# How will healthcare change when, not if, we switch to a European style single payer system? **URL:** \ **Category:** Great Debates\ **Created:** [January 22, 2019, 3:00pm UTC](https://boards.straightdope.com/t/how-will-healthcare-change-when-not-if-we-switch-to-a-european-style-single-payer-system/828196 "2019-01-22T15:00:30Z")\ **Posts on this page:** 20\ **Page:** 7
**Author:** ![Red\_Wiggler](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/red_wiggler/32/13190_2.png) [@Red\_Wiggler](https://boards.straightdope.com/u/Red_Wiggler)\ **Post date:** [January 27, 2019, 5:34pm UTC](https://boards.straightdope.com/t/how-will-healthcare-change-when-not-if-we-switch-to-a-european-style-single-payer-system/828196/121 "2019-01-27T17:34:42Z")
Wait, we can’t have single payer because our costs have increased more than everyone else’s have? Is there any possible explanation for why our costs have gone up so much more than countries with different systems and is there any action we might take to correct that? ---
**Author:** ![MemoryLeak](https://avatars.discourse-cdn.com/v4/letter/m/6f9a4e/32.png) [@MemoryLeak](https://boards.straightdope.com/u/MemoryLeak)\ **Post date:** [January 27, 2019, 7:21pm UTC](https://boards.straightdope.com/t/how-will-healthcare-change-when-not-if-we-switch-to-a-european-style-single-payer-system/828196/122 "2019-01-27T19:21:28Z")
> [@Jas09](#): > > You really need to explain the discrepancy between your last two sentences and the first ones. > > You basically said (if I’m understanding you correctly) that UHC systems have cost growth of x% and US growth is x+y%. Then you state that if we change our system to match UHC systems our growth rate won’t revert to x%. Why not? What is so special about the US that we have to, perpetually, have a higher-than-average growth in health care spending (both private and public). This makes no sense to me at all. > > You can argue, if you’d like, that we won’t get true “reduction” in spending (i.e. x won’t go negative). But surely you would agree that x% growth is better than x+y%, right? Especially when all of the data indicates that the cheaper options have as good or better results? > > I guess the only possible explanation is that the US government is just so terrible at doing it’s job that it will inevitably do it worse than every other government on the planet. I suppose the evidence of the last month tends to back that up, but man that’s quite a pessimistic view of American Exceptionalism. MAGA, indeed. Correct, the US will never get to the point where it spends about the same portion of GDP as other developed countries. Also correct, the US government (i.e., the American people) will not be able to make the choices needed to reduce y to zero. As with Medicare, the Congress will continuously declare the looming crisis fixed with heroic legislation that addressed waste, fraud, and abuse. And, of course, all those savings will be in year 10 of the 10 year forecast. ---
**Author:** ![Wesley\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wesley_clark/32/20581_2.png) [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)\ **Post date:** [January 27, 2019, 9:12pm UTC](https://boards.straightdope.com/t/how-will-healthcare-change-when-not-if-we-switch-to-a-european-style-single-payer-system/828196/123 "2019-01-27T21:12:26Z")
> [@Batano](#): > > By “every other government program” I guess you didn’t include Medicare. > > This is a country that developed the atomic bomb and put a man on the moon, but for some reason we are too stupid to accomplish what every other industrialized country has done. Lots of it is race and plutocracy. Its not that we are stupid, its that rich people don’t want health reform and because America is heavily divided by race and class. Any attempt at UHC is pushed as something that’ll benefit blacks, the poor and latino immigrants and it’ll result in higher taxes on ‘hard working’ white people. What sucks is that even deep blue states can’t get medicare for all. Vermont tried it and abandoned it because of the tax hikes (which again, seeing how [71%](http://newsroom.ucla.edu/releases/public-money-accounts-for-more-than-70-percent-of-health-care-spending-in-california) of all medical expenses are already paid by the public sector, I’m not sure why it’d cost that much more for medicare for all). In California the democrats love to talk about medicare for all, but its only ever talk. Gavin Newsom ran on it, but its probably just empty rhetoric on his part. ---
**Author:** ![survinga](https://avatars.discourse-cdn.com/v4/letter/s/cab0a1/32.png) [@survinga](https://boards.straightdope.com/u/survinga)\ **Post date:** [January 27, 2019, 11:27pm UTC](https://boards.straightdope.com/t/how-will-healthcare-change-when-not-if-we-switch-to-a-european-style-single-payer-system/828196/124 "2019-01-27T23:27:15Z")
> [@Wesley\_Clark](#): > > Lots of it is race and plutocracy. Its not that we are stupid, its that rich people don’t want health reform and because America is heavily divided by race and class. Any attempt at UHC is pushed as something that’ll benefit blacks, the poor and latino immigrants and it’ll result in higher taxes on ‘hard working’ white people. > > What sucks is that even deep blue states can’t get medicare for all. Vermont tried it and abandoned it because of the tax hikes (which again, seeing how [71%](http://newsroom.ucla.edu/releases/public-money-accounts-for-more-than-70-percent-of-health-care-spending-in-california) of all medical expenses are already paid by the public sector, I’m not sure why it’d cost that much more for medicare for all). > > In California the democrats love to talk about medicare for all, but its only ever talk. Gavin Newsom ran on it, but its probably just empty rhetoric on his part. I think California, if it wanted to try something, is in a good place to try it. It has Democrat super-majorities. It’s around 40 million people or so. I think Vermont’s decision is indicative of the difficulty of healthcare politics. When even a deep-blue state like Vermont can’t get on board with single-payer, it gives pause about doing something nation-wide. ---
**Author:** ![Jonathan\_Chance](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/jonathan_chance/32/701_2.png) [@Jonathan\_Chance](https://boards.straightdope.com/u/Jonathan_Chance)\ **Post date:** [January 28, 2019, 1:24am UTC](https://boards.straightdope.com/t/how-will-healthcare-change-when-not-if-we-switch-to-a-european-style-single-payer-system/828196/125 "2019-01-28T01:24:53Z")
> [@Bryan\_Ekers](#): > > Surely it is a purview of friendship to tell you when you’re being stupid. Brian- Please don’t, even sideways, call other posters stupid in Great Debates. D’Anconia- Do not, ever, tell another poster what they can or can’t post. A foreign national is entirely within his or her rights to comment on American policy on the SDMB. No warnings issued, but I hope that’s clear to both of you. ---
**Author:** ![yo\_han\_go](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/yo_han_go/32/130_2.png) [@yo\_han\_go](https://boards.straightdope.com/u/yo_han_go)\ **Post date:** [January 28, 2019, 2:46am UTC](https://boards.straightdope.com/t/how-will-healthcare-change-when-not-if-we-switch-to-a-european-style-single-payer-system/828196/126 "2019-01-28T02:46:24Z")
Half of the world uses indoor lavatories, half uses outhouses (or just outsomething). We can all see first one is “the thing” but other half still thinks that indoor toilets will stink da haus. And Murrica has whole ranch to sheet around anyway. Obviously. ---
**Author:** ![Bryan\_Ekers](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bryan_ekers/32/183_2.png) [@Bryan\_Ekers](https://boards.straightdope.com/u/Bryan_Ekers)\ **Post date:** [January 28, 2019, 3:02am UTC](https://boards.straightdope.com/t/how-will-healthcare-change-when-not-if-we-switch-to-a-european-style-single-payer-system/828196/127 "2019-01-28T03:02:58Z")
> [@Jonathan\_Chance](#): > > Brian- > > Please don’t, even sideways, call other posters stupid in Great Debates. Honestly, it didn’t even occur to me that the comment would be interpreted as directed against D’Anconia. I’m on record calling American policies stupid on several occasions, and I view the nation as a whole as an ally/friend of my own, despite a number of oddities in its politics, beliefs and national myths, which I will not hesitate to call out. ---
**Author:** ![Wesley\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wesley_clark/32/20581_2.png) [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)\ **Post date:** [January 28, 2019, 4:15am UTC](https://boards.straightdope.com/t/how-will-healthcare-change-when-not-if-we-switch-to-a-european-style-single-payer-system/828196/128 "2019-01-28T04:15:17Z")
> [@yo\_han\_go](#): > > Half of the world uses indoor lavatories, half uses outhouses (or just outsomething). We can all see first one is “the thing” but other half still thinks that indoor toilets will stink da haus. And Murrica has whole ranch to sheet around anyway. Obviously. I don’t know. I think a very large, and growing, % of Americans know we need radical health reform. But we won’t get it for various reasons the same way the vast majority of the public want electoral reform, and want gun control. But what hte public wants and what politicians do are not overlapping in America in a lot of ways. ---
**Author:** ![Urbanredneck](https://avatars.discourse-cdn.com/v4/letter/u/ea5d25/32.png) [@Urbanredneck](https://boards.straightdope.com/u/Urbanredneck)\ **Post date:** [January 28, 2019, 5:25am UTC](https://boards.straightdope.com/t/how-will-healthcare-change-when-not-if-we-switch-to-a-european-style-single-payer-system/828196/129 "2019-01-28T05:25:16Z")
I think it would be difficult to have all the millions of people who work in health care - suddenly become government employees. I also have to admit the government seldom runs things well. I’m thinking the public school system. Yes, in some areas they are great but not so in others. People mention the system in Canada. Are the workers unionized? Is it hard for a Canadian hospital to fire someone? ---
**Author:** ![Wesley\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wesley_clark/32/20581_2.png) [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)\ **Post date:** [January 28, 2019, 5:33am UTC](https://boards.straightdope.com/t/how-will-healthcare-change-when-not-if-we-switch-to-a-european-style-single-payer-system/828196/130 "2019-01-28T05:33:17Z")
> [@Urbanredneck](#): > > I think it would be difficult to have all the millions of people who work in health care - suddenly become government employees. I also have to admit the government seldom runs things well. I’m thinking the public school system. Yes, in some areas they are great but not so in others. > > People mention the system in Canada. Are the workers unionized? Is it hard for a Canadian hospital to fire someone? Thats more the NHS system (or the American VA system). In those systems, health care workers are government employees. In the US medicare system or Canadian medicare system, the health care workers are private but health care bills are paid via public funds. As I mentioned earlier, 71% of medical bills (at least in california) are already paid via the public sector. Only 29% of medical bills are paid via the private sector. So we already have a very heavily public sector funded health care system. And as far as healthcare, the US spends 2x more than any other wealthy nations. So government run health care seems to be better than what we have now. We have government funded healthcare, but not really government run healthcare here. Canada has some nurses unions. I think every western health care system has a huge role for government. Even the systems that are private and are basically just well run versions of the ACA (like the Netherlands or Switzerland) have a huge role for government in regulation of the system. ---
**Author:** ![Urbanredneck](https://avatars.discourse-cdn.com/v4/letter/u/ea5d25/32.png) [@Urbanredneck](https://boards.straightdope.com/u/Urbanredneck)\ **Post date:** [January 28, 2019, 12:31pm UTC](https://boards.straightdope.com/t/how-will-healthcare-change-when-not-if-we-switch-to-a-european-style-single-payer-system/828196/131 "2019-01-28T12:31:54Z")
OK, side question. Dangerous activities. In the US private health insurance doesnt cover dangerous hobbies like scuba diving or hang gliding. It also doesnt cover people dangerous sports like boxing or auto racing. How do these work out in other countries? ---
**Author:** ![Urbanredneck](https://avatars.discourse-cdn.com/v4/letter/u/ea5d25/32.png) [@Urbanredneck](https://boards.straightdope.com/u/Urbanredneck)\ **Post date:** [January 28, 2019, 12:33pm UTC](https://boards.straightdope.com/t/how-will-healthcare-change-when-not-if-we-switch-to-a-european-style-single-payer-system/828196/132 "2019-01-28T12:33:18Z")
> [@Wesley\_Clark](#): > > Thats more the NHS system (or the American VA system). In those systems, health care workers are government employees. > > In the US medicare system or Canadian medicare system, the health care workers are private but health care bills are paid via public funds. > > As I mentioned earlier, 71% of medical bills (at least in california) are already paid via the public sector. Only 29% of medical bills are paid via the private sector. > > So we already have a very heavily public sector funded health care system. > > And as far as healthcare, the US spends 2x more than any other wealthy nations. So government run health care seems to be better than what we have now. We have government funded healthcare, but not really government run healthcare here. > > Canada has some nurses unions. > > I think every western health care system has a huge role for government. Even the systems that are private and are basically just well run versions of the ACA (like the Netherlands or Switzerland) have a huge role for government in regulation of the system. In France arent all doctors government employees? ---
**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:** [January 28, 2019, 12:53pm UTC](https://boards.straightdope.com/t/how-will-healthcare-change-when-not-if-we-switch-to-a-european-style-single-payer-system/828196/133 "2019-01-28T12:53:36Z")
> [@Wesley\_Clark](#): > > Thats more the NHS system (or the American VA system). In those systems, health care workers are government employees. > > In the US medicare system or Canadian medicare system, the health care workers are private but health care bills are paid via public funds. It’s not that simple. The doctors are generally private; they run their own clinics and bill the single-payer. They pay for their own staff. Hospitals are different, and it varies from province to province. In my province, all the hospitals are public, non-profit institutions, run by a province-wide health care agency. The people who are employed in a hospital are public employees, in the broad sense, but not directly employed by the provincial government. Yes, the staff at hospitals tend to be unionised. Why is that relevant to the question? 😕 ---
**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:** [January 28, 2019, 12:57pm UTC](https://boards.straightdope.com/t/how-will-healthcare-change-when-not-if-we-switch-to-a-european-style-single-payer-system/828196/134 "2019-01-28T12:57:34Z")
> [@Urbanredneck](#): > > OK, side question. Dangerous activities. > > In the US private health insurance doesnt cover dangerous hobbies like scuba diving or hang gliding. It also doesnt cover people dangerous sports like boxing or auto racing. > > How do these work out in other countries? In Canada, if you get hurt, you go to the hospital or a doctor’s clinic, and you get treated. Doesn’t matter how you got hurt, other than if it’s relevant to treatment. The one type of accident where it is relevant if it’s a workplace accident. That’s covered by the workers’ comp plan, which is also public and non-profit. Just a different payment system. ---
**Author:** ![Red\_Wiggler](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/red_wiggler/32/13190_2.png) [@Red\_Wiggler](https://boards.straightdope.com/u/Red_Wiggler)\ **Post date:** [January 28, 2019, 1:12pm UTC](https://boards.straightdope.com/t/how-will-healthcare-change-when-not-if-we-switch-to-a-european-style-single-payer-system/828196/135 "2019-01-28T13:12:01Z")
> [@Sandwich](#): > > I think that cultural issues are significant. From a British perspective, my main contact with the State is via NHS frontline primary care staff. Who are generally likeable people whose main objective is to care for me as well as they can. Which is very comforting when you are poorly! Other contacts with the State are negligible, I can go years / decades without being stopped by the police, who will be unfailingly polite, income tax returns are a minor chore but few people have to do them, local government taxes are paid as easily as any other utility, driver and vehicle licensing issues are infrequent brief chores dealt with online or a quick stop at a Post Office. Voting typically takes around 90 seconds. > > From what I know about the USA (all learned on this board, so any misconceptions are your fault :)), the government seems to be far more malign. Police are officious and unavoidable, and need to be deferred to if you don’t want to be killed on the spot, tax returns are an epic annual headache for very many people, even the motoring bureaucracy (DMV?) is a kafkaesque nightmare. And of course, healthcare professionals see you as a profit source to be exploited rather than someone to be cared for. Voting can sometimes take hours! (What?!?) > > These differences must affect perceptions. Perhaps the path to UHC in the USA could be smoothed by fixing other aspects of your disfunctional government first? Or perhaps USA government services aren’t as bad as the whiners here make out? 😃 > > Further minor comment: if UHC did lead to an increase in demand, all that proves is that current USA healthcare is substandard, and that sick people aren’t getting the care they need. In the NHS every doctor will have some tales of hypochondriacs (and, increasingly, lonely old people), but these can be managed and are not significant. Even when health care is free, you only go to the doctor when you are sick. Obviously. This excellent, and very sad, post should have received more attention because it really does highlight how bad we are at managing simple things that others make a priority and do well. ---
**Author:** ![ElvisL1ves](https://avatars.discourse-cdn.com/v4/letter/e/5daacb/32.png) [@ElvisL1ves](https://boards.straightdope.com/u/ElvisL1ves)\ **Post date:** [January 28, 2019, 1:24pm UTC](https://boards.straightdope.com/t/how-will-healthcare-change-when-not-if-we-switch-to-a-european-style-single-payer-system/828196/136 "2019-01-28T13:24:16Z")
> [@Urbanredneck](#): > > OK, side question. Dangerous activities. > > In the US private health insurance doesnt cover dangerous hobbies like scuba diving or hang gliding. It also doesnt cover people dangerous sports like boxing or auto racing. I’ve never seen or heard of that in any US health care policies - can you show us where? Dangerous-activity clauses are common in \*life \*insurance policies, however. ---
**Author:** ![Urbanredneck](https://avatars.discourse-cdn.com/v4/letter/u/ea5d25/32.png) [@Urbanredneck](https://boards.straightdope.com/u/Urbanredneck)\ **Post date:** [January 28, 2019, 1:37pm UTC](https://boards.straightdope.com/t/how-will-healthcare-change-when-not-if-we-switch-to-a-european-style-single-payer-system/828196/137 "2019-01-28T13:37:06Z")
> [@ElvisL1ves](#): > > I’ve never seen or heard of that in any US health care policies - can you show us where? > > Dangerous-activity clauses are common in \*life \*insurance policies, however. Insurance discussions for various activities: [Skydiving](https://www.lowcosthealthinsurance.com/will-my-health-insurance-cover-a-skydiving-accident/) [Scuba Diving](https://www.scubadiving.com/training/basic-skills/consumers-guide-dive-insurance) [Extreme Sports](https://www.internationalinsurance.com/travel-medical/extreme-sports-insurance.php) [MMA Fighters](https://breakingmuscle.com/learn/insurance-for-mma-fighters-its-real-and-its-affordable) ---
**Author:** ![PatrickLondon](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/patricklondon/32/4422_2.png) [@PatrickLondon](https://boards.straightdope.com/u/PatrickLondon)\ **Post date:** [January 28, 2019, 1:42pm UTC](https://boards.straightdope.com/t/how-will-healthcare-change-when-not-if-we-switch-to-a-european-style-single-payer-system/828196/138 "2019-01-28T13:42:54Z")
> [@Urbanredneck](#): > > OK, side question. Dangerous activities. > > In the US private health insurance doesnt cover dangerous hobbies like scuba diving or hang gliding. It also doesnt cover people dangerous sports like boxing or auto racing. > > How do these work out in other countries? The NHS will certainly deal with these as they present. Periodically people float the idea of some kind of penalty after the event for “self-inflicted” conditions (more often, alcohol/obesity/smoking), but the idea gets nowhere because it isn’t worth the admin. Related taxes, however, are a go-er, which is why alcohol and tobacco duties are quite high, and taxing sugar is very much on the agenda. At the level of the individual patient, there might at some point be some “words of advice” once they’re on the road to recovery. There is also a scheme for the NHS to recover the costs of some traffic accidents from insurance payouts. ---
**Author:** ![Nava](https://avatars.discourse-cdn.com/v4/letter/n/da6949/32.png) [@Nava](https://boards.straightdope.com/u/Nava)\ **Post date:** [January 28, 2019, 2:00pm UTC](https://boards.straightdope.com/t/how-will-healthcare-change-when-not-if-we-switch-to-a-european-style-single-payer-system/828196/139 "2019-01-28T14:00:50Z")
> [@survinga](#): > > And about half the country gets insurance at the worksite, such as myself. Most of us like what we have Only because you’ve never had a decent system. I’m still traumatatized by my time in the US; no, not by the rentacop who grabbed me by the pussy in Ronald Reagan Airport, or by the diverse idjits massacring my name, or by having several managers and employers believe that they could do turn me into their slave on account of being a foreigner, but by how painful y’all make the simplest medical act. ---
**Author:** ![Nava](https://avatars.discourse-cdn.com/v4/letter/n/da6949/32.png) [@Nava](https://boards.straightdope.com/u/Nava)\ **Post date:** [January 28, 2019, 2:05pm UTC](https://boards.straightdope.com/t/how-will-healthcare-change-when-not-if-we-switch-to-a-european-style-single-payer-system/828196/140 "2019-01-28T14:05:10Z")
> [@Urbanredneck](#): > > In France arent all doctors government employees? No, most of them are either partners in a clinic, or employees of a clinic or hospital. The clinic or hospital may be government owned or not, they use the two words to differentiate by size and specialization level (a hospital will be bigger and include more types of care). Most docs in Spain are employees of a private clinic, a mutual assistance program (the worker’s healthcare people), a public hospital, or the regional healthcare system (day centers). In our case, we say “clinic” if private and “hospital” if public. As of last check, there are still a bunch of mountains and a small country between Spain and France. [Previous page](https://boards.straightdope.com/t/how-will-healthcare-change-when-not-if-we-switch-to-a-european-style-single-payer-system/828196.md?page=6) [Next page](https://boards.straightdope.com/t/how-will-healthcare-change-when-not-if-we-switch-to-a-european-style-single-payer-system/828196.md?page=8)