How would single payer function in this country

[CountofTuscany]

Another 'interesting' point about a 'single payer system'.... in the UK, 11 babies die every day. Every day. 11. That's a very high rate of deaths for this 'wonderful' National Health Service of theirs.

I know I wouldn't have faith in anything the government controlled.

 

[asterism]

They're mincing words. If you have HC through your employer, you already have socialized healthcare, not single payer. Single payer by definition suggests there's only one payer.

If you have Medicare on the other hand, you already have single payer, and it's generally accepted that it operates far more efficiently than private insurers - That is, if you're using the payout as a percentage of "Premium" model.

Only one payer of all hospital bills. And again by that logic isn't anyone with an insurance plan participating in socialized health care?

I have a hard time believing that is true of medicare. It's just economically very counterintuitive. An organization that is less sensative to costs is going to be more efficient than an organization that is? I also seem to re-call a statistic that said medicare has more incorrect billings than all private insurance companies combined.

95 cents of every dollar that goes into Medicare goes towards medical costs.

Compare that to the 60 cents of each dollar with private insurance.

Insurance companies are barred by regulation from operating like Medicare. Medicare is not required to collect and reserve premiums sufficient to fund long term obligations, nor is Medicare required to operate a self sustainable independent system properly accounting for all administrative costs.

 

[The Rabbi]

Only one payer of all hospital bills. And again by that logic isn't anyone with an insurance plan participating in socialized health care?

I have a hard time believing that is true of medicare. It's just economically very counterintuitive. An organization that is less sensative to costs is going to be more efficient than an organization that is? I also seem to re-call a statistic that said medicare has more incorrect billings than all private insurance companies combined.

95 cents of every dollar that goes into Medicare goes towards medical costs.

Compare that to the 60 cents of each dollar with private insurance.

Insurance companies are barred by regulation from operating like Medicare. Medicare is not required to collect and reserve premiums sufficient to fund long term obligations, nor is Medicare required to operate a self sustainable independent system properly accounting for all administrative costs.

How dare you bring relevant facts into this discussion! Medicare is an efficient humane system. We need to raise taxes to fund it further, to prevent grandma from dying. You don't want grandma to die, you heartless Republican, do you?

 

[asterism]

95 cents of every dollar that goes into Medicare goes towards medical costs.

Compare that to the 60 cents of each dollar with private insurance.

Insurance companies are barred by regulation from operating like Medicare. Medicare is not required to collect and reserve premiums sufficient to fund long term obligations, nor is Medicare required to operate a self sustainable independent system properly accounting for all administrative costs.

How dare you bring relevant facts into this discussion! Medicare is an efficient humane system. We need to raise taxes to fund it further, to prevent grandma from dying. You don't want grandma to die, you heartless Republican, do you?

Grandma's already dead and government healthcare killed my mom.

 

[Colin]

Another 'interesting' point about a 'single payer system'.... in the UK, 11 babies die every day. Every day. 11. That's a very high rate of deaths for this 'wonderful' National Health Service of theirs.

Now, now Cali! What's your point?

The figure you quote is the number of stillbirths per annum in Britain and comes from a new study conducted by the Lancet. The approximate number of stillbirths in the USA is 27,000 a year(Obesity, Disparities in Care Help Drive U.S. Stillbirths: Studies - healthfinder.gov). That's equivalent to 74 a day. Pretty much comparable to our rate of stillbirths.

As for infant mortality rate:

UK : 4.62 per 1000 live births
USA: 6.06 per 1000 live births

https://www.cia.gov/library/publications/the-world-factbook/rankorder/2091rank.html

 

[Douger]

My Idea on the matter is that SS should cover traumatic events at minimum. Car accidents, fires, stroke ,heart explosion etc.
If you get the sniffles OK. Pay to see a doc and deal with it. If you have a debilitating stroke you sure as hell shouldn't lose your home. Matter of fact if you have a debilitating stroke your mortgage should be cancelled out without having to buy extra insurance.
Of course this is all fantasy as the Jankers own you and everything around you.

 

[Lovebears65]

Being a military wife I can honestly say anything that the government runs SUCKS!!!

 

[California Girl]

Another 'interesting' point about a 'single payer system'.... in the UK, 11 babies die every day. Every day. 11. That's a very high rate of deaths for this 'wonderful' National Health Service of theirs.

Now, now Cali! What's your point?

The figure you quote is the number of stillbirths per annum in Britain and comes from a new study conducted by the Lancet. The approximate number of stillbirths in the USA is 27,000 a year(Obesity, Disparities in Care Help Drive U.S. Stillbirths: Studies - healthfinder.gov). That's equivalent to 74 a day. Pretty much comparable to our rate of stillbirths.

As for infant mortality rate:

UK : 4.62 per 1000 live births
USA: 6.06 per 1000 live births

https://www.cia.gov/library/publications/the-world-factbook/rankorder/2091rank.html

My point, Col, is that this NHS thing is not what America needs. It works - to a degree - in your country. It wouldn't in ours. Your system is at breaking point but woe betide any government who dares try to actually fix the damned thing - it's like some sacred cow in Britain. But I've seen it - up close and personal... and it ain't all that.

I understand why y'all are very protective of it.... but in all honesty, you know damned well that it is costing vast amounts of money - more and more every year... and delivering less and less results. Can you - hand on heart -tell me you should be paying for IVF and gender reassignments, and all kinds of bullshit - when people are dying because the system cannot afford the best quality of care for those who REALLY need it? Can you tell me that it's right that people have to sue the system to access drugs when so much money is being wasted within it? It's too big, it is no longer fit for purpose, theft is rife within it, people book appointments and don't show up - because there is no cost to them for missing appointments - while others wait for weeks to get seen by a doctor.... it's fucked. You know it. I know it. The problem is, you won't be honest about it... and idiot Americans think it's some kind of perfect system. You're stuck with it. We are not... please don't encourage America to follow you.

 

[Toronado3800]

Being a military wife I can honestly say anything that the government runs SUCKS!!!

I disagree. Hopefully we can change your mind.

How terrible it must be for you to feel the military and the government your husband works to protect suck!

Like everything there are positives and negatives. Our military is the best in the world.

Just where else would you like to live btw? What large organization works better than the United States? Microsoft and Windows Vista anyone? Apple computers? They have their ups and downs.

 

[Bern80]

Being a military wife I can honestly say anything that the government runs SUCKS!!!

I disagree. Hopefully we can change your mind.

How terrible it must be for you to feel the military and the government your husband works to protect suck!

Like everything there are positives and negatives. Our military is the best in the world.

Just where else would you like to live btw? What large organization works better than the United States? Microsoft and Windows Vista anyone? Apple computers? They have their ups and downs.

And that's where you went wrong. Her husband doe not work to protect the government or the military. What an amazingly stupid thing to say. The purpose of our military is defend your rights. Not protect the government.

And yes, most everything government does it does poorly. It doesn't have a choice in that matter. The government dynamic demands that it do things poorly. The incentive isn't there for government to do things efficiently. Government won't shut down from wasting money like a business will thus there is no incentive to not be wasteful.

 

[Wiseacre]

I think single payer in the US would be a lot like Social Security, everybody pays in via a tax and everybody gets free medical care when needed. Don't know there would be a co-pay, but unless there's some incentive to hold down the cost then such a system would bankrupt the country. I know there would be price controls, we already do that today in Medicare, so you have to wonder about how many new doctors and nurses you would have coming into the system if the financial rewards are limited. Plus, there wouldn't be any incentive for quality care, a bad doctor would make just as much as a good one.


From Wikipedia:

Single-payer health care is the financing of health care from a single insurance pool, which in all existing and proposed cases is government run.[citation needed] Under a single-payer system, universal health care for an entire population is financed from a pool to which many parties--employees, employers, the state--have contributed.[citation needed] Single-payer is a market in which one buyer faces many sellers (monopsony).[citation needed]

Single-payer health insurance collects all medical fees, and then pays for all services, through a "single" government (or government-related) source.[1] In wealthy nations, this kind of publicly-managed insurance is typically extended to all citizens and legal residents. Examples include Australia's Medicare, Canada's Medicare, the United Kingdom's National Health Service, and Taiwan's National Health Insurance. Medicare in the United States is an example of a single-payer system for a specified, limited group of persons.

Single-payer systems may contract for healthcare services from private organizations (as is the case in Canada) or may own and employ healthcare resources and personnel (as is the case in the United Kingdom). The term single-payer thus only describes the funding mechanism—referring to health care financed by a single public body from a single fund—and does not specify the type of delivery, or for whom doctors work. Although the fund holder is usually the government, some forms of single-payer use a mixed public-private system.

 

[Bern80]

It just boils down to a choice really. Do you want to be free, with all of life's risks that entails? Or do you want to be secure? You really can't have both. The more government does for people the less free you are.

I love how the libs talking about how we have unwritten social contracts in society. It seems they forgot about the social contract that says he who foots the bill gets a vote. Meaning if you need someone else to cover your medical costs, whether that be a private insurance company or government via John Q. Taxpayer, that someone else gets a say in how you run your life. So if government is going to pay for your health care, which really means I am paying for your health care, then I get a say in how you live your life, on what you consume, how much you exercise you get, etc.

While there are certainly issues with the private insurance model at least the consumer still has a say. They can voluntarily decided to enter into an arrangment with insurance company that says under what conditions they will help pay your medical costs. Which is why I believe the best solution is one that works towards cost reduction so that people can actually pay their providers directly and use insurance only for catastrophic issues.

 

[Greenbeard]

Plus, there wouldn't be any incentive for quality care, a bad doctor would make just as much as a good one.

Given that Medicare is now set to begin experimenting with value-based purchasing under the ACA as a stepping stone to system-wide payment reform, that's not really true.

 

[Bfgrn]

If the healthcare is given by your employer then you have single payer.

Wrong. Employer provided healthcare is not single payer coverage - not all employers have the same coverages, deductibles, or other options such as vision or dental included. Some employers pay 100% premiums, some pay 50% of premiums - whatever is realistic in their budget. You don't HAVE to participate in the employer's plan - your spouse may have a much better plan through his or her employer whether or not both employers have coverage with the same carrier or different carriers. In either case, you likely have the option to have PPO or HMO coverage - whatever suits your needs best. Most people choose HMO coverage because of lower premiums, lower deductibles and no further obligation to pay the balance of what is owed on the medical bill - and you have to choose from a network of doctors and hospitals specified by the carrier. With the PPO, you can go to any doctor you wish, pay a higher premium, higher deductibles and you are responsible for any costs over and above what the insurer will pay - that's usually an 80%/20% proposition.

"Single payer," as used in "Obamacare" is defined as the government being the only entity that offers coverage to all people - all wrapped up in a nice little lie that nobody will ever be denied coverage for any reason.

Under Obamacare EVERYBODY has to be covered - there's no choice in the matter. Fact is, bureaucrats and their "experts" will decide whether and when you receive medical treatment - it's not a matter of you WILL NOT be denied treatment - you WILL be denied treatments or surgeries based on a number of factors - "one size fits all" rules and regulations mentality as is currently practiced throughout all government controlled departments or agencies, your age, your general health situation and so on. You're going to have fewer choices of physicians because a lot of them will give up their practices leaving a smaller pool of doctors. It may take weeks or months before you will be seen by a doctor and will probably not see the same doctor twice because there will be a shortage of general practitioners, fewer surgeons, fewer specialists, fewer everything.

What America has today is a system where we can choose our doctors, can usually get an appointment within a week, we enjoy a personal relationship with the same doctor all the time - he or she has an intimate and informed history of our healthcare issues. Specialized physicians can be seen relatively quickly; surgeries can be scheduled within days; we can have elective surgeries just because we want it and can afford it. We can kiss all that goodbye under Obamacare.

Are some people in the position of not being able to afford medical care? Sure their are - it's sad, but true. We currently have Medicare and Medicaid to cover those people - and look where that's gotten us financially. Emergency rooms are not going to turn anyone away because of inability to pay. If we think emergency room waits are irritating and a pain in the ass now - just wait - under Obamacare it's going to be even worse.

Government has no business whatsoever being involved in making healthcare decisions for us - that should be a decision between a patient and his or her physician. Period.

WOW...The OP said: 'I don't want any assumption about what people think it will save, just how such a system would work'

Then you go off on a paranoid filled fairy tale.

Single payer would look almost identical to Medicare. Retirees have received excellent medical treatment for over 40 years...no bureaucrats making medical decisions, just doctors and patients making medical decisions.

The overhead of 'for profit' insurance companies is about 20%. Medicare is around 3%. That is why for profits spent billions defeating single payer or even a public option.

 

[The Rabbi]

Plus, there wouldn't be any incentive for quality care, a bad doctor would make just as much as a good one.

Given that Medicare is now set to begin experimenting with value-based purchasing under the ACA as a stepping stone to system-wide payment reform, that's not really true.

It doesn't matter.
Medicare reimburses at such a low rate people on it are lucky to find a doctor at all. Cranking down reimbursements ala Obamacare will make this worse. Obama's proposal is to hand all power over to a 15 person commission to find solutions. Those solutions will involve rationing care, i.e. death panels.

 

[Greenbeard]

It doesn't matter.

Of course it matters. The transition to identifying and paying for value will be a renaissance in our health care system. As it would be for any market built around an extremely important but extraordinarily opaque product that gradually becomes more transparent with time.

Medicare reimburses at such a low rate people on it are lucky to find a doctor at all.

From last month's MedPAC report:

2010 patient survey shows that, overall, access is good, but primary care continues to be a concern

To obtain the most current access measures possible, the Commission sponsors a telephone survey each year of a nationally representative, random sample of two groups of people: Medicare beneficiaries age 65 years or older and privately insured individuals age 50 to 64. The overall sample size is 4,000 in each group (totaling 8,000 completed interviews, including an oversample of minority respondents).2 By surveying both groups of people— privately insured individuals and Medicare beneficiaries— we can assess the extent to which access problems, such as delays in scheduling an appointment and difficulty finding a new physician, are unique to the Medicare population.3

Results from our 2010 survey indicate that most beneficiaries have reliable access to physician services, with most reporting few or no access problems. Most beneficiaries are able to schedule timely medical appointments and find a new physician when needed, but some beneficiaries experience problems, particularly when they are looking for a primary care physician. Medicare beneficiaries reported similar or better access than privately insured individuals age 50 to 64.

On a national level, this survey does not find widespread physician access problems, but certain market areas may be experiencing more access problems than others due to factors unrelated to Medicare—or even private—payment rates, such as relatively rapid population growth. Moreover, although the share of beneficiaries reporting major problems finding a primary care physician is small, this issue is a serious concern not only to the beneficiaries who are personally affected but also—on a larger scale—for the functioning of our health care delivery system. The Patient Protection and Affordable Care Act of 2010 (PPACA) contains several provisions to enhance access to primary care, including increasing Medicare payments for primary care services provided by primary care practitioners. This policy marks an important step toward ensuring access, but more levers should be explored. Regulatory changes have also resulted in some payment increases for services that primary care providers frequently provide. The Commission will continue examining multiple approaches for improving Medicare’s payment policies to promote primary care.

Most beneficiaries report timely appointments

Because most Medicare beneficiaries have one or more doctor appointments in a given year, an important access indicator we examine is beneficiaries’ ability to schedule timely appointments. In the 2010 survey, among those seeking an appointment, most beneficiaries (75 percent) and most privately insured individuals (72 percent) reported “never” having to wait longer than they wanted for an appointment for routine care (Table 4-1). Another 17 percent of Medicare beneficiaries and 21 percent of privately insured individuals reported that they “sometimes” had to wait longer than they wanted for a routine appointment. The differences between the Medicare and privately insured populations in their “never” and “sometimes” response rates were statistically significant, suggesting that Medicare beneficiaries were more satisfied with the timeliness of their routine care appointments. [...]

In addition to the ease of scheduling appointments, our survey also asks about respondents’ ability to find a new physician if they are seeking one. As in previous years, relatively few survey respondents reported that they tried to find a new primary care physician or specialist in the past year. This finding suggests that most respondents were either satisfied with their current physician or did not have a health event that made them search for a new one. Specifically, 7 percent of Medicare beneficiaries and 7 percent of privately insured individuals reported that they looked for a new primary care physician in the preceding year; a larger percentage (13 percent of Medicare beneficiaries and 15 percent of privately insured individuals) reported seeking a new specialist (not shown in table).

Finding a primary care physician appeared to be more difficult for privately insured individuals than for Medicare beneficiaries. Specifically, among the small share of people (7 percent in each insurance group) who looked for a new primary care physician in the past year, 79 percent of Medicare beneficiaries and 69 percent of privately insured individuals reported that they had no problem finding one. This difference is statistically significant.

Among the 7 percent of Medicare beneficiaries who sought a new primary care physician, 20 percent reported a problem, compared with 31 percent for the privately insured. Of the patients reporting a problem, 8 percent of Medicare beneficiaries characterized their problems as “small,” compared with 12 percent of the privately insured; 12 percent of Medicare beneficiaries reported their problem as “big,” compared with 19 percent of the privately insured. These comparative rates in 2010 were similar to those found in our 2009 survey.

When it comes to access, it appears you're better of being a 65-year-old with Medicare than a 55-year-old with private insurance.