one was actually, personally injured by Obamacare in 2010, and yet the reaction was huge and terrible.
When a real single-payer plan kicks people off the insurance plans they've been used to, they'll be mad. When things go wrong -- and they will go wrong -- they'll be mad. The backlash will almost certainly be worse. The legislation might be able to survive until the benefits fully kick in and people get used to the new system, but that to me seems highly unlikely. What will likely happen is another Republican president will get himself elected with another Republican congress, and we'll see the pendulum swing towards the same kind of irresponsible leadership we're watching right now.
There's a number of other criticism to be made, but I'll stop there. It's a scary move, and an ill-advised one. Every time it came up in the Democratic primary, I cringed. And besides, there are smaller, incremental steps you can take that are much better -- like expanding Medicaid. Give the poor the help they need, but leave the rest of us free to participate in the market as we see fit.
I don't agree with the notion that my ability to continue to live is a market product, but that is likely beyond the scope of the thread.
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Then just pump that 8 trillion into Government funded research. You'll get way more bang for your buck, and have far better outcomes in terms of helping poorer countries with epidemics, and wont have to fuck around with patents and generics and stuff.
Then just pump that 8 trillion into Government funded research. You'll get way more bang for your buck, and have far better outcomes in terms of helping poorer countries with epidemics, and wont have to fuck around with patents and generics and stuff.
Also, more control over research regulations instead of having to constantly negotiate with lobbying groups. As a layman, it seems as though that would allow you to ensure testing protocols and drug releases are safer?
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I disagree. The state most likely to be able to not only pass it, but actually afford it, is Cali. And large segments of Republicans (as well as some Dem's and unaffiliated) look at that state as being full of "liberal hippies and whack jobs" along with the whole "Hollywood elite" thing.
You would also need to get over the false impression that others are paying for it. I guarantee that any state run single payer system will have more than a few Republicans insinuating that it's being paid for by the broader US taxpayers, and contributing to the poor economy in deep red states. "All those libruls are on the dole with YOUR money".
Now, I still think they should do it. Because we're not getting it on a federal level in my lifetime at this point. So the more states that actually do right by the people living there the better. It'll just further the divide, but maybe the red states will actually get on board eventually once they get bad enough.
But leading by example would only work if the people (at least somewhat) objectively look at it... which we've unfortunately already proven they do not.
Getting ready to roll out the misinformation campaign to fight the CBO score.
This ad is going to play in 21 vulnerable House districts and on Morning Joe on MSNBC.
What if I don't?
Christ, they should be wishing for apathy. Gratitude is a unicorn to them at this point.
I am so happy I have have more "choices".
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No state is going to be willing to to do it though. The states that might be open to it have expanded Medicaid under ACA and have uninsured rates of ~5%. And its a massive undertaking and one that by definition can't integrate well with our existing insurance and medical structures because it is a drastic change to go single payer. Vermont tried a few years ago and they couldn't make it work when they made an honest look at the costs involved. Colorado voters rejected it very strongly last year as well.
But putting that aside there was a successful implementation of universal coverage before Obamacare that worke well with existing insurance and medical industries. Massachusetts had basically the same framework before the ACA went national. It has gone very well and the uninsured rate is very low and premium growth slowed. It hasn't convinced conservatives and it is far less drastic than a single payer and it hasn't been a model for six years, but 10. Yeah approval for ACA is up, but its still right around 50%. Its not like its wildly popular to this day and that seems unrelated to its overall success.
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They're throwing shit at the wall and seeing what sticks at this point. They know they've cooked their goose and are looking for any out. If that means convincing Americans that they should be thankful for the all the crap of the past year and a half, then that's exactly what they're going to do as a party.
I mean, it's worked so far...
What's what makes it a "radical" notion, I would argue--I don't think it's radical, but I can certainly think of quite a few significant Democratic legislators who are sickened by the idea for a few different reasons. Across the general, non-member-of-congress population, it seems to poll well, but I'm always pessimistic on that.
The idea is that you take money that folks are already spending on health care and just divert it to the government. A $10,000/year tax hike sounds obscene before you get reminded that it's going to save you $15,000/year in medical expenses (premiums and deductibles), which is actually $5,000 in your pocket instead.
But this isn't how it works. One of the things people just have to find a way to get the fuck over is, "some of you are going to pay money that you don't get a benefit from other than the intangible concept that if you were unlucky, like that guy over there, you'd get the benefit he's getting."
The stupid magic words test still applies, so they have to phrase it like that.
Increasing coverage will always require more money from somewhere. You'll never close the coverage gap with increasing efficiency alone.
Right but that's a huge assumption and completely untrue. More specifically 1/3 of of healthcare spending is not stuff that would get eliminated by single payer. Healthcare might cost say 10-20% less (that's generous) but that doesn't mean people would pay less because most healthcare spending isn't by the recipient, but by who pays for their health insurance. Generally that isn't an individual.
A large majority of people would end up paying more for healthcare even with substantial efficiency improvements because a very large percentage of people have employer provided health insurance or socialized health coverage, at least under most funding methods currently proposed. Theoretically wages should go up to compensate but that's theoretical and wouldn't be immediate. Most funding proposals also seems to be from payroll taxes like the way SS and Medicare is paid for, which are regressive. If you could get corporate taxes to pay for it, that'd be great but we haven't been able to effectively crack that nut for anything else either. In the short term its a huge transfer of financial burden from private employers to the public with massive transitional costs in order to address a problem that is largely addressed in states with Medicaid expansion. And if you're going that far, you could much more easily institute a public option that eliminates almost all the transitional costs while providing a bulwark against the added costs of private profit seeking
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Right, i way over-simplified and that scenario would only apply to some people, the higher end of the income spectrum would see absolute increases in their healthcare outlays, but the big point is that "they're gonna raise taxes!" is reductionist thinking because folks will assume that they have to eat the tax hike in its entirety, rather than only eating the portion of the tax hike that exceeds their current healthcare expenditures.
So the example is maybe a $20,000 tax hike which is 3/4ths offset by $15,000/year in medical savings.
And that's before you get into the voodoo economics part of it where single payer has net benefits due to overall healthcare costs decreasing in the long run (as universal preventative medicine access decreases the development of costly chronic diseases) and the decoupling of healthcare to employment leads to some extra entrepreneurship and labor mobility.
Yes, but my mortgage payment is due next week not in the long run. Transition costs are a thing, and that needs to be acknowledged and/or addressed rather than just hand waived away. I mean, the Feds could just eat it with deficit spending for some length of time like, say, a war or two by giving everybody a $5k shifting healthcare tax credit. But that addresses the transition. If you don't, a lot of people will be worse off for long enough that the status quo looks better for now.
There are some problems with that that, and it would be very difficult to implement, but it at least reduces the immediate shocks to the market. I think.
I've covered this quandary before: you have the tax hikes be both on individual income, and on payroll, splitting the cost of healthcare as it is already split: employer pays most, individual pays some, so you hike income taxes on all brackets a little, and hike payroll tax a more significant amount, but neither party has to worry about paying for insurance any longer.
Yes, and it would probably suck, but let's not go all sunk cost fallacy on this. The ACA was good but it's a band-aid on a gaping wound. Healthcare costs are still spiraling out of control and until we make some fundamental changes to how we get healthcare it will continue to get worse.
The ACA is better than what we had. We were seriously just completely fucked up until it passed. We've still got a long way to go though.
We don't have to get rid of private insurance entirely, those can still theoretically coexist with single payer.
England, at least, established theirs after WW2. I am gonna guess at least some of Europe did the same. It was probably a lot easier to establish sweeping changes at that point.
The harder the rain, honey, the sweeter the sun.
Yeah, realistically, it'd take something catastrophic for there to be enough political will to push it through. Maybe the ACHA passing would qualify.
Canada's was established much later, in the late 60s/early 70s. In a similar parallel to the state-first method Pelosi suggested, it was proven in Saskatchewan first, fighting against doctor and insurance groups, then once proven to be A Very Good Thing, spread to the rest of the provinces shortly after. Insurance is mostly a provincial deal, even now.
So not all single payer systems in use now were established right after a nation went through a system shock, basically.
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Any analysis which says that single payer healthcare is more expensive than the total costs of current healthcare in the US is wrong. Simple as that. Every other nation shows that they make it work better with single payer (either government provision, government minimum quality assurance, government is source of funding etc).
Introducing any new system, even in the smallest state, would save money for the people in that state since it does everywhere else in the world.
edit - If you read the article effectively what it says is that if they assume that the new single payer system can remove absolutely NONE of the inefficiencies of the current system and is obliged to continue paying for all of them at the current rates, and is also forced to pay for an entire new level of bureaucracy ABOVE the current system then it will be more expensive.
So yes, clearly if you insist that single payer healthcare must cost AT LEAST current costs + $1 then clearly the costs will rise by introducing single payer.
However, thats not how it works, and you can see clearly how this is just partisan nonsense. ALL single payer systems are cheaper. You are buying the same thing, but transitioning to a system where rather than the supplier having ALL negotiating power and the purchaser buying out of fear and terror, you are instead transitioning all power to the purchaser. It is literally impossible for this system to not save money by the 'rules' of economics.
Off the top of my head I don't actually know any where it doesn't.
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And it was done by one charismatic guy on a mission.
"it's too hard right now " is only true because you keep making it true.
Insert quote about thinking you'll win or thinking you'll lose blah blah here.
I don't mean the practical difficulty I mean anything constitutional about creating 'single payer' across state lines state by state.
The Affordable Care Act included provisions to create interstate compacts.
Two things terrify me.
One is the Republicans in power now, who seem like they're more or less on track to make massive cuts to Medicaid. They want to wage a massive assault on the poor. It is a humanitarian disaster in the making. And it's not just a moral failing -- it's dangerous. Nations that neglect the poor tend to end up in very bad situations, historically speaking.
However.
@ElJeffe's suggestion, a single-payer healthcare system, scares me too. We ought to be extremely reluctant to go that far. For the United States, it's the nuclear option. It carries massive risk.
You all are correct that a single payer system would reduce costs. A single payer system would do so by fixing prices -- the government would have the ability to say how much it'll pay for a particular device or treatment, and that would be that. Sander said his Medicare-for-all plan would cut healthcare costs by $8 trillion over ten years, and that sounds great, right?
But what effect would that have on innovation? $8 trillion is a massive amount of money. It seems almost self-evident that of course we would see less innovation. You can't cut $8 trillion dollars from an industry and expect to see no effect. The magnitude of the effect seems to be a matter of considerable disagreement, however. But it could be massive. The development of life-saving (or simply life-enhancing, which ought to be considered too) treatments might be delayed by years or decades if we collectively decide to fix prices. And typically speaking, a stifling of innovation is precisely what happens when a monopoly takes over a market.
And then there are the political consequences. A single payer system is a massive, MASSIVE political risk. Look at Obamacare. Look at the massive backlash it caused. The worst midterm election for the Democrats in modern history, and the party still hasn't recovered from it. And that was just philosophical opposition! No one was actually, personally injured by Obamacare in 2010, and yet the reaction was huge and terrible.
When a real single-payer plan kicks people off the insurance plans they've been used to, they'll be mad. When things go wrong -- and they will go wrong -- they'll be mad. The backlash will almost certainly be worse. The legislation might be able to survive until the benefits fully kick in and people get used to the new system, but that to me seems highly unlikely. What will likely happen is another Republican president will get himself elected with another Republican congress, and we'll see the pendulum swing towards the same kind of irresponsible leadership we're watching right now.
There's a number of other criticism to be made, but I'll stop there. It's a scary move, and an ill-advised one. Every time it came up in the Democratic primary, I cringed. And besides, there are smaller, incremental steps you can take that are much better -- like expanding Medicaid. Give the poor the help they need, but leave the rest of us free to participate in the market as we see fit.
Furthermore, the goal isn't single payer, it's universal health care coverage. We're better positioned to move to a European style hybrid system than single payer.
I don't agree with the notion that my ability to continue to live is a market product, but that is likely beyond the scope of the thread.
It’s not a very important country most of the time
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Also, more control over research regulations instead of having to constantly negotiate with lobbying groups. As a layman, it seems as though that would allow you to ensure testing protocols and drug releases are safer?
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But Swiss democracy is actually super effective, generally speaking, so...