h*h
发帖数: 27852 | 1 美国医疗开支60%是政府支出，其中绝大部分来自联邦政府
single payer healthcare 要 affordable,就得把政府的医疗支出也拉过来，全国一个
保险，医院药厂医疗设备公司都不得不低头
medicare, medicaid, VA hospital, Indian healthcare所有这些都被single payer取
代，政府是变小而不是变大了，美国公司的竞争力提高，创新能力提高（辞职创业不用
担心医疗保险了）
single payer healthcare不应该成为民主党的专利。在医疗保险问题上，共和党现在
成了既得利益阶层（保险公司医院药厂医疗设备公司）的代言人，实实在在的
fleecing of America by the Republic Party |
h*h
发帖数: 27852 | 2 Single payer healthcare: Pluses, minuses, and what it means for you
Andrea S. Christopher, MD
POSTED JUNE 27, 2016, 9:30 AM
Andrea S. Christopher, MD, Contributor
Follow me at @andrea_sylvie
As someone who researches inequities in health care, I’ve diligently
followed the debate about healthcare reform. However, most of my friends (
and I suspect most Americans) wonder exactly what single payer healthcare is
and how will it affect them. In a New England Journal of Medicine
perspective piece, Jonathan Oberlander, PhD, a professor of social medicine
at the University of North Carolina in Chapel Hill, expounds on the history
and obstacles facing calls for single payer healthcare reform.
Problems with the current U.S. healthcare system
Oberlander points out that the impetus for reorganizing the entire
healthcare system has to do with the regrettable state of healthcare in the
United States. Currently, the healthcare finance structure is made of an
impressively complicated network of multiple payers, involving both private
and government health insurance options. Despite spending more on healthcare
than comparable countries, the U.S. has the lowest life expectancy and
performs poorly on a variety of health outcomes. Thus, our complex network
of insurance plans is wasteful — in large part due to high administrative
costs and lack of price control.
Inequity is another major problem. The United States remains the only
developed country without universal healthcare. The Affordable Care Act has
made important gains toward improving and expanding health insurance
coverage. However, it was never designed to provide universal healthcare and
30 million Americans remain uninsured.
What is a single payer healthcare system?
In a single payer healthcare system, rather than multiple competing health
insurance companies, a single public or quasi-public agency takes
responsibility for financing healthcare for all residents. That is, everyone
has health insurance under a one health insurance plan, and has access to
necessary services — including doctors, hospitals, long-term care,
prescription drugs, dentists and vision care. However, individuals may still
choose where they receive care. It’s a lot like Medicare, hence the U.S.
single payer nickname “Medicare-for-all.”
Proponents advocate that a single payer system would address several
problems in the U.S. system. Universal health coverage would be a major step
towards equality, especially for uninsured and underinsured Americans.
Overall expenses and wasteful spending could be better controlled through
cost control and lower administrative costs, as evidenced in other countries
. Furthermore, a single payer system has more incentive to direct healthcare
spending toward public health measures. For example, targeting funding
towards childhood obesity prevention programs in elementary schools and
daycares reduces the rates and complications of obesity more effectively and
at lower costs than paying for doctor visits to recommend healthier diets
and increased physical activity.
At the same time, we must also recognize the potential tradeoffs of
transitioning to a single payer system. Lengthy wait times and restricted
availability of certain healthcare services (such as elective surgery or
cosmetic procedures) are important criticisms. Thus, despite its advantages,
single payer will not ease the constant tension of balancing access,
quality and cost in healthcare. However, Oberlander suggests these issues
are much smaller in countries with single payer healthcare when compared to
the current U.S. system.
How could single payer be successful in the U.S.?
Oberlander implies the major obstacles to adopting Medicare-for-all are
political, rather than actual practical problems within the single payer
structure. Stakeholders who stand to lose — such as health insurers,
organized medicine, and pharmaceutical companies — represent a powerful
opposition lobby. Public opinion needs to be redirected to focus on how the
net benefits of a single payer system outweigh the tradeoffs discussed above
. Furthermore, despite the individual level savings, behavioral economics
predicts the general public will wince at the notion of transferring
healthcare spending from employers to higher taxes managed by the federal
government. Additionally, despite long term savings projected from moving to
a single payer system, the upfront costs of the transition are also
politically unpopular.
A way forward
If the major barrier to implementing single payer healthcare in the U.S. is
a matter of politics, the pathway forward will require mobilizing public
support. A recent poll suggests 58% of Americans support Medicare-for-all.
Interestingly, whereas a majority of physicians support transitioning to
single payer, they are less likely to believe their colleagues share this
opinion. This raises an interesting question of whether the “conventional
wisdom” that it is too difficult to reorganize the healthcare insurance
system overshadows actual public opinion.
Multiple strategies to continue to push for Medicare-for-all have been
proposed. This includes individual states implementing a single payer system
as a demonstration of feasibility, which failed before implementation in
Vermont but will be on Colorado’s 2016 ballot. An alternative proposes
implementing a single payer system on a federal level by lowering the
Medicare qualifying age every few years. Through education of the general
population about the merits of single payer, perhaps eventually the public
will vote politicians into office willing to overcome Medicare-for-all’s
political barriers. |
t******g
发帖数: 1667 | 3 非加州居民生病了，开车到加州旅游几天顺便把病看了，可行不？可行的话我赞成加州
搞这个法案，给其它州做试点50年。 |
h*h
发帖数: 27852 | 4 所以单个州搞不下去，即使加州这么大的经济规模，vermont更不可能
【在 t******g 的大作中提到】
: 非加州居民生病了，开车到加州旅游几天顺便把病看了，可行不？可行的话我赞成加州
: 搞这个法案，给其它州做试点50年。
|
l*****6
发帖数: 7881 | 5 肯定不行呀。必须是加州的residence，交州税的。
【在 t******g 的大作中提到】
: 非加州居民生病了，开车到加州旅游几天顺便把病看了，可行不？可行的话我赞成加州
: 搞这个法案，给其它州做试点50年。
|
D*********1
发帖数: 1548 | 6 不交州税的非移龙虾党呢？
: 肯定不行呀。必须是加州的residence，交州税的。
【在 l*****6 的大作中提到】
: 肯定不行呀。必须是加州的residence，交州税的。
|
G****a
发帖数: 51 | 7 你歧视undocumented resident？
【在 l*****6 的大作中提到】
: 肯定不行呀。必须是加州的residence，交州税的。
|
t******g
发帖数: 1667 | 8 再想想其实加这个限制更好，把非法移民和票蛆都吸引到加州去
【在 l*****6 的大作中提到】
: 肯定不行呀。必须是加州的residence，交州税的。
|
l*****6
发帖数: 7881 | 9 我看很难通过。本身的idea其实还好，但是存在的漏洞太多了，加州自己很难afford。
【在 t******g 的大作中提到】
: 再想想其实加这个限制更好，把非法移民和票蛆都吸引到加州去
|
l*****6
发帖数: 7881 | 10 很多非移都是从墨西哥买药
【在 D*********1 的大作中提到】
: 不交州税的非移龙虾党呢？
:
:
: 肯定不行呀。必须是加州的residence，交州税的。
:
|
|
|
h*h
发帖数: 27852 | 11 加拿大有些专科医生供给不足，对于确实需要的病人政府会给voucher去美国看医生
美国医生开工不足，同时许多美国人有病却看不起医生
加拿大医疗开支是GDP的11%，美国是18%
你觉得哪个好？ |
u***n
发帖数: 21026 | 12 你忽略了加拿大的人口，和加拿大是靠卖资源活下来的
给加拿大3亿人口，分分钟让你破产
【在 h*h 的大作中提到】
: 加拿大有些专科医生供给不足，对于确实需要的病人政府会给voucher去美国看医生
: 美国医生开工不足，同时许多美国人有病却看不起医生
: 加拿大医疗开支是GDP的11%，美国是18%
: 你觉得哪个好？
|
h*h
发帖数: 27852 | 13 英国是GDP的10%
【在 u***n 的大作中提到】
: 你忽略了加拿大的人口，和加拿大是靠卖资源活下来的
: 给加拿大3亿人口，分分钟让你破产
|
u***n
发帖数: 21026 | 14 中国更少，不和中国学习？
我估计朝鲜最少了，怎么样？
你的例子更说明有钱，人少的地方可以实现，英国才几个人口，人家多有钱
英国还要限制外来人口，你试试谁都能去英国看病？
【在 h*h 的大作中提到】
: 英国是GDP的10%
|
h*h
发帖数: 27852 | 15 我什么时候主张外来人口免费看病了？
英国的人口密度大大超过美国，也不靠出卖资源
我举的都是single payer healthcare的例子，中国朝鲜是吗？
【在 u***n 的大作中提到】
: 中国更少，不和中国学习？
: 我估计朝鲜最少了，怎么样？
: 你的例子更说明有钱，人少的地方可以实现，英国才几个人口，人家多有钱
: 英国还要限制外来人口，你试试谁都能去英国看病？
|
Y**M
发帖数: 2315 | 16 single payer healthcare自有其好处和坏处。
但是，民主党不趁着大选时提出这个政见，反而现在提出，难道不是太阴险了么？
当然，我们可以说：这是加州在搞，和大选无关。
但如楼主所言，这个事本来就不适合一个州来搞。
这又算什么事呢？ |
a*********a
发帖数: 3656 | 17 你这是侮辱undocumented citizens.
【在 G****a 的大作中提到】
: 你歧视undocumented resident？
|
p******r
发帖数: 1127 | 18 英国有三千万，占人口10%的非法移民吗？
【在 h*h 的大作中提到】
: 我什么时候主张外来人口免费看病了？
: 英国的人口密度大大超过美国，也不靠出卖资源
: 我举的都是single payer healthcare的例子，中国朝鲜是吗？
|
G**S
发帖数: 339 | 19 在社会财富还没有达到按需分配，人的素质还没有达到以劳动为乐趣的时候，强行推行
平均主义，只会导致三个和尚没水喝的境地。当你看着你的邻居一家躺在家里不停生孩
子，白吃白喝医疗跟你一样比你还方便（不用上班），白住政府福利房，孩子上大学免
费，养老靠政府不花一分钱；而你省吃俭用，生不起孩子，上不起好大学，每天累死累
活的，还有什么动力继续工作？
欧洲已经被搞得就业率年年下降，本来人口少还能维持，现在大规模引入难民，很快就
要破产了。现在全世界基本就靠美国和几个亚洲国家养着，要是美国也瘫了，看谁来养
你。 |
h*h
发帖数: 27852 | 20 single payer healthcare 和高福利不相关
我的观点：
1. 支持single payer： 美国不能afford NON SINGLE PAYER healthcare
2. 反对高福利: 美国不能afford 高福利了，比如政府福利房，大学免费，food
stamps
3. 反对工会，特别是公务员工会: 美国经济不能afford 工会了
【在 G**S 的大作中提到】
: 在社会财富还没有达到按需分配，人的素质还没有达到以劳动为乐趣的时候，强行推行
: 平均主义，只会导致三个和尚没水喝的境地。当你看着你的邻居一家躺在家里不停生孩
: 子，白吃白喝医疗跟你一样比你还方便（不用上班），白住政府福利房，孩子上大学免
: 费，养老靠政府不花一分钱；而你省吃俭用，生不起孩子，上不起好大学，每天累死累
: 活的，还有什么动力继续工作？
: 欧洲已经被搞得就业率年年下降，本来人口少还能维持，现在大规模引入难民，很快就
: 要破产了。现在全世界基本就靠美国和几个亚洲国家养着，要是美国也瘫了，看谁来养
: 你。
|
h*h
发帖数: 27852 | 21 1. 美国非法移民人数连续8年保持不变：1100万，不是3000万。仅此一条已经使你彻底
信誉破产，你可以滚蛋了
2. 非法移民对美国经济是正贡献，没有理由认为非法移民会大量使用single payer
benefits
3. 尽管有1，2，我并不支持敞开胸怀欢迎非法移民
【在 p******r 的大作中提到】
: 英国有三千万，占人口10%的非法移民吗？
|
