View Single Post
Old 03-21-2020, 09:00 AM
filmstar-en is online now
Join Date: Aug 2013
Posts: 980
The term 'single payer', seems ambiguous and misleading.

It suggests one party picks up the bill for all health care expenses. If the final bill of split between various insurance companies, the state and individually by the patient then it is clearly not single payer.

But then the UK NHS is not strictly single payer because patients have to make a small standardised payment for drug prescriptions made by GP's if they are not in a group for which it waived is (retired, unemployed, etc) Though, with that caveat, the rest of it is single payer and almost universal. Prescription charges were a controversial issue when they were introduced soon after the NHS was founded, because they represented a potential erosion of the principle of free health care financed by the state summarised as “to provide care based on need and free at the point of delivery”.

However, the universal systems need some way of moderating the consumption of their services. A side effect of universality is that some patients can get very psychologically addicted to healthcare and can consume disproportionate amounts of medical resources for conditions may be arise from social factors. While the UK has drug prescription charges, some other universal systems charge per doctor visit.

So a pedant may claim that there is no such thing as a single payer system. But aside from these modest standard prescription payments (currently £9) the expectation is the all health care costs are picked up by the state, financed through general taxation. NHS patients seldom, ever, see any other kind of medical bill. From a patients point of view it is very simple indeed: the government picks up the tab. It is regarded as a fundamental right.

This article makes some broad comparisons: the Beveridge single payer model in the UK, the Bismark state and employer insurance financed universal model found in Europe, the Canadian state financed insurance model and various hybrid systems. Then there is the pay out of pocket model, for the poorest countries with little public health care. The US is a bit of an exceptional amongst developed economies.

Reid explains the US system it quite succinctly:

"These four models should be fairly easy for Americans to understand because we have elements of all of them in our fragmented national health care apparatus. When it comes to treating veterans, we’re Britain or Cuba. For Americans over the age of 65 on Medicare, we’re Canada. For working Americans who get insurance on the job, we’re Germany."

Does it make a difference when dealing with a pandemic? You bet it does. The US does not have the advantage of a centralised healthcare system with the machinery in place to marshal resources effectively. It became log jammed. No standard virus tests and states petitioning the federal government for resources. Healthcare provision is also very patchy. In some places it the best in the world, other places health care is like some undeveloped economy and that is an Achilles heel The virus does not discriminate between rich and poor and there are a huge number of people in the US without access to affordable healthcare.

China, another very large country with a developed economy. But with a centralised state health care system under political control. It fared much better. They almost lost control in the early stages of the pandemic, but managed to recover the situation because they realised their mistake and acted quickly and decisively to put it right. They tested, they quarantined, they locked down. Other countries are trying to do the same and a centralised health care system is a very useful lever to pull to get the machinery in gear to deal with this emergency. I think the UK nearly lost the plot when there was briefly a debate about 'herd immunity', but they seem to be doing the right things now.

The question I have is what about the nations without an effective health care system, which is most of the world. This virus could become endemic, just comes and goes with the seasons. For such countries, I guess they will wait for a cheap enough vaccine to becomes available for a national programme, like for other diseases. Until then, countries that have it under control will test everyone coming across their borders, quarantining and vaccinating those that have it. That kind of presupposes you can have effective border control and a test that is quick and accurate.

International travel could become a lot more complicated than it is at the moment.....or rather was, until a couple of weeks ago.