[quote=“Boerenkool, post:60, topic:1292”]
Maybe I don’t understand this, but how can anyone be uninsured under a single payer system?
Secondly, does California, one of the top ten largest economies in the world, really need federal money to implement single payer healthcare?[/quote]
Because in California a single payer plan was proposed, but not implemented.
Your reading is correct. And yes, the federation of states lends some strength and flexibility to the system similar to the EU. The primary difference between a large % of the taxes collected head to the federal government before being distributed back to the states, therefore things like universal medical care in one state would be difficult because so much of the tax money gets sent to Washington DC first.
So, California is a huge economy but a ton of money flows from the federal government to the states – it’s not trivial to make up that difference. Certainly California could come up with some plan where the state funds its own health insurance without any federal subsidies – but the current plan being is built assuming Medicaid & Covered California will still be around. i don’t see how it’s workable if those just disappear.
Also, I guess I just think the idea of federalism, states’ rights, etc. are theoretical constructs that are important in some ways, but that in practice, people in one country want to feel like they are (mostly) one people. And having totally standards of living and benefits in one place to another just doesn’t seem to help with this already yawning divide that’s been creeping up in our country.
I like they way you think. Unfortunately, the federal government would have to do that, and I am sure in your country you have seen many examples of large government organizations reducing their budget, but here in the good ole US of A, we are only capable of letting budgets grow.
Your reading is correct. And yes, the federation of states lends some strength and flexibility to the system similar to the EU.
Goodness, I hope our country isn’t so far gone that the difference culturally and politically between different states is equivalent to the difference between England and Greece or Estonia and Spain…
I think that the inherent differences between states in the US, is of course, much much less than differences in culture between countries in Europe.
But the Federal Power/ State Power approach lends strength and flexibility to both, where a single government entity wouldn’t. The similarities are in the approach, not in the actual execution.
Not really. The only budget that has consistently been cut over the past 20 years is the Defense budget. Now that the US has elected Trump, most parties are finally realizing that we can’t and shouldn’t always rely on the US and that we should increase the Defense budget or perhaps even keep our promise to spend 2% of the GDP on Defense.
This has been a fascinating thread. I haven’t read every single post, but read many of the posts… There have been discussions between state rights vs federal rights, and these “united states”. Historically, important discussions were held to try to have as many decisions made at the level where the impact was felt. This is one of the reasons that there are local school districts. Education in the US is not centralized, but rather decentralized, and localized. When it comes to healthcare, I feel that it’s not so much states rights vs federal mandates, but rather individual. It too ought to be as decentralized as possible. We ought to have the right to choose our healthcare providers, the types of tests, care…etc.
I had a discussion with a friend, who is not diabetic, and is in “good health”. He suggested that if every individual were given a “lifetime healthcare/wellness allowance” and also allowed to purchase additional optional healthcare, it would drive the decision making away from bureaucrats to the individual. We, the people, can choose the doctors, the tests, the operations, If my friend, has excess allowance and does not need the allowance, he can perhaps trade with those who may need additional allowance. What would be that life time allowance? not sure. This is certainly a work in progress. Such a system would incentivize people to shop around and would put control back into the hands of the people rather than bureaucrats. It is just an idea, and a discussion. I’m just throwing this out there.
Unless that allowance was incredibly high, I don’t see how that system wouldn’t result in the premature deaths of many people with cancer, chronic illnesses etc…it seems like a bad idea to me to depend on other people deciding to donate some of their allowance to you (which few cautious people would, since you never know when you might get diagnosed with a very expensive disease). I think people in good health often have no comprehension of how expensive health care can be. I still remember the years I had crappy grad student insurance with a $1000 cap on prescription spending per year. Most of my fellow students thought that was more than enough; it lasted about a 1.5 months for me—was eye-opening as someone who had previously always had good coverage and never really saw the actual costs of my meds. And diabetes is nowhere near as expensive as medical conditions can get!
Plus, inevitably, you will end up with a lot of folks who are in tough financial straights potentially trading away their allowance because they can and they need those funds NOW (and humans generally tend to prioritize their current needs over potential future ones), only then to be out and relying on emergency rooms etc, the cost of which just gets eaten by the state.
My intention is to begin a dialog. I am by no means prescribing a solution for the current health care system which is pretty messed up. Doctors are discouraged because they are being dictated as to how much time to spend with a patient and other restrictions, guidelines, imposed upon them by mostly administrators who is not necessarily interested in delivery quality healthcare and wellness.
My recent experience really blew me away:
I called my insurance company about the cost of various blood tests (lipids, A1C…etc) and learnt that the “negotiated rate” is actually higher than the “uninsured, pay at the point of service”. For example, if I were to agree to pay for my blood tests at the time of service, I would pay less than having it billed through the insurance company. Perhaps I am simple minded - does anyone see a problem with this picture?
If we have any hopes of reigning the rising cost of healthcare, we do need to properly incentivitize the users. Healthcare, wellness is a complex issue, or is it?
I don’t think there’s a contradiction there. Leaving it to the states enables your state to decentralize healthcare regardless of what other states do. Let other states implement state healthcare if they want. Many European politicians dream of a federal European Union - an important reason why I’m interested in this discussion - but it’s my nightmare. I fear that they cannot withstand the temptation to centralize everything and thereby cause the collapse of the EU. Europe’s population is way too diverse to accept a one-size-fits-all healthcare system or taxation etc. I’m happy with the healthcare system in my own country and I don’t care about the healthcare system in Belgium or Germany or Italy neither will I care when (perish the thought) the EU becomes a federal state. Let other states do whatever they like. The British seem satisfied with their NHS despite its long waiting times and other problems, so good for them. I wouldn’t like to live under that system though.
I have the same concerns as @cardamom. Interesting thought, but your friend doesn’t seem to have thought it through.
No, you’re not simple minded. The situation you describe is ludicrous.
If we really decide to solve the issue, I think the most likely system that would work would be a public/private approach.
This would allow everyone to have the public insurance and some to opt for additional insurance on top of the public plan. The issue is that the public plan will have to have some serious restrictions. i.e. above age X, we don’t do Y if you have two or more issues from this list. Or when you get cancer, the following treatments are approved, if you want different treatments you need to purchase private insurance.
The trouble is enacting these types of restrictions will require some political will to say no to some groups, and that appears to be the biggest issue to me. There doesn’t appear to be much give and take in our current political process.
@Chris, to me I think the idea of public + private makes a lot of sense. Public should be a bit more bare bones. This is the system my cousins in Israel seem to have and like it a lot. That means no one dies or goes bankrupt from getting common chronic diseases with clear treatments, but it also means that more cutting edge/experimental treatments are still somewhat available to a large swath of the population.
Of course the other issues with this approach is we will have to increase our tax rate to 50%+ on every wage earner to offer this benefit. That will also sting some powerful interests.
We also need to be doing some serious cost-cutting in healthcare too. But that’s also tricky. Everyone from the ultrasound tech to the med tech to the doctor to the pharma rep to the device supplier to the person who takes out the trash in the hospital is usually overpaid relative to other industries or similar jobs in other countries. So cutting the costs doesn’t just mean health consumers save money – it likely means many people in the healthcare field would wind up with less take-home pay.
If we moved toward single-payer/Medicare for all, yes taxes would go way up, but healthcare spending might not or might even go down—a huge part of why it’s so high in this country is insurance companies and all the cost of dealing with that for-profit system. Way bigger of a reason than how much money janitors make.
I tend to agree with TiaG on this one. Removing all of the dollars for Health Insurance and even the Government Administration won’t make a dent. Every specialist physician will need a big pay cut, jobs in the hospitals will all need significant paycuts, etc to really make a dent in the spend.
