Has any country with universal healthcare ever repealed it?

Factual Questions
101

I think it’s very wrong to jump to the conclusion that DR shortages in Canada would translate to Dr shortages of US were to go universal with their healthcare.

Look at a map. Canada is a huge country, and while populated somewhat evenly along our southern border, much more sparsely so to the northern reaches. Still our system strives to deliver equal access for all, no matter how far flung.

That alone presents challenges that the US simply would not face, on the same scale.

There are times when our system flies people, from distant locations, into places like Edmonton for treatment. Because it’s much more economical that trying to set up another cancer treatment centre in a place you’ll struggle to find Drs willing to live.

There are also times when it’s more economical to send a temporary overflow, of some service, across the border, than to buy more MRI machines etc.

All to say, some of what you hear opponents spouting, about people having to go to the US, or lack of Drs, or wait times, isn’t always as it seems.

It’s helpful to remember, those that are hugely profiting from healthcare in the US, are always drooling to find a way into the Canadian system. To get a foot in the door. Our system is always under this pressure. Those who would profit have deep pockets and contribute to political campaigns here as in the US.

Still, thus far Canadians have been loudly standing firm on such changes. They’d rather have the challenges I’ve mentioned, and a not perfect system, than ever see rich get access while the poor are treated as lesser.

Just my opinion, of course!

102

Actual studies indicate that the net flow is massively the other way. Even without counting People getting their prescriptions filled in Canada.

103

Grim Render, I just realized that I never thanked you for your response to my request for more information on this point in that other health-care thread:

Sure. But bear in mind that these are very rough figures.

Here is a Deloitte report from 2009 that estimated that numbers will hit 1,6 million in 2012, with further growth down the line.

While, on the more conservative side, Patients Beyond Borders estimated 1,4 million in 2016.

As far as I know, no-one checks why an American travels across the borders outbound or runs any kind of statistics on that. I believe the numbers have generally been obtained by surveying a number of foreign hospitals about their paying patients nationalities.

Hence, people who filch healthcare in Canada doesn’t get registered, nor people who obtain it through being resident and legally entitled. On the other hand, people do check why foreigners come into America, so the 80 000 number is on firmer ground.
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104

Piper is right. There is no coercion or conscription of doctors in the Canadian system(s). they just get a “take it or leave it” choice. Take the system and you are all in - bill all covered procedures at your province’s rate. You cannot moonlight and also do covered procedures for some patients outside the system at higher rates. Leave it, and you are free to look for patients completely outside the system and charge whatever you choose. You get no reimbursement for any procedures, nor do your patients for the money they paid you.

Hospitals are all non-profit, run by the system. Most provinces AFAIK do not allow the licensing of private hospitals. (This came back to bite the conservative types in the butt. they decided not to license private abortion clinics. Then the Supreme court said if it was limited to hospitals and available in limited circumstances and paid for then, it had to be covered and available to all.)

Since the option is there for an American or non-NHS system, the only reason it does not happen is vigilance. There are almost no patients who can afford or want to pay for their own procedures. If it’s a hospital procedure and the patient is rich, there’s always the USA or tourist medicine. No employer sees a need to offer an insurance parallel to Medicare, especially considering the expense. So it never gets off the ground.

From what I’ve read, there’s a limited market for doctors to be self employed as consultants in various categories, and for specialized markets like sports teams. Nothing stops a doctor from moonlighting and being in the system, provided the extra work she does is not a covered procedure. (I.e. cosmetic plastic surgeon - does facelifts and also does covered cosmetic surgery for burn and cancer victims…)

So it’s not so much conscription as Hobson’s choice.

105

Your last paragraph illustrates my point. In a free market system (without public or private bureaucrats) we don’t have situations where starving people are coming into restaurants or where people with hair dragging the floor are coming into barber shops.

However, in the heavily socialized medical system (both in Canada and the US) we have these things with regularity in the medical system, even in non-emergency situations.

The previous poster was not talking about emergency situations, but routine areas of care. In any event, even taking care of emergency situations can be a free market business model. It’s too complex in this thread to go into heavy detail, but there is no reason why a person with a sprained ankle should be standing in the same line (it’s “line,” not queue dammit! :slight_smile: ) as people having heart attacks. They are such different issues and they require different solutions (e.g. urgent care vs. emergency care).

In the event that the central planner has failed to have enough staff to care for heart attack patients and those with sprained ankles, of course the heart attack takes priority and nobody objects to that. However, the person with the sprained ankle should not be in a system where he waits hours upon hours for treatment. That is unacceptable.

I am not endorsing the U.S. system, however my argument is that we have already gone too far down the road of government control of health care such that we have all of the problems of a government solution, but none of the benefits of a free market system.

I disagree with the idea that health care is so much different from other areas of life that it needs to be in a special category. I need food, shelter, water, and air just as much and most of the time more immediately than healthcare. There are situations such as when the furnace goes out in the dead of winter, or the car breaks down on the highway where I am in a very poor bargaining position as a consumer. None of these require massive government solutions.

106

No it really is fundamentally different from those other items. The amount of healthcare you need is specific to you and is infinitely variable and you have no choice as to how much it varies. You need what you need to keep you alive and the cost can be run from zero to millions.
None of those other items do that. No-one is suddenly going to say to you…

“that studio apartment is no longer providing you with the shelter you need, you must immediately relocate to a sea-front mansion or you will die and by the way the rent has gone up from $400 a month to $4000…no we can’t negotiate”

107

Of course, not, the restaurant security keeps them out. They instead beg on the street for money to feed themselves, then find less discerning food sources that will admit their scruffy person… or go to the free food handout at the Salvation Army.

Because of socialized cash distribution, people who can manage basic money get fed by the government - welfare. Those who cannot manage - the homeless, often with mental problems - are fed by charities that collect money based on the government’s willingness to allow charitable donations to be tax deductible, and/or people who have no obligation but choose no to let people starve on the streets of a first-world city.

Not exactly an ideal illustration of the free market at work. Particularly when you consider the degree to which restaurant tables (and barber chairs) sit empty except during peak times.

(People with extreme scalp problems and no money would be minimally treated at the local ER for free and you and other insured people simply subsidize that loss - which is probably a form of socialized medicine, due to rules about admission and treatment imposed by the government).

I should add in centuries past, food was a scarce resource and people did encounter starvation, deprivation, and regularly had difficulty feeding themselves day-to-day. We first world 21st century people live in a fool’s paradise of excessive resources.

108

But in the free market system it’s ALL insurance hacks denying care. Even people with good coverage spend hrs and hrs fighting to get tests Drs want! The insurance hack has final say, not the Dr. That’s crazy, right there. That’s the free market at work!

109

Here is an answer to the question posed by the OP: Australia had universal healthcare, repealed it, then re-established it.

If Trump guts Obamacare, History may Repeat itself — the Australian Lesson - TPM – Talking Points Memo

110

You’re wrong because it’s a false equivalence. If your car breaks down on a lonely road at night, or if your furnace quits on a cold Saturday night, it’s quite likely that you’re going to get screwed by the wondrous invisible hand of the free market – that you will not only pay a justifiable premium for emergency assistance, but that someone may profit handsomely above and beyond what is justifiable. But here’s the difference. This is small potatoes involving relatively small amounts of money for rare events, and no sane person would consider any of those things to be major compelling social problems. No one has had their life ruined or had to declare personal bankruptcy due to a towing fee. Health care, however, is a universal necessity both on an ongoing basis for all of us and as a lifesaving emergency measure on occasion for many of us, and its costs are a significant proportion of any nation’s entire GDP. This means that it must be managed wisely, and as it turns out, the free market is the worst possible way to manage its funding, for many reasons.

Among those reasons are several counterintuitive considerations about bureaucracy. Tradition wisdom has it that the free market streamlines bureaucracy and the government is awash in it. That’s very often true, but it’s the opposite in full-fledged universal health care modeled along single-payer lines. The reason is that “insurance” as an enterprise is structured to charge premiums in accordance with risk, and then adjudicate each and every claim in accordance with policy provisions. This not only results in an enormous bureaucracy and enormous costs, it also results in insurance company bureaucrats coming between the doctor and his patient and dictating allowable and non-allowable medical procedures based on what they’re willing to pay, or denying payment entirely. This is a reprehensible invasion of the doctor-patient relationship that would be unacceptable to any doctor or patient anywhere in the civilized world, yet everyone without exception is subject to it in the US. And this onerous meddling is one of the major contributors to cost.

Whereas single-payer is essentially a payments processing system where this kind of bureaucracy almost completely vanishes. When I see my doctor here in Canada, there is zero paperwork and zero payment involved, and by the same token, there is zero interference in what treatment the doctor is “allowed” to recommend, regardless of what it costs. When I was in hospital a few weeks ago – the medical costs of which I don’t even want to know – at the end of it, I packed up my belongings and walked out. Bill? Insurance claims? Never heard of such a thing. And no insurance company told the doctors what to do. They did what their medical training told them to do, not a money-grubbing insurance enterprise.

And that’s just one example. Health care is so fundamentally different from the free market principles that govern the acquisition of merchandise that conservative ideologues are doomed from the start when they try to force-fit their consumerist ideologies to it, and they shouldn’t be surprised that no civilized country on earth relegates their citizens’ health care to the same economic equations that determine what kind of washing machine they can afford to buy.

Exactly.

111

Third party payment is a problem in and of itself. It robs the free market of one of the consumer’s most basic tools: price comparison.

There are certainly medical problems that should be insured against, but commonplace things like doctor visits and female contraception are not those things. The idea that “health care” is one single thing with a single solution is incorrect in my view.

It is as foolish to the nth degree, in my view, to insure against things like doctor visits, something we will all likely have, as it would be to insure against needing gasoline in your car, or trash bags for the kitchen. They are recurring expenses of life that should be paid as you go and budgeted for, not pooled against the likelihood (a certainty) of occurrence.

112

Yes. There is a severe disconnect between who pays and who uses the system, especially for people who actually have insurance, who oddly, tend to be the major users of the system.

the problem is - what is a trivial expense for some is an insurmountable obstacle to others. If it’s a matter of “do I get an automobile” it’s just a matter of “sorry”. If it’s a matter of “should I get my blood pressure / blood sugar / arthritis checked”, followed by “I need a prescription to treat that” then it’s not a simple commonplace option, something that can be skipped when money is tight.

(One of my co-workers has Type 1 Diabetes. he didn’t ask for it. He’s relatively healthy, runs a few miles a day. he still gets checkups regularly, every three or four months, from GP and specialist, because the problems he encounters could be crippling if not noticed - circulation, blindness, etc.)

How would you determine that someone should have or should not have paid for that doctor visit? This is the dilemma - when does a doctor visit become a normal, optional thing and when does it become a necessity? Who gets to decide that - doctor or government? How many pages or volumes to that rule?

(The Canadian rule is one checkup/physical every year. But if you go to the doctor and say “I feel dizzy at times” or “why do my feet itch so badly?” -which I did - it doesn’t count as an annual checkup which typically includes bloodwork and check for colon cancer markers after a certain age. )

As for birth control; keep in mind, that if birth control is not available, then women can always resort to the same method used in the Soviet bloc - multiple abortions. if that’s not available, there’s always illegal abortions. If someone would like to not become a “welfare queen”, avoid having more children than they want, you would deny them that option based on income level? Or, “Sorry you’ve gone $100,000 in student debt, but thanks to that broken condom, you’ll miss the finals and not graduate and spend the rest of your life at minimum wage with oppressive debt”? I would think the people you would want to help not reproduce are the same people who don’t want to reproduce just now.

The government can’t morally have it both ways, saying the government should not dictate funding for women’s reproductive behaviour but it should dictate women’s reproductive behaviour. Which can start a whole different hijack I don’t want to get into. Sorry.

113

No, it also ensures that there are enough, say, dentists. Because nobody wants to be a dentist, really. It’s consistently at the bottom of the totem pole of picks - which is understandable since it’s basically doing the same 3 or 4 things over and over again and spending one’s life with one’s nose right in somebody’s halitosis.

But because the system ensures that only so many people will get to be brain surgeons that year, we have enough dentists to go around.

Yeah. That said, I wouldn’t say that “being a good doctor” and “keeping a lot of crap crammed in one’s mind” are necessarily antithetical, at least for some specialties, and certainly for GPs who, while getting to see 95% run of the mill boring stuff also need to be good and alert enough to notice when they’re confronted with the other 5%.
Of course, bedside manners, patient psychology and so forth are outside the purview of Year 1…

I actually don’t remember being taught any anatomy in year 1 (but then, I only did half a year :o). We did a lot of biochemistry and cell mechanics however, from my hazy memories… and then we got to learn all 40 of the amino-acids plus every protein involved in the ATP cycle and their exact chemical structure by heart, OK :D.

But besides the cramming part there was also maths, chemistry, physics - the same kind of stuff you probably have to work on in first year bio or pharma.

I don’t think there is, especially considering the number of people with law or software engineering degrees who wind up working at Starbucks or managing retail shops. Indeed, you could argue that rather than letting anyone get a PhD in, say, cultural mediation or cinema, only open as many spots as there is an *actual *need for. More disillusioned hopefuls in first year, but is it less cruel than letting them work their ass off for 5 or 8, only for them to find out nobody wants them anywhere ? A girl I know is frighteningly smart & cultured, spent a good 10 years of her life working on Indian art history and fighting for her dream to curate a museum or at least set up expositions - but she’s a city hall clerk now, moving up from a job where she’d help old people with computers & internet. She tries to make the most of it and not be bitter, but she had a few rough years before finally letting go of her passion…

The trick is that in those fields you could theoretically move somewhere else in the EU (or, indeed, the world) to find a job - but medical degrees don’t travel all that well from what I understand.

114

Mainly because of protectionist barriers such as accepting the degree itself but requiring a new residency (those usually don’t get another diploma). There are also issues such as refusing to acknowledge the specialization (different names in different places), or trying to figure out what a specific type of nurse would translate to. Medical-sciences degrees now are supposed to travel well within the EU as one of the consequences of Bologna, but other first world locations aren’t part of that treaty.

115

how would price comparison work for healthcare? I broke radius and ulna playing football and sure enough next morning I was in agony. Should I have called around various hospitals at that point to compare quotes?

like what? and what mechanism do you suggest for that insurance? One that still leaves people with huge bills to pay?

Thing is though, in a system that insures against the major medical issues it is far better to have preventative measures in place which includes access to doctors appointments and contraception. Now there is an argument to be made that those who can should make a small out-of-pocket contribution for doctors appointments and prescriptions. In fact many UHC countries do just that, but it can’t be at a level that adversely affects access and it should be means-tested.

We do agree on that and if you look at the various UHC systems around the world you will find a variety of ways to organise it. The one central theme though is that it should be (basically) free at the point of use and based on medical need not ability to pay.

but all you are talking about here is some degree of payment for a routine doctors visit. That isn’t really a problem, as I say above plenty of UHC systems do exactly that. A doctor’s visit will be a known and repeatable expense that will not vary, any treatment that follows on from that visit is a different matter entirely and that is what should be fully covered by UHC.

116

Here’s a brief description of the change. It can be painted as a “repeal” only now that it’s so long ago that nobody remembers it:
reforming-australia-s-health-system-again

That part of the article assumes a limited knowledge of Australian Medicare funding:
Australia still has a separate line item in the income tax for Medicare Levy. It doesn’t cover the costs of Medicare and that was not the original intention: the “levy” was, and remains an accounting device to manipulate the economic statistics for political purposes.

117

Yes. Which is why I specified the source…

:slight_smile: Are there any such doctors?

118

I wasn’t as clear as I should have been. The word “conscription” only relates to the legal arguments that were used in Australia,

I think that the legal arguments prevented the implementation of a system like the Canadian one, as well as other options, but I only meant the “conscription” word to refer to the Aus history.

119

The published numbers I have read indicate better theatre utilisation in the USA than in Aus. I don’t know what numbers you’ve read, and I’m too lazy to do a literature review for you: if we disagree, that’s ok. Normally, in Aus, and notoriously in the NHS, surgical theatres are built and left empty, unused, for years. I understand that this is an “inefficient use of resources” that is discouraged by “Capitalism”.

Utilisation of radiology equipment is, I think, quite good in Aus. Most of / a lot of – the radiology in Australia is done with privately owned equipment, so the resource allocation is moderated by “Capitalism”.

I’m not trying to make an argument for the American health system. Doctors I know who have worked in the American health system have liked some aspects of it, and I think we need to acknowledge what people find attractive, while noting that the system as a whole is broken.

And yes, technical innovation is strong in the USA. Less so in state-run systems. I don’t agree that Medicine is a special snowflake in this regard: there is less technical innovation in state run systems.

120

Then, what if you don’t like or don’t trust this doctor? Or for that matter what if he finds you a troublesome patient and would rather not see you?
I’m pretty picky with doctors, and I think I’d have a problem with being assigned to a random one.