Bernie Sanders Single-Payer Healthcare plan

@revelette2,

Other countries do public healthcare for about the same as we spend per capita on just Medicare and Medicaid. We definitely can afford it but not if paying the inflated cost we currently pay in private systems.

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@Robert Gentel,

Perhaps the problem is how much health cost rather than how to pay for it. (probably said nothing new) I only know I don't think Sander's plan will work but that doesn't mean we shouldn't still strive to have universal health care. The middle class is already suffering, I don't think they need new taxes on top of the ones they are already paying.

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@revelette2,

revelette2 wrote:

Perhaps the problem is how much health cost rather than how to pay for it.

That is pretty much my view and I think that single-payer healthcare helps to address this concern more directly. I think that the main problem in the US is that the healthcare costs have spiraled out of control due to private practice's tendency to maximize profits over time. Single-payer government-run would directly address this and single-payer privately-run would indirectly (massive purchasing power to negotiate prices).

I'm not too familiar with Sander's particular plan but single-payer universal healthcare is something that America can afford. There are plenty of examples of first-world countries that do this and spend much less per capita than we already do on our shitty healthcare system.

I think there is a greater argument that America cannot afford to not implement a single-payer system. We are already paying about 3 times as much per capita compared to countries like the UK and Japan (or 2x that of Canada or the average industrialized nation) and getting much less to show for it.

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@Robert Gentel,

Quote:

There was political capital for a change, unfortunately we went with the wrong change.

That's very possibly true and and damned unfortunate if it proves to be so.

As regards "false dilemma", yes, if framed that way. This complex situation in the US as Obama tried to reach for a universal scheme isn't something I've delved into to any depth at all. But we all understand to some degree the broad opposition he faced. The following might be relevant. And it speaks to edgar's notion that a populist push, obviously of a dimension I see as unlikely, would be required...

Quote:

Commentators have often wondered why the campaign for state medicine succeeded in Canada and failed in the United States. The battle for Medicare occurred in the 1960s when our political culture was moving to the left. Medicare’s first breakthrough

It is not surprising that the first breakthrough would be in Saskatchewan. The province, which was the home base of “agrarian socialism,” had been governed since 1944 by the Co-operative Commonwealth Federation (CCF) led by T.C. (Tommy) Douglas. The CCF had originally intended to socialize much of the economy but, like social democratic formations elsewhere, had retreated from this position and by the 1950s concentrated on building a welfare state within a mixed economy...

https://canadiandimension.com/articles/view/the-birth-of-medicare

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@blatham,

The counter-argument to my position would be that there was not enough political capital for anything else. That may well be true, but I think that he not only squandered any political capital for healthcare reform but by rushing to push his signature change for his first term through he squandered political capital for other causes as well.

He underestimated the intransigence of his political opponents, who were not going to meet him in the middle if he compromised (and yes Obamacare is a big compromise from the single-payer that much of the left supports) but was too keen on getting something to show for it and as a result there is little but a deeply compromised Obamacare to show as a signature domestic achievement in office. Obamacare was a compromise for both the right and the left but the left has nothing to show for the compromise, the right was obstructionist the rest of the way and held to ever more extreme positions.

He should have gone for single-payer and stuck with it, it might have taken a few years longer to win that argument and might have even failed, I admit, but we are stuck with a bandaid hack to the system for now that is ultimately going to contribute to making the system worse (it will inflate the costs even further to just throw more money at it).

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@Robert Gentel,

I posted a thread here at one point about a New Yorker article by Atul Gawande, an m.d. writer I listen to. He described two types of healthcare in a Texas town in a way that showed the dreadful side of our make-lot-of-money practices (in both senses), and the benefits of the opposite both re the population and the actual treatment.
Will check if the article is still accessible, link if it is, but in any case, if you run across his name, he's worth a read.

Don't know if he has addressed the single payer system recently, might have.

Aha, that was in 2009. This post explains a bit, and gives links to two articles:

http://able2know.org/topic/89938-178#post-3732316

also, background -
https://en.wikipedia.org/wiki/Atul_Gawande

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@Robert Gentel,

I do see one problem with single-payer. The customer (patient) will not be making decisions based on cost. If I go shopping and you are paying, I have no motivation to control costs.

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@Robert Gentel,

Quote:

The counter-argument to my position would be that there was not enough political capital for anything else. That may well be true, but I think that he not only squandered any political capital for healthcare reform but by rushing to push his signature change for his first term through he squandered political capital for other causes as well.

Possibly, but I'm not certain that's so. As his opposition was concentrated on denying him any political capital at all, in any sphere, it isn't clear how he might have been more productive elsewhere if he hadn't pushed healthcare reform. But at the same time, I have to acknowledge that, for the right, this was a uniquely threatening political thrust.

Quote:

He underestimated the intransigence of his political opponents

Yes, he did. That he finally arrived at this revelation doesn't help much. Ironically, a fundamental reason I initially supported Hillary 8 years ago was
because I thought she had, as a consequence of the eight years her husband was President and all that came with that, a much clearer understanding of what the right had become. But there's a tricky factor in there as well. Obama has, I think, remained a civil and civilizing influence on present American politics through rejection of polarization. Not just because he was african american and therefore necessarily constrained (so as to minimize the potential for a more severe racial confrontation) but because of his personality. This may be a delusional or romantic notion, but it is one I hold.

Quote:

He should have gone for single-payer and stuck with it, it might have taken a few years longer to win that argument and might have even failed, I admit

If just some years longer to achieve, yes (though that seems likely to have had consequences for other initiatives). But if he'd failed, how long before any attempt would again be made? And god knows what the political climate will look like up the road.

As regards the economics involved here, I simply do not know enough to bother opening my mouth.

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@blatham,

Gawande talked about the economics, if I remember, but don't recall how deeply he did, and he likely has written more since.

Here's the Gawande article I'm remembering -
http://www.newyorker.com/magazine/2009/06/01/the-cost-conundrum

I remember that when I posted it, I could only post a short part (Paywall in place? dunno), but it appears all there, now.

Rereading it, I want to print it out as it's relatively short, but since it's clickable, I won't.

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@ossobuco,

Thanks osso. But can I beg to be excused? Of all the possible topics that I want to spend my time struggling with, economics is down near the shoeing of horses, the periodic table and Freudian analyses of career proctologists.

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@blatham,

I agree on economics, though I must have genes for that, other side of the family, I am blatantly annoyed by most mentions, lifetime uninterest, no matter that I should have listened at least some of the time.

Sorry you won't even look at this guy, your loss. He is a well regarded md who is for single payer, and early at it.

Interesting, both you and Roger dismissed him out of hand without reading further.

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@roger,

It's definitely true to say that the shopper doesn't have motivation to limit costs in this scenario, so in any such implementation it will be up to the buyer (i.e. the government) to limit coverage. The issue of the government determining treatment is tricky to get the balance right but moot for anyone who can afford to private care, and private care is much more affordable.

Ultimately the bottom lines speak for themselves, the countries with single-payer healthcare have all managed to do it for less money than we currently spend. Japan and the UK spend nearly 1/3 what we spend per capita (both private and public) and the average developed nation (or Canada for a close reference point) spends about 1/2. I think it's clear that while imperfect in such ways you point out that it can be made workable and that it can be more efficient than the way we currently do things.

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@ossobuco,

No, not dismissing him at all. Just directing my limited time and brain cells in other spheres rather than economic considerations. Honest to betsy. I know I miss tons with my allocations but there it is.

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@blatham,

blatham wrote:

Possibly, but I'm not certain that's so. As his opposition was concentrated on denying him any political capital at all, in any sphere, it isn't clear how he might have been more productive elsewhere if he hadn't pushed healthcare reform. But at the same time, I have to acknowledge that, for the right, this was a uniquely threatening political thrust.

It's hard to say and certainly an observation made in hindsight but I think pushing smaller changes first would have worked out better for him, and that focusing on resolving the mechanisms of obstructionism first (debt ceiling is certainly one that is clear in hindsight) would better prepare him for big changes.

He swung for the fences right away, which is certainly his prerogative but I think contributed to the deadlock that resulted, any huge change is going to be a bit divisive and he didn't land softly.

But who knows, I can't say for sure either.

Quote:

But there's a tricky factor in there as well. Obama has, I think, remained a civil and civilizing influence on present American politics through rejection of polarization. Not just because he was african american and therefore necessarily constrained (so as to minimize the potential for a more severe racial confrontation) but because of his personality. This may be a delusional or romantic notion, but it is one I hold.

I agree with your overall assessment of him, and think more highly of his character than I do of Hillary, but I also think that this contributed to his weaknesses. His instinct to seek consensus is a good thing, but he sometimes sought it long after the point at which it was worthwhile to seek.

Quote:

If just some years longer to achieve, yes (though that seems likely to have had consequences for other initiatives). But if he'd failed, how long before any attempt would again be made? And god knows what the political climate will look like up the road.

Impossible to say really, and there are good arguments for him being responsible for achieving what he can now for his constituents now. I personally take the longer-term outlook and prefer actions that have longer term benefits (it's often in the current constituent's interest to rob the future constituents, after all) but understand the acuteness of the here and now as an argument for doing things that might be half-measures when considering longer-term ideals.

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@blatham,

This one is the wrong drop, he may be part of the fix, not about economics as such, but about health and access to it, thus following economics as needed discussion.

I also get not liking being told what to read, so I get you.

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@Robert Gentel,

I want to slip this in here, Robert. Over the last 20 plus years I've been posting online, I've written in scads of different communities and had discussions with thousands of individuals. And I can honestly say that I don't know if I have bumped into anyone who does rational, thoughtful, intelligent, careful and mannerly discourse better than you. (I'd add a joke here but nothing comes to mind).

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@ossobuco,

Osso
I don't mind being told what reading might advance my learning. I really don't. And you have never insisted. I'm just a lazybones about some stuff.

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@blatham,

Me too. I'm a reading person to a fault and, at the same time, a lazybones.

Oh, look, we could start a lazyblog..

Bernie Sanders Single-Payer Healthcare plan

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