General Discussion
In reply to the discussion: Why California Undocumented Youth and I Interrupted Nancy Pelosis DREAM Act Press Conference [View all]ehrnst
(32,640 posts)They listed numbers. You don't provide the links or sources for those numbers - and that would be important as to the research they did.
You also keep saying that (without even knowing what the Vermont number are) that "most of what businesses and customers already spend would be offset by.... what? Lower out of pocket premiums and deductibles and the increased taxes? Do you have numbers on this?
Where does "the state" get the money to pay for this? From increased taxes - which as we saw was enough to scuttle single payer in the most welcoming state that it could have been implemented in....
Also, you need to factor in the disruption to the health care delivery upending the payment process and amounts. I think you may recall that the ACA website rollout was not a success. When you rush things, they often fail. Imagine that multiplied across all aspects of health care for everyone...not to mention the problems that exist in Medicare and Medicaid and the VA currently.
One of the biggest is exactly how to redistribute literally trillions of dollars. The problem, said Harold Pollack, a professor at the University of Chicago, is that the change will create losers as well as winners.
Precisely the thing that is a feature for single-payer proponents is a bug for everyone who provides goods and services for the medical economy, he said, since their profits and possibly their incomes could be cut.
And its not just the private insurance industry (which would effectively be put out of business) that could feel the impact to the bottom line. Parts of the health care industry that lawmakers want to help, like rural hospitals, could inadvertently get hurt, too. Many rural hospitals get paid so little by Medicare that they only survive on higher private insurance payments. Yet under single-payer, those payments would go away and some could not make it financially. You would not want to wipe out a third of the hospitals in Minnesota by accident, Pollack said. And you could, if payments to hospitals end up too low.
There are also questions about how feasible it would be to have the federal government run the entire health care system. Its hard to be nimble when a system gets that big, said Ezekiel Emanuel, a former health adviser in the Obama administration now at the University of Pennsylvania. No organization in the world does anything for 300 million people and does it efficiently.
To try to do it in one fell swoop would be massively disruptive.
The politics of Medicare which serves roughly 50 million Americans already make some things difficult or impossible, he said, pointing to a current fight in which doctors and patient advocacy groups blasted a proposal to move to a more cost-effective way to pay for cancer drugs. You already cant do certain things in Medicare because of the politicization, he said. When you cover the whole country, it would be a lot of gridlock.
http://khn.org/news/democrats-unite-but-what-happened-to-medicare-for-all/