Contributor Post Created with Sketch. How a Single-Payer Health Care System Might Really Work in the US

 

twenty20_225d2211-cdeb-472f-81f4-5913e764c27a_health_care-e1463412404193The Bernie Sanders presidential campaign isn’t going anywhere, but his idea of single-payer healthcare will surely live on. Now, an analysis earlier this year from Emory University’s Kenneth Thorpe found the Sanders plan costs much more than Team Sanders estimated — $2.5 trillion a year over the next decade vs. $1.4 trillion. A new Urban Institute report finds a similar result:

In total, federal spending would increase by about $2.5 trillion (257.6 percent) in 2017. Federal expenditures would increase by about $32.0 trillion (232.7 percent) between 2017 and 2026. The increase in federal spending is so large because the federal government would absorb a substantial amount of current spending by state and local governments, employers, and households. In addition, federal spending would be needed for newly covered individuals, expanded benefits and the elimination of cost sharing for those insured under current law, and the new long-term support and services program.

So taxes would have to go up — a lot — to pay for this increased spending. But wait: Other nations with single-payer systems spend much less as a share of GDP on healthcare than the US does. So why would a shift here entail spending so much more?

From the New York Times today:

One reason is that the Sanders plan covers far more than typical insurance plans in the United States — or abroad. The Sanders plan would charge no premiums, require no out-of-pocket spending and would pay for services like dental care and long-term nursing home stays. Those things boost the total price tag.

But imagine a universe where we had a single-payer health plan that was more like normal insurance. Perhaps it would be a true “Medicare for all,” where everyone has exactly the insurance that the federal government currently provides to older people and the disabled.

That Medicare-for-all plan would still cost more than single-payer plans in other countries. Here’s why: Medicare pays doctors and hospitals higher prices than single-payer systems do in other countries. The Organization for Economic Cooperation and Development, which looks at a group of developed countries, has found that the United States pays substantially higher prices for doctors, hospital stays and prescription drugs than the rest of the group. Medicare pays less than the United States average, but not enough less to make up that difference.

Making the American health care system significantly cheaper would mean more than just cutting the insurance companies out of the game and reducing the high administrative costs of the American system. It would also require paying doctors and nurses substantially lower salaries, using fewer new and high-tech treatments, and probably eliminating some of the perks of American hospital stays, like private patient rooms. The average family physician in the United States earns $207,000, according to the Medscape Physician Compensation Report. General practitioners in Britain, which has a single-payer system, earn $81,000 to $122,000. The gaps in pay for specialists are even bigger. The Urban Institute report assumes that the Sanders plan would cut pay for doctors substantially, but not by half. That’s a reasonable assumption. …

The Sanders plan would require a huge reorganization of the country’s health care system. Overnight, it would put the private insurance industry out of business, along with many other businesses that support it. It would shift billions of dollars of spending from individuals, workers and states into the federal budget. Doing that might well reduce some of the country’s health care spending that is going toward insurer profits and paper-pushing.

But more than 80 percent of the dollars we currently spend on health care actually go toward health care. And making big cuts all at once to doctors and hospitals could cause substantial disruptions in care. Some hospitals would go out of business. Some doctors would default on their mortgages and student loans. Even if the country decided that medicine should become a more middle-class profession — not an obvious outcome, given the substantial public support for the medical professions — it would be difficult to get there at once. All of that means that bringing a government-run, single-payer health care system could achieve many of the goals of its advocates: more equity, lower complexity and some reductions in cost. But the United States would probably continue to have the most expensive health care system in the world. And we’d have to raise taxes high enough to pay for it.

Let me add one more thing: “We are not a nation that has a cost-growth problem; we’re a nation that used to have a cost-growth problem, in the 1970s and 1980s.”

There are 13 comments.

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  1. Lily Bart Inactive

    When are they going to propose confiscating 35% of our income to provide our housing for us?

    I don’t see what right a government founded on the principal of liberty has to take over heathcare. Where do I go if I’m yearning to breath free?

    • #1
    • May 16, 2016, at 12:20 PM PDT
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  2. Old Bathos Moderator

    Another $2.5 trillion per year? Pshaw. Exxon and the Koch brothers spend that on caviar and yacht wax every other month, don’t they? Seriously, if we make only mean people and The Rich pay for it, how can there be a problem?

    You toss out these cost numbers but since math is just another form of rape why should we listen? Besides another $8000 per head per year in the US is probably like 1% of how much Wall Street steals from the middle class every day (see, dude, I can do the number rapey thing too!).

    But this whole numbers thing is a major buzzkill. It is the main reason why we Feel the Bern not Think the Bern.

    • #2
    • May 16, 2016, at 12:23 PM PDT
    • Like
  3. MLH Inactive
    MLH

    Old Bathos:[snip]But this whole numbers thing is a major buzzkill. It is the main reason why we Feel the Bern not Think the Bern.

    LIKE!

    • #3
    • May 16, 2016, at 12:47 PM PDT
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  4. PHenry Member

    The reason health care is too expensive in America is because we pay our doctors way more than minimum wage. They are getting rich off of the sickness of others!

    Lower the pay for all health care personnel and the cost will drop! Of course, unless you want the checkout guy at 7-11 to moonlight as your doctor, you might prefer they get compensated for having a doctorate degree- but that doesn’t fit the socialists ideas of justice.

    It’s easy to make a service affordable enough for everyone, just lower the quality to the point that nobody wants it at any price, and demand will drop, lowering prices!

    • #4
    • May 16, 2016, at 12:49 PM PDT
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  5. EJHill Podcaster
    EJHill Joined in the first year of Ricochet Ricochet Charter Member

    It doesn’t come down to how we practice medicine in this country, it comes down to how we practice law. Any doctor will tell you that they primarily practice defensive medicine, to mitigate any claim that they were negligent in treating a patient.

    Consider this:

    • Half of US payments going to legal costs rather than compensating patients.
    • Few other countries allow cases to be decided by jurors. Most use judges or administrative procedures to determine liability.
    • Canada and the United Kingdom impose caps on pain and suffering awards.
    • Most European countries prohibit contingency fees (where lawyers take a percentage of the damages awarded) which are almost exclusively used in the United States.
    • Canada, Europe and Australia all have loser-pays provisions in their medical malpractice systems. The US does not.
    • Sweden’s average award for 2004: $22,000. US median award for 2005: $400,000 with 21% of awards being more than $1 million.
    • Internists in Canada pay between $1800 and $3200 per year for malpractice insurance. Internists in Cook County and Madison County, Illinois pay more than $41,000 per year. Obstetricians in Cook County pay nearly $180,000 per year in malpractice insurance.

    Source: Emergency Physicians Monthly

    • #5
    • May 16, 2016, at 12:58 PM PDT
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  6. Kozak Member
    Kozak Joined in the first year of Ricochet Ricochet Charter Member

    Americans would have an absolute fit if we had the kind of wait times and limitations on treatment they have in the UK. Over 60 and kidney failure ? Sayonara. Need a hip? Take a number, we might get to you in a year. Need a CT scan? 6 months. Breast cancer? No advanced immunotherapy for you. Macular degeneration? You get a dog and a cane. In Canada, doctors are limited in compensation. So for example, Neurosurgeons are unable to bill after September because they’ve billed the max, and just …stop.

    Also, better do a major rework of our current malpractice laws. If you force me to alter my practice to save money, you better remove the “I’m gonna sue you” threat if I don’t do every possible test and study to evaluate a patient.

    Finally we need to stop throwing billions at illegal healthcare. The following is a screen shot of a single patient who is common where I work. I work at a major, US teaching hospital in a Southern state. Every day we see illegals who are cycled through the Emergency Room for dialysis. This means they make multiple visits a week. This is because the hospital cannot provide them with outpatient dialysis, so every routine dialysis becomes an “emergency”, and is covered by EMTALA. That means an ER visit and dialysis. We see at least 4-5 patients like this every day at our facility.

    IMG_1954

    • #6
    • May 16, 2016, at 12:59 PM PDT
    • Like
  7. Pelayo Inactive

    PHenry:The reason health care is too expensive in America is because we pay our doctors way more than minimum wage. They are getting rich off of the sickness of others!

    Lower the pay for all health care personnel and the cost will drop! Of course, unless you want the checkout guy at 7-11 to moonlight as your doctor, you might prefer they get compensated for having a doctorate degree- but that doesn’t fit the socialists ideas of justice.

    It’s easy to make a service affordable enough for everyone, just lower the quality to the point that nobody wants it at any price, and demand will drop, lowering prices!

    I have read about Medical Doctors in Cuba who drive a taxi cab because it pays better. There are also accounts of Cuban Doctors who are sent to Venezuela by the Government and proceed to escape across the border to Colombia. No incentives equals no motivation.

    This is a case “getting what you pay for”. If we want highly-capable and well-trained Physicians in America, we need to pay them accordingly. Otherwise intelligent students will pick other areas of study that pay better for equal or less cost, time and effort. I don’t want the kid who got C’s in high school performing surgery on me.

    • #7
    • May 16, 2016, at 12:59 PM PDT
    • Like
  8. Z in MT Member

    James Pethokoukis:That Medicare-for-all plan would still cost more than single-payer plans in other countries. Here’s why: Medicare pays doctors and hospitals higher prices than single-payer systems do in other countries. The Organization for Economic Cooperation and Development, which looks at a group of developed countries, has found that the United States pays substantially higher prices for doctors, hospital stays and prescription drugs than the rest of the group. Medicare pays less than the United States average, but not enough less to make up that difference.

    Making the American health care system significantly cheaper would mean more than just cutting the insurance companies out of the game and reducing the high administrative costs of the American system. It would also require paying doctors and nurses substantially lower salaries, using fewer new and high-tech treatments, and probably eliminating some of the perks of American hospital stays, like private patient rooms. The average family physician in the United States earns $207,000, according to the Medscape Physician Compensation Report. General practitioners in Britain, which has a single-payer system, earn $81,000 to $122,000.

    This section explains why the progressives and socialist always focus in the wrong area when it comes to American healthcare.

    • #8
    • May 16, 2016, at 1:18 PM PDT
    • Like
  9. Chris Johnson Inactive

    I echo the comments of EJ and Kozak and add that, when I was considering med school, the doctors I worked with were, (each!), paying around $90,000/year in malpractice insurance, plus the surgical instruments we used were purchased by them, for typically @ $40,000 for each surgeon, and that was in the 1980s. Add the cost for medical school itself and I/my family could simply not afford it.

    In countries with “single payer” most “doctors” patients see do not actually have doctorates. We are already seeing more of this in the US, as more patient care is being provided by Physician Assistants and Nurse Practitioners. It would be useful to see an actual, apples-to-apples comparison of costs. I am all for reducing waste and costs associated with red tape, but we need to include the mortgage and student loan defaults of all the attorneys that live well off the proceeds of “Health Care” costs when we talk about, “making medicine a more-middle-class profession…”.

    • #9
    • May 17, 2016, at 4:33 AM PDT
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  10. Tim H. Member

    PHenry:The reason health care is too expensive in America is because we pay our doctors way more than minimum wage. They are getting rich off of the sickness of others!

    Heh! I should start saying that as a professor, I get rich (or, well…) off the *ignorance* of others. ;)

    • #10
    • May 17, 2016, at 7:30 AM PDT
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  11. Tim H. Member

    Kozak:Americans would have an absolute fit if we had the kind of wait times and limitations on treatment they have in the UK. Over 60 and kidney failure ? Sayonara. Need a hip? Take a number, we might get to you in a year. Need a CT scan? 6 months. Breast cancer? No advanced immunotherapy for you. Macular degeneration? You get a dog and a cane. In Canada, doctors are limited in compensation. So for example, Neurosurgeons are unable to bill after September because they’ve billed the max, and just …stop.

    This horrifies me, and I have known of these kinds of examples for years. Yikes!

    • #11
    • May 17, 2016, at 7:35 AM PDT
    • Like
  12. Sweezle Member

    PHenry:The reason health care is too expensive in America ………… Is mainly because physicians need Cadillac malpractice insurance to support the legal profession

    ———————–

    ………….having a doctorate degree……..

    Imagine the terrifying world of medical care being delivered by ph.d’s who didn’t go to medical school (no thanks) I’ll take an M.D. to do my surgery.

    • #12
    • May 21, 2016, at 7:03 PM PDT
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  13. MLH Inactive
    MLH

    Sweezle, this drives me nuts in the world of PT, too. The current entry level degree is DPT (reminds of getting my diptheria vaccination): doctor of physical therapy. Those that have ’em all insist on calling it a doctorate (I’m a “master,” BTW).

    • #13
    • May 21, 2016, at 7:11 PM PDT
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