[pyuser583]

Standards will almost certainly decrease, especially for people in top 60%. And possibly for everyone.

The argument in favor is financial. But anyone with halfway decent medical coverage - tech workers, government employees, retirees, union workers, etc, it’s almost certainly going to go down.

Part of the reason is that Americans do get pretty decent care when they can afford it.

I can tell you personal horror stories about my time in Europe and ex-Europe.

I’d say the real problem in America isn’t even payment - it’s how medical information is siloed and treated like proprietary data. Usually under the guise of patient privacy.

[mindslight]

Have you been to a US doctor for anything more than a check up? Ten minute appointments, most of which gets spent on mechanical questions and memorized explanations is not decent care. Being pushed out through gradual ramping up of social pressure after your "allowed" one or two questions, so the doctor can move onto the next semantic billing event, is not decent care. Continually hearing, in every single setting, that everything is someone else's responsibility is not decent care. If decent healthcare gets provided in the US, it's in spite of the system, and those individual doctors/nurses/etc going above and beyond inevitably end up burning out. Lather, rinse, repeat.

I'm not a proponent of single payer because I don't think it addresses the root problem of the absolutely broken anti-patient incentives of a system that has long ago been destroyed by bureaucracy. But I'm not an opponent of single payer either - I just don't think it's the panacea people think it is.

[pyuser583]

> I'm not a proponent of single payer because I don't think it addresses the root problem of the absolutely broken anti-patient incentives of a system that has long ago been destroyed by bureaucracy. But I'm not an opponent of single payer either - I just don't think it's the panacea people think it is.

I totally agree. Payment isn’t the problem.

But I’ve had similar experiences with doctors in European and ex-European nations.

If I could make one change to the healthcare system, it would be a universal healthcare records system.

It’s nuts this is treated like it’s proprietary data.

[mindslight]

I can't speak about Europe, but I don't think the healthcare records alone would actually help care in the US. Once again the problem is the base incentives - a doctor doesn't actually want to have access to your whole medical history, as it would mean they would have to spend time reading it or otherwise possibly be liable for some detail in it. My experience is that staying at the same practice, even one with its own EMR, they basically ask you to complete a new patient health questionnaire every single year and self-enumerate all of your health concerns. Presumably it's the same incentive of not wanting to have to read, understand, integrate, and synthesize everything from the past.

My problem with your previous comment is that you just baselessly asserted that healthcare standards would go down with single payer, which is a common political talking point that completely ignores how the industry has already been captured and destroyed by private corporate bureaucracy (ie we already have "death panels", only they each consist of a single malpracticing doctor with a computer algorithm and an autosigner). Payment isn't the underlying problem of why healthcare is so bad, but it's certainly another problem for many people who go receive (shoddy) healthcare, and then afterwards end up at the pointy end of fraudulent billing shakedowns.

[giantg2]

"Standards will almost certainly decrease, especially for people in top 60%."

Arguably, private insurance will still exist for the upper class. So the top 10% or so will likely be unaffected. It would just further increase any inequality that currently exists. (The current proposals are Medicare for all and not a state run facilities)

[pyuser583]

I said 60%, not 10% - which is a tougher problem to solve.

Medicare as it currently exists is not “free at point of service”, or even “affordable at point of service.” There’s the Medicare gap, etc.

Medicare isn’t really set up to be a universal program. It assumes that providers have non-Medicare patients, and regularly uses that fact to calibrate the program.

[alistairSH]

Couldn't we just allow private policies on top of the socialized/nationalized plan? I'm pretty sure one of my Scottish uncles has a concierge plan in addition to whatever NHS offered.

[pyuser583]

I mean concierge policies are fine, but for what?

Not for core health care competencies. That wouldn’t be universal coverage.

When I say “quality would go down” in talking about actual health care.

Having a system where you have to pay extra to have a good doctor sound suspiciously like the current system, except it’s usually your employer paying extra.

[alistairSH]

Define "worse", I guess. Health care outcomes in the US are demonstrably worse than our peer nations and at a much higher cost today.

Yes, as an upper-middle-class salaryman, my care is above average. If I don't like what Uncle Sam provides, I can buy additional coverage/care. No change for me.

For everybody with worse coverage and less income? They're already receiving worse care than most of Western Europe.

My personal point of reference: Scottish immigrant, with substatial family in Scotland, Ireland, and Australia. Both white collar and working class.

[rootusrootus]

Ha, do 60% of Americans even have private health insurance? Less than half get it through their employer, so that would mean more than 10% are just paying out of pocket through the exchanges?

[nickff]

This is extremely easy to look up, from a very reliable source:

>"In 2022, private health insurance coverage continued to be more prevalent than public coverage, at 65.6 percent and 36.1 percent, respectively."

https://www.census.gov/library/publications/2023/demo/p60-28...

[rootusrootus]

Thanks for that. 65% is more than I'd have expected. 48% get it through employer, so the number paying for it on the exchanges is around 17%. I would have guessed the employer number were higher than the out-of-pocket payers lower.

[choilive]

So how would that change with increased health care access for everyone? Anyone with the means could certainly get access to elite healthcare if they wanted to like they do today.