Once Its Greatest Foes, Doctors Are Embracing Single-Payer

Sep 2013
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On a hill
I have been a fierce critic of single payer in the past. After spending enough hours debating about it and learning about how the new health care law was intended to work, and why it was so imperative that something be done about health insurance in 2010-11, I've changed my attitude about it.

I could name 3-5 changes we could make to PPACA (or provisions we could add to it) and we would basically have single payer. Consolidated, they would be:

1) No employer mandate, instead offer tax breaks or other incentives to companies that discontinue providing health insurance if they pass along at least 80% of their savings to employees in wages. One example of such an "incentive" is to reinstate the "Cadillac Tax" and make it applicable to all companies that insist on continuing to buy their employees' health insurance, starting in 3 years (giving them that amount of time to decide to stop).

2) Make everyone eligible for subsidies, assuming their insurance costs more than (x)% of their mAGI. No family glitch, no 400% poverty level subsidy cliff, no disqualification for subsidies based on an employer's offer of coverage. Literally everyone should be eligible for subsidies if the cost of insurance exceeds a certain % of their mAGI. Some people will not need the subsidies if the total cost of premiums is still less than 9.5% of their income, but there should be no one that is arbitrarily excluded and screwed over.

3) Restore the individual mandate, but allow people to buy skinnier, higher-deductible plans than are currently allowed.

4) Loosen the restrictive rules around HSAs. Let everyone set up an HSA regardless of the insurance plan they choose. Make it easier for people to save some of their own money for health needs.

If we did these things, it would cause a) health insurance to become divorced from employment, b) every individual to independently choose the insurance they feel is right for them, 3) those that are currently being arbitrarily hosed by the law's glitches and provisions would get a more fair deal, leveling the playing field for customers, 4) everyone's personal health insurance expense to be a function of their income, which is an inherent feature of single payer.

The one major downside? It would cost more federal dollars. Whoopdy doo. We're spending the money already anyway, just doing it stupidly and arbitrarily unfairly.
That would still leave a myriad of insurers for doctors to deal with, making medical decisions, and inflating the cost of health care.
 
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Nov 2010
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It would be a hell of a lot easier for them and their staff to deal with one payer, instead of all these different insurance companies with different rules
 
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Nov 2016
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Of COURSE there are!

And when we get "Single Payer" there will be gubmint death panels.
And why would that be worse? If you die because you’re denied life saving care by a “death panel,” it won’t matter if it’s the government or a private company. You’ll be dead either way.

And if you think it’s easier to deal with a private company, think again. I’ve been left totally frustrated and angry, and feeling screwed, when trying to fight my health insurer.
 
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HCProf

Council Hall
Sep 2014
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Of COURSE there are!

And when we get "Single Payer" there will be gubmint death panels.
Medicare definitely does not participate in "death panels" Neither does Medicaid. I have seen approvals from Medicare that have shocked me. For example, hip replacements for patients who are in their late 80's to 90's if they are healthy enough systemically to undergo the surgery...knowing full well the patient will never get out of a wheel chair and proposed the surgery for pain relief. I saw it with my own Mother. Her final expenses in the hospital was near a 1/2 million dollars for her last admission. She was 85 years old, zero kidney function, heart failure and they still put her on 3 days of therapeutic dialysis which included round the clock observation with one nurse in ICU. She was also vented and heavily sedated. They were hoping to rest her kidneys with a CHANCE they start functioning again.
 
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Jul 2014
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Oh, the UK.. that the same guys who voted for Brexit, and are now whining that they can't negotiate with the EU to leave while maintaining all the advantages of being a member ?

yes, those guys currently end to vote for stuff that they regret a second later.
You think we should overthrow their gubmint?

Like some want to do with other countries like the Philippines?

Yeah, that'll teach em!
 

Rasselas

Moderator
Feb 2010
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I completely agree. I don't know if I would agree on where exactly to draw that line of minimum standards, but I agree there need to be some basics. Some of the fine-print exclusions border on fraud in my opinion. It shouldn't require expertise to understand before buying what's covered and what's not, and should actually provide a modicum of protection against catastrophic loss.

The main reason people are so freaked out about letting people buy higher-deductible, "skinnier" plans is not necessarily that they're quasi-fraudulent plans for dupes (maybe some are but that's not necessarily the case), it's that it enables a sort of adverse selection which causes lower-deductible ACA-compliant plans to rise in cost, which Republicans can then point to and say "See? Obamacare's a failure!" But if we made everyone eligible for subsidies, we shouldn't necessarily care that much if there's a little bit of adverse selection in ACA-plans and premiums are steep in the lower-deductible plans that attract sicker people, because that's where the subsidies would come in to smooth that out.
My concern is less what you're talking about than my concern that we need younger, healthier people to participate in the system. Those are the people who need more health education and more contact with health professionals when they AREN'T acutely sick. Part of the reason that other industrialized nations spend less on health care is that they promote healthier lifestyles, while our laws actually encourage people to live worse than they otherwise would (I'd throw in the subsidies for growing carbohydrates in the Farm Bill as part of this problem). Universal health care means better health education for everyone. We should have more of that, not less.

Ut used to be the government offered lots of message that helped people protect themselves from fraud, encouraged better diet, supported vaccination and other preventative health services, etc. Now only privately-funded messages get out there, and they benefit the people making money off our bad health choices.
 
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Jul 2014
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Would you be so kind as to cite the news articles which refer to British 'death panels'. I am curious, as I have not heard of any such accusation in the reputable British Media. Thanks. :)
Doubtful they would be CALLED "death panels".

They would be medical doctors, and bean counters, and lawyers who would decide who gets what treatment and under what circumstances.

Regardless of the name, they would be, in fact, death panels.
 
Jul 2014
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And why would that be worse? If you die because you’re denied life saving care by a “death panel,” it won’t matter if it’s the government or a private company. You’ll be dead either way.

And if you think it’s easier to deal with a private company, think again. I’ve been left totally frustrated and angry, and feeling screwed, when trying to fight my health insurer.
Who said it would "be worse"?

I said it will suck, and the reason I said it will suck, is because it will suck.

Healthcare already sucks in this country.

Different suckiness, that's all...