Even so, if you add free riders that does not reduce the pool of financial contributors. A single-payer with universal coverage, by definition, will have the largest possible pool to spread risk out.
~Max
What?
~Max
That’s how it works here for patients on, eg: original Medicare + supplement. Medicare advantage plans are basically, you pay some private insurance company $X per month and they cover the 20% Medicare leaves out, but they also act as a middleman between Medicare and the doctor and can issue certain rules like normal commercial insurance. They can’t deny anything Medicare will pay for outright but they get to negotiate rates and require referrals and authorizations.
~Max
I am in the process of liquidating one of my small side businesses to pay for an upcoming surgery for my wife. She doesn’t have the surgery, she dies within a few years. It might be more expensive to have everyone covered, but at some point isn’t not an economic question as much as a moral one in my opinion.
We don’t have insurance. We tried to get some the last time the marketplace was open, but it would have cost almost half of my salary per month to have us both insured. That is just the premium, not the copays and deductables and everything that goes with it. Total out of pocket and premium costs for the year would have been 27,520 before everything was covered. We chose to gamble this year and see what happened next year with the marketplace. We kinda got fucked on that one. I’ll take responsibility for that I guess. We should have chosen to lose our house to keep the insurance active I suppose.
My work is now in a mad scramble to get some sort of group policy to keep my wife alive for the next decade (she works where I do), and has spearheaded me to be in charge of it and work with the independent agent trying to get us some sort of group policy. Its even more expensive than the marketplace stuff was, and they don’t actually cover any services in the county where we live.
We have a work meeting on Monday to determine if it is going to be cheaper just to pay cash for the medical procedure and hope nothing goes wrong to drive up the costs. I think that is going to be what happens. My work doesn’t know if they will have the cash on hand to pay the costs for the medical center upfront like is required. The doctor was willing to make a payment plan with no less than 10% down, but the medical center where he operates is unwilling to do a payment plan for less than 50% down, and they are about seven times the cost of the doctor doing the procedure. Its a mess.
I am liquidating this business that was going to be taking off within the middle part of the year NOW for something that wouldn’t have been billed in most other first world (or second) countries. Its kinda insane.
I wonder if the costs of lost economic opportunities due to lack of insurance get figured into the costs of our healthcare system. I would happily pay another 5 -10% in taxes a year if I knew nobody had to go through with what we are going through.
If I can’t raise enough funds, the doctor never gets paid anyway because the surgery doesn’t happen. Nobody gets paid. I (for a little while longer) am a small business owner and I would always take “some money” over “no money.”
(bolding mine)
There’s just no excuse for this kind of story in a modern, affluent country. For me, the biggest single argument in favor of single-payer is that employer-funded health insurance is just completely batshit, with no economic rationale.
I work for a medium-sized company in a volatile industry. We have excellent coverage, and it’s not cheap, but it’s a hell of a lot less expensive than I’d pay on my own. I live in fear of a downturn putting me on COBRA, where the added costs might eat up the money for my kid’s college tuition. But why on earth should our health insurance premiums double or triple based on whether I’m employed by this company or not? We’re the same people, with the same risk factors. We don’t suddenly become twice as risky to insure.
And what if I wanted to strike out on my own? A new business is risky enough. Now I have to pay twice as much for health insurance? No thanks – guess I won’t be creating any new jobs to fuel the economy.
I get that workplaces are good “pools,” and that’s why employers get better rates. But “everyone” is an even better pool – not to mention that it leaves no one uncovered, and disincentivizes no one from starting their own business.
It is kind of natural for businesses to appreciate this kind of system. It seems like it helps them maintain loyalty and good behavior among their employees as the cost of changing jobs can be a major burden to many.
That is why I like to descrive the current health care system that we have in the USA as feudalistic.
Everytime I see conservative pundits blobiating about the “evils” of the health care in other civilized nations, they are just defenders of the last remanents of a servant system in America.
That’s not how health insurance works. All plans cover the same thing. The only difference in ACA-qualified plans is the financial arrangements you (and your employer) make with the insurer.
Now if you have a non-qualified ACA plan, you don’t have true insurance, you likely just have a discount card.
Yes, it is great service for a Canadian Hospital. My local news group just did a piece on the delays in Canada and included a man that waited 3 years for what would be a routine operation. He said he contemplated suicide because of the pain. But to be honest, his opinion of the Canadian health care system was still favorable. You’re a hardy bunch.
It reduces the financial contributors in relation to the insurance costs.
I once worked for a company that was excited over a billion dollar contract. We spent more on the committed product than what we took in.
I have a similar story. I drove myself to the ER not realizing that the chest pains I was experiencing was actually a minor heart attack. I was in a hospital bed and being stabilized in a very short time – can’t really remember, but probably ten or fifteen minutes. Then there were several days of tests and diagnostic imaging and the decision was between CABG (bypass grafting, classic open-heart surgery) and PCI (stenting).
One point here is that no one cared about costs or insurance coverage – it would all be covered in full. It was only a question of what was medically best, and my own feelings about it. I strongly opted for the much simpler, safer, and relatively non-intrusive stenting option. When my cardiologist came up to my room to say that the various surgeons had conferred and agreed that stenting was a feasible alternative, I asked about the timing. He said “they’ll take you downstairs in about an hour, and we’ll keep you overnight for observation; you’ll be home tomorrow”.
Whenever I hear stories about three-year waits for a “routine operation”, I always think there is some major part of the story missing, or some other form of misdirection/misrepresentation. Is this local news organization of yours by any chance Fox News or an affiliate thereof? 
So explain this chart. How does it imply increased per-capita costs?
Paying people for doing absolutely useless work that adds no value or is often counterproductive (denying necessary health care) is not the basis for any sustainable subset of any economy.
Hasn’t happened in Canada, where incidentally there is a fair amount of pharmaceutical research. What controls drug prices in Canada is not single-payer, but the Patented Medicine Prices Review Board which prevents price-gouging.
My mother lived into her late 90s and always had the best possible health care, including a whole range of at-home health services, fully paid for by the public health system.
Every industrialized nation on earth can implement UHC, but the US health care system isn’t “robust enough” in the richest country in the world?
Not a major minus, but something to watch out for. The Canada Health Act requires provinces to fully cover all medically necessary procedures normally carried out by doctors and hospitals. Sometimes novel procedures are actually developed here and quickly adopted. But yes, there is a risk that new procedures may not be adopted into the fee schedule quickly enough due to bureaucracy. OTOH, US insurers have often used the excuse of “experimental” to deny essential coverage.
Sit back and watch what happens re: COVID-19. See how effective single-payer systems are at treating and preventing the virus vs. the US system. Get back to us in, oh, October with your assessment of each.
there’s no misrepresentation. As I said, the person stated he still liked the “free” health care despite the 3 year wait. It’s pretty simple to explain the wait. Your heart attack bumped you to the head of the list in a system that can’t handle the patient load.
Your health care system is limited to what the government has to spend. Mine is not. I have no limit to the amount spent. It’s not rocket science. If I spend 3 times what you spend on health care then logic dictates I have more options available to me. If my GP can’t see me when I need care I just walk 100 feet down the hall and use Urgent Care. If I don’t like the specialist I literally bypass him/her and see someone else. I have literally never had to wait more than a few days to see who I want or get the diagnostic tools needed or the surgery.
I pay extra for that and am damn happy to have the option to do so.
I don’t know why you and many others place such an incredible premium on having little or no wait times for specialist visits or non-urgent elective procedures and think it’s worth the trade-off to have a system that is outrageously wasteful and expensive, described by many posters in these various threads including those who support private insurance as fundamentally broken, and inhumane because of the millions who have no access to health care at all. I don’t doubt your 3-year wait story, I’m just saying I’ve never heard or experienced anything even remotely like that and can only imagine it was something exceptional like a wait for a major organ transplant.
Just like hospital ERs triage patients, Ontario has a 4-level triage system for access to specialists and surgical procedures. Priority 1 always means immediate access. Lower priorities have increasing target wait times based on medical urgency, and in a quick perusal just now I see that lately Ontario has been doing way better than the targets for many wait times. A good example would be a friend of mine who decided to finally get knee replacement surgery. Elective non-urgent knee replacement currently has one of the longest wait times of any surgery. He decided to do it after a decade or more of mildly bothersome knee problems that were gradually getting worse, but was perfectly mobile and not in pain. I would guess he must have been classified into the lowest priority, and his wait time was about two months. He had no problem with that at all, and in fact would rather it had been longer because he really wasn’t looking forward to it. OTOH, had he fallen off a ladder and broken his knee the treatment would have been immediate. That’s how rational, well-optimized systems work.
I pay nothing for that and am damn happy to have guaranteed medical care for anything I might need, no matter how expensive, with absolutely zero cost at the point of service. My cardiac episode and 5-day hospital stay cost me not one dime. And doing some research afterwards, the stents I received were the latest, highest quality available. The catheter lab where the procedure was done was a marvel of robotic automation. It was a modern facility that was participating in some clinical field trials with the US NIH on new PCI methodologies.
…what about the millions of Americans who are unable to “pay extra”? What options do they have?
No one knew it was a (mild) heart attack. I didn’t come in on an ambulance stretcher, I drove myself to ER, told the triage nurse I was feeling fine but had been having annoying chest pains for days, she took my blood pressure and found it was high, and things went very fast from there. Triage, good judgment, and an abundance of caution. What else do you want from a medical system?
Well, one option they have is RAM (Remote Area Medical Services). RAM was originally formed to provide free medical care to underdeveloped countries lacking adequate medical services. They eventually found that the greatest need was right in the USA. Kudos to them, but the fact that they need to do this should be a national embarrassment.
Or, the poor could try to go to a hospital ER, get shuffled around for a few hours, and beg for care under EMTALA. I saw a documentary on that once filmed in an LA hospital and it was a horror show. What they get is the equivalent of having a major coolant leak in your car and wrapping some duct tape around it. The hospital’s only job here is to stabilize acute conditions. If the patient is still alive when they leave, the hospital’s job is done.
of course you do, how can post that with a straight face? you know that simply isn’t true.
but I, here in the UK, have exactly as many options as you do and I spend much. much less…plus, I have a complete safety net available to me when I no longer have supplemental private insurance and it remains even if I were unemployed and had never worked a day in my life.
Heck, even with no insurance if I wanted to jump an NHS queue I could walk in off the street to a private practice and pay around £9000 out of my pocket for a hip replacement. What would the equivalent procedure cost in the USA? are you sure you have more options than me?
Between $31,839 and $44,816, with an average cost of $39,299.
The site goes on to say “Patients with health insurance typically pay out-of-pocket expenses up to several thousand dollars, or their out-of-pocket maximum. For example, at Dartmought-Hitchcock Medical Center[3] , a Medicare patient could pay up to $3,957, including deductibles and coinsurance. And a patient with health insurance that has a typical 20 percent copay for surgeries and a $3,000 out-of-pocket maximum would pay the full $3,000 at DHMC.”
In Canada, as with the NHS, the cost would be zero, all hospital costs included. And wait times should not be an issue. If an elderly person fell and broke her hip, a potentially life-threatening situation, she would be Priority 1 and get immediate treatment.