What is the SDN opinion on Single Payer Health Care?

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Lawpy

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It's rather funny, in a way. @Mad Jack is a fan of the German model, which, eleven years ago, was getting excoriated over its mistreatment of physicians. At that time Germany was the SDN poster child for the evils of universal health care.

The math behind single payer isn't very complicated. Reduce the amount of bureaucracy and you can either 1.) have more healthcare for the same expenditure, or 2.) have the same healthcare for less expenditure.

Personally, I favor a two-tier system not unlike Australia's. It's not the most efficient, and it's not the most egalitarian, but I think it's reasonably aligned with our national ethos.

In any case, I’m just going to simply stick with Understanding Health Policy: A Clinical Approach, Seventh Edition and go from there.

It’s probably the least political and most objective approach to health policy.
 
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Matthew9Thirtyfive

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It's rather funny, in a way. @Mad Jack is a fan of the German model, which, eleven years ago, was getting excoriated over its mistreatment of physicians. At that time Germany was the SDN poster child for the evils of universal health care.

The math behind single payer isn't very complicated. Reduce the amount of bureaucracy and you can either 1.) have more healthcare for the same expenditure, or 2.) have the same healthcare for less expenditure.

Personally, I favor a two-tier system not unlike Australia's. It's not the most efficient, and it's not the most egalitarian, but I think it's reasonably aligned with our national ethos.

Interesting. I’ll have to read up on it. I’m not attached to any one model, I just know what we have doesn’t work. I do, however, think that a single payer makes it too easy to stagnate and see service quality deteriorate.
 
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Mad Jack

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It's rather funny, in a way. @Mad Jack is a fan of the German model, which, eleven years ago, was getting excoriated over its mistreatment of physicians. At that time Germany was the SDN poster child for the evils of universal health care.

The math behind single payer isn't very complicated. Reduce the amount of bureaucracy and you can either 1.) have more healthcare for the same expenditure, or 2.) have the same healthcare for less expenditure.

Personally, I favor a two-tier system not unlike Australia's. It's not the most efficient, and it's not the most egalitarian, but I think it's reasonably aligned with our national ethos.
I would also be fine with a two-tier system.
 
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kwu

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As a strict constitutionalist, I don't believe it is the federal government's job to be in the healthcare business period (yes, that includes repealing their current efforts).

At the state level, feel free to institute whatever you want that you can pay for (10th amendment and all that).

[Before someone gives me the "people will die" or "we can save money" lecture, realize that I approach this problem ideologically rather than as a matter of utility. Therefore those arguments won't work for me.]

Please remind me, where exactly in the Constitution does it say that the government cannot provide health care?
The government can definitely provide health care and actually encourages people to get health care using their taxing and spending powers.
The federal government actually did that with ACA where they taxed people who refused to get insurance. The Supreme Court case National Federation of Independent Businesses v. Sebelius talks in details about this. If you want, you can review the majority opinion where they describe in details how the government can have the authority to implement health care by using their power of spending and taxation.



As for a universal health coverage, I would definitely support this idea, however, I am certain that it will be very very hard to implement. There will be huge arguments on who to cover, what to cover, how much should we cover, how long should we cover... etc
 

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I'm not an expert on the subject...

But, single-payer puts food on the table for me, since residency spots are funded by Medicare.

Some good things have come out of single-payer in the US. While I have not personally used it, I hear the VA's EHR has the highest satisfaction ratings out there among physicians.
 
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I do, however, think that a single payer makes it too easy to stagnate and see service quality deteriorate.

Like everything so massive and bureaucratic, it depends. While folks often point to Canada as being single payer, it's actually a collection of provinces that each run independent single payer systems. By their own admission they range in quality, which reflects a variety of economic, political, social, and geographic factors. The basic law of health policy is: cost, access, quality... pick two. Overall Canada gets what Canada pays for (which was ~6.4% of GDP less than the US in 2014).

As long as I'm spilling gasoline on the kindling, here are a couple of pics everyone might enjoy:

oecd_nhe.png

Bl-tZOjIQAAJUcp.jpg
 
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Matthew9Thirtyfive

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Like everything so massive and bureaucratic, it depends. While folks often point to Canada as being single payer, it's actually a collection of provinces that each run independent single payer systems. By their own admission they range in quality, which reflects a variety of economic, political, social, and geographic factors. The basic law of health policy is: cost, access, quality... pick two. Overall Canada gets what Canada pays for (which was ~6.4% of GDP less than the US in 2014).

As long as I'm spilling gasoline on the kindling, here are a couple of pics everyone might enjoy:

oecd_nhe.png

Bl-tZOjIQAAJUcp.jpg

Right, but each province has one payer, yes? And if it’s anything like the systems we have like that here, you can’t just go out of your region if you don’t think the service is up to par. Which means it’s effectively single payer. If you have even two options, that will incentivize them at least somewhat to maintain some sort of quality.
 

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I'm not an expert on the subject...

But, single-payer puts food on the table for me, since residency spots are funded by Medicare.

Some good things have come out of single-payer in the US. While I have not personally used it, I hear the VA's EHR has the highest satisfaction ratings out there among physicians.

Saying CPRS has the highest satisfaction ratings is like saying “this pile of **** stinks the least.”

I also think CPRS is one of the better EMRs, but it’s still difficult to use, and it does a particularly poor job of displaying clinical information in an easy to digest way. On the plus side, it’s certainly one of the EMRs with the least about of garbage and clutter.
 

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Saying CPRS has the highest satisfaction ratings is like saying “this pile of **** stinks the least.”

I also think CPRS is one of the better EMRs, but it’s still difficult to use, and it does a particularly poor job of displaying clinical information in an easy to digest way. On the plus side, it’s certainly one of the EMRs with the least about of garbage and clutter.

I've used Epic and CPRS, currently using Epic, and I wish I could go back to CPRS. SO much clutter I have to go through to get what I need, or enter a simple note or report. Documentation definitely takes me longer in Epic.
 

NickNaylor

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I've used Epic and CPRS, currently using Epic, and I wish I could go back to CPRS. SO much clutter I have to go through to get what I need, or enter a simple note or report. Documentation definitely takes me longer in Epic.

Completely agree - this is one of the huge plus sides of CPRS. If CPRS could display lab data (primarily) in a way similar to Epic, it would be the perfect EMR IMO.

Some people find the “display ALL THE NOTES” format a little cumbersome, but I personally find it quite nice. Way less painful than digging through 5 million encounters and dealing with different contexts as is the case with Epic.
 

WisNeuro

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Completely agree - this is one of the huge plus sides of CPRS. If CPRS could display lab data (primarily) in a way similar to Epic, it would be the perfect EMR IMO.

Some people find the “display ALL THE NOTES” format a little cumbersome, but I personally find it quite nice. Way less painful than digging through 5 million encounters and dealing with different contexts as is the case with Epic.

I generally didn't have a problem with lab values in CPRS. Granted, I'm usually only concerned with about 5-8 for any given patient, but the longitudinal graph was more than adequate for me to those. (I assume you mean bloodwork and such?"
 

NickNaylor

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I generally didn't have a problem with lab values in CPRS. Granted, I'm usually only concerned with about 5-8 for any given patient, but the longitudinal graph was more than adequate for me to those. (I assume you mean bloodwork and such?"

Yeah, mostly bloodwork. At this point I primarily work on the C/L service at our local VA, so for medically complicated patients and/or those with admissions any longer than a few days, it can be relatively difficult to quickly review labs. It’s mostly that the default view provides a whole page for a single set of labs - even if other labs were drawn at the same time. It’s also cumbersome (though not impossible) to view comparisons over the long-term; you have to select individual tests, which are sometimes not named in an intuitive way, making finding them difficult, and then review them from there.

There are certainly worse things, but it just adds to the aggravation. I imagine that in the outpatient setting, though, this would be less of a big deal, since it wouldn’t be necessary to review lots and lots of lab data collected over a relatively short period of time.
 
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Right, but each province has one payer, yes? And if it’s anything like the systems we have like that here, you can’t just go out of your region if you don’t think the service is up to par. Which means it’s effectively single payer.

It's a collection of provincial single payer systems, each run differently. I only bring this up because many people think Canada has a monolithic system run at the federal level.

Matthew9Thirtyfive said:
If you have even two options, that will incentivize them at least somewhat to maintain some sort of quality.

I'm not sure I really understand this argument. Someone who lives in Toronto, for instance, can seek hospital services from any number of options. If the citizens don't like they're options they can opt to pay for more, but they do it at the ballot box. Independent providers who go on fee-for-service have the exact same financial dynamic in Canada as in the US: maximize revenue and minimize overhead. The fact that their bills all go to one entity is not a driver of anything. One of the hospitals I have a relationship with ran some internal numbers and found that the total number of employees involved in billing, coding, and collection was approximately the same as the number of beds in the facility. This feeds a series of perverse incentives not toward quality, but toward overutilization (particularly of high margin procedures).

Quality is an enormously complex issue in healthcare, it's difficult to reduce it to econ 101.
 
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Matthew9Thirtyfive said:
If you have even two options, that will incentivize them at least somewhat to maintain some sort of quality.

Besides, insurance competition in healthcare is illusory in most of the US. Most of the insurers have merged to effectively form, at best, regional oligopolies. If you're poor you're on Medicaid, if you're senior you're on Medicare, and if you're employed you typically have little or no choice in your insurance.
 
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TheWolfOfMainStreet

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Please remind me, where exactly in the Constitution does it say that the government cannot provide health care?
The government can definitely provide health care and actually encourages people to get health care using their taxing and spending powers.
The federal government actually did that with ACA where they taxed people who refused to get insurance. The Supreme Court case National Federation of Independent Businesses v. Sebelius talks in details about this. If you want, you can review the majority opinion where they describe in details how the government can have the authority to implement health care by using their power of spending and taxation.



As for a universal health coverage, I would definitely support this idea, however, I am certain that it will be very very hard to implement. There will be huge arguments on who to cover, what to cover, how much should we cover, how long should we cover... etc

As I said, I’m a strict constitutionalist. I believe that all powers not explicitly granted to the federal government are restricted for the states and the people.
 

Matthew9Thirtyfive

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It's a collection of provincial single payer systems, each run differently. I only bring this up because many people think Canada has a monolithic system run at the federal level.



I'm not sure I really understand this argument. Someone who lives in Toronto, for instance, can seek hospital services from any number of options. If the citizens don't like they're options they can opt to pay for more, but they do it at the ballot box. Independent providers who go on fee-for-service have the exact same financial dynamic in Canada as in the US: maximize revenue and minimize overhead. The fact that their bills all go to one entity is not a driver of anything. One of the hospitals I have a relationship with ran some internal numbers and found that the total number of employees involved in billing, coding, and collection was approximately the same as the number of beds in the facility. This feeds a series of perverse incentives not toward quality, but toward overutilization (particularly of high margin procedures).

Quality is an enormously complex issue in healthcare, it's difficult to reduce it to econ 101.

I'm not talking about quality of care at individual institutions or providers. I'm talking about quality of health insurance providers. If you only have one payer, there's no reason for them to maintain a level of quality because no one has any choice in insurance. I know that's a simplified version, but that's how it works here. I have to deal with that **** with Tricare all the time.
 

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I've used Epic and CPRS, currently using Epic, and I wish I could go back to CPRS. SO much clutter I have to go through to get what I need, or enter a simple note or report. Documentation definitely takes me longer in Epic.

I have only used Epic as a medical student, so am not sure how it would work as a resident. It looks like there is a lot of clutter, but people seem pretty happy with it. It has over 50% market share in the United States though almost nothing overseas. The first EHR I used was Meditech, which was good for learning how to do H&Ps and all that since it had a pretty simple old school GUI. I do not think it would be very good to use as a resident or attending. CPRS is technically freeware, so any hospital can go ahead and implement it. I'm not sure how much resources that would cost on the back-end in terms of labor and hardware versus buying an EMR from Epic, Cerner, McKesson, etc...
 

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I have only used Epic as a medical student, so am not sure how it would work as a resident. It looks like there is a lot of clutter, but people seem pretty happy with it. It has over 50% market share in the United States though almost nothing overseas. The first EHR I used was Meditech, which was good for learning how to do H&Ps and all that since it had a pretty simple old school GUI. I do not think it would be very good to use as a resident or attending. CPRS is technically freeware, so any hospital can go ahead and implement it. I'm not sure how much resources that would cost on the back-end in terms of labor and hardware versus buying an EMR from Epic, Cerner, McKesson, etc...

The thing about Epic, is that it's built primarily as a way to bill for services, with actual clinical utility coming in second. To be fair, though, it's exceedingly difficult to satisfy the needs of dozens of different healthcare specialties operating a single system. I'm not sure "happy with it" is the right term. More, "resigned" to using it because there really aren't any great alternatives.
 
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Planes2Doc

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The thing about Epic, is that it's built primarily as a way to bill for services, with actual clinical utility coming in second. To be fair, though, it's exceedingly difficult to satisfy the needs of dozens of different healthcare specialties operating a single system. I'm not sure "happy with it" is the right term. More, "resigned" to using it because there really aren't any great alternatives.

Interesting. I haven't thought about it that way before! At our hospital, our emergency department uses a different EHR than our inpatient services. Then affiliated outpatient offices use a different EHR as well. As an internal medicine resident, our system works pretty well for working with complicated 20+ problem lists and am able to translate that all to billable problems on the discharge summary.
 
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I'm not talking about quality of care at individual institutions or providers. I'm talking about quality of health insurance providers. If you only have one payer, there's no reason for them to maintain a level of quality because no one has any choice in insurance. I know that's a simplified version, but that's how it works here. I have to deal with that **** with Tricare all the time.

Ah, there’s the disconnect. Broadly speaking, in healthcare contexts the term “quality” is usually applied to delivery. Hence we have quality measures, quality assurance, quality improvement, etc. Insurance is more commonly spoken of in terms of ratings.

There is a driver of quality in single payer: the will of the voters. Of course, that sets up a whole new set of issues...
 
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djtallahassee

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Besides, insurance competition in healthcare is illusory in most of the US. Most of the insurers have merged to effectively form, at best, regional oligopolies. If you're poor you're on Medicaid, if you're senior you're on Medicare, and if you're employed you typically have little or no choice in your insurance.

I bring up the employed insurance thing in interviews if I get asked about health care (because I don't wanna drive it to a single payer discussion). The people are usually pretty receptive, as anyone with a job knows insurance can be a huge factor that ties you to that employer even though you may want to leave.
 

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Ah, there’s the disconnect. Broadly speaking, in healthcare contexts the term “quality” is usually applied to delivery. Hence we have quality measures, quality assurance, quality improvement, etc. Insurance is more commonly spoken of in terms of ratings.

There is a driver of quality in single payer: the will of the voters. Of course, that sets up a whole new set of issues...

Yes, but we see how well the will of the voters gets represented.
 

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I cannot speak much of Germany or the United Kingdom, but I've spent a few years in Spain and shadowed there and their system seems to run mostly well and is well-rated within Europe. It is single-payer and runs through something called Social Security (not the same as American SS, it's like the public health insurance). Expenses per capita are, as everywhere, much lower than America's, and everyone is covered by the public system (through social security taxes paid either by your employer (off your salary), the government (if you're unemployed or make below a certain amount) or yourself (if you're self-employed). The private sector exists and is very attractive to doctors, but where I shadowed doctors seemed to do both public and private work.

Outside of big-name private hospitals, however, it seems the public system does a much better performance (especially got that impression with births, with some doctors explicitly recommending to pregnant patients that they go through the public and not the private hospital). There is no copay, which has been an ongoing political issue because some people believe it leads to overuse of the system and others that using a copay, even if small, will deter people from using the doc when they actually need it. Wait times are a common complaint, but as someone already mentioned it's not an issue for urgent surgeries. Instead, in the OR where I shadowed, trauma surgeons were operating on old ladies with broken hips from sunset til the wee hours of the morning

Like Canada, Spain has its healthcare broken down into autonomous communities (similar to states), though in recent years policy changes have made it so insurance and patient records are accessible outside of each community.

While systemic issues are galore, as everywhere, there does seem to be some government responsiveness to patient complaints, and the major parties tend to have opposing opinions on where healthcare reform should go (like everywhere, I suppose).

Naturally, doctors don't make American salaries, and it's a common complaint (along with the high doctor supply, and limited jobs, can you imagine that in America?) that drives a few doctors to move to UK or Germany where they're better remunerated.

Although by no means do Spanish hospitals beat their American counterparts in cancer 5-year survivals and a few other statistics, infant and maternal mortality are much lower than in America, and, as goes without saying, 11% of Spanish citizens aren't uninsured. Administrators are also very big on healthcare access to underserved populations, and health clinics are staffed even in the most remote places.
 
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So I think we can all at the very least agree that the system we have now is flawed?

I still support single payer because of the following reasons.

1. It saves money in the long run. YES, your taxes will go up. BUT, you won't be paying copays and premiums anymore. It is possible to pay for it, as per numerous studies from Harvard and Cornell.

2. Getting what we deserve. The US currently spends almost double what the UK and Canada spend on healthcare and they cover EVERYONE. Meanwhile we waste 20% our GDP on healthcare and MILLIONS are still uninsured, and millions die every year because of lack of access.

3. You can choose any doctor you want. Forget about all the BS with being out of network. Yes, wait times would increase BUT only for elective medical procedures. If you need stitches, you'll get your stitches.

4. Medicare is more efficient than private insurance companies, who are literally for-profit. 80% of every premium dollar goes towards healthcare for private health insurance companies. For Medicare, it is NINETY FOUR percent. You tell me which is better.

5. A Rebuttal- I've heard some people say "You want the US to turn into Venezuela?" and that is just nonsense. Venezuela has a corrupt government and has a long history of abusing human rights. The US does NOT, so enough with that argument.

A member of the Human Rights Foundation came out on Fox News and embarrassed the host who tried to corner him:

A little aside. We are seeing more and more Democrats support Bernie's plan as they know he is the frontrunner in 2020 for the nomination. They have finally realized that they need to support it in order to win. What's my point? I think we could have single payer in the next 10 years. I really do.
 
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Just gonna leave this here.

In the U.S., we pay more taxes for healthcare than Canada does. Canada has 100% coverage.

Canada rations healthcare by wait times for elective procedures.
U.S. rations healthcare by prohibitive cost (sucks for poor people).

Rationing healthcare is GOOD because it lowers the cost of healthcare. Which of the above methods seems more ethical?
 
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Matthew9Thirtyfive

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Just gonna leave this here.

In the U.S., we pay more taxes for healthcare than Canada does. Canada has 100% coverage.

Canada rations healthcare by wait times for elective procedures.
U.S. rations healthcare by prohibitive cost (sucks for poor people).

Rationing healthcare is GOOD because it lowers the cost of healthcare. Which of the above methods seems more ethical?

Like the link I posted up thread (and several more if you do a quick search) points out, wait times are not without their problems. Patients are harmed and have increased mortality due to wait times for elective procedures and consults. Just because something isn’t an “emergency” doesn’t mean it can wait weeks to be taken care of.

I do think you’re more likely to get a better system by rationing with wait times though. The access problem here is atrocious.
 
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multiwell

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Like the link I posted up thread (and several more if you do a quick search) points out, wait times are not without their problems. Patients are harmed and have increased mortality due to wait times for elective procedures and consults. Just because something isn’t an “emergency” doesn’t mean it can wait weeks to be taken care of.

I do think you’re more likely to get a better system by rationing with wait times though. The access problem here is atrocious.

I agree. Wait times definitely suck. I just think people being shut out from healthcare due to prohibitive cost sucks more.

It's interesting to think that rationing healthcare actually increases access to healthcare through lower costs. Not so intuitive.
 

Mad Jack

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I'm not an expert on the subject...

But, single-payer puts food on the table for me, since residency spots are funded by Medicare.

Some good things have come out of single-payer in the US. While I have not personally used it, I hear the VA's EHR has the highest satisfaction ratings out there among physicians.
Oh my god, single-payer, you keep using that word...
 
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Mad Jack

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I agree. Wait times definitely suck. I just think people being shut out from healthcare due to prohibitive cost sucks more.

It's interesting to think that rationing healthcare actually increases access to healthcare through lower costs. Not so intuitive.
Technically it shifts access to care. Some access is increased, such as basic health care services, but other access is decreased, such as access to cutting-edge and highly specialized care. There are many subspecialists, such as neuro-spine, that are incredibly hard to get access to overseas, as governments view their training as too extensive to be beneficial. That has consequences.

Samantha Smith being 'internally decapitating' by skull | Daily Mail Online
 
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Mad Jack

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Just gonna leave this here.

In the U.S., we pay more taxes for healthcare than Canada does. Canada has 100% coverage.

Canada rations healthcare by wait times for elective procedures.
U.S. rations healthcare by prohibitive cost (sucks for poor people).

Rationing healthcare is GOOD because it lowers the cost of healthcare. Which of the above methods seems more ethical?
That isn't necessarily the only way to look at things. Physicians used to not accept any insurance, and back then care was substantially less expensive. It was the establishment of widespread insurance after WWII that led to an initial rise in costs, further followed by the explosion in costs after Medicare was passed into law. When there was no insurance to be had, physicians and hospitals could only charge rates that people could realistically afford, but with the separation of patient and provider by insurance, physicians and hospitals felt they could charge faceless corporations ever-growing and exorbitant fees, and insurance companies sought to milk profit from patients, shop they increased their rates as well. Insurance is the heart of the problem tbqh, and particularly the all-encompassing nature of health insurance.
 
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That isn't necessarily the only way to look at things. Physicians used to not accept any insurance, and back then care was substantially less expensive. It was the establishment of widespread insurance after WWII that led to an initial rise in costs, further followed by the explosion in costs after Medicare was passed into law. When there was no insurance to be had, physicians and hospitals could only charge rates that people could realistically afford, but with the separation of patient and provider by insurance, physicians and hospitals felt they could charge faceless corporations ever-growing and exorbitant fees, and insurance companies sought to milk profit from patients, shop they increased their rates as well. Insurance is the heart of the problem tbqh, and particularly the all-encompassing nature of health insurance.

Then why is the only industrialized nation without universal insurance the outlier in terms of healthcare spending?

Also, let's not forget that prior to the Vietnam war the profession had x-rays, about five drugs, and all surgery was done by hand. The horror!
 
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So I think we can all at the very least agree that the system we have now is flawed?

I still support single payer because of the following reasons.

1. It saves money in the long run. YES, your taxes will go up. BUT, you won't be paying copays and premiums anymore. It is possible to pay for it, as per numerous studies from Harvard and Cornell.

2. Getting what we deserve. The US currently spends almost double what the UK and Canada spend on healthcare and they cover EVERYONE. Meanwhile we waste 20% our GDP on healthcare and MILLIONS are still uninsured, and millions die every year because of lack of access.

3. You can choose any doctor you want. Forget about all the BS with being out of network. Yes, wait times would increase BUT only for elective medical procedures. If you need stitches, you'll get your stitches.

4. Medicare is more efficient than private insurance companies, who are literally for-profit. 80% of every premium dollar goes towards healthcare for private health insurance companies. For Medicare, it is NINETY FOUR percent. You tell me which is better.

5. A Rebuttal- I've heard some people say "You want the US to turn into Venezuela?" and that is just nonsense. Venezuela has a corrupt government and has a long history of abusing human rights. The US does NOT, so enough with that argument.

A member of the Human Rights Foundation came out on Fox News and embarrassed the host who tried to corner him:

A little aside. We are seeing more and more Democrats support Bernie's plan as they know he is the frontrunner in 2020 for the nomination. They have finally realized that they need to support it in order to win. What's my point? I think we could have single payer in the next 10 years. I really do.


1. "You can choose and/or keep the doctor you want" - This has already been proven to be a myth. Many people were/will be forced to change or choose different doctors.

2. "Medicare is more efficient" - Nothing the government does is "efficient."
Go look up how much it costs for the goverment to build a bathroom in a public park. Private contractors could build these things for 10K-100K, yet the government spends millions (probably because they are paying union workers).

Other examples include the Obamacare website (initial estimates were 100million haha)
HealthCare.gov - Wikipedia

3. "A rebuttal" - Venezuela was actually doing well once it put socialism into place. Socialism is usually great at first until all the money is used up and hard workers have no real incentives to work or stay in country.
#socialsecurity = something you will probably never see

While Ben Shapiro is not a doctor, his wife is, so I'm sure he has plenty of knowledge about the system.
He brings up some good points about how competition is a good predictor for cheaper healthcare costs. Lasik eye surgery used to be insanely expensive and health insurers didn't cover it. This resulted in many people becoming Opthamologists because business was booming. Now Lasik is not only way cheaper, but also more effective and safe.

Same thing can be said about X-ray scans. You can walk into a hospital today and they probably couldn't tell you the price you are going to pay for an x-ray because there is little competition, so health insurers and hospitals will determine the price rather than the market.

We already have a doctor shortage and things don't seem to be getting any better. I simply do not see how taking incentives away, increasing medical school requirements, and allowing the government to get more involved in healthcare is a recipe for success.
 

Cadaverous

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So I think we can all at the very least agree that the system we have now is flawed?

I still support single payer because of the following reasons.

1. It saves money in the long run. YES, your taxes will go up. BUT, you won't be paying copays and premiums anymore. It is possible to pay for it, as per numerous studies from Harvard and Cornell.

2. Getting what we deserve. The US currently spends almost double what the UK and Canada spend on healthcare and they cover EVERYONE. Meanwhile we waste 20% our GDP on healthcare and MILLIONS are still uninsured, and millions die every year because of lack of access.

3. You can choose any doctor you want. Forget about all the BS with being out of network. Yes, wait times would increase BUT only for elective medical procedures. If you need stitches, you'll get your stitches.

4. Medicare is more efficient than private insurance companies, who are literally for-profit. 80% of every premium dollar goes towards healthcare for private health insurance companies. For Medicare, it is NINETY FOUR percent. You tell me which is better.

5. A Rebuttal- I've heard some people say "You want the US to turn into Venezuela?" and that is just nonsense. Venezuela has a corrupt government and has a long history of abusing human rights. The US does NOT, so enough with that argument.

A member of the Human Rights Foundation came out on Fox News and embarrassed the host who tried to corner him:

A little aside. We are seeing more and more Democrats support Bernie's plan as they know he is the frontrunner in 2020 for the nomination. They have finally realized that they need to support it in order to win. What's my point? I think we could have single payer in the next 10 years. I really do.


These are the main, data-driven arguments that any rational supporter of single-payer would make, and would be curious to hear responses to each number individually from those of you defending our current system which we can all agree costs much more than in other western countries, and I would argue results in worse health outcomes even in those patients we actually manage to cover.
 
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These are the main, data-driven arguments that any rational supporter of single-payer would make, and would be curious to hear responses to each number individually from those of you defending our current system which we can all agree costs much more than in other western countries, and I would argue results in worse health outcomes even in those patients we actually manage to cover.
The argument against that is health care isn’t a right and people should be responsible for their own consumption of services through either their own pocket or voluntary charity.
 

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The argument against that is health care isn’t a right and people should be responsible for their own consumption of services through either their own pocket or voluntary charity.

Healthcare is not a right. However, having access to healthcare/being healthy is extremely important in predicting one's success in the world. The "single-payer system" could theoretically work very well in America, but the money has to come from somewhere. The problem is that the same people who want "free" healthcare also want free college, higher wages, social security, etc. etc.
 

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No idea re a unified board opinion, but my observation and review of literature indicate that the best outcomes for the lowest cost come out of the good old VA - our national mini NHS. In my ideal world we’d have VA For All. Buy into something else if you want it, practice independently if you want to, but a baseline national integrated healthcare system accessible to everyone and free or nominal copay at the point of service.
 

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The argument against that is health care isn’t a right and people should be responsible for their own consumption of services through either their own pocket or voluntary charity.

Besides being incredibly insensitive toward your fellow man, this view also ignores the potential economic solutions to continuously rising healthcare costs inherent in our system that already far outstrip the rest of the developed world. Running a system more like theirs (and, as suggested above, like our own VA system) can be a solution to this problem while also giving baseline healthcare to those who need it.
 
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Besides being incredibly insensitive toward your fellow man, this view also ignores the potential economic solutions to continuously rising healthcare costs inherent in our system that already far outstrip the rest of the developed world. Running a system more like theirs (and, as suggested above, like our own VA system) can be a solution to this problem while also giving baseline healthcare to those who need it.
None of that matters if you are stealing from one group to pay for another, even if you were right
 

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None of that matters if you are stealing from one group to pay for another, even if you were right

Is your neighbor stealing from you when he calls the fire department that you taxes pay for when he finds his kitchen in flames? A long time ago, our society decided that services like these should be subsidized by all of us (imagine everyone paying for police insurance) - a concept that can easily be extended to healthcare if people would for once think about the bigger picture and not just their own bottom-line
 
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Is your neighbor stealing from you when he calls the fire department that you taxes pay for when he finds his kitchen in flames? A long time ago, our society decided that services like these should be subsidized by all of us (imagine everyone paying for police insurance) - a concept that can easily be extended to healthcare if people would for once think about the bigger picture and not just their own bottom-line
If you were familiar with how most municipalities find fire depts you would know that’s a poor analogy. A line item rate is assessed to propoerty taxes and every, literally every homeowner is paying in advance at all times or the govt comes literally takes their house away from them......it’s forced buy in, not forcing one guy to pay for a freeloader
 

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Tax funded healthcare is also mandatory buy in - although I anticipate objections against progressive taxation. But the fire dept doesn’t assess your property value and amount of buy in before putting out the fire either. Your 500k home probably subsides my 115k home also. So it goes.
 
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Tax funded healthcare is also mandatory buy in - although I anticipate objections against progressive taxation. But the fire dept doesn’t assess your property value and amount of buy in before putting out the fire either.
But it’s not really mandatory buy in at all because a ton of people are straight up getting taken care by their neighbors paying everything and a ton more are forcing their neighbors to pay for a percentage of their insurance

The reason the fire dept doesn’t check your bill first is because if you haven’t been paying the govt is already working on taking your house and selling it to someone who will pay the bill

Anecdotally, I know of a municipality intermingled with tribal land that won’t fight tribal fires because the tribe wouldn’t chip in
 

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Nah I’m saying I pay my bill but it’s 1/5 of hypothetical yours because my house is old and cheap. Still we get identical fire dept services and it’s okay.
 

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But it’s not really mandatory buy in at all because a ton of people are straight up getting taken care by their neighbors paying everything and a ton more are forcing their neighbors to pay for a percentage of their insurance

What does this mean? Taxes represent shared burdens - you can argue they are misused by government, but I don't understand where this thing about being taken advantage of by people who aren't paying taxes for some reason comes from.
 
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This is something I always wondered about. And for many pre-meds, it could be an interview question.

Bernie Sanders’ single payer plan would have costed $ 1.38 trillion a year, but saved 6 trillion over the next decade. We would have a 6.2% payroll tax on everyone, 2.2% health care premium increase/income tax on workers, tax on capital gains tax on people making over 250k, and eliminated deductions for the wealthy, and raised the estate tax in order to pay for it.

According to Professor Gerald Friedman, the US would save 500$ billion in the first year under single payer. (200 billion $ saved from bureaucracy and paperwork, 200$ from monopolistic practices by the drug industry, and 30 billion $ saved from the employer based HC being eliminated).

So it does save money, but people like Ben Shapiro say it would discourage people from going into the medical field (because salaries would decrease + more patients) and that there would be very long wait times for some procedures.

I'm curious to see what @Goro @LizzyM @gonnif and all the other braniacs on SDN think of it. Yay or nay?

As you can see, the SDN opinion on single payer continues to be erudite and cohesive.
 
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goatmed

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3. "A rebuttal" - Venezuela was actually doing well once it put socialism into place. Socialism is usually great at first until all the money is used up and hard workers have no real incentives to work or stay in country.
#socialsecurity = something you will probably never see

While Ben Shapiro is not a doctor, his wife is, so I'm sure he has plenty of knowledge about the system.
He brings up some good points about how competition is a good predictor for cheaper healthcare costs. Lasik eye surgery used to be insanely expensive and health insurers didn't cover it. This resulted in many people becoming Opthamologists because business was booming. Now Lasik is not only way cheaper, but also more effective and safe.

Same thing can be said about X-ray scans. You can walk into a hospital today and they probably couldn't tell you the price you are going to pay for an x-ray because there is little competition, so health insurers and hospitals will determine the price rather than the market.

We already have a doctor shortage and things don't seem to be getting any better. I simply do not see how taking incentives away, increasing medical school requirements, and allowing the government to get more involved in healthcare is a recipe for success.
The other points in your post, like cost efficiency, are already argued to death in this thread. I'll say that the rest of the developed world has tried some or another iteration of socialized care and it seems every single one costs less per head than ours. That healthcare is a commodity different from park toilets warrants attention, as does the fact, as somebody mentioned here, that most of these countries with single payer have dual systems where patients can opt for private hospital services. Granted, this is not the same as being able to opt out of single payer by its nature, and discussions of whether paying for the wellbeing of everyone is ethical relate to very abstract value judgments where much convincing cannot be done. But not offering basic health services to people is surely a good way to keep them less healthy, poorer, and less likely to ever become responsible for their own betterment.

As for the Venezuela point, I have a bit of a personal background with which to argue here. I have many relatives residing in America with political asylum given their persecution by the country's regime. The country's economic crisis cannot really be explained from lack of incentives or anything remotely so theoretical, rather with currency controls, irresponsible inflationary policy, near absolute dependence in oil (without attempts to diversify or keep capital reserves like more responsible oil exporters have) alongside a total abolition of democratic institutions that could try to revert those structural follies. It also turns out that when political and social order begin to break down anyone capable of emigrating does just that. Making out of the country's irresponsible policies, which were called out 10 years ago, some grand statement about socialism is akin to making decades of adversity that preceded this regime in Venezuela and elsewhere to be a grand statement about capitalism. Context matters more than labels.

As for the benefit of competition, which I'm sure holds for most commodities, it has problems in healthcare practice. Some extent of patent protection is necessary to make incentives for research and production, which must be balanced against the ability to inflate prices by patent holders. We also have to deal with the opportunity costs of not receiving some medications, tests, or treatments. While the patient who is gouged on lasik may just walk away and keep wearing his or her glasses, that option does not exist for every patient with every condition. Having an entity which makes for financial incentives to not gouge costs (i.e. an insurance provider which holds most of the market from which nobody wants to be excluded) helps address this.

Lastly, debate of whether there is such a thing as a doctor shortage (of which there is plenty in other threads and easily findable op-eds) aside, there is no scarcity of competent potential doctors, rather of matriculation and residency spots. The academic (and perhaps extracurricular, too) standards for getting into the discipline go up every decade from the pool of desiring applicants, so things would have to change drastically for schools or residency programs to find themselves short of competent applicants.

Edited this post to solve a few spelling errors
 
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Dr. Snow

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The other points in your post, like cost efficiency, are already argued to death in this thread. I'll say that the rest of the developed world has tried some or another iteration of socialized care and it seems every single one costs less per head than ours. That healthcare is a commodity different from park toilets warrants attention, as does the fact, as somebody mentioned here, that most of these countries with single payer have dual systems where patients can opt for private hospital services. Granted, this is not the same as being able to opt out of single payer by its nature, and discussions of whether paying for the wellbeing of everyone is ethical relate to very abstract value judgments where much convincing cannot be done. But not offering basic health services to people is surely a good way to keep them less healthy, poorer, and less likely to ever become responsible for their own betterment.

As for the Venezuela point, I have a bit of a personal background with which to argue here. I'm Venezuelan and have many relatives residing in America with political asylum given their persecution by the country's regime. The country's economic crisis cannot really be explained from lack of incentives or anything remotely so theoretical, rather with currency controls, irresponsible inflationary policy, near absolute dependence in oil (without attempts to diversify or keep capital reserves like more responsible oil exporters have) alongside a total abolition of democratic institutions that could try to revert those structural follies. It also turns out that when political and social order begin to break down anyone capable of emigrating does just that. Making out of the country's irresponsible policies, which were called out 10 years ago, some grand statement about socialism is akin to making decades of adversity that preceded this regime in Venezuela and elsewhere to be a grand statement about capitalism. Context matters more than labels.

As for the benefit of competition, which I'm sure holds for most commodities, it has problems in healthcare practice. Some extent of patent protection is necessary to make incentives for research and production, which must be balanced against the ability to inflate prices by patent holders. We also have to deal with the opportunity costs of not receiving some medications, tests, or treatments. While the patient who is gouged on lasik may just walk away and keep wearing his or her glasses, that option does not exist for every patient with every condition. Having an entity which makes for financial incentives to not gouge costs (i.e. an insurance provider which holds most of the market from which nobody wants to be excluded) helps address this.

Lastly, debate of whether there is such a thing as a doctor shortage (of which there is plenty in other threads and easily findable op-eds) aside, there is no scarcity of competent potential doctors, rather of matriculation and residency spots. The academic (and perhaps extracurricular, too) standards for getting into the discipline go up every decade from the pool of desiring applicants, so things would have to change drastically for schools or residency programs to find themselves short of competent applicants.

Edited this post to solve a few spelling errors

Comparing the cost, ease, and effectiveness of implementing a completely socialized healthcare system in America to other countries a fraction of our size with completely different budgets and priorities is no better of an argument than mine. I'm simply saying the government is highly inefficient and the "reports and estimates" of Bernie's healthcare plan costs are probably a fraction of what it would actually cost.

We need policy that makes American healthcare better, not policy that makes American healthcare more like other countries' healthcare. There are vast differences in American vs. European culture, which are likely affecting healthcare costs and outcomes more than the actual system. I would argue America's obesity and opioid pandemic are just as important as healthcare reform and likely contributing factors to our "broken" system.

And if there is no doctor shortage then I should mark the AAMC as spam b/c I get a new email every month about it.
 
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