So why hasn't it happened? Because it's very hard to finance. CA's original bill was very good, and we still couldn't make it work financially. Bern's bill was disastrous. "Tax the rich" isn't a solution, so he made 40% cuts in every category including staff pay. It was also 4x more for the poor. - ThreadSky

churchlady320.bsky.social • 85 days ago

So why hasn't it happened? Because it's very hard to finance. CA's original bill was very good, and we still couldn't make it work financially. Bern's bill was disastrous. "Tax the rich" isn't a solution, so he made 40% cuts in every category including staff pay. It was also 4x more for the poor.

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genxrbf.bsky.social•84 days ago

It hasn't happened because, unlike countries that prioritize healthcare, our healthcare system is run by private insurance and pharmaceutical lobbyists.

izaiahh.bsky.social•85 days ago

how do you wrap your brain around the US being the richest country and we "cant afford" healthcare like every other country. ITS A CHOICE to deny healthcare for PROFIT because we have the most corrupt government

churchlady320.bsky.social•84 days ago

Well, then, write a plan. Took us several years in CA. Never could make it work. VT gave up. "Tax the rich" in VT is Ben and Jerry, not enough $$. Bern's plan had to cut 40% across the boards in payments meaning to docs and janitors, equipment, supplies. So sure. Give it a whirl.

smokingjim.bsky.social•84 days ago

So difficult that every first world country managed to do it except one.

churchlady320.bsky.social•84 days ago

Has what though? Most have highly-regulated private insurance. Only a few have single payer, and it's not usually administered federally but provincially. How about looking at non single payer options. France is one, Germany (ACA model) another. All produce good results.

churchlady320.bsky.social•84 days ago

Everyone who has proposed it has run into two major problems. 1. People LIKE their care providers. Cost saving in SP means removing free choice as a purely tax based plan. See Medicaid. 2. Things are far more expensive than policy wonks realize, and NOBODY is up for a 40% cut in wages, equipment.

ejudge.bsky.social•85 days ago

Everyone pays something. Eliminate ins. Companies altogether. Hire their employees to manage the system. It can be done.

churchlady320.bsky.social•85 days ago

Do you not think CA, VT, and even Bern have tried? Maybe - just spitballing here - MAYBE it's not as easy as we are led to think.

rogue576.bsky.social•85 days ago

The overlords resist their money for nothing empire.

churchlady320.bsky.social•84 days ago

What a ridiculously simplistic assessment. In CA I was very much a part of it, and it failed BECAUSE we could NOT make it work financially. VT the same. In VT "taxing the rich" is Ben and Jerry, and it wasn't enough. It's much harder than you think.

jackiesinsecurity.bsky.social•85 days ago

There's a pretty good analysis of why VT's program didn't work from Vox, tldr pent up demand, both from in-state people who went without care for forever, as well as out-of-state employees working in VT, made the economics not work. But that's the point, you have to fix the whole problem not 1/50

ejudge.bsky.social•85 days ago

Yes. The Niskanen Center did a study some years back analyzing gov. run healthcare. 100s of billions would be saved over time.

churchlady320.bsky.social•84 days ago

Did they tell you it also meant MAJOR cuts in payments to doctors, janitors, equipment, supplies? Bern couldn't do it. It's not nearly as easy as we think. LOTS of studies show cost savings but not payout cuts. Germany, other EU countries don't use single payer but regulated private coverage. So..

churchlady320.bsky.social•84 days ago

Well, if they couldn't do it, nobody could. Single payer was Obama's 2010 grant of "state plan" in ACA to VT. There should not have been a problem since it would fold into ACA. But they couldn't make it work. MUCH more expensive than standard ACA premiums. I don't know why.

ejudge.bsky.social•85 days ago

220 billion heathcare debt is not a sustainable system. Plus, shareholders' pressure to increase profits. Let's try.

jackiesinsecurity.bsky.social•85 days ago

Not just pressure. Publicly traded companies have a LEGAL OBLIGATION to return a profit for their shareholders, not outcomes for their patients. A much broader conversation needs to be had about what kind of company should be allowed to be publicly traded.

churchlady320.bsky.social•84 days ago

Agreed. I hate for-profit insurance, but we've had it since Reagan. If we shut down ANY business, they get an immediate write down on that business. It is in the BILLIONS per company. Factor that in, too.

ejudge.bsky.social•84 days ago

Go back to Nixon. Also, look at Massachusetts. They offer a state run insurance program . Funded by the state. Its worked for years. You can't hmjust leave it up go states. Just as you couldn't leave vaccinations up to states. It had to be a federal responce.

mark-scaf.bsky.social•85 days ago

Insurance companies taking 15% of premiums for profit can't be cheaper than the government doing the same thing for a cost of 3% overhead. It hasn't worked because the rest of the system didn't change. Providers can charge less when they are sure to get paid and don't need administration in billing.

tarrog71.bsky.social•47 days ago

Service providers still need the admin work of billing in a nationalized service. Unless salaried.

churchlady320.bsky.social•47 days ago

We rejected a single national system after seeing the problems in GB. It's too vulnerable to tampering politically. How do you standardize billing when you have regional differences in suppliers and needs? Only a handful of hospitals provide trauma care. VERY different from community hospitals.

tarrog71.bsky.social•47 days ago

I feel blessed to live here with the amazing level of medical care we have. I would not trade it for another. Can it be improved? Sure, always.

tarrog71.bsky.social•47 days ago

Doctors negotiate with the prov. gov't for their fees, practice supports, rural supports, continuing ed funds, etc. and have a say re systemic issues. Not sure this answers your standardized billing question.. many issues get resolved at the table with the neg. teams.

tarrog71.bsky.social•47 days ago

We have also had under-funding and The medical system has suffered from neglect in the form of under-funding for too many decades. However, our current gov't recent negotiations resulted in the docs voting 90% in favour of the contract...

tarrog71.bsky.social•47 days ago

Not sure how a nationalized hc system is any more vulnerable. I do know that the NHS is one of the best, but deliberately under-funded.
In Canada, each province administers their medical care. Regional differences are mainly rural vs urban, are an ongoing concern, but always being improved upon...

churchlady320.bsky.social•47 days ago

That wasn't as true as we'd hoped in the CA single payer. Billing isn't simple. Being paid doesn't change costs. Do you get grade 304 or 316 stainless steel for your needles? From whom? Who makes CAT scans? How much $$? Swabs? It's not just patient care. It's EVERYTHING used for care.

churchlady320.bsky.social•85 days ago

Understand that to finance it w the gov't via taxation, Bernie had to slash all reimbursements 40%. That includes equipment, supplies, nurses, orderlies, etc. He also made the flat tax 4x higher for the poor than ACA's premium sliding scale. Maybe someone can make it work. So far not.

nincompooper.bsky.social•85 days ago

It feels like the healthcare system marks up treatment and supplies like contractors do for the government.

You want a hand towel holder? $10k.
Want a screw to hold your chair together? $500.

I don’t know how healthcare can be fixed and it sucks.

mark-scaf.bsky.social•85 days ago

What is charged is largely irrelevant, unless you're self-pay. It all gets adjusted. Contractual adjustments negotiated per-payer are one of the many bureaucratic reasons healthcare is so expensive. Every health system has people to negotiate and maintain those rules in billing systems. Inefficient.

baliin.bsky.social•84 days ago

Other countries make it work. But of course they actually tax the rich. $100's of billions of potential tax money goes to feather Elon Musk's nest. He doesn't even need it.

churchlady320.bsky.social•84 days ago

Blithely saying others tax the rich is untrue. Canada uses a regressive VAT of 17% to fund theirs. PLEASE bone up on it. It's not what you claim.

lauraloop.bsky.social•84 days ago

This is news to me as a Canadian.

churchlady320.bsky.social•84 days ago

Well, when we talked to Canadian policy people before doing the CA single payer work, that's a huge part of it. They SAID so.

churchlady320.bsky.social•84 days ago

Actually many countries don't tax but use individual premiums. The gov't sets highly regulated standards for insurance AND levels of care. It is NOT federally administered in most places. Not all UHC is single payer, in fact very little of it is. ACA was set on the German model.

idealoop.bsky.social•84 days ago

They also pay providers far less. And there is no free lunch. Buy-in to what you want will require people to understand that they will pay more. Everyone.

churchlady320.bsky.social•84 days ago

AND that's what Bern did. Set Medicaid rates, even lower, for every provider. M4A is unsustainable without 40% cuts across the boards. He doesn't care even though thousands of docs earn less than he does in the Senate. This needs work, not idealism. It's VERY hard.

maximilianlegacy.bsky.social•83 days ago

It’s so hard because 33 of 34 developed national have been doing it for decades? Sounds like an excuse to me.

tweetld.bsky.social•84 days ago

NO. it needs commitment to the People and common weal. Something lost in our broligarchichal system.

mark-scaf.bsky.social•85 days ago

Equipment/supplies/pharmaceuticals should also be price regulated. Expand the Medicare tax by rolling current premiums into it. Everyone paying into separate risk pools cannot be cheaper than one, especially when Medicare has 3% overhead versus 15% for private.

mark-scaf.bsky.social•85 days ago

The savings are on the back end, which cannot be realized with multiple systems in place simultaneously. Everyone pays into one risk pool, with one fee schedule (adjust for regional cost of living), a non-affiliated TPA for approvals, and anti-price gouging measures.

churchlady320.bsky.social•84 days ago

OK. YOU tell the USW they lose income when they roll 304 or 316 grade steel for needles. Same with every medical product made. Go ahead. Tell them it's for the common good. Un huh. Medicare has a 20% PRIVATE COPAY. That proved unworkable as a gov't-administrated fold in.

idealoop.bsky.social•84 days ago

Medicare administrative cost is not apples to apples with private insurance. A lot of their costs are run through other agencies not directly reflected on their expenses.

mark-scaf.bsky.social•84 days ago

I understand, but traditional Medicare's MLR is equivalent to about 97% (at least it was when I was still in healthcare analytics a few years ago). Given there are no premiums, that's calculated based on the amount paid on claims and how much it costs to run the program.

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