Extreme, but I have to admit I'm getting the popcorn ready for the next Presidential election.
But if the American people literally don't want affordable healthcare that is their choice.
The American people want it. Powerful business lobbies ensure it gets blocked. Things like that are why the USA is not a democracy but a corporate oligarchy.
As zytron3 said, it's all about how the question is phrased.
> > Do you want the government to give you free health care / health insurance?
> Sure, why not?
> > Do you want the government to be the only source of health care / health insurance, with everyone making more than $50k/year paying at least as much in additional taxes as they currently would pay for an unsubsidized ACA marketplace insurance plan to cover the expense?
> Wait, what?!
The question is meaningless if it only asks about what people want and not what they're willing to pay for it.
It's a difference in how the question is phrased. Most people do essentially no research and make no effort to understand the details of things. In this case it's choice = good. No further thought is required as to the actual value added by private insurance.
Defending America’s status quo by saying “choice = good” is one of the crazier things that comes up in these discussions.
A person on Original Medicare today has much more choice because there is no “in network”. All physicians[0] and hospitals and clinics are accessible, without restriction. Also, countries with national care systems like Canada and the UK still have supplemental insurance markets, if you really want that extra choice—but they are small because most people are satisfied with the state-funded care.
The main “choice” you get with the private insurance system these days is which company you want to be locked into using for the rest of your life, as they seem to be increasingly dividing the market so that doctors from health care system A only accept insurance A, and doctors from health care system B only accept insurance B. Sure, you can “choose” another insurer, but then you can’t see any of the doctors you’ve built relationships with. Choice, indeed.
[0] Technically physicians can opt out of accepting Medicare; in practice I’ve never found one who opted out of Medicare that didn’t simply refuse all insurance.
Just look towards how the VA or operated and how many problems people have it and tell me you want to force that experience on everyone.
People want healthcare to be magically free, that’s not how it’ll be. People who now pay almost no taxes and choose not to buy health insurance because they can’t afford it and their other life choices will suddenly be taxed quite a lot for “free” health insurance.
A problem is a lot of American healthcare companies give away medicine and the results of their development to export at low cost, basically whatever they can get and then make up their profit in American markets. There is also a whole lot of waste and inefficiency and not enough pressure to fix it. Many changes need to be made to lower costs and can be made in many ways, but i simply don’t trust the government to do so by giving them all the money to spend, because they already demonstrate they’re bad at administering medical payments.
Not to mention issues many countries have with their social medicine programs, if you’re not just a fan and look objectively, there is definitely a tradeoff.
If single payer is funded through a payroll tax, it should be a net savings for those of us who do choose not to live dangerously.
There’s a lot of pressure to fix the system, and there has been for decades. It’s blunted by politicians responsive to corporations and not to individuals (other than right-wing extremists, who they fear).
The pressure to fix is blunted by the issue's complexity and a public distaste for complexity. There isn't one issue, there are a million issues, and they have to be well understood to be fixed.
"Single payer" is easy to rally behind but it is not a complex solution to a complex problem. There's no guarantee that the result wouldn't be similarly expensive helathcare which was now mandatory with taxes and no longer had economic competition as a pressure to fix.
> Among the public overall, 63% of U.S. adults say the government has the responsibility to provide health care coverage for all, up slightly from 59% last year. Roughly a third (37%) say this is not the responsibility of the federal government, according to a Pew Research Center survey conducted July 27 to Aug. 2 among 11,001 adults. [1]
If you read the post from Pew, you'll find that Dems overwhelming support this policy, while it is Republicans who do not, Republicans who are overwhelming older [2]. So, over time, there will be more support for this policy as the roughly 1.8 million voters per year over the age of 55 age out of voting cohorts.
> I want to push back on the assertion Scott made that "Certainly rich people in America get good health care." After he published this book in June 2020, Ezekiel Emmanuel published an article in JAMA IM (link: https://jamanetwork.com/journals/jamainternalmedicine/fullar...) called "Comparing Health Outcomes of Privileged US Citizens With Those of Average Residents of Other Developed Countries." He wanted to test the commonly stated trope that a feature of the US healthcare system is that the rich here get the very best care in the world. To do that, he looked at outcomes across six benchmark diseases (heart attack, colon cancer, breast cancer, infant mortality, maternal mortality, and pediatric acute lymphocytic leukemia). He compared outcomes for white people in the 1% of richest counties in the US, 5% richest counties in the US, and average outcomes in 12 rich countries (i'm not going to type them all out but they're places like Australia, Canada, and Germany). The results were...not so great for rich Americans!
> While rich people in the US do better than average people in other rich countries with breast cancer, RICH children in the US have outcomes worse than AVERAGE citizens in 11/12 of this group of rich countries. Rich people in America have about the same outcomes after heart attack that average people in other rich countries have. In other words, in most cases, you're about as well off having a heart attack being the average bozo in France (for example) as you are having one in one of the wealthiest counties in the US. I was pretty shocked when I read this paper.
> The reason I think this is important is because I think it's extremely politically useful sometimes to be able to claim that rich people in the US get great healthcare! People like to imagine themselves as more privileged than they are, and think that, if and when they get sick, they'll have access to this incredible care. So we should reframe from "average care in the US is shitty but care for the upper echelons is the envy of the world" to "average care in the US is shitty, and also in the upper echelons we are about the same as the average person in America's peer countries."
How many drugs, medical devices, etc. were developed in the US and are being sold to all of those OECD countries at a significant discount?
If that pricing was forced on Americans as well, where would the now missing money come from? Is it a bunch of corporate fatcats getting rich or is the richest country in the world subsidizing the healthcare of the rest of the world? (I mean, probably both, but is your intention to nationalize and make nonprofit every aspect of healthcare including drugs and research?)
Wait up. The US develops all these things, and yet, you think they should be given away to the world at a discount, while Americans pay full fare or more? How does that make any sense to you?
The only countries with higher median incomes than the US are Norway, UAE, Luxembourg, and Switzerland. UAE and Norway because oil, Luxembourg and Switzerland because they are tiny and very specialized.
The rest of the world can't afford as much, plenty of people will argue for humanitarian reasons that things should be lower cost to those countries which can't pay as much, and in order to sell in those other countries companies simply have to lower prices.
A similar thing happens with video games, movies, streaming services, etc. etc. etc. it's called price discrimination. (it is of course not universal, but it is still quite common for companies to lower their prices in markets which can't afford as much)
I'm sorry, but that still does not make sense to me. The US (meaning really, the American people) is expected both to innovate and subsidize the world? Come on, now. If the US develops it, why shouldn't the US benefit the most? If prices keep going the way they have over the past 40 years, we're not going to be able to afford all these fancy treatments and drugs, anyway.
Imagine a corporation developing a product, then marketing it for sale, yet not only not giving its employees a corporate discount, but making them pay more for it. Again, how does that make sense?
Welcome to macroeconomics, free trade, globalization, and simple business strategy, topics which can't be adequately conveyed in a forum comment.
Almost every product you buy benefits from the lower costs of labor and everything else in foreign economies in one way or another. The flip side is you generally have to lower your own prices to sell in those economies as well.
You could try to keep prices constant globally, but in much of the world there would just be 0 sales. The strategy is to make up for a smaller profit margin with larger volume.
Buy at a discount from foreign countries, sell at a discount to foreign countries, as a result, pull their economies closer to your own and create new markets for your higher grade products.
Everyone on HN is always on about selling your product for what people will pay for it (usually with regards to raising prices) and paying employees market rates. Well it works both ways and you sell your products for what you can get, especially when their is moral pressure all around to not be seen profiting too much from the poorest countries.
This is not a sustainable phenomenon, though. Americans can't continue to pay an increasing portion of their income to healthcare while exporting the benefits to everyone else. That's simply absurd.
You can't keep squeezing people for more and more and expect to get anywhere in a sustainable fashion. This is the road to collapse. What does macroeconomics say about that?
All economics is cyclical, prices will rise until the pressure causes them to reverse the trend. Pretend any economic trend over a short period will continue forever and they’ll all be unsustainable.
I'm sorry, but a "cyclical trend" that lasts nearly the length of a human life is not a cyclical trend. What this is is the tendency for the rate of profit to fall coming home to roost. These are probably the last days of capitalism as we know it.
The analogy that the people in the US are “employees” of pharm companies is the wrong analogy. There is no obligation here.
Companies price discriminate all the time. It’s capitalism. I run a SaaS and offer lower pricing to businesses from lower cost countries. But it doesn’t mean I’m subsidizing costs thanks to richer countries. It’s so I’m not leaving money on the table.
Have you ever stopped to consider for even one second that maybe capitalism is the problem? That maybe there should be an obligation? As I said in my other comment, you can't keep squeezing people for more and more and more and expect it to be sustainable. What good are fancy new drugs and treatments when nobody can afford them, even with insurance?
Would we still have these new drugs without capitalism? There still needs to be incentive and capitalism is the best model we have for that. It's the government that needs to implement policies however to make them more available for everyone. Humans can't be relied upon to develop novel solutions for the good of everyone -- there has to be something in it for them. That's just how they operate unfortunately. Long-term solutions require the right incentives.
Where's the incentive if people can't afford them?
You're thinking too small if you think capitalism is the only system with incentives. You're locked into the idea that capitalism is the only possible economic system, and you can't see that there can be alternatives (a.k.a. "capitalist realism").
Why do you think it's reasonable that we could fix a problem created by capitalism by doing more capitalism?
> The US (meaning really, the American people) is expected both to innovate and subsidize the world?
See also, military spending. There's certainly an argument to be made that the US doesn't need to have quite the level of worldwide engagement it does, but what would that result in? Would China being an uncontested military superpower be good or bad for the world?
“responsibility to provide health care coverage for all” can mean lots of different things to survey respondents, and does not imply single payer, which is but one way of implementing this.
I would also probably respond “yes” to this question, but there are indeed other solutions.
Not when you include the word "provide". If you change it to "make accessible" or something else, something other than single-payer is possible. Government provision of health care coverage for all === single-payer.
Do you think people answering this question for this survey spent an incredible amount of time dissecting each word for the very specific implications of it's meaning?
Or did they think "government provide medicine, yay!"
People can really easily be manipulated by how surveys are presented and word patterns used. Survey results are weak arguments for how many people actually would agree with a certain outcome once they thoroughly understood it, especially when the only link between the outcome you're defending is a line about the specific implications about the word "provide".
That's four straw men in a row. Medicare is not the VA. People who pay no taxes won't suddenly be taxed "quite a lot". Medicine isn't being "given away", but rather paid for at rates set by collective bargaining. The government seems quite alright at handling Medicare payments.
I'm a proponent of markets - single payer ultimately feels like giving in to the ever-growing cancer of medical administration. I'd prefer to reform the industry to have functioning market dynamics regardless of who pays. But you're grossly mischaracterizing M4A. If rallying around giving everyone access to Medicare is what it takes to stop a lot of needless administrative suffering and end a significant drag on the labor market, I'm all for it.
The US spent $4 trillion last year on medicine, $670 billion was Medicare spending. I don't know where you think the remaining $3+ trillion dollars are going to come from except through doubling tax revenue. (The US took in $4 trillion last year)
You can't just tax high income people double, I already pay 26% in federal taxes with another 8% in state taxes... I don't think raising my income taxes from 34% to 60% is going to go over very well with everybody else (even remotely) similarly effected... money is going to have to come from people who are paying very little in taxes now too.
A straw man is a statement that is trivially disprovable. Just because you stood them up without knocking them down does not stop them from being straw men.
That money comes from premiums for Medicare and money saved from private "insurance". The correct comparison is not simply your current tax rate, but rather your tax rate plus the amount you're currently paying for "insurance".
Medicare is not some free thing for the elderly, but rather is paid into by monthly social security payments. Adjust the premium amount to remove any retirement subsidy, and allow non-retired people to buy into the existing system. This would add a well-established competitor to a market currently dominated by the health "insurance" cartel.
The "free" healthcare is Medicaid which is available to everyone, but only after they're rendered unemployable and bankrupted due to medical problems. Doesn't it make more sense to allow people to buy into a healthcare plan and keep working rather than making them stay destitute so they can quality for medical care?
Taking page 7's 85% figure for high earners, the $578.30 Part B premium figure for high earners, the $77.90 Part D premium for high earners, and the $499 Part A premium for people who didn't pay in, creates a total monthly premium of $1271. This is for old people or disabled people who have many more chronic health problems. Surely this figure can be drastically reduced for younger people without chronic health problems, and can likely beat what the governmentesque "private" companies charge for non-employer plans.
Furthermore, there is probably no better solution to paying for bankruptcy-level chronic health problems than public funds, despite the cost. The prevailing fiction is that such expensive individuals will be part of some non-correlated social "group" and paid for by other members. But the incentives are completely wrong, in that an insurer or employer doesn't want to pay for that market-inefficient burden, and will look for every reason to deny claims or remove from group. So considering those extreme expenses a fixed cost (which are being paid by the public now regardless, through Medicare, Medicaid, or unpaid debt), implies that average individual premiums would be even less.
Like I said, I'm a huge proponent of a an at cost Medicare option. I don't understand why this is a poison pill for so many people on the left especially. In my mind it is the way the government should operate: provide a non coercive option that helps people.
It can be easily separated from the economic redistributive function of government and stand alone. If at a later date, the Feds decide to Levy a tax to cover people that can't afford it, they always can. Seems like a perfect test case to see if the gov can compete with the private market on cost and satisfaction.
I think there's a huge desire to solve everything in one fell swoop in some imagined perfect plan. I'll get similar pushback when talking about common sense market based reforms for the healthcare industry, completely orthogonal to who's paying. A predictable response is always "yeah, so when you fly through your windshield you can whip out your phone in the air and search for which hospital has the best rates", completely ignoring that most healthcare is non emergency and even in many emergency situations people still make decisions to avoid being financially screwed.
There's so much low hanging fruit of things that patently do not make sense and would be politically-neutral for people, yet fixing them would disempower some middleman and no new pockets would get filled, and so there is no political support.
yeah, I guess it could have to do with big flashy ideas that capture the imagination. More cynically, I guess there is a perverse incentive in that marginal improvements reduce the pressure for major reform.
My favorite simple reform that everyone hates: encourage the training of more doctors and nurses. Wages are a major driver of healthcare costs, and there are a number of constraints on the supply.
Another is to bar hospital price discrimination between different insurance providers and cash payers. The idea that hospitals milk some customers to subsidize others is absurd
Indeed, that is not at all what a straw man argument is, go look it up.
Medicare is not at all comparable to the coverage you get with private health insurance.
Single payer healthcare systems have zero or very very low costs to the patient, nothing at all like the deductibles, coinsurance, and out of pocket maximums you find in private health insurance.
You don't really know what you're talking about on several points and it doesn't seem to be worth correcting each one of your misconceptions.
I said "straw men", not "straw man arguments". Each of my following sentences was a quick refutation of the fallacies you based your argument on. It's almost like they were talking points with no bearing in reality - for example, Medicare is decidedly distinct from the VA. It's difficult to have a discussion with someone who is drawing assertions from an alternate reality.
It's also funny you said I don't know anything about Medicare given that I handled my father's healthcare for several years. There were definitely deductibles, "coinsurance" (aka percentage-based deductibles), and out of pocket maximums for Parts A, B, and D.
I straight up said I'd prefer market based solutions, to actually address the administrative cancer that is responsible for ballooning healthcare costs - in what other industry are vendors allowed to keep prices secret and then send arbitrary bills afterwards based on how they feel? But I have seen no credible attempts for reform by the other Party, instead deferring to the absolutely insane status quo. And no, a few executive orders to publish fictitious chargemasters don't count - I'm talking real reform like requiring providers to set a single price schedule regardless of who is paying. Until there is a credible alternative plan for industry reform, then unfortunately M4A is the only plan addressing the insanity of the current system.
If the government isn't going to do it, no one is going to do it, so you're complaining about a system (with good reason) that you're determined to preserve.
> People who now pay almost no taxes and choose not to buy health insurance because they can’t afford it
I guess that's one way to phrase "are completely priced out of something guaranteed as a human right in pretty much every civilized country". A good friend of mine is in this situation, and I have a very low tolerance for the attitude of the "fuck poor people because I don't like taxes" crowd.
It's market forces at work. When most people in a certain situation neglect a cost so they can afford everything else in their lives, everything else has a tendency to raise prices to eat up all of their income anyway.
It comes down to most people paying a lot of money for rent and not being able to afford other things like healthcare. Well rent is that high because enough people neglected to pay for healthcare that the competition for space made rent go up.
I live in a place where low income people have a whole lot of access though the state to get low or zero cost health insurance which is very good. My taxes pay for that and I have no problem with it.
A lot of the states that don't have such nice programs are largely run by parties strongly favored by the low income population so I'm not really sure this is my fault now.
People don't want these solutions, especially the political parties of the people who would benefit the most from single payer. If tried it will lose elections.
The things which could win elections are pragmatic measures to address the biggest cost excesses in medicine individually, but people are pretty dumb and tend not to rally for a large number of incremental improvements instead pretending that one big solution will definitely solve their problems and not just add new, different, and perhaps bigger ones.
> Don’t most national healthcare programs also add in collective bargaining?
Which of the major cost drivers in US healthcare does collective bargaining address?
Yes, we could switch to paying marginal costs for drugs, but drugs don't happen unless the average costs are paid, so if someone is paying marginal, someone else has to pay above average.
There are things that we could do to reduce said average costs, but we can do them without doing anything else.
Having the state double income tax and then using those funds to pay for healthcare does not suddenly make it “affordable”. We need to address the underlying costs of healthcare in the US, we are paying much more than other Western Nations. Do that, maybe there is a chance of affordability.
At the same time, 19 out of 22 studies in a systematic review concluded that M4A would produce immediate cost savings, and one additional study predicted savings over time. These studies were funded by "organizations across the political spectrum": https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6961869/
I have no idea how to reconcile these findings, except to conclude that the average American has no clue how insurance works, while, at the same time, they want to keep what they have. I think it's propaganda that's getting in the way of people making an informed decision here.
And why wouldn't they? Significant changes in the US are only successful when they are backed by people who will profit massively from them. You can either continue to manage as you have, or waste effort on what is likely either an honest candidate who is going to get totally demolished or a corrupt candidate who is going to make your situation worse.
>Yet, 94% of Medicare recipients "report being very satisfied or satisfied with the quality of their medical care
I think the part you are missing is that 83% of Medicare recipients have supplemental insurance to cover their medical needs. The recipients know specifically the scope of Medicare and what they would loose.
I offered a possible explanation to the question that puzzled you. That is the relevance.
The simple and plausible answer is that 94% of Medicare recipients report being very satisfied or satisfied with the quality of their "medical care" but most would not want to rely on medicare exclusively and have their private insurance abolished.
What is really bizarre is that 67% of Medicare-for-all supporters think they would be able to keep their current health insurance under Medicare-for-all!
Other related facts:
60% of Americans would oppose a national Medicare-for-all plan if it require most Americans to pay more in taxes
Roughly half of Americans would oppose medicare-for-all if told it will increase the taxes that you personally pay, but decrease your overall costs for health care
> The stakes were especially high given that Gov. Gavin Newsom, who campaigned for governor on the promise of single-payer, has been notably uninterested in the bill
Just watched this seemingly highly relevant video yesterday:
Population wide benefits without population wide taxing power will never work. Net benefit recipients will move in and net benefit payers will move out.
Which is why healthcare (including mental healthcare), and homelessness/housing require a federal solution.
I assume any non federal politician campaigning on taxpayer funded healthcare is just posturing for votes, because the math is never going to work out on a state or smaller level.
>Population wide benefits without population wide taxing power will never work. Net benefit recipients will move in and net benefit payers will move out.
Taxing some or all of the middle/upper class to pay for healthcare of those who aren't paying taxes, is exactly this.
Also California's tax burden is nearly double that of the least burdensome states. Clearly there's something more at play here than merely the fear people will move out of California; California has demonstrated clearly they aren't terribly worried about the effects of higher taxation on emigration.
It's untrue to say that lower classes are not paying taxes. They can't access the array of techniques the wealthy use to avoid paying their fair share. Undocumented people in particular pay into the system by having social security and other taxes deducted from their wages even though they will never be able to access the services because of their status.
The US federal government spends $766B for Medicare + $571B for Medicaid, a sum of $1.337T out of a total $6.011T that will be spent in 2022. This does not even include the healthcare spending of Tricare and other federal government employees' healthcare, and it does not account for things like deductibles and copays and insurance premiums.
And that is only for old people, (very) poor people, and employees of the federal government.
Paying for every person's healthcare within a given jurisdiction would blow a massive hole in governments' budgets that I would bet even people willing to pay extra CA taxes would notice, which are currently probably only 10% to 15% extra compared to other locales. Granted this increase would be offset by not needing to pay insurance premiums or Medicare tax, but in turn, that would be offset by the additional deductible/copay expenses, plus people simply getting more healthcare because they no longer have to worry about the cost.
Note that Vermont tried and called it quits after a couple years for the same reasons:
For one more data point, I recall how much consternation the Affordable Care Act caused, and that one merely allowed poor people to access SOME part of healthcare. The outcry over increased health insurance premiums (a proxy for taxes) because people would now be paying to subsidize old people and sick people was and is massive.
> Net benefit recipients will move in and net benefit payers will move out.
The numbers don't bear this out. What we see is a bunch of anti-welfare state conservatives taking credit for poor people being gentrified out of desirable high-tax areas.
Current internal migration numbers are not representative of what would happen if a locale were to take on taxpayer funded healthcare.
The magnitude of comprehensive healthcare expenses would make other state and local level expenses pale in comparison. Even Vermont called it quits after a couple years due to inability to sufficiently increase taxes:
California is in a better spot than Vermont, of course, but I would not gamble on it being that much more desirable than elsewhere that people with the ability to move would be willing to pay an easily double digit percentage increase in taxes.
66 comments
[ 4.8 ms ] story [ 130 ms ] threadAmong the public overall, 63% of U.S. adults say the government has the responsibility to provide health care coverage for all
https://www.pewresearch.org/fact-tank/2020/09/29/increasing-...
> > Do you want the government to give you free health care / health insurance?
> Sure, why not?
> > Do you want the government to be the only source of health care / health insurance, with everyone making more than $50k/year paying at least as much in additional taxes as they currently would pay for an unsubsidized ACA marketplace insurance plan to cover the expense?
> Wait, what?!
The question is meaningless if it only asks about what people want and not what they're willing to pay for it.
A person on Original Medicare today has much more choice because there is no “in network”. All physicians[0] and hospitals and clinics are accessible, without restriction. Also, countries with national care systems like Canada and the UK still have supplemental insurance markets, if you really want that extra choice—but they are small because most people are satisfied with the state-funded care.
The main “choice” you get with the private insurance system these days is which company you want to be locked into using for the rest of your life, as they seem to be increasingly dividing the market so that doctors from health care system A only accept insurance A, and doctors from health care system B only accept insurance B. Sure, you can “choose” another insurer, but then you can’t see any of the doctors you’ve built relationships with. Choice, indeed.
[0] Technically physicians can opt out of accepting Medicare; in practice I’ve never found one who opted out of Medicare that didn’t simply refuse all insurance.
Just look towards how the VA or operated and how many problems people have it and tell me you want to force that experience on everyone.
People want healthcare to be magically free, that’s not how it’ll be. People who now pay almost no taxes and choose not to buy health insurance because they can’t afford it and their other life choices will suddenly be taxed quite a lot for “free” health insurance.
A problem is a lot of American healthcare companies give away medicine and the results of their development to export at low cost, basically whatever they can get and then make up their profit in American markets. There is also a whole lot of waste and inefficiency and not enough pressure to fix it. Many changes need to be made to lower costs and can be made in many ways, but i simply don’t trust the government to do so by giving them all the money to spend, because they already demonstrate they’re bad at administering medical payments.
Not to mention issues many countries have with their social medicine programs, if you’re not just a fan and look objectively, there is definitely a tradeoff.
There’s a lot of pressure to fix the system, and there has been for decades. It’s blunted by politicians responsive to corporations and not to individuals (other than right-wing extremists, who they fear).
"Single payer" is easy to rally behind but it is not a complex solution to a complex problem. There's no guarantee that the result wouldn't be similarly expensive helathcare which was now mandatory with taxes and no longer had economic competition as a pressure to fix.
> Among the public overall, 63% of U.S. adults say the government has the responsibility to provide health care coverage for all, up slightly from 59% last year. Roughly a third (37%) say this is not the responsibility of the federal government, according to a Pew Research Center survey conducted July 27 to Aug. 2 among 11,001 adults. [1]
If you read the post from Pew, you'll find that Dems overwhelming support this policy, while it is Republicans who do not, Republicans who are overwhelming older [2]. So, over time, there will be more support for this policy as the roughly 1.8 million voters per year over the age of 55 age out of voting cohorts.
[1] https://www.pewresearch.org/fact-tank/2020/09/29/increasing-...
[2] https://www.pewresearch.org/politics/2020/06/02/the-changing...
Does that make their opinion irrelevant?
https://www.harvardmagazine.com/2020/05/feature-forum-costli...
https://www.kff.org/health-costs/issue-brief/americans-chall...
https://insights.som.yale.edu/insights/why-is-healthcare-so-...
Not even the wealthy get better healthcare with their dollars.
https://astralcodexten.substack.com/p/highlights-from-the-co...
> GummyBearDoc writes:
> I want to push back on the assertion Scott made that "Certainly rich people in America get good health care." After he published this book in June 2020, Ezekiel Emmanuel published an article in JAMA IM (link: https://jamanetwork.com/journals/jamainternalmedicine/fullar...) called "Comparing Health Outcomes of Privileged US Citizens With Those of Average Residents of Other Developed Countries." He wanted to test the commonly stated trope that a feature of the US healthcare system is that the rich here get the very best care in the world. To do that, he looked at outcomes across six benchmark diseases (heart attack, colon cancer, breast cancer, infant mortality, maternal mortality, and pediatric acute lymphocytic leukemia). He compared outcomes for white people in the 1% of richest counties in the US, 5% richest counties in the US, and average outcomes in 12 rich countries (i'm not going to type them all out but they're places like Australia, Canada, and Germany). The results were...not so great for rich Americans!
> While rich people in the US do better than average people in other rich countries with breast cancer, RICH children in the US have outcomes worse than AVERAGE citizens in 11/12 of this group of rich countries. Rich people in America have about the same outcomes after heart attack that average people in other rich countries have. In other words, in most cases, you're about as well off having a heart attack being the average bozo in France (for example) as you are having one in one of the wealthiest counties in the US. I was pretty shocked when I read this paper.
> The reason I think this is important is because I think it's extremely politically useful sometimes to be able to claim that rich people in the US get great healthcare! People like to imagine themselves as more privileged than they are, and think that, if and when they get sick, they'll have access to this incredible care. So we should reframe from "average care in the US is shitty but care for the upper echelons is the envy of the world" to "average care in the US is shitty, and also in the upper echelons we are about the same as the average person in America's peer countries."
Emphasis on the last paragraph.
If that pricing was forced on Americans as well, where would the now missing money come from? Is it a bunch of corporate fatcats getting rich or is the richest country in the world subsidizing the healthcare of the rest of the world? (I mean, probably both, but is your intention to nationalize and make nonprofit every aspect of healthcare including drugs and research?)
The rest of the world can't afford as much, plenty of people will argue for humanitarian reasons that things should be lower cost to those countries which can't pay as much, and in order to sell in those other countries companies simply have to lower prices.
A similar thing happens with video games, movies, streaming services, etc. etc. etc. it's called price discrimination. (it is of course not universal, but it is still quite common for companies to lower their prices in markets which can't afford as much)
Imagine a corporation developing a product, then marketing it for sale, yet not only not giving its employees a corporate discount, but making them pay more for it. Again, how does that make sense?
Almost every product you buy benefits from the lower costs of labor and everything else in foreign economies in one way or another. The flip side is you generally have to lower your own prices to sell in those economies as well.
You could try to keep prices constant globally, but in much of the world there would just be 0 sales. The strategy is to make up for a smaller profit margin with larger volume.
Buy at a discount from foreign countries, sell at a discount to foreign countries, as a result, pull their economies closer to your own and create new markets for your higher grade products.
Everyone on HN is always on about selling your product for what people will pay for it (usually with regards to raising prices) and paying employees market rates. Well it works both ways and you sell your products for what you can get, especially when their is moral pressure all around to not be seen profiting too much from the poorest countries.
It's all right here: https://www.washingtonpost.com/business/2020/02/24/this-char...
You can't keep squeezing people for more and more and expect to get anywhere in a sustainable fashion. This is the road to collapse. What does macroeconomics say about that?
Companies price discriminate all the time. It’s capitalism. I run a SaaS and offer lower pricing to businesses from lower cost countries. But it doesn’t mean I’m subsidizing costs thanks to richer countries. It’s so I’m not leaving money on the table.
You're thinking too small if you think capitalism is the only system with incentives. You're locked into the idea that capitalism is the only possible economic system, and you can't see that there can be alternatives (a.k.a. "capitalist realism").
Why do you think it's reasonable that we could fix a problem created by capitalism by doing more capitalism?
https://en.wikipedia.org/wiki/Capitalist_Realism
See also, military spending. There's certainly an argument to be made that the US doesn't need to have quite the level of worldwide engagement it does, but what would that result in? Would China being an uncontested military superpower be good or bad for the world?
Many global healthcare developers also see a disproportionate part of their revenue coming from the US market/sales.
I would also probably respond “yes” to this question, but there are indeed other solutions.
Or did they think "government provide medicine, yay!"
People can really easily be manipulated by how surveys are presented and word patterns used. Survey results are weak arguments for how many people actually would agree with a certain outcome once they thoroughly understood it, especially when the only link between the outcome you're defending is a line about the specific implications about the word "provide".
I'm a proponent of markets - single payer ultimately feels like giving in to the ever-growing cancer of medical administration. I'd prefer to reform the industry to have functioning market dynamics regardless of who pays. But you're grossly mischaracterizing M4A. If rallying around giving everyone access to Medicare is what it takes to stop a lot of needless administrative suffering and end a significant drag on the labor market, I'm all for it.
The US spent $4 trillion last year on medicine, $670 billion was Medicare spending. I don't know where you think the remaining $3+ trillion dollars are going to come from except through doubling tax revenue. (The US took in $4 trillion last year)
You can't just tax high income people double, I already pay 26% in federal taxes with another 8% in state taxes... I don't think raising my income taxes from 34% to 60% is going to go over very well with everybody else (even remotely) similarly effected... money is going to have to come from people who are paying very little in taxes now too.
That money comes from premiums for Medicare and money saved from private "insurance". The correct comparison is not simply your current tax rate, but rather your tax rate plus the amount you're currently paying for "insurance".
Medicare is not some free thing for the elderly, but rather is paid into by monthly social security payments. Adjust the premium amount to remove any retirement subsidy, and allow non-retired people to buy into the existing system. This would add a well-established competitor to a market currently dominated by the health "insurance" cartel.
The "free" healthcare is Medicaid which is available to everyone, but only after they're rendered unemployable and bankrupted due to medical problems. Doesn't it make more sense to allow people to buy into a healthcare plan and keep working rather than making them stay destitute so they can quality for medical care?
That said, only a minority of Medicare funds come from payroll taxes. The biggest contribution is from other taxes. See page 7:
https://files.kff.org/attachment/Issue-Brief-Facts-on-Medica....
Furthermore, there is probably no better solution to paying for bankruptcy-level chronic health problems than public funds, despite the cost. The prevailing fiction is that such expensive individuals will be part of some non-correlated social "group" and paid for by other members. But the incentives are completely wrong, in that an insurer or employer doesn't want to pay for that market-inefficient burden, and will look for every reason to deny claims or remove from group. So considering those extreme expenses a fixed cost (which are being paid by the public now regardless, through Medicare, Medicaid, or unpaid debt), implies that average individual premiums would be even less.
It can be easily separated from the economic redistributive function of government and stand alone. If at a later date, the Feds decide to Levy a tax to cover people that can't afford it, they always can. Seems like a perfect test case to see if the gov can compete with the private market on cost and satisfaction.
I think there's a huge desire to solve everything in one fell swoop in some imagined perfect plan. I'll get similar pushback when talking about common sense market based reforms for the healthcare industry, completely orthogonal to who's paying. A predictable response is always "yeah, so when you fly through your windshield you can whip out your phone in the air and search for which hospital has the best rates", completely ignoring that most healthcare is non emergency and even in many emergency situations people still make decisions to avoid being financially screwed.
There's so much low hanging fruit of things that patently do not make sense and would be politically-neutral for people, yet fixing them would disempower some middleman and no new pockets would get filled, and so there is no political support.
My favorite simple reform that everyone hates: encourage the training of more doctors and nurses. Wages are a major driver of healthcare costs, and there are a number of constraints on the supply.
Another is to bar hospital price discrimination between different insurance providers and cash payers. The idea that hospitals milk some customers to subsidize others is absurd
Medicare is not at all comparable to the coverage you get with private health insurance.
Single payer healthcare systems have zero or very very low costs to the patient, nothing at all like the deductibles, coinsurance, and out of pocket maximums you find in private health insurance.
You don't really know what you're talking about on several points and it doesn't seem to be worth correcting each one of your misconceptions.
It's also funny you said I don't know anything about Medicare given that I handled my father's healthcare for several years. There were definitely deductibles, "coinsurance" (aka percentage-based deductibles), and out of pocket maximums for Parts A, B, and D.
I straight up said I'd prefer market based solutions, to actually address the administrative cancer that is responsible for ballooning healthcare costs - in what other industry are vendors allowed to keep prices secret and then send arbitrary bills afterwards based on how they feel? But I have seen no credible attempts for reform by the other Party, instead deferring to the absolutely insane status quo. And no, a few executive orders to publish fictitious chargemasters don't count - I'm talking real reform like requiring providers to set a single price schedule regardless of who is paying. Until there is a credible alternative plan for industry reform, then unfortunately M4A is the only plan addressing the insanity of the current system.
I guess that's one way to phrase "are completely priced out of something guaranteed as a human right in pretty much every civilized country". A good friend of mine is in this situation, and I have a very low tolerance for the attitude of the "fuck poor people because I don't like taxes" crowd.
It comes down to most people paying a lot of money for rent and not being able to afford other things like healthcare. Well rent is that high because enough people neglected to pay for healthcare that the competition for space made rent go up.
I live in a place where low income people have a whole lot of access though the state to get low or zero cost health insurance which is very good. My taxes pay for that and I have no problem with it.
A lot of the states that don't have such nice programs are largely run by parties strongly favored by the low income population so I'm not really sure this is my fault now.
People don't want these solutions, especially the political parties of the people who would benefit the most from single payer. If tried it will lose elections.
The things which could win elections are pragmatic measures to address the biggest cost excesses in medicine individually, but people are pretty dumb and tend not to rally for a large number of incremental improvements instead pretending that one big solution will definitely solve their problems and not just add new, different, and perhaps bigger ones.
I can’t imagine it’d be possible to support on state coffers alone without that.
Which of the major cost drivers in US healthcare does collective bargaining address?
Yes, we could switch to paying marginal costs for drugs, but drugs don't happen unless the average costs are paid, so if someone is paying marginal, someone else has to pay above average.
There are things that we could do to reduce said average costs, but we can do them without doing anything else.
Yet, 94% of Medicare recipients "report being very satisfied or satisfied with the quality of their medical care": https://www.kff.org/report-section/medicare-covered-older-ad...
At the same time, 19 out of 22 studies in a systematic review concluded that M4A would produce immediate cost savings, and one additional study predicted savings over time. These studies were funded by "organizations across the political spectrum": https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6961869/
I have no idea how to reconcile these findings, except to conclude that the average American has no clue how insurance works, while, at the same time, they want to keep what they have. I think it's propaganda that's getting in the way of people making an informed decision here.
And why wouldn't they? Significant changes in the US are only successful when they are backed by people who will profit massively from them. You can either continue to manage as you have, or waste effort on what is likely either an honest candidate who is going to get totally demolished or a corrupt candidate who is going to make your situation worse.
I think the part you are missing is that 83% of Medicare recipients have supplemental insurance to cover their medical needs. The recipients know specifically the scope of Medicare and what they would loose.
https://www.kff.org/medicare/issue-brief/a-snapshot-of-sourc...
The simple and plausible answer is that 94% of Medicare recipients report being very satisfied or satisfied with the quality of their "medical care" but most would not want to rely on medicare exclusively and have their private insurance abolished.
What is really bizarre is that 67% of Medicare-for-all supporters think they would be able to keep their current health insurance under Medicare-for-all!
Other related facts:
60% of Americans would oppose a national Medicare-for-all plan if it require most Americans to pay more in taxes
Roughly half of Americans would oppose medicare-for-all if told it will increase the taxes that you personally pay, but decrease your overall costs for health care
PDF: https://www.kff.org/slideshow/public-opinion-on-single-payer...
> The stakes were especially high given that Gov. Gavin Newsom, who campaigned for governor on the promise of single-payer, has been notably uninterested in the bill
Just watched this seemingly highly relevant video yesterday:
https://www.youtube.com/watch?v=hNDgcjVGHIw
Which is why healthcare (including mental healthcare), and homelessness/housing require a federal solution.
I assume any non federal politician campaigning on taxpayer funded healthcare is just posturing for votes, because the math is never going to work out on a state or smaller level.
Taxing some or all of the middle/upper class to pay for healthcare of those who aren't paying taxes, is exactly this.
Also California's tax burden is nearly double that of the least burdensome states. Clearly there's something more at play here than merely the fear people will move out of California; California has demonstrated clearly they aren't terribly worried about the effects of higher taxation on emigration.
https://www.thebalance.com/u-s-federal-budget-breakdown-3305...
And that is only for old people, (very) poor people, and employees of the federal government.
Paying for every person's healthcare within a given jurisdiction would blow a massive hole in governments' budgets that I would bet even people willing to pay extra CA taxes would notice, which are currently probably only 10% to 15% extra compared to other locales. Granted this increase would be offset by not needing to pay insurance premiums or Medicare tax, but in turn, that would be offset by the additional deductible/copay expenses, plus people simply getting more healthcare because they no longer have to worry about the cost.
Note that Vermont tried and called it quits after a couple years for the same reasons:
https://en.wikipedia.org/wiki/Vermont_health_care_reform
For one more data point, I recall how much consternation the Affordable Care Act caused, and that one merely allowed poor people to access SOME part of healthcare. The outcry over increased health insurance premiums (a proxy for taxes) because people would now be paying to subsidize old people and sick people was and is massive.
The numbers don't bear this out. What we see is a bunch of anti-welfare state conservatives taking credit for poor people being gentrified out of desirable high-tax areas.
The magnitude of comprehensive healthcare expenses would make other state and local level expenses pale in comparison. Even Vermont called it quits after a couple years due to inability to sufficiently increase taxes:
https://en.wikipedia.org/wiki/Vermont_health_care_reform
California is in a better spot than Vermont, of course, but I would not gamble on it being that much more desirable than elsewhere that people with the ability to move would be willing to pay an easily double digit percentage increase in taxes.