Author Topic: Munger Says We Will Have Single Payer  (Read 8123 times)

randomep

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Munger Says We Will Have Single Payer
« on: June 01, 2018, 01:17:16 PM »

health care in the US........

any thoughts on this?

I am worried because I am invested in the MCOs


TwoCitiesCapital

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Re: Munger Says We Will Have Single Payer
« Reply #1 on: June 01, 2018, 01:55:30 PM »
The Libertarian in me hates the idea.

The realist in me thinks its the easiest way forward and most likely to happen. I would support it to get away from the monstrosity we have in place now, though my preference would be for everyone to have high-deductible plans and thus force some semblance of pricing discipline into the system and maybe motivate some real solutions.

Why would a private market option fail to work: We can't have a free market solution if we cannot discriminate against those who don't pay or provide consumers with the information necessary to differentiate between choices.

You can get care for free at any emergency room. They HAVE to treat you. As the burden from free service gets borne by those who do pay, prices will inflate for those services forcing more people to seek the free options and more costs to be borne by fewer and fewer people. You'd expect public outcry, right? Wrong.

Paying consumers don't see the cost because they don't pay - their insurance company does. And most consumers don't pay the bulk of their insurance premiums - their employer does. And the litte bit of the cost that we do carry? Comes out automatically from your paycheck and 95% of the population couldn't tell you how much it was or what % of the total cost it represents. Ultimately, the users of the services are 2 steps removed from the cost of the service allowing for increased usage even at inflated prices.

Further, even if there was pricing discipline with consumers directly bearing the cost and having the motivation to enact pricing discipline into the process, the information isn't there. You can't differentiate based on price for most services received at hospitals because hospitals themselves cannot quote you how much it costs for a service.

A free market solution cannot exist without being able to deny those who don't pay service and allowing those who day the ability to differentiate between products. But we, as a country, don't have the political will to tell people they cannot receive treatment NOR will the government enact a forced pricing scheme on private institutions.

So, a public solution is most likely to work and receive the most support since it can coordinate all of that on the back-end.

Just my two cents.

rb

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Re: Munger Says We Will Have Single Payer
« Reply #2 on: June 01, 2018, 03:02:00 PM »
I also agree that eventually you will get single payer healthcare in the US. But I think it will be quite far in the future. So your investments are likely fine right now.

LC

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Re: Munger Says We Will Have Single Payer
« Reply #3 on: June 01, 2018, 03:56:38 PM »
Good poInt TwoCities.

It may be useful to look at another industry which we cannot deny service to: legal council. Unfortunately it not an ideal comparison but it's  the best I can think of and it gets us 60% of the way there.
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DTEJD1997

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Re: Munger Says We Will Have Single Payer
« Reply #4 on: June 01, 2018, 04:59:33 PM »
Good poInt TwoCities.

It may be useful to look at another industry which we cannot deny service to: legal council. Unfortunately it not an ideal comparison but it's  the best I can think of and it gets us 60% of the way there.

If medical care in the USA is going to be comparable to court appointed attorneys...we are in for rough times indeed.


LC

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Re: Munger Says We Will Have Single Payer
« Reply #5 on: June 01, 2018, 05:18:50 PM »
The point is, if we accept the premise that we are going to have universal coverage, there must be compromises.
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rb

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Re: Munger Says We Will Have Single Payer
« Reply #6 on: June 01, 2018, 09:51:34 PM »
Single payer universal coverage is NOTHING alike court appointed legal counsel.

Cigarbutt

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Re: Munger Says We Will Have Single Payer
« Reply #7 on: June 02, 2018, 08:07:17 AM »
https://www.nejm.org/doi/full/10.1056/NEJMp1602009
"In short, single payer has no realistic path to enactment in the foreseeable future."
Then again, when reflecting on what happened in 2008, I never considered, in the potential range of outcomes, that banks, AIG and auto manufacturers would be bailed out by a federal rescue program.

Personal anecdote: A while back, was sometimes marginally involved in contracts negotiations for medical devices. After looking at some data, I found out that, for the same patient and the same device, the price paid by the US "client" was at least twice as much as the price being regionally negotiated in Canada. To the question: "How come you charge at least twice as much in the US for the same product?", the best answer obtained: "Because we can".

rukawa

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Re: Munger Says We Will Have Single Payer
« Reply #8 on: June 02, 2018, 09:30:10 AM »
Quote
A free market solution cannot exist without being able to deny those who don't pay service and allowing those who day the ability to differentiate between products. But we, as a country, don't have the political will to tell people they cannot receive treatment NOR will the government enact a forced pricing scheme on private institutions.

I don't like the term free market in this context so I will use a different term. Normal market. You can have a pretty good "normal market" solution to this problem. And that is what Singapore has done. Its extremely effective in providing high degrees of health care availability, good outcomes, no lineups and very low costs. Singapore is a multi-payer system and its the single most effective healthcare system in the world.

By "normal market" I mean a system where the vast majority of consumers are paying for thing directly out of their own pockets with money they earned and for their own direct consumption (not to resell to someone else).  I would say that housing, stock market, education, car repair, healthcare are mostly abnormal markets since in these cases the consumers are mostly not paying using their own money directly for their direct consumption. Instead they are using loans, insurance.

Normal markets work well. In most normal markets prices typically decline, quality improves, pricing is rational and there are no large scale societal problems. Clothing, food, consumer goods are examples.

Healthcare is not a normal market since everyone uses insurance. But Singapore found a way to turn it into one. Their system is not a "free" market. But it provides all the true advantages that free markets have. Brad Delong has a solution that essentially accomplishes the same thing and is described here:
http://delong.typepad.com/sdj/2007/06/dealing_with_th.html

Basically the solution is as follows:
1) Compulsory HSA's and everything paid out of the HSAs up to a certain limit which is dependent on income
2) 100% insured coverage if you exceed the HSA limit
« Last Edit: June 02, 2018, 10:07:47 AM by rukawa »

ASTA

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Re: Munger Says We Will Have Single Payer
« Reply #9 on: June 02, 2018, 10:55:07 AM »
Was in the states on holiday and was stupid to go to ER. For a swab of my 4-month son cost me $7,000 makes me really consider if I ever want to move there. A mix between EU and USA would be good.

I do Have 2 million credit card Insurance so I should be good still have to fill the paperwork. Will test if it works :D but childbirth was 700 Euros in EU :D
« Last Edit: June 02, 2018, 11:04:00 AM by ASTA »