Is Single-Payer the Answer to the U.S. Healthcare System?

It's a well enough recorded fact by now that the U.S. overspends on healthcare. That its funding to public healthcare initiatives is now pressing in on countries that are overseeing aging crises, and in terms of the public kitty that percentage of GDP spent on Medicare, Vet Affairs HC, and other government initiatives outspends by capita any other Western nation with applicable public health service models.

So we already know the answer, single-payer is more successful. Master price lists with an understanding of acceptable profit margins that are collectively bargained for by governments rather than individuals, precisely because none of us can be expected to employ bargaining when we're already ill or injured, and no one will listen to you individually before you're sick. And heaven forbid if you're sick, uncovered, and thus have no capacity to negotiate ... your arse is firmly in the hands of debt collectors then.

The real question I want to ask is whether it is already too late for single-payer? ...

Now none of us want to think of the medical industry as self-obsessed, narcissistic and purely self-interested ... but it is. We know by now that simply having less state monopoly private healthcare isn't really the answer because each private healthcare fund has to do its own bargaining with its own hospitals, doctors and specialists.

Everyone, from 18th century economists to anyone with more than one neuron that has even caught a whiff of the exploding health budget of the U.S. understands allowing professionals to form labour unions and lobbyist firms in things like medicine is a bad idea...

That healthcare funds pass the costs of their corporate officer paycheques, the dividends they pay on shares, the medical sales reps they employ, the lobbyists and lawyers they have on retainer, the cost of negative-revenue on individual healthcare claims ... straight onto the people that get less out of their HCF than they pay into it. Essentially you're not only paying for other people, but also paying for corporations to turn a profit. It's insurance, and insurance companies will get money out of other safer/less costly patrons to cover their books.

A doctor isn't going to cut what they charge to just see a patient solely because a new healthcare fund starts up. Through proactive lobbying between medical institutions doctors already know just how much their colleagues in similar fields will charge, and lobbies aren't going to cut deals with or for bleeding hearts that might find this idea of medical hostage-taking morally wrong.

The ball is firmly with hospitals and medics, and singlepayer systems get around this through making demands as an industry whole ... so if doctors and hospitals don't want to play ball? Fine. They just miss out on upwards of 90% of their traffic. Which might be in their favour, but not exactly a stable foundation for which to build a thriving longterm business with aspirations to grow new clinics or run larger medical institutions that actually see returns on their efforts.

The question is rather ... is it too late for single-payer ... and what are you expecting singlepayer to do?

Ridiculous volumes of taxpayer money go to funding private HCFs in the U.S. in order to make HCFs even half cover their fund holders ... the game is rigged. After decades of this rigging, the lobbyists for medical institutions and doctors already have this political power and they won't back down fighting hair, tooth and nail for every item that government ever puts down on what is known as a 'master price list'.

Is the push for single-payer actually the hill that the 'evil liberals' want to die on, and has the ship already sailed? The question of single-payer being better has already sailed, but is by comparing single-payer solutions in the U.S. to other nations that have had it for decades already a venture doomed to disappoint people?

For all those people that want to see single-payer be a reality (where you actually get what you pay for and can negotiate costs BEFORE you get sick, which should be a given) ... what do you want to see in terms of the inevitable medical lobby battle that will likely paralyze single-payer initiatives for years to come?

I do not think single-payer is necessarily the best way to go for America. Single-payer health insurance is effectively nationalisation of the health insurance industry. That does result in better health care for more people, and it does generally cost less in raw dollars than the private health insurance industry, but it's a difficult process to get there.

For starters: the health insurance industry in the US employs damn near two million people. If the US went to single-payer overnight, they would have to hire all those people. But! Single-payer is much more efficient than a mix of private health insurance firms, so the substantial majority of those people will not be needed by the government to run the new system.

For context, picture the unholy fuss raised in the US over job losses in the coal mining industry, which employs about a hundred thousand people nationwide. Now imagine that was one million jobs, gone overnight. The backlash would be immediate and catastrophic.

It's not impossible for the US to shift to a single-payer system. I would not advise it, because I think a better target is to aim for a publicly funded universal healthcare system as a foundation available to all citizens, whilst allowing private health insurers to continue offering more expensive and more generous plans to those who can afford it. That's basically what we have in Australia; it would preserve the health insurance industry while eliminating the largest problem, which is the significant healthcare costs born by the poorest segment of the community.

Ideally, you'd package that with nation-wide reform of treatment costs, to stop this bizarre situation that exists currently where healthcare providers pull arbitrary charges out of their nether regions and pharmaceutical companies jack up the price of life-saving drugs by 5,600% overnight.

Couldn't this be done but at the state level. It's probably too complicated/expensive to do it everywhere at once (not too mention politically impossible with republican voter) but it's seems feasible to do it for the state, say a small one like Vermont could just switch to single payer and after a few years would show positive results from that. Other state would copy it, or even join it's scheme and eventually most of the country would be covered.

I don't know much about this myself but according to some of my friends who make medical policy one of the problems that drives up the cost of US health care is the legal culture there where doctors can get sued if they don't do enough so they recommend all kinds of unneccesary threatments and tests on the off chance that it does something.

The first thing that we need to do is put in place price controls for medicine and medical treatment. With prices where they are now it's just not going to be possible for even a nation state to cover American medical costs.

And the good news is that ballot initiatives to put such controls in place have already been introduced.

The bad news is that the medical insurance industry has been fighting them tooth and nail. One story that everyone might have missed during the Virginia elections was a ballot initiative in Ohio to put such controls in place. Unfortunately, the measure was killed after the industry spent $49 million lobbying against it.


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