Single Payer System is a Good Idea

[Wooducke]

If you work in the Health Insurance industry like me, then as you read this, try to think of that Upton Sinclair quote ("It is difficult to get a man to understand something when his salary depends upon his not understanding it") and fight the power to act in your own selfish interest.

Even though it's politically impossible with congress right now. I've outlined some reasons why I think we should have a Medicare-like single payer health system in the United States:
• Everyone would have health coverage (including People with pre-existing conditions, un-employed people, people with crappy jobs, and people who just graduated college who have now been dumped from their parents coverage)
• Everyone would be paying into the system, including the people who are currently uninsured. (i.e. Healthcare would no longer be subsidized by the insurance premiums of a few; it would be subsidized by taxes, which everyone has to pay or go to jail)
• Employers would no longer be burdened by having to provide coverage and they could compete better in our global economy.
• More people would seek preventative care instead of waiting for expensive acute illnesses to take affect, as underinsured people do now.
• Hospitals wouldn’t have to charge as much because they wouldn’t have all these losses from uninsured people coming into their ERs.
• Government monopolistic pressure would drive down some of the ridiculous healthcare inflation we’ve been seeing, because they could pretty much set the rates as long as they paid providers enough to cover their costs.
• The government could further control costs by saying “no” to paying for ridiculous high priced drugs and organ transplants for 95 year olds, and CT scans for everything.
• There would be less overhead costs and complications. Think of all the contract negotiations that currently go on between each of the different insurers and providers in this country. Think about all the different re-imbursement rates that providers have to think about when providing coverage to someone. What a waste of resources!
• Insurance overhead cost would be consolidated; pretty much everyone would be getting their insurance through some body like the Center for Medicare and Medicaid Services. Right now the Medicare benefit expense ratio is 97% compared to 81-82% at my company. If Medicare was expanded to more people you could see that benefit expense ratio climbing even higher. Right now all this insurance administrative work is duplicated by scores of private Health Insurers around the country.
• If rich people didn’t like their coverage; they could afford to pay for their own private care, as people do now with plastic surgery.
• A single payer system would be cheaper overall
• A single payer system would be fairer than the current system we have in place where lots of people die or go bankrupt.
• We already have the Medicare system in place, so the idea of single payer health insurance is not really that radically new. We already know how to do it. We could expand Medicare slowly to give time for the economy to adjust. First, raise taxes. Second, expand Medicare coverage to different ages of people over a course of several years. Maybe first expand Medicare to people age 18-29 since this demographic makes up a large portion of the un-insured and then expand it again several years later. The federal government/States already pay for the oldest and sickest and poorest people in this country, expanding Medicare coverage to a bunch of healthy 18-29 year olds would be a nice easy way to start off.
• One of the cons would be that me and most of the other people who work in the health insurance industry would lose our jobs (but hey, at least we would have health coverage when I do!). Maybe I could get a job in P&C?
• Another con would be that doctors would probaby be paid less from the government. However, we would still have the Fee-For-Service system that we have now, so Doctors could still exploit the system like they do now and up utilization to be paid more, so it’s hard to say if doctors would really lose that much.
• Supposedly there would be less incentive for people to become doctors because they wouldn’t get paid as much. If this became too much of a problem though, the government could just increase the fee-schedules that it pays doctors. The government could also pay for smart people to go to medical school as some incentive as well.
• Less Medical technology and crazy drugs would be developed than now, because the re-imbursement rates would probably be lower, and the government wouldn’t pay for frivolous or extremely expensive things like cancer drugs that cost $100,000. This might be a good thing considering how much all these new technologies and drugs have contributed to healthcare inflation. The pendulum needs to swing the other way for a while. (On the other hand, the government already subsidizes a lot of medical research so we would probably still see some innovation.)
• With one giant health insurance provider like Medicare that would cover all sorts of demographics; it would be a great source for data and studies on the health of the American public.


Maybe you disagree or think I have idealized the single payer system. I'm sure it wouldn't be perfect, but the current hybrid system that we have in the US is pretty horrible and I really do think single payer would be a better model.

If you disagree, then I honestly want to hear what you think a ideal system would be. For instance, do you think a purely capitalistic system would be the most ideal situation? How do we resolve the problems with our current employer based health care coverage? (45 million uninsured, crazy healthcare inflation, burden to employers of having to provide health insurance in the US, etc.)

[Darkness Falls]

A) If you got sick would you rather get care in the current US system (assuming you have good health insurance, which I'm sure you do) or in one of the public health systems available in the rest of the world?


B) Do you believe it's fair that people who don't take care of themselves (obesity, smoking, no exercise ....) and consequently have more health care costs, pay as much into the system as people who put in an effort to stay healthy.

[Pseudolus]

Single payer sounds like a good idea. As payer, I nominate... you. Thanks!

[Wooducke]

The Answer to A is that I would probably prefer the coverage I have now, but probably just because I'm more familiar with it. I have a pretty generous HRA plan that I never use. Also, I'm intimately familiar with the hospitals in my area. I know how much we pay them all and how they've been ranked in terms of quality so I would probably prefer to get sick in the US. But it sounds like most Industrialize countries have pretty decent systems and if they cover everyone, why not opt for one of those.

B) No I don't think it's fair. Maybe we should have a junk food tax so they pay more. Or perhaps you get certain tax breaks, if your blood pressure and cholesterol are below a certain amount. Most of the fat/smokers I see are at my work so I'm subsidizing their costs anyway. For group health insurance they don't know anyone's personal health habits. Group Health is pretty much the main system we have in the US now so unhealthy people pay the same as unhealthy people.

[MoProblems_MoMoney]

• The government could further control costs by saying “no” to paying for ridiculous high priced drugs and organ transplants for 95 year olds, and CT scans for everything.

I don't know... when I'm 95, I want an organ transplant so I can see 96.

Edit - to the OP, what do you see as the downside to universal mandated coverage/participation?

[SirVLCIV]

Originally Posted by Wooducke

If you disagree, then I honestly want to hear what you think a ideal system would be. For instance, do you think a purely capitalistic system would be the most ideal situation? How do we resolve the problems with our current employer based health care coverage? (45 million uninsured, crazy healthcare inflation, burden to employers of having to provide health insurance in the US, etc.)

France and Switzerland are better than Canada and the UK.

France and Switzerland are not single-payer. Canada and the UK are.

France and Switzerland also are easier models to transform our system into (work WITH the insurance companies rather than AGAINST them), IMO.

[SirVLCIV]

http://inlander.com/content/newscomm...nada_uk_and_us

[tenthring]

If you work in the Health Insurance industry like me, then as you read this, try to think of that Upton Sinclair quote ("It is difficult to get a man to understand something when his salary depends upon his not understanding it") and fight the power to act in your own selfish interest.

Even though it's politically impossible with congress right now. I've outlined some reasons why I think we should have a Medicare-like single payer health system in the United States:
• Everyone would have health coverage (including People with pre-existing conditions, un-employed people, people with crappy jobs, and people who just graduated college who have now been dumped from their parents coverage)
• Everyone would be paying into the system, including the people who are currently uninsured. (i.e. Healthcare would no longer be subsidized by the insurance premiums of a few; it would be subsidized by taxes, which everyone has to pay or go to jail)

Everyone would have to pay into the system whether it was a success or not, because it was mandated. If it was a bad system there would be no way out. Kinduv like you have to pay for us to invade Iraq whether you supported it or not.

• Employers would no longer be burdened by having to provide coverage and they could compete better in our global economy.

They and there employees would be burdened with higher taxes.

• More people would seek preventative care instead of waiting for expensive acute illnesses to take affect, as underinsured people do now.

Not even necessarily true. If anything, I find people that know insurance won't pay for them to get sick keep better care of themselves. And some people won't take care of themselves no matter what health care system we have. Preventative care is already cheap.

• Hospitals wouldn’t have to charge as much because they wouldn’t have all these losses from uninsured people coming into their ERs.

They will still be providing this care, perhaps even more of it. After all, they are actually going to get paid, this will likely drive up demand and strain supply.


• Government monopolistic pressure would drive down some of the ridiculous healthcare inflation we’ve been seeing, because they could pretty much set the rates as long as they paid providers enough to cover their costs.

What is cost? Does it include R&D cost? What risk premium gets used? I'm pretty sure we could drive down costs if we reduce reimbursement rates to the point no one want to develop new medicines or become PhDs, but that's not a good system.

• The government could further control costs by saying “no” to paying for ridiculous high priced drugs and organ transplants for 95 year olds, and CT scans for everything.

The government is less likely to say "no" then any other party I can think of. They are spending other peoples money. What politician is going to support a death panel or rationing.

• There would be less overhead costs and complications. Think of all the contract negotiations that currently go on between each of the different insurers and providers in this country. Think about all the different re-imbursement rates that providers have to think about when providing coverage to someone. What a waste of resources!

You can fix this without single payer.

• Insurance overhead cost would be consolidated; pretty much everyone would be getting their insurance through some body like the Center for Medicare and Medicaid Services. Right now the Medicare benefit expense ratio is 97% compared to 81-82% at my company. If Medicare was expanded to more people you could see that benefit expense ratio climbing even higher. Right now all this insurance administrative work is duplicated by scores of private Health Insurers around the country.

Medicares benefit expense ratio is the function of its expense/patient ratio. Old people are sick, they incur a lot of expenses. You can actually make your expense ratio go down by driving up expense. Hardly a solution.

• If rich people didn’t like their coverage; they could afford to pay for their own private care, as people do now with plastic surgery.

What if your middle or upper middle class (like most of us). Under the current system you have good health care. However, you can't afford to pay the new taxes for health care and buy a supplemental policy (much like you can't afford to pay school taxes and then afford private school tuition on top of that).

• A single payer system would be cheaper overall
Maybe. But will it be cheaper while providing the same level of care. How much do current single payer systems get subsidized by the US picking up most R&D cost? Are they not facing similar problems with health care cost inflation?

• A single payer system would be fairer than the current system we have in place where lots of people die or go bankrupt.
If you want to control costs, some people have to go without.

• We already have the Medicare system in place, so the idea of single payer health insurance is not really that radically new. We already know how to do it. We could expand Medicare slowly to give time for the economy to adjust. First, raise taxes. Second, expand Medicare coverage to different ages of people over a course of several years. Maybe first expand Medicare to people age 18-29 since this demographic makes up a large portion of the un-insured and then expand it again several years later. The federal government/States already pay for the oldest and sickest and poorest people in this country, expanding Medicare coverage to a bunch of healthy 18-29 year olds would be a nice easy way to start off.
• One of the cons would be that me and most of the other people who work in the health insurance industry would lose our jobs (but hey, at least we would have health coverage when I do!). Maybe I could get a job in P&C?
• Another con would be that doctors would probaby be paid less from the government. However, we would still have the Fee-For-Service system that we have now, so Doctors could still exploit the system like they do now and up utilization to be paid more, so it’s hard to say if doctors would really lose that much.
Um, so this won't be a good reform. Not a selling point.
• Supposedly there would be less incentive for people to become doctors because they wouldn’t get paid as much. If this became too much of a problem though, the government could just increase the fee-schedules that it pays doctors. The government could also pay for smart people to go to medical school as some incentive as well.
That would drive up cost. I thought the power of government monopoly to drive down reimbursement rates was suppose to save us wads of money.

• Less Medical technology and crazy drugs would be developed than now, because the re-imbursement rates would probably be lower, and the government wouldn’t pay for frivolous or extremely expensive things like cancer drugs that cost $100,000. This might be a good thing considering how much all these new technologies and drugs have contributed to healthcare inflation. The pendulum needs to swing the other way for a while. (On the other hand, the government already subsidizes a lot of medical research so we would probably still see some innovation.)

That's easy to say when you've never had a loved one saved by an advance in medical technology. My Dad and Aunt are alive today because of the radical advances we've seen. I would rather that these developments be made and those that can afford them do and those that can't go without.

• With one giant health insurance provider like Medicare that would cover all sorts of demographics; it would be a great source for data and studies on the health of the American public.


Maybe you disagree or think I have idealized the single payer system. I'm sure it wouldn't be perfect, but the current hybrid system that we have in the US is pretty horrible and I really do think single payer would be a better model.

Straw man, you can't use the current system as the only other option.

If you disagree, then I honestly want to hear what you think a ideal system would be. For instance, do you think a purely capitalistic system would be the most ideal situation? How do we resolve the problems with our current employer based health care coverage? (45 million uninsured, crazy healthcare inflation, burden to employers of having to provide health insurance in the US, etc.)
I and a million others have posted on this. It should be easy to find other options, they exist already. I would look at places like Singapore, The Netherlands, and Switzerland. Europe is not the answer, medical cost is growing faster then GDP and their systems will collapse as their populations age. They have no structural way to fix that problem.

[DownInTexas]

So let me get this straight, you admit that a single payer system would let the old and sick die, and would cause future research and development to stagnant, and still think this is preferable to the current system?

[tenthring]

Originally Posted by SirVLCIV

http://inlander.com/content/newscomm...nada_uk_and_us

You can tell someone isn't an actuary when the words "no regulations" and "US health care system" enter the same sentence. Or am I just imagining all those state insurance filings I have to do.