# Medicare for All = end of private insurance? **URL:** \ **Category:** Factual Questions\ **Created:** [July 13, 2019, 8:36pm UTC](https://boards.straightdope.com/t/medicare-for-all-end-of-private-insurance/837037 "2019-07-13T20:36:08Z")\ **Posts on this page:** 4\ **Page:** 2
**Author:** ![DrDeth](https://avatars.discourse-cdn.com/v4/letter/d/b487fb/32.png) [@DrDeth](https://boards.straightdope.com/u/DrDeth)\ **Post date:** [July 15, 2019, 5:29am UTC](https://boards.straightdope.com/t/medicare-for-all-end-of-private-insurance/837037/21 "2019-07-15T05:29:59Z")
> [@Northern\_Piper](#): > > Except I don’t think we have any private hospitals in Canada that aren’t part of the public health system. > > There are some private hospitals, but if they take any patients on the public system, they get paid the public rates and aren’t allowed to charge higher rates to other patients. > > And I’d be surprised if there are many doctors who work entirely off the public system and only take paying patients - the economics are against it, as I mentioned earlier. Less than i thought due to strong restrictions, however, common in GB. [http://www.canadian-healthcare.org/page6.html](http://www.canadian-healthcare.org/page6.html) > **[The illegality of private health care in Canada](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC80881/)** > > WE ADDRESSED THE QUESTION OF WHETHER PRIVATE HEALTH CARE IS ILLEGAL in Canada by surveying the health insurance legislation of all 10 provinces. Our survey revealed multiple layers of regulation that seem to have as their primary objective preventing... [https://www.nejm.org/doi/full/10.1056/NEJMp068064](https://www.nejm.org/doi/full/10.1056/NEJMp068064) ---
**Author:** ![md2000](https://avatars.discourse-cdn.com/v4/letter/m/73ab20/32.png) [@md2000](https://boards.straightdope.com/u/md2000)\ **Post date:** [July 15, 2019, 5:39am UTC](https://boards.straightdope.com/t/medicare-for-all-end-of-private-insurance/837037/22 "2019-07-15T05:39:43Z")
> [@DrDeth](#): > > … > > And, just like in Canada or GB, there still would be private hospitals and Doctors for those who want first class priority care and dont care what it costs. As mentioned, AFAIK I have \*never \*heard of a private hospital. Private clinics maybe for very specialized procedures - but as mentioned by others, a doctor who wants to charge outside the system cannot get reimbursed any part of any procedure for any patient by the system nor can his patients. No appreciable market for health care insurance to cover this contingency. That leaves a very small market - people who can pay out of pocket for health care, and don’t care to travel to full fledged facilities in the USA. This removes the most USA-like aspect of the UK system - where you want an appointment, and it will be six weeks - but “if you have better than National Health coverage or want to pay, the doctor will see you in two days”. The doctor is never both in or out, in Canada he is one or the other. (But as also mentioned - I know a plastic surgeon who does assorted surgeries. He can do covered procedures under the provincial health plan (i.e. burn victims, mastectomy fixes) and purely elective treatments privately in a day clinic. The criteria for a government-paid tummy tuck, for example, is medical record that show you have lost over 100lb. My understanding of most proposals in the USA for “Medicare for All” is they fall into two categories - like Canada or UK, where everyone is covered by a basic plan, and a mixed plan, where a sort of Medicare is an option you sign up for. Presumably for the average person, the government plan would be competitive or cheaper, and the implication would be that employer plans would wither away as employers realize that letting employees go on medicare (or paying for that option) would be cheaper than other plans. if nothing else, it would keep competing plans cheap and comprehensive to compete. The key point with Canada’s system is - it has nothing to do with employment. It doesn’t matter who you work for or don’t, you are covered. (Hint - for citizens and legal residents only … could be a complication in USA.) I assume Medicare for All would have that feature. ---
**Author:** ![psychonaut](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/psychonaut/32/4655_2.png) [@psychonaut](https://boards.straightdope.com/u/psychonaut)\ **Post date:** [July 15, 2019, 7:59am UTC](https://boards.straightdope.com/t/medicare-for-all-end-of-private-insurance/837037/23 "2019-07-15T07:59:11Z")
> [@Wesley\_Clark](#): > > No, it doesn’t. Most nations with single payer also have the option to purchase private insurance on top of it to get more comprehensive coverage, faster coverage or better coverage. Only “most”? Even countries with highly centralized, government-controlled economies, like the Soviet Union, had self-financed, pay-for-care systems alongside the publically funded one. (And in the some of the worse-run publically funded ones, it was routine for patients to unofficially pay doctors for a better level of service.) If there is any country today that definitely doesn’t have some kind of private healthcare system, I’d be interested in knowing. ---
**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:** [July 15, 2019, 9:12am UTC](https://boards.straightdope.com/t/medicare-for-all-end-of-private-insurance/837037/24 "2019-07-15T09:12:57Z")
> [@psychonaut](#): > > If there is any country today that definitely doesn’t have some kind of private healthcare system, I’d be interested in knowing. [Canada.](https://laws-lois.justice.gc.ca/eng/acts/c-6/FullText.html) Which explicitly prohibits a private tier of health care under the Canada Health Act. Provinces technically can opt out and lose CHA funding, but no province or territory has done so. As noted before, there is “private healthcare” in the sense of physicians who are employed by organizations like sports teams, and there are some “executive health care center” type things that provide certain supplemental services in luxurious environments for high fees, but for practical purposes there is nothing that could be called a “system” of privately funded (either by private insurance or personal cash) health care services. There are, of course, private clinics and a few for-profit private hospitals, but all are accessible to all residents and fully paid for by the public insurance system. And of course almost all doctors are in private practice, but bill the public insurance system. [Previous page](https://boards.straightdope.com/t/medicare-for-all-end-of-private-insurance/837037.md?page=1)