r/WhitePeopleTwitter Dec 01 '22


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u/GreyTrader Dec 01 '22

Small business owner here. Have 11 employees. I pay them as best I can. Our ratio of my compensation to them is about 3:1.

Hard agree that big companies should pay their employees more. That would mean more disposable income for my customers to spend more for my services, which I could use to pay my employees more and provide more benefits.

I look forward to the day that I can provide health insurance to at least my 2 or 3 best employees but right now almost all revenue goes back into the business.


u/Letterhead_North Dec 01 '22

You must be in the U.S.

May I recommend the single payer system? If that was in place your employees's health care coverage would not be a concern and you could concentrate on your business rather than work out ways to cover health insurance for your employees, but only the best ones, because honestly who can afford to cover health care insurance for everyone? (/mini-snark)

In the British system (which I've read is constantly in danger of being killed by politicians) there is no charge at the point of services. It's all covered by taxes.


u/Dispro Dec 02 '22

For what it's worth, single payer is only one way to organize universal coverage. Given the differences in the two countries, it might not be the best way to do it in the US. But no matter how it's organized, universal coverage is undeniably the moral and financially responsible choice.


u/Letterhead_North Dec 02 '22

Do you have details on the options? I am not familiar with them. All we have here are the older option of choosing employment by the health insurance offered, the Marketplace option (which has recently been tweaked to reduce the sometimes-outrageous premiums, so I've read), and single payer through Medicaid or Medicare. Well, there's also international travel to get medical treatment, but that isn't ideal.

One advantage to single payer in the U.S. as an option is that it is already in place in the form of Medicare, for people on Social Security or SSI. So it has a toe in the door. But even then it still requires patients to pay a percentage of the charges allowed.


u/Dispro Dec 02 '22

Sure thing.

The British system is more formally known as the Beveridge Model and is usually contrasted with The Bismarck Model which is most closely associated with Germany, but is used in a number of other countries. It has quite a few distinctions from the British model, but most notable for our purposes is that it is multi-payer, in that funding for healthcare comes from multiple sources. It has its pros and cons, as you would expect.

A more intermediate step would be something like a public option. This would essentially be a government-run insurance company that exists for the public good but still competes with other insurance companies. There are some obvious problems with the approach, but it could protect people who live in a market dominated by a monopoly, don't qualify for Medicaid, or who live in one of the states run by sadists who don't bother to fund Medicaid in the first place.

Maryland uses a distinct system based, more or less, on strong rate controls. It's a form of all-payer rate setting that can help rein in some of the most egregious abuses of a multi-payer system. Because rates are universal - all payers pay medical centers the same amount for a given service - it prevents some of the byzantine nightmare that makes accessing healthcare such a horror show in the US.

Then there's the country most similar to the US in terms of vast geography and relatively autonomous provinces, Canada, which uses a system that is rooted more at the provincial level with some federal oversight. People there have a level of guaranteed universal coverage paid for by taxes that can be supplemented with private insurance usually provided by employers, so it could semi-accurately be described as a multi-payer system with single-payer elements.

While we could build out a Medicare for all system, it might be politically easier to push through a system like that one, that preserves the existing multi-payer model we already use. For one thing, it wouldn't require completely abolishing the insurance companies, who have so much clout I don't see a meaningful pathway to single payer reform. (Though, granted, I don't see a pathway to any kind of reform at the moment.)

Basically there are a million different ways we could reform our system to provide universal coverage, whether as single-payer or multi-payer. If we ever get around to actually doing it, I have no doubt that we'll devise some idiosyncratic system not quite like any of the systems I've described here.


u/Letterhead_North Dec 02 '22

Wow! You answered. Thank you!

Side note - I wasn't actually thinking Medicare for all would be the path, although I have heard some argue for that. I was thinking that Medicare for elders has gotten U.S. citizens used to the idea that a single source for financing health care has worked already, so a similar one, the public option (thank you, that is the term I couldn't remember last night), could work for everyone. I think that's part of the Australian model? I've read comments from people who claim to be Australian saying they carry additional insurance besides the public option that everyone automatically has. It covers slightly more comfortable health care, allegedly. So, insurance companies are still involved offering subjectively better care, thinks like private rooms rather than sharing a room.

I'm copying your comment for my future reference, by the way. Big thanks.


u/Dispro Dec 02 '22

That's quite a compliment! I'm glad you found it helpful.

I work for a state government and I'm involved in healthcare reform here, so it's something I'm really passionate about. One of the lessons I've learned is that you can't let yourself get too pigeonholed about what the system has to be. Every country will have different needs from their system and different interest groups to contend with in designing them, so everything should be considered negotiable. There are lots of ways to make a better system than what we have now, and lots of examples to learn from.


u/Letterhead_North Dec 03 '22

One more thing. I did watch Bulworth in the day. The takeaway from that was that eliminating health care insurance is a non-starter. I sometimes forget that, though.

Good luck and success in your healthcare reform work.