DSA - How Will this Work?

[FLaw47]

For any solution that has a chance to improve the situation getting employer and government provided healthcare out of play is essential. There are really two solutions, government provided or single-payer systems or a system that is funded by people and in necessary cases added to by the government and then used as a forward facing funding means of healthcare between patient and doctor/medical practice. That's the only way to fix this mess that I have seen.

What country has done that?

 

[Willence]

What country has done that?

As far as I know, none and I couldn't care less if anyone has. We live here and this country is one of one in almost every way. There are some really good ideas we see around the world and we can take some of those and build off them perhaps. But unwinding the mess we've created here is going to require real reform and a new solution.

 

[BelemNole]

Works well,.. I've used it, incurred medical bills, and haven't gone bankrupt.

Ah, so since it worked for you it must work for all.

Tell me, did it work for the lady I know whose critically ill son had to be transported by helicopter to a different hospital in an adjacent state due to lack of ability at the local hospital to care for him. After he died her insurance rejected the bill for the helicopter and charged her $50,000 for that 'unnecessary flight' that was approved at the time?

 

[FLaw47]

As far as I know, none and I couldn't care less if anyone has. We live here and this country is one of one in almost every way. There are some really good ideas we see around the world and we can take some of those and build off them perhaps. But unwinding the mess we've created here is going to require real reform and a new solution.

So you're just reforming on vibes, then. Cool cool cool.

 

[tarheelbybirth1]

I am not saying it cannot be done, it's just that the US is much, much harder (expensive) than other countries that have done this due to population. Also, DSA is proposing much more than just healthcare for all so the costs would be astronomical.

• U.S. population is currently ~343 million.
• Most European countries with universal systems are much smaller: Germany ~84 million, France ~68 million, UK ~68 million, Canada ~41 million, Sweden ~10 million, etc.

Finally I doubt those other countries are spending at the levels of social program spending that the US is today. We wonder why we have deficit spending when we spend the MAJORITY of tax revenues on social programs already today.

Fiscal Year	Social Program Spending (Human Resources)	Total Federal Tax Revenues / Receipts	Social Spending as % of Revenues
2020	$4.34	$3.42	127%
2021	$4.81	$4.05	119%
2022	$4.71	$4.90	96%
2023	$4.16	$4.44	94%
2024	$4.55	$4.92	92%
2025	$4.71	$5.24	90%

Here's a thought. Stop me if I start sounding crazy. The moderate wing of the Democratic Party welcomes - you know, Big Tent style - the social democrats/Democratic socialists from THEIR OWN PARTY with open arms and they all sit down and put together programs that address the needs of the country. It's called compromise. It used to be the backbone of our legislatures at the state and federal levels.

Or they can pour money into advertising to "discredit" this wing of their own f'n party and let the GOP keep power. Genius move that.

 

[Willence]

So you're just reforming on vibes, then. Cool cool cool.

What in the world are you talking about? It's reform based on facts and reality. If you want to have a debate based on substance, I'm all for it. But if you're just looking to clown around and make no point whatsoever, that's OK as well but I'll not participate in that. So far it's the latter.

 

[FLaw47]

What in the world are you talking about? It's reform based on facts and reality. If you want to have a debate based on substance, I'm all for it. But if you're just looking to clown around and make no point whatsoever, that's OK as well but I'll not participate in that. So far it's the latter.

I think it's a little rich to accuse me of "clowning" around when your entire healthcare proposal is "get the government and employers out of health care".

 

[Willence]

I think it's a little rich to accuse me of "clowning" around when your entire healthcare proposal is "get the government and employers out of health care".

We spend over $5T on healthcare each year. That equates to about $15k per year per person in the US. Health insurance premiums are up over triple digits since 1999 and the 2009 ACA hasn't really helped there at all. Might it be that wages are not increasing due to the ever increasing cost of employer provided health insurance plans? Well the numbers bear this out. In 2025, the average total annual premium for employer-sponsored family health coverage was $26,993, with employers contributing an average of $20,143 toward that cost.

This is an under-covered impediment on wage growth which is seriously impacting family wealth. So all told, you can argue we're looking at about $40k per family spent on health care each year. That is insane!

Everyone wants to blame insurance companies for this situation. But the reality is a combined effort with healthcare providers and also with the insurance providers all empowered and facilitated by idiotic government policy. Medicare gets worse by the year. The whole thing is a giant mess and totally unsustainable. The best possible answer is getting everyone into one pool (which is using a single payer principle) and then empowering people through HSA accounts and catastrophic insurance to work directly with doctors and providers on a cash basis. We have to destroy the cost structure that has created this mess. It's why a hospital system can charge thousands for imaging yet you can go across the street to a private imaging service and pay 1/4 of the cost. Yet people don't know and they are herded into this system now with every increasing premiums and ever decreasing levels of service.

The best part is there can then be pressure to put that $20k the average employer spends into the pockets of employees so they can do what's best for their families. And for those that can't do that because they don't have the money, we can use some of the savings of getting out of all of these expensive plans to actually empower those people to directly deal with their healthcare and not feel like they are second class citizens in a crappy system like Medicaid. Medical care should be uniform for everyone. That shouldn't be something only the wealthy can have access to.

 

[baltimorened]

Here's what I said to Moogy:

I think you are correct that we'd need all of those details ironed out before passing a single payer bill into law (obviously) but I find it very suspicious how single payer is supposed to have a fully fleshed out policy ready to go before anyone will even talk about it when (and I don't think I'm exaggerating much here) that's not the standard for any other high level policy proposal.

well it should be for every major policy proposal.

 

[baltimorened]

I'm fully aware of that,.. What you don't seem to understand is that in the ultimate single payer scenario those non-contributors will both expect and receive 100% the same level of care that the contributors are now receiving,... One of two things will have to happen,.. Either my currently acceptable cost for excellent healthcare goes up so that everyone can receive that product, or the quality of my healthcare goes down to a level that's deemed to be marginally acceptable to the average,... Neither are acceptable to me.

I don't know how people say our quality of car is poor. I'm on Medicare with a secondary and I find the system to be very good.

Wasn't the ACA sold as a means to get more people to use preventative care so as not to go to the ER? How's that working?

 

[baltimorened]

What we have been discussing is the traditional single payer approach,... What I think we should be looking at is more of a hybrid, where a single payer system covers "basic" healthcare, and then supplemental private insurance picks up services above and beyond what has been defined as "basic",.. The category of "basic" would be limited to what we as a society are willing to pay for.

I believe that the procedure for one of the countries that has universal healthcare..don't know which one

 

[TC_Nole_OX]

 

[baltimorened]

exactly...

you can have our healthcare system that costs more for worse results when you pry it from my cold dead hands!

I don't know why you say this. I find out healthcare system to be darned good.

I'll say this, we'd better have a better, cheaper - for everyone - approach lined up before we blow up what we have.

 

[jimneffer]

I don't know why you say this. I find out healthcare system to be darned good.

I'll say this, we'd better have a better, cheaper - for everyone - approach lined up before we blow up what we have.

your anecdotal experience aside, we have a healthcare system that delivers worse results systemwide for significantly more money per person

How does the quality of the U.S. health system compare to other countries? - Peterson-KFF Health System Tracker

Across a wide variety of measures of quality, the U.S. health system appears to perform worse than peer nations on more indicators than it does better. Across a wide variety of measures of quality, the U.S. health system appears to perform worse than peer nations on more indicators than it does...

www.healthsystemtracker.org

How does health spending in the U.S. compare to other countries? - Peterson-KFF Health System Tracker

This chart collection examines how U.S. health spending compares to health spending in other similarly large, wealthy OECD countries using the OECD Health Statistics database.

www.healthsystemtracker.org

 

[baltimorened]

We spend over $5T on healthcare each year. That equates to about $15k per year per person in the US. Health insurance premiums are up over triple digits since 1999 and the 2009 ACA hasn't really helped there at all. Might it be that wages are not increasing due to the ever increasing cost of employer provided health insurance plans? Well the numbers bear this out. In 2025, the average total annual premium for employer-sponsored family health coverage was $26,993, with employers contributing an average of $20,143 toward that cost.

This is an under-covered impediment on wage growth which is seriously impacting family wealth. So all told, you can argue we're looking at about $40k per family spent on health care each year. That is insane!

Everyone wants to blame insurance companies for this situation. But the reality is a combined effort with healthcare providers and also with the insurance providers all empowered and facilitated by idiotic government policy. Medicare gets worse by the year. The whole thing is a giant mess and totally unsustainable. The best possible answer is getting everyone into one pool (which is using a single payer principle) and then empowering people through HSA accounts and catastrophic insurance to work directly with doctors and providers on a cash basis. We have to destroy the cost structure that has created this mess. It's why a hospital system can charge thousands for imaging yet you can go across the street to a private imaging service and pay 1/4 of the cost. Yet people don't know and they are herded into this system now with every increasing premiums and ever decreasing levels of service.

The best part is there can then be pressure to put that $20k the average employer spends into the pockets of employees so they can do what's best for their families. And for those that can't do that because they don't have the money, we can use some of the savings of getting out of all of these expensive plans to actually empower those people to directly deal with their healthcare and not feel like they are second class citizens in a crappy system like Medicaid. Medical care should be uniform for everyone. That shouldn't be something only the wealthy can have access to.

so here's a real question...the employer gives the employee the $20,000...what percentage of employees will then use the money for health insurance as opposed to a trip to the Bahamas?

 

[AndreWoolridgeB10MVP]

so here's a real question...the employer gives the employee the $20,000...what percentage of employees will then use the money for health insurance as opposed to a trip to the Bahamas?

 

[Willence]

so here's a real question...the employer gives the employee the $20,000...what percentage of employees will then use the money for health insurance as opposed to a trip to the Bahamas?

That's just it. They won't need to spend it on the insurance. The system will adjust because of the change and the way things are done. We need transparency and accountability. We have neither of those things now and a lot of demonization of health insurance companies and not enough healthcare providers who are ripping people off up one side and down the other. Employers are negotiating with insurance companies and insurance companies then pass on to healthcare providers who charge more for services than they need to meanwhile the premiums continue to go up up and away.

Ask yourself this question. Why is it that people used to get their health insurance for free from their employer with better coverage than we have now? What exactly happened that caused all this? That's where we need to focus. I am overweight and I should have to pay more than someone who's in shape does. It's just that simple. I need to take much better care of myself and I shouldn't benefit from costs that are paid by someone who is in shape. We don't need anywhere near as much insurance as we have now. What we need is a better pay as we go system for people with their regular services. That would not be hard to achieve with more transparency. with more transparency.

 

[scotchtiger]

I'll say this, we'd better have a better, cheaper - for everyone - approach lined up before we blow up what we have.

Exactly. The only possible solution I could ever support cannot include any one of: lower quality care, higher costs (including taxes) or reduced/delayed access to care.

If someone can devise a system that guarantees higher quality, lower costs for everyone (including taxes) and at least equal access to care, then I'm willing to listen.

 

[hawkeyetraveler]

I sure hope not.

 

[HoggI74]

You know that you're already footing the bill, right? All of these "non-contributors" are going to the ER because they ER has to see them and all of that gets passed back to us in the form of higher costs.

I think we were told that after the ACA was passed usage of the ER would be down so much that it would practically pay for itself...

 

[FLaw47]

I think we were told that after the ACA was passed usage of the ER would be down so much that it would practically pay for itself...

I don't find this comment in any way interesting.

 

[TC_Nole_OX]

Not a socialist, but wants socialism when the need hits home

 

[baltimorened]

Exactly. The only possible solution I could ever support cannot include any one of: lower quality care, higher costs (including taxes) or reduced/delayed access to care.

If someone can devise a system that guarantees higher quality, lower costs for everyone (including taxes) and at least equal access to care, then I'm willing to listen.

a very real problem is that we will be told all the benefits that are going to accrue from the new system....similar to the ACA...and somehow they never happen. I don't know enough about how it happened, but I think someone would be hard pressed to debate that the system is better today than before passage of that law. Sure there were 41 million people without health insure pre ACA and an estimated 28 million today, so some people benefitted. And there some other good parts like the "stay on your parent's plan til 26". But it sure seems like premiums have increased, deductibles have increased, hospitals have closed, and care has not gotten better.

 

[baltimorened]

I don't find this comment in any way interesting.

maybe not interesting, but wasn't that one of the selling points...that preventative care would lessen the usage of the ER. You probably can find data on that..maybe it's true. maybe not. ..But I know this, if I have a medical issue and can't get immediate care from my physician, i'm off to the ER, regardless of my insurance situation. And, i'd wager the vast, vast majority feel exactly the same way.

 

[FLaw47]

maybe not interesting, but wasn't that one of the selling points...that preventative care would lessen the usage of the ER. You probably can find data on that..maybe it's true. maybe not. ..But I know this, if I have a medical issue and can't get immediate care from my physician, i'm off to the ER, regardless of my insurance situation. And, i'd wager the vast, vast majority feel exactly the same way.

My response is basically:

• I have no idea if that was a formal selling point or not. Your side of the aisle is historically very comfortable with misrepresenting such things
• I have no idea if it "bent the curve" of ER spending or not. I'd wager that it likely did but that would mysteriously be insufficient to the OP
• I'm not particularly interested in defending the ACA because the GOP has done everything they possibly could to make it a failure, as you well know

So I'm left with: what does it really matter? And even if none of what I outlined above breaks my way (unlikely) why are the impacts of a fundamentally different healthcare solution relevant to what we'd do now? Is it just "ha ha government no can do anything?".

 

[FLaw47]

Exactly. The only possible solution I could ever support cannot include any one of: lower quality care, higher costs (including taxes) or reduced/delayed access to care.

If someone can devise a system that guarantees higher quality, lower costs for everyone (including taxes) and at least equal access to care, then I'm willing to listen.

Whenever we have change management training at work, they talk about how there are different types of people as it relates to the change. I'm paraphrasing here but it's like the enthusiastic supporters, the tepid supporters, the tepid opposers, and the militant opposers. The consistent theme is "the militant opposers aren't interested in doing anything and are going to tank the whole initiative with their bitterness. Don't try to change their mind; exclude them from the conversation".

 

[baltimorened]

My response is basically:

• I have no idea if that was a formal selling point or not. Your side of the aisle is historically very comfortable with misrepresenting such things
• I have no idea if it "bent the curve" of ER spending or not. I'd wager that it likely did but that would mysteriously be insufficient to the OP
• I'm not particularly interested in defending the ACA because the GOP has done everything they possibly could to make it a failure, as you well know

So I'm left with: what does it really matter? And even if none of what I outlined above breaks my way (unlikely) why are the impacts of a fundamentally different healthcare solution relevant to what we'd do now? Is it just "ha ha government no can do anything?".

so here's a few questions for debate (and yes the benefits of preventative care vis a vis the ER was one of the selling points for ACA):

Questions: What is the problem we are trying to solve with Medicare for all solution?
Have your healthcare costs increased or dec
Are we better off with the ACA? Can the ACA be fixed rather than blown up?
Has medical care improved since the ACA?

 

[hawkeyetraveler]

a very real problem is that we will be told all the benefits that are going to accrue from the new system....similar to the ACA...and somehow they never happen. I don't know enough about how it happened, but I think someone would be hard pressed to debate that the system is better today than before passage of that law. Sure there were 41 million people without health insure pre ACA and an estimated 28 million today, so some people benefitted. And there some other good parts like the "stay on your parent's plan til 26". But it sure seems like premiums have increased, deductibles have increased, hospitals have closed, and care has not gotten better.

The biggest problem with ACA IMO is that it was half baked on arrival.

To get anything passed the Dems had to eliminate some of the most important elements of the legislation - notably a low cost public insurance option and a price control mechanism. To me that low cost option is the big missing ingredient. Create a market force that keeps prices lower.

So yeah, we can safely say that ACA is not doing what it intended to do, but it was not the legislation Obama intended either. It would be disingenuous to say this was the legislation that people expected to solve the problem. It is not that legislation.

We should just adopt the German model and move on.

 

[FLaw47]

so here's a few questions for debate (and yes the benefits of preventative care vis a vis the ER was one of the selling points for ACA):

Questions: What is the problem we are trying to solve with Medicare for all solution?
Have your healthcare costs increased or dec
Are we better off with the ACA? Can the ACA be fixed rather than blown up?
Has medical care improved since the ACA?

What problem are we trying to solve with any left wing healthcare improvement is to ensure that everyone is able to get a reasonable baseline of care.

I truly don't know how to answer the healthcare question in a way that you'll find satisfactory. I have seen evidence that the ACA bent the curve. At the same time, though, I heard that lots of insurers used the ACA as an excuse to shove more of the costs onto employees (I did just look into this and it seems like it's true) and obviously the overall costs of healthcare and premiums keep going up because of inflation and everything else.

We're clearly better off with the ACA than without. I think coverage for pre-existing conditions and the essential benefits were extremely important. My next step would be adding a public option.

Medical care has obviously improved but who is to say if that's because of the ACA or not. I'm sure that all of the electronic records directives have been very useful, if nothing else.

 

[FLaw47]

We should just adopt the German model and move on.

Sign me up.

 

[Rifler]

Ah, so since it worked for you it must work for all.

Tell me, did it work for the lady I know whose critically ill son had to be transported by helicopter to a different hospital in an adjacent state due to lack of ability at the local hospital to care for him. After he died her insurance rejected the bill for the helicopter and charged her $50,000 for that 'unnecessary flight' that was approved at the time?

Yes,.. She requested and accepted the services that were recommended, offered, and provided,.. What her insurance covered is between her and her insurance provider,... That's not on the medical staff that served her.

 

[FLaw47]

Yes,.. She requested and accepted the services that were recommended, offered, and provided,.. What her insurance covered is between her and her insurance provider,... That's not on the medical staff that served her.

I'd like you to put your empathy hat on for a moment; in a moment where you child is actively dying, how much thoughtful consideration are you able to give to "does my insurance cover this service at this place?" In fact, should you have to consider that, in that moment, in your ideal world?

 

[jimneffer]

I'd like you to put your empathy hat on for a moment; in a moment where you child is actively dying, how much thoughtful consideration are you able to give to "does my insurance cover this service at this place?" In fact, should you have to consider that, in that moment, in your ideal world?

the best healthcare system in the world requires parents to consider a $50,000 out of pocket expense to save their child's life

what's the problem here?

 

[Rifler]

I'd like you to put your empathy hat on for a moment; in a moment where you child is actively dying, how much thoughtful consideration are you able to give to "does my insurance cover this service at this place?" In fact, should you have to consider that, in that moment, in your ideal world?

No, in that moment you do what you have to do,... But when it comes time to take care of the accounting it all goes back to the policy that was selected and paid for,... Her coverage is what she chose,.. Giving people things they didn't pay for is exactly what drives up costs for everyone else.

 

[FLaw47]

No, in that moment you do what you have to do,... But when it comes time to take care of the accounting it all goes back to the policy that was selected and paid for,... Her coverage is what she chose,.. Giving people things they didn't pay for is exactly what drives up costs for everyone else.

So your contention remains that a system that allows for such outcomes is fine?

 

[Rifler]

So your contention remains that a system that allows for such outcomes is fine?

Absolutely,.. I appears to me that the best available care was provided, and her insurance carrier participated according to the terms of their contract,... I'm not sure what more anyone could expect.

 

[jimneffer]

Absolutely,.. I appears to me that the best available care was provided, and her insurance carrier participated according to the terms of their contract,... I'm not sure what more anyone could expect.

exactly...why would we ever consider changing a system to costs 1.5X more than any other system and delivers objectively worse results?

not knowing whether saving your child's life will bankrupt you or not is just a cherry on top...a roll of the dice to make everything a little more fun

these people just don't get it...

 

[hawkeyetraveler]

Absolutely,.. I appears to me that the best available care was provided, and her insurance carrier participated according to the terms of their contract,... I'm not sure what more anyone could expect.

People are making an argument against the system itself, but your argument does not address the system at all. Your argument is she got what the system delivered her by contract. That is NOT an argument FOR the system, if anything it is yet more proof that the system is broken since a parent has to contemplate bankruptcy in exchange for a life.

You suggest we accept a devil’s bargain simply because that is the way the system is today. But in every other western nation this scenario does not happen. And they have better health outcomes than the US. Therefore the system IS broken and your argument is actually reinforcing how broken it is.

 

[FLaw47]

Absolutely,.. I appears to me that the best available care was provided, and her insurance carrier participated according to the terms of their contract,... I'm not sure what more anyone could expect.

 

[Rifler]

People are making an argument against the system itself, but your argument does not address the system at all. Your argument is she got what the system delivered her by contract. That is NOT an argument FOR the system, if anything it is yet more proof that the system is broken since a parent has to contemplate bankruptcy in exchange for a life.

You suggest we accept a devil’s bargain simply because that is the way the system is today. But in every other western nation this scenario does not happen. And they have better health outcomes than the US. Therefore the system IS broken and your argument is actually reinforcing how broken it is.

We can move towards the single payer system that you seem to be suggesting,... Just understand that when that system is imposed upon the previously discussed scenario no helicopter transport would be offered, and the woman's son would have simply died at the first hospital, which would likely be even more severely lacking in it's ability to provide care.