
The doctor’s strike that nearly killed Canada’s Medicare-for-all plan - smacktoward
https://www.vox.com/policy-and-politics/2019/3/29/18265530/medicare-canada-saskatchewan-doctor-strike
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jimrhods23
My issue with a single-payer system in the US is that it won't get rid of the
middleman. You are essentially replacing a bunch of insurance companies with
one insurance company, which is the government.

Hospitals can now charge whatever they want and the cost continues to
skyrocket. This is exactly what has happened with college loans.

I would rather the hospitals have to charge patients directly, which would
drastically reduce costs..and then have a smaller layer of protection for
people that can't afford it.

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smacktoward
This is not how things work out in practice. Larger payer pools end up paying
_less,_ because they have enough market power to force providers to meet cost
targets if they want access to the customers in the pool. Medicare famously
gets much more out of each dollar it spends than does just about any private
insurance provider (see
[https://www.healthaffairs.org/do/10.1377/hblog20110920.01339...](https://www.healthaffairs.org/do/10.1377/hblog20110920.013390/full/)).

A single-payer system just takes this to its logical conclusion and creates a
single pool with nearly everybody in it. That pool is so large that only niche
providers of extremely high-margin services can survive without access to it,
so the single payer has the leverage to drive the rates it pays down to the
bone.

