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

[CheapScholar]

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. 

[obstinate]

Maybe! We should hope that they don't choose to use a wealth tax to pay for it. This is the Mustachian's worst nightmare. (It's also not very likely.)

[JLee]

I would say this is unlikely.  Anyone who is FI is by most definitions RICH.  There's a lot of backlash against the rich right now, and it's not limited to just the 1%ers.  You're wondering if the situation is going to get even better for those that are FIRE.  I'm preparing for the worst where 'loopholes' that allow the rich access to generous subsidies are closed. 

Currently anyone with $1MM in assets, but low income due to FIRE can purchase a subsidized Obamacare plan.  I'm worried if the pendulum swings too far to the left, healthcare will become a method to increase wealth equality by forcing the rich to pay extreme prices.  Rich people can afford full price health insurance, so that benefit may be unavailable in the future until assets are spent down (similar to today's medicaid program).

wat?

I think "the left" would be thrilled to have a modern health care system like the vast majority of other advanced countries, which do not operate by charging people with high net worth exorbitant prices.

[expatartist]

I would say this is unlikely.  Anyone who is FI is by most definitions RICH.  There's a lot of backlash against the rich right now, and it's not limited to just the 1%ers.  You're wondering if the situation is going to get even better for those that are FIRE.  I'm preparing for the worst where 'loopholes' that allow the rich access to generous subsidies are closed. 

Currently anyone with $1MM in assets, but low income due to FIRE can purchase a subsidized Obamacare plan.  I'm worried if the pendulum swings too far to the left, healthcare will become a method to increase wealth equality by forcing the rich to pay extreme prices.  Rich people can afford full price health insurance, so that benefit may be unavailable in the future until assets are spent down (similar to today's medicaid program).

wat?

I think "the left" would be thrilled to have a modern health care system like the vast majority of other advanced countries, which do not operate by charging people with high net worth exorbitant prices.

+1!

[Cranky]

It's interesting to look at how other countries fund it - it seems to mostly be a payroll tax in Germany, for instance.

But frankly, I think that an expense that you can realistically plan for makes it a lot easier to save than some random enormous number that you can't anticipate does.

[1962colreb]

I'd like to see a tariff on imported manufactured goods used to pay for single payer.  This would make employing workers in the US more attractive and give workers the ability to switch jobs
without having to take health insurance into the equation .

[tooqk4u22]

It's interesting to look at how other countries fund it - it seems to mostly be a payroll tax in Germany, for instance.

But frankly, I think that an expense that you can realistically plan for makes it a lot easier to save than some random enormous number that you can't anticipate does.

That's not correct.  Germany generates almost equal amounts of tax from VAT (31% of total tax revenue) as it does Wage Taxes (30% of total tax revenue). I recently mentioned this in another thread incidentally and couldn't find the link below.   

The main ways to cover health care publicly are: (1) higher income taxes, (2) wealth taxes, (3) reduced costs, (4) other taxes such as VAT (although this would dramatically increase the cost of goods and services and would be similarly as consequential has having a wealth tax)

https://www.chicagofed.org/publications/chicago-fed-letter/2017/382

[CheapScholar]

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.

I'm not sure why you are describing this as the "Golden Age of Savings." There's a pretty good chance that if single payer is introduced that the net disposable income (i.e., income less taxes, insurance, etc.) will go up for most people. If your net disposable income goes up that means you should have more money to save to FIRE.

Good point.  I'm not saying this IS the golden age.  I'm merely posing the question.  My reasoning is that, for some people, a Single Payer very well might NOT increase disposable income.  A lot of upper middle class taxpayers might get hit with heavy income taxes.  All depends on your personal faith in how the US would create/pay for the system.

[MrMoneySaver]

What's all this talk of taxes and paying for things? I thought single-payer was free!

[Imma]

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.

Our health care system is paid through a combination of direct taxes, indirect taxes and premiums. Insurances are offered through private company, but the government decides a certain minimum 'basic' coverage. It includes basically all medication and everything that happens in a hospital. It doesn't cover dentistry, several types of elective surgery or contraception. There's a heavy competition for this insurance, it costs beteen €1200-1400 a year and there's a €400 co-pay a year. If you have a low income or are chronically ill, you can get a monthly benefit to compensate these costs up to €1000/year. Only adults pay, all health care for children is free. On top of that, you pay about 5% of your gross wages towards health care costs and your boss pays about 6% of your wages.

We have a wealth tax of 1,2% of your savings/investments over €50000, but the house you live in and pre-tax pension accounts are excluded. So yes, it's a little more difficult to FIRE in here. On the other hand, everyone has access to good quality health care and it's a lot more difficult to be truly poor in here. I'd say it's worth it.

I think when everyone has access to low cost, high quality health care, costs in the long term will probably decrease too, because people go to the doctor when they first start feeling unwell instead of waiting until they have heart attack.

[Bicycle_B]

You have a Money Mustache.  Any age where you have a good job is a Golden Age of saving!

[Bicycle_B]

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.

Excellent points about US health care costing more than anyone else's, and raising the economic mystery of why this is so. 

Here's an article that offers a comprehensive summary of why; includes some microeconomic explanations, along with resulting recommendations:
http://catalyst.nejm.org/make-crazy-expensive-amazing-uneven-health-care-system-better-faster/

Another article with economic focus drills in briefly on 3 factors; also mentions the intriguing remark that even at the higher-than-necessary existing price, Americans get more value from the system than we pay into it.  In other words, it creates value, just less value per investment dollar than all other major country health care systems:
http://www.pbs.org/newshour/rundown/why-does-health-care-cost-so-much-in-america-ask-harvards-david-cutler/

From these, I agree that the main issue is total cost rather than distribution of cost; that savings are achievable; and conclude that both today and tomorrow can reasonably be viewed as part of a Golden Age of Saving.  From the details of the articles, Single Payer appears compatible with solutions, so a switch to Single Payer may help rather than hinder.

[slugsworth]

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.

I did a quick google so take these stats with a grain of salt, but ""Of the subtypes of health insurance, employment-based insurance covered the most people (55.4 percent of the population), followed by Medicaid (19.5 percent), Medicare (16.0 percent), direct-purchase (14.6 percent) and military health care (4.5 percent)." - as of 2014

Which means that only 14.6% of people choose their health insurance.  There is nearly no price competition between providers as the insurance companies negotiate discounts for those services. We don't have a good system in the states for keeping costs down or for helping ensure people get care.  Really, we just have a system of vested interests and I hope we get single payer soon!

[Schaefer Light]

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.

There's really not much competition in the US when it comes to prices for health care.  I can see any doctor I want to see and they all cost me exactly the same amount because of the way insurance works.  Therefore I have no incentive to shop for a lower cost doctor.  In fact, it's quite the opposite.  I have every incentive to go the best (i.e. the most expensive) doctor I can find even if I'm going for a very minor treatment.  It won't cost me any more than going to the cheapest doctor in town.

Competition and capitalism do lead to lower prices when insurance companies and government regulations aren't involved. 

[Malloy]

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.

There's really not much competition in the US when it comes to prices for health care.  I can see any doctor I want to see and they all cost me exactly the same amount because of the way insurance works.  Therefore I have no incentive to shop for a lower cost doctor.  In fact, it's quite the opposite.  I have every incentive to go the best (i.e. the most expensive) doctor I can find even if I'm going for a very minor treatment.  It won't cost me any more than going to the cheapest doctor in town.

Competition and capitalism do lead to lower prices when insurance companies and government regulations aren't involved.

 The push on prices against the provider pull can be 1. high deductible plans as bender mentioned 2. negotiated insurance rates-insurance companies will negotiate a lower reimbursed price with a provider.  If the provider chooses, they can ding you for the unreimbursed portion, which would give you an incentive to choose a lower cost provider  3. networks-providers who price themselves out of your network would be subject to different reimbursement rules.  Again, you'd be incentivized to find a provider in your network, which can serve as a market force to push providers into certain networks and, in turn, lower their rates to the network standard.

 It's definitely complicated, but I don't think it's fair to say that there is no pressure on prices.  There is also room for improvement, for sure.  Unfortunately, there are many people on the other side who benefit from these market inefficiencies, so there are also forces that resist price control measures (pharma company vouchers to cover the co-pay on expensive drugs, AMA lobbying against expanded roles for nurse practitioners, etc.).

To address the topic at hand, I have my doubts that universal single payer will ever take hold in the US.  That kind of commie nonsense is only appropriate for god-fearing people over the age of 65, who would appreciate it if you kept your filthy government hands off their Medicare, thank you very much.

[Schaefer Light]

There is typically no incentive for the healthcare consumer to choose the cheaper route, and often they are not even made aware of the option unless they ask.  In many cases the out of pocket cost is the same (a $20 co-pay for example) independent of the level of care received.

Yep.  That was exactly the point of my post above.  My co-pay is the same regardless of which doctor I go to.  I have no idea how much the doctor charges my insurance company.  I think they send me a statement after the fact containing this information, but what good does that do?  I've already paid my $20 co-pay, so it makes no difference to me.

[tooqk4u22]

Excellent points about US health care costing more than anyone else's, and raising the economic mystery of why this is so. 

Here's an article that offers a comprehensive summary of why; includes some microeconomic explanations, along with resulting recommendations:
http://catalyst.nejm.org/make-crazy-expensive-amazing-uneven-health-care-system-better-faster/
.
.
.
From these, I agree that the main issue is total cost rather than distribution of cost; that savings are achievable; and conclude that both today and tomorrow can reasonably be viewed as part of a Golden Age of Saving.  From the details of the articles, Single Payer appears compatible with solutions, so a switch to Single Payer may help rather than hinder.

The article indicates that 10% of the population accounts for 65% of the spending and is for those with chronic diseases....so distribution might matter somewhat. This subject came up in another thread.  Much of the research focuses on life expectancy, which in the US is lower overall because of self induced issues like violent crime and domestic issues (many gun related), greater prevalence of autos/accidents, and overall poor health disciplines.  Many of these chronic diseases are likely minimized with healthier lifestyles (diet, exercise, stress, etc.) that seem to be more prevalent in other OECD nations.  There are absolutely inefficiencies and competitive restrictions in the US, as well as waste and fraud, but as a nation the US is its own worst enemy - more self-discipline and health education would do us good. 

https://www.forbes.com/sites/theapothecary/2011/11/23/the-myth-of-americans-poor-life-expectancy/#5d36ba222b98

But back on topic - hard to say if single payer would be good or bad for FIRE bc it all depends on how it is paid for and who pays for it, but it would have to be paid for and while the net payments would be neutral it would likely result in an economic adjustment for a period.

[JLee]

Excellent points about US health care costing more than anyone else's, and raising the economic mystery of why this is so. 

Here's an article that offers a comprehensive summary of why; includes some microeconomic explanations, along with resulting recommendations:
http://catalyst.nejm.org/make-crazy-expensive-amazing-uneven-health-care-system-better-faster/
.
.
.
From these, I agree that the main issue is total cost rather than distribution of cost; that savings are achievable; and conclude that both today and tomorrow can reasonably be viewed as part of a Golden Age of Saving.  From the details of the articles, Single Payer appears compatible with solutions, so a switch to Single Payer may help rather than hinder.

The article indicates that 10% of the population accounts for 65% of the spending and is for those with chronic diseases....so distribution might matter somewhat. This subject came up in another thread.  Much of the research focuses on life expectancy, which in the US is lower overall because of self induced issues like violent crime and domestic issues (many gun related), greater prevalence of autos/accidents, and overall poor health disciplines.  Many of these chronic diseases are likely minimized with healthier lifestyles (diet, exercise, stress, etc.) that seem to be more prevalent in other OECD nations.  There are absolutely inefficiencies and competitive restrictions in the US, as well as waste and fraud, but as a nation the US is its own worst enemy - more self-discipline and health education would do us good. 

https://www.forbes.com/sites/theapothecary/2011/11/23/the-myth-of-americans-poor-life-expectancy/#5d36ba222b98

But back on topic - hard to say if single payer would be good or bad for FIRE bc it all depends on how it is paid for and who pays for it, but it would have to be paid for and while the net payments would be neutral it would likely result in an economic adjustment for a period.

The top five causes of death in the US:
heart disease
cancer
lung disease
stroke
unintentional injuries

Tobacco use is involved in four out of those five. Curious how you put violent crime first on your list, when it doesn't even make the top 5.  We can even go up to top ten, causing 75% of deaths in the US, and violent crime still isn't there.

If we could kick fast food and tobacco, we'd be so much better off...

[tooqk4u22]

Excellent points about US health care costing more than anyone else's, and raising the economic mystery of why this is so. 

Here's an article that offers a comprehensive summary of why; includes some microeconomic explanations, along with resulting recommendations:
http://catalyst.nejm.org/make-crazy-expensive-amazing-uneven-health-care-system-better-faster/
.
.
.
From these, I agree that the main issue is total cost rather than distribution of cost; that savings are achievable; and conclude that both today and tomorrow can reasonably be viewed as part of a Golden Age of Saving.  From the details of the articles, Single Payer appears compatible with solutions, so a switch to Single Payer may help rather than hinder.

The article indicates that 10% of the population accounts for 65% of the spending and is for those with chronic diseases....so distribution might matter somewhat. This subject came up in another thread.  Much of the research focuses on life expectancy, which in the US is lower overall because of self induced issues like violent crime and domestic issues (many gun related), greater prevalence of autos/accidents, and overall poor health disciplines.  Many of these chronic diseases are likely minimized with healthier lifestyles (diet, exercise, stress, etc.) that seem to be more prevalent in other OECD nations.  There are absolutely inefficiencies and competitive restrictions in the US, as well as waste and fraud, but as a nation the US is its own worst enemy - more self-discipline and health education would do us good. 

https://www.forbes.com/sites/theapothecary/2011/11/23/the-myth-of-americans-poor-life-expectancy/#5d36ba222b98

But back on topic - hard to say if single payer would be good or bad for FIRE bc it all depends on how it is paid for and who pays for it, but it would have to be paid for and while the net payments would be neutral it would likely result in an economic adjustment for a period.

The top five causes of death in the US:
heart disease
cancer
lung disease
stroke
unintentional injuries

Tobacco use is involved in four out of those five. Curious how you put violent crime first on your list, when it doesn't even make the top 5.  We can even go up to top ten, causing 75% of deaths in the US, and violent crime still isn't there.

If we could kick fast food and tobacco, we'd be so much better off...

First it wasn't in order of priority as they were examples of self-induced issues as a population.  Its curious that you think suicide (#10 on your list) somehow wouldn't fall into that generalization of violent crime/domestic issues and if you combine it with the homicide stats that would move it up #7 on the list. 

But basically your list confirms my point - self-induced issues are big problem. 

[hoping2retire35]

I would guess it would come from(1) increased payroll taxes(FICA) and sort of (2)forcing everyone into the medicaid type situation where you pay some kind of higher premium toward the end of you life or they take up to a certain amount of assets, once your services used exceed some dollar amount after certain age, etc.

[JayhawkRacer]

...I have my doubts that universal single payer will ever take hold in the US.  That kind of commie nonsense is only appropriate for god-fearing people over the age of 65, who would appreciate it if you kept your filthy government hands off their Medicare, thank you very much.

This is gold.

[gentmach]

Supposedly 70% of Americans are financially illiterate. (http://freakonomics.com/podcast/everything-always-wanted-know-money-afraid-ask/) Therefore I doubt people are going to experience savings, instead spending money else where. And the cycle begins again.

[Leisured]

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.
people go to the doctor when they first start feeling unwell instead of waiting until they have heart attack.

I understand the problem is what economists call unequal market knowledge. Doctors and specialists have most of the knowledge; the patient usually has little.

In Australia we got national health in 1975, and it became clear that most of the demand for specialist time came from doctors writing referrals, not surprisingly. The doctor knew that the patient would pay little or nothing for the specialist's time.

I understand that our system assesses doctors' use of treatments, such as pathology, and sees which doctors make disproportionate use of medical services, in which case the outliers would receive a 'please explain' letter. In many cases, the doctor could have a legitimate need for a lot of medical services such as pathology, if his practice was in a predominantly elderly suburb.

[Leisured]

To address the topic at hand, I have my doubts that universal single payer will ever take hold in the US.  That kind of commie nonsense is only appropriate for god-fearing people over the age of 65, who would appreciate it if you kept your filthy government hands off their Medicare, thank you very much.

At last, a sensible remark (my late mother used to say, 'dripping with sarcasm'). I am Australian, and I hear that Cuba and Costa Rica benefit from Americans doing travel tourism, to get pharmaceuticals and other treatments at low cost. Have your cake and eat it too. A handy source of foreign exchange for Cuba and Costa Rica.

[Cranky]

It's interesting to look at how other countries fund it - it seems to mostly be a payroll tax in Germany, for instance.

But frankly, I think that an expense that you can realistically plan for makes it a lot easier to save than some random enormous number that you can't anticipate does.

That's not correct.  Germany generates almost equal amounts of tax from VAT (31% of total tax revenue) as it does Wage Taxes (30% of total tax revenue). I recently mentioned this in another thread incidentally and couldn't find the link below.   

The main ways to cover health care publicly are: (1) higher income taxes, (2) wealth taxes, (3) reduced costs, (4) other taxes such as VAT (although this would dramatically increase the cost of goods and services and would be similarly as consequential has having a wealth tax)

https://www.chicagofed.org/publications/chicago-fed-letter/2017/382

I have a friend who is German, and is gainfully employed there. She says that ~10% of her salary is deducted for health care premiums, and her employer pays the same.

I don't know how much is paid for otherwise, but that's her premium. It's a definite and predictable and managable sum, and frankly, I think it would make planning a retirement a LOT easier than the current American roll the dice and guess the premium and coverage system does.

[Malloy]

To address the topic at hand, I have my doubts that universal single payer will ever take hold in the US.  That kind of commie nonsense is only appropriate for god-fearing people over the age of 65, who would appreciate it if you kept your filthy government hands off their Medicare, thank you very much.

At last, a sensible remark (my late mother used to say, 'dripping with sarcasm'). I am Australian, and I hear that Cuba and Costa Rica benefit from Americans doing travel tourism, to get pharmaceuticals and other treatments at low cost. Have your cake and eat it too. A handy source of foreign exchange for Cuba and Costa Rica.

I'd rethink my harshness towards that generation, except then I think of them greedily feasting from the public trough of single payer medical benefits while also shouting about "socialism." 

[Bicycle_B]

Excellent points about US health care costing more than anyone else's, and raising the economic mystery of why this is so. 

Here's an article that offers a comprehensive summary of why; includes some microeconomic explanations, along with resulting recommendations:
http://catalyst.nejm.org/make-crazy-expensive-amazing-uneven-health-care-system-better-faster/
.
.
.
From these, I agree that the main issue is total cost rather than distribution of cost; that savings are achievable; and conclude that both today and tomorrow can reasonably be viewed as part of a Golden Age of Saving.  From the details of the articles, Single Payer appears compatible with solutions, so a switch to Single Payer may help rather than hinder.

The article indicates that 10% of the population accounts for 65% of the spending and is for those with chronic diseases....so distribution might matter somewhat.

But back on topic - hard to say if single payer would be good or bad for FIRE bc it all depends on how it is paid for and who pays for it, but it would have to be paid for and while the net payments would be neutral it would likely result in an economic adjustment for a period.

Good point, distribution matters.  Especially to an individual making retirement plans!

I guess I have the idea that Republican policy proposals are trying to change primarily the distribution of costs (charge older people more, allow healthy people the option not to pay, allow premiums to be raised for sick people who join the system) with the idea that this will reduce overall costs somehow.  Whereas I think the articles are saying that the cost reduction key is in other factors.  If the other factors are more important, redistributing the costs is moving the deck chairs around without fixing the ship's engine.  If the overall cost engine is repaired, on average all of the costs could go down.  How the system distributes cost will affect each individual's cost, though.  Complex.

PS.  If I'm still missing the point, please accept my apology.

[tooqk4u22]

Excellent points about US health care costing more than anyone else's, and raising the economic mystery of why this is so. 

Here's an article that offers a comprehensive summary of why; includes some microeconomic explanations, along with resulting recommendations:
http://catalyst.nejm.org/make-crazy-expensive-amazing-uneven-health-care-system-better-faster/
.
.
.
From these, I agree that the main issue is total cost rather than distribution of cost; that savings are achievable; and conclude that both today and tomorrow can reasonably be viewed as part of a Golden Age of Saving.  From the details of the articles, Single Payer appears compatible with solutions, so a switch to Single Payer may help rather than hinder.

The article indicates that 10% of the population accounts for 65% of the spending and is for those with chronic diseases....so distribution might matter somewhat.

But back on topic - hard to say if single payer would be good or bad for FIRE bc it all depends on how it is paid for and who pays for it, but it would have to be paid for and while the net payments would be neutral it would likely result in an economic adjustment for a period.

Good point, distribution matters.  Especially to an individual making retirement plans!

I guess I have the idea that Republican policy proposals are trying to change primarily the distribution of costs (charge older people more, allow healthy people the option not to pay, allow premiums to be raised for sick people who join the system) with the idea that this will reduce overall costs somehow.  Whereas I think the articles are saying that the cost reduction key is in other factors.  If the other factors are more important, redistributing the costs is moving the deck chairs around without fixing the ship's engine.  If the overall cost engine is repaired, on average all of the costs could go down.  How the system distributes cost will affect each individual's cost, though.  Complex.

PS.  If I'm still missing the point, please accept my apology.

I agree that moving around the deck chairs won't matter much, but I don't know the answer.  Healthier people opting out isn't the right answer, having newly sick people pay exorbitant amounts isn't the right answer, everyone paying equally doesn't seem to be the right answer when so much seems to be lifestyle driven.....so where do we go.

I think a big opportunity lies in preventive and routine care combined with health/nutrition education.  Think about it, if 10% of the population accounts for 65% of the costs that means the cost for them is $2 trillion ($3.2T per the article x 65%) much of it related directly or indirectly to bad choices - if people became healthier, were evaluated/educated/monitored earlier or and more frequently a lot of these issues would be reduced or avoided altogether.  The inducement in those earlier stages should include some form of extra payment if they don't work to get healthier or don't make appointments.   If this group saves 20% that would be $400 Billion - it wouldn't happen overnight though as it would take time to improve the current population and you have to wait to prevent the issues of the future population.  But that's not even getting into the waste and inefficiency.

[talltexan]

I think it's the golden age of saving because incomes are as high as they've ever been.

I think single payer is politically within reach for about the same reason: that a wealthy society can afford it to a degree that a poorer one cannot.

One doesn't cause the other. Both are caused by a third thing.

[NoStacheOhio]

I get a little tired of the existential freak-outs when we talk about new taxes, and how to pay for healthcare.

We're already paying a lot for a deeply flawed and unfair system. One where people like me (and my family) can consume well over $100k (sticker price) of care in three months while only paying ~$400 in cost-sharing. Other people in the same situation would be looking at, what, $7,500? More? I'm glad I won the employer lottery, but damn is that unfair to everyone who didn't.

The vast majority of people are already paying for healthcare (mostly via health insurance premiums and cost-sharing, call it a private tax to insurers). Everything I've seen points to single-payer being roughly the same or more efficient than private insurance. So instead of paying the private tax, we pay the public tax. Yes, the question of current employer subsidies remains open, but if they revamped FICA, companies would still be contributing some amount of money like they are now.

We're a wealthy society that can afford a fairly good standard of care for everyone. Whether or not we're willing to do it seems to be the current debate.

[BlueMR2]

(I use the words sometimes/often/typical as I know there are some in the US that have some incentive to control costs via high deductible health plans with large out of pocket maximums)

There's a disconnect between the healthcare professionals and the rest of the country in that regard.  The healthcare people just don't seem to have any clue what they're prescribing in regards to cost.  My wife was recently (as noted elsewhere on the forums) prescribed a $1600 bottle of eye drops!  The doctor uses them and thinks nothing of it!  Doesn't even want to try to research any alternative because that's what she uses and thinks we should just pay for it.  I'm sure it's great, but that's just outrageous!  I wish I could say that's an isolated incident, but I hear the same story over and over from everyone I talk to that's outside healthcare.  Everyone in healthcare is like "oh, a couple thousand a month out of pocket on pills is normal".

[NoStacheOhio]

(I use the words sometimes/often/typical as I know there are some in the US that have some incentive to control costs via high deductible health plans with large out of pocket maximums)

There's a disconnect between the healthcare professionals and the rest of the country in that regard.  The healthcare people just don't seem to have any clue what they're prescribing in regards to cost.  My wife was recently (as noted elsewhere on the forums) prescribed a $1600 bottle of eye drops!  The doctor uses them and thinks nothing of it!  Doesn't even want to try to research any alternative because that's what she uses and thinks we should just pay for it.  I'm sure it's great, but that's just outrageous!  I wish I could say that's an isolated incident, but I hear the same story over and over from everyone I talk to that's outside healthcare.  Everyone in healthcare is like "oh, a couple thousand a month out of pocket on pills is normal".

They cost $1,600 for you, but they may cost another patient $50. There are so many different plans and coverage situations that there's no way to know. Healthcare prices, in general, are disconnected from reality in a unique way. It's largely due to our system of insurance, lack of transparency and the games everyone plays with billing.

[Valhalla]

Supposedly 70% of Americans are financially illiterate. (http://freakonomics.com/podcast/everything-always-wanted-know-money-afraid-ask/) Therefore I doubt people are going to experience savings, instead spending money else where. And the cycle begins again.

This blows my fucking  mind away.  The information is so widely available now, free, and people still choose to spend time doing mindless / meaningless things, like watching sports, useless TV drama / reality shows, etc., instead of spending a fraction of time to gain financial literacy.   

Silver lining - it makes people who are eager to learn and improve stick out of the crowd easily, people like you and me.  We are not only way ahead of the competition, the competition is taking a break and falling backwards.

[Valhalla]

(I use the words sometimes/often/typical as I know there are some in the US that have some incentive to control costs via high deductible health plans with large out of pocket maximums)

There's a disconnect between the healthcare professionals and the rest of the country in that regard.  The healthcare people just don't seem to have any clue what they're prescribing in regards to cost.  My wife was recently (as noted elsewhere on the forums) prescribed a $1600 bottle of eye drops!  The doctor uses them and thinks nothing of it!  Doesn't even want to try to research any alternative because that's what she uses and thinks we should just pay for it.  I'm sure it's great, but that's just outrageous!  I wish I could say that's an isolated incident, but I hear the same story over and over from everyone I talk to that's outside healthcare.  Everyone in healthcare is like "oh, a couple thousand a month out of pocket on pills is normal".

They cost $1,600 for you, but they may cost another patient $50. There are so many different plans and coverage situations that there's no way to know. Healthcare prices, in general, are disconnected from reality in a unique way. It's largely due to our system of insurance, lack of transparency and the games everyone plays with billing.

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.

[NoStacheOhio]

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.

[Valhalla]

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.

[WhiteTrashCash]

I think we should fund single-payer health insurance in the US by opening lots of new casinos and taxing them. Oh, wait, sorry. For a second there, I thought I was a 21st century politician.

[NoStacheOhio]

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.

Many cancers don't care if you're "responsible."

I'm sick of people picking this to be outraged about how unfair it is. Of the unfair things in our world, this is so far down it's not even funny.

Maybe people will stop making bad decisions when they stop being poor. Because the stress of being poor literally leads people to make worse decisions than they otherwise would.

We spend all of this money on stupid, ineffective and expensive assistance programs. Some of which actually have the opposite effect of what's intended.

You know what works better for less money? Universal basic income. Every study I've seen on it concluded that it's cheaper, more effective at reducing poverty AND would have all sorts of cascading benefits, including health outcomes. Yeah, it's giving people money for nothing, but we're already doing that anyway. Badly.

[ketchup]

(I use the words sometimes/often/typical as I know there are some in the US that have some incentive to control costs via high deductible health plans with large out of pocket maximums)

There's a disconnect between the healthcare professionals and the rest of the country in that regard.  The healthcare people just don't seem to have any clue what they're prescribing in regards to cost.  My wife was recently (as noted elsewhere on the forums) prescribed a $1600 bottle of eye drops!  The doctor uses them and thinks nothing of it!  Doesn't even want to try to research any alternative because that's what she uses and thinks we should just pay for it.  I'm sure it's great, but that's just outrageous!  I wish I could say that's an isolated incident, but I hear the same story over and over from everyone I talk to that's outside healthcare.  Everyone in healthcare is like "oh, a couple thousand a month out of pocket on pills is normal".

They cost $1,600 for you, but they may cost another patient $50. There are so many different plans and coverage situations that there's no way to know. Healthcare prices, in general, are disconnected from reality in a unique way. It's largely due to our system of insurance, lack of transparency and the games everyone plays with billing.

This is very much the case.  I was prescribed a certain Schedule II painkiller after some minor surgery recently, and my insurance wouldn't cover the prescription because it was very slightly the wrong dosage (like 5% less potent than the magical specific dosage insurance would have covered).  So I paid ~$50 out of pocket instead of ~$8 (I could have gone back to the doctor and gotten a different prescription, but my local anesthetic was wearing off so I couldn't exactly wait until the next day).  It's all a fucking game.  The guy at Walgreens was very polite and helpful with explaining it, and I could tell he was frustrated, but it would have been much more than an annoyance if there were more zeros on both prices (or was a recurring thing like many have).

[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.

[Hash Brown]

If we switch to single payer...taxes might go up, but obviously employee and employer insurance payements would cease. 

Costs to companies go down because they could shrink their HR departments.  Ownership/management no longer has to schedule a bunch of meetings to figure out what the hell is going to happen next year.  Costs for care go down because giant commissions are no longer paid to salesman who successfully switch companies from one insurer to another.  Costs for care go down because billing is simplified by orders of magnitude.  Costs go down because the government tells medical device and pharma how much they're going to pay instead of each negotiating with each insurer.  Costs go down because there is much less or almost zero advertising by insurers (who don't exist anymore) or health networks.  Costs go down because hospitals and "clinics" aren't compelled to renovate their buildings every six years as part of ongoing branding.  Costs go down because we don't tear down perfectly-good facilities to move to new buildings next to freeways with better visibility for branding. 

[NoStacheOhio]

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/

[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.

[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/

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

[YttriumNitrate]

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.

Actually, "miserable lifestyles" result in lower lifetime healthcare costs:
https://webcache.googleusercontent.com/search?q=cache:-rZcKqzJUp8J:https://www.forbes.com/sites/timworstall/2012/03/22/alcohol-obesity-and-smoking-do-not-cost-health-care-systems-money/+&cd=21&hl=en&ct=clnk&gl=us

https://www.washingtonpost.com/news/wonk/wp/2012/12/07/cutting-smoking-rates-will-save-lives-it-wont-save-money/?utm_term=.50d0a84d4900

The obese smokers are actually subsidizing your healthcare.... :-)

[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.

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.

[hoping2retire35]

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.

Then what is wrong with the current system, or preACA? Whether you pay for insurance or pay directly for medical services then we are all paying for everyone else anyways, what do we gain (for cost efficiency) as a system or as individuals by having single payer?

As I understand it, from what you are saying, the only benefit left is the humanitarian one; everyone has regular access and care because everyone else is required to pay into a system. I don't see how that would create a cost savings other than possibly some in administration; though that seems unlikely.

[Valhalla]

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.

Actually, "miserable lifestyles" result in lower lifetime healthcare costs:
https://webcache.googleusercontent.com/search?q=cache:-rZcKqzJUp8J:https://www.forbes.com/sites/timworstall/2012/03/22/alcohol-obesity-and-smoking-do-not-cost-health-care-systems-money/+&cd=21&hl=en&ct=clnk&gl=us

https://www.washingtonpost.com/news/wonk/wp/2012/12/07/cutting-smoking-rates-will-save-lives-it-wont-save-money/?utm_term=.50d0a84d4900

The obese smokers are actually subsidizing your healthcare.... :-)

Interesting articles, I'd like to see the data behind the assertions.   I have seen some acquaintances who suffered cancer from smoking, obesity, and their medical bills have shot into the $1 million + in terms of costs.  A few ultimately did succumb from the diseases, but not before they incurred medical bills of $1 million +, most of which were covered by health insurance / medicare.  It was quite sobering...seeing the huge cocktails of drugs they had to take that cost thousands per month, along with the frequent medical care needed. 

Seeing those things in person made me quickly give up eating an unhealthy diet, being sedentary, and taking my health for granted.  I have to help some distant relatives a few times a year...they are unable to change light bulbs or do anything physically strenuous.   So I make it a point to visit, take care of random things like replacing burnt out bulbs, oil their garage door openers, clean gutters, anything that is too small to ask someone to help with, and too big for them to do it themselves.  Very sad situation, all due to unhealthy lifestyles.

[Hash Brown]

^Cheap industrialized food and our automobile-dependent cities has come at a terrible cost. 

[YttriumNitrate]

Interesting articles, I'd like to see the data behind the assertions.   I have seen some acquaintances who suffered cancer from smoking, obesity, and their medical bills have shot into the $1 million + in terms of costs.  A few ultimately did succumb from the diseases, but not before they incurred medical bills of $1 million +, most of which were covered by health insurance / medicare.

Here's a pretty good article from the New England Journal of Medicine: http://www.nejm.org/doi/pdf/10.1056/NEJM199710093371506 Basically, at all points throughout their life smokers have higher healthcare costs, but their shorter life expectancy compensate for the higher costs and then some.