Politics Single Payer

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Denny Crane

Denny Crane

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Vox (a far left wing tilted site) explains why single payer fell apart in New Hampshire.

For @dviss1

https://www.vox.com/2014/12/22/7427117/single-payer-vermont-shumlin

Putting a price tag on Vermont’s single-payer plan was a maddening task for health economists after Act 48 passed. In just the past two years, different economic modeling firms have priced the project anywhere from $1.6 billion to $2.5 billion during its first year.

...


The Shumlin administration contracted with London and a team of economists at her university last year to estimate the cost of Vermont’s plan. Their report estimated that Vermont will need to raise an additional $1.6 billion in tax revenue in 2017 to pay for a single-payer system. (Lunge says, due to some different assumptions, this report and the new one estimating a $2.5 billion price tag are not completely "apples to apples" comparisons).

As the 2017 launch date for single-payer grew closer, the Shumlin administration began to dive into the details of how, exactly, it would work — and began to falter.

...

Covering more people meant spending more money. "This is a challenge we face as a state setting up a system, rather than an entire country," said Lunge. "We have borders, and people come in across those borders every day."

The increased costs and decreased revenue started to add up. The Shumlin administration estimated it would need to increase payroll taxes by 11.5 percent and income tax by 9 percent.

About half of countries who attempt to build single-payer systems fail. That’s Harvard health economist William Hsiao’s estimate after working with about 10 governments in the past two decades.
 
http://reason.com/blog/2017/05/23/california-single-payer-health-care-cost

The latest stop on this magical mystery tour of progressive health care plans is California, where U.S. Sen. Bernie Sanders (I-Vermont) has been campaigning on behalf of a proposed state-run single-payer system. On Monday, state lawmakers in Sacramento got their first look at the price tag for the proposal, which rings in at a whopping $400 billion annually.

The Sacramento Bee notes that, even after accounting for an estimated $200 billion that could be saved by replacing current state-run health programs with the single-payer program, the state would still need to come up with $200 billion annually.

This year's state budget in California, by the way, is about $180 billion.
​
The state would have to more than double all of its taxes on everything from sales tax to property tax to gas tax to income tax. EVERYTHING.
 
The cost analysis is seen as "the biggest hurdle to creating a universal system," the Bee reports.

If this sounds familiar, that's because it is. Just last week, we reported on a similar single-payer proposal in New York State, which would require doubling (and possibly quadrupling, depending on which projection you believe) the state's tax burden. Vermont's attempt to implement a single-payer health care system collapsed in 2014 because the costs were too high. Colorado voters rejected a proposed single-payer system in 2016 when faced with the prospect of increasing payroll taxes by 10 percent to meet the estimated $25 billion annual price tag.
 
There's one other thing that's fairly consistent among the states that have proposed single-payer systems in recent years: When voters find out how much a single-payer system will cost, they are much less likely to support one.

Single-payer advocates learned that lesson last year in Colorado at the ballot box, as the state turned blue for Hillary Clinton even as 79 percent of voters said "no" to single-payer health care.

Other polling bears out that relationship. A recent poll commissioned by the California Association of Health Underwriters, found that 66 percent of California residents are opposed to single-payer health care. Opposition increased to 75 percent when those polled were told the price tag for the system is $179 billion annually—which is actually lower than what the legislative analysis suggests.

There's also this analysis from the Kaiser Family Foundation, which shows how support for single-payer health care declines when there is a price tag attached to the idea.
 
This is all crap. Created by those who want to keep a profit motive in healthcare.
 
Created by the governor of NH who ran on single payer?

200_s.gif
 
I wonder--and these are legitimate questions in my mind--for those who are in favor of single-payer health systems, are there different levels of what you would and would not have the system cover? All cancer treatments? Organ transplants? Long-term hospitalization? Experimental procedures? Would there be a board that would determine what is/isn't covered?

And as far as cost is concerned, would there need to be cost fixing for procedures covered by the single-payer systems? And would prospective health-care providers have the option to operate outside of the single-payer system?
 
The problems with single payer system are the same as what was uncovered with obummer care and the current VA. The payer determines what it will pay, and many providers opt out. Cost of coverage skyrockets due to what is expected to be covered. Lets face it, if you could buy car insurance after you had an accident, costs would be ridiculous. Well, with pre existing conditions, along with the concept of coverage of adults up to age 26 on parents plans, forcing blanket coverage in all plans etc etc etc.

The idea that the Gov will be all things to all people has never been the answer. The free market did a far better job. If you doubt that the insurance companies and medical conglomerates have been the only beneficiaries, check for your self. The best investments from wall street to private portfolios have heavily favored the two.
 
Denny Crane said:
http://reason.com/blog/2017/05/23/california-single-payer-health-care-cost

The latest stop on this magical mystery tour of progressive health care plans is California, where U.S. Sen. Bernie Sanders (I-Vermont) has been campaigning on behalf of a proposed state-run single-payer system. On Monday, state lawmakers in Sacramento got their first look at the price tag for the proposal, which rings in at a whopping $400 billion annually.

The Sacramento Bee notes that, even after accounting for an estimated $200 billion that could be saved by replacing current state-run health programs with the single-payer program, the state would still need to come up with $200 billion annually.

This year's state budget in California, by the way, is about $180 billion.
​
The state would have to more than double all of its taxes on everything from sales tax to property tax to gas tax to income tax. EVERYTHING.
Click to expand...

They would also have to fence in the state to keep taxpayers from leaving.
 
DaLincolnJones said:
The free market did a far better job.
Click to expand...

I don't doubt that the free market is best--for people to whom money is no object. The free market routinely leaves people without money behind and can even be a burden to middle class and lower middle class. Single payer isn't meant to be the best for everyone--it's meant to redistribute the costs for everyone onto everyone. This is a bad deal the richer you are, and a better deal the poorer you are. I won't deny that at all. Money for health care isn't a problem for me, but I think it's a moral duty for society to allow access to health care to everyone, even the very poor. And not just ER care--preventative care, long-term care for things like cancer, all of that.
 
Minstrel said:
Single payer isn't meant to be the best for everyone--it's meant to attract uniformed voters.
Click to expand...
Anyone with a brain would chose healthcare be available rather than a government managed healthcare waiting list.
 
MarAzul said:
Anyone with a brain would chose healthcare be available rather than a government managed healthcare waiting list.
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I'm sorry that the VA isn't working well for you. Hopefully a proper single-payer system would be better funded and better managed.
 
Minstrel said:
but I think it's a moral duty for society to allow access to health care to everyone, even the very poor. And not just ER care--preventative care, long-term care for things like cancer, all of that.
Click to expand...

I understand the sentiment.

Here is the problem. Where do you start and where do you stop? Take California or even Oregon to a smaller extent. Start of with good intentions. It gets politicized. Seen as a vote farm. Next thing its an industry unto itself. Not only does it cover those who were originally intended, but now it covers illegals.

Now it is unsustainable.
 
DaLincolnJones said:
I understand the sentiment.

Here is the problem. Where do you start and where do you stop? Take California or even Oregon to a smaller extent. Start of with good intentions. It gets politicized. Seen as a vote farm. Next thing its an industry unto itself.
Click to expand...

That's a problem with everything, even something that I assume is near and dear to your heart--military funding. There's a reason why Eisenhower referred to the "military industrial complex." Anything we commit to doing as a society, and spending money on, is going to start to have a constituency and industry around it and thus vested interests which leads to lobbying groups and all the rest. Ultimately, it comes down to what your priorities are--for anything you think is extremely important, you still commit to doing it and you try your best to limit inefficiency or corruption.
 
Minstrel said:
That's a problem with everything, even something that I assume is near and dear to your heart--military funding. There's a reason why Eisenhower referred to the "military industrial complex." Anything we commit to doing as a society, and spending money on, is going to start to have a constituency and industry around it and thus vested interests which leads to lobbying groups and all the rest. Ultimately, it comes down to what your priorities are--for anything you think is extremely important, you still commit to doing it and you try your best to limit inefficiency or corruption.
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How about using some basic cost benefit annalist.

Personally, I would prefer a stronger military rather than another 30 million illegals that drain every social system we currently provide.

http://www.fairus.org/publications/...llegal-immigration-on-united-states-taxpayers
 
Minstrel said:
It's good to have both successes and failures to examine when we create our own so that we can learn from both to build it right. That's generally the best way to do anything properly.
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And this my friends is the same logic that allowed millions of muzzies into Europe..
 
Minstrel said:
It's good to have both successes and failures to examine when we create our own so that we can learn from both to build it right. That's generally the best way to do anything properly.
Click to expand...

It's better to avoid the most massive spending mistake in the history of humanity.

The more government has been involved the worse the health care system has become. It's a direct correlation, and causal. Worse outcome than other nations and we used to have, and higher costs.

The expense of complying with the existing single payer scams drive doctors out of that system (refuse to see medicare patients).

All you are going to end up doing is to give the politburo an even more obscene amount of control over the people.

The government is already so big that it isn't run well and can't control its costs. No government social program has lived up to its promised expenses or savings - ObamaCare is a case in point.
 
I don't think Denny really understands what "far left" means.

Of course, why should that be the one thing he understands?
 
http://www.pnhp.org/facts/singlepayer_myths_singlepayer_facts.php

Facts about National Health Insurance (NHI) You Might Not Know

The health care delivery system remains private.
As opposed to a national health service, where the government employs doctors, in a national health insurance system, the government is billed, but doctors remain in private
practice.

A national health insurance program could save approximately $150 billion on paperwork alone.
Because of the administrative complexities in our current system, over 25% of every health care dollar goes to marketing, billing,
utilization review, and other forms of waste. A single-payer system could reduce administrative costs greatly.

Most businesses would save money.
Because a single-payer system is more efficient than our current system, health care costs are less, and therefore, businesses save money. In Canada, the three major auto manufacturers (Ford, GM, and Daimler-Chrysler) have all publicly endorsed Canada’s single-payer health system from a business and financial standpoint. In the United States, Ford pays more for its workers health insurance than it does for the steel to make its cars.

Under NHI, your insurance doesn’t depend on your job.
Whether you’re a student, professor, or working part-time raising children, you’re provided with care. Not only does this lead to a healthier population, but it’s also beneficial from an economic standpoint: workers are less-tied to their
employers, and those that dislike their current positions can find new work
(where they would be happier and most likely more productive and efficient).

Myths about National Health Insurance (NHI)

The government would dictate how physicians practice medicine.
In countries with a national health insurance system, physicians are rarely questioned about their medical practices (and usually only in cases of expected fraud). Compare it to today’s system, where doctors routinely have to ask an insurance company permission to perform procedures, prescribe certain medications, or run certain tests to help their patients.

Waits for services would be extremely long.
Again, in countries with NHI, urgent care is always provided immediately. Other countries do experience some waits for elective procedures (like cataract removal), but maintaining the US’s same level of health expenditures (twice as much as the next-highest country), waits would be much shorter or even non-existent.

People will overutilize the system.
Most estimates do indicate that there would be some increased utilization of the system (mostly from the 42 million people that are currently uninsured and therefore not receiving adequate health care), however the staggering savings from a single-payer system would easily compensate for this. (And remember, doctors still control most health care utilization. Patients don’t receive prescriptions or tests because they want them; they receive them because their doctors have deemed them appropriate.)

Government programs are wasteful and inefficient.
Some are better than others, just as some businesses are better than others. Just to name a few of the most successful and helpful: the National Institutes of Health, the Centers for Disease Control, and Social Security. Even consider Medicare, the government program for the elderly; its overhead is approximately 3%, while in private insurance companies, overhead and profits add up to 15-25%.
 
I can post links too but you'll hate on them:

Why Single-Payer Health Care Saves Money

Lingering uncertainty about the fate of the Affordable Care Act has spurred the California legislature to consider adoption of a statewide single-payer health care system.

Sometimes described as Medicare for all, single-payer is a system in which a public agency handles health care financing while the delivery of care remains largely in private hands.

Discussions of the California measure have stalled, however, in the wake of preliminary estimates pegging the cost of the program as greater than the entire state government budget. Similar cost concerns derailed single-payer proposals in Colorado and Vermont.

Voters need to understand that this cost objection is specious. That’s because, as experience in many countries has demonstrated, the total cost of providing health coverage under the single-payer approach is actually substantially lower than under the current system in the United States. It is a bedrock economic principle that if we can find a way to do something more efficiently, it’s possible for everyone to come out ahead.

By analogy, suppose that your state’s government took over road maintenance from the county governments within it, in the process reducing total maintenance costs by 30 percent. Your state taxes would obviously have to go up under this arrangement.

But if roads would be as well maintained as before, would that be a reason to oppose the move? Clearly not, since the resulting cost savings would reduce your county taxes by more than your state taxes went up. Likewise, it makes no sense to oppose single-payer on the grounds that it would require additional tax revenue. In each case, the resulting gains in efficiency would leave you with greater effective purchasing power than before.

Total costs are lower under single-payer systems for several reasons. One is that administrative costs average only about 2 percent of total expenses under a single-payer program like Medicare, less than one-sixth the corresponding percentage for many private insurers. Single-payer systems also spend virtually nothing on competitive advertising, which can account for more than 15 percent of total expenses for private insurers.

The most important source of cost savings under single-payer is that large government entities are able to negotiate much more favorable terms with service providers. In 2012, for example, the average cost of coronary bypass surgery was more than $73,000 in the United States but less than $23,000 in France.

Despite this evidence, respected commentators continue to cite costs as a reason to doubt that single-payer can succeed in the United States. A recent Washington Post editorial, for example, ominously predicted that budget realities would dampen enthusiasm for single-payer, noting that the per capita expenditures under existing single-payer programs in the United States were much higher than those in other countries.

But this comparison is misleading. In most other countries, single-payer covers the whole population, most of which has only minimal health needs. In contrast, single-payer components of the United States system disproportionately cover population subgroups with the heaviest medical needs: older people (Medicare), the poor and disabled (Medicaid) and returned service personnel (Department of Veterans Affairs).

In short, the evidence is clear that single-payer delivers quality care at significantly lower cost than the current American hybrid system. It thus makes no sense to reject single-payer on the grounds that it would require higher tax revenues. That’s true, of course, but it’s an irrelevant objection.

In addition to being far cheaper, single-payer would also defuse the powerful political objections to the Affordable Care Act’s participation mandate. Polls consistently show that large majorities want people with pre-existing conditions to be able to obtain health coverage at affordable rates. But that goal cannot be achieved unless healthy people are required to join the insured pool. Officials in the Obama administration tried, largely in vain, to explain why the program’s insurance exchanges would collapse in the absence of the participation mandate.

But the logic of the underlying argument is actually very simple. Most people seem able to grasp it if you ask them what would happen if the government required companies to sell fire insurance at affordable rates to people whose houses had already burned down.

No home insurer could remain in business if each policy it sold required it to replace a house costing several hundred thousand dollars. Similarly, no health insurer could remain in business if each of its policy holders generated many thousands of dollars in health care reimbursements each month.

That’s why the lack of a mandate in the alternative plans under consideration means that millions of people with pre-existing conditions will become uninsurable if repeal efforts are successful. An underappreciated advantage of the single-payer approach is that it sidesteps the mandate objection by paying to cover everyone out of tax revenue.

Of course, having to pay taxes is itself a mandate of a sort, but it’s one the electorate has largely come to terms with. Apart from fringe groups that denounce all taxation as theft, most people understand that our entire system would collapse if tax payments were purely voluntary.

The Affordable Care Act is an inefficient system that was adopted only because its architects believed, plausibly, that the more efficient single-payer approach would not be politically achievable in 2009. But single-payer now enjoys significantly higher support than it did then, and is actually strongly favored by voters in some states.

Solid majorities nationwide now favor expansion of the existing single-payer elements of our current system, such as Medicare and Medicaid. Medicaid cuts proposed in Congress have been roundly criticized. Perhaps it’s time to go further: Individual states and, eventually, the entire country, can save money and improve services by embracing single-payer health care.
 
Denny Crane said:
About half of countries who attempt to build single-payer systems fail. That’s Harvard health economist William Hsiao’s estimate after working with about 10 governments in the past two decades.
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Do you have a list of those 10 countries?
 
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