Timelordwho wrote:
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Single payer would not solve this. Single provider, might, but that's an entirely different concept, with a huge amount of additional changes required. All a single payer system does is say that the government pays on your behalf (and you fund that cost via taxes rather than via insurance premiums). The problem is that this just adds another middleman to the equation. And frankly, a middleman that has even less desire or need to keep costs low than the insurance companies do now.
Single payer is not in addition to the various middlemen/billers, it is in lieu of.
Already addressed this in my post. Those middlemen it actually replaces have at least some motivation to keep costs down today (well, less today than a few years ago, and less then than a few decades ago, so we can see what direction this has gone). Obviously, it depends on the specific implementation of your single payer system.
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It replaces the general health insurance system for routine & cato, but does not replace EoL, elective, and ultra premium care.
Again. This depends on the specific implementation. Honestly, it always sounds easy to say that "basic" care should just be paid for, but where's the boundary of that care? The devils in the details IMO. And this tends to creep into a larger and larger set over time as we find more cases of things that "should be paid for", but aren't.
For me it's less about how the care is covered as how it's paid for. I'm a firm believer in the principle that when someone has a direct out of pocket cost for something they receive, that they tend to make greater effort to be more responsible with all choices related to that thing. The more you abstract that cost, the less care will be taken. I know that one of the great arguments for free basic care is the concept of preventative care. If you make it free to get regular checkups, more people will get them, and they'll be healthier as a result, right? Except you can argue the opposite as well. If the care is free, then one might argue "why should I go to the doctor unless/until I get sick"? If me getting sick presents a major cost to me, I might take the responsible action to prevent it ahead of time. But if my illness will be paid for by the government, there's less of a need.
The point is that there will always be people, who, left to their own devices will make poor decisions. So you really have two choices. You either allow them the freedom to make bad choices, but then hold them responsible for the consequences, or you cover the costs for their poor choices, but will almost certainly have to take some sort of coercive action to control their choices as a means of "reducing costs". He who pays for a thing controls that thing. And that's what bothers me the most about this. Ultimately, the only real cost savings methodology a single payer system has is to attempt to control the choices of those it covers. Which is problematic IMO. In the other direction, you save costs by just not paying for people's health care. It starts out costing "the people" nothing at all. Each person is responsible for their own actions and their own outcomes. Does that suck for the percentage of the population that will develop some illness or ailment that had nothing to do with their own choices? Sure. But it sucks to get hit by a car and killed through no fault of your own too. We live in an imperfect world, and bad things do just sometimes happen. I'm just not sure that giving up a massive amount of individual liberty is worth it to avoid that.
Hey. We're just one step away from Carousel. Logical conclusion and all that.