factual questions regarding universal health care

I’m looking for data and will accept anecdotes when that’s all that’s available. I really really don’t care about anyone’s politics, though. Go start a Great Debate if you want to talk about that.

Many sites might have these answers, but it’s extremely difficult for me to figure out who’s spinning what.

Now for some questions with, I hope, factual answers.

  1. What happens to malpractice within an universal care system? Are there limits on awards/damages/“suable” offenses? If there are limits, could the same limits be put into place in a non-universal system?

  2. Are prescription drugs, which are a major cost for even many insured people, covered under most universal plans, or is there a different system? Does it work?

  3. I have sinus problems. I called my doctor on Monday and he saw me on Tuesday. He sent me to have a CT scan on Thursday. Would timing like this be possible for most universal care systems?

  4. If I lived in a country with universal care, would I ever see the bills for that visit and CT scan?

  5. Right now in the US, many clinics and doctors’ offices have multiple people handling billing. There are many errors made, and a boatload of paperwork. Is this true of universal care systems in general?

  6. How many doctors leave countries with universal care to work in the US? If many, is it for the money? If few, is it because of malpractice or other litigation? If the US instituted a universal care system, would any doctors we had return to their original countries? Would any new doctors come here?

  7. Are there shortages of specialists or generalists or any ists in countries with universal care? Is the US shortage of GPs likely a symptom of a non-universal system?

  8. If the US institututed universal care, would business taxes (and other taxes) go up while business expenses went down? Is this true for other countries? Has there been an effect on the GNPs of countries that have switched?

Feel free to cherry pick any questions you’d like to answer. Thanks.

All answer are for the German public system, for practical purposes compulsory for most employed people.
I have a private health insurance which is not part of the system because my parents were not in the system, now I am a student and chose to keep a private insurance. So those answer don’t actually apply to me.

The patient pays 10% of the price, but not less than EUR 5 or more than EUR 10.

It is possible, but it is not easy unless it is an urgent case.

No. Actually this has been proposed to show the actual cost of treatments to people.

Yes, but if the insurance covers the expenses in general, that will happen in the background. During my alternative civilian service I worked in a hospital archive dealing with exactly those cases on a low level.

Off the top of my head, for The Netherlands.
There are two kinds of insurance: private and public (‘Ziekenfonds’).

If you earn less than approximately EUR 30.000 (roughly $ 30.000) you have public insurance, which means that you pay a fee that increases with your income, and the state covers the remainder of the insurance cost. The actual insurance is still covered by insurance companies, so even with public care you can choose which company you prefer. Howev, the content of the public care package is determined by the government, as are the rates paid to doctors (at least that’s how I understand it).

If you earn more than the limit, you have to get your own private insurance. This allows greater flexibility in what is covered and the level of care you receive (private room in hospital etc.).

  1. What happens to malpractice within an universal care system?
    Same as in U.S, I guess: the doctor gets sued, and in effect his insurance company pays. Awards are generally much lower than in the U.S., as only actual damage is awarded, no punitive damages. There is no cap on awards, at present people are not so sue-happy that insurance costs get too high for doctors.

  2. Are prescription drugs, which are a major cost for even many insured people, covered under most universal plans, or is there a different system? Does it work?
    The government and parliament set the kinds of treatments and drugs that are covered under public care; as far as I know all necessary stuff is covered.

  3. I have sinus problems. I called my doctor on Monday and he saw me on Tuesday. He sent me to have a CT scan on Thursday. Would timing like this be possible for most universal care systems?
    As far as I know, you can. There are waiting lists for specific kinds of treatments, but I am not aware of an overall problem for all treatments. Recently I visited the G.P. by calling in the morning for an appointment in the afternoon, no problem at all. As far as I know emergencies are always covered properly.

  4. If I lived in a country with universal care, would I ever see the bills for that visit and CT scan?
    If you are public insured you won’t see the bill, that’s handled by the insurer and the doctor. If you are privately insured you will for small amounts receive the bill: you can either pay it yourself and ask the insurer to reimburse you, or forward it to the insurer. I believe for large amounts they will also contact the insurer directly.

  5. Right now in the US, many clinics and doctors’ offices have multiple people handling billing. There are many errors made, and a boatload of paperwork. Is this true of universal care systems in general?
    Actually the growing ‘privatization’ of health care has increased the level of bureaucracy. In the past doctors would simply get paid directly by the public health care system, nowadays they have to enter negotiations with every single health insurance company which is a chore. Universal health care used to be simpler for the paperwork, but increased stress on accountability to the government has changed that, too.

  6. How many doctors leave countries with universal care to work in the US? If many, is it for the money? If few, is it because of malpractice or other litigation? If the US instituted a universal care system, would any doctors we had return to their original countries? Would any new doctors come here?
    As far as I know must Dutch doctors far prefer to stay in The Netherlands, but that may be a general tendency among the Dutch. Fear of malpractice might be a deterrent, but I wouldn’t be surprised if the main factor is the difficulty to get a work permit. An incentive would be the money. AFAIK Dutch doctors who do work abroad prefer Europe, as there is an open job market in the European Union, and Dutch doctors are considered highly qualified and may work well in meditteranean countries.

  7. Are there shortages of specialists or generalists or any ists in countries with universal care? Is the US shortage of GPs likely a symptom of a non-universal system?
    The current shortage of doctors in The Netherlands is mostly due to tight government restrictions on the number of medical students. Another factor is the increased number of part time doctors (parly due to women taking time off for motherhood, which is a good thing, but does influence the availability of health care). It is possible that the Dutch system encourages people to become doctor for ideological reasons, not for the money, which may help to get people for less-paying specialisms. But it could be completely different.

  8. If the US institututed universal care, would business taxes (and other taxes) go up while business expenses went down? Is this true for other countries? Has there been an effect on the GNPs of countries that have switched?

I don’t know when the present system entered into existence. However, as far as I see the difference of switching to a non-universal health care wouldn’t change much. The difference is mostly that poor people, who at present can access a doctor and are ultimately paid for by the ‘richer’ people’s contributions, can visit a doctor. The other people have to pay slightly more, I guess, but I wouldn’t know how much. Of course the effect is that consumers have less to spend, which therefore may affect the GNP. On the other hand, the money now goes to health care which is also a form of spending, no?

Generally speaking, as a Canadian

  1. What happens to malpractice within an universal care system? Are there limits on awards/damages/“suable” offenses? If there are limits, could the same limits be put into place in a non-universal system?

Here in Canada, all awards for damages tend to be much lower than in the US. I’m not sure if it’s because of caps, or because juries here tend to be a bit more realistic about things.

  1. Are prescription drugs, which are a major cost for even many insured people, covered under most universal plans, or is there a different system? Does it work?

In Alberta (where I am), drugs are not covered by Alberta Health Care (AHC) - I have to have a seperate plan for that which costs me about $20 per month and my employer $20 per month. There is a $25/year deductable and then 100% coverage. The elderly and those on social assistance don’t generally have to pay for perscriptions, but their selection is limited.

  1. I have sinus problems. I called my doctor on Monday and he saw me on Tuesday. He sent me to have a CT scan on Thursday. Would timing like this be possible for most universal care systems?

Well, you could certainly see your Dr. the next day - probably same day in many cases. The CT could take a bit longer, depending on which province you’re in.

  1. If I lived in a country with universal care, would I ever see the bills for that visit and CT scan?

Nope.

  1. Right now in the US, many clinics and doctors’ offices have multiple people handling billing. There are many errors made, and a boatload of paperwork. Is this true of universal care systems in general?

I have no idea, as I’ve never seen a bill from anyone. I know a while back there was a big push in Alberta to make things more efficient, which seems to have happened.

  1. How many doctors leave countries with universal care to work in the US? If many, is it for the money? If few, is it because of malpractice or other litigation? If the US instituted a universal care system, would any doctors we had return to their original countries? Would any new doctors come here?

I think quite a few do leave and almost always for the $$.

  1. Are there shortages of specialists or generalists or any ists in countries with universal care? Is the US shortage of GPs likely a symptom of a non-universal system?

It depends where you are. Currently in Alberta there’s a bit of a shortage of GPs - the govt has addressed this by allowing more non-Canadian physicians to enter residency programs to upgrade their training to Canadian standards.

  1. If the US institututed universal care, would business taxes (and other taxes) go up while business expenses went down? Is this true for other countries? Has there been an effect on the GNPs of countries that have switched?

I dunno.

The only thing I do know for sure, is that the horror stories I read about here because of the US health care system are pretty well non-existant in Canada.

Answers for the UK, to the best of my knowledge:

No there aren’t limits - but it’s rarer for mistakes to result in litigation, and awards tend to be lower than those found in the US.

For drugs prescribed by a general doctor, there’s a flat charge equal to about $10 for each prescription. Children, the elderly, the unemployed etc are exempt from this charge. Certain drugs are exempt. People with a long-term or permanent condition can be exempt. Drugs prescribed in hospital etc are all free.

Nobody knows whether it’s possible. It certainly doesn’t happen like that on the NHS, where one of the big problems constantly being ‘tackled’ :tolleyes: by politicians is waiting times.

The patient never sees any bills. There’s certainly too much paperwork and bureaucracy, as is typical of large government-funded systems which are being tweaked with every two minutes.

A significant number do go overseas, although much of our staffing shortage is a homegrown problem (Margaret Thatcher never permitted any increase in medical school numbers, despite an obvious impending crisis). A large (and increasing) number of our medical staff are recruited from overseas. As for why those who leave for the US do so, money is certainly a major factor. And often simply the desire to live there.

There’s shortages in just about every field, which I touched on earlier.

There are a lot of variations between countries with health care systems that aspire to be universal. The system can be financed via taxes or via a mandatory insurance scheme (with additional degrees of freedom as to calculation of premiums), services can be free at point of consumption or reimbursed, a large or small part of the system can be private-practice.

I’ll try to give some answers regarding the system that I am familiar with: the German one. Of course a lot of answers will be different for other countries with a comprehensive health care system.

  1. That’s less a question of the health care system as of the civil law system of the respective country. In Germany, as I think in most other countries, malpractice suits are common in clear and severe cases (e.g. dropping a baby or giving someone brain damage as a result of an anestesist’s fault) but awards are not so high as in the US. Some reasons: no punitive damages (only actual damages and a modest pain and suffering award), no contingency fees for lawyers, no jury trials. A lot of cases are resolved by mediation; I have read numbers on separate sites of 15,000 malpractice complaints/yr in all and 9,800 cases that mediation chambers of the medical associations tried to resolve. The principle is that wrong behaviour is meant to be less deterred by the thread of malpractice suits and instead to be prevented by quality-control regulation and the thread of criminal penalties, which can range from a fine to jail time or being barred from practicising medicine.

  2. Prescription drugs are covered. There is a small co-payment (if I rightly recollect it’s 10 % capped at 10 EUR at the moment). Doctors are required to prescribe the more economical drug (e.g. there are several proton pump inhibitor drugs (against too much stomach acid) that are of roughly the same medical efficacy; of these omeprazole is available as a generic so I get prescribed omeprazole.) The prescription habits of doctors get audited by an organization responsible to the health ministry.

  3. Difficult to say. when I want to see my doctor (i.e. general practicioner) I usually drop in without an appointment and wait about half an hour, maybe one hour in high influenza season, only occasionally longer when there is an emergency. When I needed an X-ray (non-emergency, just pain in the foot) he sent me to an X-ray practice where I waited another half an hour. Other specialists and other non-urgent diagnostics, usually same day to one week. For some reason orthopaedic surgeons have waiting periods for non-emergency cases (said pain in the foot, after the x-ray had determined that no bone was broken) of two weeks or so. In the cases where I or people in my family had something really painful or potentially life-threatening (pneumonia, high/low blood pressure, heart problems) it was an ambulance to a specialized hospital and immediate treatment.

Do I understand ‘sinus problems’ correctly as some kind of inflammation or congestion, i.e. not something potentially dangerous? IANAD but I don’t think my doctor would have sent me to have a CT scan righ away, more likely it would be ‘take this drug that relieves the symptons, don’t overexert yourself, live healthy for a week, if it’s still there in a week come back and we’ll see then.’

  1. Depends on the country. In Germany you are usually insured with one of the free-at-point-of-consumption schemes, i.e. you don’t see the bill - only any co-payment bills. If you are high-income you can opt out of that system and take private health insurance; these are usually reimbursement-based.

  2. Doctors in private practice in Germany bill the work they do for patients covered by the statutory insurance schemes through the Kassenärztliche Vereinigung, a statutory body of the medical profession that in turn deals with the various insurance schemes. Services are itemized, assigned point values, the Kassenärztliche Vereinigung converts points to euros (the points have somewhat different values depending on the insurance schemes) and pays into the practice’s account. For patients covered by private insurance doctors often use specialized factoring firms (run by physicians because of medical confidentiality), these firms get billng data, reimburse the doctor and deal with patients that cannot or won’t pay. So most individual billing is not done by medical practices. For hostpitals the accounting load is larger as they deal with the individual insurance schemes directly.

  3. I don’t hear much of German physicians leaving the country. There are sometimes accounts of physicians working in hospitals leaving to work in e.g. the Scandinavian countries because apparently in Germany junior doctors in hospitals are worked to exhaustion while in some other countries there are more humane work conditions.

  4. I don’t hear of shortages in the media, except for some very depressed rural areas of East Germany (i.e. areas where almost everyone under 40 has left for West Germany and nobody wants to move there). Generally there is an oversupply in a lot of regions; in some popular regions the mandatory insurance schemes do not accredit new practices (i.e. these practices can only take private-insurance patients). The thinking behind this is: if there are more doctors in practice they will need to diagnose more illnesses to make their living.

  5. The change to the present system was made in Germany more than a century ago and economic conditions obviously were a lot different. The present burden for employers is circa 7 % of gross pay for the mandatory insurance scheme that the employee has chosen (the employee pays the same percentage), plus the employer pays sick pay to the first six weeks of an illness (if the employee continues to be unfit for work after that the medical insurance scheme pays.)

[QUOTE=jsgoddess]
3. I have sinus problems. I called my doctor on Monday and he saw me on Tuesday. He sent me to have a CT scan on Thursday. Would timing like this be possible for most universal care systems?[\quote]

A few months ago, a study came through Reuters that indicated that people in the UK who were diagnosed with skin cancer waited on average 2-3 weeks for treatment, while in the US an equivalent patient could receive treatment in days. For skin cancer, speedy treatment is critical. Considering that the study was a self-audit of the healthcare ministry in the UK, I think it’s trustworthy. I have realtives in Canada who complain about the long waits for medical procedures as well, although I couldn’t tell you if it’s slowness in general or if it’s for more specialized procedures.

Most of that billing paperwork is due to insurance companies. A few doctor’s offices are switching to a no-insurance policy. They ultimately make less money, but they tend to feel the savings to personnel costs make it worth it.

In comparison to a universal healthcare system, I don’t know how much paperwork is required, I’ve never known a beauracracy to NOT love tons of paperwork.

That’s all I can comment on.

I cannot breathe through my nose at all when I lie down, and only sometimes when sitting up. It’s been going on for over 6 months. I think he feared I had a blockage.

IANAD, but I suspect that here, you’d get refered to an ENT department. And the first page of Google for ‘NHS ENT “waiting times”’ gives a variety from 2 to 14 weeks, depending on the NHS trust in question.

Canada - Ontario

  1. What happens to malpractice within an universal care system? Are there limits on awards/damages/“suable” offenses? If there are limits, could the same limits be put into place in a non-universal system

no clue.

  1. Are prescription drugs, which are a major cost for even many insured people, covered under most universal plans, or is there a different system? Does it work?

in hospital patients, seniors, disabled/social assistance have coverage - others need private insurance.

  1. I have sinus problems. I called my doctor on Monday and he saw me on Tuesday. He sent me to have a CT scan on Thursday. Would timing like this be possible for most universal care systems?

I could see my doc same day, CT only if necessary.

  1. If I lived in a country with universal care, would I ever see the bills for that visit and CT scan?

I’ve seen one - kind of a spot check OHIP does to make sure the docs aren’t making things up.

  1. Right now in the US, many clinics and doctors’ offices have multiple people handling billing. There are many errors made, and a boatload of paperwork. Is this true of universal care systems in general?

nope. errors can be made, of course, but most docs have one secretary.

  1. How many doctors leave countries with universal care to work in the US? If many, is it for the money? If few, is it because of malpractice or other litigation? If the US instituted a universal care system, would any doctors we had return to their original countries? Would any new doctors come here?

too many go to the US for the money.

  1. Are there shortages of specialists or generalists or any ists in countries with universal care? Is the US shortage of GPs likely a symptom of a non-universal system?

yeah, I think we’re short on ‘ists’.

  1. If the US institututed universal care, would business taxes (and other taxes) go up while business expenses went down? Is this true for other countries? Has there been an effect on the GNPs of countries that have switched?

no clue.

Oh, regards to the tax burden…it’s worth noting that as well as costing the treasury an immense amount of money, the NHS is also the biggest employer in the UK, employing 5% of the population. And worldwide, it’s beaten only by Indian railways and the Chinese army.

As already mentionned, the system varies widely from a country to another.

Concerning France (the public healthcare system is called “Social security”) :

There are damages limits. There use to be a limit for suable “offenses”. The medical practitionners used to be responsible only for “heavy faults”. Think really groos negligence. But the court reversed their jurisprudence during the last 20 years or so, first awarding damages for “simple faults” and then, in some case, even when there was no fault at all (the patient suffers adverses consequences, despite the hospital/doctor not being at fault).

However, it seems that the court are less generous than in the US. Fewer people sue, too. It’s more a cultural thing, though.

There are different levels fo reimbursment for drugs, from 95% (necessary and prescribed drugs) to something like 35% or so (drugs prescribed but deemed to have very few actual benefits, or even none at all, like homeopathy, or treating minor medical problems, like acnea). Non prescribed drugs (say aspirine bought over the counter) and drugs without medical benefit (for instance some cosmetic product prescribed by a dermatologist, or very old drugs that some people are still accustomed to use).

I wrote “95%” because there’s a small co-payment (I don’t know how much exactly because it’s covered in my case by a complementary insurance). But there’s a list of diseasefor which there’s no co-payment at all (for instance cancer, AIDS,…) and the drugs are fully reimbursed.

And I wrote “reimbursed” because in theory you pay the drugs upfront and are reimbursed latter by the Social Security. In practice, most people register their infos with the pharmacist, and pay only the part not covered by the Social Security (and their complementary insurance, if they have one). The pharmacist get reimbursed latter directly.

Having an appointment with a generalist on the same or following day, or a home call generally isn’t an issue (well…except on sunday in august, that is). It might take longer with specialists, though if you don’t care about seeing a random one, you can call several of them until you find one who can see you quickly. Actually, it depends on the doctors. Some are fully booked for months, some are desperate for patients.

As for the CT scan , I don’t know what is it, so I couldn’t answer. I don’t remember having had to wait for a significantly long time for a medical exam, though.

Once again, it would depends on the system implemented in your country. In France, I see all the bills. I would generally also pay upfront and be reimbursed latter (except if I had this “CT Scan” thing in an hospital or public medical center, in which case, they would deduce the reimbursed part. I still would see the whole bill, though).

If I were hospitalized, though, I wouldn’t see the actual cost. I would be biled a lump sum/day, regardless of the treatment I received ( just see a couple doctors and was handed some pills or had a heart transplant).

There’s only one kind of form (well…actually not exactly. There’s one form when I see a doctor, another one for the drugs from the pharmacist, and dentists have a different kind of form. They roughly look the same, though, and you fill them the same way). You get two copies of the form. One for the Social security and the other for your complementary insurance, if you have one.

Generalists and most specialists generally fill them themselves (it means he writes the name or code number of whatever he did, the amount he billed you and his signature. So, it takes him roughly 10 seconds). Some specialists, large cabinets with a number of doctors, etc… can have them filled by their secretary. However, now, they generally also have to access a database and type the infos directly “on-line”. This annoys them a little bit, but with this system, you’re reimbursed directly by the social security without having to send the form. So, on the overall, the paperwork is quite minimal.
Generally, there’s perhaps one secretary for two or three doctors.

I wouldn’t know.

I suspect it would depend on how much they would make in country A and B. Though many people won’t leave their country just because they can make more money somewhere else. It’s quite a drastic change, and in the case of doctors, often more complicated, since their diplomas aren’t necessarily recognized by the other country, so they might have to get additionnal training, pass exams, etc…

There’s currently a shortage of obstetricians (not attractive, many litigations and costly insurances) and psychiatrists (I wouldn’t know why, especialy since they’ve a particularily high income, on average, when compared to other doctors).
Some hospital also have to rely on immigrants, but it’s for the most part due to an issue not related at all with the health care system but to the “numerus clausus” the doctor’s unions lobbyed for for many years (limiting the number of students allowed to begin medical studies, hence reducing a potential concurrence) which is biting us in the ass now that the doctors which lobbyed for it are retiring.
There’s also a shortage of nurses, in this case mostly related to their pay, rather low when compared with their responsabilities, number of hours of work, etc…

It would depends on the system implemented, on again. But of course, you would have to pay some way or another.

In France, the healthcare system is funded by deductions made directly from your paycheck (and actually the healthcare system is ran by an equal number of elected representants of the employers and of the unions, not directly by the governement). Taxes pay only for a complement from the government for some people who otherwise wouldn’t be covered (had been unemployed for more than two years, illegal immigrants, etc…).

I don’t think there’s any example of a country having recently “switched”. In France, for instance, the system progressively evolved from “mutual insurances” created by unions and/or companies (which explain historically why it isn’t directly ran by the government) to an universal coverage.

I’m not sure what effect a “switch” could have on the GNP. To impact it, it would have to result in a significant increase or decrease of the medical services provided (the GNP being very roughly the total value of all products created and services provided for a cost in a country), for instance doctors becoming unemployed, without an equal decrease/increase of other services, for instance newly unemployed doctors emigrating rather than becoming, say, lawyers.

Sorry. I meant : "there ** aren’t ** damage limits.

Grrr…I forgot the end of the sentence. I intended to write that these aren’t reimbursed at all.

A few more answers, this time from Ireland.

1. What happens to malpractice within an universal care system? Are there limits on awards/damages/“suable” offenses? If there are limits, could the same limits be put into place in a non-universal system?
Doctors get sued for negligence, the same as in the US. Their insurers meet any liability. Negligence suits are on the increase, so insurance costs are rising; this is perceived as a problem. Awards of damages are generally much lower than in the US, but this is true across the board; it’s not specific to medical negligence. There is no cap.

2. Are prescription drugs, which are a major cost for even many insured people, covered under most universal plans, or is there a different system? Does it work?
Covered for the lower-paid only - about 40% of the population. Others would mostly have health insurance which would cover the cost of drugs, subject to an excess of a couple of hundred dollars a year per family. Drugs prescribed and supplied in a public hospital are free to all.

3. I have sinus problems. I called my doctor on Monday and he saw me on Tuesday. He sent me to have a CT scan on Thursday. Would timing like this be possible for most universal care systems?
Very unlikely to get that for sinus problems. You’d get a scan – free – within hours for something life-threatening, such as an aneurism, but a cost-benefit analysis would mean that an expensive diagnostic procedure such as a CT scan would be fairly low down on the list of priorities for treating a sinus problem. Other procedures and therapies would be tried first and, if you were eventually referred for a CT scan, there would be a waiting list which would certainly be longer than two days. (The same would be true for a fully-insured private patient, incidentally, so this may reflect a different philosophy, approach or attitude by doctors rather than the consequences of univeral provision.)

4. If I lived in a country with universal care, would I ever see the bills for that visit and CT scan?
No. Or you might pay a small fixed charge on the spot, with no further bill.

5. Right now in the US, many clinics and doctors’ offices have multiple people handling billing. There are many errors made, and a boatload of paperwork. Is this true of universal care systems in general?
Patients rarely see any bills. There are of course billing and accounting systems, and those in the industry complain about inefficiency and bureaucracy. I believe, however, (sorry, no cite) that the propoportion of medical expenditure and personnel devoted to billing is vastly smaller in must countries with publicly-provided healths systems than it is in the US, and one of the major criticisms of the US system is the high overheads of running it.

** How many doctors leave countries with universal care to work in the US? If many, is it for the money? If few, is it because of malpractice or other litigation? If the US instituted a universal care system, would any doctors we had return to their original countries? Would any new doctors come here?**
Most Irish doctors work abroad for part of their career – it’s considered necessary for fully rounded professional development – and many of these work in the US. Most return to Ireland, although some do not. The choice, I think, is made for the following reasons, in descending order of importance:

(a) Lifestyle:do you prefer life in the US, or in Ireland? Have you perhaps met and married a US spouse, and does he/she wish to remain in the US?

(b) Professional: do you prefer practising in the US, or in Ireland? Some doctors like the highly-resourced, cutting-edge US medical practice environment; others find it too corporate, too bureaucratic, or too profit-focused.

© Money. Doctors earn more in the US, though they’re not exactly poor in Ireland.

(d) Visa. I don’t know of any doctor who wished to remain in the US but couldn’t get a visa, but I suppose it must be an issue to some extent.

I’ve not hear that fear of malpractice suits is an issue at all.

Incidentally, all of the above could equally be said of Irish nurses.

7. Are there shortages of specialists or generalists or any ists in countries with universal care? Is the US shortage of GPs likely a symptom of a non-universal system?
There’s no shortage of GPs, but there are shortages of specialists in certain specialisms.

8. If the US institututed universal care, would business taxes (and other taxes) go up while business expenses went down? Is this true for other countries? Has there been an effect on the GNPs of countries that have switched?
Don’t know if there has been an effect of the kind you describe, but I would expect so. A universal medical system has to be paid for out of taxes. There’s no particular reason why it should be business taxes, but in the US, where business currently pays for much health care and would benefit from the introduction of wider public provision, the political pressure to pass at least some of the cost on to businesses rather than other taxpayers would be considerable.

The general perception (at least among advocates of public provision of healthcare) is that public provision is more efficient, and that the same health outcomes can be achieved at a lesser cost. This is, basically, because a universal health system is not a monopoly (a single supplier of healthcare) so much as a monopsony – a single purchaser of healthcare. And a monopsony typically uses its bargaining power to drive down prices from competing suppliers.

If this analysis is correct, even if the entire cost of a universal system were passed on to businesses, there would still be a net saving for business.

I somehow doubt if it’s as simple as that. In the first place, by introducing universal provision, the US would not be looking for the same health outcomes, but for improved outcomes, especially for the (fairly large) proportion of the population which is not currently insured. A decision might be taken to spend roughly the same proportion of national income on health, but to try to spend it to greater effect. And, secondly, switching to a universal system doesn’t necessarily mean that, for example, US doctors will accept the rates of pay that European doctors enjoy. Once you’ve got your cost base up to a certain point, it’s not that easy to get it down again.

I can comment on some of these from a Canadian perspective.

1. What happens to malpractice within an universal care system? Are there limits on awards/damages/“suable” offenses? If there are limits, could the same limits be put into place in a non-universal system?

Malpractice is a common law tort here, just as in the U.S. (civil delit in Quebec). However, since you don’t pay for health care costs, you’ve not suffered a monetary loss, and therefore don’t have a claim for health costs against the defendant doctor. This isn’t a difference in the law per se, but just an application of the law of damages to the particular facts.

You still would have a claim for other types of damages. For example, if the doctor’s malpractice left you with a physicial disability, you’d be compensated for that loss. If it’s so serious that you need special aids that aren’t covered by medicare (e.g. - 24 hour home care attendant) that too could be claimed against the doctor.

As well, there is a monetary cap in Canada on “loss of enjoyment of life” factors. That has nothing to do with universal health care, but is just an aspect of the law of damages in general; also applies to other personal injury torts. The cap on “loss of enjoyment of life” was set by the Supreme Court back in 1978 as a matter of common law; I think it’s currently a maximum of around CAN $250,00. Nothing stopping a state legislature in the US from imposing a similar cap, I would think.

2. Are prescription drugs, which are a major cost for even many insured people, covered under most universal plans, or is there a different system? Does it work?

Drugs prescribed for you during a stay in hospital are covered. There are also plans for seniors on low-incomes.

3. I have sinus problems. I called my doctor on Monday and he saw me on Tuesday. He sent me to have a CT scan on Thursday. Would timing like this be possible for most universal care systems?

I’ve never had to wait more than a day or two to get in to see my GP. If I want to see a doctor right away and don’t insist on seeing my GP, I can go to a walk-in clinic right away.

Dunno about CT time.

4. If I lived in a country with universal care, would I ever see the bills for that visit and CT scan?

Not in Canada. You’re not paying, so you don’t get the bill.

5. Right now in the US, many clinics and doctors’ offices have multiple people handling billing. There are many errors made, and a boatload of paperwork. Is this true of universal care systems in general?

Not in Canada. This is one of the key advantages of a “single payer” system - all bills go to the provincial health commission, which pays them at the rates negotiated with the doctors in that province. As well, the single payer plan means that everyone has the same coverage - you don’t have to figure out if a particular patient is covered under a particular plan. The adminstrative savings over HMOs, private insurers, etc. are considerable.