I don’t think the question is about remote places. I think it was about a situation that sometimes happens in the US where there are plenty of providers in an area, but perhaps none both accept your insurance and are taking new patients.
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I think the area to focus on are specialties, procedures, and drugs for which the US (specifically private insurance companies) pay way more than public insurance models do (either Medicare or government-run systems in other countries).
Based on some quick checks, the primary specialties where US providers get paid significantly out of line which world-wide norms are surgeons, ENT, and radiologists (the last cite is good for this).
Another big difference is that we have something like 2/3 specialists and 1/3 GPs, where a typical UHC system is the opposite. So you have a small heart problem and you are immediately paying cardiologists rates rather than your GP handling it. All for not much in the way of better outcomes (if at all). The lack of a true “gatekeeper for care” is a problem that UHC could address (some PPO-style plans in the US have done this before I believe).
It’s not all perfectly clear that cutting doctors salaries is required (the second cite has some relevant data here), but finding a way to incentive GPs (perhaps by requiring all specialists visits to be approved by a GP, or bumping primary-care visit reimbursement relative to procedures) could help get the ratios more in-line with other countries, which should reduce overall costs. Capitation funding for GPs may reduce the number of redundant or unnecessary tests and labs as well.
One thing that also really needs to be included in the financial discussions regarding overall cost is what employers are paying. I get the impression that most employees don’t even realize that their employee may be paying 5-figure sums to cover their health insurance annually. That money is part of their compensation and a discussion of overall costs should include that as money that is currently being “paid” by the health consumer even if they never see it in their bank account.
Some cites:
https://www.politico.com/agenda/story/2017/10/25/doctors-salaries-pay-disparities-000557
In the context of an article on (as it happens) flu vaccination in my paper, Jeremy Brown of the US NIH identifies some cultural attitudes that may be relevant here:
*At the beginning of the 1976 flu outbreak, President Gerald Ford had to choose between two perfectly sound recommendations. One was to quickly vaccinate as many people as possible, while the other was to stockpile the vaccine and wait to see whether things got worse. Ford rejected the wait-and-see approach. “We cannot afford to take a chance with the health of our nation,” he said. “Better to err on the side of overreaction than underreaction.”
This is the overriding approach to healthcare in the US. They are always ready to do more, to try the latest medications or surgical procedures, because, well, why take a chance? Compared with other western countries, the US does more invasive studies of the heart for patients with chest pain, without actually improving their outcomes. We in the US put more of our patients into the intensive care unit, even though they are, on average, less sick than their counterparts abroad. We give more chemotherapy to cancer patients near the ends of their disease, even though it improves neither the quality nor the length of their lives. We do these things because we can, because to do otherwise would be considered giving up – even if doing less would be an extremely sensible and kind decision.
Influenza is not cancer, and it is not heart disease. But the US approach to it is emblematic of the way it treats most diseases: doing more is better. If there is an unexhausted option, exhaust it.
Well if we’re gonna get all propagandy, I suggest calling it Canada Care; the Juno Beach Model. Link it to something heroic and historical like Canadians taking one of the beaches at Normandy and managing to cover more territory in the initial assault (“The Juno Plan; More Coverage”) than anyone else.
Plus, who doesn’t like the beach?
I agree that these things happen, leading to unnecessary testing, unnecessary procedures, and over-utilization, but I think they’re ascribed to completely the wrong cultural causation. If there is such a cultural preoccupation with always doing more, with never giving up on medical intervention, how come the US is the only country in the developed world in which 15% of the non-elderly population (nearly 30 million people) have no health care coverage at all? And that’s after the ACA; in the years it was being set up, the uninsured population hit 46.5 million, or nearly 18% of the non-elderly. Republicans are bound and determined to drive those numbers even higher. If there were really a culture driving an impetus to “do more” in health care, the first thing that would happen is the establishment of a principle of universal access as a basic human right.
The operative culture that is at work here, instead, is a fundamental distrust of government, and, by extension, anything the government runs including any and all social programs and anything that even remotely smacks of “socialization”, exacerbated by a plutocracy that largely controls the legislative processes. Faith is instead put into the putative power of capitalism, which forms the basis of US health care, and particularly and tragically the basis of its health insurance system. I think it’s more realistic to say that the problems of unnecessary procedures and over-utilization are primarily due to two factors emerging from this underpinning of unfettered capitalism: (a) the opportunity for profit, and (b) the excessive proliferation of defensive medicine as a bulwark against rampant medical lawsuits.
This is a warning for accusing another poster of lying which is not permitted in this forum. If you feel you must, the the Pit is right around the corner.
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So you don’t have a cite, after all. :dubious:
So still no cite? That’s what I figured. :rolleyes:
The first problem doesn’t arise in Canada. There is one network, called “Canada” and every doctor is in-network.
The second can be a problem, but more in remote areas. But even if you can’t find a doctor who will take you as a regular patient, there are always walk-in clinics (in the larger centres, at any rate). You just walk in and ask to see a doctor.
In the UK NHS, the vast majority of GPs are in large-ish group practices, rather than “sole practitioners” with maybe an assistant (and potential partner) or two, funded mainly from capitation fees. So adding more patients means more money to take on additional staff.
Overarching the whole system is a statutory duty on the Secretary of State to provide through the NHS a health service for everyone. If for some reason a particular area is under-served, say with GPs retiring and no-one willing to take over the practice, it will set up a directoy-employed practice with salaried GPs. Currently there are areas where not enough GPs want to go on running the self-employed partnership model (because of workload pressures as a result of demographic changes and assorted management pressures), and the local NHS commissioning group is recruiting salaried GPs in that way.
In individual cases, where patient and GP just don’t get on, a group practice makes it possible for the patient to see someone else. Or the local commissioning group will simply register them with one or another local practice willy-nilly, though that’s rare.
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.
It’s a bit like the poor buggy-whip manufacturers. Folks lost jobs, families were greatly affected. The buggy-whip moguls were desperate to fight for their survival but no amount of bribery and palm-greasing could get around the reality of automobiles being vastly superior to horse-drawn buggies.
Unfortunately, the benefits of a superior healthcare provision system like single-payer are not as immediately evident to people of average intelligence. This leaves the door wiiiiiiiiide open to billion dollar lobbying aimed at convincing those of slacker jaw-edness that what is good for them is actually Commie evil.
I still don’t understand why more pro-entrepreneur right-wingers aren’t on board with that economically valuable aspect of universal healthcare. You like job creators? There’s your job creators.
The few right-wingers who don’t currently believe that Canada = Socialism will suddenly swear the country was founded by Stalin the very moment “Canada Care” is jeeringly reported on by Fox News.
(I already apologized for creating a minor thread hijack, and didn’t want to make a big issue over my comments.
This thread is supposed to be about how Americans will see their healthcare services change; But I commented instead about the politics of how to bring about that change.
That’s a bit off-topic, but since I’ve been quoted 5 times already, I’ll return to the thread.)
Yes, I proudly declared “Half of all Americans are totally unaware that there exists any civilization, or any world, outside the USA”.
And yes, I assumed that most Dopers recognize hyperbole when they see it.
So, yeah, I was a little surprise when somebody took me literally. (and also called me a liar;–though I didn’t feel terribly insulted, and don’t think he deserved to be given a warning by a mod.)
My point was that the OP’s topic of "European style " health system is unlikely to happen anytime soon, because many, many Americans get their only news by watching Fox, and are pretty ignorant about the rest of the world. (you want a cite–so here it is:… D.Trump)
And many of those people are afraid of anything foreign or European style. Once they decide that something is “socialist”, they refuse all further discussion*.
The only way to engage these people is to use terms that don’t scare them.
And to them, Europe is scary, but Canada is much less so. cite:You can drive there in your pickup truck, listening to country music the whole time. 
America desperately needs single-payer, and calling it Canada Care would help people get used to the concept.
*For comparison: this attitude has a parallel on the left: when Liberal social-justice-warriors define something as racist, they immediately declare that no further discussion is possible.But that’s a real hijack, for another thread)
And there’ll be a $1T saving. And that money will be put to better use.
Single-payer UHC could be very sellable to conservatives if focused on efficiency and effectiveness. The moment it is sold as “socialized medicine” or “let’s do what those Europeans do,” the well is poisoned.
UHC proponents need to steer the talk away socialism and more towards “cheaper, better.”
European health care differs a lot from place to place. Although single payer systems work better IMHO, I do not think the US will have one within ten years.
It’s rarely “sold” as “socialized medicine”, particularly not in the US. Even Bernie Sanders’ lengthy page on his “Medicare for All” plan doesn’t include the term “social …” anything. Doesn’t help. It’s the health insurance lobby, far-right wingnuts, the worst of the medical profession, and right-wing media that drag in the twin boogeymen of “socialism” and “government-run health care”. When the ACA was being developed, the “public option” was actually getting pretty good public support until Fox News turned it into “the government option”, then “socialized medicine”, and finally, the government death panels that would come after your grandmother – a vision that the big health insurers and far-right morons cheered on as a highly accurate depiction of the horrors of socialized medicine. It makes one despair that health care reform in America will ever be possible.
One might argue that some of the same fabrications and scare tactics were employed by Republicans against Medicare in the 50s and early 60s, with a young Ronald Reagan proclaiming that the passage of Medicare would inevitably bring on the dark days of socialism in America, and that “one of these days you and I are going to spend our sunset years telling our children and our children’s children what it once was like in America when men were free.” Medicare was passed anyway, and America survived and prospered, but those were much saner times. I’m certain that Medicare could never be passed today if it didn’t already exist, and indeed I’m certain that Republicans would try to abolish even what already exists if it wasn’t for the fact that it’s hugely popular. The trouble with an ideology like that of current Republicans, which is wrong about almost everything, is that it’s tough going if the program you want to kill has been in successful nationwide operation for more than half a century. So they’re directing their wrongness against the ACA and against any possibility of expanded coverage or (heaven forfend!) universal coverage!
Huh! I guess we can add that to the $2,500 each family is saving as a result of the ACA! So we’re at, what?, $1.3 trillion. In no time at all the government will generate money and none of us will pay any taxes - suck on that Canada.