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Old 03-20-2020, 03:15 PM
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Does having single-payer health care make a difference in how countries can deal with this?


I've been listening to the Ohio governor's daily updates (really mostly for Dr. Amy Acton) and interspersed with tons of other info is some directives that are being given to health insurance companies. One about making sure covid-19 testing is covered, one about how telemedicine needs to be covered, and one about companies not having to pay premiums for a while but can keep their employees on insurance (even if the employees aren't able to work).

If we had single payer, this stuff would just automatically happen I assume. Maybe some tax relief regarding taxes paid towards health care.

Does it make a huge difference in America that we don't have single payer, or is it not holding us back too much?
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Old 03-20-2020, 03:51 PM
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are you discussing single payer, or universal health care?

Because you can have universal health care without single payer. Germany has UHC but doesn't have single payer and they are handling things well.

One thing to consider is that coronavirus tends to hit the elderly hardest, and pretty much everyone over age 65 is covered by medicare which is a single payer health care system. So its hard to tell in some ways, since many hospitalizations occur among people who are covered by a US single payer system.
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Old 03-20-2020, 04:19 PM
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I don’t want to derail this thread, but would like a point of clarification.

I thought Medicare actually isn’t single payer, that people on Medicare have to pay for additional parts or something, through private insurers, and also still have to make floats themselves, or have limits on how much Medicare will pay. Have I misunderstood?
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Old 03-20-2020, 04:29 PM
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To answer the questions in the OP, I don’t think any of those things are issues in our single-payer system in Canada.

• medical tests ordered by a doctor or hospital are covered;

• telemedicine - we have a 811 line which is free and you can get advice about whether you should go get tested. (It got swamped with calls and last I heard the gov’t was hiring more people to answer calls)

• employers and individuals in my province don’t pay any premiums for health-care (all funded for general revenue), so that’s not an issue.
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Old 03-20-2020, 04:30 PM
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I don’t want to derail this thread, but would like a point of clarification.

I thought Medicare actually isn’t single payer, that people on Medicare have to pay for additional parts or something, through private insurers, and also still have to make floats themselves, or have limits on how much Medicare will pay. Have I misunderstood?
Medicare is a single payer system with an actuarial value of maybe 80% (meaning it covers about 80% of your medical bills). I forget the actual actuarial value. But some single payer systems have actuarial values closer to 95%, meaning you have almost no deductibles or copays.

It is funded via FICA taxes, each employee pays 2.9% of their gross income in taxes split between employer and employee. High income people pay a 3.8% FICA tax for medicare.

So its a single payer system in the sense that its a publicly funded insurance system. However not all medical practitioners take it, and it only covers about 70-80% of medical costs.

The remaining 20% of medical costs are usually paid out of pocket or via private insurance. Medigap, medicare D, long term care insurance, etc.
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Last edited by Wesley Clark; 03-20-2020 at 04:33 PM.
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Old 03-20-2020, 04:48 PM
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Thanks for the explanation.
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Old 03-20-2020, 05:00 PM
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From the Netherlands, which has universal healthcare, but not single payer...it just hasn't been mentioned.

It is all about capacity, symptoms, how the disease progresses. Money just hasn't been mentioned when the medical side has been discussed.

Money has been discussed when talking about the economy. There have been quite a few actions there.

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Old 03-20-2020, 05:01 PM
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If we had single payer, this stuff would just automatically happen I assume. Maybe some tax relief regarding taxes paid towards health care.
...I'm in New Zealand and yes, everything is just happening automatically. If the GP thinks you need a test you get a test at no cost out of pocket. If you end up in hospital there is no cost out of pocket. Everything is being handled behind the scenes. All we have to do as citizens is practice safe distancing. It really takes a lot of stress out of the situation.
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Old 03-21-2020, 09:00 AM
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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.

https://www.theweek.co.uk/nhs/87658/...thcare-systems

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.
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Old 03-23-2020, 02:36 AM
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Originally Posted by filmstar-en View Post
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."
Based on the information given earlier in this thread, Reid is wrong, at least for his comparison of US Medicare to Canada. We don't pay for medical care except through our taxes, not on an amortized basis of 80%. There are no additional "Parts" that you buy yourself. All physicians take it. Those are significant differences.
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Old 03-23-2020, 06:50 AM
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Probably not. Even the US will have to go single-payer for Covid-related care. You can't afford to let a single case to fall through the cracks. Now is when you discover that, no matter how many you could blow off when there was no emergency and you had an expendable sub-class.

Imagine what it would already be like if all Covid-positive case were treated according to their ability to self-pay, and a quarter of them were walking around untreated.
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Old 03-23-2020, 08:01 AM
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Probably not. Even the US will have to go single-payer for Covid-related care. You can't afford to let a single case to fall through the cracks. Now is when you discover that, no matter how many you could blow off when there was no emergency and you had an expendable sub-class.

Imagine what it would already be like if all Covid-positive case were treated according to their ability to self-pay, and a quarter of them were walking around untreated.
The danger is that the divide comes about a bit differently. The walking infected don't need treatment. They need to be isolated, but they will get better. They are not much of a burden on the health system. It is the critically ill who are the serious problem. They need expensive (in all senses) care, and they compete for that care with one another and with people who are seriously ill for other reasons. Currently it seems there is little chance the US has enough capability to cope with the expected onslaught. Even best case scenarios are showing significant deficits in capability, and bad scenarios have the country with a 3:1 shortfall of capability running for many months. There is only one source of money to even try to cover this, and it isn't private health funds. Any notion that private cover and private hospitals will be in some way able to run on a different pair of rails to the public system is not going to work. The private sector will be overwhelmed, and it won't matter what level of private insurance you have, you will only get what the system can spare, no more. In the face a major blowout expect the private hospitals to be simply commandeered to the effort. Sorting out the money will have to come later. It will probably be years before it is sorted.

Here in Oz, it is pretty clear, despite having a dual public/private health system, the public sector will be carrying the brunt. Currently testing and care is almost all public sector. Access to GPs is pretty much assured to the entire populace, so first line care is on the public purse.
Private hospitals will be getting ready for the worst. For them that means they won't be filling beds with lucrative short stay surgical patients. Indeed, bar emergencies, theatres are probably going to silent as equipment is pressed into service keeping the critically ill alive. Private hospitals hate long stay patients. They hold down a bed that could be used for a surgical patient. They make their money on the theatres, not on the beds. The private health insurance business isn't in great shape over here. It is hard to make money. How this crisis affects the insurers will be interesting to see. If things go really bad I would expect some serious conversations with the government about how to avoid the insurers all exiting the market.
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Old 03-23-2020, 08:07 AM
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Originally Posted by ZipperJJ View Post
I've been listening to the Ohio governor's daily updates (really mostly for Dr. Amy Acton) and interspersed with tons of other info is some directives that are being given to health insurance companies. One about making sure covid-19 testing is covered, one about how telemedicine needs to be covered, and one about companies not having to pay premiums for a while but can keep their employees on insurance (even if the employees aren't able to work).

If we had single payer, this stuff would just automatically happen I assume. Maybe some tax relief regarding taxes paid towards health care.

Does it make a huge difference in America that we don't have single payer, or is it not holding us back too much?
Single payer isn't the only way to ensure access to the health system. What matters is that the government can regulate the private insurance and medical provider industry to require affordable admission to healthcare facilities, and there can be a degree of standardization in providing care across the system. It's universal access to care, and yes, that matters a LOT.

If people are thinking "Will my insurance cover this" they're going to stay at home until they literally can't breathe. Or worse, they'll try to 'gut it out' and go to work and spread their 'cold' to others, many of whom will be in the same predicament and asking similar questions a week later. It's a monumental failure of our system and our society that we don't have universal access to care in place, let alone the colossal failure to monitor the spread of a pandemic and prepare the health system for it well in advance.

But this is what you get when you tell people "Government sucks" and "Government cain't do nuthin' right." We made our bed. Time to sleep in it.
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Old 03-23-2020, 09:26 AM
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Taiwan had a horrible experience with SARS and consequently make a master plan to deal with epidemics.

Have UHC allows many things which wouldn’t be possible in America’s fragmented system.

All of a person’s medical records are accessible to the doctor making the examination. They also have tied immigration information with the health records and found that — no surprise here— people lie to their doctors concerning overseas trips.
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Old 03-23-2020, 11:15 AM
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Single payer and other medical systems have been discussed elsewhere at length.

I’m going to discuss issues specific to coronavirus: centralized decision making, ability to carry out testing, supplying hospitals with needed equipment and public health messaging.

More government involvement in the medical system means potentially greater influence in how things are done. Centralized decision making may help get things done more quickly - hospitals are compelled to follow directives, a strategy can be made and articulated, regional hospitals have some guidance.

Carrying out testing means having access to testing kits and necessary reageants and labs, guidelines for whom to test, testing centres away from hospitals to divert the “worried well” or mildly symptomatic and a strategy for improving things and collecting and analyzing the data.

Supplying hospitals means manufacturing or procuring needed equipment including masks, PPE, ventilators and having available staff and enough hospital isolation and critical care beds.

Public health messaging means having experts involved in creating a strategy, having a consistent message, educating the public, cultivating an atmosphere of trust, avoiding an excess of fear, reassurance with regard to economic issues (and although health is “more important”, health and economic issues hugely overlap) and changing the message and strategy as new information is available.

Different countries have done these jobs at different levels of efficacy. Health system is a major influence on all of these things, though obviously government, media, business and society play key roles.

To discuss Canada, since I lack detailed knowledge of other places...

We have a degree of central decision making with a lot of local independence. Canada is not autocratic and there were some delays in deciding what to do but once done things happened reasonably quickly. Regions in this case have followed government directives and local differences in messaging have been small.

Canada has opened up nearly 60 testing centres after some delay and only tests symptomatic people or those exposed. Retesting is minimal and tests are limited due to system capacity. Since only public labs were being used initially, testing capacity is less and prioritized to more serious cases. A public system and some distrust of private involvement can mean delays.

Procuring supplies is done regionally, and medical licenses are provincial. Both smaller and bigger centres are running low on some supplies. The system is designed to use beds efficiently during normal operation and has very limited surge capacity. This needs to change.

Because people like the system, they tend to trust health messaging and are not generally concerned about being bankrupted by enormous bills (unless by the cost of obscure drugs for rare conditions or auxiliary costs). 35 million Americans have a friend or family member who died since 2014 due to high costs of treatment. But if treatment in Canada is unlikely to help, it may not be offered at any price. More than 50% of Americans fear the high costs of treatment. (Stats from January 2020 Harper’s Index). The question of how Canada responds to complex and changing circumstances remains to be seen. I think they have done a good job reacting to the crisis and an excellent job of messaging. Business have been supportive and the media informative with some fearmongering incidental to constant attention to the issue. Backing off from measures is going to be tough, though, and the costs are both large and not fully known.
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Last edited by Dr_Paprika; 03-23-2020 at 11:18 AM.
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Old 03-24-2020, 04:51 AM
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Here's a couple of opinion pieces from that hotbed of socialism, the Guardian, about the ability a profit-driven US healthcare system will have to deal with COVID:

America's extreme neoliberal healthcare system is putting the country at risk

Quote:
But there’s more to it than that. We need single-payer not only to protect us from healthcare costs, but to transform our healthcare infrastructure. In recent weeks, you may have heard that the US, despite our high healthcare spending, has fewer hospital beds per capita than many other wealthy nations. You may have also heard in recent years about an epidemic of hospital closures in poorly served rural areas, or the 2019 closure of a major academic safety-net hospital in Philadelphia. These hospitals closed not because they are unneeded, but because they are unprofitable. For the American hospital landscape is shaped by market forces, which largely determine where hospitals grow and where they wane.

At the same time, while our hospital bed supply is relatively low, our ICU bed supply per capita is among the highest in the world. Yet those beds aren’t necessarily where they need to be: a 2010 study in the Journal of American Medical Association, for instance, found large regional disparities in the distribution of ICU beds; the researchers concluded that in the face of a major epidemic, some areas might have empty beds, while others would have too few. Again, this distribution, far too often, is driven by market logic – not health needs.
Responding to the hospital issue, I can point out that 25 years ago, our provincial government did a major re-org of hospitals. There were closures of some in small towns and rural areas, but that was balanced by creation of regional health centres. It's a big province and driving distances are an issue, but overall, the goal was to ensure that the health care dollars were spent wisely and provided relatively equal access to all in the rural areas. The government took a lot of political heat for the decisions, but those reforms seem to have worked. The government was able to do that because of the single-payer system, and government funding for hospitals. The decisions whether to close or downgrade a hospital to a health centre were based on an overall rational plan for providing health care across the province, not on whether a particular hospital in a small town was unprofitable but needed.

And then there's this piece, from an uninsured young person, also in the Guardian:

Millions of uninsured Americans like me are a coronavirus timebomb

Quote:
Like 27.5 million other Americans, I don’t have health insurance. It’s not for a lack of trying – I make too much to qualify for Medicaid, but not enough to buy a private health insurance plan on the Affordable Care Act exchanges. Since I can’t afford to see a doctor, my healthcare strategy as a 32-year-old uninsured American has been simply to sleep eight hours, eat vegetables, and get daily exercise. But now that there are confirmed coronavirus cases in the United States, the deadly virus could spread rapidly, thanks to others like me who have no feasible way to get the care we need if we start exhibiting symptoms.
...
This system is exactly why a 2018 West Health Institute/NORC at the University of Chicago national poll found that 44% of Americans declined to see a doctor due to cost, and why nearly a third of Americans polled said they didn’t get their prescriptions filled due to the high cost of their medicine. This is the same system that killed 38-year-old Texas public school teacher Heather Holland, who couldn’t afford the $116 co-pay for her flu medication and later died from flu complications. It’s the same system that Guardian contributor Luke O’Neil refers to as “Go viral or die trying”, in which Americans who can’t afford life-saving healthcare procedures are forced to become their own advocate and PR agency by launching a viral GoFundMe campaign to ask strangers on the internet to save their lives.

When you multiply my situation by 27.5 million, you end up with a country full of people who won’t see a doctor unless they’re extremely sick. And when you combine a for-profit healthcare system – in which only those wealthy enough to get care actually receive it – with a global pandemic, the only outcome will be unmitigated disaster. This could be somewhat remedied if the US had a single-payer, universal healthcare system, like every other industrialized nation. And as a team of Yale epidemiologists discovered in a study recently published in the Lancet, a single-payer healthcare system in the US could simultaneously save 68,000 lives and $450bn in taxpayer dollars each year.
There's no doubt that the Canadian health care system is under a severe strain right now. But the one thing we don't have is people who are going to work, even if they are feeling sick and potentially spreading COVID, because they can't afford to go to a doctor unless they're really sick. In the United States, where uninsured and underinsured people are afraid to go to the doctor unless they're really sick, they will have done their bit in spreading the disease, because of the financial cost to them of a doctor visit.
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Old 03-27-2020, 11:46 AM
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Originally Posted by ZipperJJ View Post
I've been listening to the Ohio governor's daily updates (really mostly for Dr. Amy Acton) and interspersed with tons of other info is some directives that are being given to health insurance companies. One about making sure covid-19 testing is covered, one about how telemedicine needs to be covered, and one about companies not having to pay premiums for a while but can keep their employees on insurance (even if the employees aren't able to work).

If we had single payer, this stuff would just automatically happen I assume. Maybe some tax relief regarding taxes paid towards health care.

Does it make a huge difference in America that we don't have single payer, or is it not holding us back too much?
Italy has Universal Healthcare and generally has a very good health care system*
Their current situation is the result of a failure to recognize the threat. Noone keeps enough hospital beds to handle something like this.

*In 2000, Italy's healthcare system was regarded, by World Health Organization's ranking, as the 2nd best in the world after France,[3] and according to the World Health Organization, Italy has the world's 6th highest life expectancy.[4] The life expectancy at birth in Italy was 82.3 years in 2012, which is over two years above the OECD average)
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