A misguided question - and a good question - about single-payer health care.

[PETRUS]

As a whole, this is a complicated issue and I don't have the time (or expertise) to be thorough in one post, but I do want to make a couple of key points.

First, the misguided question: "How do we pay for it?" I've long since become accustomed to the fact that most people have a very limited (and often incorrect) understanding of macroeconomics. In spite of many prominent economics pointing this out repeatedly, a significant chunk of the population can't wrap their head around the reality that the Federal government's budget is nothing like a household budget or a firm's budget (or, for that matter, state and local budgets). The U.S. government issues its own fiat currency, borrows in that currency, and it presides over a large pool of labor and resources. That gives it significant fiscal space for any and all of its spending priorities. The only real constraint on Federal spending is the availability of resources. If the combined demands of the government and the private sector exceed the available resources, inflation will result. But if the resources are available, the government can spend as much as it wants without ill effects. While it makes sense to have a well-designed fiscal policy, the question of "how we pay for it" is far less crucial than most people seem to believe. Surely most readers of DU have noticed that questions about the availability of funds or the specific mechanisms for covering costs are never seriously entertained or cause for hesitation when the government wants to bomb foreign countries, bail out financial institutions, or give tax breaks to the rich.

That brings us to the "good" question: Are there enough hospitals, clinics, equipment, trained medical personnel, etc. to meet the health care needs of the entire population? This is a critical question (perhaps THE critical question) even if one's preferred route to universal health care relies on the private sector. Currently, I think the answer is quite possibly "no." In some areas (e.g. the number of M.D.s), the scarcity is artificial. We could expand the number of slots for residencies. We could also make sure that there are no financial (or other) barriers to a medical education for all of those with the inclination and ability. Additionally, if we put as much effort into designing a trade in medical services policy as we do into other trade deals (like NAFTA and the TPP), that would both increase capacity and bring down costs.

As a final note, although the Federal government has the ability to spend whatever it takes to purchase available goods and services, there are large economic rents in the medical sector. This is wasteful (and increases inequality), and decreasing or eliminating them would bring down costs. Among the culprits are the artificial scarcity of M.D.s (mentioned above), and the rents associated with pharmaceuticals and medical equipment (revising our intellectual property law and increasing public funding for medical research are approaches I would take). And of course there are significantly higher administrative costs (plus the profit imperative) associated with private health insurance vs. Medicare, Medicaid and the VA.

[MaryMagdaline]

1. Thank you for this post. I need education in this issue.

Seeing things as you do, whose medical plan(s) seem feasible to you?

[PETRUS]

12. Thanks for the reply.

Honestly, it's been a while since I've tried to slog through the text of any specific proposal (e.g. H.R. 676). I don't remember feeling completely clear on all of the details (I'm not a legislator or a lawyer). But I'm in favor of a single-payer solution.

[ismnotwasm]

2. Thank you

I’m not nearly as concerned about “how it will be paid for” as how it would be implemented.

[PETRUS]

13. This is your field, right? Can you help me with a question?

I've been led to believe there are any number of tasks/procedures that doctors reserve for themselves (by custom or law) that other people with medical training (nurses, physician's assistants, whatever) are perfectly capable of handling. Is this true or false?

[brush]

3. Thanks for the broader perspective and info.

[shadowmayor]

4. How do we pay for it?

Last edited Sun Jun 30, 2019, 05:36 PM - Edit history (1)

We already pay for it. We pay into a system of third-party profiteers who take money out of the doctor-patient equation in the form of insurance pools and profits extracted by those same insurers. Eliminate the profit part of the equation, and we all get better, cheaper, and universal health care. Most so-called socialized medical systems in other countries (especially western Europe) use insurance companies to manage the system. But, and this is the big but, the government exerts control over how they manage the system including not allowing the for profit idiocy that prevails in our "free market" nightmare that is the USA.

Health care is a fundamental right, and should be provided as a service, not a business in the general sense of the word.

And national health care system would be an enormous relief to small businesses, and many low, middle, and even upper middle-class Americans would find that they actually pay less at the end of the year. No premiums, no to extremely low deductibles, and no doctors turning a patient away because they have the wrong insurance plan.

To those who can't fathom this, thank our stupid "objective" BS media who refuse to discuss this topic honestly.

Either get on board or get out of the way, but if you choose to stand in front of this train, prepare to be soundly run over.

[area51]

5. "Are there enough hospitals...."

Likely not. Surely you're not suggesting that we wait until we have enough, while 123 people die per day, which is 45,000 dead per year due to lack of healthcare. We already have a doctor shortage, but we will have that with or without Medicare for All; that's no excuse to put off saving lives. PNHP has some good resources; as they're a physician group, they've given a lot of thought to this.

[PETRUS]

14. I totally agree with you.

Obviously, I failed to make my position clear in the O.P. My post wasn't meant to be a "why we can't do it" essay - it was written out of frustration with the nature of the conversation around this issue. I think we can and should treat healthcare as a public good/service.

[Voltaire2]

6. So in summary, we might not be able to provide eve

with healthcare so let’s just continue to let “those people” do without.

The uninsured still show up in the system, they show up when they are critically ill in the ER, have to be treated at everyone’s expense at grossly inflated ER rates, and become another facet of a stupendously broken healthcare system.

You might, for a while, have marginally longer wait times for non critical care as more people start using the system properly, but the increased demand for services will quickly be met with an increase in service providers.

[PETRUS]

15. No, that's not what I meant. But you're not the only person take it that way...

...so clearly my OP was lacking in that respect. Please see post #14.

[safeinOhio]

7. Follow the money

Heath care markets have been rigged for years. Here is a great article on the subject.

Since the early 1900s, medical special interests have been lobbying politicians to reduce competition. By the 1980s, the U.S. was restricting the supply of physicians, hospitals, insurance and pharmaceuticals, while subsidizing demand. Since then, the U.S. has been trying to control high costs by moving toward something perhaps best described by the House Budget Committee: “In too many areas of the economy — especially energy, housing, finance, and health care — free enterprise has given way to government control in “partnership” with a few large or politically well-connected companies” (Ryan 2012). The following are past major laws and other policies implemented by the Federal and state governments that have interfered with the health care marketplace (HHS 2013):

https://mises.org/wire/how-government-regulations-made-healthcare-so-expensive

[PETRUS]

19. Yep.

Although I'd personally refrain from citing mises.org for anything.

[planetc]

9. The "How do we pay for it?" question always annoys me, because ...

it seems to assume that we have to pay extra for single-payer health care. If we can't arrange it so we pay less for health care while getting better results, then we don't deserve any health care at all. Let us imagine a simple tax, withheld from our paychecks like FICA, and the addition of a tiny tax on the trades made by the gamblers on Wall St. Okay, these sources pay for the care. Meanwhile, no patient pays co-pays for services or drugs; no patient pays for drugs; no patient pays deductibles; and no one pays a share of employer-sponsored health coverage. Meanwhile, everyone who works for employers who used to sponsor coverage gets a raise, in approximately the amount previously diverted to private insurance companies. Also, the people benefiting from single-payer coverage will be: health care providers at all levels, as well as the population at large who will be able to go to the doctor if they're ill or injured, and pay nothing out of pocket. No one will declare bankruptcy because of medical bills. Prescription drug manufacturers will bargain with the US Health Service, who will not approve any drug if it hasn't been proved useful.

If you say there aren't enough primary care doctors to treat the entire population, I'll take your word for it. But it's a practical problem that can be dealt with by organizing and increasing the number of Nurse Practitioners, Physician Assistants, and primary care doctors. And by doing other things I haven't thought of. Right now, we have doctors, dentists, and nurses volunteering to run free clinics for the under-doctored. That would be a thing of the past. All medical personnel would work for pay, and send in bills to a single payer, who would pay the bills promptly. Everyone would be clear up front what services and treatments were allowed and approved, and doctors could get off their phone with insurers. Doctors would have one objective: to make people healthier, and patients would have one goal: to get healthy, without worrying about bankruptcy.

American ingenuity is not a myth. All we need is the will.

[PETRUS]

17. Actually, I don't know for sure if there are enough or not.

My point is merely that the real issue is capacity, not financing.

[JustThinking...]

10. Thanks for posting this

I've been having discussions about it all lately and what always comes through to me is your point about our fiat currency.

I believe can figure out how to supply the increased demand for medical care without much hassle.

I believe the only real problem is the one (false) kink that the profiteers keep throwing in the works about (warning; head-exploding panic trigger) "How Do We Pay For It????!!!"

Obviously a less costly system will cost less I can't see why the general public doen't get that but...

The real problem is that the public is being fooled by the current profiteers to think that we will be somehow paying MORE, individually, for the less expensive system.

As a last ditch effort, if we can't get the public to understand logic, we could cut the b.s. and just be honest with ourselves that we literally could simply write a government check for it, that could be cashed but never sent in for payment, as so many other projects are funded, the only loss would be to the already very wealthy insurance company shareholders.

Perhaps they can replace their yachts with new ones through a go fund me page.

[Turin_C3PO]

11. We got to do it.

Get everyone covered even if there’s not enough doctors. The alternative is worse which is people dying due to lack of funds/coverage.

[PETRUS]

16. I agree.

My only concern is that if people are unsatisfied with the short-term results, that could give ammunition to reactionary forces. But even so, I lean towards doing it and working out the details (and ramping up capacity) as we go forward.

[Turin_C3PO]

18. I see what you're saying.

Hopefully we can train more doctors and also relegate some tasks to Nurse Practitioners and Physicians Assistants.

[Hoyt]

21. That's one reason I think a Public Option is the best way to start.

At least with a PO, people will voluntarily select the Medicare buyin, rather than feeling like it was crammed down their throats, signicantly increasing complaints. Uninsured and poorer citizens would get subsidies for their buyin.

If people like the public cover, and it really is significantly cheaper, people will gravitate to it quickly. Then, when 30% or so are left in private plans, it will be easier to go straight to single payer if necessary.

In the meantime, we can wring out the financial abuses among providers.

In any event, everyone needs to be covered, even if it costs more and results in some delays for nonemergent care. There are ways to minimize wait times, including more use of virtual encounters.

BTW: Good OP.

[MaryMagdaline]

20. One of the arguments I keep having to battle against -

And I am ill-equipped to argue since my background in economics is weak - is “Obamacare is bad because our insurance went sky high.”
My first response was always “hasn’t it been going up your entire life?”
And second, when there’s no lifetime cap and we’re covering pre-existing conditions, isn’t that at least double the coverage we had before? If we are paying for a Cadillac vs a corolla, aren’t we going to pay more?

I support single payer but I wasn’t able to calculate whether bernie’s 2% payroll tax increase would cover it.

Today I was arguing with a trumper (also a medical doctor) complaining about having to pay 2500 per month in health insurance. I told her I would gladly pay that amount if there were no co-pays or deductibles and it came out of my income taxes. (She has a family of 4, I am single).

The problem is I just don’t have the mathematical facts at hand to state the case. I have a moral sense that government should find a way to do this, and I have good examples from many countries. I just don’t know how things could work in this country.

Those of you with strong medical and economic backgrounds should start a new topic in DU - Universal Healthcare to educate the rest of us.