Single Payer Healthcare in the US

[tantalus]

So there are many different ways to go about deilvering single payer healthcare, healthcare for the citizens provided by the state. Various western governments have various models. They vary in private v public, coverage, how they handle immigrants, how they distribute funds, they are not universal in the true spirit of the word. I understand this in principle and my question is more first principles, not dissecting medicare for all.

First principles being if you have an accident or get sick, the state will look after you, you won't go bankrupt, you wont expected to enter heavy debt, or endure chronic pain or sickness.

What is the real level of support for some model that more closely resembles that of canada or other western countries in delivering some system which delivers on this first principle?

Where do the bulk of democrats fall on this?

Where do yhe bulk of republicans fall on this?

Where do the economic libertarians fall on this?

I do understand the power of the idea that big government is bad and governments are inefficient compared to the free market.

It seems agreed upon near universally in america that if a terrorist or foreign nation seeks to harm usa citizens, spending taxpayers money to combat this is wise. And if the threat of terrorism or foreign militaries grow, increased taxation to combate this increased threat is also seen as wise. But the desire to extend this logic to falling down a stairs or getting cancer is nowhere near as universal.

I understand this topic has been thread upon heavily but I appreciate people's insights.

[zraver]

So there are many different ways to go about deilvering single payer healthcare, healthcare for the citizens provided by the state. Various western governments have various models. They vary in private v public, coverage, how they handle immigrants, how they distribute funds, they are not universal in the true spirit of the word. I understand this in principle and my question is more first principles, not dissecting medicare for all.

First principles being if you have an accident or get sick, the state will look after you, you won't go bankrupt, you wont expected to enter heavy debt, or endure chronic pain or sickness.

What is the real level of support for some model that more closely resembles that of canada or other western countries in delivering some system which delivers on this first principle?

Where do the bulk of democrats fall on this?

Where do yhe bulk of republicans fall on this?

Where do the economic libertarians fall on this?

I do understand the power of the idea that big government is bad and governments are inefficient compared to the free market.

It seems agreed upon near universally in america that if a terrorist or foreign nation seeks to harm usa citizens, spending taxpayers money to combat this is wise. And if the threat of terrorism or foreign militaries grow, increased taxation to combate this increased threat is also seen as wise. But the desire to extend this logic to falling down a stairs or getting cancer is nowhere near as universal.

I understand this topic has been thread upon heavily but I appreciate people's insights.

As a conservative Libertarian: Let markets compete by making insurance portable and customizable and outlawing surprise billing and require a unified bill If you go to a hospital the hospital sends you one bill for all services provided. Providers should have clearly defined prices and those prices should be relative to the actual cost of the product (including a reasonable profit). $50 bucks for an aspirin, $200 for a bag of saline, $1000 for .50 cents worth of epinephrine.... That is usury. Build and buy the plan you want, or as an employer build and buy the plan you want to offer. I don't mind health insurance for kids and elderly, or even pandemic assistance for all affected but working age adults need to be adults. Before Covid19 the tight labor market was leading to increased wages and benefits as employers competed for workers

[DOR]

The bulk of Democrats, and the bulk of Republicans, don't fall anywhere special on this or any other issue. Very few think about it unless they have to, and far, far fewer understand the options or costs of healthcare provision on a large scale. My guess is you're not going to find the answer you're looking for, because there isn't one.

The one or two true economic libertarians that exist would state that it is no part of government responsibility to look after individual health, and that includes pandemics. Most thinking people would acknowledge that a healthy society is a national asset, an unhealthy one is a national danger, and therefore there is clearly a role for government to play, if only on national security grounds.

- - - -

Here's one example of a healthcare system that works:

In Hong Kong, it costs HK$100-200 to get medical treatment, provided one is able to pay. If you can't pay, you don't. If it costs more than that, the government pays … provided that you go to a government-run clinic or hospital. The cost is about US$12.50-25.00 (including open-heart surgery, or whatever), and the cost to the government is roughly US$700 per person per year, paid for out of general taxes.

As with all healthcare programs, something is rationed simply because healthcare is a service for which there is, practically speaking, no limit to demand. Rationing may be by price (US model), quality (underdeveloped world), or time (most universal healthcare programs), or by a combination of two or three of the above. In Hong Kong, the quality of care is on par with anything available to the general public in the develop world. Like elsewhere, some procedures will be scheduled several months down the road.

The government owns its own hospitals and employs its own staff. However, private hospitals and staff are freely available to anyone who wants to pay for them.

[tantalus]

The bulk of Democrats, and the bulk of Republicans, don't fall anywhere special on this or any other issue. Very few think about it unless they have to, and far, far fewer understand the options or costs of healthcare provision on a large scale. My guess is you're not going to find the answer you're looking for, because there isn't one.

Well thats' true but people think they think. That's really my question.

When most democrats think they think (having been forced to do so/brought to their attention), what do they think?

When most Republicans think they think ((having been forced to do so/brought to their attention), what do they think?

But that comes across as condescending and very confusing.

The one or two true economic libertarians that exist would state that it is no part of government responsibility to look after individual health, and that includes pandemics. Most thinking people would acknowledge that a healthy society is a national asset, an unhealthy one is a national danger, and therefore there is clearly a role for government to play, if only on national security grounds.

Well that's a good point. Also a great economic asset whcih feeds back to national security if that's your only value of importance.

[tantalus]

As a conservative Libertarian: Let markets compete by making insurance portable and customizable and outlawing surprise billing and require a unified bill If you go to a hospital the hospital sends you one bill for all services provided. Providers should have clearly defined prices and those prices should be relative to the actual cost of the product (including a reasonable profit). $50 bucks for an aspirin, $200 for a bag of saline, $1000 for .50 cents worth of epinephrine.... That is usury. Build and buy the plan you want, or as an employer build and buy the plan you want to offer. I don't mind health insurance for kids and elderly, or even pandemic assistance for all affected but working age adults need to be adults. Before Covid19 the tight labor market was leading to increased wages and benefits as employers competed for workers

but where do come at it from first principles?

You are not a libertarian and therefore...

You considered from first principles upon healtcare...xxxxxx....and that made you a libertarian....

But Iam curious to why libertarians feel that small government is appropriately applied to healthcare.

[zraver]

but where do come at it from first principles?

You are not a libertarian and therefore...

You considered from first principles upon healtcare...xxxxxx....and that made you a libertarian....

But I am curious to why libertarians feel that small government is appropriately applied to healthcare.

Because markets allowed to freely compete without the government picking winners and losers produces a superior product at a superior price. Hidden pricing distorts the market, its the equivalent of using different weights and measures. If pricing was honest and up front people could choose for themselves what they wanted now, and what they wanted later and build an insurance plan to match. I have 2 hospitals in my city, they charge different prices for different procedures, one being cheaper on one than the other but switching back and forth. However, I don't know the cost so I can't select based on price and can't even really base it on quality because even that info is either hidden or very hard to track down in a meaningful way. This deliberate obfuscation is enabled by government. Call up a dentist, or an ophthalmologist and they can give you up front pricing if there are no complications. My PCP can tell me how much an office visit costs, and how much a given test is, but the hospital can't can't, I have to sign for financial responsibility before being told the price. I don't buy my groceries that way, didn't buy my car or my house that way either.

[tbm3fan]

As a conservative Libertarian: Let markets compete by making insurance portable and customizable and outlawing surprise billing and require a unified bill If you go to a hospital the hospital sends you one bill for all services provided. Providers should have clearly defined prices and those prices should be relative to the actual cost of the product (including a reasonable profit). $50 bucks for an aspirin, $200 for a bag of saline, $1000 for .50 cents worth of epinephrine.... That is usury. Build and buy the plan you want, or as an employer build and buy the plan you want to offer. I don't mind health insurance for kids and elderly, or even pandemic assistance for all affected but working age adults need to be adults. Before Covid19 the tight labor market was leading to increased wages and benefits as employers competed for workers

Some markets don't compete. Health care is one. If you were in health care you would have learned that over the last 40 years. So I suggest going to school and become a doctor dealing with insurance companies. Once you do that you will understand what I say. Till then you truly have absolutely zero clue how insurance companies make it the Tower of Babel intentionally.

[tantalus]

Because markets allowed to freely compete without the government picking winners and losers produces a superior product at a superior price. Hidden pricing distorts the market, its the equivalent of using different weights and measures. If pricing was honest and up front people could choose for themselves what they wanted now, and what they wanted later and build an insurance plan to match. I have 2 hospitals in my city, they charge different prices for different procedures, one being cheaper on one than the other but switching back and forth. However, I don't know the cost so I can't select based on price and can't even really base it on quality because even that info is either hidden or very hard to track down in a meaningful way. This deliberate obfuscation is enabled by government. Call up a dentist, or an ophthalmologist and they can give you up front pricing if there are no complications. My PCP can tell me how much an office visit costs, and how much a given test is, but the hospital can't can't, I have to sign for financial responsibility before being told the price. I don't buy my groceries that way, didn't buy my car or my house that way either.

I hate hidden pricing. We are aligned on that.

And a partially operating market place is the worst of both worlds. Just look at your universities. We are aligned on that.

But If you are unlucky enough to fall down a stairs, and unlucky enough to occur a very specific set of injuries, the healtcare can ballon out over the rest of your life. How do poor people fare in such a system...

The cheapest price may not be cheap enough. Healthcare costs can't trend to zero they are intrinsically expensive, there is a floor on how low they can go, even in a very efficient market place.

[tantalus]

If pricing was honest and up front people could choose for themselves what they wanted now, and what they wanted later and build an insurance plan to match. I have 2 hospitals in my city, they charge different prices for different procedures, one being cheaper on one than the other but switching back and forth.

Healtcare is very complicated and unpredictable.

IMO, People will never operate efficiently in this model. You might personally with enough application but if you create a model that depends on people making good decsions. Expect disaster.

https://en.wikipedia.org/wiki/Rational_choice_theory

In the end psychology eats into rational agency.

I guess libertarians will say tough, people have to take responsibility. I suggest we have to take a more practial approach. A great idea can take you a long way but eventually you may have to leave it on the side of the road and keep going without some or all of it.

[zraver]

Some markets don't compete. Health care is one. If you were in health care you would have learned that over the last 40 years. So I suggest going to school and become a doctor dealing with insurance companies. Once you do that you will understand what I say. Till then you truly have absolutely zero clue how insurance companies make it the Tower of Babel intentionally.

They should, it would improve care and reduce costs

The government more than insurance, but both cause problems.

[DOR]

They should, it would improve care and reduce costs

The government more than insurance, but both cause problems.

It would appear that you cannot / will not grasp the most basic point: healthcare does not react to the usual rules of supply and demand; demand is as close to unlimited as to make no difference.

More, making healthcare readily available to all — in the national interest — negates any logic about regulation, pricing, and markets. Just as we don’t manage military defense by market forces, neither should we subject the medical security of the nation by mere price measures.

[tbm3fan]

They should, it would improve care and reduce costs

The government more than insurance, but both cause problems.

You're still ignorant of what you talk making this exercise forever useless.

[GVChamp]

Healtcare is very complicated and unpredictable.

IMO, People will never operate efficiently in this model. You might personally with enough application but if you create a model that depends on people making good decsions. Expect disaster.

https://en.wikipedia.org/wiki/Rational_choice_theory

In the end psychology eats into rational agency.

I guess libertarians will say tough, people have to take responsibility. I suggest we have to take a more practial approach. A great idea can take you a long way but eventually you may have to leave it on the side of the road and keep going without some or all of it.

There are a lot of things that are complicated and unpredictable. We typically use markets for most of those, even if we also have certain government interventions or regulations to support said market. This goes into how even the simple act of creating a pencil is actually really damn complicated, especially when you consider global logistics.

That's not to say that there isn't a government role to play, but using "it's complicated, so we need government to just manage the whole thing for us" is straight-up slippery slope and ignores the effectiveness of markets in providing clarifying information. I sure as fuck don't know how to farm, and I sure as fuck don't understand commodities trading and hedging, and I SURE SURE SURE SURE as fuck don't want government to nationalize all the farms because "it's complicated."

Your typical voter isn't going to be thinking too deeply into these issues, because they are indeed pretty complicated, so...you know, typical slogans "the insurance companies are screwing us over!" and "listen to the doctor!" and "personal responsibility!" and "socialism!"

National Defense and social safety nets are not directly comparable. In the first, a foreign agent is committing a malicious act against you, in the second, the facts of life are smacking you up the head. We obviously will punish and deter malicious, willful acts committed against our citizens, and we obviously cannot argue with a hurricane because hurricanes do not have ears to listen to us. We do have social safety nets, of course, but the expectation that society will simply take care of you if you run into a problem is not really something your conservatives/libertarians are going to be able to stomach. As an adult, you should be expected to purchase the necessities of life on your own, which includes the expectation to purchase the risk-sharing insurance required to protect you from catastrophic health incidents.

It's also all well-and-dandy to say that "if you have cancer you should be covered," but, cancer isn't one thing. The prognosis and expense of treatments vary widely.

In the American-specific case, I am not willing to give up my health care coverage in order to sign up for the government-run health care coverage because they promise it can do better. And it doesn't matter what they do in other countries. To use your national defense analogy, go transfer the US Navy to, say, Austria and see how well a land-locked country can run a super-carrier without the better part of a century of experience in operating it. Then remember a US carrier has a few thousand people, not the millions making up the US health care system.

[tantalus]

There are a lot of things that are complicated and unpredictable. We typically use markets for most of those, even if we also have certain government interventions or regulations to support said market. This goes into how even the simple act of creating a pencil is actually really damn complicated, especially when you consider global logistics.

That's not to say that there isn't a government role to play, but using "it's complicated, so we need government to just manage the whole thing for us" is straight-up slippery slope and ignores the effectiveness of markets in providing clarifying information. I sure as fuck don't know how to farm, and I sure as fuck don't understand commodities trading and hedging, and I SURE SURE SURE SURE as fuck don't want government to nationalize all the farms because "it's complicated."

Your typical voter isn't going to be thinking too deeply into these issues, because they are indeed pretty complicated, so...you know, typical slogans "the insurance companies are screwing us over!" and "listen to the doctor!" and "personal responsibility!" and "socialism!"

National Defense and social safety nets are not directly comparable. In the first, a foreign agent is committing a malicious act against you, in the second, the facts of life are smacking you up the head. We obviously will punish and deter malicious, willful acts committed against our citizens, and we obviously cannot argue with a hurricane because hurricanes do not have ears to listen to us. We do have social safety nets, of course, but the expectation that society will simply take care of you if you run into a problem is not really something your conservatives/libertarians are going to be able to stomach. As an adult, you should be expected to purchase the necessities of life on your own, which includes the expectation to purchase the risk-sharing insurance required to protect you from catastrophic health incidents.

It's also all well-and-dandy to say that "if you have cancer you should be covered," but, cancer isn't one thing. The prognosis and expense of treatments vary widely.

In the American-specific case, I am not willing to give up my health care coverage in order to sign up for the government-run health care coverage because they promise it can do better. And it doesn't matter what they do in other countries. To use your national defense analogy, go transfer the US Navy to, say, Austria and see how well a land-locked country can run a super-carrier without the better part of a century of experience in operating it. Then remember a US carrier has a few thousand people, not the millions making up the US health care system.

I meant something very specific when I meant its complicated and unpredictable in regard Z talking about people selecting for their options using their well reasoned minds. if you use government to manage the entire medical apparatus, it won't be a slippery slope, it will be a cliff into a stormy sea, so I think we are aligned on this. Nationalising whole sections of the economy has been tried enough now, it ends mostly in disappointments, failures and somtimes truly bibilical disasters. Other western nations have not done this and depend on the innovation of private companies.

The market has proven itself as simply remarkable at driving efficiency when it comes to incredibly complicated supply chains that allows you to produce a tin of beans for less than a dollar. It's no dispute. Truly incredibly efficient. We are aligned in acknowledging this efficiency. The danger is having a great idea or mechanism and applying it too freely beacaue it has worked so well, so often.

They are not directly comparable you are right. Its not apples for apples. But its an interesting thought experiment to see the agreement for defense dry up for healthcare from a first principles perspective, it seems the next closest step, where some choose to stop and others continue on.

I don't understand the logic of it doesn't matter what other countries do, an empirical approach is the right approach. It is possible on any given topic that the country one is born into has gotten it wrong or that something has been discovered in another country that has proven to work better. The usa is an outlier in the industrialised world on healthcare, and there certaintly seems to be a body of evidence that other first world nations have delivered efficient and more humans healthcare models.