There are tons of different public healthcare systems out there. The answers to your questions would be different depending on the system used. So, you can’t assume that an US public healthcare system would be similar to the Canadian, or to the German system. I actually I suspect it would be very peculiar, probably including much more free markets elements to to the current situation and general philosophy in the USA (private insurers certainly aren’t going to lose 90% of the market, for instance, which they would do if any existing system was implemented in the USA).
What I mean is that people responding should probably base their answers on what has been actually stated by Mr Obama, rather than making assumptions on the basis of what’s currently existing in other countries.
The question is, why does it cost $875?
I have private health insurance from a UK company which has excellent coverage for $270/mo coving both my wife and I (mid 30s). This is valid everywhere in the world except the US. So what is it about the US that triples the cost of care?
Note that I am American and have no recourse to any state system… my $270/mo is fully private coverage. Certainly the quality of coverage is not 3 times greater than Canada, Germany, UK etc.
I’d guess it’s because private insurers here don’t have to compete with UHC. They’ll charge as much as they can, and deny coverage as much as they can.
In Spain, Seguridad Social gets 15% of each employee’s base salary: half is paid by the employer, half by the employee. One common strategy used by the Government to incite companies to hire more of certain kinds of people, or to have more of certain kinds of contracts, is to reduce the employer’s SS contribution for those contracts and a limited time.
SS covers both medical services (including the most basic of dental and eye checks but either nothing or a minimum amount off the cost of glasses) and other social safety things like unemployment benefits, skill-up training for both the employed and unemployed, etc.
The amount paid by the self-employed is different; I’m currently self-employed and paying the minimum. This gives me full medical coverage but if I was, say, in a car crash and got total disability the monthly amount I’d be getting from SS would also be the minimum amount.
COBRA lets an individual who has left a company (either voluntarily or not) stay on the company’s group insurance plan. The ex-employee pays the entire premium for his coverage, whereas before the company paid all or a portion of the premium. Since the ex-employee is paying a group rate, this is usually less expensive than paying for an individual policy.
The cost of COBRA coverage will depend on whether the coverage is for an individual, and individual and dependent, or a family. It will vary depending on the level of coverage (high deductible? co-insurance? HMO or PPO?). It will vary based on the age of the individual. It varies depending on the cost of living of your location.
There may be some places where a couple can get a group rate of $400/mo. (and remember this was a low end estimate). It may be very basic coverage, or it may be in a section of the country where the cost of living is lower than most other sections.
I don’t think we have “very mediocre” healthcare; I think we have serious flaws in our system, including wait times (which we citizens are pressing our governments to rectify). Other than the wait times (which is somewhat of an artificial measurement; the healthcare professionals here do triage at almost every level - your wait time for a life-threatening condition is not the same as your wait time for a vasectomy), what measurements are you making to come to the conclusion of “very mediocre”?
(That’s genuinely asking, not snarking. 
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As featherlou says, the Canadian system doesn’t always have long delays.
A few years ago when I was still in Vancouver, I had a seizure and saw a neurologist, who said he’d schedule me for a scan. I went for lunch and got a few groceries on my way home, to find phone messages telling me I had already missed two potential appointments. I called back, and attended the third appointment the same day.
I don’t much care about somebody waiting for a vasectomy. I do care about people who can’t get the treatment they need.
Since the US* usually wants to do things in their own way (because they’re too unique to learn anything at all from other countries), I won’t explain the german system. Although I want to point out that in Germany, Health insurance isn’t financed by taxes, but by a seperate pay into a seperate fund (although it does come from your gross monthly income).
- in the sense of what a majority of Americans, not 100% of Americans, say on TV when asked or on messageboards,
But one thing that always puzzles me when posters says in Britain or Canada, people have to wait months (because of Nationalized Health Care) while in the US, with private care, they can have an appointment with their doctor the next morning.
How the heck does this work for the doctors? Are they sitting around all day waiting for their dozen or so privately insured patients? If all their patients are private, whom do they bump from their regular appointment to make place for you at 10 am tomorrow?
Because when I need an appointment, depending on how busy my doctor is (and that depends on how many patients want to see him), I might have to wait a couple of weeks (okay, my specialist has a waiting time of 2 months - but then he’s one of the best experts).
Now, they recently did a test here and found that private patients got an appointment about a week earlier than normally insured patients.
And of course, it varies from Doctor to Doctor. Some have no time-planning skills at all, so they schedule everybody in 15 min. intervals, but they actually need 30 min. for each patient, and so everybody waits for ages. Some have a “first come first served” policy without any appointments (general practioners), where you show up at 9 am and find out whether you’re 3rd or 10th person in the line.
But from the doctors perspective, who has to balance his books to pay the rent and buy food (and pay the nurses and the machines), he wants a full waiting room, which means that patients have to wait for appointments.
Obviously none of this applies to emergiencies - if I have an accident, I go the nearest doctor and jump ahead of the queue sitting there. Probably I would go to a hospital, though. If I need an emergency OP, I will get it as soon as a room and doctors are available, but if it’s a “simple” broken leg, I might have to wait half a day or two for the more urgent cases.
So how do doctors in the US organize their practises that there is almost no waiting time yet they earn enough?
I can’t answer the OP question because I don’t think there are answers as of yet. I would be greatly surprised if there is ever a single payer system in the USA. What I imagine will happen is that all fees will be capped such as Medicare fees are capped now and different providers will hold different contracts. It isn’t going to be easy.
Considering the fact that Medicare has recently cut fees 10% and has another cut coming in 2009 if Congress doesn’t step in, the elderly are losing physicians already. Many geriatric practices have already begun laying off and I don’t see that ending any time soon. Exactly what the AMA said would happen is happening. I have no “cite” what I have is MGMA (Medical Group Management Association) colleagues around the nation who are struggling to keep the employees they have to accommodate the same volume of patients with 10% less revenue and higher overhead.
As far as the successful physicians staying in? I would suspect (and have heard) that some will opt out. Meaning they would see patients on a cash only basis. This is similar to those treated now by the cream of the crop in the USA that come from other countries for surgeries that they either cannot get or get soon enough if they are non life threatening.
Of course to do that, these doctor’s would have to be already established or pretty brave and cocky coming out of their fellowship programs.
Personally, I would love to have universal healthcare. What I don’t want to sacrifice is the expertise, care and options that I have now. I can’t see a way around that.
One of the reasons (but not the only one) I’m on the fence, is because while not having to worry about doctor and hospital bills if you’re unemployed or only work part-time (since most employers here in the U.S. don’t offer insurance to part time employees) give me warm fuzzies :), unfortunately, when I hear discussions about UHC, the more specific the questions become, the less clear the answers are.
There are a lot of great unknowns about what will happen if we take the plunge. Now since Canada, and most European countries have one form or another of UHC, it can be done. However, from what I hear, there are just about as many styles of UHC as there are countries that have it, so the question is, what would a U.S. style UHC look like?
Actually, Obama says he wants all Americans to enjoy the same health coverage benefits that members of Congress have. So, how does Congressional coverage work? And could it be used as a template for America as a whole?
I. Income may be reduced definitely. This is not necessarily a bad thing.
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I’m not sure it would. I’m basing all my opinions here on my own experiences with public healthcare as practised in Australia and New Zealand (compared to here). Those who go into medicine solely to make a lot of money scare the hell out of me anyway.
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Good question. We use government loans at home that tend to have a much lower than average interest rate. Income below a certain level is not counted towards paying them back. Meaning you have to earn a certain amount to have to make payments (voluntary payments are always allowed). Less than that level also gives you complete interest write-offs. This isn’t perfect (I’d rather have tertiary education be completely state funded) but it helps.
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Those that would should never have been in the field in the first place.
II. There are wait times here. I watched my wife, with total insurance cover, wait three months for a simple gyno exam. Of course for the uninsured the wait can be fatal. Waiting forever.
III. The average income tax in NZ is significantly smaller than in the US. Cite at just over 20% compared to nearly 30%
IV. I would hope to see legislation pushing corporates to raise payrates to reflect the money they no longer pay for insurance. Unlikely, but I can hope.
Just popped in to say that when we paid COBRA, we paid $1200/month for a family of 5. It about killed us financially.
Sorry to hear about your wife. What happens when your Medicare days run out? I hope you have a case manager who has been helpful. Navigating the Byzantine health care system we have in this country is a full time job in and of itself.
UnwrittenNocturne, thank you very much for answering each question.
eleanorigby, after graduation, once I get a job, if I can afford the cost of keeping Medicaid, then I may have to since they’re the ones paying for the extra help my mother and I are hiring.
If I can’t afford to keep Medicaid, then even though I’ll have my own insurance which should pay for the equipment, I’ll be screwed because I’ll have to hire all new care-givers. Thankfully though, I have three people I can talk to about this to find out my options, and I won’t have to worry about it for about a year, so hopefully, I’ll have time to work it all out.
I forgot one other fairly large difference - in Canada, we don’t make decisions to stay at or leave jobs based on healthcare. It took me years to figure out what you guys here were talking about when you indicated you had to stay at a job. It never occurred to me that people in the US are stuck in bad jobs simply because of healthcare insurance.
Are you saying that all Americans have fast and easy access to surgeries, CT scans, and MRIs? or are you saying that Americans with good insurance coverage have fast and easy access? because those are two different things, as I understand it. If the latter, then it’s not really a good comparator to the Canadian system.
Jobs and marriages, there’s been mentions in these boards of staying legally married in order to keep the insurance.
I. Not intially but pretty quickly the income of doctors and nurses would go down.
I. Not initially but pretty quickly the income of doctors and nurses would go down. Doctors would do less and nurses would do more.
- Less people would enroll in medical school, but foreign doctors might make up some of the difference.
- Medical School tuition would go down slightly and loans would take a little longer to pay off. Recent graduates would be hit hardest.
- Older doctors would probably retire earlier, but medicine is not a skill set that would transfer easily to other professions, especially for young doctors with loans to repay.
II. Yes, though MRI and CAT scan wait would not be as long since the machines are already purchased.
III. Taxes would go up 10-20%, spending on non-healthcare government expenses would go down.
IV. Salaries would go up, though probably not enough to make up the difference for most people.