Is this the Golden Age of saving if the future is Single Payer?

[WhiteTrashCash]

I would love to have single payer healthcare because Canada has that and Canadians don't really have to worry about shit. I would love to not have to worry about shit. That would be so blissful.

[CSuzette]

I think that there are some misconceptions about single payer. My sister was in the U.K. For 7 years and saw it first hand.

1.  It provides a very bare-bones coverage. If you want anything elective (like knee surgery) you must have private insurance.

2.  Expect things like "fracture clinics". Everyone with a fracture shows up on a set day and has their cast checked. Forget about "my doctor".

3.  There are money saving methods - such as assembly line endoscopies without anesthesia.

Doctors do not make much in the U.K. And are not revered like here. I suspect that it leads to the best and brightest becoming something else. There are private doctors and once again the well off will get the best care and everyone else will not. That is why the hospitals in Boston are stuffed with foreign patients.

This might be acceptable to some. Just know what you are advocating for.

[Drifterrider]

I would love to have single payer healthcare because Canada has that and Canadians don't really have to worry about shit. I would love to not have to worry about shit. That would be so blissful.

Someone once said "ignorance is bliss".

I suggest you carefully question some Canadians about their national health service (it isn't national, it is regional).  Things we take for granted in the US (insurance coverage for medications) aren't necessarily the same.  Then, ask carefully about how much in taxes Canadians pay for that "free" stuff.  Not just insurance premiums but also GST (Goods and services tax), etc. 

Nothing is free. 

Don't be blissful, be informed.

[mm1970]

I would love to have single payer healthcare because Canada has that and Canadians don't really have to worry about shit. I would love to not have to worry about shit. That would be so blissful.

Someone once said "ignorance is bliss".

I suggest you carefully question some Canadians about their national health service (it isn't national, it is regional).  Things we take for granted in the US (insurance coverage for medications) aren't necessarily the same.  Then, ask carefully about how much in taxes Canadians pay for that "free" stuff.  Not just insurance premiums but also GST (Goods and services tax), etc. 

Nothing is free. 

Don't be blissful, be informed.

I know some Canadians, and they are generally happy with their health care, and appalled by the US health care.

While basic healthcare is covered and generally affordable, it's still difficult for the poor.  There are plenty of costly extras that someone who is truly poor cannot pay for (physical therapy, some drugs, and hospital parking!!)  However, overall my friends worry less about health care bankrupting them, and for those who *need* the  care, it's more affordable than in the US.

[Hash Brown]

Nobody in any other country in the world is begging to get off of single-payer and switch to the chaotic American "system". 

The whole business about "taxes" is a scare tactic.  It's pretty unbelievable that this point needs to be made (and I already made it on this thread, but it was ignored), that if all costs remained the exact same, a $200~/mo payroll tax increase would be offset by not having a $200~/mo insurance split between the employer and employee. 

My own experience with the American health care "system" is that it is largely rigged.  The doctors and nurses are all competent and enthusiastic about their jobs, but the packaging of "care" is fashioned in such a way as to discourage shopping and extract maximum cash from those who are able to pay.  That money goes to salesman, executives, etc., which would barely exist in a single-payer system. 

[Imma]

I wonder how much of this mess is also associated with people living far unhealthier lifestyles.  People are a lot more sedentary, eat processed foods, drink too much sugary drinks, etc.   

I eat cleanly, work out / exercise regularly, and focus on my health as #1 priority.  I still end up paying for other people's miserable lifestyles with my rising medical insurance bills.  It's truly terrible that I can't avoid paying for other people's laziness and general poor health.

I'm sick of this argument. As I mentioned upthread, we've consumed well over $100k in healthcare YTD. We're 30-year-old never smokers with healthy BMIs. You can only avoid some health problems with diet and exercise.

We live in a society for better or worse. [Unhealthy] human life doesn't make the list of things I'm subsidizing for that I don't like/agree with.

Do I wish people would make better decisions? Absolutely, but it just isn't that simple.

you can be sick of it, doesn't make it fair or right, to not penalize (or even rewarding via subsidies by healthy folks) people for making bad decisions.  At some point in life, you have to be responsible for your decisions and lifestyle choices.

As someone who was diagnosed with a chronic illness as a teenager, I'm sick of this argument too. I get told this at least three times a week, 'oh, I eat healthy, I excerise, what did you do wrong to cause your illness?'. The truth is, while an unhealthy lifestyle increases your chances of getting certain illnesses (and there are illnesses that are mostly lifestyle-related like lung cancer, diabetes type 2, COPD, heart disease, obesity) you can't avoid illness by living healthily, just lower your chances. These days, many people seem to think that if you fall ill, you somehow caused it yourself, that you failed to live in a certain way.

I'm not saying eating healthily, living a generally active life and exercising frequently isn't important, but I think the main reason why we see so many ill people these days compared to 50 years ago is that so many people survive. I have an auto-immune disease that some people tell me must be lifestyle-related - there's a much bigger chance to get it if you smoke, but the cause is mostly genetic. I have never smoked in my life, grew up rurally, eating home grown food and have always lead an active life. Still, I fell ill at age 16. The real reason why my illness is much more common in the 21st century is that I almost certainly would have died soon after diagnosis, had I lived in the 60s. I had an aunt who had a mild form of the disease since the 40s and she was bedridden for long periods of time and never married because of that. I'm living an active, independent life, I have a job, while I have a much more serious form of the disease.

Heart disease was just as common in the 60s, maybe more common, but the difference is that people used to die during their first heart attack. Dying while young was pretty common then and as harsh as it sounds, a higher mortality rate leads to lower health care spending.

[GenXbiker]

Single payer would cause massive tax increases or an even larger spike in the enormous national debt because someone has to pay for it.   Costs will continue to go up.   But like I said, it's not going to happen anytime soon, if ever.

You're already paying for it in the form of private insurance, higher cost of care (hospitals write off bad debt and charge everyone else more) AND taxes. Money is fungible.

I would rather keep paying my very low private insurance premiums through my employer than the enormous taxes that would give "free" health care to everyone.

That changes nothing about what said.  It's still a bad idea, always has been, and it won't happen in the foreseeable future.

"It's a bad idea" may be a complete sentence, but it's completely lacking in substance.

Also, I never said it (or single-payer) was going to happen. Just that all the data points to both systems being better and cheaper than what we currently have.

Wrong.  Regarding universal basic income, there are no data points that giving everyone "free" money for not working is better and cheaper.  That's just taking money from the job creators and workers and rewarding the non-contributors who will leech off people like me.  That takes incentive away from everyone and is contrary to the great capitalist society we have in the U.S.

[GenXbiker]

As someone who was diagnosed with a chronic illness as a teenager, I'm sick of this argument too. I get told this at least three times a week, 'oh, I eat healthy, I excerise, what did you do wrong to cause your illness?'. The truth is, while an unhealthy lifestyle increases your chances of getting certain illnesses (and there are illnesses that are mostly lifestyle-related like lung cancer, diabetes type 2, COPD, heart disease, obesity) you can't avoid illness by living healthily, just lower your chances. These days, many people seem to think that if you fall ill, you somehow caused it yourself, that you failed to live in a certain way.

You are correct of course.  And on the flip side, some people live a very unhealthy lifestyle, smoke, and are overweight, and they live a long happy life.  There are no guarantees - you can only change the odds.

[NoStacheOhio]

Single payer would cause massive tax increases or an even larger spike in the enormous national debt because someone has to pay for it.   Costs will continue to go up.   But like I said, it's not going to happen anytime soon, if ever.

You're already paying for it in the form of private insurance, higher cost of care (hospitals write off bad debt and charge everyone else more) AND taxes. Money is fungible.

I would rather keep paying my very low private insurance premiums through my employer than the enormous taxes that would give "free" health care to everyone.

That changes nothing about what said.  It's still a bad idea, always has been, and it won't happen in the foreseeable future.

"It's a bad idea" may be a complete sentence, but it's completely lacking in substance.

Also, I never said it (or single-payer) was going to happen. Just that all the data points to both systems being better and cheaper than what we currently have.

Wrong.  Regarding universal basic income, there are no data points that giving everyone "free" money for not working is better and cheaper.  That's just taking money from the job creators and workers and rewarding the non-contributors who will leech off people like me.  That takes incentive away from everyone and is contrary to the great capitalist society we have in the U.S.

"Nuh-uh" isn't an actual argument.

You don't know what you're talking about (perhaps willfully, since it challenges your predetermined worldview). There are lots of data points that refute your point that everyone requires a job, and "takers takers takers." If you had bothered to read the link I posted last week, you might know that. Five years ago, I would've been more apt to follow your line of reasoning, but I've seen, read and experienced too much to the contrary to take it seriously.

The reality is that we're going to be hemorrhaging entire classes jobs over the next 20 years, and they won't be replaced with something else (unless you count robots as people).

Your point about your "very low premiums" ignores the fungibility of money.

[Leisured]

As someone who was diagnosed with a chronic illness as a teenager, I'm sick of this argument too. I get told this at least three times a week, 'oh, I eat healthy, I excerise, what did you do wrong to cause your illness?'. The truth is, while an unhealthy lifestyle increases your chances of getting certain illnesses (and there are illnesses that are mostly lifestyle-related like lung cancer, diabetes type 2, COPD, heart disease, obesity) you can't avoid illness by living healthily, just lower your chances. These days, many people seem to think that if you fall ill, you somehow caused it yourself, that you failed to live in a certain way.

I agree, Imma. We all die of something. Live unhealthy die in your fifties, or live healthy and die in your seventies. I am Australian, where we have a universal health system, and I do not hear other Australians suggest that people who live an unhealthy life are driving up costs for everyone else.

[Leisured]

Single player won't happen for years, if ever.  So I wouldn't let it stress you out too much in the meantime.

Universal Basic Income - terrible idea.  I can't see that happening in the next few decades.

Just going to leave this here ...

https://www.jacobinmag.com/2016/05/richard-nixon-ubi-basic-income-welfare/

Nice link, NoStache. But if GenX is right and UBI is a bad idea, surely that means UBI will happen.

[MrMoneySaver]

As someone who was diagnosed with a chronic illness as a teenager, I'm sick of this argument too. I get told this at least three times a week, 'oh, I eat healthy, I excerise, what did you do wrong to cause your illness?'. The truth is, while an unhealthy lifestyle increases your chances of getting certain illnesses (and there are illnesses that are mostly lifestyle-related like lung cancer, diabetes type 2, COPD, heart disease, obesity) you can't avoid illness by living healthily, just lower your chances. These days, many people seem to think that if you fall ill, you somehow caused it yourself, that you failed to live in a certain way.

The idea that poor health is a result of choices is popular, and probably comforting to still-healthy individuals. But it greatly undersells the importance of genetics, random chance and general aging. Good living isn't the armor that many seem to think it is.

[GenXbiker]

Single payer would cause massive tax increases or an even larger spike in the enormous national debt because someone has to pay for it.   Costs will continue to go up.   But like I said, it's not going to happen anytime soon, if ever.

You're already paying for it in the form of private insurance, higher cost of care (hospitals write off bad debt and charge everyone else more) AND taxes. Money is fungible.

I would rather keep paying my very low private insurance premiums through my employer than the enormous taxes that would give "free" health care to everyone.

That changes nothing about what said.  It's still a bad idea, always has been, and it won't happen in the foreseeable future.

"It's a bad idea" may be a complete sentence, but it's completely lacking in substance.

Also, I never said it (or single-payer) was going to happen. Just that all the data points to both systems being better and cheaper than what we currently have.

Wrong.  Regarding universal basic income, there are no data points that giving everyone "free" money for not working is better and cheaper.  That's just taking money from the job creators and workers and rewarding the non-contributors who will leech off people like me.  That takes incentive away from everyone and is contrary to the great capitalist society we have in the U.S.

"Nuh-uh" isn't an actual argument.

Oh how clever.  LOL.  I guess you win the argument.  LOL

since it challenges your predetermined worldview

I haven't stated my worldview, which goes beyond this topic, so you are making "ASS-umptions."

There are lots of data points that refute your point that everyone requires a job.

This is a straw man argument.  I never said that "everyone" needs a job.  You are arguing against a point I never tried to make.  Nice try, but I had to call you out on that one.

Don't believe everything you read on the internet, or hear in the mainstream media, either.  Too many people like you are gullible and believe every liberal talking point you hear, even when it's not based on fact.

The reality is that we're going to be hemorrhaging entire classes jobs over the next 20 years, and they won't be replaced with something else (unless you count robots as people).

Many experts disagree with you and state that there will simply be "new" and "different" jobs for people than the ones that are replaced.  I could give examples of how this has happened over history, but I'm sure you will ignore that.

Giving free money to people is not a solution.  That encourages people not to look for work or to quit working if they can get free handouts from the working taxpayers.

Your point about your "very low premiums" ignores the fungibility of money.

It ignores nothing.  You just don't like to hear it because it doesn't fit your narrative.

[GenXbiker]

Single player won't happen for years, if ever.  So I wouldn't let it stress you out too much in the meantime.

Universal Basic Income - terrible idea.  I can't see that happening in the next few decades.

Just going to leave this here ...

https://www.jacobinmag.com/2016/05/richard-nixon-ubi-basic-income-welfare/

Nice link, NoStache. But if GenX is right and UBI is a bad idea, surely that means UBI will happen.

Besides being a bad idea, it would be very expensive, result in high taxes, and more people dropping out of the labor force.  I can't see something like that getting passed into law in the foreseeable future, although that won't stop the far left from talking about it.  I can assure NoStache that I am not worried about it and would definitely oppose the idea if were to ever gain traction.

[NoStacheOhio]

Besides being a bad idea, it would be very expensive, result in high taxes, and more people dropping out of the labor force.  I can't see something like that getting passed into law in the foreseeable future, although that won't stop the far left from talking about it.  I can assure NoStache that I am not worried about it and would definitely oppose the idea if were to ever gain traction.

It's cheaper than all of our current welfare/social programs, which would be eliminated. The whole thing would result in smaller government with less bureaucracy.

since it challenges your predetermined worldview

I haven't stated my worldview, which goes beyond this topic, so you are making "ASS-umptions."

It's pretty clear what your worldview is without you coming out and stating it.

Don't believe everything you read on the internet, or hear in the mainstream media, either.  Too many people like you are gullible and believe every liberal talking point you hear, even when it's not based on fact.

What does this even mean? Everything I said is based on nonpartisan research. You know who almost gave America UBI? Richard Nixon. Except someone fucked up counting and made it look like the divorce rate went up (it didn't).

Many experts disagree with you and state that there will simply be "new" and "different" jobs for people than the ones that are replaced.  I could give examples of how this has happened over history, but I'm sure you will ignore that.

AI isn't like anything we've seen in history. Widespread nonhuman labor has no precedent. Plenty of experts are saying what I said.

Giving free money to people is not a solution.  That encourages people not to look for work or to quit working if they can get free handouts from the working taxpayers.

The data opposes this conclusion. Again, if you bothered to read the link, you would be able to see for yourself. ALSO, hours of paid work isn't a very good metric in the first place. It ignores a bunch of time spent doing productive, unpaid things like parenting, volunteering, household labor, etc. Other stuff: reduced crime (positive monetary effects) and better health outcomes (positive monetary effects).

It ignores nothing. You just don't like to hear it because it doesn't fit your narrative.

You have a pile of money A that you're giving to a private insurance company for health coverage. You have pile of money B that goes to taxes. We revamp the system, and pile of money A gets added to pile of money B. Repeat for the employer side. Fungible.

The key is to remove many of the current public programs that are sucking down resources while only helping a small number of people.

Yeah, it is more expensive if you try to add UBI on top of food stamps, HUD, HEAP, unemployment, social security and the million other piecemeal programs we have. That would also be stupid.

[CBnCO]

Sorry I was re-using wording from the OP - did not mean to offend.  My concern comes from the US having an extremely high cost structure unlike other countries that have successfully implemented single payer.  If there isn't enough focus on reducing costs, a single payer system will require more aggressive means of financing.

I'm from the Netherlands. We have generally very good quality and affordable health care system, even though people on both the right and the left wing say otherwise. It's also very much focused on cost-reducation and whenever I read about health related costs in the US, I keep thinking it must be possible to do all of that for half the price. There just isn't the incentive to make care affordable. If you look at OECD reports (and those are fairly reliable) in the US, average health care cost per year per person are $9500. And you have to take account that a fairly big proportion of Americans don't have access to proper health care at all. In the Netherlands, that's about $5300 per person per year and everyone has access to good quality health care and that's fairly average for Europe.

What I find hard to understand about the US health care system is that there's a lot of economic freedom but costs don't seem to go down. That's absolutely contrary to what I was taught at school in economics, that competition and capitalism would lead to lower prices. It doesn't seem to at all.

The U.S. used to have a free economic system, like in 1850!. Health care is now highly regulated by federal and state governments and it would seem their primary goal is to line the pockets of the donor class (insurance companies, hospitals companies, accredited medical schools, junk food companies, etc..) rather than create more affordable care options. It's basic economics, increase the supply of care providers and open up the market, then prices will come down as a result of competition. Further, we give almost no attention to preventative education (diet & exercise). Eat, drink, and smoke whatever you want..don't worry the government sponsored system will take care of you. Yep, a far cry from the free market and society that we started with here.   

[Jouer]

I think that there are some misconceptions about single payer. My sister was in the U.K. For 7 years and saw it first hand.

1.  It provides a very bare-bones coverage. If you want anything elective (like knee surgery) you must have private insurance.

2.  Expect things like "fracture clinics". Everyone with a fracture shows up on a set day and has their cast checked. Forget about "my doctor".

3.  There are money saving methods - such as assembly line endoscopies without anesthesia.

Doctors do not make much in the U.K. And are not revered like here. I suspect that it leads to the best and brightest becoming something else. There are private doctors and once again the well off will get the best care and everyone else will not. That is why the hospitals in Boston are stuffed with foreign patients.

This might be acceptable to some. Just know what you are advocating for.

Canadian here. I can't speak to these things being true in the UK but they are patently false here in Canada. The closest this came to be true of single payer health coverage is the knee surgery bit; everything is paid for but you might wait a while for the surgery. For instance, if you are an office worker who hurts their leg, you may wait a while before you get your surgery. Biggest downside: miss a summer of slow pitch softball.

Oh, and the amount of my income tax allocated to healthcare is much lower than insurance costs in the states. We do have higher sales tax, that's for sure. But as mustaches, sales taxes doesn't affect us much, right?

[mm1970]

I wonder how much of this mess is also associated with people living far unhealthier lifestyles.  People are a lot more sedentary, eat processed foods, drink too much sugary drinks, etc.   

I eat cleanly, work out / exercise regularly, and focus on my health as #1 priority.  I still end up paying for other people's miserable lifestyles with my rising medical insurance bills.  It's truly terrible that I can't avoid paying for other people's laziness and general poor health.

I'm sick of this argument. As I mentioned upthread, we've consumed well over $100k in healthcare YTD. We're 30-year-old never smokers with healthy BMIs. You can only avoid some health problems with diet and exercise.

We live in a society for better or worse. [Unhealthy] human life doesn't make the list of things I'm subsidizing for that I don't like/agree with.

Do I wish people would make better decisions? Absolutely, but it just isn't that simple.

you can be sick of it, doesn't make it fair or right, to not penalize (or even rewarding via subsidies by healthy folks) people for making bad decisions.  At some point in life, you have to be responsible for your decisions and lifestyle choices.

As someone who was diagnosed with a chronic illness as a teenager, I'm sick of this argument too. I get told this at least three times a week, 'oh, I eat healthy, I excerise, what did you do wrong to cause your illness?'. The truth is, while an unhealthy lifestyle increases your chances of getting certain illnesses (and there are illnesses that are mostly lifestyle-related like lung cancer, diabetes type 2, COPD, heart disease, obesity) you can't avoid illness by living healthily, just lower your chances. These days, many people seem to think that if you fall ill, you somehow caused it yourself, that you failed to live in a certain way.

I'm not saying eating healthily, living a generally active life and exercising frequently isn't important, but I think the main reason why we see so many ill people these days compared to 50 years ago is that so many people survive. I have an auto-immune disease that some people tell me must be lifestyle-related - there's a much bigger chance to get it if you smoke, but the cause is mostly genetic. I have never smoked in my life, grew up rurally, eating home grown food and have always lead an active life. Still, I fell ill at age 16. The real reason why my illness is much more common in the 21st century is that I almost certainly would have died soon after diagnosis, had I lived in the 60s. I had an aunt who had a mild form of the disease since the 40s and she was bedridden for long periods of time and never married because of that. I'm living an active, independent life, I have a job, while I have a much more serious form of the disease.

Heart disease was just as common in the 60s, maybe more common, but the difference is that people used to die during their first heart attack. Dying while young was pretty common then and as harsh as it sounds, a higher mortality rate leads to lower health care spending.

This is, of course, a very good and often overlooked point.  Just got into a discussion with a HS classmate about how she "hates socialism, and would rather work harder for what she has!"  Which, as a healthy, childfree, married woman of 47 who has never been through a serious illness...well, duh.  Of course she hates socialism.  This all started on a conversation about Denmark being the happiest place on earth, but of course she'd hate it.  (I mean, I argued with her, because I actually have friends in Denmark, have been there, MIL was Danish and all.)  She is okay with the "essentials", which apparently doesn't include healthcare, but does include police, fire, military, roads, clean water, clean air, safe food, functioning sewers, public school, social security. 

In any event, the vast majority of the time that I read about people uninterested in any kind of national health care, it's from people who have never had a health issue, so "it can't happen to me".  Or to their parents I guess.  I have a college roommate who is disabled due to a genetic autoimmune disease.  She's been disabled since her early 20s, but as she quit working to raise kids, never acquired enough "points" to actually get disability.

Even worse, she passed on the genetic disease to her 3 kids, because she had them before she was diagnosed.  So now there are 3 teenagers (all of whom have decided to never have children) who are living with a differing amount of disability due to a genetic disease - through no fault of their own.  (I mean, nevermind the children who are born addicted to alcohol or drugs and are permanently disabled there - also, do to no fault of their own.)  But I guess, it doesn't matter?  Clearly they aren't deserving of affordable health care, or any health care at all.

[talltexan]

My BIL's son was born seven weeks premature, and will be forever in the "pre-existing condition" camp.

My BIL is an attorney, so he supported the ACA repeal anyway, figuring he'd do so well in subsequent litigation he'd be able to more than offset the future cost of insurance for his son.

[lemonlyman]

Single payer would cause massive tax increases or an even larger spike in the enormous national debt because someone has to pay for it.   Costs will continue to go up.   But like I said, it's not going to happen anytime soon, if ever.

It would cause massive tax increases, but it would replace premiums a lot of people and businesses already pay. Costs wouldn't rise nearly as much as they do now. The federal government already insures the riskiest populations. Adding all the younger, healthier groups into that payment pool would only help costs. Also, CMS sets their own fee schedule with providers. Hospitals can't just raise prices and leverage insurance companies to pay more with CMS like they do now. Premiums would stabilize.

[starguru]

With respect to the OP, it's not hard to see that the answer is "it depends".  Specifically, it depends on how the single payer system is paid for.  It would be great for savers if savings aren't taxed.  If we were to fund a single payer with taxes on investment income or just moved to a wealth tax in general savers would obviously fare worse.

With respect to whether single payer is a "good" idea, it might be more productive to just examine single payer as a series of tradeoffs against what we have now, a list of pros and cons.

So pros would be:

* Simple health care would be cheaper.  Treating issues like colds, "simple" surgery, normal births, etc, would be cheaper.  Common tests would be cheaper.
* Society would probably reap benefit since more people would get diagnosed earlier, no more showing up at the emergency room when someone's diabetes causes a crisis, for example.
* The issue of "what does this cost" insurance shell game goes away.

Some cons would be:

* Might be harder to get care as more people seek care.  In other words, care is rationed by time, not by ability to pay.
* Depending on the details, single payer includes cost setting for services by the government.  Without the profit motive, what motivates companies to research new treatments or find treatments for rare diseases?
* Quality of care might decrease.  How do we insure the people giving the medical care are qualified and are paid fairly?  Why would people want to go thru the hell to become doctors if they are not going to get paid well?
* Research into new treatments might suffer.  We will be very good at dealing with appendicitis, but not so good at dealing with rare cancers. 

The way I view are health care system now is that for those with insurance it's pretty good.  We pay more for our checkups and routine things then we probably should.  It's sort of absurd; my wife is pregnant and her ob billed insurance $800 for a blood test to confirm the pregnancy.  That's just nuts.  As another anecdote, every time I have a checkup the Dr asks me how my not-smoking is going.  He asks one or two questions and gives two sentences on how smoking is bad.  The practice bills insurance an extra $120 for smoking cessation counseling. 

On the other hand, I think we also have more options for complicated health care scenarios.  I often hear about rich people from other countries coming here for treatment of their serious diseases.  I don't hear about rich Americans going elsewhere for treatment.

[lemonlyman]

Some cons would be:

* Might be harder to get care as more people seek care.  In other words, care is rationed by time, not by ability to pay.
* Depending on the details, single payer includes cost setting for services by the government.  Without the profit motive, what motivates companies to research new treatments or find treatments for rare diseases?

That is a con, but the assumption implies that the government is a bad payer isn't correct. In regards to Medicaid, it certainly is, but Medicare is a different story. Profit is very easy treating Medicare patients for my business. Medicaid is profitable in certain scenarios, but there are many commercial payers who are not profitable at all. For example, UHC has a per diem cap limit on physical therapy of $50. That doesn't pay for the facility plus hourly wages of the staff, and I can name many more who are like that. We treat patients of those insurances anyways because it's the right thing to do. Many physicians don't. That's the market, but many times, patients don't pick their carrier. Their employer does or their state is small enough to only have a couple of choices. It's a perverted market where the consumer doesn't actually have much control.

* Quality of care might decrease.  How do we insure the people giving the medical care are qualified and are paid fairly?  Why would people want to go thru the hell to become doctors if they are not going to get paid well?

CMS is the leader in creating standards for quality care. No commercial insurance has quality measures that I'm aware of. Right now, physicians are implementing MIPS programs paying providers bonuses or levying penalties for controlling costs, reporting quality standards of care, implementing quality changes to their practices, and using updated technology. One of the advantages of single payer is that providers are paid the same for the same treatments. That leaves consumers more mobility to choose physicians based on reputation and quality instead of who's in the network.

On the other hand, I think we also have more options for complicated health care scenarios.  I often hear about rich people from other countries coming here for treatment of their serious diseases.  I don't hear about rich Americans going elsewhere for treatment.

That's true, but there's a flipside for non serious treatment. For the middle class, routine procedures are done overseas often. Dental care is a big one. Here's Mike and Lauren's experience (series of videos) of giving birth in Costa Rica to save money.
https://www.youtube.com/watch?v=uJhDon4wjmg

That's different behavior from what is done compared to serious diseases, but the rich in America already receive better care in America than the middle class and the poor. If what the rich do is the standard, any health care system could apply.

[Hash Brown]

In any event, the vast majority of the time that I read about people uninterested in any kind of national health care, it's from people who have never had a health issue, so "it can't happen to me".  Or to their parents I guess.

Exactly.  But slowly, people are learning what a scam our "system" is.  When my grandfather decided to avoid care for a cancer diagnosis (after age 90 and various other health problems) and go into hospice, we found out after he died that he had signed the wrong form.  So instead of Medicare covering hospice, his estate was responsible for an $18,000 expense payable to the nursing home.  Obviously, we are all suspicious that the nursing home cajoled him into filling out the paperwork incorrectly. 

Recently I had a doctor request head and neck MRI's for vertigo symptoms.  They booked me at the hospital's MRI machine and somebody called to tell me it was going to be $5,500 out-of-pocket (my lousy Trump-loving employer's insurance covers almost nothing).  So I "shopped" and got both MRI's for $1,500 at an independent place.  Then I had to pay for a re-reading of the MRI's because the cheap place outsourced their readings to India and the original reading was unintelligible. 

 

[Drifterrider]

Another thread got me thinking, could this be a Golden Age of saving if (maybe a BIG if) the US does implement a Single Payer healthcare system?  Obviously there are infinite ways we could structure and pay for national healthcare.  I think most likely we would pay for this through additional federal and state income taxes.  And I think it's also likely those taxes are progressive graduated brackets.  It's not inconceivable that the pendulum swings left in the next 3-10 years and we get some form of Single Payer.  Taxes could go up big to pay for it and it would be nice to be FIREd and enjoy the benefits and not pay much of the taxes.  I realize that national healthcare would not cover everything, and that in Canada people need private insurance for certain things and certain drugs.

No.  Most people who don't save, don't save because they spend (not because they don't have any left).

Most of the developed world has been taught to be consumers.  We measure our lives based on what we accumulate.  Success = Stuff.

 

[Jrr85]

Besides being a bad idea, it would be very expensive, result in high taxes, and more people dropping out of the labor force.  I can't see something like that getting passed into law in the foreseeable future, although that won't stop the far left from talking about it.  I can assure NoStache that I am not worried about it and would definitely oppose the idea if were to ever gain traction.

It's cheaper than all of our current welfare/social programs, which would be eliminated. The whole thing would result in smaller government with less bureaucracy.

...
Yeah, it is more expensive if you try to add UBI on top of food stamps, HUD, HEAP, unemployment, social security and the million other piecemeal programs we have. That would also be stupid.

Good luck convincing voters that exchanging people's social security and medicare for a $12k per year cash grant is reasonable. 

I'm not necessarily opposed to it, but I think if it ever got the slightest bit of traction, the politician that proposed it might literally be tarred and feathered.   

[Drifterrider]

Besides being a bad idea, it would be very expensive, result in high taxes, and more people dropping out of the labor force.  I can't see something like that getting passed into law in the foreseeable future, although that won't stop the far left from talking about it.  I can assure NoStache that I am not worried about it and would definitely oppose the idea if were to ever gain traction.

It's cheaper than all of our current welfare/social programs, which would be eliminated. The whole thing would result in smaller government with less bureaucracy.

...
Yeah, it is more expensive if you try to add UBI on top of food stamps, HUD, HEAP, unemployment, social security and the million other piecemeal programs we have. That would also be stupid.

Good luck convincing voters that exchanging people's social security and medicare for a $12k per year cash grant is reasonable. 

I'm not necessarily opposed to it, but I think if it ever got the slightest bit of traction, the politician that proposed it might literally be tarred and feathered.

Whomever believes anything short of an ELE will result in a smaller government with less bureaucracy must own unicorns.

[talltexan]

Wait, isn't Social Security basically...a cash grant?

[bufar]

Never get facts get in the way of your agenda!

LOL both the USA political parties know that game all too well, unfortunately. But they both think it's only the other side being selective.

I agree that it's the fast food, processed food, soft drinks, etc, that are why the heart disease is number one. The official government food pyramid is a crock of sh*t, and the reason heart disease first became the number 1 killer in the 1950s and remains so today.

[bufar]

Wrong.  Regarding universal basic income, there are no data points that giving everyone "free" money for not working is better and cheaper.  That's just taking money from the job creators and workers and rewarding the non-contributors who will leech off people like me.  That takes incentive away from everyone and is contrary to the great capitalist society we have in the U.S.

I was reading in the paper the other day about some homeless woman who had been found dead. The article described her occupation as "homeless by choice", as though that were a profession like doctor or carpenter, etc. Yes, I live on the left coast in CA in a small northern town on the beach. There are so many "homeless" here that it beggars the imagination. The city council coddles them like you would not believe. You cannot go anywhere in town on foot without being set upon by these beggars and moochers.

When I was driving here in my Uhaul, I was pulled over by a state trooper on a winding mountain road. He told me that no one uses moving trucks to move, but rather to transport their drugs. He wanted to see what I had in the back there. When he saw furniture, he said I could go. But then he asked me why in the WORLD would I want to move to such and such town with all the lazy bums practicing their profession and what was I going to do there. I told him who I was working for, a skilled labor position.

The stater actually thanked me for being part of the working class, as there are so few of those where I was going and we needed more and more to pay for the freebies the leeches were getting from the state and the city. I see "Help Wanted" signs all over town, but none of these holy and blameless people busy putting the touch on people who work for a living can be bothered to work.

Why should they work? They don't want to, that's just not who they are. It wouldn't be authentic, they'd be betraying who they really are inside.

I, for one, am sick and tired of lazy, good for nothing leeches on society who think work is for other people, and money is what we earn to give to them that would rather not. I hate getting up in the morning, I hate my job with a holy passion, I can't wait for the day that I don't have to work anymore...and to see these lazy bums begging me to give me some of the money I've suffered for to compensate for the fact that they don't have because they don't work, well, they can kiss my lily white buttocks. All of them.

[bufar]

Wait, isn't Social Security basically...a cash grant?

For those that are taking more out than they put in, yes. I've put over 100k into SS since I started working. If I live long enough to get it, I'm just getting the money that I earned back.

[NorthernBlitz]

I think we should implement a VAT tax in the US.

Money can go to fund Healthcare.

Perhaps as importantly, it would serve as a disincentive for rampant consumption.

But, I grew up in Canada so its not surprising that I'd be open to more taxes for better "essential" services

[RedwoodDreams]

I wonder how much of this mess is also associated with people living far unhealthier lifestyles.  People are a lot more sedentary, eat processed foods, drink too much sugary drinks, etc.   

I eat cleanly, work out / exercise regularly, and focus on my health as #1 priority.  I still end up paying for other people's miserable lifestyles with my rising medical insurance bills.  It's truly terrible that I can't avoid paying for other people's laziness and general poor health.

I'm sick of this argument. As I mentioned upthread, we've consumed well over $100k in healthcare YTD. We're 30-year-old never smokers with healthy BMIs. You can only avoid some health problems with diet and exercise.

We live in a society for better or worse. [Unhealthy] human life doesn't make the list of things I'm subsidizing for that I don't like/agree with.

Do I wish people would make better decisions? Absolutely, but it just isn't that simple.

you can be sick of it, doesn't make it fair or right, to not penalize (or even rewarding via subsidies by healthy folks) people for making bad decisions.  At some point in life, you have to be responsible for your decisions and lifestyle choices.

As someone who was diagnosed with a chronic illness as a teenager, I'm sick of this argument too. I get told this at least three times a week, 'oh, I eat healthy, I excerise, what did you do wrong to cause your illness?'. The truth is, while an unhealthy lifestyle increases your chances of getting certain illnesses (and there are illnesses that are mostly lifestyle-related like lung cancer, diabetes type 2, COPD, heart disease, obesity) you can't avoid illness by living healthily, just lower your chances. These days, many people seem to think that if you fall ill, you somehow caused it yourself, that you failed to live in a certain way.

I'm not saying eating healthily, living a generally active life and exercising frequently isn't important, but I think the main reason why we see so many ill people these days compared to 50 years ago is that so many people survive. I have an auto-immune disease that some people tell me must be lifestyle-related - there's a much bigger chance to get it if you smoke, but the cause is mostly genetic. I have never smoked in my life, grew up rurally, eating home grown food and have always lead an active life. Still, I fell ill at age 16. The real reason why my illness is much more common in the 21st century is that I almost certainly would have died soon after diagnosis, had I lived in the 60s. I had an aunt who had a mild form of the disease since the 40s and she was bedridden for long periods of time and never married because of that. I'm living an active, independent life, I have a job, while I have a much more serious form of the disease.

Heart disease was just as common in the 60s, maybe more common, but the difference is that people used to die during their first heart attack. Dying while young was pretty common then and as harsh as it sounds, a higher mortality rate leads to lower health care spending.

I'm sick of it too. We've always eaten fresh, wholesome foods at our house, never fast food, no sodas or sugars, nada. I'd go visit my sister and her kids would be eating McDonald's, junk food, soda, gogurts, and Lunchables. She'd sort of laugh at me when we'd go to the grocery store and I'd pick up fresh veggies and organic foods. Yet my son was diagnosed with Crohn's disease at age 11; hers are all fine. (Bad) luck of the genetic draw.

I get really aggravated by people who want to blame us, surely you did something wrong to cause this, whether spoken or unspoken. And it has made me wonder if this is a distinctly American attitude, and a result of our screwed up health insurance system and/or phony rugged individualism attitude... Does this attitude exist in Canada or Denmark, or is it just a way to make the issue of rising health care costs about people making poor choices instead of addressing the core issues that got us to this disaster of a system? It's a way to blame each other and avoid the central problem.

Sure, some people make poor choices that lead to poor health. But that will always be true, though of course we can work to improve education and access to better choices. And I think sometimes you learn this lesson when you see someone you love struggling and in pain, and on top of it blamed for their illness. It's truly unfortunate.

[BuildingFrugalHabits]

Wrong.  Regarding universal basic income, there are no data points that giving everyone "free" money for not working is better and cheaper.  That's just taking money from the job creators and workers and rewarding the non-contributors who will leech off people like me.  That takes incentive away from everyone and is contrary to the great capitalist society we have in the U.S.

I was reading in the paper the other day about some homeless woman who had been found dead. The article described her occupation as "homeless by choice", as though that were a profession like doctor or carpenter, etc. Yes, I live on the left coast in CA in a small northern town on the beach. There are so many "homeless" here that it beggars the imagination. The city council coddles them like you would not believe. You cannot go anywhere in town on foot without being set upon by these beggars and moochers.

When I was driving here in my Uhaul, I was pulled over by a state trooper on a winding mountain road. He told me that no one uses moving trucks to move, but rather to transport their drugs. He wanted to see what I had in the back there. When he saw furniture, he said I could go. But then he asked me why in the WORLD would I want to move to such and such town with all the lazy bums practicing their profession and what was I going to do there. I told him who I was working for, a skilled labor position.

The stater actually thanked me for being part of the working class, as there are so few of those where I was going and we needed more and more to pay for the freebies the leeches were getting from the state and the city. I see "Help Wanted" signs all over town, but none of these holy and blameless people busy putting the touch on people who work for a living can be bothered to work.

Why should they work? They don't want to, that's just not who they are. It wouldn't be authentic, they'd be betraying who they really are inside.

I, for one, am sick and tired of lazy, good for nothing leeches on society who think work is for other people, and money is what we earn to give to them that would rather not. I hate getting up in the morning, I hate my job with a holy passion, I can't wait for the day that I don't have to work anymore...and to see these lazy bums begging me to give me some of the money I've suffered for to compensate for the fact that they don't have because they don't work, well, they can kiss my lily white buttocks. All of them.

I totally understand your point.  From a fairness perspective, if people are able-bodied and can work and there are jobs to employ them it's nonsensical to have one segment of the population working to support a large contingent of moochers.  However, can you envision a world where the need for human labor is reduced to the point where there are insufficient high paying jobs to support the population?  Is there a point at which income inequality or wealth inequality becomes too great and becomes detrimental to society?  Is there a basic standard of living that we should allow for as a society (the level of which would be subject for debate)?  I ask because I think these issues are only going to become more prominent as we move forward.  I think having a UBI is a long way from complete socialism where everyone theoretically lives on the same amount.  There is a spectrum and it seems like the key is finding middle ground. 

My personal of-the-cuff list of basic stuff:
Roads
Education (K-12, community college or vocational training)
Libraries
Public Safety
Medical/Dental/Vision (with a copay)
UBI to support for groceries and basic shelter

Nobody would be starving, people are off the streets overall crime would be significantly decreased.  Society is safer and more egalitarian which benefits everyone.

Most people (even Mustacians) wouldn't be happy with just "the basics" so I think even with a UBI there's still plenty of room to incentivize people to work to afford consumer products or other "finer things." Things like, organic food, elective surgery, pets, turbocharged SUVs, RVs, boats, iphones, iPads, laptops, vacations/travel (or vacation homes), restaurant or brewpub visits, pumpkin spice anything, mountain bikes, road bikes, skis, camping gear, climbing gear, bougie gym memberships, fancy blenders, and nicer homes with granite counters, tile, wood floors, stainless etc, leather sofas, handbags or whatever....  The list is endless and advertisers are very good at their jobs.

I think that when people rail against welfare, UBI, or universal healthcare, it's not because it's total socialism but really that it's more like the gateway or slippery slope towards socialism that makes people uncomfortable. 

[Sean Og]

I think that there are some misconceptions about single payer. My sister was in the U.K. For 7 years and saw it first hand.

1.  It provides a very bare-bones coverage. If you want anything elective (like knee surgery) you must have private insurance.

2.  Expect things like "fracture clinics". Everyone with a fracture shows up on a set day and has their cast checked. Forget about "my doctor".

3.  There are money saving methods - such as assembly line endoscopies without anesthesia.

Doctors do not make much in the U.K. And are not revered like here. I suspect that it leads to the best and brightest becoming something else. There are private doctors and once again the well off will get the best care and everyone else will not. That is why the hospitals in Boston are stuffed with foreign patients.

This might be acceptable to some. Just know what you are advocating for.

Canadian here. I can't speak to these things being true in the UK but they are patently false here in Canada. The closest this came to be true of single payer health coverage is the knee surgery bit; everything is paid for but you might wait a while for the surgery. For instance, if you are an office worker who hurts their leg, you may wait a while before you get your surgery. Biggest downside: miss a summer of slow pitch softball.

Oh, and the amount of my income tax allocated to healthcare is much lower than insurance costs in the states. We do have higher sales tax, that's for sure. But as mustaches, sales taxes doesn't affect us much, right?

I can speak for the UK having lived there (and Ireland / USA also), the account of CSuzette is completely false. Like Canada, an elective surgery will happen but you will wait in line behind those deemed more urgent than your niggling pain and desire to start the next football season on time!

Doctors are absolutely held in high regard and the best and brightest with interest in becoming a Doctor (or earning lots of money) all aim to get into Human Medicine courses. In Ireland Medicine courses have consistently taken the top results to get in and many students end up studying abroad.

Most Europeans have one point of dread when travelling to the US and that is the thought of getting sick here.

[starguru]

Read this on cnn today.  Seems relevant to the discussion.  http://www.cnn.com/2017/09/25/politics/graham-cassidy-health-care-status/index.html


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