What would a single payer system look like?

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So as we enter 2016 we have a democratic candidate opting for a single payer system or rather "Medicare for all". Now whether something like this could or should pass, what would the healthcare system look like with this in place. Please note that this is not a political argument as far as democrat vs republican or anything like that. I am simply curious to see how the system would change and if the change would be better, worse, or the same. Please feel free to post your thoughts!

I just read Trump's plan and it sounds to me he really has no plan for healthcare reform.

One interesting thing I did see is that he wants individuals to be able to purchase health insurance across state lines.

How will that work?

Currently insurance companies are exempt (largely) from federal anti-trust laws. See: McCarran–Ferguson Act - Wikipedia, the free encyclopedia

Antitrust Law and Insurance | III

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It's basically the same thing as Medicare. If local states ran their own system, it would be beneficial. This is what Dr. Hsiao at Harvard has been advocating for years. He is widely regarded as the best person to understand the overall health system.

Lower costs for getting rid of the middle man.

First problem is that unlike Medicaid which is a 50/50 split (for the most part) between states and federal government, Medicare is 100% funded by federal (SSA) funds. Cannot see Congress and or a POTUS handing over total funding to different states. That would be a whole lot of money and the temptations for getting into all sorts of misuse would be great.

Yeah, actually nobody has a plan for health care reform. Most of the legislators in my state say it's too difficult to work on and impossible to fix. None of them have a plan of any kind.

You could support the free market side by providing transparent pricing and quality data; all of which is readily available just not for the public.

The AMA makes releasing their codes illegal. I find this to be one of the main barriers.

Colorado is trying to take over their own system and start over in amendment 69. It's one of the only states you can go around the politicians.

I like what Christopher Hitchens said, "Right now our healthcare system gives us the worst part of capitalism and the worst part of socialism."

In other words we have high cost and poor choices as outcomes.

I think the states have the only chance to fix it, but they are all waiting for the Feds to do it for them.

All the consultants say the health care prices are coming down drastically because it's unsustainable. If you ask how, they simply shrug their shoulders.

To fix the system, we simply need transparency and more doctors and nurses.

Since they will never give us that, single payer will at least kick the greedy insurance people out of the way for something better than what we have.

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There are flat-rate "boutique" primary care practices popping up in varying states. The flat rate buys you a system free of the insurance industry meddling and gets you in quicker and for preventive care before things become a big problem....that is forward thinking and I believe, a model for ushering in single-payer systems. No it won't fix everything but it increases access for relatively low flat rates. It makes sense. The suits hate it, of course, as it cuts into their status-quo profits which naturally, they cannot abide. But the barn door is open and the horses are out, so to speak. It's coming and it's gonna change a lot.

Specializes in Critical care, tele, Medical-Surgical.

The Only Way to Fulfill the President's Pledge of More Coverage, Better Benefits, and Lower Costs

The economic case for single-payer reform is compelling. Private insurers' overhead currently averages 12.4% versus 2.2% in traditional Medicare (2).

Reducing overhead to Medicare's level would save approximately $220 billion this year (Table) (3).

Single-payer reform could also sharply reduce billing and paperwork costs for physicians, hospitals, and other providers...

Single-Payer Reform | Annals of Internal Medicine | American College of Physicians

There are flat-rate "boutique" primary care practices popping up in varying states. The flat rate buys you a system free of the insurance industry meddling and gets you in quicker and for preventive care before things become a big problem....that is forward thinking and I believe, a model for ushering in single-payer systems. No it won't fix everything but it increases access for relatively low flat rates. It makes sense. The suits hate it, of course, as it cuts into their status-quo profits which naturally, they cannot abide. But the barn door is open and the horses are out, so to speak. It's coming and it's gonna change a lot.

"Relatively low flat rates"? Where is this? The only practices like that I've heard of so far are the "boutique" (as you note), "concierge" practices that cater to the wealthy and charge high rates for the convenience of having round-the-clock access, no waiting for appointments, house calls, etc.

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There are flat-rate "boutique" primary care practices popping up in varying states. The flat rate buys you a system free of the insurance industry meddling and gets you in quicker and for preventive care before things become a big problem....that is forward thinking and I believe, a model for ushering in single-payer systems. No it won't fix everything but it increases access for relatively low flat rates. It makes sense. The suits hate it, of course, as it cuts into their status-quo profits which naturally, they cannot abide. But the barn door is open and the horses are out, so to speak. It's coming and it's gonna change a lot.

There are a few of these practices in my town. One is a large, multi-service practice with multiple specialists, lab, pharmacy, therapists, etc. Others are more typical family practice providers. They are meant to be combined with a no-frills, high deductible catastrophic plan, which we are not allowed to have under Obamacare because we are "too old."

So we're forced to carry an Obamacare compliant plan that is much more expensive and covers a multitude of services we'll never use.

We receive most of our healthcare from a specialty practice due to a condition that affects more than one family member. I would love to see their practice offer a subscription service, and would even be willing to help fund and/or staff a start up. But for that to be practical, the individual mandate requiring fully Obamacare compliant insurance coverage must go away.

The problem with a single payer program in real time is that it will still emphasize sick care. In the U.S., our coding system for diagnoses and procedures is all about sick care. I envision a single payer program as being focused on prevention, promotion, and primary care with the continuation of third party auditors to maintain vigilance on fraud, waste, and abuse practices. I envision increasing use of telephonic patient encounters and telehealth in a single payer system. I envision more meaningful partnerships between practitioners, clinicians, patients and their families to establish health education practices that would place more of the onus of health status on the patient and caregiver. Hopefully, emphasis on prevention, promotion, and primary care will hold the line on substantial increases in our taxes or outgo under a single payer system.

Right now, with emphasis on sickness care and extreme profit and consumers low level of health literacy and indifference toward their health status, healthcare is out of control. If single payer is done right, it may work.

However, I wonder if we just should not have a hybrid system whereby prevention, promotion, and primary care is sponsored by a single payer entity and the catastrophic is paid for by a combination of the patient and other entities. I feel that in the case of most chronic diseases and certain injuries, the patient should be on the hook when the condition perhaps could have been avoided. For instance, if my primary care provider advised me to avoid engaging in high risk activities such as overeating, eating unhealthy foods, avoiding exercise, or driving dangerously then there should be some liability on my part particularly if I demonstrate high risk activity under the primary care provider's watch for some time and it's documented in my record.

Specializes in Critical care, tele, Medical-Surgical.

For First Time Ever, Majority of House Dems Support 'Medicare-for-All' Bill

A record-breaking 104 House Democrats are co-sponsoring a Medicare-for-All bill

As President Donald Trump and the GOP attempt once again to repeal and replace the

The bill, H.R. 676, known as the "Expanded & Improved Medicare for All Act," has been introduced into Congress repeatedly by Rep. John Conyers (D-Mich.).

It has now received support from more than half of the Democratic caucus, a record for the party...

For First Time Ever, Majority of House Dems Support 'Medicare-for-All' Bill | Common Dreams

H.R.676 - Expanded & Improved Medicare For All Act

Text - H.R.676 - 115th Congress (2

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Economic case for ‘Medicare for All' compelling

Our system carries huge administrative costs because health care providers must deal with a myriad of different provider plans, each with its own panel of other approved providers, rules and copays, etc.

The result is for every doctor in the USA, there are eight workers in administrative and non-medically productive roles; in contrast, other Western countries have a miniscule fraction in non-medically productive support personnel and can afford superior coverage for their entire populations.

We spend approximately $3.5 trillion a year on our complex mix of public and private coverage, each with different rules and excessive administrative departments.

Duke University employs 900 insurance clerks, said to be more than they have nurses.

Our very complex $3.5-trillion system has overhead and administrative expense of over 33 percent; Canada's system has 12 percent and Taiwan's is even less. Simply eliminating that waste within our system would save an estimated $630 billion a year...

Bellamy and Clay: Economic case for ‘Medicare for All’ compelling

Specializes in Critical care, tele, Medical-Surgical.

The Public Option – Doomed From the Start

There's a significant danger that a public option would not only fail to improve the ACA, it could undermine the movement for Medicare for All...

... Granted, the ACA did enact some important course corrections, especially the expansion of Medicaid, to a profit-focused healthcare system that had plummeted to 37th in World Health Organization rankings.

But ignoring the highly successful and popular model of a proven system, Medicare, the ACA architects instead opted for an alternative that left 28 million Americans uninsured and failed to reign in the price gouging practices of the private market.

The inevitable result was millions of newly insured people paying premiums for insurance they increasingly could not use because of ever-rising deductibles, co-pays and other out of pocket costs.

Enter the proposal for a public option, now again in vogue as the solution for driving down costs by offering competition for the private insurers.

The public option, the argument goes, can offer less expensive coverage because it doesn't have to divert massive sums for administrative costs, mainly profits, lush executive pay packages, claims denial paperwork, and marketing.

But in practice, the outcome would be far different.

Medicare works in large part by including all the people it covers in one large risk pool so that healthier patients balance out sicker patients in costs that must be reimbursed to providers.

But the public option would not have that protection...

The Public Option – Doomed From the Start | By RoseAnn DeMoro | Common Dreams

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Single-payer reform could also sharply reduce billing and paperwork costs for physicians, hospitals, and other providers.

A hospital physician once told me that one of the biggest frustrations in running a medical office was dealing with a multitude of insurance companies, each one with different forms and procedures, and if you omitted one thing, you didn't get paid. He said that he had one claim in his office that he had been waiting for over a year to get payment for, because the insurance company kept coming up with technicalities not to pay him. He said that when he dropped some insurance plans, it was because the companies were giving him such a hard time getting payment that he just got tired of it. "It's not like I can take a surgery back", he said. "I have done the work, and I'm still waiting on my money."

Single payer would eliminate this, and hopefully would put more negotiation into things like drug prices. Drug companies sell their drugs elsewhere for far less, because they know that they can soak Americans and make most of their money here. This system is a train wreck.

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