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About that "World's Best Healthcare System" the U.S. is supposed to have...

What are the objections to single payer?

Socialism! Keep your gummint hands off my Medicare! Seriously, it's kind of hilarious that the most reliable voting bloc for the party that's against single-payer is basically 100% served by single-payer.

And what Bob said.
 
The objections are distrust of the government to be efficient, reasonably free from waste/corruption, free from partisanship. There are already examples of government inefficiency, waste/corruption, and partisanship already in current programs. That when the US exceeds its ability for debt, hard decisions that have to be made will fall on the elderly (death panels! yet most healthcare is spent on those in final months/year of life, so yeah, death panels). If the government decides that something is not covered, there is nowhere else to go.
 
But practically, what are the problems with it? I understand roadblocks/impediments towards implementing, but what are the potential flaws?

First and foremost, you'd have the US Government running the healthcare system in the same manner they do all of their other functions. Some would be fine with that, others would not. Have you ever tried to sort out a problem with the IRS even if you were 100% correct? Getting that same level of "customer service" with regard ot healthcare would be an absolute nightmare.

You also have the massive question of how do we pay for it. The obvious answer, of course, is taxes. So you end up with the same 10% or so of people who pay most of the income taxes now paying for most of the costs of everyone's health care on top of that. Which I guess is great if you are one of the people getting your healthcare paid for, but there will be a huge fight from the people who are forced to do all of the paying, because it distances the cause from the cost even more so than it is now.
 
The objections are distrust of the government to be efficient, reasonably free from waste/corruption, free from partisanship. There are already examples of government inefficiency, waste/corruption, and partisanship already in current programs. That when the US exceeds its ability for debt, hard decisions that have to be made will fall on the elderly (death panels! yet most healthcare is spent on those in final months/year of life, so yeah, death panels). If the government decides that something is not covered, there is nowhere else to go.

I suppose. I don't think any of those are very convincing, since none of them has occurred in the 60-year history of Medicare nor am I aware that any of them are a major problem in single-payer Euro systems.

The more convincing arguments are care rationing in the form of wait lists and tighter restrictions on what kinds of drugs you can demand from your doctor. The wait list issue is a real issue, although overblown (average wait times are short in the US, unless you factor in all the people who need the procedure and actually never get it because they are uninsured or can't afford it because of our country's stingy medical leave policies - adding those numbers in would probably make our wait times look a lot longer). I think less patient freedom to demand brand name drugs because they see them on TV all the time is probably a good thing.
 
The objections are distrust of the government to be efficient, reasonably free from waste/corruption, free from partisanship. There are already examples of government inefficiency, waste/corruption, and partisanship already in current programs. That when the US exceeds its ability for debt, hard decisions that have to be made will fall on the elderly (death panels! yet most healthcare is spent on those in final months/year of life, so yeah, death panels). If the government decides that something is not covered, there is nowhere else to go.

Yet the single payer system we have now deals specifically with end of life care.
 
I suppose. I don't think any of those are very convincing, since none of them has occurred in the 60-year history of Medicare nor am I aware that any of them are a major problem in single-payer Euro systems.

The more convincing arguments are care rationing in the form of wait lists and tighter restrictions on what kinds of drugs you can demand from your doctor. The wait list issue is a real issue, although overblown (average wait times are short in the US, unless you factor in all the people who need the procedure and actually never get it because they are uninsured or can't afford it because of our country's stingy medical leave policies - adding those numbers in would probably make our wait times look a lot longer). I think less patient freedom to demand brand name drugs because they see them on TV all the time is probably a good thing.

Wait, what? You are unaware of Medicare or Medicaid corruption/fraud?
 
I suppose. I don't think any of those are very convincing, since none of them has occurred in the 60-year history of Medicare nor am I aware that any of them are a major problem in single-payer Euro systems.

The more convincing arguments are care rationing in the form of wait lists and tighter restrictions on what kinds of drugs you can demand from your doctor. The wait list issue is a real issue, although overblown (average wait times are short in the US, unless you factor in all the people who need the procedure and actually never get it because they are uninsured or can't afford it because of our country's stingy medical leave policies - adding those numbers in would probably make our wait times look a lot longer). I think less patient freedom to demand brand name drugs because they see them on TV all the time is probably a good thing.

Bush's Medicare part D expansion would be a recent example.

Medicare compensates doctors so poorly, they limit their number of Medicare patients; and there is worry there would be a mass exodus from the field if that was the norm.
 
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The objections are distrust of the government to be efficient, reasonably free from waste/corruption, free from partisanship. There are already examples of government inefficiency, waste/corruption, and partisanship already in current programs. That when the US exceeds its ability for debt, hard decisions that have to be made will fall on the elderly (death panels! yet most healthcare is spent on those in final months/year of life, so yeah, death panels). If the government decides that something is not covered, there is nowhere else to go.

Death panels? Really???

The reality is we spend much, much more for less care than many countries do. Exactly what good do all the dollars that we spend on insurance companies do for our healthcare?

Oh, you'd also immediately save for the premiums for those who aren't covered.
 
This three has taken an interesting turn. Lets looks at a few things…

Under the ACA there are thresholds of how much $ can be spent on marketing/admin/salary etc versus what needs to spent on claims. Excess margins are returned to the policy holders. On average, the break out is roughly 85% spent paying for health care, 10% on admin and 5% on margin. Of the 10%, I can assure you executive pay is a minuscule amount (and thats a high estimate). We've looked at it and its not even a rounding error for our leadership. Im not crazy about excess executive compensation (I'm probably am more anti the egregious Wall Street packages than the $2M CEO salary) but it has NOTHING to do with increased medical trend. The enemy is increasing demand for care and the increasing costs of care. Insurers price for this and try to control it. They don't cause it. Insurers have their sins but this isn't it.

Now, a funny thing happened with the ACA. While there are caps on your medical loss ratio, the rules are so complex administrative costs have begun to increase. I can't underscore just how complex these rules are. And the rules are also somewhat crazy. Here's on example I've referenced before…

Exchnage buyers who don't pay premiums get one month free. If I buy in Jan, pay Feb and don't pay March, all my claims paid in March HAVE to be covered by the insurer. This has a MUCH bigger impact on trend than salaries. Its not even close. In fact, the cost of issuing the federally mandated delinquency notices have more impact. This is the ACA at work.

Now, businesses have marketing spend since you know, they are trying to sell products. Not sure what the beef is there (especially given the rules noted above). But lets look at how much HHS spent this year to get people enrolled on the exchanges (and they wanted to spend a ton more). And remember brokers actually had to help people get enrolled based on its incredible complexity. The feds paid brokers $0 to do this. Are these not acceptable "marketing" expenses? They seem so to me.

As an aside, the spike in advertising from insurers was a 100% a result of the ACA as plans rebranded themselves in prep of the exchanges. All of the big national carriers went through a significant transformation but thats a post for another day.

Last, we need to also realize administrative costs aren't a bad thing. The value insurers bring is to control trend, find waste/fraud thats rampant and also develop innovative programs to lower costs. Outcome based reimbursement and quality profiling were an innovation from the private sector. Many of the case management programs that control disease (and costs) are costly but have positive ROIs. There are countless medicare demonstration projects i pact to control costs. Out own internal ROI translates to roughly a 5/1 return. Dinsingg the value of payers is just ignorant of how the HC industry works.

I will agree with RJ that selling across state lines is a red herring. However, is reasoning is 100% wrong. If you talk tot he M&A guys, they will all tell you the OPPOSITE is true. There's no need for consolidation when selling nationally. Nationsla nut regional players to get into local markets. They won't need to do that if we had this.

Single payer has its mrot. It can lower the cost per unit (i.e. paying doics LESS) and limiting the # of units (rationing of care). Medicare does a horrible job of the later thus it has problems (amongst a how tof totters). The tradeoff of single payer (quality debate aside) are pretty clear. That being said, the US system (and culture) just couldn't accept a true. The state of of our culture and our delivery system today would make it a disinter IMHO.

BTW, I've been accused of being a shill so in full disclosure, I work in the industry, but am not compensated more than your average MBA grad with 20 yrs experience. I work for a not for profit, not that that matters.
 
Go to the cheapest doctor and have them ration your health care. That what every other civilized nation does.
 
While CEO salaries are a minuscule portion of our health care dollar, the following are pretty large numbers by any standard:

http://c-hit.org/2013/06/10/top-execs-at-big-five-health-insurers-each-pull-in-millions/

"The highest-paid executive at each of the “Big Five’’ health insurers – UnitedHealth Group, Aetna Inc., WellPoint Inc., Humana Inc. and Cigna Corp. – made more than $8 million in 2012, according to filings this spring with the Securities and Exchange Commission. The CEO of EmblemHealth Inc., a nonprofit that owns ConnectiCare, also had total compensation at that level in 2011, the last year for which information is available."
 
"While there are caps on your medical loss ratio, the rules are so complex administrative costs have begun to increase. I can't underscore just how complex these rules are."

This is a good point. Hopefully those administrative costs can come down with proper training and familiarity leading to more efficiency.
 
While CEO salaries are a minuscule portion of our health care dollar, the following are pretty large numbers by any standard:

http://c-hit.org/2013/06/10/top-execs-at-big-five-health-insurers-each-pull-in-millions/

"The highest-paid executive at each of the “Big Five’’ health insurers – UnitedHealth Group, Aetna Inc., WellPoint Inc., Humana Inc. and Cigna Corp. – made more than $8 million in 2012, according to filings this spring with the Securities and Exchange Commission. The CEO of EmblemHealth Inc., a nonprofit that owns ConnectiCare, also had total compensation at that level in 2011, the last year for which information is available."

And if you think that a government official doing the same kind thing would not get rich, you are mistaken. The difference is that if the insurance company is not profitable it goes out of business in favor of someone who can actually do the job. Government failure is a good excuse for a larger budget. Maybe a new czar or underczar.
 
And if you think that a government official doing the same kind thing would not get rich, you are mistaken. The difference is that if the insurance company is not profitable it goes out of business in favor of someone who can actually do the job. Government failure is a good excuse for a larger budget. Maybe a new czar or underczar.

LOL
 
Before I answer that question, tell me this: What is the cumulative amount being paid in this country today to all the CEOs of the various healthcare companies that he would be replacing?

I'm guessing that this person would be paid less than 1% of that amount. Maybe less than 0.1% of that amount.

How much would you pay the government official doing the work that an insurance company CEO making $8m does now?
 
And if you think that a government official doing the same kind thing would not get rich, you are mistaken. The difference is that if the insurance company is not profitable it goes out of business in favor of someone who can actually do the job. Government failure is a good excuse for a larger budget. Maybe a new czar or underczar.

I don't understand this post at all. The salaries of top health executives in government-run health systems all over the world are public information. The provincial health system in Canada spends about 1% of its budget on overhead. 1%.

Just some simple googling makes this evident.

http://www.vancouversun.com/business/public-sector-salaries/INDEX.HTML

http://www.denverpost.com/opinion/ci_12523427


http://www.law.harvard.edu/programs/lwp/healthc.pdf

The facts are pretty simple: single payer systems in the US (Medicare) and around the world operate with much less overhead and far lower executive salaries than American insurers, and provide health outcomes that are at least as good and often better. You're entitled to your own ideology but not your own facts.
 
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