Forum adverts like this one are shown to any user who is not logged in. Join us by filling out a tiny 3 field form and you will get your own, free, dakka user account which gives a good range of benefits to you: No adverts like this in the forums anymore. Times and dates in your local timezone. Full tracking of what you have read so you can skip to your first unread post, easily see what has changed since you last logged in, and easily see what is new at a glance. Email notifications for threads you want to watch closely. Being a part of the oldest wargaming community on the net. If you are already a member then feel free to login now.

As a Colorado resident, this is a question that I heard about a month ago, and I'm not sure how to feel about it, despite looking into single-payer systems a bit. Since this is an international forum, I thought it might be appropriate to ask for thoughts on single payer systems, both how they could work in America, and how they work abroad for individuals.

TL : DR - If you could vote for a single-payer healthcare system for your country, would you?

Unfortunately, in America, views on this sort of thing either gets broadly lumped into "How to create a socialist hellscape" or "The government owes me a living", so it's kind of hard to find moderate information.

So, on one hand:

More taxes. Highest state tax in the country, actually.

Longer wait times for service, as anyone can get any medical attention or service performed for free.

Increased workload without commensurate pay increase could burn out medical professionals, and force them out of the state, making the above issue worse.

Colorado is already struggling with massive amounts of people moving due to legal pot. How much worse would that become if we tossed in free healthcare as well?

Colorado is also struggling with a massive homeless problem. So, now we'd be giving out free healthcare to people who don't contribute to the system at all.

On the other hand:

It would be higher taxes, but would eliminate insurance premiums and co-pays. I'm....not sure how that evens out, honestly. For me, personally, it would about be triple my current insurance premiums, which honestly isn't that bad, from like $30 to $90 a month, or thereabouts.

Higher wait times for service does seem to be a pretty valid criticism. I've heard that about the UK and Canada. And, if it's free, than yeah, I don't doubt people will start scheduling doctors visits for stuff they don't need to, or wouldn't if they had to pay.

Not sure about single-payer forcing medical professionals to run for the hills, but I have heard about medical professional strikes in the UK. It does, at least, follow that medical systems will have greatly increased demand, which would strain the staff.

It is funny to joke about complaining that the law would make Colorado so awesome to live in that everyone would want to, but the Denver metro is really struggling to build new homes and apartments fast enough. I've read that we have the highest rate of increasing real estate values in the nation, we recently surpassed san Francisco. If we put out the 'free healthcare' banner, I'm sure that would attract even more people, especially uninsured people with big health issues, which would be a problem for the system. Uninsured people are generally not very affluent, so they won't be able to afford housing, which leads to more homelessness.

I don't really like the idea of giving out free healthcare to homeless who contribute nothing to the system, especially if they are coming specifically to exploit the new law, but there is also the fact that hospitals already do kind of provide free healthcare, in the form of being unable to refuse emergency service. So, if by providing healthcare, even to homeless, would that expense be more or less than treating them in an emergency ward for free?

Colorado did pave the way for legal pot, which I voted for, and I will say that it has been a massive economic boon for the state. So, I guess we made the right decision there.

Would we be paving the way for a better single-payer system with Coloradocare? Or would it collapse under its own weight? I honestly don't know what to think.

I will admit that I am pretty conservative, and as such my instinct is to say SOCIALISM BAAAAAAAD!!!, but it's fair to say the American health system has big problems which I do not think obamacare fixed. If this sort of thing hasn't created nightmare scenarios in other countries, maybe it could work here.

Preventative care is less costly than emergency care. It would actually be helpful. Plus, how many people are homeless because they couldn't afford to pay for a medical emergency?

Right now, there is a serious issue with health insurance in this country and it is structural. People get their health insurance through their work. However, if you need to use the health insurance for anything serious, you lose your job because you can't work for a bit while the issue is being taken care of...Then you lose your health insurance.

Health insurance at my job is absolutely ridiculous. If it wasn't for my wife's job we'd have to move. The insurance scam needs to end. I'm curious about your taxes. Is it state income tax? The real estate tax in my State is stupid high. I'd be willing to pay more in taxes if I actually saw a benefit, but I'm doubtful politicians would make good use of it. Last time we upped the income tax our legislature p!ssed it away rather than fixing our fiscal problems.

It can't be worse than the system we have now. Having been in Colorado for about 6 months and having traveled quite a bit before coming here it's hard to say whether it'd be good for Colorado though.

Colorado already has a huge issue with people moving to it faster than growth can accommodate. Legal weed alone has been a massive part of that, along with it being a "wild" state, a lot of 20 somethings are moving out here. Surprise surprise, most 20 somethings who move out here to smoke pot, live in their cars, and go hiking don't contribute much and put a strain on local resources. I saw this a lot in flagstaff as well, and they don't have legal weed. Many parking lots have a "no overnight parking" sign to prevent people from setting up shop there, and there's a noticeable resistance to be people moving in from the locals. Keep in mind I live in the mountains right now, mostly small communities that are magnets for these kinds of people. When I was in Denver they weren't as common.

One of the problems with legalising weed though is that it's attracted a lot of weird people to here. Friends who have lived here for a long time said this happened shortly after legalisation. Basically people thought "if weed is OK, I can do anything!" Or at least that's how my friends described it. So naturally you get the more out there and wild folk moving in. And I can believe it too, it's pretty crazy the stuff youll see if you go out at night when resort season is going on.

If this was a different state it wouldnt be a big deal, but legal weed and a nationalized style healthcare in the vein or Canada or Britain may as well be a massive "invade me" sign for my generation, Californians especially If I was Colorado, I would wait until more states legalize weed or let someone else try the system first. They're under enough strain as is, this would seriously worsen things for the state.

There are also the regular homeless problems though. Rent, food, and gas are all more expensive here. Unless you're sharing a house or have a good job, it can be very rough on low income people up here. The problem is the ski resorts don't want these people messing with their image and just dump them off on neighboring towns. With the weather getting better though, you're seeing more of them however. You also have gentrification in ski resort towns and lots of "cleaning up" of low income areas.

Colorado is in a weird spot right now, there's a lot of things they're doing right, but if they don't slow down they could undo all they've accomplished in my opinion. My generation is seeing it as the place to be and I just have a feeling that bubble of "opportunity" is going to burst soon. I'm getting out of here for that very reason.

 Kap'n Krump wrote:
TL : DR - If you could vote for a single-payer healthcare system for your country, would you?

The best system really is a hybrid, where there's a base level of guaranteed care for everyone, but if anyone wants to have higher coverage then they are free to do so.

This system has the advantage of reducing the number of horror stories - people will get treatment for basic things. It also has the advantage of being much cheaper, as skyth says prevention is cheaper than cure, but there's also the big issue that a national system can control costs better.

But with that said, I'd be very wary of a single state putting something like this in place. People who know they have expensive surgeries later in life could move to Colorado. There'd be a temptation to live elsewhere with lower taxes while you're earning, then move to Colorado when you retire to take advantage of the healthcare that other people are paying for.

I think a healthcare in the US could benefit greatly from a strong public system, but as to whether one state should go it alone? I'm not sure that's viable.

 MrMoustaffa wrote:
It can't be worse than the system we have now. Having been in Colorado for about 6 months and having traveled quite a bit before coming here it's hard to say whether it'd be good for Colorado though.

Colorado already has a huge issue with people moving to it faster than growth can accommodate. Legal weed alone has been a massive part of that, along with it being a "wild" state, a lot of 20 somethings are moving out here. Surprise surprise, most 20 somethings who move out here to smoke pot, live in their cars, and go hiking don't contribute much and put a strain on local resources. I saw this a lot in flagstaff as well, and they don't have legal weed. Many parking lots have a "no overnight parking" sign to prevent people from setting up shop there, and there's a noticeable resistance to be people moving in from the locals. Keep in mind I live in the mountains right now, mostly small communities that are magnets for these kinds of people. When I was in Denver they weren't as common.

One of the problems with legalising weed though is that it's attracted a lot of weird people to here. Friends who have lived here for a long time said this happened shortly after legalisation. Basically people thought "if weed is OK, I can do anything!" Or at least that's how my friends described it. So naturally you get the more out there and wild folk moving in. And I can believe it too, it's pretty crazy the stuff youll see if you go out at night when resort season is going on.

If this was a different state it wouldnt be a big deal, but legal weed and a nationalized style healthcare in the vein or Canada or Britain may as well be a massive "invade me" sign for my generation, Californians especially If I was Colorado, I would wait until more states legalize weed or let someone else try the system first. They're under enough strain as is, this would seriously worsen things for the state.

There are also the regular homeless problems though. Rent, food, and gas are all more expensive here. Unless you're sharing a house or have a good job, it can be very rough on low income people up here. The problem is the ski resorts don't want these people messing with their image and just dump them off on neighboring towns. With the weather getting better though, you're seeing more of them however. You also have gentrification in ski resort towns and lots of "cleaning up" of low income areas.

Colorado is in a weird spot right now, there's a lot of things they're doing right, but if they don't slow down they could undo all they've accomplished in my opinion. My generation is seeing it as the place to be and I just have a feeling that bubble of "opportunity" is going to burst soon. I'm getting out of here for that very reason.

Agreed. There has actually been a push for other states to legalize weed simply to stop people from coming here. People are showing up here only for the weed while contributing nothing at all, and it's annoying as gak. I don't smoke, I don't have a problem with people who do, but I have a problem with potheads, who are basically alcoholics in that they take something okay and abuse the hell out of it.

To clarify, you are talking about a tax-funded system that provides free healthcare to anyone in need of it, such as the NHS in Britain?

Because if so, then I am all for it, and I struggle to see what grounds anyone could oppose it on (though I'm sure people will and do). In the First World, healthcare should be a right; it should not be something you have to pay for directly and thus can find yourself unable to afford, it should not be something that excludes anyone for any reason or something used to turn a profit. It should be as much a part of the state infrastructure as policing, education or local government, it should not be farmed out to corporations who would use it to make money.

If you have a medical emergency or develop some debilitating medical condition, it should be on the health service to deal with that to the best of their ability. The question 'can I afford to have this injury or illness treated?' should be one that is never asked.

I see it creating a significant burden on those whose jobs provide their health insurance, as their tax rates will rise, without seeing a corresponding dip in out of pocket expenses. Colorado citizens who serve in the military are an example. Colorado is one of the states who makes them pay state taxes, so even though a service member may be living in Florida at the time, they'll still have to pay extra taxes, even though they are getting nothing for it. *shrugs*

Just another consideration.

Are employees allowed to resign from workplace health insurance schemes?

 Kilkrazy wrote:
Are employees allowed to resign from workplace health insurance schemes?

I don't know honestly, but I'm sure that if Single Payer comes around, business will drop their health care plans as fast as possible, since it's redundant spending at that point.

If that happens, people won't be crippled by paying job-linked health insurance and social health insurance.

Social health insurance tends to be cheaper than private insurance.

 Kilkrazy wrote:
If that happens, people won't be crippled by paying job-linked health insurance and social health insurance.

Social health insurance tends to be cheaper than private insurance.

Yeah, I'm referring to those who don't pay job-linked. There are a decent number of jobs out there that make it a no cost perk, mine for example. Not arguing it should be a stop all type of consideration, but should definitely be added to the list of considerations.

 Kilkrazy wrote:
Are employees allowed to resign from workplace health insurance schemes?

Yes - From what I understand, Coloradocare would eliminate insurance premiums and co-pays, and instead would leverage a ~7% income tax from employers and 3% from employees. People who self-employed would be responsible for the full 10% out of their pay. Medical insurance would cease to be a thing, in Colorado at least.

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.


Automatically Appended Next Post:

 Paradigm wrote:
To clarify, you are talking about a tax-funded system that provides free healthcare to anyone in need of it, such as the NHS in Britain?

Because if so, then I am all for it, and I struggle to see what grounds anyone could oppose it on (though I'm sure people will and do). In the First World, healthcare should be a right; it should not be something you have to pay for directly and thus can find yourself unable to afford, it should not be something that excludes anyone for any reason or something used to turn a profit. It should be as much a part of the state infrastructure as policing, education or local government, it should not be farmed out to corporations who would use it to make money.

If you have a medical emergency or develop some debilitating medical condition, it should be on the health service to deal with that to the best of their ability. The question 'can I afford to have this injury or illness treated?' should be one that is never asked.

I believe so, yes - healthcare would be funded by taxes with no out-of-pocket cost to Colorado citizens.

An oft-quoted sentiment in America is that there are extreme wait times in England for medical services. I'm curious - what is your experience with NHS? Generally positive?

http://www.theguardian.com/society/2015/apr/09/nhs-hospital-waiting-time-figures

A recent story about NHS wait times.

 Paradigm wrote:
To clarify, you are talking about a tax-funded system that provides free healthcare to anyone in need of it, such as the NHS in Britain?

Because if so, then I am all for it, and I struggle to see what grounds anyone could oppose it on (though I'm sure people will and do). In the First World, healthcare should be a right; it should not be something you have to pay for directly and thus can find yourself unable to afford, it should not be something that excludes anyone for any reason or something used to turn a profit. It should be as much a part of the state infrastructure as policing, education or local government, it should not be farmed out to corporations who would use it to make money.

If you have a medical emergency or develop some debilitating medical condition, it should be on the health service to deal with that to the best of their ability. The question 'can I afford to have this injury or illness treated?' should be one that is never asked.

I'd prefer a Canadian style system, but the net effect is the same.

 djones520 wrote:
http://www.theguardian.com/society/2015/apr/09/nhs-hospital-waiting-time-figures

A recent story about NHS wait times.

It depends what you are waiting for, where you are waiting, and how well you know how to get the best out of the system.

My daughter was admitted for osteomyelitis a few years ago, and was extremely quickly and well treated.

My father was very quickly admitted and seen when he was very seriously ill a couple of years ago.

This was partly because we always had one or two family members hanging around checking that stuff was getting done, talking to doctors and nurses and so on.

If you're seriously ill and on your own, things are going to be more difficult.

At least there is the option of private health, which doesn't deal with emergency cases but does a good if expensive job with non-urgent work.

 MrMoustaffa wrote:
It can't be worse than the system we have now. Having been in Colorado for about 6 months and having traveled quite a bit before coming here it's hard to say whether it'd be good for Colorado though.

Colorado already has a huge issue with people moving to it faster than growth can accommodate. Legal weed alone has been a massive part of that, along with it being a "wild" state, a lot of 20 somethings are moving out here. Surprise surprise, most 20 somethings who move out here to smoke pot, live in their cars, and go hiking don't contribute much and put a strain on local resources. I saw this a lot in flagstaff as well, and they don't have legal weed. Many parking lots have a "no overnight parking" sign to prevent people from setting up shop there, and there's a noticeable resistance to be people moving in from the locals. Keep in mind I live in the mountains right now, mostly small communities that are magnets for these kinds of people. When I was in Denver they weren't as common.

One of the problems with legalising weed though is that it's attracted a lot of weird people to here. Friends who have lived here for a long time said this happened shortly after legalisation. Basically people thought "if weed is OK, I can do anything!" Or at least that's how my friends described it. So naturally you get the more out there and wild folk moving in. And I can believe it too, it's pretty crazy the stuff youll see if you go out at night when resort season is going on.

If this was a different state it wouldnt be a big deal, but legal weed and a nationalized style healthcare in the vein or Canada or Britain may as well be a massive "invade me" sign for my generation, Californians especially If I was Colorado, I would wait until more states legalize weed or let someone else try the system first. They're under enough strain as is, this would seriously worsen things for the state.

There are also the regular homeless problems though. Rent, food, and gas are all more expensive here. Unless you're sharing a house or have a good job, it can be very rough on low income people up here. The problem is the ski resorts don't want these people messing with their image and just dump them off on neighboring towns. With the weather getting better though, you're seeing more of them however. You also have gentrification in ski resort towns and lots of "cleaning up" of low income areas.

Colorado is in a weird spot right now, there's a lot of things they're doing right, but if they don't slow down they could undo all they've accomplished in my opinion. My generation is seeing it as the place to be and I just have a feeling that bubble of "opportunity" is going to burst soon. I'm getting out of here for that very reason.

Pretty apt description.

Point of contention... Boulder... man, they've always been weird.


Automatically Appended Next Post:

 Kap'n Krump wrote:

 Kilkrazy wrote:
Are employees allowed to resign from workplace health insurance schemes?

Yes - From what I understand, Coloradocare would eliminate insurance premiums and co-pays, and instead would leverage a ~7% income tax from employers and 3% from employees. People who self-employed would be responsible for the full 10% out of their pay. Medical insurance would cease to be a thing, in Colorado at least.

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.

Housing market is insane now in Colorado... especially around the Denver 'burbs. Best to look at the tiny mountain towns and learn to love driving.

I am dubious at the idea that 10% income tax would cover Coloradocare....

I have no idea what it would take to cover Colorado citizens, but 10% overall payroll tax is quite a bit.

Then again, the amount that employers pay for insurance premiums is flying rodent gak crazy. When I quit my job in Oklahoma, I looked into the supplemental insurance plan they offered - basically a way to carry on my employee health care plan for 6 months after I quit - I was told that the monthly premium was something to the tune of a $1,000 a month, most of which had been paid by my employer for the duration of my employment.

As for the housing, yeah - I bought a home in aurora (east Denver) in 2012 for ~230k, and I recently had it appraised for ~340k. I've put a ton of work into it, but still, it's increased in value by almost 50% in 4 years.

I think this is a good thing. A good way to show that a single payer system run by the government wont work. The govt here does not create successful programs. Never have. So we watch this failure in Colorado and people will stop asking for it nation wide.

 Kap'n Krump wrote:
I have no idea what it would take to cover Colorado citizens, but 10% overall payroll tax is quite a bit.

It is... but, I'm struggling to picture that 10% increase would cover the premiums that the employees AND employers pays.

Then again, the amount that employers pay for insurance premiums is flying rodent gak crazy. When I quit my job in Oklahoma, I looked into the supplemental insurance plan they offered - basically a way to carry on my employee health care plan for 6 months after I quit - I was told that the monthly premium was something to the tune of a $1,000 a month, most of which had been paid by my employer for the duration of my employment.

Indeed... that's part of why it's so frustrating to have any debates on what to do with healthcare policy-wise. There are MASSIVE price distortions all over the industry, it's literally a shell-game. If people only truly understood how much we individually pays (including what your employer pays because... face it: that is part of what you earn and the cost of your employer's labor cost).

As for the housing, yeah - I bought a home in aurora (east Denver) in 2012 for ~230k, and I recently had it appraised for ~340k. I've put a ton of work into it, but still, it's increased in value by almost 50% in 4 years.

And it's still going to skyrocket for the next Decade.

I'm looking to move once my kids are in college... and Colorado may be outpriced by the time I'm ready.

 namiel wrote:
I think this is a good thing. A good way to show that a single payer system run by the government wont work. The govt here does not create successful programs. Never have. So we watch this failure in Colorado and people will stop asking for it nation wide.

On the other hand a lot of people in other countries with govt. run healthcare really do like it (despite admitting problems with it) so it could pave the way for other states to adopt if the people there really like it.

Something else to consider...the rising demand will trigger an increase in supply to meet that demand.

In other words, people will see an opportunity to make money by opening up medical practices to help people.

I'm sure it won't just be funded by payroll taxes from CO. Likely medicare/caide funding can go towards it as well.

In the UK we pay income tax in several bands from 20% up to 45%, plus a social security tax that is 11%. There is a tax free band up to about £10,500 a year.

The general result is that someone on £30,000 to £50,000 pays about 25 to 30% deductions from their monthly salary.

In return you get the UK (meaning the government, armed forces, police and legal systems, major national infrastructure, etc) free medical on the NHS, social security and a state pension from the age of 66 currently.

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.

 skyth wrote:
Something else to consider...the rising demand will trigger an increase in supply to meet that demand.

In other words, people will see an opportunity to make money by opening up medical practices to help people.

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...

Actually, long term trends can shift supply curves through investment due to increased demand. In this case, the demand curve is being changed to an increase of demand.

 djones520 wrote:
http://www.theguardian.com/society/2015/apr/09/nhs-hospital-waiting-time-figures

A recent story about NHS wait times.

That's down to a current freeze in funding. It's got nothing to do with the concept of government run medical care.

 Ketara wrote:

 djones520 wrote:
http://www.theguardian.com/society/2015/apr/09/nhs-hospital-waiting-time-figures

A recent story about NHS wait times.

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?

 Ketara wrote:

 djones520 wrote:
http://www.theguardian.com/society/2015/apr/09/nhs-hospital-waiting-time-figures

A recent story about NHS wait times.

That's down to a current freeze in funding. It's got nothing to do with the concept of government run medical care.

It has everything to do with the concept of government run medical care. Private orgs don't just "freeze spending".

 whembly wrote:

 Ketara wrote:

 djones520 wrote:
http://www.theguardian.com/society/2015/apr/09/nhs-hospital-waiting-time-figures

A recent story about NHS wait times.

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?

What, wait times go up slightly?

Compared to 'Only people with insurance get to not die of/suffer from various illnesses', I know which of the two I'd consider a negative.

djones520 wrote:It has everything to do with the concept of government run medical care. Private orgs don't just "freeze spending".

I know, right? Private orgs can go bankrupt. Or be asset stripped so they're incapable of fulfilling their obligations. Or one of many, many other things problems with relying on a company for any sort of contract/service that happen in the world of commerce/business.

I'd like to point out here that I was reading the linkage to NHS wait times as a negative perspective as to the idea of the Government running healthcare instead of private companies. My argument here was simply that as a negative, it really isn't much of one for judging an entire system of healthcare by. If that wasn't what was being advanced, then ignore my comments.

I just provided the link because someone asked about it.

I've been living off of government provided healthcare my entire life. I've seen the goods, I've seen the bad's. *shrugs*