
Why Single-Payer Health Care Saves Money - frgtpsswrdlame
https://www.nytimes.com/2017/07/07/upshot/why-single-payer-health-care-saves-money.html?partner=rss&emc=rss&_r=0
======
galeaspablo
How do we compare apples to apples (between countries)? Compare health
expenditure per capita (public and private) with multiple health indexes. I.e.
get the _bang for buck_.

In the list of nations with the best _bang for buck_ healthcare programs, you
will notice that top 20 healthcare programs are mostly single payer.

[http://www.who.int/healthinfo/paper30.pdf](http://www.who.int/healthinfo/paper30.pdf)

But there are single payer healthcare systems with bad health indexes, you
might say... Well, combine single payer healthcare systems and add some
transparency in healthcare and you now have an unmissable correlation.

[https://www.transparency.org/whatwedo/publication/global_cor...](https://www.transparency.org/whatwedo/publication/global_corruption_report_2006_corruption_and_health)

The top 20 _bang for buck_ healthcare programs (mostly single payer systems),
have an average ranking in terms of healthcare transparency of 18.7.

Are you from the USA? Notice the countries with universal healthcare, who have
a similar healthcare transparency ranking to that of the USA: Luxembourg,
Canada, Germany, France, Belgium, Ireland, and Chile. Their _bang for buck_
rankings are 16, 30, 25, 1, 21, 19, 33 respectively. All of these countries
have a better _bang for buck_ ranking than the USA's 37.

In one sentence... Universal and transparently managed healthcare consistently
gives more _bang for buck_.

And now to quote the original article... "It is a bedrock economic principle
that if we can find a way to do something more efficiently, it’s possible for
everyone to come out ahead."

EDIT: Check page 18 in the first source. Check chapter 11 in the second
source.

~~~
frgtpsswrdlame
This is a really good point. One problem I think though is that not everyone
will come out ahead in a single payer system. Our system is explicitly
organized around the fact that you must pay for care and we have the best and
most expensive care in the world. Our system is setup so that those at the top
of the economic ladder can buy a level of care they could not get anywhere
else. They will undoubtedly receive worse care were the US to switch to a
system which diminished the effect of personal wealth.

~~~
makomk
Indeed. One of the core ways single payer systems achieve such great results
in terms of bang-for-buck is by not covering treatments that offer bad value
for money, and this is almost certainly not politically viable in the US. For
example, I understand the ACA specifically forbids assessing the cost-
effectiveness of treatment based on dollars per QALY, which is how the NHS in
the UK rations care to reduce costs.

It simply does not follow that, because single payer systems offer better
value in terms of benefit gained for the dollars spent, those efficiency
improvements mean it's possible for everyone to come out ahead. Those last few
iotas of healthcare improvement are a lot more expensive than the lower-
hanging fruit.

~~~
inopinatus
This is flat wrong mis-statement of both the facts and the outcomes.

The NHS does not assess cost-effectiveness of treatment in the UK in that
fashion, and does not deny it on that basis.

Cost-effectiveness by QALY is one factor included in assessments by a separate
body, NICE, which a) is not part of the NHS and b) does not inhibit NHS bodies
from offering any particular treatment. If NICE gives a treatment option the
green light, then the NHS trusts are obliged to offer it in applicable
circumstances. If NICE does not, then individual (local) NHS trusts can make
their own assessment. If there is a local cost constraint, that _is_
considered as a matter of simple necessity.

It is a common falsehood often repeated by opponents of single-payer systems
that doctors in such systems are directly prevented from offering treatments
by faceless beancounters. It simply isn't so. Quite the opposite. The
assessors may say "you must offer this treatment". They do not say "you must
not".

However, QALY itself is IMO a terrible metric mainly because it is
sufficiently describable to non-practitioners to become a political football.

~~~
makomk
Part of running an "efficient" healthcare system is that cost constraints are
always a factor. Sure, NHS trusts are legally allowed to offer treatments that
aren't approved by NICE, but they have piles of money lying around to do
expensive things beyond the basics that are required of them at the best of
time, and this isn't the best of times - like many countries the UK has a
healthcare funding crisis right now.

At best, requiring a treatment rejected by NICE leaves your fate up to a
postcode lottery where your location determines whether you have access to it.
At worst, nowhere will cover it. Also, cost per QALY is one of the main
factors NICE uses, and the ACA means it and similar measures cannot be used as
any kind of factor at all in the US.

~~~
inopinatus
NICE was founded to reduce that postcode lottery by creating a base set of
what is nationally achievable. Over time, that set grows. It's grossly unfair
to misrepresent it as some kind of net-negative body, or to suggest that
doctors won't treat a patient. Indeed one of the effects is to encourage
research into more affordable treatments. This is in antithesis to the US
system where, for example, the drug companies are incentivized to R&D long-
term treatments for symptoms, not cures for diseases.

I like the incentives that NICE creates instead. Over time, it's a strong net
national benefit.

The failure to include such a mechanism in the ACA seems more to do with US
politics than any intrinsic characteristic of single-payer systems.

The NHS has apparently been under-funded for decades, far too long a period to
call it a "crisis". I would maintain it is simply grossly inefficient at
spending the money it does receive, due to horrible management. Again, this is
not an intrinsic characteristic of such systems.

------
warcher
It's still absurd to me that we make the false differentiation between taxes
and insurance premiums. If you've got a family, neither is negotiable. If you
have a job that pays, I promise you it affects your check in nearly
identically the same way as payroll taxes do. There's a tradition in America
where the price isn't actually the real price, we artificially advertise fake
prices to get you in the door and stuff a bunch of surcharges on the back end.
I wish we'd cut it out-- our taxes aren't crazy, but the way they're presented
make people flip their shit.

~~~
Joeri
Whenever I've visited the U.S. this drives me crazy. I always wonder how
people shop for anything, given that the only time you find out the actual
price of things is when you're about to pay for them. Do you just in your head
have to tack on 10 to 20 percent (depending on the context)?

~~~
warcher
Basically yeah. I bought a car last month and I paid an extra... twenty
percent before I walked out the door. Drives me nuts. That and fucking
tipping, man. Enough already. Just put the price on the menu- I'm good for it,
I swear.

~~~
pas
Tipping is. Meh. If you're broke, don't do it. It's not compulsory/mandated by
law. (There are states where waiters don't get compensated, if patrons don't
tip enough, but you're still broke, so don't feel too bad.)

~~~
warcher
The problem with tipping is that it's spreading, as wages aren't keeping up
with cost of living, but employers won't hand out raises. Uber driver? Tip.
Sandwich shop? Tip. Coffee shop? Tip. Pizza delivery? Delivery fee plus tip.
Have I been in drive-throughs with a tip jar? You better believe I have.

Enough already, guys.

~~~
pas
Drive-through with tip jar. Wow. Anyhow, I can't really condemn them for
trying, and you can understand why management won't either.

Yeah, it's just annoying, and it'll take a loooot of time to fix these small
annoyances.

~~~
warcher
It's never going away, I don't think. Workers love getting extra money, and
most food industry operations are barely staying alive as it is. I'm annoyed
enough to whine, but I still tip.

------
nostromo
I imagine _both_ single-payer and a truly free market health care system would
be substantially cheaper than the current system -- which has none of the
benefits of either approach.

With the federal government unable to act, turning healthcare back to the
states to test a number of different solutions seems entirely reasonable. Let
California try single-payer and Texas try something different -- after a few
years see if we've found a solution that could work for the whole country.

~~~
cortesoft
The problem with a 'each state do their own thing' solution is the very
problem with health care in this country in general - the freeloader problem.

If California implements a single payer system, it would make people in other
states more likely to choose not to get healthcare; if they get sick, they can
just move to California.

This is the reason the ACA has the 'individual mandate' to go along with
preventing the denial of care because of pre-existing conditions - without
some coercive force, there is no reason to buy health care until you get sick.

This is why a national single payer system is the solution.

~~~
flavor8
I'm not convinced this is insurmountable. How do countries with single payer
handle this?

Surely you could require an newly established resident who wants treatment to
pay a portion since they hadn't been funding it directly via taxes, and then
add a further penalty if they move back out of state within a certain period
of time (to discourage moving in-state just for treatment).

~~~
rayiner
It would be unconstitutional for a U.S. state to treat newly-established
residents differently than long-established ones with regard to a welfare
benefit: [http://www.washingtonpost.com/wp-
srv/national/longterm/supco...](http://www.washingtonpost.com/wp-
srv/national/longterm/supcourt/stories/court051899.htm).

Countries like Germany don't have this problem because they have the power to
control their borders. Accessing Germany's healthcare system requires being a
German resident. That, in general, requires applying for immigration, which
the government may or may not grant. EU citizens can, of course, become German
residents without applying for immigration, but every EU state has universal
healthcare so there is no incentive to free-ride.

And there's a push within Germany and other countries to limit access to
welfare benefits for new residents, even ones from other EU countries:
[https://www.theguardian.com/world/2016/oct/12/german-
governm...](https://www.theguardian.com/world/2016/oct/12/german-government-
approves-bill-to-stop-eu-migrants-claiming-benefits). U.S. states don't have
the power to do that.

~~~
cortesoft
Interesting... I wonder how places like California are allowed to still offer
different rates for in-state vs out-of-state tuition at the UCs?

~~~
tptacek
This is a really good question. The most recent case I could find here is the
one Rayiner cited, Saenz v. Roe. If you read it, both the opinion and the
dissent grapple explicitly with college tuition.

The reasoning goes, it seems, that only bona fide citizens of (say) California
will consume welfare in California (you don't move to California to consume
California welfare benefits in Ohio). But college education benefits are
"portable"; you could conceivably move to California solely for the purpose of
accumulating the benefits of a UC education, then take it back with you to
Ohio.

Further, the way in-state tuition benefits are structured, the residency
requirement is (supposedly) carefully tailored to address just that scenario,
by imposing relatively short durational requirements on residency, rather than
evidence of permanent residency.

It's tricky to piece out how health care would fit into this rubric. Depending
on the condition, you might move to California to benefit from their health
care and return to Ohio when you're cured, or you might need to stay in
California indefinitely to treat a manageable illness.

------
prostoalex
> One is that administrative costs average only about 2 percent of total
> expenses under a single-payer program like Medicare, less than one-sixth the
> corresponding percentage for many private insurers.

That story needs to come with a caveat that Medicare's anti-fraud efforts are
covered by law enforcement budgets, namely FBI
[https://news.google.com/news/search/section/q/medicare%20fra...](https://news.google.com/news/search/section/q/medicare%20fraud/medicare%20fraud?hl=en&ned=us)

~~~
tvchurch
Here's the other thing about administrative costs: Medicare's patients cost a
lot more per person than private insurance.

In other words, if it costs you $500 in administration costs and one patient
has care that totals $5,000 and another has care that totals $10,000, then
their administrative costs are 10% and 20%.

And yet we think that if we shifted more people onto a Medicare-like system,
we'd save money.

~~~
jefurii
Medicare patients are more expensive because of who it currently covers:
elderly and disabled people, two groups that use more services than the
general population. The whole point of a single payer AKA Medicare for all
system is to cover the entire population, which would (because math) bring
down the average cost per person.

------
peterhadlaw
The word "negotiation" is a euphemism here:

> The most important source of cost savings under single-payer is that large
> government entities are able to negotiate much more favorable terms with
> service providers.

If there are no other options for clients, it's essentially the government
telling doctors how much their services are worth.

~~~
lb1lf
Living in what is essentially a single-payer health care system (Norway), I
assure you we don't see many MDs sleeping in cardboard boxes under freeway
overpasses.

On a more serious note - education and skills tend to pay off.

Around here, doctors with their own practice are reimbursed by the state via
several mechanisms, the two most significant ones are probably a fixed sum for
each patient they are responsible for (they get this regardless of whether the
patient sees them or not) and a fixed sum for each treatment, prescription
filled &c.

Anecdotally, an MD with his own practice earns approx. $100k-$150k annually
before taxes; this is 2-2,5 times the national average. (Very roughly
speaking, but in the right ballpark)

~~~
DrScump
How is medical school funded? It's not uncommon for medical school grads in
the USA to graduate with six-figure student loan debt.

~~~
lb1lf
University tuition is free (well, tax-funded, to be precise) - so students
typically take out a student loan of approx. $1k/month to cover living
expenses. A lot (most?) work part-time on the side to make ends meet.

Part of this loan (methinks ~30%) is converted into a scholarship once you
pass your exams, thus leaving you (very roughly) $50,000 in debt after six
years in med school.)

------
caseysoftware
> _" The most important source of cost savings under single-payer is that
> large government entities are able to negotiate much more favorable terms
> with service providers. In 2012, for example, the average cost of coronary
> bypass surgery was more than $73,000 in the United States but less than
> $23,000 in France."_

A more useful comparison would be the average cost of coronary bypass surgery
for someone with a employer-provided health plan versus the cost that
Medicare, Medicaid, or the VA pays. And then compare the average wait times of
each along with recovery time/effectiveness.

Out of pocket is only one "cost" in this picture.

~~~
krath94
I feel like the numbers they picked are intentionally misleading. Is the
$73,000 the cost for no insurance or with insurance? I know it says average,
but average out of which group?

------
methodover
Yes, a single-payer system would save money, but you have to be honest about
the downsides. It's unfortunate that they are not honestly discussed in the
article. Or, for that matter, almost anywhere.

The vast majority of the savings come from government price fixing. This is
what the article means by "large government entities are able to negotiate
much more favorable terms with service providers." It's not really a
negotiation; at least not like it is in the private sector. When the
government controls an entire market, they set prices. They can (and should)
take input from providers and drug/device developers, but at the end of the
day, whatever they say goes.

There are incredible risks when the government sets prices for a good/service.
We should not take on those risks lightly.

~~~
esturk
You rip NYT for not openly discussing the downsides, yet after reading your
comment about the 'risks', you haven't talked about the downsides either.

Aside from "negotiation is not negotiation in the private sector", you aren't
adding much to the discussion. Yes, government negotiation is still
negotiation and yes it is not like in the private sector but it doesn't make
it any less legitimate.

~~~
methodover
I'm not really an expert at all either when it comes to healthcare or
economics. I feel not particularly qualified to get into the downsides. I'm
just a regular person trying to understand the debate and take an informed
position. That said, I'll try and take a stab at answering your comment in an
honest way.

> Yes, government negotiation is still negotiation and yes it is not like in
> the private sector but it doesn't make it any less legitimate.

When the government owns an entire industry (as is being proposed in this case
with the health insurance industry) I'm not sure if there is any meaningful
difference between the sentences, "the government will set a price" and "the
government will negotiate a price with providers."

We are talking about price controls as a means of lowering prices. It seems to
be about that simple.

I'm a bit confused by what you mean when you say that when the government does
it, "it doesn't make it any less legitimate." I'm not arguing about it would
be illegitimate or unlawful of the government to set prices. I am, however,
suggesting that there are known negative consequences of government price
controls.

The general criticism of price controls, as I understand it, is that when the
government sets prices too low, it causes shortages. Applied to healthcare, I
would imagine that we risk slower development of new drugs and devices, lower
quality service from doctors and nurses, and shortages of drugs and devices.

------
tabeth
The article makes the assumption that the goal is to save money. Perhaps the
way things are keeps the status-quo alive for those who make the rules, and
_that 's_ why we don't have single payer.

I hate to be the conspiracy theorist, but I can't help but think that's the
truth.

~~~
cortesoft
Anytime one person saves money, it is also costing someone else money (the
person or people that money was going to). Saving money on healthcare will
cost money for people who are currently making money from the excessive costs
of healthcare.

This is not a secret, and not really a conspiracy; the groups that make money
from the current system are always the ones opposed to change. It just sucks
because there aren't nearly as many of them as the rest of us, but they just
have more to lose than the rest of us have to gain - a classic example of
concentrated benefits and diffuse costs.

~~~
luxuryballs
But the 'rest of us' can only gain for as long as those people stick around to
pay for it. There is a lot of wealth in this country, for now. If you wanna
really see things go down hill then watch the wealth scramble out of the
country as soon as we tell them they're going to have to fund the healthcare
of everyone else.

~~~
cortesoft
I was talking about people making money off of the health care industry, not
wealthy people in general. We aren't asking them to fund the healthcare of
everyone else, just not make profit off of waste.

Also, scramble out of the country.... where? There are very few places they
can 'run off to' that don't already have a single payer health care system.
People don't seem to be 'fleeing' those countries.

~~~
luxuryballs
Those countries have way less population who can't contribute. The US is huge,
there's so many more people who need healthcare but don't pay any taxes.

~~~
cortesoft
Why would the absolute number of people who don't pay taxes matter? Wouldn't
it be more about the percentage of people? It is not easier for 100 people to
support 1 than 1000 to support 10...

------
sailfast
> "Of course, having to pay taxes is itself a mandate of a sort, but it’s one
> the electorate has largely come to terms with."

Some taxes maybe? The whole "mandate vs. tax" argument was at the core of the
opposition to the Affordable Care Act. I would argue that this issue is not
decided by a long shot and a great deal of people are still upset by this.

Further, this article addresses aggregate costs but doesn't acknowledge that
costs of the change to single payer will impact people in much different ways.
Some folks will be asked to pay a lot MORE, and some will be asked to pay
LESS, and it may settle out to be cheaper in aggregate, but cheaper to whom?
These impacts (especially felt in the short term) need to be considered and
mitigated.

~~~
DrScump

      I would argue that this issue is not decided by a long shot 
    

On the contrary. The SCOTUS defined this already. ObamaCare still exists only
because it _is_ a tax and, therefore, pre-emption applied.

~~~
sailfast
Certainly, the legal issue of a tax vs. a mandate is decided, but Americans'
comfort with this tax to cover other Americans as a matter of preference is
not.

------
mcrad
Agency costs. Fools (& idealistic Americans) be thinking of "administrative
costs" as able to be managed like the phone center that books your
appointment, mail shop that sends your test results or janitors that clean the
floor. Yes, these kinds of costs are basically in proportion to medical
services provided, and yes, economies of scale apply. But if you have worked
for a giant corporation or government, you might understand the danger of
agency costs: not only can't be controlled, but in time, you get a worse
product. Sad!

No, there's no perfect solution, but there must be a balance of market forces
and semi-trustworthy regulators to make it work.

------
donmatito
I would like to understand better what is meant by "single payer". I think I
know what it should mean, but then I see France as an example of single-payer
system. France has a complex system of insurance bodies (public entities,
privates companies, some weird stuff in between)...

If I understand correctly the biggest savings come from the _mandatory_ nature
of the coverage - everybody is covered at least partially by the State, +
employees by their employers, + private offers for the others + universal
coverage for immigrants and the most destitute. Risk is shared between the
healthy and sick people, and prevention can be maximized.

~~~
coredog64
When I see it in the NYTimes, I assume it means that the health care fairy
pays for it. As you've noted, very few people are wonky enough to be able to
discern any difference between the systems in the UK, France, Germany, and
Switzerland. Instead, they're all lumped into "European single payer"
regardless of the level of truth or correctness.

~~~
pas
That's just bad faith.

There are pretty well graspable differences.

Germany has both private and public krankenkasse-s (sick people funds, so
healthcare insurance providers).

The UK has NHS, a big public insurance system.

And so on.

The economics are pretty well understood, so like climate change, it's not
100%, because it's big and complex as fuck, but a lot more certain, than a
50-50 coin flip.

Of course people will have to still pay. The question is, what's the fair
amount to ask from people. And it seems a progressive healthcare tax would be
fair.

------
yegle
I find it hilarious that this article uses state government taking over road
maintenance as an analogy and claim it will save money, while it's known that
California has a bad reputation in road repair, due to _funding_ problem.

[http://www.latimes.com/politics/la-pol-sac-road-funding-
prob...](http://www.latimes.com/politics/la-pol-sac-road-funding-
problems-20160512-snap-story.html)

~~~
undersuit
>“I think the missing element in this is Republican votes and identified
Republican support,” said Brian Kelly, secretary of the California State
Transportation Agency.

>California’s reliance on gas taxes to repair its transportation network is
becoming less and less tenable. Increased fuel economy standards have led to
less spending on gasoline

Why stop at saying it's a funding problem? (Allegedly) Obstructionist
Republicans won't allow the government to react to changing conditions to
update laws needed to fix the funding problem.

~~~
DrScump
Republicans have _no_ power in CA. Democrats hold the governorship and have
supermajorities in both the Assembly and Senate.

CA infrastructure doesn't have a _funding_ problem. It has a _spending_
problem.

~~~
undersuit
Hey man, I'm just repeating what the article said. If the article is wrong go
after the poster. They included an article link in their argument that it was
a funding problem, and the article doesn't say that.

------
erentz
Dan Carlin also did an episode on these numbers recently. The numbers are
undeniable. We get terrible value for our money on health care in the US.

[https://itunes.apple.com/us/podcast/common-sense-with-dan-
ca...](https://itunes.apple.com/us/podcast/common-sense-with-dan-
carlin/id155974141?mt=2&i=1000382690497)

------
leepowers
> It thus makes no sense to reject single-payer on the grounds that it would
> require higher tax revenues. That’s true, of course, but it’s an irrelevant
> objection.

> The most important source of cost savings under single-payer is that large
> government entities are able to negotiate much more favorable terms with
> service providers.

I agree these objections are not relevant for the overall system. But certain
individuals and groups within the current system will get screwed.

The wealthy and upper middle-class will oppose any tax increases, as it will
decrease their take-home income. Plus the resentment of having to pay for
someone else (the moochers).

Providers will oppose any haircut that comes with single-payer rates and price
controls. No more millionaire doctors, specialists, or dentists.

And of course the overhead of health insurance middle-men and the huge
administrative bureaucracy costs.

This is the crux of the problem. We could have a reasonably good system for
everyone. But it requires a lot of people with heavily vested interests into a
less ideal situation.

~~~
luxuryballs
Yeah, and we ban people from public roads for bad behavior. Will we ban people
from public healthcare for bad health choices? Do we really want to give the
government that kind of exclusive control over a service while giving up
control of our bodies?

~~~
coredog64
Smokers typically exhibit compressed mortality. Yes, they die younger than
non-smokers, and yes, they have health issues. But the health issues are
typically of the sort that get deadly in short order and so actually save
money.

~~~
camiller
Not sure how fighting lung cancer for three years with multiple rounds of
chemo and radiation saves money....

------
Aron
"An underappreciated advantage of the single-payer approach is that it
sidesteps the mandate objection by paying to cover everyone out of tax
revenue.

Of course, having to pay taxes is itself a mandate of a sort, but it’s one the
electorate has largely come to terms with. Apart from fringe groups that
denounce all taxation as theft, most people understand that our entire system
would collapse if tax payments were purely voluntary."

Seriously? This is the argumentation from someone that has absolutely no idea
what the other side is thinking.

------
RichardHeart
What is more likely, insurance companies beat more than 50% more care per
dollar out of doctors/hospitals etc, or people would be better of getting rid
of the giant middleman? Insurance companies don't heal you. Medicine does. Get
rid of the 33% overhead of insurance and gain the free 50% extra money for
healthcare. Then all the people in that industry can move on to better gainful
employment.

------
kbutler
What government-run service do you consider a model of efficiency and good
management?

Highways? Defense? Education? National parks?

Why would single payer health care be the exception?

------
blizkreeg
The government (county, state, or federal) pays for infrastructure, safety,
defense, (public) schools, and a lot of other things. All out of tax revenue.
With the help of _private_ contractors. Through a bidding process for
contracts and work - thereby getting the lowest price (even if not necessarily
value).

It blows my mind that health is treated differently. It seems to me a lot of
middle-America mistakenly assumes it's socialist, which single provider is.
Single-payer is similar to most systems we already enjoy. It's the only way
prices will come down. You need negotiating leverage and a single-payer system
that a majority of your population uses is the only way to have that kind of
leverage over drug companies and healthcare providers.

Single payer universal healthcare with more expensive private plans (for those
who can afford) is the only system that can come close to fixing the broken
healthcare system in this country.

------
vowelless
I personally think Medicare for all could potentially be a good system. But
this article doesn't make a good argument at all.

> Voters need to understand that this cost objection is specious. That’s
> because, as experience in many countries has demonstrated, the total cost of
> providing health coverage under the single-payer approach is actually
> substantially lower than under the current system in the United States.

Not a valid comparison. They literally give examples of three liberal states
where there were cost concerns. And the response? It is not to compare to
states where single payer actually worked, bit compare it to different
countries with widely different budgets and levels of centralization from
medical research, medical school to employment of doctors. Just not a valid
comparison at all.

> It is a bedrock economic principle that if we can find a way to do something
> more efficiently, it’s possible for everyone to come out ahead.

Useless fluff statement

> By analogy, suppose that your state’s government took over road maintenance
> from the county governments within it, in the process reducing total
> maintenance costs by 30 percent. Your state taxes would obviously have to go
> up under this arrangement

How is this an "obvious " point? Need some justification for this very
important point !

Hence this statement doesn't follow as the premise is not established

> Likewise, it makes no sense to oppose single-payer on the grounds that it
> would require additional tax revenue.

.

> One is that administrative costs average only about 2 percent of total
> expenses under a single-payer program like Medicare, less than one-sixth the
> corresponding percentage for many private insurers. Single-payer systems
> also spend virtually nothing on competitive advertising, which can account
> for more than 15 percent of total expenses for private insurers.

Finally, some relevant fact and justified points. These are good points in
favor of single payer.

> The most important source of cost savings under single-payer is that large
> government entities are able to negotiate much more favorable terms with
> service providers

Ah this is infuriating. The link compares USA to other countries. Why not
given evidence of Medicare compared to private insurers? That would be such a
strong point in favor of Medicare. I just don't think you can compare the
entirety of the American healthcare system to other countries without
controlling for the wide disparity in the systems as mentioned above.

> In 2012, for example, the average cost of coronary bypass surgery was more
> than $73,000 in the United States but less than $23,000 in France

Sad reality but again this comparison is meaningless without controlling. Why
not compare states with single payer with states that don't have it? Or why
not compare Medicare bypass surgeries with those of private? If none of those
support the argument for single payer, then at least control for the variables
when comparing countries... Otherwise the comparison is just lazy (or worse,
just narrative building ).

> In short, the evidence is clear that single-payer delivers quality care at
> significantly lower cost than the current American hybrid system. It thus
> makes no sense to reject single-payer on the grounds that it would require
> higher tax revenues. That’s true, of course, but it’s an irrelevant
> objection.

I agree with this point, I am willing to take a higher tax hit to support
single payer but the tax question is not an irrelevant object at all!

Anyway, sorry if I sound bitter. I really want to see the US have a robust
single payer system that respects it's ability to innovate with drugs and
provide great healthcare to everyone. I just hope defenders of single payer
(especially economics professors like the author ) can build a better case for
it. I hope.

~~~
jefurii
> Ah this is infuriating. The link compares USA to other countries. Why not
> given evidence of Medicare compared to private insurers?

If Medicare covered the same set of people as private insurers it might be a
good comparison. However in the U.S. Medicare currently covers certain groups
(elderly, disabled) that have very different profiles from most private
insurance customers.

------
al3xnull
I'm still wondering if it's possible to little by little add single-payer. If
we could agree for basic 6-month checks at a doctor for preventive heads-up,
basic immunizations, a single child delivery, and potentially a few other
things; I wonder whom would get on-board. If at least very basic healthcare is
guaranteed, why couldn't we as a nation at least provide that? Interested to
see what someone more knowledgable would say is wrong with trying that.

------
dogruck
I'd like to see more about how that "negotiation" over costs would work. Would
it be like retail suppliers negotiating with Walmart? Or like military
suppliers negotiating with the Pentagon?

There's also the tough questions, such as who gets access to the best doctors,
at the best hospitals?

------
fleitz
A big part of this to is drs in places like Canada get training on how to save
costs which generally means not providing service. I had to switch to a
private system in Canada to get drs who would take a proactive approach.

~~~
vkou
Oftentimes, not providing any service is better for patient outcomes then
providing unnecessary services. Especially if those services are surgeries.
[1]

[1]
[https://www.usatoday.com/story/news/nation/2013/06/18/unnece...](https://www.usatoday.com/story/news/nation/2013/06/18/unnecessary-
surgery-usa-today-investigation/2435009/)

~~~
fleitz
I'm talking about ordering an ultra sound / MRI and running other tests.

I'm talking about sinuses so collapsed they couldn't be scoped so the ENT Dr
just assumed they were fine.

