Free Minds & Free Markets

3 Reasons 'Medicare for All' Is a Really Bad Idea

It will cost way too much, increase wait times, and slow down the development of new drugs.

Bill Clark/CQ Roll Call/NewscomBill Clark/CQ Roll Call/Newscom"Medicare for All" is, arguably, the rallying cry for progressive Democrats these days. Health care costs were a major issue in the midterm elections and the best way to fix everything once and for all, say progs, is to give all Americans the same sort of coverage given to those of us who are 65 and over. What's not to like about Medicare, say proponents. Seniors love it and it's a proven form a single-payer health care.

Er, no, says a concise and persuasive op-ed in The Wall Street Journal, by Scott W. Atlas of the Hoover Institution. For starters, there is the cost problem:

For California alone, single-payer health care would cost about $400 billion a year—more than twice the state's annual budget. Nationwide "Medicare for all" would cost more than $32 trillion over its first decade. Doubling federal income and corporate taxes wouldn't be enough to pay for it. No doubt, that cost would be used to justify further restrictions on health-care access.

In 2017, Eric Boehm noted at Reason that a single-payer bill passed by New York's state assembly would cost $173 billion annually (the state generates about $71 billion a year in revenue). Even when you factor in savings from people not having to pay insurance premiums and co-payments, there's just no way to raise the revenue on such plans. In 2014, Boehm writes, Vermont had to throw in the towel because it "would have required an extra $2.5 billion annually, almost double the state's current budget, and would have required an 11.5 percent payroll tax increase and a 9 percent income tax increase."

But cost isn't the only problem. Atlas writes that in Great Britain, "a record 4.2 million patients were on England's [National Health Service] waiting lists." And there's this:

In Canada last year, the median wait time between seeing a general practitioner and following up with a specialist was 10.2 weeks, while the wait between seeing a doctor and beginning treatment was about five months. According to a Fraser Institute study, the average Canadian waits three months to see an ophthalmologist, four months for an orthopedist and five months for a neurosurgeon.

In contrast, wait lists are not a major concern in the United States.

Finally, there's also the development of new drugs. Atlas writes:

Single-payer systems also impose long delays before debuting the newest drugs for cancer and other serious diseases. A 2011 Health Affairs study showed that the Food and Drug Administration approved 32 new cancer drugs in the decade after 2000, while the European Medicines Agency approved 26. All 23 drugs approved by both Europe and the U.S. were available to American patients first. Two-thirds of the 45 "novel" drugs in 2015 were approved in the U.S. before any other country.

Most proponents of Medicare for All say they don't want to fully nationalize health care, as Canada has done. Instead, they want to guarantee a basic, accessible, free (or near-free) system. Atlas has an answer for that, too: "America's poor and middle class would suffer the most from a turn to single-payer, because only they would be unable to circumvent the system." In fact, he warns that,

the nations most experienced with single-payer systems are moving toward private provision. Sweden has increased its spending on private care for the elderly by 50% in the past decade, abolished its government's monopoly over pharmacies, and made other reforms. Last year alone, the British government spent more than $1 billion on care from private and other non-NHS providers, according to the Financial Times. Patients using single-payer care in Denmark can now choose a private hospital or a hospital outside the country if their wait time exceeds one month.

Read the whole article here.

Our health care system is definitely screwed up, but that's because we refuse to let markets function with the same sort of effectiveness they do in other parts of the economy. There are ways to take care of people who have pre-existing conditions that don't end up causing costs for everyone to go berserk. We can speed up drug trials without compromising safety, and we also need to rethink how we certify and license doctors, nurses, and everyone else who provides some dimension of health care.

Given the way the Republicans refused to take health-care policy seriously in the wake of Obamacare's passage, it seems unlikely that we'll be moving toward market-friendly solutions any time soon. That's a damn shame and if we do end up with Medicare for All, the bill will be almost incalculable in terms of more than taxes.

Related video (from 2012): Meet Keith Smith, a doctor in Oklahoma who brought market forces to bear on the delivery of surgery.

Photo Credit: Bill Clark/CQ Roll Call/Newscom

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  • Fist of Etiquette||

    There's always death panels.

  • Rat on a train||

    Followed by death squads?

  • loveconstitution1789||


    The death squads will lead the charge.

  • Liberty Lover||

    And there always has been. It was called major medical limits. My ex worked for a major health insurance company. I remember her coming home many times upset some kid had hit their major medical limit and was sent home to die. This was true often when transplants became available. The money had all been used, so the kid was sent home to die, when they could have had the transplant and survived, but the money was gone and it was too late.

  • Liberty Lover||

    And there always has been. It was called major medical limits. My ex worked for a major health insurance company. I remember her coming home many times upset some kid had hit their major medical limit and was sent home to die. This was true often when transplants became available. The money had all been used, so the kid was sent home to die, when they could have had the transplant and survived, but the money was gone and it was too late.

  • Juice||

    Do they mean single payer that pays 100% of all medical bills? Because that's not Medicare (the US version).

  • Juice||

    Single-payer systems also impose long delays before debuting the newest drugs for cancer and other serious diseases.

    Thankfully in the US it takes a mere 5 - 10 years. Like the blink of a gnat's eye.

  • DesigNate||

    How fucked up is it that even with those lag times, we still get stuff to market faster.

  • Juice||

    I think it's because in other places the incentives aren't there for the pharma companies. They're not anticipating being able to charge $150,000 for a cancer treatment so they don't take as many shots on goal.

  • JesseAz||

    Medicare for all proponents can never answer a simple hypothetical. How much should government spend to keep someone alive for 6 months longer. They can't answer because it leads to a conversation on rationing. They know they can't have a real logical discussion since their arguments are built on beds of emotion.

  • Sebastian Cremmington||

    That is why the group market is so important—it gives Medicare benchmarks based on a free market. So liberals always point to our costs versus Europe which is the product of the free market dictating we allocate more resources to health care.

  • Rat on a train||

    It depends. Is the someone a stranger, a friend, a relative or me?

  • sarcasmic||

    They can't answer because it leads to a conversation on rationing.

    It depends. Is the someone a stranger, a friend, a relative or me?

    There will always be rationing. There is rationing now. It's based upon ability to pay.

    The left wants rationing to be based upon politics and nepotism.

  • JFree||

    I'm not Medicare for all proponent but it is all sides in the US who cannot discuss rationing/death. 'Death panel' was not thrown out as a call for honest discussion. It was thrown out there to pretend that we don't currently have rationing in the US. We do. And it's done by insurance companies and doctors and nursing homes. And despite that nearly 50% of total medical spending in the US is spent in the last 2 years of life.

    Some countries actually do a very good job of rationing spending by providing BETTER healthcare near the end. Denmark has roughly the same number of geriatricians as the US with 1/50th of the peeps. That is considered the main GP for those elderly who have more than one condition (which is most of them). Unlike specialists, they can/do talk about the reality of longer recovery times and the ways in which aggressive treatment can make life miserable. Unlike relatives, they can talk about end-of-life decisions, bucket list and medical priorities that make that happen. NL and CH do it well too.

    The result is much healthier imo. Realistic attitude leads to far less aggressive curative/heroic treatment but more 'enabling' treatment. Much less spending overall for those peeps - and they are able to die at home (50-70% there) rather than in hospital (75% here).

    Unfort their solution can't work here cuz nothing can work here cuz we can't talk about it.

  • Bubba Jones||

    Because we file in the us first and then in the EU.

  • DajjaI||

    It will be medicare for bullies - great for the people who can sit home all day badgering the local doctors offices to see them and their kids for unnecessary medical tests and fake diagnoses like addiction, autism, anxiety, depression, and PTSD. And everyone else has to pay for it. Basically everyone will be hospitalized requiring round-the-clock medical checks and I'll be the only one left working and if I question why you are disabled everyone will cry "Murderer!"

  • Thomas O.||

    If the medical lobby would allow for it, I'm all for automated diagnosis machines or diagnosis-by-phone-app. Pay $20, step in a fully-enclosed kiosk (or hook a special instrument up to your smartphone), hold a small camera or pulse monitor wherever the machine tells you, and if you need medication, it spits out a valid prescription.

    If we can't have regular 24-hour fully-staffed clinics, this would be a good way to reduce the patient load at emergency rooms (thus reducing the ridiculous hospital costs). If someone shows up at the emergency ward at 2 AM with just the sniffles, they can be directed to the nearby rows of Sympt-O-Matic machines, and if they're poor, they may be given a special code to enter for a free/reduced-cost session.

  • ThomasD||

    Explain to me how these "diagnosis machines' or phone apps do their magic?

    Your real name isn't Elisabeth Holmes is it?

    Are your machines sold in the same aisle as the replicators from the Enterprise?

  • ThomasD||

    And which way to the Holodeck?

  • ThomasD||

    but thanks for pointing out the major problem with these discussions.

    Too many people pulling things entirely out of their asses.

  • Echospinner||

    What you are talking about is already being done although not in the way you describe

    Telemedicine is a big growth area as is AI in medicine

    Just read about a new product with FDA approval. It is a program to help radiologists. The program scans CT images as they are acquired to look for major abnormalities. It flags those to the top of the list for the radiologist, who may be physically anywhere, to read next.

  • jerbigge||

    The AMA would strongly protest against the idea since like any group of professionals, their incomes are actually higher than what they'd be in a free market health care system. Just eliminate prescription laws (drug laws too) and let everyone decide for themselves...

  • DesigNate||

    Healthcare is different! It's the only sector of the economy that can't respond to markets. Except for Education. And Housing.

  • Trigger Warning||

    There has got to be a medium between a $200,000 bill for spine surgery, and single payer.

  • loveconstitution1789||

    Catastrophic insurance for major medical needs and paying cash for minor medical needs.

  • sarcasmic||

    That is basically what millions have been forced into since Obamacare. The only policies my employer offers now have deductibles in the thousands. Thing is, they cost about the same as the old policies that actually paid for stuff. So you're not saving any money. You just have the added cost of contributing to the HSA.

  • JWatts||

    No, you're ignoring the contributions to Obamacare. There's a 2% tax on medical insurance now and there's probably more in implicit subsidies going to support it.

  • Curmudgeon44||

    There is a 3.8% extra tax on investment income when one has income over $250K. I thought that was part of Obamacare too.

    And doesn't the 1.45% tax for Medicare apply to ALL income, whereas it used to end with the Social Security upper income limit?

    A penny here, a penny there, it adds up.

  • buybuydandavis||

    Insurance that is actually insurance instead of a tax to pay all medical costs?

    Perish the thought.

  • TuIpa||


  • sarcasmic||

    Imagine what mechanics would charge for an oil change if it was covered by car insurance. You don't care. You're not paying for it. As long as you pay your insurance premiums the insurance company doesn't care. Well, they do, but less than you. Why wouldn't it cost $100? $200? It is essential for keeping your vehicle running. Only a highly trained professional should be allowed to do it. There must be licensing and special training to do this important procedure on your vehicle. Let's make it $500.

    That's why spine surgery costs $200,000. Third party payer system.

  • TuIpa||

    That doesn't answer my question.

    His statement was "There has got to be a medium between a $200,000 bill for spine surgery, and single payer."

    You response doesn't answer why there has to be a medium.

  • sarcasmic||

    My response was answering why there isn't a medium.

  • Trigger Warning||

    To answer you, Tulpa: I guess there doesn't necessarily need to be. But there should be, because it only costs what it does for the reasons sarcasmic mentioned.

    The people who go through the 15 years of education and training to be spine surgeons don't necessarily do it for the paycheck. You don't even know how hard it is to get there. Money is not enough motivation.

    So, the pricing is skewed upwards due to third-party payers, regulation, and generally fuckery.

    I would like for physicians to be able to own and operate hospitals, and for health insurance to be more like actual insurance.

  • TuIpa||

    Oh and by the way, that thing you do where you answer a question you didn't understand by giving people information they already know like you did there is suuuuuuper lame.

  • sarcasmic||

    By the way, not everyone out there is super intelligent like you. Some of the readers may not have been born with your superior intellect. So without hot women fawning over them they may miss some basic points.

    My comment was for the dummies on the sidelines.

  • CE||

    the medium ground between the free market and single payer is why spine surgery costs 200K. it would be like 20K in a free market.

  • JeremyR||

    Waiting lists always get brought up, but the only reason we don't have waiting lists is that people can't get on a list to begin with.

  • Rat on a train||

    Or the VA discards the waiting list to clear the backlog.

  • buybuydandavis||

    "Clear the backlog" is a great euphemism for waiting vets out until they die.

  • CE||

    the waiting list is forever right now

  • JFree||

    We do have waiting lists. We just don't talk about them.

    Waiting times have increased by 50% since 2014

    Avg is now 29 days to see a GP - from 8 days in Minneapolis to 109 days in Boston
    Avg 26 days to see an ObGyn - from 12 days in LA and Minneapolis to 51 days in Philadelphia
    Avg 21 days to see a cardiologist - from 12 days in Dallas to 32 days in Portland

    We have much shorter waits for surgery and specialists. Lots of folks making lots of money with that so no lines. But even the 8 days for GP's in Minneapolis would be unacceptable in most countries. 8 days just to see a doctor?? No wonder people end up going to ER instead and passing on those costs instead. The NHS (usually considered the worst) has a 4-day average for GP's now and is getting complaints because that means some are waiting a week.

  • KevinP||

    Obamacare took effect in 2013, so these waiting times are likely the result.

  • JFree||

    Probably. But that just means our healthcare system is designed to exclude 10%+ of the population from having access to it. And it breaks down when people are able to access it.

  • Sevo||

    1) Money
    2) Money
    3) Money

  • OpenBordersLiberal-tarian||

    "Medicare for All" is, arguably, the rallying cry for progressive Democrats these days.

    I disagree. The progressives I know are concerned with general healthcare to some extent, sure. But they're most passionate about unlimited immigration and reproductive healthcare (abortion access), which makes them natural allies for us Koch / Reason libertarians.

    Don't weaken the progressive / libertarian alliance by asserting that "progs" are in fundamental disagreement with us on major issues. In fact, it's on the major issues where we agree. Differences of opinion on Medicare for All, or the minimum wage, or billionaire tax rates are comparably minor problems we'll address later — after we've vanquished our common enemy, the alt-right.

  • CE||

    as always, the voice of reason on Reason.


  • JWatts||

    And of course:


  • mpercy||

    #LibertariansForMoreFreeStuffForMe PaidForByForcingOtherPeopleToPonyUpTheirCash

  • Diane Reynolds (Paul.)||

    I feel like our heart isn't in it anymore...

  • Fuck you, Shikha (Nunya)||

    That's just you. W took yours to give to someone that needed it more.

  • JFree||

    This has been 30 years in the making - ever since the early Clinton attempt at reform.

    For all the talk of some market-based solution, the reality is that those who advocate that came up with absolutely nothing re some action plan to get from where we are to where we would go.

    One thing is always true. If you can't coherently voice your ideas in 30 years, then there's a good possibility there isn't a coherent idea to voice.

    Now the Ds get to do what they will do.

  • Sevo||

    JFree|11.13.18 @ 11:21PM|#
    "This has been 30 years in the making - ever since the early Clinton attempt at reform."
    30 years of trying to screw up medical care worse than it is. Great, you fucking ignoramus.

    "For all the talk of some market-based solution, the reality is that those who advocate that came up with absolutely nothing re some action plan to get from where we are to where we would go."
    You are full of shit as you constantly are, lefty fucking ignoramus.

    "One thing is always true. If you can't coherently voice your ideas in 30 years, then there's a good possibility there isn't a coherent idea to voice."
    One thing is always true. Lying for 30 years makes you a 30-year liar, lefty fucking ignoramus.

    "Now the Ds get to do what they will do."
    Not unless it's veto proof, lefty fucking ignoramus.
    BTW, lefty fucking ignoramus, I'm still waiting to hear how some company forced you to buy their product, lefty fucking ignoramus.

  • Sevo||

    In case it is not clear, JFree is among those who post here whom I find the most ignorant and willing to make that stupidity quite clear in his/her posts; econ ignorance and stupidity is thy name.
    Is that clear you to you, fucking lefty ignoramus JFree? Don't want you to misunderstand and I'm sure you're start ducking and dodging again, as lefty fucking ignoramuses do.

  • prolefeed||

    "Crappy insurance ... that I and all the other members of Congress won't have to put up with because we've voted ourselves effective insurance ... for all ... of y'all."

    Translating the pic of Bernie Sanders accompanying the article.

  • Sebastian Cremmington||

    Medicare for All is stupid because it would end up being a windfall for the well off with good jobs that for some reason are happy overpaying for something everyone else gets free! Medicare for All would obviously be overall cheaper than our current health care spending but it would also probably produce worse results than our current system. We are very fortunate the UAW and New Deal Democrats created the group market which is probably the only way to create a robust relatively free market in health care. Obama and the Democrats were correct to protect the group market when crafting Obamacare.

  • Rev. Arthur L. Kirkland||

    If someone develops and implements something better, and soon, great. Otherwise, prepare for the arrival of universal health care in the short to medium term.

    Then, prepare for the new program -- let's call it Obamacare, because that is what I hope it is formally named -- to be as bad for America as Social Security, Medicare, Medicaid, the school lunch program, and environmental regulations have been.

  • TuIpa||

    Fuck off Hihn.

  • Rev. Arthur L. Kirkland||

    The day you receive your official Obamacare card is going to be a great day.

  • Sevo||

    Rev. Arthur L. Kirkland|11.14.18 @ 12:05AM|#
    "The day you receive your official Obamacare card is going to be a great day."

    I'm sure you hope for the day a brain cell is delivered to you, asshole.

  • buybuydandavis||

    I like that the good Rev. is here. He bares the Left's soul for all to see. All hatred and will to domination.

  • Here for the outrage||

    The tribe that understands healthcare isn't mentioned in the constitution?

  • Rev. Arthur L. Kirkland||

    Keep muttering bitterly and inconsequentially about all of this damned progress, clingers. It's your natural station in life while your betters do the work of improving America against your wishes and efforts..

  • JWatts||

    C-, you're letting the parody of a mindless Leftwinger be a little too obvious

  • CE||

    have you tried school lunches lately?

  • I'm Not Sure||

    "Health care costs were a major issue in the midterm elections..."

    When it comes to health care, progressives complain about increasing spending, yet insist that ever-increasing amounts of money spent on education is a good thing.


  • PC Wood Chipper||

    After 37 years in medicine, I don't believe Medicare for all will happen. Too many corporate owned hospitals. What would they do, sell? Who would buy? The feds? Close? Too many specialists making Big Bucks. They would just walk away, then services & that hip replacement for granny is a goner. This is the road to having VA-for-all.

  • Robert||

    Why wouldn't the corp.-owned hosps. go on as before?

  • TuIpa||

    Hey look, David Nolan shows up, get's the "Fuck off Hihn" so Hihn busts out his Robert sockpuppet.

    Jesus Christ you're a fucking amateur, Hihn. Now fuck off.

  • TuIpa||

    It's just so fucking sad. You DELIBERATELY abbreviate words NO ONE abbreviates in order to hide your posting style, and fail at that while looking like a stuttering imbecile.

    "Hosps."? Stop being an idiot.

  • buybuydandavis||

    David Nolan - Sock = Hihn

  • JWatts||

    Hihn, Haven't you realized by now that when you type in ALL CAPS and with mindless name calling, any observant readers spots it as another one of your sockpuppets, immediately.

    You couldn't be anymore obvious without signing the post.

  • Longtobefree||

    1. Eliminate Obamacare and all related regulations and programs
    2. Prohibit employer purchased health insurance
    3. Require all healthcare providers to charge the same amount to all customers
    4. Require healthcare insurers to reimburse all policyholders the same amount for the same care.
    5. Allow healthcare insurers to provide reduced benefits for a period of time to policy holders who have not maintained health insurance with other companies. (This to address the 'pre-existing' issue. There would need to be a transition period equal in length to the reduced benefit period when those without insurance would be expected to obtain coverage.)
    Now the 'only' problem is that some people actually could not afford health insurance. Ideally charity, if necessary subsidy, will address that.
    Of course, this will require individuals to actually take responsibility for researching health care costs and healthcare insurance policy reimbursement and determining the appropriate combination of providers and insurance. Which makes it untenable.

  • Qsl||

    Your post hints at what the problem is. It's not healthcare. It's insurance reform.

    There is also the problem of researching healthcare costs as there is no transparency, which is also tied to insurance.

    This looks promising as a model for a public-private partnership, but ultimately Nolan is right- there is nothing on the table from the right or libertarians to address healthcare (i.e.- insurance) costs (no consensus anyway).

    And as kill them all and let the freemarket sort them out isn't on the table either, libertarians are in the uncomfortable position of standing on principle and watching medicare for all come to fruition, or swallowing some pride and devising a hybrid system that at least points the way towards market solutions.

    By the looks of things, it is a question of when, not if, medicare for all is policy.

  • Sevo||

    "..but ultimately Nolan is right- there is nothing on the table from the right or libertarians to address healthcare (i.e.- insurance) costs (no consensus anyway)."

    You are full of shit; either an ignoramus or a liar.

  • cynicalretiree||

    Is USA the only country on Earth where doctors perform a wallet biopsy before examining the patient?

  • cynicalretiree||

    I worked in pediatric hospitals for 30 years. This surgicenter does looks promising.

  • An Non||

    Insurance reform is necessary, though. I live in a regional center for health care, and a significant number of practices will charge you less if you don't make them deal with insurance--assuming they accept it anymore. One insurer actually got a rep for not paying their bills.

    And then there was the state deciding to do a retroactive paycut for in-home nurses...

  • TuIpa||

    Fuck off Hihn

  • Robert||

    Hey, that can't be Hihn; I'm Hihn, remember?

  • TuIpa||

    Yes I do. Are you so fucking stupid that you don't realize we know they're both your sockpuppets you fucking clown?

    I mean, what kind of god damned idiot thinks your post even makes sense?

    More Honest Robert/Hihn "I know, I'll act like I CAN'T HAVE TWO SOCKPUPPETS!! THAT'S GENIUS!!!"

    Fuck off Hihn. With both of your sockpuppets.

  • Definitely not TuIpa||

    Yes, Robert is clearly also a Hihn sockpuppet.

  • TuIpa||

    Thank you not me, it is in fact obvious that Robert is a Hihn sockpuppet.

  • Sevo||

    David Nolan|11.13.18 @ 8:55PM|#
    "Behold the anti-gummint gooberism,"

    You fucking ignoramus, do you think posting as a sock makes you look other than a fucking ignoramus.
    Please go die someplace; the world will be better off.

  • Sevo||

    Fuck off, Hihn. You're too stupid to be embarrassed.

  • buybuydandavis||

    " Even worse, consider that fiscal conservatives have NO alternative."

    Both Reason and the Republicans are unwilling to attack the major problem - government enabled rent seeking.

    The medical mafia can shake us down for whatever they like because they are deputized by the state to control access to medicine, medical equipment, and medical care. The system spends much more time cost shifting and divvying up our pounds of flesh than the do healing anyone.

  • Thomas O.||

    BBDD is explaining how the government-permission-slip system is robbing us blind, and all you see are "slogans and soundbites"?

    Something something forest something trees...

  • Thomas O.||

    Getting rid of those stupid "certificates of need" would be a good start. We shouldn't have to have a government permission slip to buy extra equipment or open additional hospitals/clinics. Problem is, both Team Red and Team Blue loves them some artificially inflated demand. Gotta keep that tax money rolling in!

  • ThomasD||

    How the Hell do CoNs inflate demand?

  • retiredfire||

    A free supply/demand system results in an equilibrium.
    Certificates of Need removed the freedom on the supply side, thus creating a ratio that places demand at an inflated level.

  • jerbigge||

    All very true. Professional organizations are all "labor unions" operating under a different title. Ditto for the licensed occupations. The repeal of prescription laws (which give doctors a legal government enforced monopoly over access to medical drugs) means that people will once again enjoy the freedom of taking care of their own health to the limits of their ability. Which today given current computer technology is far higher than it was anytime in the past.

    Probably won't affect the specialists that much, but much of what passes today for "primary care" is pretty much just a means to get money from patients for doing very little real "doctoring" thanks to prescription laws.

  • Longtobefree||

    " . . Seniors love it . . . "

    Uh, no. Most emphatically no. Absolutely not.

    Three calls a day;
    first to the specialist to confirm again that they sent the forms to the primary care physician for post surgery physical therapy.
    second to the primary care physician to have them say again that they have not received the forms.
    third to the administrator to see if there is any other process at all to get the permissions to begin the physical therapy before the affected joint atrophies. (there is not)

  • Michael Hihn's mother||

    I'm sure it'll all work out after twenty phone calls.

  • loveconstitution1789||

    No social security and no medicare for me. Saved tens of thousands over the years in taxes.

    I wish y'all could too.

  • Longtobefree||

    Stay well.

  • sarcasmic||

    How'd you manage that?

  • Rev. Arthur L. Kirkland||

    A van down by the river?

  • TuIpa||

    No one cares where you lost your virginity today.

  • Rev. Arthur L. Kirkland||

    I care about winning the culture war. And watching you lose it. It has been enjoyable for decades, and will be enjoyable for more decades to come.

    Carry on, clingers. Somebody has to be the losers.

  • Sevo||

    Rev. Arthur L. Kirkland|11.14.18 @ 12:08AM|#
    "I care about winning the culture war. And watching you lose it. It has been enjoyable for decades, and will be enjoyable for more decades to come."
    We care about calling assholes on being assholes, asshole.

    "Carry on, clingers. Somebody has to be the losers."
    You're doing a good job being a loser, asshole. Keep it up.

  • sarcasmic||

    Profits are the price we pay for efficiency. That is why government is ridiculously inefficient and wasteful. There is no profit incentive.

    So there's a practical reason to keep health care in the private sector. It keeps it efficient.

    Thing is, the left just doesn't care. For them it's a moral issue. Profiting from the sick and dying is immoral, so health care must be done by government because government doesn't profit. So what if it's inefficient and wasteful? So what if it results in long waits and retards innovation? It's better than rich people making profits.

  • Loup-Bouc||

    Nick Gillespie's article epitomizes the religion of Libertarianism.

    The libertarian religion says universal Medicare (or any similar heath-care-insurance system) is bad because it is socialist or because it imposes a tax or because it involves government regulations. To "prove" the point, Mr. Gillespie asserts that universal medicare costs too much or is somehow inefficient or saps liberty without justification.

    Reality belies Mr. Gillespie's assertion.

    Since this journal will not permit my posting a sufficient deconstruction of Mr. Gillespie's assertion (because, necessarily it would involve "too long"), I shall cite an excellent essay published by a conservative journal, The American Conservative:

  • Loup-Bouc||


    "...(because necessarily it would be 'too long')...." NOT "...(because, necessarily it would involve 'too long')...."

  • BigT||

    Sure. Government run monopolies are super double-plus good.

    You think our health insurance system is f'd now, wait until it's free!

  • Loup-Bouc||

    To: BigT|11.14.18 @ 7:20AM

    You are hallucinating Martian economics. Read this:

  • Magnitogorsk||

    In the interest of mobilizing a better defense against single payer, its opponents REALLY need to stop:
    1) throwing out these supposedly scary, unworkable hypothetical costs that are less than we currently pay for healthcare
    2) confusing single payer with the NHS or VA

  • sarcasmic||

    Single payer would cost more than what we currently pay because the profit motive, and the resulting efficiency, would be removed.

    Profits are the price we pay for efficiency. People think that profit is just some expense that can be removed when government takes over. Ohhhhh, hell no! When government takes over there will be no reason to be efficient, there will be rampant waste, and costs will go through the roof while efficiency goes down the shitter.

  • buybuydandavis||

    May cost less.

    Most of the "profit motive" is spent chasing government enabled rent seeking. That's only "efficient" for the rent seeked.

  • Thomas O.||

    And then there's those greedy fucks that decide to jack up the price of their patent-protected medication by 2000%. Who cares if people are dying because they can't afford the life-saving medicine anymore, I need a third vacation home in Miramar!

    And I'm not saying single-payer and high taxes are the answer, but it would help if there was a rule saying if you markup your product by some insane amount, you immediately forfeit your protection from other companies making generic versions of your product.

  • jerbigge||


  • Loup-Bouc||

    To sarcasmic|11.13.18 @ 9:42PM

    Both false & irrelevant.

    Consider, E.G., economies of scale and related bargaining power. (Though mostly "economies of scale" is a term applied to the supply-side, its concept fits, equally, the demand side.) Now see the article I cited earlier [11.13.18 @ 9:27PM]:

  • sarcasmic||

    Dude, I've seen it. OK? I've been on both sides. I've been a part of businesses who lived on a razor's edge, and I've watched government bureaucrats waste hundreds of thousands, if not millions. I'd rather have a profit minded guy running things than some government person who says "I've got a $900,000 a year budget and all they gave me was this cell phone!" That is what the guy said. And he wasted most of it over petty personal feuds. I'll trust my lying eyes and ears over some link of yours that I will never click.

  • TuIpa||

    "Dude, I've seen it. OK? "

    That's a shit argument sarc.

  • sarcasmic||

    When I want your opinion I will take a shit, and then take a deep breath.

  • Ordinary Person||

    I hear smelling shit is good for your health.

  • sarcasmic||

    It's all I've got. I've seen it. Government waste that would get me fired if I reported it. What purpose is served by belittling me for it? Other than to be a dick. Money that could buy homes for me and my family, pissed away. And you want to make it something personal? Dude, your a dick. You apologized for your inexcusable comments about my drinking, but you just can't stop. You just can't stop.

  • sarcasmic||

    I'm sorry that my company records aren't part of your library.

  • sarcasmic||


  • Jerryskids||

    Look, just because you've seen a thousand designs for perpetual motion machines and have debunked them all doesn't mean that this particular perpetual machine won't work. If you haven't examined it closely and pointed out exactly where the design flaws are then you have failed to debunk the perpetual motion machine. Loup-Bouc has said the perpetual motion machine will work, if you're going to claim that it will not then the burden of proof is on you to show why he's wrong. Now put up or shut up, tell us all why the perpetual motion machine won't work or admit that you don't know what the hell you're talking about and you know nothing at all about perpetual motion machines.

  • ThomasD||

    Wishful thinking is as wishful thinking does

  • Sevo||

    Loup-Bouc|11.13.18 @ 10:05PM|#
    "Both false & irrelevant."

    To Loup-Bouc: Bullshit.

  • Vandalia||

    There are no wait lists in America?

    Here it is a minimum of 9 months to see a neurologist. 5 months to see a dermatologist. Don't even ask about pain management.

  • TuIpa||

    "Here it is a minimum of 9 months to see a neurologist"

    I got in in 3 days. Why are you lying?

    "5 months to see a dermatologist"

    I got in NEXT DAY. Why are you lying?

    "Don't even ask about pain management."

    Would have been seen same day if Neuro hadn't taken care of it.

    What the fuck kind of propaganda have you swallowed?

  • Vandalia||

    It is called reality. That may be the way it is in your neck of the woods, but in real America, people wait forever to see a specialist. Those are actual appointment wait times in southern Indiana.

  • Jerryskids||

    All the money "we" already pay toward health insurance? See, here's the problem with the "nation's health care costs" formulation - we don't pool all our money together and buy one big chunk of healthcare, everybody's got there own. If the government's going to start paying all the bills, where are they going to get the money and who are they going to get the money from? As it is now, Grandma needs a new pair of knees and she doesn't have the money for them, Junior doesn't have a damn thing wrong with him and very likely isn't going to have anything wrong with him for many years. As it is now, Grandma's looking for somebody to pay her medical bills, Junior's not worried about medical bills. Under single payer, we're all going to split the bills equally - Grandma gets half-price knees, Junior gets to pay half the bill for Grandma's knees. Great deal for Grandma, sucks to be you, Junior. But notice, under single payer the total cost of medical care hasn't gone up a nickel. Whee! Big success!

  • Jerryskids||

    And that's all single payer is - making people who don't have any medical bills help pay for those who have lots of them. It's like an all-you-can eat buffet at a set price and it doesn't matter if you eat 3 bites or 12 plates of food. Except you're not allowed to decline the buffet, you're going to the buffet whether you like it or not. Now if you only wanted 3 bites of food but you're not allowed to go down the street and buy a pack of crackers but instead have to go to the all-you-can-eat buffet, are you going to still just eat 3 bites or are you going to cram as much of the most-expensive food you can find down your gullet even if you have to pack it in there with a stick? And that's why single payer isn't going to be cheaper.

  • retiredfire||

    Car insurance doesn't include oil changes.
    Homeowner's insurance doesn't include painting the building.
    Insurance is pre-paying for unexpected future costs, whether they materialize, or not.
    What is euphemistically called medical insurance is expected to pay for routine expenses.
    That's not "precisely how insurance works".

  • Bronze Khopesh||

    The Feds could pay. It's not single-payer that's the problem, it's single-management that's the problem.

    People are very happy to get free stuff but are generally not fans of bureaucrats. So take the bureaucrats out of the equation.

    No level of government should be providing, managing, or controlling healthcare services. Government bureaucrats should not be in charge of running anything. I think that's be shown enough that it should be just taken as a given.

    However the Feds can create as much money as is needed to pay for anything they might want to do. So use that ability and put them in the spot of only paying and no control.

    Leave all healthcare provision to the market. Providers would not be competing on price but they would still have to compete on services offered, quality of care, customer service and convenience.

    Of course cost-creep and fraud are concerns but there are ways to mitigate those.

    Taxes don't need to go up. And inflation is unlikely so that's not a problem. If inflation does tick up, increase the interest rate on Treasuries until enough money is drained out of the economy to bring the inflation rate down.

    If you went to the American people and said "The Federal Government will pay your medical bills but no bureaucrat will get in between you and your provider on what care or how much care you receive." You'd have a winning campaign.

    Of course the progs don't want the problem solved that way.

  • Bronze Khopesh||

    For progs the point is to get people immeshed in some sort of complicated scheme that requires more progs to manage. That leads to control over people and patronage for crony-progs.

    Plus if the system works, the progs lose an evergreen political crisis to flog each election cycle.

  • ThomasD||

    "The Feds could pay."

    Who the Hell do you think 'the Feds' are????

    Fuck off slaver.

  • I'm Not Sure||

    Medicare for All? You mean like the DMV, but with doctors?

  • Echospinner||

    It would turn into that.

    Medicare works kinda, because it is designed for and evolved to a specific population.

    It will not work that way if we apply it to the whole population.

    Medicine is not a box of cornflakes. When you show up to the hospital with acute chest pain you do not really make informed choices except as medical consent. Nobody talks about cost at that point and the providers have no clue and do not really care.

    So for routine stuff not much problem if you just hold out at home with a flu unless it gets serious. Then you don't care about cost.

    What do people want?

    There is no such thing as a free angioplasty.

  • jerbigge||

    DMV's don't need to be "bad". Here in Michigan we used to have great DMV's with very little waiting for service. In and out perhaps 15 minutes or so. However it costs money to run the DMV's and since the service is not something the consumer has any real "say" about, our former governor (Jennifer Granholm) took money from the DMV system and spent it on something else.

    The same is true of every "government service". Give it sufficient financing and everyone will be exclaiming how "great" it is. Of course you'll be paying "more" for the service as there is no such thing as "free lunch"...

  • buybuydandavis||

    One thing is lacking in Reason health care proposals. Freedom.

    Despite pretending to be a libertarian mag believing in free markets, the only drugs Reason wants you to be able to buy without a prescription are pot and birth control pills.

    Gotta protect pharma profits.

    "Libertarian Moment"

  • No Yards Penalty||

    Everything stated in this article about the Canuckistani health care system - and feared by commenters - is absolutely true.
    I would add, if you talk to Canadians who have received life-saving acute care at ''no cost,'' they will defend the system.
    If you talk to Canadians who have suffered while waiting for basic tests, an appointment with a specialist, diagnostic testing, ''elective'' surgery to fix wrecked knees and hips, etc., you get a different story.

  • buybuydandavis||

    And when you talk to the ones who died while waiting for treatment, they don't complain at all.

  • JFree||

    That's like the NHS too. Those who are healthy (90% of the population) like it because it doesn't cost much (roughly half of what it costs here - paid via taxes rather than premiums/etc) and there are no lines re real emergency stuff or the cheap preventive stuff that keeps one healthy. Those who are unhealthy don't like it much because they can't get whatever they want for free without waiting in lines. And NHS is usually seen by most countries as the worst model out there because it turns doctors into civil servants.

    Personally I think the best model is a combo of Singapore, France - and Mayo Clinic for the specialist/tertiary stuff.

  • Newborn Photography TX||

    We are very fortunate the UAW and New Deal Democrats created the group market which is probably the only way to create a robust relatively free market in health care.

  • BigT||

    Absolutely! We NEED a government run monopoly. Always the best solution.

    We need it for food as well! Who needs 7,462 brands of beer? Coffee? Bread? Yogurt? Very inefficient. Bud Light, Folgers, and Wonderbread for all!

  • Ordinary Person||

    No we just need to make sure every American has the resources to access the products that are produced by the market. Your market could the tastiest beer but it might as well not exist if it's unaffordable.

  • Ordinary Person||

    Your market could produce the tastiest beer...

  • Daniel||

    I am disappointed that the decline in the physician population was not mentioned. The number of people choosing to become doctors is declining and fewer people are even attending medical school to try to become a doctor.
    How many less will want to become a doctor and work within a nationalized system? Sure, some US doctors don't mind being employees of hospitals or healthcare systems but the trend is falling. Why spend all that time in school and the financial cost off medical school if the salary is not there.
    Britain already imports a large number of doctors as is Canada.
    How many doctors will the US have to import to provide any sort of decent access?
    One of the biggest issues with access and wait times is that there will not be enough doctors to support the demand of 340 million patients.

  • JFree||

    The French model works far better than most (and better than ours) re supply of doctors. They use their knowledge of what they are paying for to drive the supply of doctors (esp generalists) who will fit that. It means they actually have eg geriatricians (GP's for the elderly) who don't exist in the US outside hospice/dementia care. Those doctors graduate with no med school loans to pay off - who can earn a reasonable income focusing purely on delivering care rather than selling their services.

    The result is that France has about 3x more GP-types (pediatricians, GP's, geriatricians - maybe OBGYN and internal) than we do. They have fewer patients each than here so they can spend time with them and build trust and end up serving a gatekeeper role to specialists which lowers overall costs.

    Doesn't mean the US govt can replicate that because Americans are incapable of actually discussing healthcare.

  • Thomas O.||

    Opening more medical schools, loosening qualification standards, coming up with automated diagnosis machines or phone apps might help in that area. Good luck with convincing politicians or medical-industry lobbyists, though.

  • ThomasD||

    " fewer people are even attending medical school to try to become a doctor."

    You got a link for that ?

  • jerbigge||

    Medical training in the US is "overkill" for the most part. For much the same reasons that all the "knowledge" imparted to you in our educational system only remained "available" to you if you had some reason to "use" that knowledge outside of the educational system. What is the value of "English literature", much of "history" taught in schools, music and art, etc. Every medical student gets a lot of training that they will likely never use again since it is outside whatever sort of medical practice they go into after medical school. Other countries do it differently with the training being based upon what sort of medical practice they will be performing afterwards.

  • Rev. Arthur L. Kirkland||

    Those who don't like the prospect of a universal health care system in the United States have three choices:

    1) Devise and implement a better system soon.

    2) Move to another country.

    3) Mutter bitterly and whine inconsequentially about it.

    Choose wisely, clingers. And have fun!

  • Ordinary Person||

    How are the present costs for the care of human health being met? Why would that cost go up if more people could access healthcare? It would logically only increase if people were using and receiving more care. That's a good thing. The alternative is dying or suffering.

  • Sevo||

    "How are the present costs for the care of human health being met? Why would that cost go up if more people could access healthcare? It would logically only increase if people were using and receiving more care. That's a good thing. The alternative is dying or suffering."

    Sarc or stupidity?
    I'm going with abysmally stupid.

  • ||

    And, it will be as intrusive as hell.

  • Olga||

    If you look at Lasik, then clearly some services would come down in price if we made health care cash based. However, with Lasik, you don't NEED it to live. When it comes to things you need to live like chemotherapy and other cancer treatments, that is very expensive. At least 90% of the population can't afford it. So would 90% of the people die if they get a cancer diagnosis? If Medicare for All isn't your answer then what would you do to bring down price AND make it possible for all people to access life saving medical care?

    Charity, would never be enough.

  • ThomasD||

    Lasik is also a procedure. Some of the medications used on Lasik aren't all that different in price than some drugs used in chemotherapy.

    Whereas chemotherapy is an ongoing and usually extensive course of treatment. It involves lab and diagnostic expenses, as well as (usually) multiple drugs, and multiple administration sequences. Even when every drug used in chemo is a generic that has been around for years it still all adds up to a lot of money.

    Talking about lasik and chemo is not like apples to oranges it is apples to the Moon Shot.

  • XM||

    Cancer patients die in single payer systems all the time. Patients who can't pay can be legally discharged from their hospitals in countries like Korea.

    It is logistically and statistically impossible for hospitals in a nation to provide meaningful preventative healthcare to all of its citizens. CA ha nearly 40 million people. Imagine if at everyone in that state visited a doctor at least once a year. Healthcare would come to a screeching halt.

    There are obviously tradeoffs in a single payer system that will stop it from spiraling into total chaos, but as I said here before, those will be harder to enforce in an American system because the electorate is emotionally invested in the concept of equal representation (to the exclusion of all else). Any sort of tiers, waiting list, or "rationing" will be met with a tidal wave of complaints alleging discrimination. We won't do a thing about doctor and administrative salaries, even though overhead costs drive up healthcare costs a ton.

    The government will have to significantly alter the healthcare landscape for even "medicare for all". Seniors will likely balk at sharing what was their privilege with 300 million snot nosed kids.

  • Sevo||

    XM|11.14.18 @ 5:47PM|#
    "Cancer patients die in single payer systems all the time."

    Cancer patients die waiting for services in single payer systems, along with others, but hey, it's government, so it must be good:

    "Deaths, delayed diagnosis and poor care were among the serious incidents recorded by the NHS in Birmingham last year.
    Among serious incidents at the Heart of England trust in 2016/17 were four unexpected neonatal deaths, as well as two unexpected maternal deaths, including one postnatal death."

  • blondrealist||

    Total nominal health care spending in 2017 was about $3.5 trillion. If we do nothing in our current multi-tiered mess of a system, we will spend more than the $32 trillion estimate for "Medicare-for-All" in the next decade. The spending will continue to be spread around employer-provided plans, Medicare, Medicaid, the individual insurance policy markets, and plain old consumer spending without insurance. Perhaps a case can be made that the spending total will go up even more in a single-payer system, but trying to scare us with the $32 trillion projection reveals either poor math or poor research (or maybe both).

  • KevinP||

    Why single payer died in Vermont

    Vermont was supposed to be the beacon for a single-payer health care system in America... Until Wednesday, when the governor admitted what critics had said all along: He couldn't pay for it.

    "It is not the right time for Vermont" to pass a single-payer system, Shumlin acknowledged in a public statement ending his signature initiative. He concluded the [additional] 11.5 percent payroll assessments on businesses and sliding premiums up to 9.5 percent of individuals' income "might hurt our economy."
  • BunnyFaber||

    I feel like this will end in a bad reality show version of Logan's Run.

  • jerbigge||

    Medicare will pay for hospital stays only up to a certain limit. The total maximum time is 150 days with the first 60 days being almost fully covered. The next 30 days you will have sizable co-pays. Then there are 60 "lifetime" days (can be used only once) with more co-pays. After that you are on your own and likely will be put on Medicaid. And will be effectively bankrupt.

    I don't know if other countries (ones with national systems) operate the same way or not. But the idea that Medicare "covers everything" is far from the truth. Even Medicare Advantage plans have a "limit". Mine is 90 days.

  • cynicalretiree||

    1: First challenge to Medicare for all would be a deluge of new patients in clinics of existing doctors. We will have to train more doctors and expand medical schools.2: If you are a hard working family unable to afford insurance for an expensive chronic condition and pay car repair, Medicare for all is a beckoning reality.Unless..3: what happened to Romneycare ? I never met a Massachusetts citizen who complained about Romneycare.

  • cynicalretiree||

    Countries in Europe that have health care for everybody usually did so after the catastrophe of WW2. Starvation and devastation in Netherlands, for example, prompted compassionate universal health care. Trump has not a hint of a feeling for tragedy that Netherlands or anyone else suffered. Romneycare was a humane effort.The first national health care proposal was from Teddy Roosevelt and the Progressive Party, 1912. How is Romneycare doing today?

  • cynicalretiree||

    Great video. I wonder how much RN's make there?

  • coolth||

    Canada does not have fully nationalized health care -- it has single-payer health insurance, and that's it. Most physicians operate as professional corporations. I go to a hospital outpatient clinic but my doctor there operates as a professional corporation.

    I'm not excusing Canadian wait times, but how big would the difference be if you controlled for population density? How well would American-style health care do in reducing wait times in Northern Ontario, where fewer than 800,000 people live in a region 25% larger in area than France? Your population density is eight times ours. Does density affect your wait times?

    Finally, I wouldn't recommend Canadian-style health care for the US, or for anywhere else. Its success depends on it being used by people with particular Canadian values. American health care should reflect American values or it isn't going to work. So why don't Americans come up with a system that reflects their values? There are successful private healthcare systems you could look to for inspiration. A better approach, anyway, than claiming Canadian health care is something it's not.

  • John Galt Jr||

    This is when the anti-gummint types go bat-shit crazy. The Mercatus projection was ridiculed almost immediately -- for both ignorance and hysteria.

    For openers. their 10-year average of $3.2 T is LESS than we spend now! $3.5T in 2017.
    For a decade. using 4% annual increases, that's $45T -- so Mercatus says M-F-A would be 30% cheaper.

    The tax hysteria in downright shameful. Roughly half our total health care is already paid from taxes. The other half would be LESS than we now spend on private health insurance!!! So Mercatus must think we'd still pay health insurers for ... NOTHING.
    This is why progressives have been kicking our ass on health care for decades.

    Massive errors like this are common from Mercatus. An even bigger one is that postwar spending cuts of pox 50% were a "stimulus" for the postwar boom. Also shameful, their "boom" uses nominal dollars for GDP, at a time of double-digit inflation! Lotsa suckers on that one also.


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