# Healthcare Myths in America **URL:** \ **Category:** Great Debates\ **Created:** [November 27, 2018, 9:28pm UTC](https://boards.straightdope.com/t/healthcare-myths-in-america/825179 "2018-11-27T21:28:14Z")\ **Posts on this page:** 12\ **Page:** 8
**Author:** ![PhillyGuy](https://avatars.discourse-cdn.com/v4/letter/p/ed655f/32.png) [@PhillyGuy](https://boards.straightdope.com/u/PhillyGuy)\ **Post date:** [December 16, 2018, 1:27pm UTC](https://boards.straightdope.com/t/healthcare-myths-in-america/825179/141 "2018-12-16T13:27:00Z")
> [@Northern\_Piper](#): > > The Chaoulli decision of the Supreme Court said that the province could not prohibit private health insurance. However, 13 years on, the decision’s had little to no effect. There simply aren’t enough people who want to pay insurance premiums . . . According to page 4 of this three year old industry link, [24 million Canadians have supplementary health insurance.](https://www.clhia.ca/web/CLHIA_LP4W_LND_Webstation.nsf/resources/Factbook_2/$file/2016+CLHIA+Factbook+ENG.pdf) That’s two-thirds. I tried to find something from Statistics Canada as a tie-breaker between your post and the industry source I found googling, and didn’t. However, this [from Statistics Canada](https://www150.statcan.gc.ca/n1/en/pub/82-003-x/2014004/article/11924-eng.pdf?st=Dqhyspxf) shows, on page 16, that Canadians, nine years ago, were paying about the same for supplemental insurance as for dental and prescriptions combined. So I’m going to say that the industry source is plausible and Canada is multi-payer with signficicant disparities. Every country has health care disparaties between rich and poor. I’m for lowering them. I’m not for jumping to the conclusion that slapping the words “single payer” on a bill, and passing that, automatically does it. I think the US is rich enough that we can have good competing payers that will satisfy even affluent consumers. My experience with non-profit Blue Cross plans says this is possible. My family’s experience with US Medicare – where roughly half the seniors have supplemental insurance and roughly half don’t, is otherwise. ---
**Author:** ![survinga](https://avatars.discourse-cdn.com/v4/letter/s/cab0a1/32.png) [@survinga](https://boards.straightdope.com/u/survinga)\ **Post date:** [December 16, 2018, 1:54pm UTC](https://boards.straightdope.com/t/healthcare-myths-in-america/825179/142 "2018-12-16T13:54:14Z")
> [@Northern\_Piper](#): > > Sure, but neither of your cites support your assertion that multi-tier health care inevitably develops under single-payer. Here’s a good link that compares systems of all types all over the world. > **[\_\_\_media\_files\_publications\_fund\_report\_2017\_may\_mossialos\_intl\_profiles\_v5.pdf](https://www.commonwealthfund.org/sites/default/files/documents/___media_files_publications_fund_report_2017_may_mossialos_intl_profiles_v5.pdf)** > > 3.36 MB It’s very common to have private insurance as either a supplementary type, or to get you into a “higher-tier” facility, private room, quicker access to service and so forth. I’m not going to say that multi-tier develops inevitably under single-payer. But it is very common in single-payer systems for a portion of the population to also have some type of private insurance which either supplements on co-pays (Japan for example has a very large market for this, US medicare supp also) or for “better cadillac healthcare service” (In England, 11% have this). Some portion of the population will always want more than what the basic single-payer provides, and is willing to spend to do so. I think it’s very fair to say that single-payer systems often end up with companion or supplemental private systems around them. I tried to make this point, backed up with cites, on other threads, and I’m not sure why something that’s so obviously true creates angst among some. This is a good reference link, btw. The commonwealth fund has some good info. ---
**Author:** ![Northern\_Piper](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/northern_piper/32/5304_2.png) [@Northern\_Piper](https://boards.straightdope.com/u/Northern_Piper)\ **Post date:** [December 16, 2018, 3:50pm UTC](https://boards.straightdope.com/t/healthcare-myths-in-america/825179/143 "2018-12-16T15:50:22Z")
> [@PhillyGuy](#): > > According to page 4 of this three year old industry link, [24 million Canadians have supplementary health insurance.](https://www.clhia.ca/web/CLHIA_LP4W_LND_Webstation.nsf/resources/Factbook_2/$file/2016+CLHIA+Factbook+ENG.pdf) That’s two-thirds. I tried to find something from Statistics Canada as a tie-breaker between your post and the industry source I found googling, and didn’t. However, this [from Statistics Canada](https://www150.statcan.gc.ca/n1/en/pub/82-003-x/2014004/article/11924-eng.pdf?st=Dqhyspxf) shows, on page 16, that Canadians, nine years ago, were paying about the same for supplemental insurance as for dental and prescriptions combined. So I’m going to say that the industry source is plausible and Canada is multi-payer with signficicant disparities. Except that what is covered by supplemental health insurance is things that are not covered by the medicare system. So no concierge practices, no quicker access to treatment, which is what you seemed to be suggesting in your earlier posts. What is covered by medicare is single-payer, and supplemental health insurance doesn’t change that. ---
**Author:** ![survinga](https://avatars.discourse-cdn.com/v4/letter/s/cab0a1/32.png) [@survinga](https://boards.straightdope.com/u/survinga)\ **Post date:** [December 17, 2018, 12:04am UTC](https://boards.straightdope.com/t/healthcare-myths-in-america/825179/144 "2018-12-17T00:04:12Z")
> [@Voyager](#): > > Why don’t you stop talking about satisfaction with doctors and start talking about satisfaction with insurance companies. > For instance, [this article](https://healthpayerintelligence.com/news/commercial-health-plan-customer-satisfaction-remains-steady) does not give the satisfaction level, other than it being constant, but does say: > and > > which doesn’t sound so great to me. > > But [this article](http://time.com/money/4116325/health-insurance-obamacare-satisfaction/) gives more data - if a bit old. > > Worse than airlines? That’s pretty bad. > Satisfaction with Medicare is well above this. So why don’t you focus on the real issue, not the strawman issue? It’s not a strawman to talk about someone’s view of their own healthcare. But people are also fairly satisfied with their employer-provided coverage. This article, even though critical of the system, notes that a 2016 Kaiser poll found that 83% of employees either think their employer-sponsored health insurance is good or excellent. That’s 5 out of 6: > **[Medicare-for-all has one big riddle it needs to solve](https://www.vox.com/policy-and-politics/2018/12/14/18117917/medicare-for-all-explained-health-insurance-deductibles)** > > Company insurance is deeply entrenched and poses a big challenge to Medicare-for-all — but costs for those plans are on the rise. AHIP pegs the number at 71% (not 5 out of 6, but still not bad): [https://www.ahip.org/majority-of-americans-satisfied-with-their-employers-health-plan-new-survey-shows/](https://www.ahip.org/majority-of-americans-satisfied-with-their-employers-health-plan-new-survey-shows/) I think if you want single-payer, you’re going to have to deal with the real (not strawman) view that people have of their insurance that they already have, and of the healthcare that they have. I have employer-based, and I use it, and like it. Don’t take away my doctors and my coverage…that’s a common view, and shrug it off at your peril. ---
**Author:** ![wolfpup](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wolfpup/32/10618_2.png) [@wolfpup](https://boards.straightdope.com/u/wolfpup)\ **Post date:** [December 17, 2018, 12:30am UTC](https://boards.straightdope.com/t/healthcare-myths-in-america/825179/145 "2018-12-17T00:30:44Z")
> [@PhillyGuy](#): > > According to page 4 of this three year old industry link, [24 million Canadians have supplementary health insurance.](https://www.clhia.ca/web/CLHIA_LP4W_LND_Webstation.nsf/resources/Factbook_2/$file/2016+CLHIA+Factbook+ENG.pdf) That’s two-thirds. I tried to find something from Statistics Canada as a tie-breaker between your post and the industry source I found googling, and didn’t. However, this [from Statistics Canada](https://www150.statcan.gc.ca/n1/en/pub/82-003-x/2014004/article/11924-eng.pdf?st=Dqhyspxf) shows, on page 16, that Canadians, nine years ago, were paying about the same for supplemental insurance as for dental and prescriptions combined. So I’m going to say that the industry source is plausible and Canada is multi-payer with signficicant disparities. This is misleading. The main reason so many Canadians have supplementary insurance is that it’s pretty much a standard employee benefit, and the main reason it’s pretty much standard is that it’s a cheap benefit, which in turn is because it doesn’t pay for much except common prescription drugs and dental. When I took early retirement nearly two decades ago, the thought of getting my own supplemental insurance never even entered my mind. Since then I’ve had a few doctors’ visits, a few prescriptions, and never spent more than a few tenners on the drugs and nothing on the medical care. But then a few years ago I had a major cardiac event, with hospitalization, surgery and ongoing drug treatment. None of it cost a cent except for $100 deductible for the drugs every year. Why the hell would I pay for supplemental insurance? > [@PhillyGuy](#): > > I think the US is rich enough that we can have good competing payers that will satisfy even affluent consumers. My experience with non-profit Blue Cross plans says this is possible. My family’s experience with US Medicare – where roughly half the seniors have supplemental insurance and roughly half don’t, is otherwise. Medicare is so far removed from full-coverage unconditional and unlimited single-payer that there is no comparison. ---
**Author:** ![Quartz](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/quartz/32/267_2.png) [@Quartz](https://boards.straightdope.com/u/Quartz)\ **Post date:** [December 17, 2018, 12:38am UTC](https://boards.straightdope.com/t/healthcare-myths-in-america/825179/146 "2018-12-17T00:38:14Z")
> [@survinga](#): > > I think if you want single-payer, you’re going to have to deal with the real (not strawman) view that people have of their insurance that they already have, and of the healthcare that they have. I have employer-based, and I use it, and like it. Don’t take away my doctors and my coverage…that’s a common view, and shrug it off at your peril. Why do people persist with the view that it’s either one or the other? Here in the UK we have private health insurance on top of the NHS. ---
**Author:** ![Voyager](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/voyager/32/133_2.png) [@Voyager](https://boards.straightdope.com/u/Voyager)\ **Post date:** [December 17, 2018, 3:56am UTC](https://boards.straightdope.com/t/healthcare-myths-in-america/825179/147 "2018-12-17T03:56:04Z")
> [@survinga](#): > > It’s not a strawman to talk about someone’s view of their own healthcare. But people are also fairly satisfied with their employer-provided coverage. > > This article, even though critical of the system, notes that a 2016 Kaiser poll found that 83% of employees either think their employer-sponsored health insurance is good or excellent. That’s 5 out of 6: > > [Medicare-for-all explained: insurance deductibles for work plans rising - Vox](https://www.vox.com/policy-and-politics/2018/12/14/18117917/medicare-for-all-single-payer-pros-cons-work-health-insurance) > > AHIP pegs the number at 71% (not 5 out of 6, but still not bad): > > [https://www.ahip.org/majority-of-americans-satisfied-with-their-employers-health-plan-new-survey-shows/](https://www.ahip.org/majority-of-americans-satisfied-with-their-employers-health-plan-new-survey-shows/) > > I think if you want single-payer, you’re going to have to deal with the real (not strawman) view that people have of their insurance that they already have, and of the healthcare that they have. I have employer-based, and I use it, and like it. Don’t take away my doctors and my coverage…that’s a common view, and shrug it off at your peril. If everyone had good employer provided coverage as you have and as I have we wouldn’t be having this discussion. But\ only 55.7% of Americans who have health insurance have this (8% have no insurance) and 16% direct purchase, which is often expensive or inadequate. So we might expect that those with direct paid insurance or no insurance are not going to be quite as satisfied. Not sure about Medicaid, but Medicare gets higher ratings. I liked the insurance I already had. I like Medicare more. Satisfaction with one does not mean you won’t be satisfied with a new plan. And the plan won’t take away your doctors. If we are dumb enough to get insurance companies too involved, maybe. If a doctor wants to quit, maybe. But the Medicare network is bigger than any single insurance company network. And it would be even bigger if it is the only game in town. ---
**Author:** ![Northern\_Piper](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/northern_piper/32/5304_2.png) [@Northern\_Piper](https://boards.straightdope.com/u/Northern_Piper)\ **Post date:** [December 17, 2018, 4:30am UTC](https://boards.straightdope.com/t/healthcare-myths-in-america/825179/148 "2018-12-17T04:30:44Z")
> [@Quartz](#): > > Why do people persist with the view that it’s either one or the other? Here in the UK we have private health insurance on top of the NHS. I think it’s because the Canadian single-payer system does not allow for a private system in addition, for various reasons. The Canadian system is the one most Americans are familiar with. ---
**Author:** ![septimus](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/septimus/32/410_2.png) [@septimus](https://boards.straightdope.com/u/septimus)\ **Post date:** [December 17, 2018, 11:10am UTC](https://boards.straightdope.com/t/healthcare-myths-in-america/825179/149 "2018-12-17T11:10:13Z")
I think there was a typo in the following, which I’ve corrected in Red. > [@XT](#): > > , There is also a difference between Americans and a lot of other people in other nations, that being an almost innate distrust of big government wrt doing a good job at things. While I know this isn’t universal, it’s something I’ve seen a lot of examples of with friends from other countries and those in the US. And to a lot of people it would be a huge leap of faith that we could get such a system implemented, that it would cost less or even the same and that they, personally, would get as good or better healthcare than they currently get. Because, again, for the majority of Americans it is good enough and, again, what they know. So, instead of large systemic changes to bring us to single payer UHC type service, paid for by taxes instead of by deductions from your pay stub and payed for mainly by your employer, we get small changes that often actually muck things up worse. Part of the reason we pay so much for hospital stuff stems from this happening, and it’s **[del]not[/del] now** so entrenched that just changing that one thing would be a monumental undertaking. > > I am totally for a new system, and freely acknowledge that the one we have is broken. I believe pretty much everyone agrees on that second part anyway. But I think it’s not so simple as the OP or others on this board, pointing at what other countries do and saying we could just do that. I agree with this completely. It sums up the big problem. Getting from the present system to a single-payer UHC is hugely difficul. Obamacare was touted as a first step in the right directiont — towards a goal that can only be achieved incrementally. (Obamacare with a public option would have been better — it might have had 59 votes but was vetoed by the Senator from Insurancicut.) But the mandate was essential to ACA, and it was maliciously repealed by the very party that first explained its necessity. If the Democrats treated the country the way the Republicans do, they would destroy the health insurance companies as soon as the forces of sanity defeat the Dark Lords of Mordor. > [@DrDeth](#): > > Health care in America, for those that have it- is pretty darn good. Slavery was pretty darn good for those who owned the slaves. When will the U.S. grow up and understand that Democracy is not supposed to be a device for the 51% to exploit the 49%? > [@JcWoman](#): > > We should NEVER have an interruption in our medical care simply because we change jobs. [sarcasm] Job Creators would suffer if employees were not motivated by fear to stay despite better prospects. Without the threat of insurance cancellation, employers would have to divert shareholder profits to compensating employees. Why do you hate Job Creators? Why do you hate America? ---
**Author:** ![survinga](https://avatars.discourse-cdn.com/v4/letter/s/cab0a1/32.png) [@survinga](https://boards.straightdope.com/u/survinga)\ **Post date:** [December 21, 2018, 3:32am UTC](https://boards.straightdope.com/t/healthcare-myths-in-america/825179/150 "2018-12-21T03:32:03Z")
> [@septimus](#): > > I agree with this completely. It sums up the big problem. Getting from the present system to a single-payer UHC is hugely difficul. Obamacare was touted as a first step in the right directiont — towards a goal that can only be achieved incrementally. (Obamacare with a public option would have been better — it might have had 59 votes but was vetoed by the Senator from Insurancicut.) But the mandate was essential to ACA, and it was maliciously repealed by the very party that first explained its necessity. Amazingly, even with all the sabotage that Trump has tried on the ACA, the exchanges are still standing. All counties in America have at least one insurer willing to sell. And the numbers signing up are still respectable. > **[UPDATE: HC.gov vs. the State-Based Exchanges: The Definitive Comparison](https://acasignups.net/19/01/04/update-hcgov-vs-state-based-exchanges-definitive-comparison)** > > It's been pretty obvious for the past two years that the states which fully control their own ACA exchanges (including their own marketing and outreach budgets and their own exchange website platform) seem to be outperforming the states hosted by the... About 11.4 million expected to sign up. States that run their own exchanges are doing better at keeping their numbers up than states that are at the mercy of [healthcare.gov](http://healthcare.gov). It looks to me like even without a functioning mandate, there’s still an ability to keep the exchanges going and for companies to make money. I think we need a real mandate at some point. But glad the Trump sabotage isn’t working so far. ---
**Author:** ![DrDeth](https://avatars.discourse-cdn.com/v4/letter/d/b487fb/32.png) [@DrDeth](https://boards.straightdope.com/u/DrDeth)\ **Post date:** [December 21, 2018, 5:00am UTC](https://boards.straightdope.com/t/healthcare-myths-in-america/825179/151 "2018-12-21T05:00:09Z")
> [@septimus](#): > > I… > Slavery was pretty darn good for those who owned the slaves. When will the U.S. grow up and understand that Democracy is not supposed to be a device for the 51% to exploit the 49%?.. wow. :rolleyes::rolleyes::rolleyes::rolleyes::rolleyes::rolleyes: ---
**Author:** ![survinga](https://avatars.discourse-cdn.com/v4/letter/s/cab0a1/32.png) [@survinga](https://boards.straightdope.com/u/survinga)\ **Post date:** [January 5, 2019, 7:34pm UTC](https://boards.straightdope.com/t/healthcare-myths-in-america/825179/152 "2019-01-05T19:34:35Z")
> [@survinga](#): > > Amazingly, even with all the sabotage that Trump has tried on the ACA, the exchanges are still standing. All counties in America have at least one insurer willing to sell. And the numbers signing up are still respectable. > > [UPDATE: HC.gov vs. the State-Based Exchanges: The Definitive Comparison | ACA Signups](http://acasignups.net/18/12/20/hcgov-vs-state-based-exchanges-definitive-comparison) > > About 11.4 million expected to sign up. States that run their own exchanges are doing better at keeping their numbers up than states that are at the mercy of [healthcare.gov](http://healthcare.gov). It looks to me like even without a functioning mandate, there’s still an ability to keep the exchanges going and for companies to make money. I think we need a real mandate at some point. But glad the Trump sabotage isn’t working so far. > **[UPDATED: Where Things Stand: 11.3 million QHPs and counting](https://acasignups.net/19/01/08/updated-where-things-stand-113-million-qhps-and-counting)** > > OK, with the FINAL HC.gov Report having been released, I can now fill in even more blanks in the 2019 Open Enrollment Period: A grand total of 11.24 million 11.3 million QHP selections nationally so far. That includes 8.41 million on the federal... This has an interesting graph. States that run their own exchange in most cases are outpacing last year. This is in the face of the Trumpist attacks. [Previous page](https://boards.straightdope.com/t/healthcare-myths-in-america/825179.md?page=7)