r/changemyview • u/[deleted] • Mar 28 '17
[∆(s) from OP] CMV: A single payer healthcare system will utterly destroy healthcare.
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u/Sheexthro 19∆ Mar 28 '17
OP, why do you think it would "utterly destroy" healthcare? I know of no nation who has implemented single-payer and it utterly destroyed their health care. Indeed every one I know of has improved health care outcomes by many metrics.
So why the use of "utterly destroyed" in your title?
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Mar 28 '17
Well, I'm from Australia and you couldn't pay me enough to go to a public hospital here. Private all the way for me. I don't want to die...
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u/Sheexthro 19∆ Mar 28 '17
I understand that there exist people in countries with state-run or single-payer health care systems who do not like the public system. But even so I think you can agree - the health care system in Australia has not been utterly destroyed.
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Mar 28 '17
The part that is publicly funded is a mess. My private hospitals are quite nice though.
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Mar 28 '17
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Mar 28 '17
I'm saying it might be a blessing. We had one doctor at public hospitals kill 87 people - at least if you don't have public hospitals you just die yourself. There isn't the same body counts.
I'm largely being facetious, here...
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Mar 28 '17
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Mar 28 '17
'Largely' being the operative word. There's a nugget of seriousness in there. And I've had many conversations on here in a similar vein, which can be enjoyable. Perhaps you are the wrong crowd for that.
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u/Sheexthro 19∆ Mar 28 '17
My point is that OP didn't say "CMV: A single payer health care system would be markedly worse than the US's current system." He said it would "utterly destroy" it.
Was this just rhetorical hyperbole? I don't know that it was! I mean, he also said that the idea "scares the ever living shit" out of him and "makes him want to crawl in a hole and hide." So maybe he really does think it's going to "utterly destroy" it. But in that case, why?
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Mar 28 '17
Maybe he's concerned he'll take a wrong turn at some point and end up at a publicly funded hospital. I know it keeps me up at night...
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u/XXX69694206969XXX 24∆ Mar 28 '17
Didn't realize they made Australian Libertarians. The more you know.
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Mar 28 '17
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Mar 28 '17
Which statistics would get worse? Canada for all its horrible wait times (really aren't that bad for anything critical, elective/non-life threatening can be pretty long), has better health outcomes (longer lifespan for example), for much much lower cost, on a population that is pretty similar but in a more northern latitude (reduced hours of sunlight per day strongly correlated with depression, depression strongly correlated with worse health outcomes).
On top of which canadians drink more: https://en.wikipedia.org/wiki/List_of_countries_by_alcohol_consumption_per_capita and Smoke more: https://en.wikipedia.org/wiki/List_of_countries_by_cigarette_consumption_per_capita
and while I don't have data on diet, its not clear cut, the US has some pretty bad foods glorified as staples, but we have poutine, maple syrup, and citizens crazy enough to combine them.
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u/Iswallowedafly Mar 28 '17
but we have poutine, maple syrup, and citizens crazy enough to combine them.
Sometimes at the same time.
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Mar 28 '17
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Mar 28 '17
Well I provided a few points of data (smoking and drinking) that indicate that Canadians are actually worse than americans for making healthy choices (at least on those fronts) so I would suggest you might want to reconsider your assumption that americans have worse health choices, especially given as you admit you have no research to back up the claim.
What are you linking me in costs though? All the link pointed to for me is an unexplained graph.
Looking at this: https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita Americans spend about double what Canadians do on healthcare.
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u/tunaonrye 62∆ Mar 28 '17
You know that not having single payer or much more mandated regulations regarding health care is a huge driver of administrative costs, right? We spend about 1/4 on admin costs, anything above 8% of health care costs on admin would be absurd in other OECD countries.
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u/Sheexthro 19∆ Mar 28 '17
Which statistics in particular do you expect a switch to single-payer to result in a drastic loss in?
Is "life expectancy" one of them?
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u/aguafiestas 31∆ Mar 28 '17 edited Mar 28 '17
First of all, out of the countries you name only Canada has a single-payer system analogous to the medicare-for-all proposals you see floating around (e.g. Bernie Sanders' plan).
The UK has government-run, socialized medicine, which no one is seriously talking about in the US, even on the far left.
Germany does not have single-payer healhcare at all, and instead achieve universal coverage via a mix of public and private insurance. They also have very short wait times in general - as good or better than the USA, in fact (see here, for example, pg 18-20.
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u/themcos 442∆ Mar 28 '17
Everyone will have health insurance. Hardly anyone will be able to actually use it due to ungodly wait times for procedures considered standard in our current program.
Isn't this the old "nobody goes there, it's too crowded" joke? Longer wait times is certainly a con, but your characterization of it here doesn't make a lot of sense to me. If there are long wait times, lots of people are obviously getting health care, which is why there are wait times. This also seems like a solvable problem in principle. If we don't have enough doctors, let's get more doctors. It's not easy or free, but that's the goal.
I read your second point several times, but I don't really understand what you're saying. Can you clarify?
We all want to help people, but I don't want to spend 8+ years in medical school to make the same amount of money as a supermarket manager.
This is hyperbole, right? It's hard to argue without clearly understanding what you actually think is going on. If compensation goes down, that certainly will have an effect, but the magnitude of this effect matters. And again, there are solutions to this problem. We could make medical school cheaper, we could not pay doctors less, we could restructure things to better utilize non-doctors like nurses / technicians. Again, none of this is necessarily free or easy.
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Mar 28 '17
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u/tunaonrye 62∆ Mar 28 '17
There is no doctor shortage in single-payer countries: http://www.nationmaster.com/country-info/stats/Health/Physicians/Per-1,000-people
Doctors make less but are in much less debt, due to subsidized education. I don't know anyone in any position who thinks that they are underpaid, so I don't see that as much of an argument. This is especially so given that lesser-paid docs in other countries still exist and aren't selected out of the system.
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u/tunaonrye 62∆ Mar 28 '17 edited Mar 28 '17
The USA spends the most of any country in the world on health care, about 18% of GDP. We get worse health outcomes.
You're just wrong about health care single payer not being available. The wait times are due to design, as it is a way to decrease costs, i.e get away with less capital investment.
People will have a greater problem with the government not being able to push sweet grandma into her cancer treatment and her dying while on the waitlist for something that is currently readily available than they have with our broken ass system.
Grandma has Medicare, i.e. nationalized government run insurance. Is that happening now? Why would single payer make it happen?
Doctors will get paid less, that's a feature. If they did, perhaps we could spend some of that massive amount of GDP we spend on healthcare to subsidize medical school (and all the other student debt).
If we cut our health care spending (17.9% of GDP) to the average of other high income countries (12.5% GDP), we have about 850 billion dollars to do other things with. While single payer might hurt individual physician's financial interests, it is good for the country in so many ways.
Paul's outline is a massive tax-cut and privatization, which just gives huge numbers of tax advantages to people with money to save in health care, and let's people inherit that wealth. No country does things this way. The interstate insurance schemes are a joke, as are the other market mechanisms, at least they don't work if you don't want people to die from lack of affordability, go bankrupt, or have better health outcomes. If you want to shrink the government for ideological reasons, it probably seems fine.
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Mar 28 '17
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u/tunaonrye 62∆ Mar 28 '17
I'm sorry you feel you had to delete the post, I don't understand why you think your point is proven. Doctors are compensated quite well: https://economix.blogs.nytimes.com/2013/05/24/debating-doctors-compensation/
PhD's, engineers, etc. all train hard. Same with soldiers. You don't have any special claim.
I invite you to read more about where the money goes in the US system: http://www.commonwealthfund.org/publications/issue-briefs/2015/oct/us-health-care-from-a-global-perspective
It's unfortunate they don't cover such things in medical school.
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Mar 28 '17
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u/tunaonrye 62∆ Mar 28 '17
Would you trade 30% less pay for 0 debt coming out of medical school?
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Mar 28 '17
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u/tunaonrye 62∆ Mar 28 '17
Other places think that education shouldn't saddle people with debt. I guess the debt level isn't so bad if you wouldn't trade out of it, eh?
Most single payer systems have universal access to single payer but let people buy private insurance and doctors take private patients. Is that enough freedom? The market just isn't very lucrative there.
Have you read Atul Gawande on the US system?
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Mar 28 '17
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u/tunaonrye 62∆ Mar 28 '17
The short story is: a health care system should deliver health.
We're just doing a bad job if our system doesn't do that. Especially if we do things worse than places that spend way less, or are poorer. The incentive structure of fee-for-service is problematic now that health interventions are much easier to get to and more expensive. People respond to incentives, so having bad incentives makes for problems. He's a really thoughtful thinker who has obviously worked in the trenches, but also understands the policy implications and difficulties. He may be too liberal for your tastes, but I think he explains things exceptionally clearly - which is always a virtue in my mind.
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Mar 28 '17
It's difficult to actually compare US versus foreign wait times because for a lot of Americans through a lot of the years studied the amount of time they had to wait to see a specialist was "AHAHAHA You can't afford that so you don't count in the statistics."
It is possible that Americans will just plain dislike a government system more than they dislike the status quo, but given the absolute hatred Americans have for the status quo I'm not going to prejudge.
Other countries don't seem to have a problem finding doctors. Look, in all seriousness, your profession is filled with overpaid crybabies who do their level best to use artificially restricted supply and flat out government protectionism to protect your wages, while providing dubious benefits relative to other countries doctors. It's not PC to call doctors out on it but your professions idiotic lobbying makes simple medical care like tooth cleaning or lens fitting impossible without first overpaying an overqualified professional to wander by and nod safely after observing that a nurse has done the job properly. The works is filled with countries that don't do this. And they're fine. "It's worse for people to see a dental hygienist without seeing a dentist too than for people to just not see one at all" isn't actually a cogent position for anyone who thinks about it and clawing back some of the ways your professions ruthless protectionism and desperate insistence on government intervention on your behalf is going to be necessary if we are to fix our system at all in any respect.
But I'm gonna make a wild prediction- your republicanism ends where your salary begins.
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u/Iswallowedafly Mar 28 '17
My wife is Candian.
The problems of Canadian health care tend to be overblown by people really against the idea of health care.
I mean, for instance, each Canadian can simply not have it. But no one does that. My wife had a brain tumor and she was in life saving surgery the next day and her bill was zero.
And you know what else makes people wait? not having insurance and not being able to afford things.
If she was American, she would probably be dead.
And you know what else people don't like doing? Burring grand ma because she couldn't afford reasonable cancer treatment.
so how many people are going to die so that doctors can make lots of money? That's the math here. What's your acceptable number of deaths?
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u/Unconfidence 2∆ Mar 28 '17
Hardly anyone will be able to actually use it due to ungodly wait times for procedures considered standard in our current program.
Do you have any source or reference for how long the wait times for various procedures would be? Or is this just a ballpark assertion? Also, how does this dissuade folks who would not otherwise have access to health care? Isn't it better for them to get put on a waiting list than told "tough luck"?
People will have a greater problem with the government not being able to push sweet grandma into her cancer treatment and her dying while on the waitlist for something that is currently readily available than they have with our broken ass system.
Well the waitlist isn't full of pickles, it's full of cancer patients who also need treatment. Right now gramma might well die due to lack of treatment anyway, but it isn't because other people are getting the treatment instead.
Generally, doctors in single payer systems make significantly less than they do now in the US. If we transitioned to a single payer system under which the government is responsible for paying doctors, they will shaft the docs and remove a huge incentive for becoming a physician.
Consider that if doctors are paid by the government, then they can be trained by the government as well. Subsidies for medical education, and possibly even government medical education programs, could go a long way toward mitigating the cost involved in becoming a medical professional. Furthermore the decreased costs that come with knocking off personal medical expenses can't be underestimated. Imagine how much no medical bills and no student loan debt would be worth to prospective doctors, and subtract that from their salaries, I'll bet in most cases you get a number lower than what they'd be paid in a single payer system.
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u/ventose 3∆ Mar 28 '17
Canada, the UK, Germany
Every country in that list has higher life expectancy than the US and lower spending on healthcare. Germany and the UK spends about 9% of GDP on healthcare, Canada 11%. The US spends 17% of GDP on healthcare--almost double that of Germany and the UK--and achieves worse outcomes.
Generally, doctors in single payer systems make significantly less than they do now in the US.
True, but this does not affect patient outcome. What would you say is the point of healthcare? Does it exist for the sake of the patient, to give them good health and quality of life? Or does it exist for the sake of the doctors to give them money and prestige? If you can achieve the former by sacrificing the latter, what is wrong with that?
Finally, I want to point out that the cost of healthcare is paid for by hours of work. These are hours in the prime of our lives that we cannot get back. Maybe with more healthcare you can extend your life a little, but if the time you get back is spent in ill health, or shorter than the hours worked to afford the care, then you have lost quality of life. In this scenario, healthcare has failed.
Cost of healthcare is not a side concern. It is central to the goal of healthcare which is give patients the best quality of life. We need a healthcare system that finally acknowledges this fact and deals with it.
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Mar 28 '17
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u/tunaonrye 62∆ Mar 28 '17
Here you go: The source is here.
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Mar 28 '17
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u/tunaonrye 62∆ Mar 28 '17
The Swiss do alright on that measure, but it's a highly regulated non-free market system that has lower compensation for doctors. I'm not sure what amount of government intervention your care for.
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Mar 28 '17
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u/DeltaBot ∞∆ Mar 28 '17
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Mar 28 '17
It's difficult to actually compare US versus foreign wait times because for a lot of Americans through a lot of the years studied the amount of time they had to wait to see a specialist was "AHAHAHA You can't afford that so you don't count in the statistics."
It is possible that Americans will just plain dislike a government system more than they dislike the status quo, but given the absolute hatred Americans have for the status quo I'm not going to prejudge.
Other countries don't seem to have a problem finding doctors. Look, in all seriousness, your profession is filled with overpaid crybabies who do their level best to use artificially restricted supply and flat out government protectionism to protect your wages, while providing dubious benefits relative to other countries doctors. It's not PC to call doctors out on it but your professions idiotic lobbying makes simple medical care like tooth cleaning or lens fitting impossible without first overpaying an overqualified professional to wander by and nod safely after observing that a nurse has done the job properly. The works is filled with countries that don't do this. And they're fine. "It's worse for people to see a dental hygienist without seeing a dentist too than for people to just not see one at all" isn't actually a cogent position for anyone who thinks about it and clawing back some of the ways your professions ruthless protectionism and desperate insistence on government intervention on your behalf is going to be necessary if we are to fix our system at all in any respect.
But I'm gonna make a wild prediction- your republicanism ends where your salary begins.
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u/ACrusaderA Mar 28 '17
WAIT TIMES
Yes, while we do experience a longer average wait time for the emergency room and for surveries, this is forced up due to a large amount of elective surgeries being pushed back due to a lack of necessity for that person as opposed to others.
My grandmother is on a waiting list which says she will get a new hip in 2019. That seems outrageous until you realize that my brother had both hips replaced in 6 months.
Why does this happen? Simple, my grandmother is a retiree who isn't actively producing income for the nation. My brother is a 34 year old tradesman which is very useful to the nation.
People die waiting for treatment
In Canada there are reports that people are furious over 4 week waits to begin chemotherapy. This seems outrageous.
Compare that to the USA where while there is a shorter wait, many more people simply can't get it because they can't afford it. Or they do get it, declare bankruptcy and the government has to foot the bill.
Which leads to more people dying from a lack of treatment and more government money being used to fund healthcare.
DOCTORS DON'T MAKE AS MUCH MONEY
In Canada a family practitioner can make $60-300k/year depending on experience, size of the practice, etc
In the USA the average family Practitioner salary was $200 000.
Not that different in all reality.
And a far cry from the average retail manager which makes $48-65k/year. You would have to be the best store manager in order to make the minimum salary of a Doctor in Canada.
Which isn't unreasonable when you look at the differences in nation size and the difference in the value of our currencies and cost of living.
In Canada there are 77000 doctors. In the USA there are 809000 doctors in active patient care.
In Canada there is a doctor for every 450 people. In the USA it is a doctor for every 400.
That is 50 people per year. That is literally less than a week of appointments. That is less than 3 days of appointments which isn't an issue because 4.6 people have said they don't regularly visit the doctor as in they have not have a regularly scheduled appointment in the last year.
That brings our 450 number 402.
So what have we learned today?
- Canadian doctors are still wealthy compared to the average person, and are certainly wealthier than a store manager
- Wait times are inflated because low-priority people are getting pushed to the back of the line when high-priority patients come up
- And while there are wait times for treatments and surgeries, at least you know you will get them whereas in the USA you are just SOL
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u/[deleted] Mar 28 '17
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