Medicare for All

A New Government Report Shows Why Single Payer Would Be Really, Really Hard

Designing and implementing a government-run health plan would raise many difficult questions.

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In most ways, yesterday's Congressional Budget Office (CBO) report on single payer health care looks scrupulously neutral. It takes no position on the merits of single payer, which is often popularly referred to as Medicare for All. It does not estimate the costs or budgetary effects of the single payer plans proposed by liberal lawmakers like Sen. Bernie Sanders (I–Vt.) and Rep. Pramila Jayapal (D–Wash.).  

Instead, the CBO report acts as an introduction to the many questions that would need to be resolved in order for such a system to be put in place. It highlights the obstacles standing between where we are now and a single payer system, and the potential consequences—to both individual patients and taxpayers writ large—of the various tradeoffs required to get there.  

By simply raising these questions, the CBO report serves as a sober and practical guide to single payer skepticism.

The report portrays any potential move to single payer health care—in which the federal government would run a national health plan that acts as the primary financier of most health care services in the country—as a huge and difficult undertaking. "The transition toward a single payer system could be complicated, challenging, and potentially disruptive," it says, before laying out several of the major decisions that would have to be made, such as the speed at which individuals would be expected to move to the new government-run plan (a recent plan backed by Democrats in the House called for a two-year transition), and what to do about job losses in the health insurance industry.

The transition process, however, is not the primary focus of the report, most of which is devoted to laying out the various policy considerations and specific choices that would be involved in designing a single payer system. These questions can seem wonky and bureaucratic. But what the report drives home is that the dry, wonky stuff would have significant effects on the quality, value, and availability of care that patients could expect to receive. 

For example, what would happen when the expansion of health coverage inevitably increased the demand for health care? More people with insurance would invariably mean more people trying to access medical services, posing a challenge to the system. "Whether the supply of providers would be adequate to meet the greater demand would depend on various components of the system, such as provider payment rates," the report says. "If the number of providers was not sufficient to meet demand, patients might face increased wait times and reduced access to care."

Single payer plans like the one proposed by Bernie Sanders typically assume that the new system would pay something like today's Medicare rates, which are often quite a bit lower than those paid by private coverage. So the delivery infrastructure, from hospitals to doctors offices to emergency rooms, would face a dual shock—lower rates to providers on the one hand, greater demand on the other—that would likely result in longer waits for care. That's hardly surprising, given that long wait times are a frequent complaint in countries like Canada, which has single payer, and Britain, which runs a fully socialized health care system.

Moving to a single payer system would also risk depriving patients of choice and individual customization. Compared with today's arrangement, "the benefits provided by the public plan might not address the needs of some people," and a "public plan might not be as quick to meet patients' needs, such as covering new treatments."

Questions about what is covered, and how much the government pays for particular products and services, would, in a government-run, taxpayer-financed system, inevitably become political, which is to say politicized, decisions: "A single payer system would also need a way to decide which new treatments and technologies it would cover."   

These decisions would necessarily become political decisions in part because they would have implications for the program's overall cost. Covering more services would be more expensive; covering fewer would place limits on the types of care people receive.

Policymakers might respond by, say, requiring no cost sharing for some types of treatments deemed better values, while requiring patients to contribute out of pocket for others. But that, in itself, is a judgment call, and would have consequences of its own, pushing people into one type of care that bureaucrats and politicians view as preferable. Or, as CBO puts it, "because some judgment would be required to determine the value of services, some of those determinations would be imperfect, and the use of value-based insurance design would increase the administrative complexity and costs of the single payer system." No doubt the lobbying surrounding these judgments would be intense, as health providers jockeyed for bureaucratic favoritism. 

Cost, of course, would be a major point of contention for any single payer system, and the Medicare for All plans have so far largely avoided the question, issuing lists of "pay-fors" without specifying exactly how (or if) the enormous price tag would be offset. Multiple estimates have put the additional cost to the government at around $32 trillion, which would require more than doubling federal corporate and individual taxes to pay for. Single payer advocates tend to argue that this actually represents a savings, since although government spending would increase, total national spending on health care would be somewhat lower.

But CBO's report casts doubt on whether those savings would actually occur. "Total national health care spending under a single payer system might be higher or lower than under the current system," it says, "depending on the key features of the new system, such as the services covered, the provider payment rates, and patient cost-sharing requirements." Some of the ideas favored by single payer supporters, like negotiating for prescription drugs, might not pay off, because in a nationwide system, it would be difficult for policymakers to refuse to cover certain drugs. "It is uncertain whether the single payer plan could use the threat of excluding certain drugs from the formulary as a negotiating strategy," the report says. "It is also unclear whether a single payer system could withstand the political pressure that might result from excluding some drugs. By contrast, private insurers can threaten to exclude drugs from their formularies and can follow through on that threat." Without competition from private plans, drugmakers might have the upper hand in negotiations.

Other countries with single payer systems allow for private health insurance that works alongside or on top of the government-run plan. Yet the high-profile plans from lawmakers like Sanders and Jayapal would virtually wipe out private health insurance in the space of just a few years.

The CBO report offers an overview of numerous other, often technical questions, from who owns hospitals to what sort of payment scheme—global budgets? Fee for service? Capitated payments?—would be used to pay providers. It lays out, in some detail, what international single payer systems cover, and what they don't, highlighting the various trade-offs they entail, few if any of which are part of Bernie Sanders' Medicare for All plan. Certainly, these trade-offs are not part of the way he advertises it.

What the CBO report shows, in other words, is that designing and implementing a single payer health care system would be enormously difficult as both a pragmatic and political matter. It's a warning, in a way, about the scale, scope, and likely consequences of the challenge.

If anything, the report, which at just 34 pages is more of an overview than a deep dive, probably understates the challenge. But it asks many of the right questions, and in doing so, makes clear that there are no easy answers.

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  1. I like the lady with the sign. Live it. Improve it.

    What’s she’s missing is pay for it.

    1. “What’s she’s missing is pay for it.”

      Tax the rich. There are 585 billionaires in the US. Just tax them $55 billion each and it’s paid for.

      1. And she will throw that sign in the trash when they tell her they will raise her taxes.

        Universal health care has been proposed in NYS every year since 1992 (I think). A couple of years ago it finally passed the lower house but was left for dead because they figured out that piece of legislation would cost as much as the entire NYS budget. The Senate never voted on it. Now that dems control both houses in NYS, there is talk that it will pass the Senate. Rumor has it that Cuomo will veto it if passed.

      2. Being a billionaire means you have a net worth(value of total assets – debts, not annual income) of at least $1 billion.
        Probably less than 10% of those 585 billionaires have networth’s over $55 Billion.

        So now you’ve taxed the vast majority of the super-rich into the poorhouse and you’ve collected barely enough to fund the program for 1 year. How do you plan to fund the program next year?

        1. He’s being sarcastic. Here’s a more detailed answer you are free to copy.

          I added up the Forbes 400 on 30 Jan 2019. It came to $2.891T. Not even three trillion dollars, not even one year of the Federal budget, or three years’ deficit, even if you could confiscate all of it.

          And if you did confiscate all of it, it’s not Scrooge McDuck swimming pools full of gold and jewelry, or even cash, or sitting in bank accounts. It’s assets: things, property, not-cash. Investments mostly: stocks and bonds; some mansions, yachts, biz jets, Ferraris, and other toys. But all of it has to be sold to become the cash you can use to pay down the national debt or even eliminate the budget debt for a measly three years. $3T is peanuts and won’t even put a dent in all the single-payer schemes.

          You couldn’t convert it to cash anyway. You’d have to sell it, and the only people who could buy it, couldn’t, because all their wealth has been confiscated.

          You couldn’t nibble at it either with Lizzie Warren’s 2% or 5% wealth tax, or Bernie Sanders’ 77% inheritance tax. Not only does the basic problem remain, that it is not cash but assets which have to be sold, but the value isn’t even known until you sell it, so you’d just be guessing what your stolen 2% or 5% or 77% is. With so many more sellers than buyers, the values would be depressed and you’d get pennies on the dollar, if you managed to sell much at all; everyone with the wealth to afford buying it would be scrambling to sell their own assets to pay their own wealth tax.

          1. If you are forced to sell off assets to pay the government , do you care what you get for them? And what happens to the stock market if the estates have to sell off their stock? I believe what would happen is you see a flood of money leaving the country into foreign trusts.

          2. This is what gets me about the whole “TAX THE RICH!” screaming party. Tell me, where do the rich hide their money? For you lefties, they “hide” it in INVESTMENTS, many of which are the exact same investments that YOU make with your retirement savings. Where do you think THEIR money is doing the most good for us ALL: being used by the (what used to be) free marketplace, or essentially being BURNED by the government?

        2. “Probably less than 10% of those 585 billionaires have networth’s over $55 Billion.”

          Less than 1% of those 585 billionaires have net worth’s over $55 Billion. Five actually.

          “How do you plan to fund the program next year?”

          By taxing the 14,814,453 millionaires in the United States $2,160,053 each.
          .

      3. Here’s a better idea.
        Tax all the liberals and proggies who want Medicare for All.
        This way the liberals and proggies won’t look like a bunch of hypocrites who just want to spend other people’s money.

        1. If America’s accomplished, modern communities were no longer asked to subsidize the depleted human residue in our emptying-out, can’t-keep-up rural and southern communities, that might be enough to pay for the strong communities’ universal healthcare.

          1. Is this the parody Rev or the real one?

            1. I’m not sure there’s a difference. The Rev is OBL without the humor.

          2. Arty thinks himself President Snow in the Hunger Games. The reality is that people like him continue to breathe as long as people like us tolerate him.

          3. Strong communities like the open where they poop on the street? What about the ones with the highest poverty level (Cough CA).

            Ooo I know it’s the one with all the murders and mayor who writes childrens books.

        2. I have a really awesome idea. Take all the progressive pols and their backers, round them up, and summarily execute all of them in a decisive act of will. Then tell the rest of the progs to shut up or GTFO.

          Problem solved.

    2. It would be especially disruptive to the crony-capitalist triumvirate, the AMA (doctors’ labor union), the insurance companies (parasitical paper pushers and looters), and the legislatures that approve every bill that the previous two propose in return for some kind of consideration. There should be a free market in health care or regulation as a public utility, instead of the medical “care” cartel.

    3. Where, OH PLEASE: WHERE is the government department that doesn’t WASTE MONEY? And you think THIS will be any different?

      1. The biggest waster of money in the government is the DOD and we have no problem giving them money. I think we can reprogram some of that money for healthcare.

  2. Deconstructed Potato feels intense disgust and revulsion at his father’s impossibly loud, and perpetual intestinal gurglings and rumblings. Deconstructed Potato knows, as always, that his father is just brewing another batch of frothy explosive diarrhea with which to spatter up the back of the toilet seat and noxious gasses to waft through DP’s house.

    I seriously cannot stand to be in the same building as my father let alone the same room. It’s horrible and he doesn’t acknowledge it at all. I have no sympathy for the man who used to wake me up for school every morning with a crescendo of the loudest and most violent sharts I have ever had the misfortune of hearing and smelling. Recently his guts have started making VERY loud noises all the time, I mean so loud you might have to ask him to repeat what he said, and at a much louder volume than you could possibly imagine such noises would ever occur. I know he had some gall bladder surgery a couple of years back on his commiecare. Seriously he is banned from here until he consults a fucking intestinal specialist to sort his guts out.

    I’m inhuman and cruel.

    1. I wish you the best. Maybe the government can fix his guts. Yeah, probly not.

  3. Single payer is bad because it requires the government to initiate force. The word health doesn’t even appear in the Constitution.

    1. It could be covered under “promote the general welfare” if you stretch that as much as “provided for a common defense” has been stretched.

      FYI, I’m opposed to Medicare for All.

      1. we should start a pool, will the mental gymnastics to validate the constitutional authority for federal takeover of health care rely on ‘general welfare’ or ‘commerce among the several states’?

        i got a fiver on the latter

        1. I would not take that bet.

      2. To me, ‘promote the general welfare’ means that I get to fuck Jennifer Lawrence, so send some marshals to her house and bring her to me.

        1. To me, ‘promote the general welfare’ means the government gives me, for free, a nice ranch home. One of those mid 50s ranch homes that were well made, with a garage, a patio, and a pool. And a sweet ride, like a 1966 Corvette.

        2. No, *I* get to fuck Jennifer Lawrence. You get to watch. That’s your welfare.

          You’re welcome.

          1. No, *I* get to fuck Jennifer Lawrence. You get to watch. That’s your welfare.
            ——
            Can I take pictures and sell them on pornhub?

            1. You guys could always spitroast her.

        3. Since it’s taxpayer money, I’ll take seconds.

    2. ‘Interstate compact’ is the mechanism by which a ton of these sorts of issues shuld be addressed. It is constitutional. ANYTHING on which states themselves want to come up with some way of working together is required to be done thru interstate compact since states are not allowed to cooperate on their own.

      FEMA and Education are direct govtl responsibilities of states – who have expressed interest in cooperating on those issues – that SHOULD be managed thru an interstate compact rather than a federal agency.

      Likewise, retirement and health and disability are things that travel with citizens and can end up creating an impact to the states. but better to manage that thru an interstate compact – even if it takes taxes or money-printing – rather than in DC by federales.

    3. They already initiate force, in case you haven’t noticed. Free market or public utility.

  4. Does Bernie look like he is filling up his prototype Federal adult diaper?

  5. Greater demand for a service is a good thing and should help lower the cost of the service. Is health care a business? Is selling a service a burden? Presumably the industry would hire more employees to meet the new demand. Americans already spend more than anyone on health care. The insurance company under the ACA are almost superfluous anyway considering they must cover preexisting conditions.

    1. LOL ! Funny stuff.
      Are you doing the health care while OBL does borders?

    2. Whether you mean “should” as “probably” or “ought to”, you are economically illiterate. Greater demand raises prices. It is greater supply which lowers prices. Medicare’s lower prices will increase demand and decrease supply just as rent and wage controls do.

      “Presumably they will hire to meet the increased demand” assumes there is a willing supply of labor at the decreased wage dictated by the decreased revenue dictated by the decreased payout. Econ 101 says you assume wrongly.

      1. Walmart is able to offer the lowest prices because they sell the greatest volume. The insurance industry is the fat. You don’t need them especially now that there’s more scheming by only insuring the healthy and throwing the sick into the public system. What does the insurance company do exactly now that they can’t pick and choose who and what they cover? The answer is the you pay the cost so they can maintain a profit.

        1. “no” more scheming

        2. “Walmart is able to offer the lowest prices because they sell the greatest volume. ”

          Nope.

          1. Yes. Having lots of customers is an integral part of Walmart’s system.

            1. No. Your statement “Walmart is able to offer the lowest prices because they sell the greatest volume. ” is demonstrably factually wrong.

              The prices they offer are not a result of selling anything, but buying in bulk.

              Selling is a corollary to that, but your statement is incorrect in totality.

              1. You are partially correct, but not completely.

                Part of their low prices is that by having high sale volumes, they can maintain high profits in absolute $$ while having a lower markup (per item profit margin) on the items they sell.

                So it’s part bulk purchasing, part lower markups and partly the size of their stores.

                As to the size of their stores, a store half the size of a Walmart couldn’t match Walmart’s prices because the don’t have the physical capacity to handle the necessary volumes on both purchasing and sales,

                1. Most of the Walmart genius is (or at least was) in the most efficient process of distribution the world had ever seen on that scale. From the manufacturer to the store shelf, nobody did it cheaper.

            2. They have lots of customers because they offer lower prices, not the other way around.

              1. He’s an idiot who doesn’t understand the actual relationships in play.

                1. Supply and demand means if the demand increases, the supply automatically increases more. That looks like what OP is saying.

                  1. The AMA enforces barriers to entry. The insurance companies and legislatures are cool with that.

        3. The mistake is that we are not talking about free market capitalism here. We are talking about a government run system with no competition. So basic laws of supply and demand do not apply.

          ACA partly works because while the government has set certain conditions and pays subsidy there is still some competition between insurance companies who must then negotiate with the provider to determine what they will pay for individual services. The doctor or hospital are free to opt in or out which they do. If the insurance company cannot get enough on board nobody will choose the plan.

          So it ain’t Walmart.

          1. Huzzah!

        4. Walmart is able to offer the lowest prices because they sell the greatest volume.

          That doesn’t tell the whole story.

          Walmart is able to offer the lowest prices because it buys in great volume (which is the actual thing, but since they’re ability to do that is driven by the fact that they sell in such great volume, your point, while economically illiterate, is not illegitimate).

          What you are missing is that Walmart does offer the lowest prices because it is incentivized to do so by competition.

          Remove Walmart’s competition and grant it a monopoly and do you think they’ll still offer lower prices?

          1. “Walmart is able to offer the lowest prices because it buys in great volume (which is the actual thing, but since they’re ability to do that is driven by the fact that they sell in such great volume”

            There is a third factor involved, physical plant. You can only move so many customers through a store of a given size in any given amount of time. So the number and size of physical retail locations will limit the potential sales volume. A boutique retail shop with a single small location would go broke trying to match the Walmart strategy.

            1. There is a third factor involved, physical plant.

              That, too. But OP’s main mistake is the Marxist one that sees price as being a function of cost rather than a function of market. Eliminating the market doesn’t make price = cost. It makes price = whatever the vendor wants it to be.

              To extend OP’s analogy, Medicare-for-All would be Walmart-level service at boutique-level prices.

              1. You would also have to factor in Walmart level wages.

        5. Walmart is able to offer the lowest prices because they sell the greatest volume.
          Which is great when I’m shopping at Wal-Mart. In health care “greater volume” means more patients per doctor, more patients per rehab therapist, more patients per MRI machine. So you get 10 minute office visits with your physician instead of 20, one rehab session per day instead of two, and you wait a week instead of a day for an MRI scan.

          The insurance industry is the fat.
          Ask any physician’s bookkeeper whether they spend more time complying with insurance or government. Then ask your insurance guy what percentage of time spent on insurance requirements is mandated by government regulations.
          Almost all of the increased insurance premiums that resulted from implementing the ACA were the result of less expensive plans being cancelled because, even if customers were completely satisfied with them, they didn’t meet the ACA’s bloated government requirements.

          1. Almost all of the increased insurance premiums that resulted from implementing the ACA were the result of less expensive plans being cancelled because, even if customers were completely satisfied with them, they didn’t meet the ACA’s bloated government requirements.

            ^ This.

        6. The govt.. isn’t Walmart. They aren’t efficient, and are generally incompetent. The system you want to expand, Medicare, has at least 20% of it’s gross expenditures paid out to fraud. This is according to the CBO. Multiplying this system will only make it worse, and more inefficient and byzantine than it already is.

        7. Trudat.

      2. The current Medicare system is flat out unsustainable as it is. Furthermore it being subsidized by private sector insurance because hospitals and other providers charge private pay patients more to make up for what they are losing on Medicare low reimbursement rates.

        Also Medicare does not pay 100% of the charges for those enrolled in it. That’s why people have to pay for Medicare Supplemental insurance and Part D drug insurance or a Medicare Advantage plan.

        1. That’s the funny thing. Our current Medicare system which doesn’t pay all, nor covers all, is unsustainable.

          Yeah, let’s go big on that.

          1. We’ll make up the losses on volume.

            1. Look: if we increase supply, demand will rise; and when demand rises, prices will fall; and when prices fall, supply will rise. Thus, the cycle moves forward.

              C’mon, it’s all so simple and logically consistent!

    3. Oh, goody! One of our resident econ-ignoramuses here to make an ass of himself!
      Ordinary Person
      May.2.2019 at 3:02 pm
      “Greater demand for a service is a good thing and should help lower the cost of the service.”
      Exactly backwards: Greater supply lowers prices, greater demand raises them.

      “Is health care a business? Is selling a service a burden?”
      WIH is this supposed to mean?

      “Presumably the industry would hire more employees to meet the new demand.”
      So long as there is money to pay for them; probably means higher costs.

      “Americans already spend more than anyone on health care.”
      Non-sequitur

      “The insurance company under the ACA are almost superfluous anyway considering they must cover preexisting conditions.”
      Just bullshit.
      Bzzzt,. You lose!

    4. You do realize most doctors would retire or not go into the field. Medicare pays crap. A lot of doctors work long hours. Why would they if they aren’t reimbursed.

      It’s not a business like Walmart. You need special training. Yes, nurses, medical assistants etc help. But you will still need doctors and right now a lot hate medicare payments

  6. The task is made somewhat simpler by the fact that the people designing the system, being nomenklatura, won’t have to live under it, and so don’t really care if it’s a disaster.

    1. Gov’t employees should have to deal with the same system as us proles. The problem would be sorted out in a jiffy.

    2. Why in he11 do we elect these people and let them get away with this? Where in the he11 is the fourth estate when we NEED THEM?

  7. Medicare for All?
    More like Bankruptcy for All.

    1. There is good reason to believe Americans would spend less and get more care under a cooperative self-insurance plan. It’s the same idea of a credit union cutting out the bank except all Americans are the members of this cooperative and our buying power should reduce cost. Everyone would have insurance and your premium would be determined by the income you earn.

      1. So you’re gonna cut out the middle man and insert an even more inefficient and disinterested middle man, and expect things to get better and cheaper.

        1. We already have universal coverage. That’s the irony of it. You can buy insurance twice a year. It’s a right. The insurance company can’t charge you more or less than they charge the next guy. We’re there already. Now it’s just a manner of ridding ourselves of an industry that primarily made it’s more by picking and choosing their customers.

          1. By cutting out the middleman with an even more inefficient and disinterested middleman.

            Just say yes when you mean yes.

            1. By all means keep your favorite insurance company. Keep paying them to do what exactly? What service are they providing?

              1. What service are they providing?

                They used to provide a service known as “Risk Management.” They are no longer allowed to. Now their service is simply paying whatever medical bills you choose to run up.

                In that context, yes – they are pointless, and they’re going to stop participating in that before too long (many already have).

              2. The govt.. isn’t Walmart. They aren’t efficient, and are generally incompetent. The system you want to expand, Medicare, has at least 20% of it’s gross expenditures paid out to fraud. This is according to the CBO. Multiplying this system will only make it worse, and more inefficient and byzantine than it already is.

                1. CORRECT!

        2. What middleman is being cut out? You are still going to need to process claims, unless you think it will be a system where the doctors salaries are paid directly by the government. You are still going to need administrators to make sure everything is working and compliant with the law.

          1. So they wouldn’t be insurance companies they’ll be administer claims companies.

            1. Assumingly also working for the government which has much more fringe benefits that your average jobs.

              How are you saving money again?

              1. I have decided those who think the government can do anything cheap or efficient have never worked for the government and especially, have never served in the military. Considering how many times I showed up at the armory at 0400 hrs and the armorer didn’t start issuing weapons until 0700 hrs, or all the times I spent unloading, inventorying and reloading the conex for our ICU (just to do it again a month later) because they didn’t have anything better for us to do, you would understand why I really don’t want the government in charge of my health care. (Also considering how many times my medical records got lost).

                1. The govt. loses money on everything they do. Post Office, Amtrak, and even the Amtrak food service of which they have a monopoly. Even that loses money.

                  These people are incompetent, just like our congress. I liked things a lot better when I could still buy decent health insurance at a reasonable cost. Now I can’t. I have three options, and they’re all hugely expensive with shitty coverage.

                  If they ever pass single payer it will be time to overthrow the idiots and execute all the progs.

        3. Taiwan manages to take care of everyone at a very reasonable cost. Of course the doctors in Taiwan actually care about helping people. American MDs only care about their investment portfolios.

          1. Of no! American Doctors don’t care. Why isn’t this on the news!

      2. There is good reason to believe Americans would spend less and get more care under a cooperative self-insurance plan.

        Too bad the ACA outlawed those.

        our buying power should reduce cost

        Not if you only have one provider it won’t.

        I think everyone agrees that insurance companies play too much of a role in healthcare delivery. The government has only aggravated that, and the ACA has made it worse than ever.

        You know how you get back to things like co-op insurance programs and more affordable coverage? Deregulate the insurance market.

        What you are advocating is the opposite of what will get you what you say you want.

        1. Tell that to the Christian self insurance group that advertises on brainwash crybaby whine all day, every day rightwing radio. If you buy into their plan they’ll cover your wife’s cancer treatment. Fingers crossed.

          1. Looked into that. It actually IS pretty good, but my employer wouldn’t agree to paying me the money he currently pays the insurance company if I switched, says it would reduce the plan size too much.

            1. I believe you. Those God fearing people live forever.

              1. It’s weird – those Christian medical co-ops do exactly what you say you want (as noted above by square and brett). I know someone who has benefitted from being a member.
                But because it is a rival faith (the cross vs Capitol hill), you belittle it.
                This only goes to show that you are NOT at all interested in real solutions to healthcare problems, but rather that you simply want more people to be subjugated to your faith.

              2. OP is a bigot. Big shock. Then again, I’ve never met a progressive who was really a decent person when you got down to it, or had any real integrity. Just soulless garbage people.

          2. What in Sam Hell are you talking about and in what way does it respond to what I just said?

            1. I did respond to your belief that the ACA outlawed cooperative self insurance by telling you about a commericial on crybaby radio for something that seems like cooperative self insurance.

              I can’t argue with you on the other part. I believe everyone should be covered and that means doing away with the scheming. Under deregulation no one would insure people with preexisting conditions. The companies would plans that no one would use. That’s the scheming part.

              1. something that seems like cooperative self insurance.

                I guess as long as it seems that way. Did you get the larger part about the government having narrowed your range of insurance options? That the market would gladly offer what you want if it were allowed to?

                Under deregulation no one would insure people with preexisting conditions.

                No one does now, either. That’s not what insurance is. I can’t come to you and say “I want to pay you $4k a year to mitigate the risk of me getting the cancer that I have right now.” That’s just me asking you to pay for the cancer treatments I know I need.

                If the government took its filthy mitts off the insurance market, you could get whatever personally-tailored plan you wanted, and you wouldn’t have to change insurers every time you changed employers.

                1. Maybe most people would pay cash if pharmacists could prescribe, like most other countries. In the USSA that’s crazy talk.

              2. “”I believe everyone should be covered and that means doing away with the scheming””

                Wrong, you just want government in charge of the scheming.

                What good is having everyone covered when you end up rationing health care. Insurance is not health care.

        2. Actually insurance started as a co -op in a way. Someone from Baylor in Texas went to a group of teachers and said “ how about you pay us a monthly fee and that will cover all of your cost at our clinics and hospital” That became Blue Cross.

          1. Actually insurance started as a co -op in a way.

            ^ This. Cooperatively collectivizing risk is what insurance is.

        3. Huzzah!

      3. Why stop with health insurance? Why not price everything determined by income (and give everyone incentive not to have an income)? You commie shit.

  8. Really hard? If only there were a successful country that had implemented universal healthcare to demonstrate it could be done. Or dozens of countries.

    The word for universal healthcare is likely ‘inevitable.’ Republicans had their chance to devise and implement something else. They have failed miserably. As usual, progress will be effecting over their whimpering objections.

    1. So name them. Name the countries, so we can laugh at how pitiably stupid you are and how little you understand economics.

      1. Cuba. I bet he says Cuba.

        1. The fact that he didn’t name them in his original post means he is aware of the flaws in his argument, and is trying to avoid addressing them honestly, choosing instead to vaguely suggest at successful countries allows him to do this.

          1. Kirk isn’t to be taken seriously.

          2. The fact that he didn’t name them in his original post means he is aware of the flaws in his argument

            You’re giving him way too much credit.

      2. Several developed nations have all their citizens (or close enough) covered, and not all of them are “single-payer” or socialized medicine. I’m not saying we can copy their systems or that all of them are great, but France, Germany, Japan, Norway, and Switzerland are all examples – with different approaches, that have excellent health care quality and essentially universal coverage – and the spend less per capita than the USA.

        1. They also don’t have millions of fat people who eat garbage, don’t exercise and then expect pills or surgery to enable them to continue their terrible lifestyle.

          1. That is a problem. If we’re giving anything away we should at least condition it on people taking better care and meeting certain…. and we’re fascist Germany now but seriously isn’t that what Republicans do. They tell people on Medicaid to work or job train as a condition for the receipt of the benefit.

            1. If your kid goes to public school you have get them immunized and clothe them. It’s “free” education with shitloads of conditions. I would love to save money on clothing and send junior to school naked but I gave up that freedom when I took the freebie.

              1. It’s “free” education with shitloads of conditions.

                Except that it’s not free. You pay for it through property taxes. I understand they act like it’s free and that they’re providing you some kind of charitable service that you have no right to complain about, but that’s actually not true.

                1. And it isn’t compulsory. I can homeschool my kids or (if I could afford it) send them to private school. The Democrats want to ban private insurance and give me no choices.

            2. we’re fascist Germany now but seriously isn’t that what Republicans do

              Setting aside the idiocy of this comment, are you now advocating for Republican-German-Style Fascism? Because I get the impression from other things you’ve said that you don’t exactly approve of Republicans.

              Did you change your mind?

              1. Just playing around with ideas. I honestly think cutting out insurance companies is good business and will lower costs and help maintain equitable compensation for care providers by reducing inefficiencies.

                1. I honestly think cutting out insurance companies is good business and will lower costs.

                  And I honestly said most would agree with you. The current regulatory regime in this country is very much counter to this.

                  Further, what you are proposing is not “cutting out insurance companies.” What you are proposing is creating an insurance monopoly that will closely resemble public utility monopolies.

                  In other words, what you are proposing is not the elimination of insurance – it’s the creation of a single, all-encompassing insurance monopoly that will set prices and dictate the terms of care.

                  As I said elsewhere, what you say you want and your proposed method of getting there are in direct conflict. What will produce what you want is deregulating both insurance and healthcare. That way you and your healthcare provider can structure the risk management any way you choose rather than only in the small set of ways approved by the monopoly.

                  And nothing you have proposed has anything to do with “scheming,” unless you’re proposing that your regime would come with a law outlawing scheming by politicians. But how effective do you suppose that would be?

                2. “I honestly think”

                  Everything you said after ‘I’ was total bullshit.

        2. France, Germany, Japan, Norway, and Switzerland are all examples

          Of which the very largest (Japan) has less than half of the US’ population in less than 1/20th the space, with the next largest (Germany) having less than a quarter the US’ population with roughly the same amount of space as Japan. And all of these countries’ defense is heavily subsidized by the US, which really helps out their budget situations and causes troubles for ours.

          Note that there is no EU-wide healthcare system, for a lot of reasons.

          If such a thing could happen in this country it would (and could only) happen at the state level, and it would need to come with a message to the rest of the world they all need to start handling their own defense. Not that I’m opposed to that, but it would be a pre-condition to any sort of national healthcare system in the US.

          1. “and it would need to come with a message to the rest of the world they all need to start handling their own defense.”

            Actually, that wouldn’t help much. Medicare, Medicade, CHIPS and the ACA subsidies and other federal government health insurance programs already take up 26% of the total federal budget. The DOD budget and all the defense related foreign aid is a mere 15% of the budget.

            We already have doctors who won’t take new Medicare/Medicade patients due to the low reimbursement rates with a large percentage of our current supply of doctors being within just a few years of being able to retire (with full SS). And you think we can expand those programs into a single payer system for a fraction of the DOD’s budget?

            1. And you think we can expand those programs into a single payer system for a fraction of the DOD’s budget?

              No. Especially not as a simple Medicare expansion, which is idiotic. My point is more that Europe’s ability to do this has at least something to do with our subsidization of their military (in addition to their collecting taxes at rates that would cause revolution in this country) rather than that we could do it if only we cut ours. Some states maybe could, but many couldn’t.

              And my main point is even more simple: comparing Switzerland or Japan to the US is not an apples-to-apples comparison.

              1. our subsidization of their military

                This is the silliest whiniest permababble. They all pay less for healthcare than we do. A lot less. So what if they pay for it via taxes where we pay for it via premiums/etc. It gets paid for — and they pay LESS than we do. Let me repeat. A LOT less.

                They are not able to pay more for that because we subsidize their military – because in fact they do not pay more for healthcare. They pay LESS. You want me to repeat that so the logic sinks in?

        3. The middle class in those countries pays shitload of taxes to support that system.

        4. Maybe but they also have a uniform cultures. (and smaller populations)

      3. I am reluctant to conduct basic research for right-wingers — how are they to learn if always able to rely on the efforts of others? — but here is a head start: Norway, Finland, Switzerland, Sweden.

        Carry on, clingers. But only so far and so long as your betters permit.

        1. You’re about an hour behind in this discussion, Rev. Do try to keep up.

        2. Rev. Arthur L. Kirkland
          May.2.2019 at 5:38 pm
          “I am reluctant to conduct basic research for right-wingers…”

          But not at all reluctant to make an ass of yourself, you bigot.

          1. If I ever met this guy and he ran his mouth the way he writes here, I’m not sure I couldn’t resist breaking his neck.

            1. I think you would feel to sad for him. I mean he acts tough on the computer but you can tell he’s a sniveling little child hiding in a basement (Or straightjacket somewhere).

              I think you would realize your fist to punch him and realize that would be doing him a favor.

        3. Sure, that could work in the US. After you cull all the diverse people out and make the US as mono-cultural (and mono-colored) (and dedicated to work) as your examples.

        4. Arthur L. Hicklib reveals his white supremacism by promoting the healthcare systems of super-majority white countries.

        5. “” but here is a head start: Norway, Finland, Switzerland, Sweden.””

          Your examples lack diversity.

      4. Taiwan, for one.

    2. “If only there were a successful country that had implemented universal healthcare to demonstrate it could be done. Or dozens of countries.”

      The thing y’all always ignore – always – is the level of taxation that will be required to pay for it. “We’ll just tax the rich” you say. Bullshit. To pay for universal healthcare you’ll have to tax EVERYBODY. In Sweden, just to pick one, the 50% tax bracket kicks in at a little above $50k US. Try to raise taxes to that level here and see what happens to the popularity of your plan…….

      1. “”Try to raise taxes to that level here and see what happens to the popularity of your plan…….””

        We already know. In the polls, support drops dramatically when you ask about paying for it.

      2. Sweden spends 11% of their GDP on healthcare, we spend 18%. No one else comes close. I’m not advocating single payer by any means, but this is an inconvenient statistic for people saying single payer is unaffordable.

        1. “Sweden spends 11% of their GDP on healthcare, we spend 18%.”

          But are the coverages the same and the usages the same? The comparison isn’t good when it comes to GB and Canada, for example, because they don’t cover as much and there are loooooooog waits for specialists, etc.

          And regardless of your statistic, I don’t think that people here are going to be happy to push people making $55k into the 50% marginal tax bracket. If one of the political parties tries to do that, they’ll get a couple of generations in the wilderness to contemplate their stupidity. Which is why the advocates of single payer never say how they intend to pay. Because basically, they don’t intend to do so.

          1. And, judging by my personal experience within the industry, people on the dole (Medicaid) see doctors and other providers much, much more frequently than people on private insurance plans (or even Medicare, but I’m less sure of that).
            Some because they’re sicker, some because they have nothing else to do and have made a routine social function of it (they live to go to the doctor).

            1. judging by my personal experience within the industry, people on the dole (Medicaid) see doctors and other providers much, much more frequently than people on private insurance plans

              Well that’s just bullshit. Medicaid folks go to the emergency room a lot more than the private insured do (0.6 visits/yr v 0.2/yr) but that is precisely because they CAN’T go to the doctor instead (1.5/yr v 4/yr). We have a massive shortage of GP’s – who have entirely disappeared from large parts of the US and often don’t accept Medicaid anyway – and the waiting list for an appointment is 7-25 days even for non-Medicaid. Most countries set 4 days max as the target for that cuz GP access (in an office or clinic or even an ‘urgent care’ type clinic which usually aren’t in the poorer neighborhoods) saves tons of money from being spent on the specialist/expensive side.

              1. A shortage of GPs? Wait u til they try this bullshit for real. You will see a mass exodus of doctors that is unprecedented.

                1. That GP shortage dates from 1910. That’s when the ‘Flexner Report’ commissioned by Carnegie/Rockefeller opined that what they/US really needed was world-class specialists working in high-tech hospitals – not ‘family doctors’. Med schools immediately started training doctors like that cuz that’s what the donor class wanted – and the med schools that didn’t do that were forced to close. Took decades for the composition of doctors to really change a lot – but once employer/govt insurance was written to subsidize specialists and force GP’s to treat their patients like hamsters, it embedded that problem in stone.

                  govt is def part of the problem here – but mostly cuz they have simply adopted ‘insurance’ that copies employer-style fee-for-service insurance. Everywhere else once govt started being a last-resort payer, they also forced a rethink on training doctors so that capacity meets the needs of regular folks rather than the donor class.

              2. In Taiwan, you can be seen in a matter of hours, minutes if you’re in serious pain. Prescriptions are included, at a cost of about $US 30 per month and a co-pay of 6 to 25 bucks per visit, depending on the hospital or clinic.

              3. I scheduled for these people, jfree. Got a pretty good idea of their habits. Some were able to travel over 300 miles for cancer treatments to one of the nation’s premier hospitals. That’s great. Others traveled hundreds of miles to visit their infants. That’s ok, not great. But most had regular trips to GPs, therapists, pain management, etc etc. Some made their way from ER to ER trying to con rides home.
                Youd be surprised at the amount of medical care Medicaid people receive. It’s not as low level as you believe. Doesn’t mean its necessarily good, but it’s definitely abundant.

    3. There is no such thing as true “universal healthcare” anywhere. No one in this country calls the public school and police force “universal” government service for obvious reasons. And no single payer system funds itself only through taxation of the very wealthy.

      I guarantee you that most people in single payer systems are deeply dissatisfied with it. I read Korean comics and mangas and it’s common to see characters fretting over hospital bills. The liberals in this country exist in some alternate universe where healthcare abroad is like some free candy store and that’s the basis for their policy.

      If you pay 5 bucks for gallon and gas and pay taxes everywhere, cheap MRI and free prescription drugs is the least the government can do for you. You’re still stuck with medical bills for anything that’s not covered by the government. Hospitals can kick you out all the time outside of America.

      Medicare for all is going to screw the seniors big time, and under Prez Bernie’s generous amnesty program the caravan will receive free healthcare before they put in a dime into the economy. But when millions of young immigrants work full time at Mcdonalds, our entitlement system will be safe! Even though they’ll take in 3 times what they put in!

      1. I guarantee you that most people in single payer systems are deeply dissatisfied with it.

        You are dead wrong. I’ve lived in those countries and I know a ton of people who have lived in both.

        For any healthy person not in the 1%, other systems are FAR FAR cheaper and that’s the only thing that counts for the healthy.

        For the 1%ers, they can (and will) get their medical care cheaper somewhere else if cheap’s what they want – guaranteed. deVos will pay $50k to get his heart transplant from the NHS in the UK even tho drs in the US say he’s too old to be on waiting list here. They’ll fly to Singapore to get their bypass or tummy tuck and combine it with a vacation/rehab – and still save money.

        For the 90% of ‘regular sick’ (regular meaning actuarially predictable in a group of x peeps), they’ll have the same results everywhere in the developed world

        Which leaves only the elective surgery types (who always want someone else to pay) and the ‘unusual sick’ (who can get caught in bureaucracy – here too if they can’t get insurer to pay for Mayo/tertiary).

    4. Rev. Arthur L. Kirkland
      May.2.2019 at 3:47 pm
      “If only there were a successful country that had implemented universal healthcare to demonstrate it could be done.”

      Yep, there are none.
      Fuck off, bigoted asshole.

  9. Single payer sends a great message to people thinking about being a doctor or in med school now:

    “Keep busting your butts and racking up enormous med school debts, because you’ll emerge to a market that will want you to work even harder and will pay you only half of what you need to earn a living and pay your loans.”

    1. Exactly, you’ll be able to make much more being a “have you been injured in an accident” guy than you will a surgeon. Law school is easy compared to medical school too.

      1. Nope. Can’t agree with that.

  10. Our multi-tiered present system – a combination of employer-provided coverage, Medicare, Medicaid, Tri-care, and the individual insurance market (and total private pay) – will spend about the same $32 trillion in the next ten years. One key thing that the “Medicare-for-all” people like Bernie want us to believe is that employers (a huge part of the insurance puzzle) will give employees raises since the companies will no longer have health insurance expenses. Then, of course, those “raises” will be taxed away to pay for government health insurance. To say that the transition would be disruptive is an understatement. Bernie’s plan is deeply flawed, but so is our present system, and I wish Libertarians and conservatives would get serious and offer some REAL reform ideas.

    1. Bernie’s plan is deeply flawed, but so is our present system, and I wish Libertarians and conservatives would get serious and offer some REAL reform ideas.

      We have. I think what you meant to say was

      Bernie’s plan is deeply flawed, but so is our present system, and I wish Libertarians and conservatives would get serious and offer some REAL reform ideas that left-wingers want to hear.

      1. I’ll let you decide if the following points are left or right leaning:

        Employer-provided health insurance has enjoyed a tax code quirk since around WWII. Employers get a tax deduction for the cost of providing health insurance as part of employee compensation, while employees have zero tax liability for that part of their compensation. Employees have little or no choice on the type of health plan their employers offer. Those plans usually had very low deductibles until recent years, but costs are so high now that co-pays and deductibles are increasing. Employer provided health insurance has covered workers with pre-existing conditions for decades, due primarily to regulation. Basic take aways on employer-provided health insurance (the biggest piece of the insurance puzzle besides Medicare): consumers shielded from most free market incentives for health care and insurance, while the costs are tax subsidized. Oh – and until the ACA, the individual insurance market would routinely deny coverage for people that they HAD to cover when part of an employer plan.

        Medicare is essentially a single-payer hybrid that for seniors age 65 and over is very popular – they like it. The program is running out of money, but it’s been suggested a minor increase in payroll tax can fix the financing problem. Perhaps that is foolish thinking.

        When Libertarians push to have their tax-subsidized health insurance taken away (are you listening – Cato Institute?) and let each individual fend for themselves on the individual health insurance market – and let the insurance companies go back to the pre-ACA regulations – then I’ll take their reform ideas seriously.

    2. I wish Libertarians and conservatives would get serious and offer some REAL reform ideas.

      Here’s a REAL reform idea for you. Fuck off, slaver.

      The pimple on your ass that you ignored and is now a boil is not society’s problem. Why should your cancer or heart disease or diabetes be society’s problem. The only fair reform is to take responsibility for yourself or rely on (private) charity. I have extensive experience with private charity, and you have to be pretty much a complete asshat to get denied. The world could use a few less asshats.

      1. “The world could use a few less asshats.”

        Unfortunately, the US (and global) supply of asshats will continue to greatly exceed demand for the foreseeable future.

        1. But on the up side, prices will remain low.

    3. “”will spend about the same $32 trillion in the next ten years.””

      I think it’s more than that. I don’t believe the 3.2 trillion a year accounts for grant money that props up FQHCs and CHCs.

    4. In Taiwan, it’s a subsidy to businesses who don’t have to deal with the paperwork, and allows greater labor mobility because the Taiwanese, and residents here, don’t have to worry about losing their insurance. Motor vehicle insurance is cheaper, too, because everyone’s medical care is already taken care of, regardless of who’s at fault. In many/most situations it would be cheaper to fly here and pay cash than to deal with the bullshit in America.

  11. Of course it would be hard. Because INSURANCE AIN’T THE PROBLEM. To wit:

    More people with insurance would invariably mean more people trying to access medical services, posing a challenge to the system.

    This is just silly. People don’t go to the doctor solely because they have insurance (second opinions and overdiagnosis/testing and elective stuff is a different matter). They go to the doctor because they are sick. If they aren’t currently going to the doctor then what it means is that our system currently rations care to the sick on the basis of price. Since doctors are highly compensated, that means anyone who earns less than a doctor is going to have to self-ration their access much as they would retaining a lawyer or even maybe a plumber.

    ‘Insurance’ is nothing more than finding some group of healthy people who will subsidize other people who are sick. And there ain’t no way that will or can ever work in a purely market-based system cuz it requires anti-self-interest by ‘customers’, anti-profit-seeking (no cherry picking and they pay claims according to contract) by insurers, and dishonesty by everyone as to the outcome. The next pol who is elected on a platform of ‘let them die’ (re those who won’t be able afford unsubsidized access in a market system) rather than shuffling them off to govt will be the first pol so elected.

    1. ‘Insurance’ is nothing more than finding some group of healthy people who will subsidize other people who are sick.

      No – it’s people mitigating their own personal risk by paying into a pool with others knowing that the downside risk may never manifest. I.e. “Risk Management.”

      1. No it isn’t. Health insurers themselves don’t assume any serious risk. If you have individual coverage and get diagnosed with cancer, they are only on the hook for the appointments/treatment that you will incur in the window until the next annual enrollment. Where they will then either jack up the rates or dump you and you are now uninsurable with pre-existing condition. For the employer market, they mainly act as claims administrators – and it is the employer who incurs the risk but that’s very different cuz employers don’t actually get diagnosed with cancer.

        EVERYONE who works for an employer who provides health insurance is a total idiot on the subject. But they are idiots who vote which is why pols propose idiotic solutions that have nothing to do with solving any actual problem.

        1. It seems like you’re talking about this peculiar institution that operates in this country currently that we refer to under misnomer “health insurance.” In that case, I agree.

          In the traditional insurance model, it’s not the insurer who is taking risks. The insurer is insuring against risks. You are taking the risk, and you are turning to the insurer to mitigate that risk.

          The existing situation that you describe is one that is largely government-created.

          1. The existing situation that you describe is one that is largely government-created.

            Cool. So your solution is the usual libertarian crap and we can click our heels three times, say ‘there’s no place like home’, and we’ll be in libertopia. Or maybe Somalia. Our problem is too much govt. Those countries (like EVERY OTHER FUCKING COUNTRY OUTSIDE AFRICA) where govt has a bigger role than it does here but have solved the simplest problems of ACCESS are just deluded. Just click our heels.

            1. So your solution is the usual libertarian crap and we can click our heels three times, say ‘there’s no place like home’, and we’ll be in libertopia. Or maybe Somalia.

              I didn’t propose a Solution. And neither did you.

              But thanks for the Somalia thing, I haven’t heard that one in a while.

              My actual point, should you care to address it, is that what you are complaining about is not properly insurance. It’s a government-created clusterfuck that we refer to using that same set of syllables.

              My apologies if the thought triggers you.

              1. +1 golf clap

              2. +1

            2. From what I’ve read of the British and Canadian system, they haven’t solved access. In fact they have longer wait times for almost everything.

              1. In fact they have longer wait times for almost everything.

                Well those happen to be the two worst systems imo.

                But even then. They have MUCH longer wait times for some common orthopaedic (knee/hip replacement), opthalmic (cataracts), and plastic (necessary reconstruction). Why would you be upset that those aren’t front-of-the-line to be paid for in a taxpayer system? Those countries agree – and as long as private can exist (or allow people to get on a plane to Singapore and get a new knee for less than half of what it costs in the US) what’s the problem if rationing-by-queue results in greatly reduced costs (read taxes) cuz capacity itself can be managed better?

                For true life-depends-on-it emergencies, there’s no real difference in any developed country – but much lower costs elsewhere cuz those other systems aren’t pure supply-side driven by specialists. For ‘regular doctors’ access, most countries are far better than the US (maybe not Canada – but UK yes) and that’s the important access for Pareto purposes – 80% of people for 80% of their life.

                It doesn’t require govt intervention/mgmt. And I think our govt would clusterfuck it all. But laissez-faire doesn’t work for healthcare either and even Hayek wrote about that rationally.

                1. JFree
                  May.2.2019 at 10:17 pm
                  “For true life-depends-on-it emergencies, there’s no real difference in any developed country – but much lower costs elsewhere cuz those other systems aren’t pure supply-side driven by specialists. ”
                  Lie.

                  “For ‘regular doctors’ access, most countries are far better than the US (maybe not Canada – but UK yes)”
                  Lie.

                2. On average treatment for cancer is delayed by months in both Britain and Canada, compared to the US. These delays lead to higher mortality and lower rates of remissions. Time does matter in treating cancer. So even in life and death situations they have delays.
                  Also, if you were in need of a knew replacement, it is because the pain is so bad that there is no alternative. This increased pain can result in higher incidents of hypertension, stroke and cardiac disease. So while you classify these as unnecessary, they actual do severely impact people’s health. They also severely impact their quality of life.

                  1. And if it is necessary reconstructive surgery, then that also can severely impact their lives and worsen both morbidity and mortality. Sure, anyone walking into an ER with an AMI or GSW I should hope has the same wait time as the US. But that is a stupid comparison.

                    1. “.Sure, anyone walking into an ER with an AMI or GSW I should hope has the same wait time as the US. But that is a stupid comparison.”

                      I like that because it cuts right to the laparotomy the surgeon will never get paid for in the night. All that went into it before is not even thought of in trauma bay.

                      So what do you want America?

        2. JFree
          May.2.2019 at 5:52 pm
          “No it isn’t.”

          Yes it is. Now fuck off and quite pestering the adults.

    2. “what it means is that our system currently rations care to the sick on the basis of price.”

      Nope.

      It’s only rationing when government force is involved.

      If one person can afford to buy a new car and another cannot that does not mean the former was “rationed” a car and the latter was not.

      1. All scarce resources are rationed – one way or the other.

        If you are too delusional to accept the use of that word to describe the reality of it, then that is your problem not mine.

        1. “If you are too delusional to accept the use of that word to describe the reality of it, then that is your problem not mine.”

          In other words, you cannot refute what I said.

          As usual.

  12. Going to the doctor is almost a pastime for certain people, particularly those advanced in age who (i) have little to do and (ii) are increasingly paranoid of their mortality.

    Even if you believe that one has some fundamental right to health care (citation?), Sanders’ proposal does little to address health care costs, which have been and remain the larger problem.

    As other commentators have mentioned, the political proponents of the bill are almost dead anyway, or otherwise would be exempt. For the laypeople, the rich will be able to do whatever they want as always, leaving the “entitlement class” who won’t pay for anything to primarily benefit and the rest to suffer. It is not a serious proposal to maximize health outcomes, rather an excuse to grow the government for its own sake.

    1. Correct, t

  13. It does not estimate the costs or budgetary effects of the single payer plans proposed by liberal communist lawmakers like Sen. Bernie Sanders (I–Vt.) and Rep. Pramila Jayapal (D–Wash.).

    FTFY

    Calling B.S, a liberal is an insult to the English language. It is time we rectify that situation.

  14. I am old enough to remember when Medicare For All, f/k/a Single Payer, was called “socialized medicine.”

    A turd by any other name still stinks.

  15. In the big picture, the problem with single payer is that a progressive Democrat would implement it, and progressive Democrats are idiots, as are the people who work for them.

  16. Vermont tried it, it failed and they have a relatively healthy population.

  17. Medicare for All?

    They can count me out.
    They can kiss my ass.
    I would refuse to comply.

    1. There will always be malcontents, some belligerent.

      Our society generally has handled them. At Ruby Ridge, for example.

      1. At Ruby Ridge, for example.

        I thought you were against guns.

      2. Rev. Arthur L. Kirkland

        Fukc off poser. You’re as much a Rev as I am the Queen of Sheba.

      3. Rev. Arthur L. Kirkland
        May.2.2019 at 5:41 pm
        “There will always be malcontents, some belligerent.”

        And you’re here to prove it, you bigoted asshole.

      4. At Ruby Ridge where they killed a woman holding a baby and a 14 yo boy (in the back as he was running away) and dog? Then the government ended losing the case against Randy Weaver and in fact ended up having to pay him millions of dollars and the FBI sniper was charged with manslaughter but only escaped prosecution on a technicality? Where the DOJ OPR ruled the second killing as unconstitutional? And a US Marshal was killed? That is your example you want to use?

        1. It would figure the Rev chooses as an example of how the government fucked up big time and ended up achieving none of it’s goals as an example of how the government deals with malcontents.

        2. Mr. Weaver fought society and the law. I doubt he considered himself to be a winner. LaVoy Finnicum was another belligerent malcontent. America handled him. People can whine and rant about universal healthcare but it is coming to America, in part because conservatives have been ineffectual in this contest. Those who refuse to comply after enactment will lose.

          I hope universal healthcare is called Obamacare. We probably should have named Social Security for FDR, too.

          1. Rev. Arthur L. Kirkland
            May.2.2019 at 11:05 pm
            “Mr. Weaver fought society and the law. I doubt he considered himself to be a winner….”
            He fought nothing of the sort, you pathetic piece of shit. His family was gunned down by trigger happy asshole who are supported by pathetic pieces of shit like you.
            YOU are, by extension a murderer. Do you understand that? YOU ARE A MURDERER.
            Fuck off.

            1. So the Rev supports shooting women while they hold their baby in their arms.

              *Pelosi clap*

          2. You really don’t know anything about Ruby Ridge do you? You just pulled it out of your ass and when called out you made yourself look even stupider by doubling down. Randy Weaver was entrapped (the courts ruled so) by the Federal Government to force him to infiltrate the Aryan Nation’s compound; this was such a huge threat (sarc), only 25 people in a county with a population of about 100,000, a fair percentage of who lived on an Indian Reservation (where I grew up). At no point did he fight the government, in fact the government later concluded they had been in the wrong from the get go. No he didn’t win anything, but he also didn’t pick the fight. The Federal Government broke the law to take down 25 idiots living on a compound in North Idaho. We never even saw them except when they had their stupid rally (which the media made a big deal out of, and tried to imply that the residents supported it despite the fact that the city of Coeur d’Alene tried banning it and lost in court). And even then, more people showed up as counter-protestors than to attend the rally. The rest of the time the hid on their compound because they knew how much people hated their fucking guys. But the government was convinced they had to be stopped. So they entrapped a man, killed his son (shot him in the back) and his wife, and wounded him and his best friend. And the government still never closed down the fucking compound. Also, Weaver was never a member of the Aryan Nation’s. So, you now admit you support Gestapo like tactics? And the slaying of innocent women and children?

            1. Arthur L. Hicklib doesn’t know much about anything.

      5. And at Kent State. Should be an American holiday.

  18. Single payer would be really, really wrong.
    Financially, morally.
    “Hard” shouldn’t even enter into the discussion.

  19. To supporters of socialized medicine.

    Under this plan, in which everything is free,
    Can a man get his penis enlarged for free?
    And
    Can a woman get her bosoms enlarged for free?

    Asking for the newly weds next door.

  20. What the CBO report shows, in other words, is that designing and implementing a single payer health care system would be enormously difficult as both a pragmatic and political matter.

    The socialist calculation debate is so 20th century.

  21. If they ever get medicare for every one it will be medicaid for every one and long wait to go along with it. There would no longer be anyone in the states that would be come a doctor to practice here, So in the long run we the US may well have to depend upon Cuba to send doctors here.
    I hate to say it but if the democrats get it passed and it becomes law that may be the least we will have to worry about though.

    1. No, it will be time to overthrow the de coral aprty and get rid of them. I’m sure there are millions of people here who would have no problem with Rev. War 2.0 if the alternative is an authoritarian socialist/Marxist regime.

      If this happens, the progtards will only have themselves to blame. The fact of the matter is that my individual rights are infinitely more valuable than their lives if they wish to enslave me.

  22. Fact is there is excellent medicine and research from what we might call socialist countries all of them high on the wealth scale. The euro countries, Scandinavia, Israel, Canada, Japan, England.

    The US is still a major world leader.

    I do not understand the angst. Wealthy countries have better health care and more advances. China is getting there.

    Each differs in social political financing. That is good because the US is not Switzerland nor Israel.

    Bernie does not get it. Grow the economy by capitalism then people will have the money to invest in payment for disease.

    1. People from China who can afford it come to Taiwan for surgery.

  23. As I have said before, we should offer a grand bargain to the commies:

    We can have guaranteed healthcare for anybody who wants to via a Medicare buy in thing… The price is total deregulation of the remaining free market, as if there is always the AMAZING government option, there’s no reason to burden the private sector right?

    This would make the healthcare industry so much cheaper and more efficient, nobody would bother to buy into the shitty government plan except total fucking losers, who would be covered anyway. Everybody wins. THE END.

  24. Another thing nobody takes into account is that a US single-payer system would be almost 5X larger than any other in the world, and comprised of individual states that are far more autonomous and varying than any other developed country.

    It wouldn’t be like Germany or Canada’s single payer system. It would be like if the entire EU had one single payer system.

    It would make more sense for each state to have its own system, if they wanted to try. After all, even our smallest state, Wyoming, is almost twice the size of Iceland.

    1. I agree that looking at some other health care systems in developed countries does not mean we could successfully copy their systems, for several reasons – such as the fact that those countries are smaller (as you mentioned), are culturally cohesive, have smaller (relatively) military budgets, different tort systems ( less malpractice litigation), their doctors don’t have the high medical school debt, etc.

      By the way, Germany does not have a single-payer system. Germany has 124 competing statutory health insurance companies, in a national exchange and it’s funded primarily with an employer/employee earmarked income and payroll tax. Around 11% of Germans opt out of that system and buy substitute coverage. There are also supplemental insurance plans in Germany for those wanting upgrades (like private hospital rooms).

  25. This article is pretty much pointing out the obvious. You know what else is difficult? Our current health system. If we were starting from scratch and evaluating different health systems they would pint out how in our current health system there are fewer waiting lines because poor people don’t bother showing up. You can see your doctor because there are no poor people in line ahead of you.

    And how convenient is it now to know that if you break your leg while on vacation and out-of-network you will be taking the most expensive vacation of your life? Thinking about switching jobs now or retiring and taking on a part-time job? Forget about it. Cling to your crappy job until you can get Medicare. Yeah, that’s freedom for you.

    Of course a transition would be tough. We don’t need the CBO to tell us this. What makes it extremely tough is that the GOP will fight it every single step of the way and throw all kinds of wrenches into it to ensure that it fails. That’s the cynical truth.

    1. But the fact is that there will be sacrifices, and instead of a system where half the country gets the best care in the world and half barely gets any, we will have one where 90% of the population gets kind of mediocre care. Is that worth it? Possibly. That is the debate that needs to be had, though. Democrats will never ever in any way acknowledge any trade offs or downsides to a single payer system, which there are many. They will never tell the millions of people with fantastic health insurance that their quality of care will go down. They will never say that a switch to single payer would require many doctors being paid far less.

      And once again, are these things worth it? That’s up for debate. Let’s not pretend the Democrats are any more honest or serious about fixing the problem than the Republicans though.

  26. Single Payer?

    Medical insurance no longer exists. So-called healthcare plans replaced them. There is no free market in medical delivery (“aka/”healthcare”, a term that essentially did not exist until the 1980s). Accordingly, the role of government becomes an issue.

    So, what to do? A plan based upon personal opinion? A plan based upon abstract ideology?

    How about a plan based upon Science — the Science of Human Behavior — a plan designed by a physician — a plan nominated for two national awards by the insurance-industry? One exists.

    For a description, visit …
    https://www.nationonfire.com/healthcare-reform/ .

  27. At least Bernie has a plan. Current Republican plan is don’t get sick if you can not afford health care. I prefer the Affordable Care Act but if Republican sink that then I am in for Medicare for All. We need a national health care program. So to Mr. Suderman I say come up with a plan, support the ACA or get out of the way.

  28. […] an undertaking. The CBO report is “a sober and practical guide to single-payer skepticism,” wrote  Reason’s Peter […]

  29. […] A New Government Report Shows Why Single Payer Would Be Really, Really Hard Peter Suderman, Reason […]

  30. […] has he answered numerous other practical, necessary questions that designing and implementing single payer would entail: How exactly would health care providers […]

  31. […] has he answered numerous other practical, necessary questions that designing and implementing single payer would entail: How exactly would health care providers […]

  32. […] has he answered numerous other practical, necessary questions that designing and implementing single payer would entail: How exactly would health care providers […]

  33. […] has he answered numerous other practical, necessary questions that designing and implementing single payer would entail: How exactly would health care providers […]

  34. […] a year (the current federal budget is $4.4 trillion). Medicare for All is also expensive—around $32 trillion over 10 years—and it’s not immediately clear how Yang would pay for all this. His campaign website talks […]

  35. […] a year (the current federal budget is $4.4 trillion). Medicare for All is also expensive—around $32 trillion over 10 years—and it’s not immediately clear how Yang would pay for all this. His campaign website […]

  36. […] a year (the current federal budget is $4.4 trillion). Medicare for All is also expensive—around $32 trillion over 10 years—and it’s not immediately clear how Yang would pay for all this. His campaign website talks […]

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