Defeating the bogeyman of single payer healthcare

You still fail to realize that instead of getting tens of millions of people off the taxpayers' backs, you'll have 300 million people on the taxpayers' backs instead. It may work better in a homogenous country of smart, successful people, but it won't work in a country where 34% of the population is minority. In Canada, the poverty rate is between 10-12%. In Finland, it's around 5%. In the US, it's about 17%, and that's a lowball figure. The only reason longevity and infant mortality are better in those countries than in the US is because of the poorer results of minorities. Longevity and infant mortality of whites in the US matches that of European nations. Our costs are higher because we have so many poor people to support. And tell me, if it's so cost-efficient, why would it add two trillion dollars to an already three and a half trillion dollar budget?

 

Ah, isn't racism lovely?

Now where is that list of mine...

 

Your racism runs deep..

Read this again:

Just as it would be incredibly inefficient to eliminate the Department of Defense and replace it with multiple private sector entities, a single, coordinated, unified US military to which everyonecontributes and that protects everyone is, obviously, the sensible approach.

 

You underestimate the United States. Instead of finding excuses for having, by far, the most expensive health care system in the world that fails to cover tens of millions, you should have confidence that we can accomplish what advanced nations have accomplished, if not exceed their level of success, creating a system in which we can take pride, not offer apologies.

Don't resign yourself to the multiple lavish executive compensations, the duplicated payrolls, infrastructures, agency commissions, marketing and advertising costs, and other operating expenses, etc., the cost of all of which is diverted from actual healthcare to feed the superfluous ravenous middle man.

Let's direct the nation's health care dollars at health care, not to feed those who enrich themselves off the system whilst treating or curing no one.

 

Why Single Payer Health Care Is a Terrible Option
Scott Atlas
CNN
September 25, 2017

The Affordable Care Act (ACA) is failing. Without regard for consequences, the law expanded government insurance programs and imposed considerable federal authority over US health care via new mandates, regulations and taxes. Insurance premiums skyrocketed even as deductibles rose; consumer choices of insurance on state marketplaces have rapidly vanished; and for those with ACA coverage, doctor and hospital choices have narrowed dramatically. Meanwhile, consolidation across the health care sector has accelerated at a record pace, portending further harm to consumers, including higher prices of medical care.

Almost inexplicably, even more top-down control -- single-payer health care, a system in which the government provides nationalized health insurance, sets all fees for medical care and pays those fees to doctors and hospitals -- has found new support from the left. And this despite its decades of documented failures in other countries to provide timely, quality medical care, and in the face of similar problems in our own single-payer Veterans Affairs system.

Clearly, this moment cries out for the truth about single-payer health care -- conclusions from historical evidence and data.

Single-payer health care is proven to be consistently plagued by these characteristics:

Massive waiting lists and dangerous delays for medical appointments
In those countries with the longest experience of single-payer government insurance, published data demonstrates massive waiting lists and unconscionable delays that are unheard of in the United States. In England alone, approximately 3.9 million patients are on NHS waiting lists; over 362,000 patients waited longer than 18 weeks for hospital treatment in March 2017, an increase of almost 64,000 on the previous year; and 95,252 have been waiting more than six months for treatment -- all after already waiting for and receiving initial diagnosis and referral.
In Canada's single-payer system, the 2016 median wait for a referral from a general practitioner appointment to the specialist appointment was 9.4 weeks; when added to the median wait of 10.6 weeks from specialist to first treatment, the median wait after seeing a doctor to start treatment was 20 weeks, or about 4.5 months.

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Ironically, US media outrage was widespread when pre-ACA 2009 datashowed that time-to-appointment for Americans averaged 20.5 days for five common specialties. That selective reporting failed to note that those waits were for healthy check-ups in almost all cases, by definition the lowest medical priority. Even for simple physical exams and purely elective, routine appointments, US wait times before ACA were shorter than for seriously ill patients in countries with nationalized, single-payer insurance.

Life-threatening delays for treatment, even for patients requiring urgent cancer treatment or critical brain surgery
Those same insured patients in single-payer systems are dying while waiting for the most critical care, including those referred by doctors for "urgent treatment" for already diagnosed cancer (almost 19% wait more than two months) and brain surgery (17% wait more than four months). In Canada's single-payer system, the median wait for neurosurgery after already seeing the doctor was a shocking 46.9 weeks -- about 10 months. And in Canada, if you needed life-changing orthopedic surgery, like hip or knee replacement, you would wait a startling 38 weeks -- about the same time it takes from fertilization to a full-term human life.

Delayed availability of life-saving drugs
Americans enjoy the world's quickest access to the newest prescription drugs, in stark contrast to patients in single-payer systems. In Joshua Cohen's 2006 study of patient access to 71 drugs, between 1999 and 2005 the UK government's guidelines board, NICE, had been slower than the United States to authorize 64 of these. Before the ACA, the United States was by far the most frequent country where new cancer drugs were first launched -- by a factor of at least four -- compared to any country studied in the previous decade, including Germany, Japan, Switzerland, France, Canada, Italy and the UK, according to the Annals of Oncology in 2007.

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In a 2011 Health Affairs study, of 35 new cancer drugs submitted from 2000-2011, the US Food and Drug Administration (FDA) had approved 32 while the European Medicines Agency (EMA) approved only 26. Median time to approval in the United States was about half of that in Europe. All 23 drugs approved by both were available to US patients first. Even in the most recent data, two-thirds of the novel drugsapproved in 2015 (29 of 45, 64%) were approved in the United States before any other country. And yet, only months ago, NHS in England introduced a new "Budget Impact Test" to cap drug prices, a measure that is specifically designed to further restrict drug access even though the delays will break their own NHS Constitution pledges to its citizens.

Worse availability of screening tests
Despite what some might suppose about a likely strength of a government-centralized system, the facts show that single-payer systems cannot even outperform our system in something as scheduled and routine as cancer screening tests. Confirming numerous prior OECD studies, a Health Affairs study reported in 2009, before any Affordable Care Act screening requirements, that the United States had superior screening rates to all 10 European countries with nationalized systems for all cancers. Likewise, the single payer system of Canada fails to deliver screening tests for the most common cancers as broadly as the US system, including PAP smears and colonoscopies. And Americans are more likely to be screened younger for cancer than in Europe, when the expected benefit is greatest. Not surprisingly, US patients have had less advanced disease at diagnosis than in Europe for almost all cancers.

Significantly worse outcomes from serious diseases
It might be said that the bottom line about a health care system is the data on outcomes from treatable illnesses. To no one's surprise, the consequences of delayed access to medications, diagnosis and treatment are significantly worse outcomes from virtually all serious diseases, including cancer, heart disease, stroke, high blood pressure and diabetes compared to Americans.
And while some studies have noted that Canadians and Germans, for example, have longer life expectancies and lower infant mortality rates than Americans do, they are misleading. Those statistics are extremely coarse and depend on a wide array of complex inputs having little to do with health care, including differences in lifestyle (smoking, obesity, hygiene, safe sex), population heterogeneity, environmental conditions, incidence of suicide and homicide and even differences in what counts as a live birth.

The truth is that the UK, Canada and other European countries for decades have used wait lists for surgery, diagnostic procedures and doctor appointments specifically as a means of rationing care. And long waits for needed care are not simply inconvenient. Research (for example, here) has consistently shown that waiting for medical care has serious consequences, including pain and suffering, worse medical outcomes and significant costs to individuals in foregone wages and to the overall economy. In contrast to countries with single-payer health systems, it is broadly acknowledged that "waiting lists are not a feature in the United States" for medical care, as stated by Dr. Sharon Wilcox in her study comparing strategies to measure and reduce this important failure of centralized health systems.
What has been the response to the public outcry about unacceptable waits for care in single-payer systems? First, a growing list of European governments have issued dozens of "guarantees" with intentionally lax targets, and even those targets continue to be missed. Second, many single-payer systems now funnel taxpayer money to private care to solve their systems' inadequacies, just as we now do in our own Veteran Affairs system, and even use taxpayer money for care in other countries.

Instead of judging health system reforms by the number of people classified as "insured," reforms should focus on making excellent medical care more broadly available and affordable without restricting its use or creating obstacles to future innovation. Reducing the cost of medical care requires creating conditions long proven to bring down prices while improving quality: increasing the supply of medical care, stimulating competition among providers and incentivizing empowered consumers to consider price.

Single-payer systems in countries with decades of experience have been proven in numerous peer-reviewed scientific journals to be inferior to the US system in terms of both access and quality. Americans enjoy superior access to health care -- whether defined by access to screening; wait-times for diagnosis, treatment, or specialists; timeliness of surgery; or availability of technology and drugs. As those countries turn to privatization to solve their systems' failures, progressives here illogically pursue that failed model.

And make no mistake about it -- America's most vulnerable, the poor, as well as the middle class, will undoubtedly suffer the most if the system turns to single-payer health care, because they will be unable to circumvent that system.

 

Sounds like Scott Atlas never heard of "triage".. Are you deceived by the failure to address the facts?

 

I am not a socialist and wouldn't be one because everywhere socialism goes, so does failure. I think I addressed the facts that single payer is NOT an option for the US. A lot of people from Canada and England come here for treatment.

 

A lot of RICH people. We have a great system if you are rich

 

I thought Jimmy79 brought up some good points. Particularly about cost sharing and fraud. How do you handle that issue as, under a Medicare for all plan, more and more patients are coming in with Medicare, paying at lower Medicare rates? And fraud? Medicare fraud is about 60 billion a year.

60 Billion. How does Medicare for all handle that?

 

Like I said what is your point? The link merely describes a situation. It makes no policy point, merely corrects a misperception on the part of some "observers" and pundits. Do you understand this, or should you be doing more homework?

 

The link describes a situation - exactly. And what situation is that ?? That is my point.

 

How long do you think it would take to build up your HSA to cover the cost of say a "triple bypass" operation, which can cost anywhere from $80K to 200K? Thats one helluva lotta saving required especially on top of retirement savings - unless dog food appeals.

 

Okay make an irrelevant point that consists of straightforward description of current cost allocations.

 

Did you miss the part about the high deductible catastrophic care plan? Or did you see it but ignore it since it doesn't fit the narrative you are pushing?

 

I'd recommend some changes to the malpractice laws before experimenting that way.

 

missed it.

 

I'm still waiting for and open to the naysayers' offering an alternative approach to the paradigm of advanced nations that cover everybody at far lower cost.

In case you have not noticed, the GOP that has kvetched about the ACA for seven years, has been impotent in replacing it with anything better.

If someone insists the US does not have the ability to achieve what all those nations have achieved, I disagree.

 

When is somebody decrying the ills of average wait times going to learn the word TRIAGE.

Yes wait times are much longer if it isn't immediately life threatening. Its not first come first serve in the Canadian system.

That's the trouble when superficially examining statistics using medians as benchmarks. the stat is true, but the implication that the system is bad/inferior is most definitely not.

 

Well the fraud issue is one that we have right now with Medicare. Why can't you fix it? If we have that ability, why not use it?

 

I need to come back to my response to you tonight when I get home from work and can properly source everything.

In general though, the best way to bring down costs is to support the cash market through law and employer contributions, the same way they work insurance now.

 

These same comments can be made about both sides of this argument. What better metric is there though? Cost is a bad one as it also incorporates MANY expenses that aren't directly related to health care. As you point out, outcomes aren't very good as they are too broad.

 

Are you covered under a taxpayer-subsidized employer-administered plan?

Why do employers need to bear the bureaucratic borden and be gifted with enormous tax breaks for having to do so? The likelihood of anyone needing medical care has no relationship to whether or where she is employed at the time the care is needed. It began as an insignificant company perquisite before costs skyrocketed, but the State diverting private business from their normal profit-making activities has no logical excuse now. No rational person would never have planned it that way.

Would you retain the health insurance cartel's repeatedly-duplicated executive compensations, company payrolls, operating costs, marketing and advertising budgets, profit margins, agency commissions, etc., etc., etc. for the behemoth middle man that treats or cures no one? Why divert so large a portion of every health care dollar to what is a parasitic entity? (Of which I had once been in middle management before opting for self-employment.)

Trump's admirable stated vow was to replace the ACA with "something terrific!" that covered "everybody!" at "lower cost!"

How's that coming along?

 

1. I'm not covered under a taxpayer subsidized plan. I may even be subject to the Cadillac tax if/when that is incorporated.

2. The burden is an incentive to prospective employees. The added burden of choice is already in most large company's accounting system so it would require no real added work. You want to.see business lose the ability to write off business expenses? I don't see how anyone that claims to own a business would be for that.

3. Reinforcing and expanding a free market would do more to break up the insurance cartels than any other idea. Even single payer is just an even more restrictive insurance option. You change who the middle man is, then claim to get rid of the middle man. That makes no sense.

 

Calling people racist for pointing out facts has gotten old. Would you like me to point out that white people have smaller dicks, run slower, and jump lower than black people to equal out the racial differences?

Seattle and Detroit have approximately the same number of people, but have far different racial and economic makeups. Seattle is 66% white with an additional 14% Asian, for 80% of the population that has an IQ of 100 or maybe a little better, while only 13.5% is black or Hispanic. Detroit is 80% black, a population that has an average IQ of 85, and only 10% white. Seattle's median household income is $80,000+. Detroit's median household income is $24,000+. Seattle's city budget last year was $5.6 billion. Detroit's city budget last year was $1.9 billion. (Which prompts me to ask all you liberals on this board, where do you live? In an upscale neighborhood/state where there's lots of money available, or in a poor neighborhood/state, where there's very little money to go around?) Comparatively speaking, far more of America's population is at the low end of the economic distribution spectrum than countries like Canada and Sweden. The census bureau says half the population of the US has either poverty income or low income, defined as twice the poverty rate or less, which would fall around $24K per year for a household, meaning half the population of the US is like Detroit. Only 33.4% of the population earns Seattle-type wages of $80K or more. (According to a chart on this page, https://en.wikipedia.org/wiki/Household_income_in_the_United_States, only 23.5% of households earn less than $25K, but poverty and low income are also defined by family size.) So then the question becomes, what kind of health care system could Detroit afford, not Seattle? I guarantee, it's not single-payer.

According to this study, https://www.researchgate.net/public...ivate_Sector_More_Efficient_A_cautionary_tale, neither the public sector nor the private sector is inherently more efficient than the other. So, no, there will be no cost-savings from going to a single-payer plan. Next.

And then which system innovates more, the public or private sector?

(A note on that comment: most of the "government's" ability to spy on and track people has come from private sector innovations, not public sector ones.)

Edit: subject/verb agreement

 

It sounds as if you want to keep pouring a large percentage of every healthcare dollar into all the multiply-duplicated lavish executive compensations, company payrolls, infrastructures, profit margins, advertising and marketing budgets, agency commissions, etc, of the parasitic middle man cartel that treats or cure no one.

All employer-administered plans are subsidized by the taxpayer via a tax write-off of around $250 billion annually. Not only is administration a bureaucratic burden, especially for smaller companies, but the senseless link between employment and health insurance coverage is an impediment to entrepreneurial initiatives, an added bureaucratic barrier for job-creating start-ups.

Airy-fairy ideological confections abound, but the reality is that the US has, by far, the most expensive health care system on earth, yet it still fails to cover tens of millions. That is a disaster by any reasonable standards, especially given the empirical reality of all the advanced nations insuring all citizens at half the cost. For pragmatists, the paradigm that has been shown, repeatedly, to actually work better is the way to go.

Is the United States capable of emulating what has been demonstrated to work for advanced nations? I don't see why not. Yet US politicians, in the pocket of Big Pharma, can't even take the obvious step of allowing Medicare to negotiate Rx costs. That would allow Americans to pay the lower prices that all those advanced nations enjoy.