Well, Harvard is partially based in Cambridge Massachusetts, but it wasn’t founded in the reign of King John I of England
adaher, it is good to see you coming around on single-payer. Can you bring some of your Republican colleagues along? 
But …
… it is disingenuous to compare ACA_as_designed with ACA_with_the_GOP_doing_all_it_can_to_sabotage_it.
I’m only coming around to the extent that it might be better than ACA. I think fixing ACA is probably a better move. Plus my single payer would look a lot more conservative than your single payer in all likelihood. It would cover catastrophic costs and some preventive care, but not routine care. People could buy supplemental for that, and supplemental would be offered free to the poor.
Routine care can help to prevent catastrophic.
Routine care can also help to mend someone so that they can return to being a productive member of society, rather than battling a treatable ailment.
I would cover everything, but have upcharges for perks. Private rooms, shorter wait times, even higher quality medical staff. Anyone who graduates medical school is qualified to be a doctor, but there are those who are better, and you can pay a premium to see one of these Magna Cum Laude Doctors, rather than a lower ranked class member.
Moving more of doctor’s duties to nurse practitioners and online services (we just got telemed here, I haven’t tried it myself yet, but it is cheaper and easier than going to a doctor for routine sickness or injury. They are limited in what they can prescribe, and obviously very limited in what they can treat, but it should work for quite a number of doctor visits) would save quite a bit.
Computer aided diagnostics means that the doctor no longer needs to remember thousands of different possible ailments to diagnose you. Instead, you give your history and symptoms to the computer, maybe with a nurse or NP, and then a doctor can interpret the results, rather than having to remember or look up a bunch of obscure conditions.
Robotic surgery is making the surgery easier, faster, and with less recovery time, meaning that the same surgery should cost much less overall, including hospital stay. Making the equipment and the technical skills to use it more readily available would drive down costs there as well.
Every time you see an ad for a drug, those are your dollars at work. Get them to stop spending money pushing their drugs on the public and on doctors, and you both save that money, and you save people wanting to be overtreated because they saw an ad on TV that told them they had restless legs, and doctors not over treating because they get a benefit out of prescribing certain medications.
Turning around and making college more affordable also puts doctors in a position where they don’t need to charge as much, and cannot justify charging as much for their services.
Medical malpractice could be looked at, but is an insignificant cost saver.
Do all that, maybe even open up some gov’t run hospitals that do not have a profit motive to service ares that are not profitable to service (rural areas, mostly), and you are well on your way to a single payer system where the wealthy still get to spend their dollars for a better experience, and maybe even slightly better outcomes, but that all receive adequate levels to keep them as productive members of our society.
ETA:This is certainly not a comprehensive list of all things to be adjusted in our healthcare system, but it’s a start.
I don’t agree, but as with a lot of complex issues, the devil is in the details, so basically the answer is: it depends.
I would presume that the ruling you’re referring to is Chaoulli v Quebec. It wasn’t a human rights court ruling, it was in fact a ruling of the Supreme Court of Canada, and it was a complicated multi-part ruling that did, in fact, touch on the issue of human rights. However the basic human right in question that was deemed to be guaranteed by the Constitution was the right to health care, a view that appears to be anathema to American conservatives, so you probably don’t want to go around touting the Chaoulli ruling too much! 
Based on this reasoning, the court ruled that universal access to health care wasn’t health care if wait time was excessive, and that in those circumstances a prohibition on private insurance was unreasonable. It was a more limited ruling than some have made it out to be, and it arose out of a situation in Quebec and its applicability was limited to Quebec. Frankly some aspects of health care in Quebec have been characterized by major suckage, due to budgetary constraints and various political factors, and don’t reflect the state of affairs in the rest of Canada.
The reason I disagree with your prognosis for the future is that this ruling was 12 years ago and since then the federal and provincial governments and the public have unconditionally rejected the prospect of two-tier health care, and have instead fully embraced the principles enshrined in the Canada Health Act and in the 2002 Romanow Report (formally: Royal Commission on the Future of Health Care in Canada) which is a wholehearted endorsement of one-tier single-payer public health care for all. The improvements the report recommended were organizational improvements, funding reallocations, and increased funding in some areas, among others. Since then, steady improvements have been made including reductions in wait times and other service improvements.
The major risk with a two-tier system in Canada comes precisely from the fact that the US health care system is so intensely commercialized and profit-oriented, and Canada is so close and so closely aligned culturally and economically. When single-payer was first proposed in Saskatchewan many decades ago, it was incredible the extent to which American insurers and the AMA tried to kill it. To this day they still see Canada as a vast market for private health insurance and for an associated private health care sector that would swallow up the best doctors and top hospital resources and leave the public system a poor second cousin with second-rate resources. Some conservatives may be OK with this, but those are fundamentally not Canadian values. If a two-tier system ever evolves, it will likely be like the one in Germany, where the private tier offers luxuries and conveniences but not a higher quality of health care. Until and unless this can be guaranteed, Canada is not going commercialize and monetize the basic human right to quality health care.
All other UHC nations allow private payment for health care.
All other UHC nations don’t share a 3000-mile open border with the USA across which profit-seeking American health care megacorporations are already oozing, both in the health insurance space and in the health care provider space, frequently on or beyond the borderline of legality. If private health insurance and a private provider tier were actually legalized, they wouldn’t be oozing across the border, it would be something more like this.
I’ve just been doing a little Googling and right now the US government is paying for about 125 million people’s health insurance. There are about 9 million in the VA system, 44 million covered by Medicare. There is around 2.8 million federal employees and the largest group is 70 million Medicaid patients. So, the government is already paying for over one third of the country’s healthcare.
There are prob. more people covered because of the 2.8 million employees having families. I didn’t even count the actual military. There has to be a way to affordably cover the other two thirds of the country without breaking the bank.
Canada already has two tiers. Citizens can easily cross the border if they wish to pay for care.
So, if folks are going to Mexico for facelifts, and they are, It’s now a three tier system?
That’s a pretty silly take on it, I think. That’s not another tier in Canadian health care, that’s foreign healthcare for purchase, like buying a kidney in India. Available to the whole world. Doesn’t make every system a two tier system. Sheesh.
Citizens of almost any country can go to almost any other for health care if they wish to pay for it. If that were a meaningful or useful observation it would render your previous comment in #146 moot. This is not, however, what we mean by a “health care system”, or by “two tiers”. For the reasons I outlined, the risks of a two-tier system in Canada are very real.
What risks? That Canadian health care might be as horrid as France’s?
GEEZ ! You damn well what ?
The French system is generally acknowledged as the best in the world.
**World Health Organization’s Ranking of the World’s Health Systems **
2000 AD
Top Ten:
1 France
2 Italy
3 San Marino
4 Andorra
5 Malta
6 Singapore
7 Spain
8 Oman
9 Austria
10 Japan
Canada is no. 30 and the USA no. 37.
Canadian Healthcare Information
Did you ever for one minute think America was in the top ten ?
One change that I would like to see, that would decrease costs and improve outcomes: All research into lifesaving treatments is 100% funded by the federal government, out of taxpayer dollars. If a treatment works, the patent is owned by the Feds. The patents are licensed for a low price to American pharmaceutical companies, and to a higher price to companies in other countries (with “American” being defined in terms of where the company’s money actually goes). Pharmaceutical companies can compete with each other on who can make the patented medicines most cost-effectively, and they can do whatever they’d like on researching elective treatments like Viagra.
Presto, now you can buy drugs without having to subsidize all of the money the drug company spent on R&D for it and for all of the other drugs that didn’t pass testing. And we’d see drugs being developed which are sorely needed but aren’t currently researched because they’re not profitable, like new antibiotics.
Sarcasm. Canada’s outlawing of private care for services provided by Medicare is unique to Canada among democracies with UHC. Cultural jingoism is not limited to the US. Their peculiar law isn’t really based on anything empirical, it’s just a value that they alone adhere to.
I was just saying sarcastically that if Canada allowed private care that they’d be like France. Which I’m sure horrifies them.
I explained the reasons for prohibiting private insurance for medically necessary procedures in #145 and then again in #147. And those aren’t the only reasons, just some of the most dramatic ones. There’s also a great deal of misunderstanding about the “two-tier” European systems. They are all different, and none of them looks anything like what some imagine: they are not simply single-payer with American-style freewheeling private insurance bolted on. What is actually “peculiar” and not even remotely empirical is the American health care system which has been shaped by nothing but self-interested mercenary opportunism by both insurers and providers. It’s a system that eschews regulation and the enactment of public policies in the service of the patient and instead embraces the free market in the service of commerce. It’s a system that would be unrecognizable in any civilized country on earth.
Well, Canada’s system of outlawing private payment for care is not TOTALLY unknown in the world. North Korea also has that policy, for a total of two countries that ban private payment for care.
Returning late to the discussion on new technologies and specifically Proton Beam Therapy, the NHS considers this the kind of “highly specialised service” that’s dealt with through central rather than local budgets, and limited to specialised centres. We have only one, at an eye centre, but are building two for more general use. Until they come into service, the NHS has been paying for eligible patients to get the treatment abroad:
http://www.england.nhs.uk/commissioning/spec-services/highly-spec-services/pbt/
Clearly, as with so many new treatments, there has been debate about who it works for, and who not, as well as the cost.
http://www.derbytelegraph.co.uk/news/derby-news/derby-dad-calling-nhs-invest-320508.amp
There is a lot of anxiety in the UK that the proposed dispute resolution system in the Transatlantic Trade Agreement under discussion might be used in exactly that way to undermine the NHS through its internal market mechanism. That’s all gone quiet in the Brexit furore, but there are some free-market nutters among the Tory Brexiteers who would be only too happy to see that happen when we have to negotiate our own trade agreements outwith the EU.