Should we have single-payer healthcare?

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My beef isn't between the doctor who has 5 apples compared to the janitor who has 1. It's the means in which the janitor and doctor earn their apples, and pay their respective taxes compared to the billionaire who accumulates 2,000 apples.





According to the government there are 3 ways to make money.

  1. Inherit it when someone dies

  2. Make “ordinary income” by working. This is how the janitor and doctor earn their respective apples
Dependent on income, a married couple who makes


  • 10k a year
    • pays 10% tax
  • 50k moves into second tax bracket
    • (17k-70k) is taxed in the second at 15%.
  • 100k goes into 3rd tax bracket
    • (with 70k-142k) taxed at 25%
  • 500k
    • Goes to 35% and includes many tax brackets. But they still pay into all of the lower tax brackets before they get to their higher up one


3. Capital gains. Money made in the stock market, real estate etc. that you get when you buy something and then you wait, and then you sell it for more later on
  1. Capital gains tax is a flat 15% if you make more than 30k or so.

  2. Capital gains is how really rich people like Warren Buffet make most of their money, they invest in stuff, then it gets more valuable then they sell it.

  3. My problem is, money in the stock market isn’t actually doing anything, it’s not being used for space travel, making cars, video games, or anything whatsoever. Investment is important for our economy, but so is income
    1. I argue that income is worth more to our economy than capital gains

    2. So why do we tax, almost invariably more on the money people earn providing actual value proportionate to the amount of money they make?

    3. The idea is investments are important to our economy and you want to encourage people to invest so, presumably tax it less; but there isn’t much data to support this claim
    • The problem is the people who advise the government on tax policy decisions are people who make their money this way; and they, like you or me probably overvalue their particular impact on american society, or are super-greedy or maybe they’re right, they need low taxes which trickles down to all of us- but this means that a waitress at Applebees pays a proportionally higher tax rate than a billionare like Donald Trump or Warren Buffet. That is ethically wrong.
    • This system tremendously favors people like Donald Trump, who start out with millions of dollars and sit on their ass making ludicrous amounts on capital gains while the rest of us are taxed proportionally higher for our ordinary working incomes as a result of our own labor.
Capital gains are also the only realistic way for a person to retire without relying on the government.

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My beef isn't between the doctor who has 5 apples compared to the janitor who has 1. It's the means in which the janitor and doctor earn their apples, and pay their respective taxes compared to the billionaire who accumulates 2,000 apples.





According to the government there are 3 ways to make money.

  1. Inherit it when someone dies

  2. Make “ordinary income” by working. This is how the janitor and doctor earn their respective apples
Dependent on income, a married couple who makes


  • 10k a year
    • pays 10% tax
  • 50k moves into second tax bracket
    • (17k-70k) is taxed in the second at 15%.
  • 100k goes into 3rd tax bracket
    • (with 70k-142k) taxed at 25%
  • 500k
    • Goes to 35% and includes many tax brackets. But they still pay into all of the lower tax brackets before they get to their higher up one


3. Capital gains. Money made in the stock market, real estate etc. that you get when you buy something and then you wait, and then you sell it for more later on
  1. Capital gains tax is a flat 15% if you make more than 30k or so.

  2. Capital gains is how really rich people like Warren Buffet make most of their money, they invest in stuff, then it gets more valuable then they sell it.

  3. My problem is, money in the stock market isn’t actually doing anything, it’s not being used for space travel, making cars, video games, or anything whatsoever. Investment is important for our economy, but so is income
    1. I argue that income is worth more to our economy than capital gains

    2. So why do we tax, almost invariably more on the money people earn providing actual value proportionate to the amount of money they make?

    3. The idea is investments are important to our economy and you want to encourage people to invest so, presumably tax it less; but there isn’t much data to support this claim
    • The problem is the people who advise the government on tax policy decisions are people who make their money this way; and they, like you or me probably overvalue their particular impact on american society, or are super-greedy or maybe they’re right, they need low taxes which trickles down to all of us- but this means that a waitress at Applebees pays a proportionally higher tax rate than a billionare like Donald Trump or Warren Buffet. That is ethically wrong.
    • This system tremendously favors people like Donald Trump, who start out with millions of dollars and sit on their ass making ludicrous amounts on capital gains while the rest of us are taxed proportionally higher for our ordinary working incomes as a result of our own labor.
and I need to correct one more piece of information.....stock investments absolutely DO something.

for instance I got in on the initial stock offering for a company. They were trying to raise funding for their big expansion/start and a hundreds/thousands of us from around the country invested our earned and already taxed dollars into their company in exchange for stock. The company uses that money to hire staff, buy equipment, build prototypes, hire marketing etc......and we get out of it the hope that the company grows and with it our investment becomes profitable.
 
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Haven't read the entire thread, but like with everything there are pros and cons to a single payer healthcare system.

And we have to ask ourselves does health coverage = a healthier individual?

My main issue with government run health care is that our government is largely inefficient and inept. Look at Medicare and all the unnecessary rules and regulations it has. Plus, it only covers 65-70% of medical costs.

And of course we have to think about pay. Single payer would definitely drive down compensation. Which isn't the end of the world, but you can't charge 250k for medical school and only give docs 100k a year. And after taxes, retirement, etc 100k is more like 55k. It's just not sustainable.

This is coming from a guy with no health coverage. If I get hit by a car or find a strange lump I'm f***ed.
 
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Oh, I'm not attacking you, merely pointing out that 100% of these discussions rapidly devolve into emotional, politically-charged, fact-bare arguments that persuade exactly zero people in either direction.

Anyone interested in factual but readable account of this topic should pick up Tom Bodenheimer's book and call it a day. I know that ruins all the fun, but hey, if you get bored I'm sure it would equally entertaining to debate abortion via Twitter.
To any incoming med student is interested in reading this book before school starts: My school's online library allows us access to AccessMedicine, a McGraw-Hill website with online textbooks- your school may offer the same. You can read through the new 7th edition for free.
 
https://drhurd.com/2016/05/17/59212/

Medicine Needs Profit Just Like Any Other Enterprise


The latest from Gallup Poll: Presented with three separate scenarios for the future of the Affordable Care Act (ACA), 58% of U.S. adults favor the idea of replacing the law with a federally funded healthcare system that provides insurance for all Americans.

In other words: More than half of Americans want socialized medicine. That’s what “federally funded” medicine is. Government pays the bills, guarantees the service; and determines how the service is performed. Medicare already works this way, and now the push is to extend Medicare to the whole population.

It’s little wonder Bernie Sanders is so popular. He wants socialism — including but not limited to socialized medicine — outright. Hillary Clinton was for socialized medicine before it was cool. And Donald Trump, who won over the majority of Republicans, has said “he” will make sure everyone has medical care. Once he’s president “he” will mean us — i.e., the taxpayers, those of us who pay taxes.

These poll number make sense. Most Americans, I believe, don’t think that medical care should be provided for a profit; or at least not “too much” profit, whatever that means.

The reasoning goes like this: “We need health care to survive. It’s outrageous that anyone — doctors, hospitals, insurance companies — should be making a profit at something that fosters survival.” I hear this again and again, from Bernie Sanders supporters and Donald Trump Republicans alike.

I find this fascinating. We want there to be profit — or at least are willing to tolerate profit — when it comes to things like automobiles, clothing, smart phones, televisions and computers. Ditto for entertainment and sports. Somehow, it’s not morally repugnant for producers of these items/activities to make a profit, sometimes a huge profit. (I’m not suggesting it is morally repugnant.) But the moment something becomes life or death — or otherwise seriously important, like education — we don’t like the idea of profit, not the majority of us. We turn up our noses at it. It shocks and offends us. We rush to government to make it not so.

It makes no sense. Profit is an indicator of freedom. Profit happens because people are free to produce, create, innovate and competently deliver services or make products. The more freedom, the better the results. The better results, the more profit there is.

You would not want to live in a world without profit. A world without profit would be one where there’s only stagnation, no innovation, no results, no efficiency. Redistribution or “spreading” of goods are beside the point, because without profit, there are far fewer (if any) goods or wealth to distribute. Without profit, there are no interested parties. Everyone is a disinterested, removed bureaucrat. Nothing suffers from such a mentality more than medicine.

Medicine is, at the core, service-oriented and patient-oriented. In economic and psychological terms this means: Customer-oriented. You can turn up your nose at the idea of profit in medicine all you want. The fact remains, and will always be true, that if you want customer-friendly doctors and nurses, you’ll have to pay them well, and you’ll have to do so in a free market where it’s possible for them to go out of business. Under socialized medicine, which a majority of Americans now seem to want (based on Gallup polling), there’s no possibility of medical providers going out of business. That’s the moment doctor’s offices, quite literally, become government agencies. If you think things are dysfunctional now in medicine, you ain’t seen nothing yet.

Why is it morally fine to make a profit at being a sports star, or an entertainer, or to create video games and smart phones, while it’s morally questionable or wrong to make a profit at being a brain surgeon, a heart surgeon, or even someone who provides relief for your sore throat or aching back?

We have to get past this idea that important things like medicine are somehow above profit. To eschew profit is to eliminate freedom. Profit and freedom are more desperately needed in fields like medicine than in any other enterprise, precisely because medicine is so important. The same goes for education, by the way, another field where we minimize profit and free markets in favor of government controls, regulations and monopoly.

Go ahead America. Rid the world of what little remains of profit, self-responsibility, self-interest, pride and innovation in medicine. Let the government run everything. See how much better it makes your lives, when health care providers are no longer free to benefit from what they do, and trade with others as they want.
 
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https://drhurd.com/2016/05/17/59212/

Why is it morally fine to make a profit at being a sports star, or an entertainer, or to create video games and smart phones, while it’s morally questionable or wrong to make a profit at being a brain surgeon, a heart surgeon, or even someone who provides relief for your sore throat or aching back?

Not that I necessarily disagree with your intended point - but you can have both government healthcare and adequate physician compensation. Much of "profit" in medicine (past or present, likely not future) does not go to physicians.
 
Not that I necessarily disagree with your intended point - but you can have both government healthcare and adequate physician compensation. Much of "profit" in medicine (past or present, likely not future) does not go to physicians.

What is "adequate" physician pay? The evil of socialized medicine is that it gives government the sole discretion to dictate that.
 
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What is "adequate" physician pay? The evil of socialized medicine is that it gives government the discretion to dictate that.
I don't want some central force determining what's "adequate" for me...let my customers decide what my services are worth
 
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There is a central force regardless. The consumer does not decide how much your services are worth.
 
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Good luck finding consumers that can afford you in that case.

EDIT: Since I have a feeling I know what your response will be - private insurance will not take the risk of insuring old folks that are too expensive.
 
Good luck finding consumers that can afford you in that case.

EDIT: Since I have a feeling I know what your response will be - private insurance will not take the risk of insuring old folks that are too expensive.

private insurance absolutely would insure them if the company was allowed to charge enough to handle the risk......but you can't show up as an 80yr old with 17 pre-existing conditions and expect to have everything covered for $200/month. That's not how math works
 
Correct, it's all based on risk and private insurance costs would squeeze out people who can't afford it. It would create a true death spiral.

No medicare = we all lose.
 
Also, in your example - we just let the 80 yr old die without providing care? Pretty sure that's not how medicine works.
 
Also, in your example - we just let the 80 yr old die without providing care? Pretty sure that's not how medicine works.

We have no moral right to force one person to pay for another, we can't have services/goods that we can't pay for
 
Glad to learn your viewpoint. I disagree when that comes to healthcare.

Are you familiar with other (western) civilizations that have succeeded under such a model? Specifically "pure" capitalism.
 
Glad to learn your viewpoint. I disagree when that comes to healthcare.

Are you familiar with other (western) civilizations that have succeeded under such a model? Specifically "pure" capitalism.
when we allow it to, it's worked quite well here
 
I wouldn't be so sure. Do a quick wikipedia search to brush up on that history.

Interesting to learn your view though, have a good night sir.
 
I wouldn't be so sure. Do a quick wikipedia search to brush up on that history.

Interesting to learn your view though, have a good night sir.
I'm pretty familiar with american history...(side note, please use the "reply" feature as it helps me keep track of when someone responds)
 
I'm pretty familiar with american history...(side note, please use the "reply" feature as it helps me keep track of when someone responds)

Sure thing.

Then you should know US has never been had a pure capitalism model (maybe early 1800s). Nor has there ever been a society that has flourished without some government intervention.
 
Sure thing.

Then you should know US has never been had a pure capitalism model (maybe early 1800s). Nor has there ever been a society that has flourished without some government intervention.
we had great growth in our early years and managed to avoid our atrocious income tax for most of roughly the first 100 or so...capitalism works
 
we had great growth in our early years and managed to avoid our atrocious income tax for most of roughly the first 100 or so...capitalism works

There was still much government intervention during those 100 years. Also, greatest growth has been post New Deal. Capitalism works, 100% agree, but only with government intervention. There has never been a pure hands off, pure capitalism society. There are lots of articles on this in economics journals.

EDIT: Any examples in history beyond the first 100 years of US that you can come up with? World society is much larger than that and has been around for much longer
 
There was still much government intervention during those 100 years. Also, greatest growth has been post New Deal. Capitalism works, 100% agree, but only with government intervention. There has never been a pure hands off, pure capitalism society. There are lots of articles on this in economics journals.

EDIT: Any examples in history beyond the first 100 years of US that you can come up with? World society is much larger than that and has been around for much longer
exactly what intervention do you think capitalism requires?
 
exactly what intervention do you think capitalism requires?


To keep it short and relevant - healthcare.

I understand your position, I am just arguing there has never been a situation where a pure capitalism society, flourished - nevermind existed. Nor is there any evidence that it would. All evidence points towards a death spiral by its strictest definition. I would be thrilled if you could prove me wrong however.
 
To keep it short and relevant - healthcare.

I understand your position, I am just arguing there has never been a situation where a pure capitalism society, flourished - nevermind existed. Nor is there any evidence that it would. All evidence points towards a death spiral by its strictest definition. I would be thrilled if you could prove me wrong however.
I would argue that healthcare is actually made more expensive and less efficient by govt intervention. Look at how much time we have expensive staff doing mindless charting because the glorious govt decides we should
 
I would argue that healthcare is actually made more expensive and less efficient by govt intervention. Look at how much time we have expensive staff doing mindless charting because the glorious govt decides we should

It's far from perfect. I am not a fan of consequences of ACA. However, unlike yourself, I think we have moral imperative to take care of sick. Medicare for all its faults, and inefficiencies, works. Otherwise, as you imply, we let the old dudes die off and create a spiraling effect. That's not why I pursued medicine. It sounds like you prefer to maximize your earnings, there is nothing wrong with that, just a difference in how we view provision of healthcare. I don't view my patients as consumers.
 
It's far from perfect. I am not a fan of consequences of ACA. However, unlike yourself, I think we have moral imperative to take care of sick. Medicare for all its faults, and inefficiencies, works. Otherwise, as you imply, we let the old dudes die off and create a spiraling effect. That's not why I pursued medicine. It sounds like you prefer to maximize your earnings, there is nothing wrong with that, just a difference in how we view provision of healthcare. I don't view my patients as consumers.

1. bullcrap...you won't show up for free, they are consumers to you, you just don't care if they pay the bill directly or steal your payment from someone else
2. I believe that I am responsible for funding my own charitable impulses and that when I want to a feed a man, I don't get to rifle through your pockets for lunch money. I have to feed them with my own earnings.
 
1. bullcrap...you won't show up for free, they are consumers to you, you just don't care if they pay the bill directly or steal your payment from someone else
2. I believe that I am responsible for funding my own charitable impulses and that when I want to a feed a man, I don't get to rifle through your pockets for lunch money. I have to feed them with my own earnings.
I never said free. Nor do i consider insurance or Medicare stealing.

Under that belief system all the poor and disabled receive no care. Not everybody is as generous as you sound.

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we had great growth in our early years and managed to avoid our atrocious income tax for most of roughly the first 100 or so...capitalism works
Btw, it was cause of slavery. Doesn't work.

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I never said free. Nor do i consider insurance or Medicare stealing.

Under that belief system all the poor and disabled receive no care. Not everybody is as generous as you sound.

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you're not as generous as you sound, you want to give away money that isn't yours. Every dollar I promise to others is mine to give
 
nope, capitlalism is not the cause of slavery. Capitalism is about free and voluntary exchange. Slavery was caused be evil.
You missed the point, the economic growth was because of slavery. Yes, forces behind slavery was evil.

I go back to my question, show me where it has worked.



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you're not as generous as you sound, you want to give away money that isn't yours. Every dollar I promise to others is mine to give

I'm not trying to sound generous, I get it taxes upset you. But I don't believe as a society we leave people behind. That's not saying Obamacare is the solution, God no. But without govt intervention our society fails.

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You missed the point, the economic growth was because of slavery. Yes, forces behind slavery was evil.

I go back to my question, show me where it has worked.



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slavery was not reason for the growth. The north had the most economic/technological boom and they didn't do it on the backs of slaves.
 
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I'm not trying to sound generous, I get it taxes upset you. But I don't believe as a society we leave people behind. That's not saying Obamacare is the solution, God no. But without govt intervention our society fails.

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no, society works just fine. socialized programs fail, society still exists.
 
We had one that worked...I've already said that.
Yeah there was government intervention there in terms of overall economy. It was not pure capitalism.

In terms of healthcare specifically -leaving half the population without care is not something I consider to be"working"

Again, i hope you can come up with example. Regardless, it was interesting to learn your view, good night sir.

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Yeah there was government intervention there in terms of overall economy. It was not pure capitalism.

In terms of healthcare specifically -leaving half the population without care is not something I consider to be"working"

Again, i hope you can come up with example. Regardless, it was interesting to learn your view, good night sir.

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I'll repeat that we were a country without a govt social welfare system.
 
There is a central force regardless. The consumer does not decide how much your services are worth.

The consumer does decide how much your services are worth to him.
 
No he/she does not. Third party does that. Healthcare economics is rather complicated. In the US system patient and physician lose, hopefully we can agree there. Cheers.

Read this Amazon product
 
No he/she does not. Third party does that. Healthcare economics is rather complicated. In the US system patient and physician lose, hopefully we can agree there. Cheers.

Read this Amazon product

As a guy who runs a cash only practice I can tell you that it's much cheaper and more efficient than any third party system
 
As a guy who runs a cash only practice I can tell you that it's much cheaper and more efficient than any third party system

What are your patient demographics like? Do your patients have insurance for surgery, specialty care etc?

It works on a micro level in certain zip codes and only for primary care. I agree third party system naturally makes it more expensive, doesn't make cash only feasible on macro level.

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What are your patient demographics like? Do your patients have insurance for surgery, specialty care etc?

It works on a micro level in certain zip codes and only for primary care. I agree third party system naturally makes it more expensive, doesn't make cash only feasible on macro level.

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About half of my patients are uninsured, part of the working but can't afford ACA health insurance since I'm cheaper than both insurance and regular insurance-based practices.

Cash can be very feasible on a large scale. Granted we will always need some form of insurance for length hospital stays or open heart surgery, but most things can be done cheaply. For example: I had a patient who needed his uvula taken out. His ENT agreed to do it for $500 but warned that the OR fee would be around 15 grand since he only operates at the local hospital. I set him up with a private ENT group who agree to do the surgery for $350 and the OR fee at their free standing surgical center was only $900.

But yeah, cash will obviously never work for anything other than niche primary care...
 
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About half of my patients are uninsured, part of the working but can't afford ACA health insurance since I'm cheaper than both insurance and regular insurance-based practices.

Cash can be very feasible on a large scale. Granted we will always need some form of insurance for length hospital stays or open heart surgery, but most things can be done cheaply. For example: I had a patient who needed his uvula taken out. His ENT agreed to do it for $500 but warned that the OR fee would be around 15 grand since he only operates at the local hospital. I set him up with a private ENT group who agree to do the surgery for $350 and the OR fee at their free standing surgical center was only $900.

But yeah, cash will obviously never work for anything other than niche primary care...
the AAPS has a number of cash only surgeons...
 
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