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A thread about state single payer efforts, single payer groups, @PNHP, (lead by @awgaffney) @CalNurses, the failure of the left to advance any real reform at the state level and the big important priority/goal divide among people who actually support single payer 1/
There are several things SP could do:
reduce admin spending.
assure economic protection for people.
assure a more equitable provision of health care
dramatically reduce total health spending by forcing providers drugmakers to stop charging so much with a single clear price. 2/
reduce admin spending.
assure economic protection for people.
assure a more equitable provision of health care
dramatically reduce total health spending by forcing providers drugmakers to stop charging so much with a single clear price. 2/
Single payer groups which are lead by health care providers really value health care services. This is neither surprising nor nefarious, they dedicated life to something so tend to value that thing more highly. Teachers value education, artists art, gardeners gardens, etc… 3/
If you look at their plans/statements they want to reduce admin spending and use that money to increase the use doctors and clinics. Basically keep the pie the same size but slice it better. Their plans really value people getting health care services above almost everything. 4/
Their plans have no cost-sharing, no gatekeeping, no pre-approval, no analysis for deciding which services are cost effective, or other measures you see in other SP system to keep cost down. Nothing wrong with this being your value but be clear what it is. 5/
Their plan is to squeeze out as much admin waste as possible to pay for this increase in the use of health care services without making any real change to how much we pay total or prices. This is definitely better than the status quo. 6/
There are two problem with this:
1) They see their being no way to do a multiple step process to get this end point so you need a one big leap
2) There is no way to adopt true state SP under federal law. You can't get the same admin saving with ERISA in place. 7/
1) They see their being no way to do a multiple step process to get this end point so you need a one big leap
2) There is no way to adopt true state SP under federal law. You can't get the same admin saving with ERISA in place. 7/
on other side there are people who excited about SP to really drive down health care prices. I don't value health care services nearly as highly. Every dollar gov spends on a drug or doctor salary above international norm is a dollar not spend on education/SNAP/Etc... 8/
If you think a top reason for SP is to reduce health spending overall then there are multiple step paths states can take to move that direction. I would love price regulation with saving split between more care, more edu spending and high general wages for everyone. 9/
This has result in people with this policy goal not understanding why single payer groups have not gotten on board with a multiple step plans that would move states to say 85% government coverage and instead keep seeing failed pure SP ballot measures and bills 10/
The "reduce admin to spend all on more health care" camp has the bulk of the grassroots energy. The "reduce total health care spending to use on other social services" I suspect based on polling has more general support for voters. 11/
To move policy you need to understand the politics and I don't think people on the left understand this divide. It is not merely a strategy question or one of tactics. That hides a bigger question about values and what the main goals of SP should be. 12/
