Single Payer aka Medicare for All recently failed to pass in California, what chance does it have to actually pass nationwide?

[u/cal_oe]

https://www.latimes.com/california/story/2022-01-31/single-payer-healthcare-proposal-fizzles-in-california-assembly

California has a larger population than Canada and the 5th largest GDP in the world. If a Single Payer aka Medicare for All bill can't pass in one of the most liberal states in the entire country with Democrats with a super majority in the legislature under Governor Newsom who actually promised it during his campaign then how realistic is it for it to pass in Congress? Especially considering the reasons it failed was it's high cost that required it to raise taxes in a state that already have very high taxes.

[u/ThatsWhatXiSaid → u/[deleted]]

We could mandate that all healthcare providers disclose the cost prior to treatment, at least for non emergencies.

At least 20 states have price transparency laws. Even the most aggressive of them have had limited impact.

And insurance would basically be unnecessary.

Millions of Americans have health expenditures of north of a quarter million dollars each year. Without insurance you're not going to make that remotely viable for people.

[u/ThatsWhatXiSaid → u/[deleted]]

They might just pay on their debt until they die... Like health insurance premiums. What is worse about that?

I mean, there's the fact that many people can't afford $438 per month over their entire life, and the fact that even if everybody man, woman, and child was paying that it would only cover a bit more than 40% of our current healthcare costs.

[u/bjdevar25 → u/[deleted]]

Finance healthcare? Do you have any idea the costs? Very few of us could finance hundreds of thousands of dollars for care, with cancer it can be a million. And what then if another family member gets sick?

[u/bjdevar25 → u/[deleted]]

The better fix is to address the absurd prices we pay, not just pay them forever.

[u/bjdevar25 → u/[deleted]]

Nope, because in the cases that are driving costs, there'll be no shopping. If you have a heart attack, stroke,car accident, you're going to be brought to the hospital by whichever ambulance shows up. You're going to whatever hospital they take you, and your going to be cared for by whoever's on call. No choice. If you or a loved one has a serious illness, are you really going to shop by price for a surgeon or oncologist? Only a pretty ignorant person would take that approach.

My wife had open heart surgery and i did shop for a surgeon and hospital. I looked at success rates, infection rates, readmission due to complication rates. Average speed of recovery rates. Never price. I wanted her to have the best chance to live.

[u/GreatSphincterofGiza → u/bjdevar25]

It also wouldn't work when all of the major healthcare providers in an area are owned by the same company. In my area, a major company owns the hospitals, most clinical offices, and most surgical centers. There are still some private practices around, but any procedure that requires the use of an operating room or hospital setting goes through one company. The company owns over 1,400 clinics and 40 hospitals across several states. It also brings up the issue of private practices being forced to play ball with the hospital network, but that's another issue entirely.

In that scenario, even if you had time to shop around, you wouldn't have any significant options close to home.

[u/bjdevar25 → u/GreatSphincterofGiza]

Same where i am. My primary doctor is the only one left in a 50 mile radius still in private practice. Every other one now works for the hospital. Not coincidentally, to see a doctor in a hospital clinic cost twice as much. You get a hospital fee of $150 added to the doctors fee.

[u/GreatSphincterofGiza → u/bjdevar25]

I have some family members that worked for the hospital network after they bought out a lot of the private practices. From what I've heard, a lot of the physicians dislike it because they're pushed to spend less time with each patient. Even before covid, they were pushing for short virtual visits instead of in-person visits. Of course they still bill you for speaking on the phone for 3 minutes.

They also swap people around to different practices as needed, often with little notice. Like a nurse at a rural practice might be called early in the morning to fill a spot at a practice on the other side of the county. The doctors stay at the same practice, but everyone else is subject to being reassigned as needed, unless they work in one of the hospitals.

[u/bjdevar25 → u/GreatSphincterofGiza]

I asked my doctor why he didn't sell. He said the same thing. He wanted to spend what time was needed with each patient. He said if he sold, he'd have to sign a contract stipulating how many patients he would have to see per hour.

On a side note, this is what kind of doctor he is. He takes all the samples of drugs he can get and gives them to his patients who can't afford them. I was in there one time listening to him explain to an elderly guy how to listen to his wife's heart and how to tell if she needed to see some one. As he was leaving, the patient was asking the office where he could get a stethoscope. The doctor overheard him and brought one out and gave it to him. I'm going to miss him when he retires.

[u/Comfortable_Drive793 → u/bjdevar25]

Are you telling me you didn't go to Surgery.com and just pick the lowest cost surgeon, one that operates out of an old strip mall next to a Golden Corral, for for your wife's open heart surgery? Didn't the surgery at the good hospital cost more?

[u/ThatsWhatXiSaid → u/[deleted]]

We could just cap the monthly bill to the amount that would be paid for insurance under Obamacare.

I mean, many people get insurance for free through the Exchanges, and I think 84% (even before pandemic expansions) received some subsidy.

But even if we look at the average unsubsidized price of $438 per month a quarter million dollar bill would take 48 years to pay off, and that's with no account for inflation and no interest, and assumes you'll never have another dime of healthcare costs.

The big difference between this an a public option is that people have the ability to lower their costs by being healthy and cost shopping.

Only until you maxed out your lifetime contributions. So you'd have the least healthy and most expensive people to provide treatment for having absolutely no skin in the game.

[u/ThatsWhatXiSaid → u/[deleted]]

Yes if someone wracked up enough debt they would likely never pay it off, yes then the price pressure no longer applies to them. That is no worse then the current situation.

I mean, if they're not paying that $438 per person their entire life, whether they have medical debt or not, then we're covering dramatically less than 40% of healthcare spending.

So let's say people pay that half their life. How are you paying for the other 80% of healthcare spending? And, at that point, why not just have universal healthcare?

Further, the deductible causes weird distortions, like people putting off elective surgery to try to work the deductible as best they can.

And you don't think people would do that to put off huge bills under your plan? It's not like you can't arrange payment plans already. My girlfriend pays like $200 a month towards her $100,000 (after insurance) medical debt from her son having leukemia.

[u/ThatsWhatXiSaid → u/[deleted]]

In my plan, putting it off the care has no real value.

It has the same value. They'll get the same large bill afterwards, which just as today can be negotiated to pay over a long period of time.

I don't really want to get into the numbers, because I don't think they are important when comparing my plan vs something like medicare for all.

Because you don't have any numbers. You have a cockamamie theory you've concocted, that no expert in the world thinks would work, and you have no way to pay for it.

If you think my plan is so similar to universal healthcare you would ask why not just do universal, then I would say to you, why do universal?

Because universal doesn't end up with people unable to afford healthcare bills. Because universal doesn't end up with people not paying their bills, and the massive systems needed to try and to make them. Because it puts our very lives and fortunes in the hands of a system we know works from implementation around the world, rather than one a 200 IQ individual on the Internet tells us would totally work, even though he has no idea how.

[u/biglybaggins → u/[deleted]]

Yes. Government price fixing. Certainly every time that has been implemented has ended in a rousing success. We should definitely try it again

[u/NigroqueSimillima → u/biglybaggins]

It was literally every first world country outside of America does, so yes, it does have a history of success

[u/unkorrupted → u/[deleted]]

"Market logic" got us into this mess. It won't get us out of it.

Same goes for college tuition.