
Single Payer Is Not a Principle- the Principle Is Universal Coverage - iamjeff
http://democracyjournal.org/magazine/single-payer-is-not-a-principle/
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trendia
The three issues of healthcare:

1\. Who has access to it?

2\. How much does it cost?

3\. Who pays for it?

This article mostly addresses (1) and somewhat (3), but doesn't really give
enough attention to (2). If pharmaceutical companies are granted a patent for
a drug, then they have the sole capability to set the price, which the
purchaser of the drug will be required to pay. The most obvious example is
that of Martin Shkreli, who bought a patent for an _existing_ drug and hiked
the price.

How do you fight someone like Martin Shkreli who raises the price?

One option: don't buy the drug until the price is lowered. Collateral: anyone
who doesn't have access to the drug. Problem: it is "unethical" to not pay for
a drug that could save someone's life. (That is, our emotional brains set the
value of a life at infinity).

Another option: set price controls for drugs. Problem: pharmaceutical
companies will inevitably lobby the government so that the "right" price
control will be a very high one.

Yet another option: Remove patents altogether. Problem: This removes the
incentive to produce pharmaceutical drugs with a low barrier to entry (which
is practically all pharmaceutical drugs).

So, any discussion of healthcare that says we need "universal coverage" needs
to balance all of these issues. So far, everyone seems to ignore (2).

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mullingitover
> Yet another option: Remove patents altogether

Another option: free market, but create a streamlined process for removing
patents in a punitive fashion so bad actors like Shkreli can lose their patent
within a very short time for price gouging.

~~~
trendia
How do you determine whether a price is "price gouging"?

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gremlinsinc
Why couldn't hospitals.. create a union... where they negotiate together for
better drug prices, AND they ALSO become the insurer-- your primary hospital
is your insurer--you pay them monthly to keep you healthy. They get recurring
income from sick/healthy people alike, they get to control the costs...and
they could set prices to be related to income...say 4% of income goes to
healthcare... When someone travels to another hospital, their primary hospital
picks up the bill...etc... I think costs could be a LOT lower because w/out
insurance agencies there's more money for the hospital directly and being MRR
the hospital can have a better idea of how much revenue they bring in on
average per month.

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Veratyr
I believe this is basically Kaiser Permanente and it exists. The main thing
missing is the income-based payments.

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Overtonwindow
Paying for it will always be the problem, but not just who pays for it, but
whom will be paid for those services. IMO the problem with today's healthcare
and insurance dilemma is that everyone wants to get in on the gravy train.
Doctors, specialists, and everyone in between, are eager to take a fee.
Pharmaceutical companies charge just about whatever they want because they
know, eventually, they'll get paid. Insurance is best left to the private
market, because if it goes universal through the government, then there will
never truly be any limitations on what is covered, how much is paid, and the
system will collapse upon itself.

For those that want to draw parallels to other nations, please remember those
nations tend to be considerably smaller than the U.S., and they've had a LOT
longer to work on these problems.

For my two cents, healthcare in America could be greatly improved with the
following:

1) No one gets turned down for insurance, no matter what. Even if it's just
basic prescription drug coverage, some basic level. 2) The cost of insurance
is tied to your income, with the price gradually increasing as your wage
increases so people are not forced to keep a low paying job for low paying
insurance, unless of course that's what they want. 2a) The longer you have
continuous insurance the more coverage you get, and the lower your costs.
Incentive people to get, maintain, and keep insurance. 3) A cap on the price
of drugs that have been on the market for more than 2 years. 4) Exclusive
patents on drugs no more than 4 years. 5) Insurance is available nationwide,
portable, and covers you no matter where you live, work, or go. 6) Finally, if
you cancel your insurance you may not reapply for insurance for six months.
Stop people from dropping insurance and waiting to pick it up only when they
need it.

There are a dozen holes you can poke in that, I understand, but it's a start,
and it's a short law that I think many would agree with.

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EwanG
Article points out that the important thing is that everyone has healthcare
that they can access as they need to. Many ways to get there, and Single Payer
isn't the only option. Rather partial to the German system myself...

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payne92
The real underlining principle is a question: Should healthcare be the
responsibility of an individual, or a collective responsibility of a group?

Without some agreement on this principle, we will continue to spin our wheels.

