[iamerroragent]

Imagine a world where one entity received all the peoples medical bills and was incentived to negotiate for the lowest possible rate from each provider. Imagine the savings alone from reducing a massively overly bureaucratic and complicated system down to just one entity negotiating and paying the health service providers. Just imagine in that world this article would have never needed to have been written.

[elzbardico]

The reality is that both systems suck, and I say this having lived in systems with universal public healthcare.

They just suck in different manners, different countries have different degrees of "suckness" and so on.

And then there's the big problem beyond the question of who is paying: How much is being paid.

Healthcare costs in the US are absurdly high both on relative terms (things are way more expensive) and on absolute terms (more of the same things is needed because the American population is relatively too unhealthy for what you'd expect in a developed country with similar demographics). You need to ask why relatively inexpensive stuff like insulin is so much expensive in America than say, Germany or the UK.

If you don't solve this issue, a single payer system would probably become more similar to the terrible situation in most Latin American countries, where you have terrible supposedly universal public healthcare systems, but where in practice if you can pay for private insurance, you will do it.

[relaxing]

> Healthcare costs in the US are absurdly high both on relative terms (things are way more expensive) and on absolute terms (more of the same things is needed because the American population is relatively too unhealthy for what you'd expect in a developed country with similar demographics). You need to ask why relatively inexpensive stuff like insulin is so much expensive in America than say, Germany or the UK.

Must be that law of economics that says the more you make of something the more expensive it gets.

[vianneychevalie]

I know you're joking here, however, increasing marginal costs products are well-know and studied in microeconomics.

https://www.investopedia.com/terms/l/lawofdiminishingmargina...

[Alupis]

> Imagine a world where

Yes, and let's also imagine all of the existing single-payer systems (de facto or otherwise) work as advertised and didn't have elites-with-means flee to other nations for quality care.

Let's also imagine these systems provide stellar quality care and more importantly, timely care.

We can daydream all we want - but the reality isn't so obvious or absolute.

For those who are really in the know... the US already is a socialized medicine nation. Look at how much of the US annual budget is blown on medical care. Hint... it's larger than the military budget.

[eftychis]

My personal experience as a European citizen living in the U.S. is drastically different.

I flee the U.S. to have all my medical related tests and work, out of pocket, in the E.U. And it is cheaper and much much better experience. (And I don't get different treatment compared to any members of my family that are insured in Europe for paying out of pocket.)

First of all: I speak with a doctor. Not a nurse, an administrator to size me up, to see if I am in actual need of an appointment, but a doctor. (Yes, this has happened to me in the U.S. I find it unacceptable, especially given that I was apparently in much more dire situation than I even thought, and was lucky to be seen by a doctor, otherwise I would have joined the disabled group of individuals.)

I am not sure why people in the U.S. keep bringing up the UK [Edit: -- not sure if that is what you are implying but most people are in other comments]. Pick any EU country. Sure, you might not have a 5 star doctor's office, but you are going to be treated by a doctor efficiently. And that is what matters. Don't waste money on administrative tasks and fees.

[BoorishBears]

Not a solution for everyone... but I have to ask, since you have the time to go to the EU for routine medical work, why not move to somewhere in the US that has doctors?

Also looking at a primary care wait time is fine, but what is broken in most single player systems is specialists and "non-emergency surgery"... which is often stuff that significantly affects your quality of life.

https://worldpopulationreview.com/country-rankings/health-ca...

(the colors represent a primary care, but actually hover over each country...)

-

I ruptured a ligament in my knee and since it wasn't a traumatic injury, the surgery to repair it was considered a non-emergency and I was sent home from the ER.

My uncle is an orthopedic surgeon in Norway and was shocked to hear I was already scheduled for surgery to repair within a week. He said in Norway that would easily have been a month or two wait, which is alarming to me.

At the end of the day the US system is broken, but I think this illusion that single player is some strictly better concept that the US is just rejecting is also wrong. Care is noticeably worse in many EU countries when you look past the singular measure of "Time to see your primary care"

[inetknght]

> why not move to somewhere in the US that has doctors?

Do you have a suggestion where in the US that is? The US has many doctors but essentially all of them are gated behind insurances and especially hospitals.

[Alupis]

What are you imagining it should be?

You can see your doctor pretty much freely within the US for nearly any reason. This idea you cannot see your doctor in the US, or that you receive treatment from nurses or administrators is simply not true.

> insurances and especially hospitals

You may be confused, because some doctors operate private practices, while others choose to work for large hospital organizations. Private practices may be more akin to what some people's idea of a doctor should be. Most insurance plans offer a selection of hospitals and doctor networks, allowing you to chose the style and type that works best for you.

In all cases, you can see your doctor if needed, with very little lead time if any.

[genocidicbunny]

> You can see your doctor pretty much freely within the US for nearly any reason.

Sorry, as someone who knows multiple people in various parts of the US healthcare system, this is pretty laughable. At the very least, we have different definitions of 'freely'.

Most of the urgent care clinics near me, for example, no longer accept patients without appointments. ER wait time is several hours, and you will owe hundreds if not thousands of dollars after unless you have _very_ good insurance.

> This idea you cannot see your doctor in the US, or that you receive treatment from nurses or administrators is simply not true.

Not from administrators, but nurses yes. Many clinics will only have a RN on duty large parts of the time. There are also systems where you can set up telehealth appointments, but a lot of the time they will be with a nurse and not a doctor.

> In all cases, you can see your doctor if needed, with very little lead time if any.

My parents have been trying to address some conditions they've developed, in one case, pretty serious. There's a several month lead time on their appointments to deal with this.

[jcrawfordor]

There are large parts of the US where private practices are very rare and the major care provider organizations have multi-month waits for both primary care and specialists. As I understand the overall trend is towards longer wait times but it is significantly worse in some cities than in others. Where I am, for example, it is around six months to get an appointment with some fairly common specialists... and that's a mid-size city with a university hospital and everything. My former primary care doctor only had availability about three months out, but I am fortunate enough to have found a small private practice that has far fewer patients per provider... at the cost that I pay a large annual practice fee to be a patient.

I think this is pretty uneven across the country but it is definitely far from guaranteed that you can see a doctor on demand with a short lead time. I have heard of similar problems pretty much throughout the central region of the country. In an attempt to alleviate the situation a number of states have programs where they pay subsidies to providers in areas with longer wait times, but this turns into a complex billing system and states often can't afford enough to really make a big difference.

In some ways the private insurers are doing some good here, as several offer "patient concierges" that will do things like try to find a provider for you that's accepting new patients. But in a recent experience that involves calling every two weeks and being told they still can't find any availability, for a couple of months.

[callalex]

I’m happy for you that you have been served so well. However that is not the case for everyone, and your dismissal of others’ experience is so strong and condescending to the point that you sound like a real jerk. Other people report a lot of problems with their healthcare. You should listen to them, as they have very little incentive to lie.

[BoorishBears]

I mean I've lived in 4 cities in the last 8 years, and in every single one I could see a primary care provider on a day's notice.

Although actually re-reading your post, it sounds like you're really just trying to take a dig at Nurse Practitioners, most of which hold doctorates.

I guess if you're too good for a DNP, the primary care must in fact seem like an impossible thing, in which case I do wish you good luck on the 8 hour flight for "all my medical tests".

[drstewart]

>to have all my medical related tests and work, out of pocket, in the E.U.

Wow. Imagine a world where one entity received all the peoples medical bills instead. Too bad the EU can't achieve that.

[nhinck2]

There are plenty of countries which operate functioning public health systems with optional private care. There is no daydreaming required.

[Alupis]

> There are plenty of countries which operate functioning public health systems with optional private care.

You mean the US...?

It's a quaint idea... but nobody likes the reality once it's implemented. Evidenced by the fact that the US is already the largest public health system in the world, and people do not even realize it.

[nhinck2]

No, functioning, so not like the US, universal public health care with costs covered by the government.

I'm not sure why you're ignoring a lot of Europe, Canada, Australia and New Zealand.

[dsfyu404ed]

The states that were well on their way to having public options before obamacare generally have ok public options at this point. Frankly they probably would have done better without the federal wrench being thrown into things.

[Alupis]

> I'm not sure why you're ignoring a lot of Europe, Canada, Australia and New Zealand.

These are exactly the ones I had in mind.

> universal public health care with costs covered by the government.

To be pedantic, this doesn't exist anywhere in the world. The taxpayers foot the bill universally. You may not personally care, but it matters when we're discussing spending other people's money.

In the US, we already have universal public health care. If you cannot afford to pay a portion of your premium, you can be eligible for healthcare at zero expense to you.

The US government spends more on healthcare than any other nation. The US is already socialized healthcare. It's just not the utopia people thought it would be so they continue to complain...

It gets way more complicated than we can discuss here - things like private premiums are so expensive because the socialized system does not pay it's entire bill, etc. The entire thing is a massive C.F. but speeding further down that same tunnel is not going to suddenly magically make it better. It's very much-so the "but we can do it better" mentality, despite however many previous attempts there has been.

[CraigJPerry]

>> These are exactly the ones I had in mind

Those countries citizens rate their happiness with the healthcare system in their country ~2x higher than US citizens do. So that line of thinking doesn’t hold.

>> it matters when we're discussing spending other people's money

That’s not how money works and until that fundamental misunderstanding is eliminated, learned helplessness will prevail. A country that issues its own currency cannot save money in its own currency.

The hard limitation a government faces is resources, not capital.

[ratboy666]

The provider of care gets paid "a reasonable amount". The care is provided. No bureaucratic nonsense. Sound ideal. Except... someone invents a novel care. They can choose to provide it "for a reasonable amount". But it can ONLY be provided by the entity paying "a reasonable amount". That entity has to make the call "novel care/old care". Old care is ALSO provided at a "reasonable amount" and has entrenched interests. There is no way that novel care wins. Without setting up an alternate system, or going OUTSIDE the system. Then, consumers of old care can see novel care and its benefits. They can then demand novel care. This happens within the American system, and the American system provides that "outsider status" to other systems (like the one we have in Canada). What does the Canadian system eventually go? Without sufficient external force, it is less expensive to provide MAID (medical assistance in dying) that actual healthcare. The current debate in Canada is whether mental illness is a sufficient trigger for MAID. Depressed? Best cure is death. And, yes, Canada has been mocked for that.

[Nition]

https://pharmac.govt.nz/about/what-we-do/pharmac-history/

[avidphantasm]

Bu…bu…but we can’t have “big government”!!! Imagine the horrors!

[firstlink]

> was incentived to negotiate for the lowest possible rate from each provider

So, not an entity which by its very nature spends other people's money and can never run out? I agree, sounds like a great idea, but someone will have to invent such an entity first. The ones we have would not meet the requirement.

[yamtaddle]

Thank god no-one's tried, I'm sure the population of any such country would riot to reform to something free-market-based instead in short order, because expenses would rapidly grow out of control, vastly in excess of, say, what the US spends per-capita, and service would be completely terrible, leading to plainly-worse-in-every-way outcomes than in countries that retained more-enlightened systems.

... what's that? The entire OECD has more centralized government control of healthcare than the US, ranging from extensive price controls, to de-facto or de-jure monopsony, to outright direct control of the healthcare system, and nowhere is there a strong populist movement to ditch that for a heavily free-market-based solution? And literally all of them are way cheaper per-capita than our system? And outcomes remain between pretty-good and great? And instead of the bureaucratic billing mess we have, that's all nice & simple and takes up almost none of the time of sick people and their families? This makes no sense, I read several columns on mises.org proving from first principles that this is impossible!

[mlyle]

Of course, the existing private entities are barred from doing something like this by antitrust law.