What would a single payer system look like?

DoGoodThenGo · Jun 5, 2016

1. There are a number who pay by cash. There are doctors and hospitals that charge less when one pays cash.
2. No, it doesn't sound like a better system. A better system to me would be the smallest government possible to guarantee our constitutional rights, the only insurance that would exist (if any) would be to cover catastrophic events, and we would have a direct provider to patient relationship where no payment provider would have a single say as to what's best for the patient.

My previous GP (sadly now retired) did not accept insurance or Medicare; you paid in cash and his office filled out or gave you the information to fill out any forms required for reimbursement. That is if you had any type of coverage. This is a common arrangement for many private practice physicians in NYC.

Being as this may only accepting or preferring cash obviously restricts access to those able to pay and wait for reimbursement (if any). That obviously leaves out a huge segment of population.

Again average hospital bills vary wildly but if you can afford to "self insure" by paying cash, so be it:

Bitter ‘bill’ at some Big Apple hospitals | New York Post

Average cost per inpatient day across 5

pmabraham, BSN, RN · Jun 6, 2016

Do you know how much money was wasted on ACA (web site, inception, ongoing, etc)? Take that money and each "legal" American citizen could have had a HSA (cash value) of one or more million U.S. dollars. Yes, American's would be rolling with that sort of money.

When I talk to patients in our geographic area, either they don't have any insurance (because even with subsidies they cannot afford ACA-based insurance) or they don't dare use it because they cannot afford the high out of pocket expenses (often 10K or more). Single payer will not fix that.

elkpark · Jun 6, 2016

When I talk to patients in our geographic area, either they don't have any insurance (because even with subsidies they cannot afford ACA-based insurance) or they don't dare use it because they cannot afford the high out of pocket expenses (often 10K or more). Single payer will not fix that.

How would it not? Everyone would have insurance, and, in the countries that have single-payer systems, or something similar now, individuals do not have "high out of pocket expenses." One of the main points of having a universal insurance system is that people don't get stuck with high OOP expenses.

MunoRN, RN · Jun 6, 2016

Do you know how much money was wasted on ACA (web site, inception, ongoing, etc)? Take that money and each "legal" American citizen could have had a HSA (cash value) of one or more million U.S. dollars. Yes, American's would be rolling with that sort of money.

You keep repeating that number, you need to check you math. Even using a high-end reported amount for the website at $2.1 billion, that amount divided among all "legal" Americans is $6.58, not "more than a million US dollars".

When I talk to patients in our geographic area, either they don't have any insurance (because even with subsidies they cannot afford ACA-based insurance) or they don't dare use it because they cannot afford the high out of pocket expenses (often 10K or more). Single payer will not fix that.

Single payer would involve whatever deductible rates we decide to use, so there's nothing that keeps it from being affordable. Complaining about high deductibles seems really odd coming from you, since you've been arguing that we essentially should pay for all our healthcare services directly, yet you avoid questions about what happens when someone needs care beyond what they can afford independently which would suggest you're not opposed to insurance kicking in at some point. That's already how it works, people pay for what they can independently (aka their deductible) then when they've spent that amount on their own insurance kicks in beyond that. So are you saying deductible should be higher or lower?

pmabraham, BSN, RN · Jun 13, 2016

How would it not? Everyone would have insurance

Because in a free country, providers do not have to accept insurance. Simple.

pmabraham, BSN, RN · Jun 13, 2016

The facts speak for themselves | Surgery Center of Oklahoma - interesting read and video.

heron, ASN, RN · Jun 13, 2016

The facts speak for themselves | Surgery Center of Oklahoma - interesting read and video.

So, insurance companies are bad. I agree, which is one of the reasons I want to have a single payer system.

I note with interest that you never addressed Muno's posts on the math or explained how an HSA would work for someone who barely makes enough to cover basic expenses. Is that where the million dollar give-away comes in? What happens when the million runs out. Just die, already?

I don't think you have a clue what you're talking about.

elkpark · Jun 13, 2016

When I talk to patients in our geographic area, either they don't have any insurance (because even with subsidies they cannot afford ACA-based insurance) or they don't dare use it because they cannot afford the high out of pocket expenses (often 10K or more). Single payer will not fix that.

How would it not? Everyone would have insurance, and, in the countries that have single-payer systems, or something similar now, individuals do not have "high out of pocket expenses." One of the main points of having a universal insurance system is that people don't get stuck with high OOP expenses.

Because in a free country, providers do not have to accept insurance. Simple.

We are all aware of your obsession about whether providers will or won't accept insurance obtained through the ACA. However, your original statement to which I was responding was that many people in your area either don't have insurance or can't afford to use it because of the associated OOP costs, and that "single payer will not fix that." You commented on whether or not people have insurance, and the costs associated with using their current insurance coverage. Nothing about whether providers will accept a given insurance policy. My response was that single payer would address those specific problems because everyone would have insurance and, based on the experiences of other countries, it is reasonable to assume that OOP costs would be lower and affordable. Your response (once again, sigh ...) about how providers don't have to accept insurance is a non sequitur in this instance.

And, even in a "free country" in which providers are not required to accept insurance, if we ever reach that blessed day when we finally go to a single payer system, a lot of your "free" providers will have the "free" choice of either accepting the coverage everyone has or going out of business. A choice they are not only "free," but welcome to make, as far as I'm concerned. (After all, it's a free country ...)

allnurses Guide · Jun 18, 2016

http://www.pnhp.org/single_payer_resources/FAQ_2016.pdf

http://www.pnhp.org/facts/single-payer-faq

toomuchbaloney · Jun 20, 2016

So, insurance companies are bad. I agree, which is one of the reasons I want to have a single payer system.
I note with interest that you never addressed Muno's posts on the math or explained how an HSA would work for someone who barely makes enough to cover basic expenses. Is that where the million dollar give-away comes in? What happens when the million runs out. Just die, already?
I don't think you have a clue what you're talking about.

So say we all.

smartnurse1982 · Sep 20, 2016

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?

nurseryrhythme · Sep 28, 2016

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.