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Old 04-23-2016, 02:18 PM
 
Location: Prescott Valley, AZ
2,659 posts, read 2,306,510 times
Reputation: 2657

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We already have single payer health care via the government, that's called moving to Canada.

 
Old 04-23-2016, 02:54 PM
 
285 posts, read 272,447 times
Reputation: 286
Quote:
Originally Posted by asusual View Post
Well, how does universal care work for all in those nations where it is implemented and has been for decades, if not centuries? You have access to care without the problem of deductibles, co-pays or medical bankruptcies facing you. You do not worry about insurance plans or being eligible for them because of barriers like age or income limits.
There is no country which has had "universal care... for all" for more than a few decades. In those countries, they do not have access to all care for all - just certain amounts of care. They make choices about what to offer people and what not to offer them. Those choices are NOT put to some vote, but typically made by a committee. For example, the NHS in the UK does not offer long term dialysis for the elderly. I'm sure that some people would like to get it through the NHS, but the NHS will not offer it. A lady a while back wanted a drug called herceptin from the NHS for her breast cancer. They said no. She had to sue the system, and eventually got it. I'm not saying that isn't an acceptable tradeoff. I am saying that a single payor system, by definition, will limit what is available to the population through that system, usually a decision made by a committee. That doesn't mean it's bad. We just need to be clear what it is. There may be no copays to me, but there are definitely limits to what will be done inside such a system. Not everyone agrees that those tradeoffs are worth it. Some people LEAVE the US to be treated elsewhere. Some people from other countries COME to the US to be treated. That says to me that there are varying values about what different levels of health care are worth to people, and what people are willing to pay for it.

We have not had a good, robust conversation in our country about the very real possibilities that might exist with a single payor system, for many reasons - those on the right overstate their case (e.g. DEATH PANELS?!?!?!), those on the left overstate theirs (e.g. you won't have to give anything up! you'll get great health care for all), and so we rarely discuss the real issues at hand with any sort of civility or honesty.

If we really sit down and talk, we might find that deep down, we do share enough of our values to come up with a national health care system funded on a federal level from federal tax dollars, but I'm not optimistic in the short-term.

Quote:
How does Medicare, which is our true-blue universal care system, work with "such a diversity of people with different values"? Yet it does work for all its recipients with their diverse values, despite the attempts by private insurance to get their hands on it. Like all universal care systems, it works because it provides a common ground of core values -- in this case, care -- that is paid for by all and is for all upon our retirement. All these systems work by that universality. As for what would work and what would not work for this diversity, that depends on the patient/physician, but they all have that universal core to work from, no matter how differently they wanted to live their lives.
Even within medicare, there are a diversity of plans (potentially) reflecting a diversity of values. But only sort of. This gets complicated because it's not a true single-payor system because there are managed care medicare plans that are administered by someone other than the government. Even so, these plans do not give the people what they want or need. Often, people buy supplemental insurance. Some people would rather medicare do less and let them buy other plans. Others want medicare to do more, and do not accept that there are limitations to the system (not necessarily ones that make sense to the patient, but limitations still). Additionally, it is NOT paid for by all - only those who work. And it is not available to all, again only to those who have worked or are married to someone who worked enough to pay into the system. It is NOT a true single payor system for all. It's close, but we should be accurate in our discussion.

Quote:
One of the reasons our health care costs have nearly reached the moon is because we do not have this universal core. It is just competing entities with no special interests in keeping costs either on the level or down. Universal care works as a system and they do have an interesting in keeping costs under control as much as humanely possible.
The reasons for costs is complicated. But yes, part of the reason is that we do NOT have an agreeement about what health is, what health care is, what should be paid for by whom, and so on. Some say that's part of what being in a large and diverse country entails - difficulty coming up with truly common expectations, common desires, and agreement on what to do to have those desires met in the public sphere.

Please do not read me as being inherently opposed to a single payor system. I think I could be convinced depending on the details. I am not convinced by any current plan I see put forth so far. The devil is in the details, for health care plans as for most things. Additionally, in order to implement such a plan in a country as ours, I do think we will need to have a much more robust discussion about our values, what we share in common, and what might actually be acceptable to the various parties. I don't think we've ever had such a conversation, and I'm not optimistic about the current atmosphere engendering that sort of conversation on a national level.

On a state level, similar problems exist, albeit usually less pronounced. Let us just remember that a part of Colorado almost voted to secede. That seems like quite a diversity of values to me.

Last edited by philberf; 04-23-2016 at 03:53 PM.. Reason: a few typos
 
Old 04-23-2016, 05:05 PM
 
Location: Evergreen, Colorado
650 posts, read 564,243 times
Reputation: 999
Quote:
Originally Posted by philberf View Post
We have not had a good, robust conversation in our country about the very real possibilities that might exist with a single payor system, for many reasons - those on the right overstate their case (e.g. DEATH PANELS?!?!?!), those on the left overstate theirs (e.g. you won't have to give anything up! you'll get great health care for all), and so we rarely discuss the real issues at hand with any sort of civility or honesty.
Good post Philberf
 
Old 04-24-2016, 05:55 AM
 
20 posts, read 34,479 times
Reputation: 35
I'm trying to understand the math on this. I'm not in Colorado so forgive my ignorance. I'm reading that there's basically a flat 4.63% tax on everyone regardless if you're an employee, an S-Corp owner or whatever. I read somewhere just now that for some people in Colorado, their tax could be as high as 14.63%. Without getting into who pays what and exactly how it's divided up, wouldn't this new tax be a 10% increase in taxes for business owners (14.63%), and not from 4.63% to 10%?
 
Old 04-24-2016, 06:26 AM
 
1,561 posts, read 2,817,479 times
Reputation: 1994
Quote:
Originally Posted by asusual View Post
Well, how does universal care work for all in those nations where it is implemented and has been for decades, if not centuries?
They ration care.
They don't spent tremendous sums of money on the first and last year of life (eg., crack babies, preemies, and extending the life of the terminally ill)
They don't have the Frank Azars of the world chasing ambulances.
 
Old 04-24-2016, 06:58 AM
 
Location: Foot of the Rockies
86,886 posts, read 102,281,764 times
Reputation: 32946
Quote:
Originally Posted by BarryK123 View Post
They ration care.
They don't spent tremendous sums of money on the first and last year of life (eg., crack babies, preemies, and extending the life of the terminally ill)
They don't have the Frank Azars of the world chasing ambulances.
They also pay health care workers less.
15 Highest Paying Countries for Nurses - Insider Monkey
 
Old 04-24-2016, 08:20 AM
 
285 posts, read 272,447 times
Reputation: 286
Quote:
Originally Posted by Katarina Witt View Post
They also pay health care workers less.
15 Highest Paying Countries for Nurses - Insider Monkey
and health care workers are often started down their educational path sooner and end with less/no debt. Some would say that's good since they get through the educational pipeline sooner with less of the income-maximization incentive. some say that's bad because it's limiting the scope of good health care workers in terms of broader life experience/education (e.g. fewer humanities majors going into health care related fields)
 
Old 04-24-2016, 08:31 AM
 
1,561 posts, read 2,817,479 times
Reputation: 1994
No question there's a brain drain. When I applied to med school, in the 70s, there were 10 applicants for every spot. Now it's in the 2-3:1 range.
 
Old 04-24-2016, 08:41 AM
 
Location: Foot of the Rockies
86,886 posts, read 102,281,764 times
Reputation: 32946
Quote:
Originally Posted by philberf View Post
and health care workers are often started down their educational path sooner and end with less/no debt. Some would say that's good since they get through the educational pipeline sooner with less of the income-maximization incentive. some say that's bad because it's limiting the scope of good health care workers in terms of broader life experience/education (e.g. fewer humanities majors going into health care related fields)
I don't think you looked at the link. It's about nursing salaries, not physician's. The US is #2, even though most all of those other countries have higher COL. Nurses have worked hard to get decent wages commensurate with education. They're not about to take a pay cut "for the team". And while there are a few specialist physicians who make a lot, the average primary care doc's salary isn't that high. Not to mention, in a lot of these countries, the average physician's education is more comparable to a nurse practitioner here in the US.
http://www.insidermonkey.com/blog/16...octors-314590/
 
Old 04-24-2016, 10:06 AM
 
285 posts, read 272,447 times
Reputation: 286
Quote:
Originally Posted by Katarina Witt View Post
I don't think you looked at the link. It's about nursing salaries, not physician's. The US is #2, even though most all of those other countries have higher COL. Nurses have worked hard to get decent wages commensurate with education. They're not about to take a pay cut "for the team". And while there are a few specialist physicians who make a lot, the average primary care doc's salary isn't that high. Not to mention, in a lot of these countries, the average physician's education is more comparable to a nurse practitioner here in the US.
16 Highest Paying Countries for Doctors - Insider Monkey
I think we're saying the same thing, or at least similar. My point is that single payor systems in other countries are able to keep costs down in a ways that the US system is unable/not capable of achieving in the short term - namely, they pay their medical folks less. They are often able to do so because many of their practitioners leave school with less debt than our practitioners and because their educational pipeline is shorter because they often do not go through the same number of years of education (especially physicians).

In particular, and I agree with you, US nurses get paid more than nurses in other countries. US doctors get paid more than physicians in other countries. The training is not always commensurate across countries for either nurses or physicians. That was sort of my point about how the medical education "pipelines" are structured in other countries. I have not worked with many nurses in other countries, but I would agree in my limited non-US experience, that in general, I prefer how well-trained US nurses are and I think they should be paid appropriately for their expertise, experience, and knowledge.

Some talk about a single payor system as some sort of panacea for our health care system. It might solve certain problems, such as decreasing the number of "uninsured." But that won't necessarily address the PCP shortage, or any number of other problems.
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