“Free” Healthcare in the United States? How?

Dec 2018
4,949
1,893
Florida
#1
So I’ve thinking about this recently. On a few levels really. So one of the questions that I have to ask at this point is how is “free” healthcare supposed to work in the United States? I’d like to be walked through the idea here. Especially since I currently have valid health insurance paid by my employer.

Obviously healthcare isn’t ACTUALLY free. Nobody is expecting doctors or drug companies or hospitals to work for free. So my first question:

1) how is this to be funded?

2) If we are to switch to “single payer” and so on...how do I continue to go to my doctor? Since they are not working for free? How does that switch happen? Are they just submitting all claims to the government now? Will there be a screening process for my care? This leads me to my third question.

3) How do we prevent a run on doctors/hospitals? Now that everything is “free,” how do we stop people from going to the ER with the sniffles? That seems like a totally unavoidable and realistic problem. ESPECIALLY for small scale and underserved areas (and my understand is that this a common problem for similsr areas in Canada where small rural areas have trouble seeing a specialist of any kind).

I’d like to actually get some viewpoints on how it is supposed to work. Most of the people I end up talking to about this just tend to respond with “well it is free.” Which is crap of course. And then don’t bother to learn HOW it is supposed to work.
 
Dec 2013
3,449
2,400
Switzerland
#2
Look at how it works in most Western European countries, where there is a universal coverage of all people and different system for financing health spendings. And at least in Western Europe people live longer than in the US and money is already available and could be spent in a more performing way. What is needed is a political will for that.
 
Feb 2011
18,197
12,910
The formerly great golden state
#3
So I’ve thinking about this recently. On a few levels really. So one of the questions that I have to ask at this point is how is “free” healthcare supposed to work in the United States? I’d like to be walked through the idea here. Especially since I currently have valid health insurance paid by my employer.

Obviously healthcare isn’t ACTUALLY free. Nobody is expecting doctors or drug companies or hospitals to work for free. So my first question:

1) how is this to be funded?

2) If we are to switch to “single payer” and so on...how do I continue to go to my doctor? Since they are not working for free? How does that switch happen? Are they just submitting all claims to the government now? Will there be a screening process for my care? This leads me to my third question.

3) How do we prevent a run on doctors/hospitals? Now that everything is “free,” how do we stop people from going to the ER with the sniffles? That seems like a totally unavoidable and realistic problem. ESPECIALLY for small scale and underserved areas (and my understand is that this a common problem for similsr areas in Canada where small rural areas have trouble seeing a specialist of any kind).

I’d like to actually get some viewpoints on how it is supposed to work. Most of the people I end up talking to about this just tend to respond with “well it is free.” Which is crap of course. And then don’t bother to learn HOW it is supposed to work.

First, of course, we'd have to train more doctors and nurses. If the guy with a $20,000 deductible can suddenly go to the Dr. and pay a small co pay, then more people will go see doctors and more will be needed. Subsidizing the outrageous cost of medical school would be the first step.

Even with the current system, in which not just anyone can get medical care outside of an ER, there aren't enough doctors. Lots of patients instead see physician's assistants. Some pay for "concierge" coverage, which gives them priority when scheduling appointments. Others have to wait.

Then, we'd need to come up with a plan and ease into it gradually. Lowering the age of Medicare gradually should do the trick.
It could be done, but the insurance lobby will have to lose some of their power first.
 
Dec 2018
4,949
1,893
Florida
#4
First, of course, we'd have to train more doctors and nurses. If the guy with a $20,000 deductible can suddenly go to the Dr. and pay a small co pay, then more people will go see doctors and more will be needed. Subsidizing the outrageous cost of medical school would be the first step.

Even with the current system, in which not just anyone can get medical care outside of an ER, there aren't enough doctors. Lots of patients instead see physician's assistants. Some pay for "concierge" coverage, which gives them priority when scheduling appointments. Others have to wait.

Then, we'd need to come up with a plan and ease into it gradually. Lowering the age of Medicare gradually should do the trick.
It could be done, but the insurance lobby will have to lose some of their power first.
Who do you blame for the high cost of medical care by chance?
 

Babba

Former Staff
Jul 2007
76,467
67,458
So. Md.
#5
The single biggest obstacle Is the infrastructure, as Dittohead not! points out. The funding really wouldn't be particularly difficult. Under single payer for most people it would not be free. It would require an added payroll tax. For people who pay for their insurance, they would instead pay the government. Not a private insurance company. For those who get their health insurance fully paid by their employers, their employers could pay the payroll tax instead of paying for private health insurance.

And Dittohead not! is also correct that we will probably have to ease into it while we get the infrastructure in order. And we'll need to encourage young people to become primary care doctors and in some cases require them to work in areas short of doctors in exchange for their education being paid for.
 

Devil505

Former Staff
Jan 2008
72,101
30,165
Florida
#7
So I’ve thinking about this recently. On a few levels really. So one of the questions that I have to ask at this point is how is “free” healthcare supposed to work in the United States? I’d like to be walked through the idea here. Especially since I currently have valid health insurance paid by my employer.

Obviously healthcare isn’t ACTUALLY free. Nobody is expecting doctors or drug companies or hospitals to work for free. So my first question:

1) how is this to be funded?

2) If we are to switch to “single payer” and so on...how do I continue to go to my doctor? Since they are not working for free? How does that switch happen? Are they just submitting all claims to the government now? Will there be a screening process for my care? This leads me to my third question.

3) How do we prevent a run on doctors/hospitals? Now that everything is “free,” how do we stop people from going to the ER with the sniffles? That seems like a totally unavoidable and realistic problem. ESPECIALLY for small scale and underserved areas (and my understand is that this a common problem for similsr areas in Canada where small rural areas have trouble seeing a specialist of any kind).

I’d like to actually get some viewpoints on how it is supposed to work. Most of the people I end up talking to about this just tend to respond with “well it is free.” Which is crap of course. And then don’t bother to learn HOW it is supposed to work.
The same way we have a free army, navy, Police, fire dept and many other organizations that protect us from threats.......We pay taxes to finance them!!
(Middle class out of pocket expenses will be less because insurance company greed will not be paid anymore)
 
Dec 2018
4,949
1,893
Florida
#8
Look at how it works in most Western European countries, where there is a universal coverage of all people and different system for financing health spendings. And at least in Western Europe people live longer than in the US and money is already available and could be spent in a more performing way. What is needed is a political will for that.
There is not a comparable nation to the United States. The closest to our population thst is “European” is Russia. Then there is Japan (at less than half on an island). Then there is Germany. At 81 Mil people with 138 Mil square miles where the Us is 315 mil people with 3.7 million square miles.

The reason I bring population and geography in is that it absolutely does impact how and where you seek care (and can explain issues with regional access to medicine/care/outpatient). It is a unique issue for the United States. India and China are too big for the United States to model after (with different laws and values and economies) and the slightly smaller nations than the US do not have an economic infrastructure that we could model.
 
Dec 2018
4,949
1,893
Florida
#9
The same way we have a free army, navy, Police, fire dept and many other organizations that protect us from threats.......We pay taxes to finance them!!
(Middle class out of pocket expenses will be less because insurance company greed will not be paid anymore)
So it isn’t free. Like I said. We still pay for it.

I’m glad you said it in that tone.

Burnout, Financial Losses Cause PA EMS Corp to Close

Employees Claim Bounced Checks, Money Problems Inside Decatur EMS

This is a problem that happens with small towns. I have family in emergency services. Lots of family. And their volunteer departments have a hard time running. Money is a finite resource too. It comes from somewhere. And how you tax it and fund it is VERY important. Do you have projections on the price tag for annual costs? I don’t. But I’m betting it would be expensive.

THAT is a big reason I’m not on board with “free healthcare.” Not as long as it is “pass it to see what’s in it” legislation.

To use an analogy? I have always felt like it is a problem that is being treated like it is a patient that is bleeding out that needs emergency care rather than A patient with multiple systemic issues that require long term solutions. If that makes sense.
 
Feb 2011
16,920
6,053
Boise, ID
#10
So I’ve thinking about this recently. On a few levels really. So one of the questions that I have to ask at this point is how is “free” healthcare supposed to work in the United States? I’d like to be walked through the idea here. Especially since I currently have valid health insurance paid by my employer.

Obviously healthcare isn’t ACTUALLY free. Nobody is expecting doctors or drug companies or hospitals to work for free.
Virtually no one is arguing "it's free!" What some of them are arguing for is taxes in lieu of cost-sharing (cost-sharing being premiums, deductibles, co-insurance, and co-pays).
So my first question:

1) how is this to be funded?
By taxes, to the extent there is political will to raise them, and by federal deficit spending, to the extent that there isn't.
2) If we are to switch to “single payer” and so on...how do I continue to go to my doctor? Since they are not working for free? How does that switch happen? Are they just submitting all claims to the government now? Will there be a screening process for my care?
This hasn't been clarified and there is no consensus even among liberals/single payer advocates as to the answer to this question. Some recent iterations of single payer propose abolishing fee for service and instead paying providers by way of a federal global budgeting scheme (i.e., the federal government pays the facility's/provider's total operating costs up to a point). In this scenario, idealistically every facility and provider would continue operating exactly as it used to, except that instead of getting paid each time a service is provided, it is paid the way a government department is paid, by way of a "global budget" within which they are required to operate. Realistically though, this begs a litany of other spin-off questions.
3) How do we prevent a run on doctors/hospitals? Now that everything is “free,” how do we stop people from going to the ER with the sniffles?
Again, this too hasn't been clarified and there is no consensus even among liberals/single payer advocates as to this question. Recent iterations of single payer propose eliminating all cost-sharing, which removes the patient's incentive to avoid unnecessary care. You have some single payer idealists supporting single payer because they think it would mean the elimination of all cost-sharing, and then you have others that understand the complexities of the policy balking at this idea and saying "nah there would still need to be some cost-sharing."
I’d like to actually get some viewpoints on how it is supposed to work. Most of the people I end up talking to about this just tend to respond with “well it is free.” Which is crap of course. And then don’t bother to learn HOW it is supposed to work.
No one has any idea how they think single payer should work. They just say the same things over and over again. "It works in Europe!" They have no idea what they want, other than political support for single payer to help get a Democrat elected. When even a policy's strongest ideological proponents can't remotely agree on the core fundamentals of a policy, it becomes evident the whole thing is nothing but populist campaign fodder.
 
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