How Could Single Payer Healthcare Become a Reality?

let's talk a little bit about single-payer health care now that the American Health Care Act is moving through Congress we're even more so concerned now that the state of health care in the u.s. could get much worse over the next few years and it's already really really bad and a popular sort of pushback to that is we should be looking at single-payer health care we should either take this as an opportunity to push universal health insurance or single-payer health care or state-level single-payer health care or something so let's go through this and talk it through ok for anyone who doesn't know first of all single-payer health care is a system where everyone pays taxes into a single fund that finances everybody's health care as opposed to paying people paying premiums to health insurance companies and then the health insurance companies decide what to cover at the providers when you're talking about single-payer you're talking about circumventing the system of health insurance altogether the government can take all the money that is paid in and either contract out to private service providers that's how it's done in Canada single-payer system or the government can have their own medical facilities and employees that's how it's done in the United Kingdom there's really no one way that this is done except for in the United States we see a system that is different then in just about every other developed country every other developed country in the world has a single-payer type system of one kind or another ok we actually were sort of going in this direction in the United States in the early 20th century wendell potter former a Cigna executive writes about this in his great book deadly spin and I've interviewed him about it it ended up being scrapped the US was going in the direction of single-payer I think it was between World Wars 1 and 2 and it was scrapped partially because it was too similar to what our enemy at the time Germany was doing and instead we went in the direction of this atrocious employer connected for-profit health insurance system nowhere in the u.s. is there a single-payer system in place although you do have government-run health care when you look at programs like Medicare and Medicaid all those a little bit different but there are possible state solutions for single-payer health care which we will talk about there's a couple of ways that this could be done one is you could provide health care to all residents of a state even though the federal government is going in the opposite direction and and Vermont looked at doing this although it's failed and we'll talk about that a little bit later this could be something which could also if it started in one state maybe spread to other states if it went well now it would require raising state taxes in the short run that's going to be a hit on people's income most people Pat don't cheer when their taxes are going to go up even people who understand that taxes are there for a reason it is very hard to pass significant tax increases yeah obviously people aren't going to cheer for higher taxes at first but I think in a few years once they realize how it works they'll be more customed to the idea and the fact that Social Security and Medicare gets taken out of your paychecks and their popular systems I think really goes to that idea California currently has a bill moving through its legislature that would set up a single-payer health care system in the state the New York Health Act which just passed the New York State Assembly and is two votes short of being passed in the Senate would enroll every New Yorker in a state-run insurance program as I mentioned Vermont actually passed a bill in 2011 setting up a single-payer system but the plan was abandoned in 2014 for a number of reasons which I'll get into in a second a handful of other states have introduced single-payer legislation the bills have died somewhere in the process before being passed historically single-payer systems save money they obviously give people more coverage they tend to create better health outcomes but the biggest stigma surrounding single-payer is it increases taxes and it needs government employees if you're in the mindset Pat of a small government smaller government agencies lower taxes how on earth are you going to be convinced of this I think you have to make a moral argument that's the only way I could imagine convincing a small government conservative that this makes sense and saying hey the morality of the system we have is essentially nil and we need to do something more moral that's why I think the state-by-state approach would be very effective because that's how gay marriage came to be the law of the land yeah that's how it was with marijuana you see more and more states adding on to that I think that's a good approach there's a there's a lot of there's a strong case to be made so that when Vermont walked away from its single-payer system in 2014 it was still in the process of being set up and analyses showed that the system would have nearly doubled the state budget if fully implemented so a single-payer system saves the government money in the long term it does have significant start-up costs and this is a challenge for individual states Vermont would have it would have needed to issue a two hundred million dollar bond to fully implement that system and states have to abide by balanced budget laws it's much harder for states to borrow money than it is for the federal government so the alternative solution was you drastically raise taxes above the board and that's very politically unpopular as well as the reality that economies are cyclical healthcare demand is pretty constant so tax revenue fluctuates healthcare spending would sort of stay the same and in the beginning if you're just raising this money it can still create funding problems which Vermont had so I think Pat that we really need a federal single-payer system it's much more financially viable but it's just such a non-starter given the politicians we currently have in place I don't think that means that we shouldn't try though because as we see at a federal level some politicians are pushing for HR 676 we would expand Medicare for all the many problem is obviously Republicans are not going to get in support of this but some Democrats won't either you have people like Dianne Feinstein who say that they're not ready to support single-payer you have Hillary Clinton who gave an applause line that single-payer will never come to pass that's why Medicare for all or the expansion of Medicare is seen by many as a good direction to go because you have the system in place as I mentioned earlier Medicare is a sort of single-payer system you can say well let's allow people to get into that system a little bit earlier there's a mechanism to just say hey you can buy in to Medicare but then you could subsidize the cost to buy into Medicare at either the federal or state level that's an approach that is increasingly being discussed but I just be when you've got a Republican house and a Republican Senate and a Republican president it's hard to imagine that you're going to be able to do anything federally and the problem is that because of the patchwork of federal and state laws who's allowed to do what and when it's going to be tough to do it at the state level it would definitely be tough to do right now but I think looking towards 2020 there could be a resurgence of more progressive ideals when it comes to health care because the Affordable Care Act didn't go far enough and now you have the Republican replacement option which is polling it anywhere from I think 17 to maybe thirty eight percent yeah so there's going to be a demand for an alternative to those two systems and what's the most popular system around the world its universal health care it is and even within the u.s. Medicare Medicare is not a perfect system it has its problems but by and large those who receive Medicare would not want to lose it in favor of the alternatives that are out there the problem in the u.s. is mostly ideological because as we've heard from professors like Gerald Friedman from my alma mater the University of Massachusetts in Amherst it's completely affordable when you eliminate so many of the costs of the system we have and look at a single-payer system it's totally affordable people are partisan and they're steeped in the private industry is better dogma people like this take a look at this video clip with regard to the idea of whether or not you have a right to a health care you have to realize what that implies it's not an abstraction I'm a physician that means you have a right to come to my house and can script to me means you believe in slavery the games that you're going to enslave not only me but the janitor at my hospital right the person who cleans my office the woman behind Randy hall if you were watching that she may be that's just the expression she always has on her face but she seemed genuinely perplexed by what Rand Paul was saying and Bernie Sanders responded to this by asking the healthcare professional who was testifying to that committee do you feel like a slave and the whole room there laughed at him the American healthcare act is and will continue to be a disaster if it passes the Affordable Care act is a middle ground that hardly seems ideal to anyone but you have people like Rand Paul who were willing to go as far as to say if health care is a right doctors are slaves which is hard for me to even really wrap my head around and statistically here and abroad public health care is more popular with patients you hear these anecdotal stories pat about Oh in Canada you've gotta wait X number of months for Y procedure there's no doubt that in any system you are going to have individual cases where someone waited longer than what would be ideal but overall these systems work pretty well there can be delays for elective procedures there can be delays for non urgent procedures but by and large people like their systems and in all of these countries that have single-payer health care if you don't like it you can supplement your care with a private Platt plant and people don't like this idea that we would be rationing care but in this instance we do rationing based off of the need that the person has right whereas now we're just rationing based off of how much money you have we have rationing now based on your ability to pay there's no doubt about it and we hear story after story after story pointing that out you're completely right about that and when you talk about remember death panels Sarah Palin's death panels from Obama care it's not true that Obama care had death panels as described by Sarah Palin but it's actually true that any system that is based on merely ability to pay is a form of death panel insofar as people will die due to lack of access to care and I don't know how much further we have to go with the death panel thing but bottom line the system we have is immoral this isn't not everything has to be to make a profit we can still be a capitalist society that says certain areas are not going to be left merely to for-profit companies this includes for example the building of roads uncontroversially the military I mean yes you've got these private mercenary groups that do government contracts but the military is a socialist endeavor so to speak education yes you can go to private schools but we have public education that are in some places and in others healthcare healthcare need not be a product to be bought and sold and the government should be in charge of the institution's where it doesn't make sense to have a profit incentive for them so as you mentioned the military roads the police and I think healthcare is first and foremost limitless even with a socialist military we've still figured out a way for contractors to make nice little profits working with the military but yet in principle the military itself as Pat points out and as I pointed out is on that list discuss this with us on our reddit discussion forum david slash our EDD IT


  1. Conversely speaking, we would want things like consumer goods to remain in a capitalist market as the profit incentive is a positive influence in order to ensure they are created with the highest quality, therefore demanding more money for that good. The return on investment for the consumer is a comfortable bed, safe cars, etc. I agree, it’s immoral to attach a capitalist profit incentive to goods such as healthcare and education. Hybrid capitalist/socialist government with a safety net for our most vulnerable citizens.

  2. This is literally THE ONLY solution at his point,. The repubs proved that with their utter failure to pass any other publicly acceptable solution. Single payer is the inevitable solution if it weren't for the koolaid drinking low functioning tribal Republican brainwashed humans.

  3. the taxes replace Copays, Premiums, prescription, dental, er costs, etc etc. Single Payer is cheaper.

  4. every other developed country – aka socialized countries – has universal healthcare.

    there are only a handful of capitalistic healthcare systems in the world. We should compare our Pre ACA healthcare market between them alone.

  5. The cost of healthcare in the US is simply too high, no matter who pays for it. In order for statewide universal healthcare to work, there must be some cost controls.

  6. Would states like California or New York who pass universal healthcare have the power to negotiate for lower healthcare prices?

  7. We pay almost 3 times more per capita for healthcare than the average of all other developed countries. Since outcomes are not better, their is only one reason. Big pharma, insurance companies raping the system exploiting sick and desperate people. This insanity needs to end. Our system has failed, no one denies this. Medicare for is the only logical solution. Any other answer, you are being paid to say otherwise

  8. it would be nice to see one state raise minimum wage to $15 per hour and have a single payer healthcare system that would tax the minimum wage earners $100 per month for healthcare deductions on the payroll increasing on higher wage earners, this should be enough in a properly regulated healthcare system once you take away the insurance system and re-evaluate hospital fees cutting out the hidden costs of uninsured procedures that hospitals must still recoup and other inflated costs in the health for profit system we now have in the usa.

  9. I live in the uk, and I have American family. When I've visited and I've heard how expensive healthcare is over there I find it shocking how they haven't copied the NHS, like another user said, when labour are in power the NHS does well the conservatives like to strip it, a bit like your republicans they are greedy rich people. It makes you realise how lucky you are to live in the uk with free healthcare. I say free because you pay the same contribution no matter how much you use it, so it more than pays for itself. I'm unemployed at the moment, and even though I'm unemployed I can go to the doctor without fear of not being able to afford it, I can get my mess for free, I can go to the dentist for free, I have to go to hospital for a health problem I have, I couldn't afford that if I lived in the states. Yes the NHS has problems but it's been going since after the Second World War, and no one is rejected just because r wealth, and I've never had a huge wait. Even when I went in to a and e after an accident. And those that want extra can pay for private healthcare.citd the best of both worlds

  10. This is the way insurance works. Everyone pays a premium and a few people make claims. The most efficient group of insured people is the entire country. It has the greatest spread of risk. The most efficient way to run the insurance company is the reduce its staff. No membership office. No underwriting office. No claims office etc… and no profits goes to shareholders. 100% of the money going to healthcare with the minimum of money going into administration. This is the most dangerous thing. If you put the government on the hook for health costs the government will seek to reduce the cost by making the general population more healthy. They will screen the health of children as they grow up. They will vaccinate and improve the water quality and public health in general. People with immediate health issues will be prioritised. People with cronic illnesses will be treated and not backrupted. People who have concerns will seek advice earlier and get treated when their problems are less costly to treat.

  11. Canada started off like the UK with some private hospitals regulated by the government. Privatization of our health care is creating a health issue, more infections, longer wait times, and higher costs.

  12. Funny that America/ the allies installed a very different voting system as well as health care and more in Germany after the war. But back at home they couldnt do it.

  13. The US Department of Veterans Affairs is a Single Payer Healthcare in the US. Just Google VA scandal that's why it will never work in this country.

  14. I'm in Canada and had a heart attack 10 years ago. I went to the Emergency Ward at midnight Friday, was immediately transferred to the world-class Ottawa Heart Institute and had a quadruple bypass on Monday. So much for extreme waiting times and "death panels".

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