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2016/05/24 18:43:41
Subject: ColoradoCare - potentially America's first single payer system.
That's down to a current freeze in funding. It's got nothing to do with the concept of government run medical care.
How could it not?
Government decides to freeze fundings... then this happens.
Right?
Government decides not to freeze fundings... then this doesn;t happen.
Durrrr...
Right... so the claim that it had nothing to do with it being ran by the government, kinda falls flat on its face.
The supposition that it demonstrates the inevitable failure of government funded medicine falls flat on its face. Amasingly, it turns out that if you spend more on stuff you get more stuff whether you are the government or not.
And read above, as there was no supposition. Just someone asking about NHS wait times, and me providing a link from a UK source discussing said NHS wait times.
Full Frontal Nerdity
2016/05/24 19:01:12
Subject: ColoradoCare - potentially America's first single payer system.
djones520 wrote: And read above, as there was no supposition. Just someone asking about NHS wait times, and me providing a link from a UK source discussing said NHS wait times.
And then someone points out it results from a fall in funding.
And then someone points out the fall in funding shows a government cause of medical treatment.
This is so immediately obvious to the most limited intelligence that the only reason for stating the point is to imply that government funded medicine is bad.
Alternatively the user is very stupid, which I refuse to believe to be the case.
I'd prefer a hybrid system like others have mentioned. Basically, open up medicare/medicaide to anyone who applied to it and open up a number of state-run clinics. Offer med-school graduates complete education-debt forgiveness if they work there for a period of time. The overworking of these grads couldn't be much worse than residency already is, and they'd likely get more out of it financially - seeing as they would be getting crap pay but debt-forgiveness. If there are any staffing problems send in military medics. If there were no state clinics in the area, you'd still have medicare/caide on top of it to use at any hospital that receives anything resembling state funding.
In addition, health insurance would become an employment perk rather than baseline necessity because if you think that hospitals don't give people with guaranteed pay with less quibbles better treatment...
And of course, private practices would only take medicare/caide voluntarily.
2016/05/24 22:27:54
Subject: ColoradoCare - potentially America's first single payer system.
I think that on a national level, the most realistic way of implementing and transitioning to a single payer system would be to have the government run it's own health insurance that competes with the privately owned companies.
2016/05/24 22:56:28
Subject: ColoradoCare - potentially America's first single payer system.
d-usa wrote: I think that on a national level, the most realistic way of implementing and transitioning to a single payer system would be to have the government run it's own health insurance that competes with the privately owned companies.
They do... 'tis called Medicare.
They'd have to open it up to everyone.
Plus, something has to be done with the bureaucratic nightmare as it exists today.
Live Ork, Be Ork. or D'Ork!
2016/05/24 23:33:55
Subject: ColoradoCare - potentially America's first single payer system.
d-usa wrote: I think that on a national level, the most realistic way of implementing and transitioning to a single payer system would be to have the government run it's own health insurance that competes with the privately owned companies.
They do... 'tis called Medicare.
They'd have to open it up to everyone.
Plus, something has to be done with the bureaucratic nightmare as it exists today.
Isn't Medicare service actually contracted out to folks like Blue Cross (amongst others depending on state)?
Every time a terrorist dies a Paratrooper gets his wings.
2016/05/24 23:39:09
Subject: ColoradoCare - potentially America's first single payer system.
As a filthy socialist swimming in a sea of free healthcare, I can tell you it's pretty great.
The only time you're going to deal with any kind of wait is if you have to see a specialist for something minor. If it's serious you get pushed to the front of the line.
When we were dealing with my dad's tumor we had no wait times. Appointments would be booked for the same or next day in most cases.
We were once so close to heaven, St. Peter came out and gave us medals; declaring us "The nicest of the damned".
“Anti-intellectualism has been a constant thread winding its way through our political and cultural life, nurtured by the false notion that democracy means that 'my ignorance is just as good as your knowledge.'”
2016/05/25 00:04:01
Subject: ColoradoCare - potentially America's first single payer system.
d-usa wrote: I think that on a national level, the most realistic way of implementing and transitioning to a single payer system would be to have the government run it's own health insurance that competes with the privately owned companies.
They do... 'tis called Medicare.
They'd have to open it up to everyone.
Plus, something has to be done with the bureaucratic nightmare as it exists today.
Isn't Medicare service actually contracted out to folks like Blue Cross (amongst others depending on state)?
I think you're thinking of Medicaid (the state's version).
I know in MO, the providers deal directly with Medicare (and CMS).
Live Ork, Be Ork. or D'Ork!
2016/05/25 00:12:09
Subject: ColoradoCare - potentially America's first single payer system.
d-usa wrote: I think that on a national level, the most realistic way of implementing and transitioning to a single payer system would be to have the government run it's own health insurance that competes with the privately owned companies.
They do... 'tis called Medicare.
They'd have to open it up to everyone.
Plus, something has to be done with the bureaucratic nightmare as it exists today.
Isn't Medicare service actually contracted out to folks like Blue Cross (amongst others depending on state)?
I think you're thinking of Medicaid (the state's version).
I know in MO, the providers deal directly with Medicare (and CMS).
Could also be thinking about supplemental insurance, Part D, or Medicare Advantage.
2016/05/25 00:51:32
Subject: ColoradoCare - potentially America's first single payer system.
d-usa wrote: I think that on a national level, the most realistic way of implementing and transitioning to a single payer system would be to have the government run it's own health insurance that competes with the privately owned companies.
They do... 'tis called Medicare.
They'd have to open it up to everyone.
Plus, something has to be done with the bureaucratic nightmare as it exists today.
Isn't Medicare service actually contracted out to folks like Blue Cross (amongst others depending on state)?
I think you're thinking of Medicaid (the state's version).
I know in MO, the providers deal directly with Medicare (and CMS).
Could also be thinking about supplemental insurance, Part D, or Medicare Advantage.
Aye... that too.
Live Ork, Be Ork. or D'Ork!
2016/05/25 02:45:34
Subject: ColoradoCare - potentially America's first single payer system.
Kap'n Krump wrote: Someone mentioned people moving to Colorado before a big operation in order to get it done for free, which I think would be a problem, but I also read that you wouldn't benefit from Colorado state health care until you lived in the state for a year.
Which would work well to control people who were diagnosed with cancer on Monday, moving to Colorado on Tuesday, and having the operation on Wednesday. But what about people who are simply getting old - who expect that in five or more years they'll start having a lot of issues? What would stop Colorado becoming the place to retire and get free healthcare?
Like I said above, I'm a big fan of having a universal base level of healthcare provided by government, but when a single state goes alone there are a lot of potential issues.
Automatically Appended Next Post:
whembly wrote: I am dubious at the idea that 10% income tax would cover Coloradocare....
This is a fair question, and I'll attempt to answer it with what I'm aware are some very loose figures.
At its simplest, the 10% won't cover Coloradocare by itself. In the US about 17% of GDP is spent on healthcare, so if we assume Colarado or normal for healthcare costs, then by the simplest measure the 10% payroll tax is short by 7%.
But there's probably some efficiencies in moving to a public system (other countries with national healthcare spend somewhere around 10 to 12%), but its kind of crazy to think you'd drop to that level in a single year. In fact it probably won't drop that low at all - there's lots of reasons beyond the private mess that US healthcare is so expensive... so maybe we put the new system at around 15%? That still leaves this 10% tax falling short by 5%.
But then the next thing to consider is that a lot of healthcare is already paid by government. Around 40% of the total costs are covered by state and federal spending, in one way or another. So if we say that over time costs will drop to about 15%, and various state and federal programs continue to pay 40% (6% of GDP), then you'd only need revenue to cover 9% of GDP. Which the payroll tax would cover.
But those numbers are very loose, of course. But it's probably something like the work already done in proposing Coloradocare. And there's potentially all kinds of other problems - with a state tax that high then a lot of high income earners (who's 10% would be expected to subsidise the rest) are likely to declare their residence in another state - I'm not sure what kind of drain that might have.
This message was edited 4 times. Last update was at 2016/05/25 03:09:48
“We may observe that the government in a civilized country is much more expensive than in a barbarous one; and when we say that one government is more expensive than another, it is the same as if we said that that one country is farther advanced in improvement than another. To say that the government is expensive and the people not oppressed is to say that the people are rich.”
Adam Smith, who must have been some kind of leftie or something.
2016/05/25 03:09:11
Subject: ColoradoCare - potentially America's first single payer system.
Kap'n Krump wrote:
Someone mentioned people moving to Colorado before a big operation in order to get it done for free, which I think would be a problem, but I also read that you wouldn't benefit from Colorado state health care until you lived in the state for a year.
Which would work well to control people who were diagnosed with cancer on Monday, moving to Colorado on Tuesday, and having the operation on Wednesday. But what about people who are simply getting old - who expect that in five or more years they'll start having a lot of issues? What would stop Colorado becoming the place to retire and get free healthcare?
Like I said above, I'm a big fan of having a universal base level of healthcare provided by government, but when a single state goes alone there are a lot of potential issues.
Honestly? Overcrowding and an overly expensive housing market. Which will eventually lead to less opportunities for work and make it difficult for new people to move in.
Because Colorado is already heading to that and all they have right now is free weed.
This message was edited 2 times. Last update was at 2016/05/25 03:16:17
'I've played Guard for years, and the best piece of advice is to always utilize the Guard's best special rule: "we roll more dice than you" ' - stormleader
"Sector Imperialis: 25mm and 40mm Round Bases (40+20) 26€ (Including 32 skulls for basing) " GW design philosophy in a nutshell
2016/05/25 03:16:01
Subject: Re:ColoradoCare - potentially America's first single payer system.
Kilkrazy wrote: Medical bills are very high in the USA for various reasons, among them the profit motive, high insurance premiums for malpractice, and the sheer cost of accounting in great detail for all the high costs.
The NHS avoids much of these costs, and also gains economies of scale. It isn't perfect, but cost is about half in terms of GDP spent on the system.
There are three really big savings in a national system;
1) Doctors get paid less.
2) There's much lower costs of administration. You don't get bills going back and forth between hospitals, patients, and healthcare providers, with large amounts of debate and negotiation and all that debt recovery.
3) National health systems don't cover really expensive stuff that is unlikely to do very much. This is the one no-one really likes to talk about, but it's probably the biggest saving. A full 1/3 of medical expenditure is on people in the six months of their lives. National systems have metrics which say spending x amount to extend someone's life another month will not happen.
“We may observe that the government in a civilized country is much more expensive than in a barbarous one; and when we say that one government is more expensive than another, it is the same as if we said that that one country is farther advanced in improvement than another. To say that the government is expensive and the people not oppressed is to say that the people are rich.”
Adam Smith, who must have been some kind of leftie or something.
2016/05/25 03:29:15
Subject: ColoradoCare - potentially America's first single payer system.
How would one state having a nationalized style healthcare work when no other state in the country uses it.
For example, lets say my job is in Colorado. I work there, I get the fancy new healthcare.
My job sends me to Texas, and I break my leg on a work related accident and have to be treated in Texas.
What happens next? Does Colorado pay the Texas doctor to do the work? Do I have to return to Colorado to get any meaningful treatment? Will I be forced to pay for any treatment outside the state? Would I even count as insured as far as Texas is concerned?
Surely they've given this some thought, I'm just curious how that would work.
'I've played Guard for years, and the best piece of advice is to always utilize the Guard's best special rule: "we roll more dice than you" ' - stormleader
"Sector Imperialis: 25mm and 40mm Round Bases (40+20) 26€ (Including 32 skulls for basing) " GW design philosophy in a nutshell
2016/05/25 03:30:24
Subject: ColoradoCare - potentially America's first single payer system.
CptJake wrote: You'll remember from Eco 101 that the supply/demand meet at a price point. If the state is paying the price point is fixed, so supply may not grow to meet demand the way you are thinking, unless providers come in thinking they can provide the service at a lower cost to themselves and therefore still profit at the fixed price point. Generally, the companies that can provide and remain profitable at a fixed price point are already doing so...
There's a much complained about thing among economists called 101ism, and its dealing with exactly what you've done above. You're right that per a straight forward demand and supply chart that if the supply is fixed but the demand is no longer fettered by having to pay for the service themselves, then you should see a high shortage of supply. But the thing is - the basic 101 econ model is just there to illustrate a basic bit of logic, it is the first model shown because it's the simplest, the one on which you can start to build in real world factors to explain real markets. At no point does economics pretend it is how things always work, or even that they things work that way very often at all.
On healthcare, I know that even when visits to the doctor are free or the cost is negligible, then doctors still complain that people still don't go when issues are minor and able to be treated simply. So even when the price is close to zero, demand still isn't hitting the optimum point.
“We may observe that the government in a civilized country is much more expensive than in a barbarous one; and when we say that one government is more expensive than another, it is the same as if we said that that one country is farther advanced in improvement than another. To say that the government is expensive and the people not oppressed is to say that the people are rich.”
Adam Smith, who must have been some kind of leftie or something.
2016/05/25 11:29:06
Subject: ColoradoCare - potentially America's first single payer system.
d-usa wrote: I think that on a national level, the most realistic way of implementing and transitioning to a single payer system would be to have the government run it's own health insurance that competes with the privately owned companies.
They do... 'tis called Medicare.
They'd have to open it up to everyone.
Plus, something has to be done with the bureaucratic nightmare as it exists today.
Isn't Medicare service actually contracted out to folks like Blue Cross (amongst others depending on state)?
I think you're thinking of Medicaid (the state's version).
I know in MO, the providers deal directly with Medicare (and CMS).
No, I'm not. The Fed gov't doesn't have 'insurance'. It contracts out to other companies who run insurance programs for them.
CptJake wrote: You'll remember from Eco 101 that the supply/demand meet at a price point. If the state is paying the price point is fixed, so supply may not grow to meet demand the way you are thinking, unless providers come in thinking they can provide the service at a lower cost to themselves and therefore still profit at the fixed price point. Generally, the companies that can provide and remain profitable at a fixed price point are already doing so...
There's a much complained about thing among economists called 101ism, and its dealing with exactly what you've done above. You're right that per a straight forward demand and supply chart that if the supply is fixed but the demand is no longer fettered by having to pay for the service themselves, then you should see a high shortage of supply. But the thing is - the basic 101 econ model is just there to illustrate a basic bit of logic, it is the first model shown because it's the simplest, the one on which you can start to build in real world factors to explain real markets. At no point does economics pretend it is how things always work, or even that they things work that way very often at all.
On healthcare, I know that even when visits to the doctor are free or the cost is negligible, then doctors still complain that people still don't go when issues are minor and able to be treated simply. So even when the price is close to zero, demand still isn't hitting the optimum point.
I know there are other factors. But the bottom line is there is excess demand and suppliers are not jumping into the market to meet it. There are various reasons why, but fixed compensation to the providers is one of them. We see it in other health care areas. For example, DoD uses a program called TriCare. Due to what TriCare pays out and the perceived complexities of the program (for providers to get paid) there are many providers who refuse to accept it.
This message was edited 1 time. Last update was at 2016/05/25 11:32:07
Every time a terrorist dies a Paratrooper gets his wings.
2016/05/25 12:31:47
Subject: ColoradoCare - potentially America's first single payer system.
For example, lets say my job is in Colorado. I work there, I get the fancy new healthcare.
My job sends me to Texas, and I break my leg on a work related accident and have to be treated in Texas.
What happens next? Does Colorado pay the Texas doctor to do the work? Do I have to return to Colorado to get any meaningful treatment? Will I be forced to pay for any treatment outside the state? Would I even count as insured as far as Texas is concerned?
You'd probably have to get some level of travel insurance. When travelling to Europe we use a European Health Insurance Card (EHIC). It's free, we just have to register and it means anybody that's in the agreement bills your country's health provider, not the individual. When travelling to any where outside of the agreement we get normal travel insurance.
2016/05/25 14:16:05
Subject: ColoradoCare - potentially America's first single payer system.
d-usa wrote: I think that on a national level, the most realistic way of implementing and transitioning to a single payer system would be to have the government run it's own health insurance that competes with the privately owned companies.
They do... 'tis called Medicare.
They'd have to open it up to everyone.
Plus, something has to be done with the bureaucratic nightmare as it exists today.
Isn't Medicare service actually contracted out to folks like Blue Cross (amongst others depending on state)?
I think you're thinking of Medicaid (the state's version).
I know in MO, the providers deal directly with Medicare (and CMS).
No, I'm not. The Fed gov't doesn't have 'insurance'. It contracts out to other companies who run insurance programs for them.
I mis-understood ya. You're correct. The Government defines the reimbursements and base coverage.
How would one state having a nationalized style healthcare work when no other state in the country uses it.
For example, lets say my job is in Colorado. I work there, I get the fancy new healthcare.
My job sends me to Texas, and I break my leg on a work related accident and have to be treated in Texas.
What happens next? Does Colorado pay the Texas doctor to do the work? Do I have to return to Colorado to get any meaningful treatment? Will I be forced to pay for any treatment outside the state? Would I even count as insured as far as Texas is concerned?
Surely they've given this some thought, I'm just curious how that would work.
The single-payer option is like any other insurance, only that it's the only one in the game in Colorado. (right? Could you still have private plans as well???). So, it should have "out of network" coverage where the fee/co-pays are typically higher.
whembly wrote: I am dubious at the idea that 10% income tax would cover Coloradocare....
This is a fair question, and I'll attempt to answer it with what I'm aware are some very loose figures.
At its simplest, the 10% won't cover Coloradocare by itself. In the US about 17% of GDP is spent on healthcare, so if we assume Colarado or normal for healthcare costs, then by the simplest measure the 10% payroll tax is short by 7%.
But there's probably some efficiencies in moving to a public system (other countries with national healthcare spend somewhere around 10 to 12%), but its kind of crazy to think you'd drop to that level in a single year. In fact it probably won't drop that low at all - there's lots of reasons beyond the private mess that US healthcare is so expensive... so maybe we put the new system at around 15%? That still leaves this 10% tax falling short by 5%.
But then the next thing to consider is that a lot of healthcare is already paid by government. Around 40% of the total costs are covered by state and federal spending, in one way or another. So if we say that over time costs will drop to about 15%, and various state and federal programs continue to pay 40% (6% of GDP), then you'd only need revenue to cover 9% of GDP. Which the payroll tax would cover.
But those numbers are very loose, of course. But it's probably something like the work already done in proposing Coloradocare. And there's potentially all kinds of other problems - with a state tax that high then a lot of high income earners (who's 10% would be expected to subsidise the rest) are likely to declare their residence in another state - I'm not sure what kind of drain that might have.
Here's my issue with this. I've yet to see any meaningful structural changes across the board.
If this is simply the current state + having a state-run single payer to be funded by simply increases in taxes... it's a setup for failure.
How are they going to reduce ER admissions for non-emergency ailments?
How are they going to ensure there are assessible clinics in the region?
How will they negotiate price with the providers/hospitals/medical equipements/drugs/etc...?
What's the plan man?
New Hampshire had to kill their single-payer plans as it wasn't viable... because, imo, they couldn't/wouldn't address the underlining structural issues.
This message was edited 4 times. Last update was at 2016/05/25 14:32:34
Live Ork, Be Ork. or D'Ork!
2016/05/25 15:55:55
Subject: ColoradoCare - potentially America's first single payer system.
whembly wrote: Here's my issue with this. I've yet to see any meaningful structural changes across the board.
If this is simply the current state + having a state-run single payer to be funded by simply increases in taxes... it's a setup for failure.
Agreed. Any reform needs to come with structural reforms. Actually, even when there's no major reforms in place there needs to be constant pushes at new structural reforms. Health is a fiscal blackhole, unless you apply constant discipline you end up with, well, you end up with what the US has right now.
“We may observe that the government in a civilized country is much more expensive than in a barbarous one; and when we say that one government is more expensive than another, it is the same as if we said that that one country is farther advanced in improvement than another. To say that the government is expensive and the people not oppressed is to say that the people are rich.”
Adam Smith, who must have been some kind of leftie or something.
2016/05/25 16:08:35
Subject: ColoradoCare - potentially America's first single payer system.
feeder wrote: As a filthy socialist swimming in a sea of free healthcare, I can tell you it's pretty great.
The only time you're going to deal with any kind of wait is if you have to see a specialist for something minor. If it's serious you get pushed to the front of the line.
When we were dealing with my dad's tumor we had no wait times. Appointments would be booked for the same or next day in most cases.
We told you about that. Keep rubbing your superior healthcare in our faces and we'll appropriate your strategic maple and Molson reserves. We'll drink those Molsons right in front of you. Don't think we won't do it.
This message was edited 1 time. Last update was at 2016/05/25 16:28:38
-"Wait a minute.....who is that Frazz is talking to in the gallery? Hmmm something is going on here.....Oh.... it seems there is some dispute over video taping of some sort......Frazz is really upset now..........wait a minute......whats he go there.......is it? Can it be?....Frazz has just unleashed his hidden weiner dog from his mini bag, while quoting shakespeares "Let slip the dogs the war!!" GG
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-TBone the Magnificent 1999-2014, Long Live the King!
2016/05/26 09:49:54
Subject: Re:ColoradoCare - potentially America's first single payer system.
In response to the OP, that doctors' strike you mentioned was the first of its kind in the NHS's 70 year history, so it's not exactly an everyday occurrence!
And it only happened in England. The NHS in Britain is a separate organisation for each part of the UK (England, Scotland, Wales, Northern Ireland) so don't blame Scotland for England's problems!
Our doctors are happy, productive, and know where the re-education camps are if they step out of line
On a serious note, I don't know why a rich and smart nation like the USA doesn't have a better healthcare system.
Up here in Scotland, we get free medicine when we get ill. You may think that's the nanny state, but studies have shown that giving somebody heart drugs for free, is a lot cheaper than having a team of heart surgeon's operating on that person when their heart fails, because they couldn't afford the heart drugs...
The NHS is not perfect, but there are a number of advantages to the system.
"Our crops will wither, our children will die piteous
deaths and the sun will be swept from the sky. But is it true?" - Tom Kirby, CEO, Games Workshop Ltd
How could it not?
