# Medicare For All / Single Payer system. Pros, Cons, versus our current system and other systems? **URL:** \ **Category:** Great Debates\ **Created:** [November 23, 2018, 5:52am UTC](https://boards.straightdope.com/t/medicare-for-all-single-payer-system-pros-cons-versus-our-current-system-and-other-systems/824968 "2018-11-23T05:52:16Z")\ **Posts on this page:** 20\ **Page:** 4
**Author:** ![survinga](https://avatars.discourse-cdn.com/v4/letter/s/cab0a1/32.png) [@survinga](https://boards.straightdope.com/u/survinga)\ **Post date:** [November 27, 2018, 1:51am UTC](https://boards.straightdope.com/t/medicare-for-all-single-payer-system-pros-cons-versus-our-current-system-and-other-systems/824968/61 "2018-11-27T01:51:58Z")
> [@Voyager](#): > > I have changed the source of payment for my healthcare several times without it affecting my care. > Now I do expect that a single payer system will be able to enforce things like evidence based medicine that might affect care, but for the better overall. > Does your doctor look at your insurance before deciding on a course of action? My doctor doesn’t accept any medicare patients and no medicaid patients. When changes are made at the macro level, there are reactions. I’m not saying it’s all bad. But anyone arguing that changing to single-payer won’t impact healthcare itself is being illogical. Again, this is one of the reasons for the ACA. ---
**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:** [November 27, 2018, 2:21am UTC](https://boards.straightdope.com/t/medicare-for-all-single-payer-system-pros-cons-versus-our-current-system-and-other-systems/824968/62 "2018-11-27T02:21:40Z")
> [@LAZombie](#): > > Here in California, ambulance companies are paid for each trip $450.00 by Medicare, $100.00 by Medical, $1800.00 by private insurance companies, and Zero dollars by people who can’t pay. The cost of an average of an ambulance trip is $750 dollars. Private insurance subsidizes government insurance and the indigent. This tells me that once private insurance is gone the actual costs to the taxpayer will be much higher. > > [http://www.voterguide.sos.ca.gov/propositions/11/analysis.htm](http://www.voterguide.sos.ca.gov/propositions/11/analysis.htm) What that tells you appears to be driven by preconceived notions that are completely wrong. Here in Ontario, everyone is covered by public single-payer insurance and there is no private insurance for medically necessary services. Yet the _uninsured_ total cost of an ambulance trip is set at $240, and even then only if the ambulance was judged not medically necessary or the person is out of country and not insured; otherwise the patient is billed $45 or, in many cases, nothing at all. In other provinces the uninsured cost of an ambulance trip varies between $245 and $270. [Cite](https://www.thespec.com/living-story/7485861-why-am-i-getting-an-ambulance-bill-/). [Regulations](http://www.health.gov.on.ca/en/public/publications/ohip/amb.aspx). What that tells me is that the ludicrous costs of ambulance services in California are just another example of the completely out-of-control costs in all aspects of medical care in the US, driven largely by reckless profiteering that has been enabled by the private insurance industry. It’s also, incidentally, an example of why health care reform has to be managed in a holistic, systematic manner, and why piecemeal solutions or so-called “incremental” solutions generally won’t work. Ambulance services have to be treated as a regulated part of the health services infrastructure and not just a freewheeling business like a car dealership. ---
**Author:** ![LAZombie](https://avatars.discourse-cdn.com/v4/letter/l/b38774/32.png) [@LAZombie](https://boards.straightdope.com/u/LAZombie)\ **Post date:** [November 27, 2018, 2:22am UTC](https://boards.straightdope.com/t/medicare-for-all-single-payer-system-pros-cons-versus-our-current-system-and-other-systems/824968/63 "2018-11-27T02:22:04Z")
> [@Voyager](#): > > Or the ambulance companies can figure out how to cut the cost of a trip. > It is amazing how the free enterprise system and competition can force companies become more efficient. I started working for the Bell System, and left fifteen years later after we were no longer a monopoly. We did things a hell of a lot more efficiently at the end than at the beginning. > Some cities or counties negotiate prices with ambulance services. I think they still make money. If you had read my link, you would know that there is a bidding process. I understand that $750 per ride seems very expensive. Then again, I don’t know all of the costs involved. Ambulances have to be available 24/7 and stationed in various areas to cover all possible scenarios. They only get paid if they are called. When one is on a call, another has to be brought in to cover for it. Insurance. Trained personnel. It would be far more expensive to have the fire department provide ambulance services. Beyond the observation that private insurance subsidizes public, the business model looks dysfunctional and may give insight into what troubles the rest of the health care industry. ---
**Author:** ![survinga](https://avatars.discourse-cdn.com/v4/letter/s/cab0a1/32.png) [@survinga](https://boards.straightdope.com/u/survinga)\ **Post date:** [November 27, 2018, 3:18am UTC](https://boards.straightdope.com/t/medicare-for-all-single-payer-system-pros-cons-versus-our-current-system-and-other-systems/824968/64 "2018-11-27T03:18:20Z")
By the way, even in the face of Trump’s attacks, the ACA is holding up fairly well. As the link says, Obamacare is having a good year: > **[Obamacare is having a surprisingly good year](https://www.vox.com/policy-and-politics/2018/11/26/18113313/obamacare-mandate-tax)** > > It’s time to rethink the individual mandate. It appears that the premium subsidies are strong enough to keep the basic exchanges in reasonably decent shape, with millions still signing up, overall average premiums coming down, and insurers not fleeing the exchanges. This is occurring even in the face of the repeal of the individual mandate, and a pullback of support from the trump administration in keeping things running (shorter signup period, no outreach, cutbacks in navigator funding, no CSR funding, pushing more short-term & skimpy plans). Even with all of this, the exchanges look healthy. ---
**Author:** ![Urbanredneck](https://avatars.discourse-cdn.com/v4/letter/u/ea5d25/32.png) [@Urbanredneck](https://boards.straightdope.com/u/Urbanredneck)\ **Post date:** [November 27, 2018, 4:13am UTC](https://boards.straightdope.com/t/medicare-for-all-single-payer-system-pros-cons-versus-our-current-system-and-other-systems/824968/65 "2018-11-27T04:13:43Z")
What would happen to the existing insurance companies? Would companies like Aetna and Blue Cross go out of business? ---
**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:** [November 27, 2018, 10:05am UTC](https://boards.straightdope.com/t/medicare-for-all-single-payer-system-pros-cons-versus-our-current-system-and-other-systems/824968/66 "2018-11-27T10:05:35Z")
> [@survinga](#): > > A movement to single-payer affects not only insurance but also the delivery of healthcare itself. You can’t make a huge move like that and not affect both, which is why the “3 out of 4 like their healthcare” statistic is important. > > And I would put more weight on that stat than any other stats about people’s view of the overall healthcare/health-insurance system. Most people don’t like congress either, but they like their own congressman. The average person doesn’t have a clue about the greater healthcare system, but they know a lot about their own situation. Which comes back to the question I raised earlier: what specific features of the service available to people now are most valued, and could they be replicated/protected in a universal system? As ever, the devil is in the detail. We only have the NHS because the minister who got it through persuaded the doctors - as he put it “I stuffed their mouths with gold”. My guess is that you’d have to consider a similar sort of trade-off for providers: some form of securely guaranteed income and relief from some current costs, in return for providing the service (designed to reflect the public’s favourite features of the existing system) at some notionally reasonable necessary cost. You have specialist/professional regulatory and accreditation agencies and organisations - can’t their remit be extended to setting, or at least recommending, tariffs? > [@LAZombie](#): > > Here in California, ambulance companies are paid for each trip $450.00 by Medicare, $100.00 by Medical, $1800.00 by private insurance companies, and Zero dollars by people who can’t pay. The cost of an average of an ambulance trip is $750 dollars. Not quite. That’s the average **price** in the current market. Does it make a difference whether this is a mean or a median? And how does what’s charged relate to what it actually costs the providers to run the service, and are all of their costs strictly necessary? ---
**Author:** ![Spoons](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/spoons/32/3141_2.png) [@Spoons](https://boards.straightdope.com/u/Spoons)\ **Post date:** [November 27, 2018, 10:32am UTC](https://boards.straightdope.com/t/medicare-for-all-single-payer-system-pros-cons-versus-our-current-system-and-other-systems/824968/67 "2018-11-27T10:32:32Z")
> [@Urbanredneck](#): > > What would happen to the existing insurance companies? Would companies like Aetna and Blue Cross go out of business? Not necessarily. Here in Canada, Aetna, which provided health insurance prior to Canada’s provinces making the switch to single-payer, still found itself quite profitable afterwards, providing supplementary health insurance (vision care, dental care, prescriptions, etc.), as well as providing whole- and term-life insurance. It also dealt in casualty insurance (auto, home, etc.). I am unsure if Aetna still operates in Canada, but this was how it dealt with making the switch from “health insurer” to “general insurer.” Blue Cross is still viable and profitable, providing vision, dental, and prescription insurance; among other coverages that the single-payer system does not cover (chiropractic, I think, plus physiotherapy, and some others). My point is, that abolishing private health insurance does not necessarily lead to the death of health insurance companies. They can grow and adapt, providing what the state-run single-payer system does not; and can even look at new insurance products to sell. ---
**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:** [November 27, 2018, 1:07pm UTC](https://boards.straightdope.com/t/medicare-for-all-single-payer-system-pros-cons-versus-our-current-system-and-other-systems/824968/68 "2018-11-27T13:07:02Z")
> [@Isamu](#): > > And go where? They can fill orders at Amazon! Physician shortages have more than one cause. It will remain a well-compensated profession after we establish single payer. As for the arguments that costs increase overall, that again demonstrates an unwillingness to look at countries with more advanced health care systems where the opposite is true. So, to make this argument cogent at all, let’s hear what makes us special that we can’t do what many others can. ---
**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:** [November 27, 2018, 5:27pm UTC](https://boards.straightdope.com/t/medicare-for-all-single-payer-system-pros-cons-versus-our-current-system-and-other-systems/824968/69 "2018-11-27T17:27:13Z")
> [@survinga](#): > > My doctor doesn’t accept any medicare patients and no medicaid patients. > > When changes are made at the macro level, there are reactions. I’m not saying it’s all bad. But anyone arguing that changing to single-payer won’t impact healthcare itself is being illogical. Again, this is one of the reasons for the ACA. I realize that not everyone accepts Medicare. My ex-step-brother-in-law’s wife railed against medicare. He is a psychiatrist specializing in the problems of the rich, so he liked charging an arm and a leg. I had assumed you were worried about changes for the worse. We had better be able to change things for the better, since paying what we are paying now puts on the road to bankruptcy. **wolfpup** has eloquently given plenty of ways in which we can save money. ---
**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:** [November 27, 2018, 5:32pm UTC](https://boards.straightdope.com/t/medicare-for-all-single-payer-system-pros-cons-versus-our-current-system-and-other-systems/824968/70 "2018-11-27T17:32:58Z")
> [@Urbanredneck](#): > > What would happen to the existing insurance companies? Would companies like Aetna and Blue Cross go out of business? Aetna is in the process of being bought by CVS. Perhaps they can be contracted by Medicare to do administration. My supplemental Medicare coverage (not Medicare Advantage) is supplied by United Health Care. I pay them separately, but the coverage is pretty much set by law. ---
**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:** [November 27, 2018, 6:10pm UTC](https://boards.straightdope.com/t/medicare-for-all-single-payer-system-pros-cons-versus-our-current-system-and-other-systems/824968/71 "2018-11-27T18:10:26Z")
> [@Voyager](#): > > I realize that not everyone accepts Medicare. My ex-step-brother-in-law’s wife railed against medicare. He is a psychiatrist specializing in the problems of the rich, so he liked charging an arm and a leg. Just as well he wasn’t an orthopaedic surgeon. ---
**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:** [November 27, 2018, 10:20pm UTC](https://boards.straightdope.com/t/medicare-for-all-single-payer-system-pros-cons-versus-our-current-system-and-other-systems/824968/72 "2018-11-27T22:20:21Z")
> [@Urbanredneck](#): > > What would happen to the existing insurance companies? Would companies like Aetna and Blue Cross go out of business? In countries like Australia and the UK, you can purchase private health insurance to augment the public health care system. You get better care and less wait times. They could do that. ---
**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:** [November 28, 2018, 3:00am UTC](https://boards.straightdope.com/t/medicare-for-all-single-payer-system-pros-cons-versus-our-current-system-and-other-systems/824968/73 "2018-11-28T03:00:32Z")
> [@PatrickLondon](#): > > Just as well he wasn’t an orthopaedic surgeon. Surgeons are one and done. Psychiatry is the gift that keeps on giving. ---
**Author:** ![jasg](https://avatars.discourse-cdn.com/v4/letter/j/f0a364/32.png) [@jasg](https://boards.straightdope.com/u/jasg)\ **Post date:** [November 28, 2018, 5:30am UTC](https://boards.straightdope.com/t/medicare-for-all-single-payer-system-pros-cons-versus-our-current-system-and-other-systems/824968/74 "2018-11-28T05:30:08Z")
> [@Wesley\_Clark](#): > > In countries like Australia and the UK, you can purchase private health insurance to augment the public health care system. You get better care and less wait times. They could do that. Here in the US, Medicare pays only 80% and there is no out of pocket limit - and sometimes extra charges that the government won’t pay. This is very different from employer provided insurance and is quite a surprise to many. Many insurers offer ‘gap’ insurance to avoid expensive surprises. These are good with any providers, nationwide. Another popular add-on insurance for Medicare is Part-C (aka Advantage plans). These function much like traditional plans with co-pays, out of pocket max limits, regional provider networks and pre-approvals for specialists. Insurers seem to make money on these and that could continue with Medicare for All. ---
**Author:** ![survinga](https://avatars.discourse-cdn.com/v4/letter/s/cab0a1/32.png) [@survinga](https://boards.straightdope.com/u/survinga)\ **Post date:** [November 28, 2018, 5:14pm UTC](https://boards.straightdope.com/t/medicare-for-all-single-payer-system-pros-cons-versus-our-current-system-and-other-systems/824968/75 "2018-11-28T17:14:34Z")
> [@Voyager](#): > > I realize that not everyone accepts Medicare. My ex-step-brother-in-law’s wife railed against medicare. He is a psychiatrist specializing in the problems of the rich, so he liked charging an arm and a leg. > I had assumed you were worried about changes for the worse. We had better be able to change things for the better, since paying what we are paying now puts on the road to bankruptcy. **wolfpup** has eloquently given plenty of ways in which we can save money. Yeah, some specialists probably don’t get paid as much under government plans. The private plans pay better, typically. People don’t realize it, but healthcare cost growth slowed noticeably after the ACA was passed. There are some things that were in the ACA that were designed to slow the growth in costs. So, it’s not as if there’s been no progress. I think a good change for the better is getting all states to finally accept the Medicaid expansion. That’s slowly happening, but not fast enough. Given the current politics, it’s states that will be the driver of getting us closer to UHC, at least for now. ---
**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:** [November 28, 2018, 5:56pm UTC](https://boards.straightdope.com/t/medicare-for-all-single-payer-system-pros-cons-versus-our-current-system-and-other-systems/824968/76 "2018-11-28T17:56:41Z")
I know the OP asked specifically about single payer, but it bears repeating that UHC can also be multi0payer, under the “Bismarck” model mentioned by **Grim Render**. Under that model, used in Germany, France and I think Australia, you still have private insurance companies covering medical care, but heavily regulated so they all provide the same coverage. Private US insurance could survive in that type of UHC. ---
**Author:** ![carnivorousplant](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/carnivorousplant/32/3563_2.png) [@carnivorousplant](https://boards.straightdope.com/u/carnivorousplant)\ **Post date:** [November 28, 2018, 7:17pm UTC](https://boards.straightdope.com/t/medicare-for-all-single-payer-system-pros-cons-versus-our-current-system-and-other-systems/824968/77 "2018-11-28T19:17:06Z")
> [@survinga](#): > > Yeah, some specialists probably don’t get paid as much under government plans. The private plans pay better, typically. I thought people became physicians to heal and ease the pain of others. ---
**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:** [November 29, 2018, 1:56am UTC](https://boards.straightdope.com/t/medicare-for-all-single-payer-system-pros-cons-versus-our-current-system-and-other-systems/824968/78 "2018-11-29T01:56:00Z")
Depends on the doctor. Our paediatrician trained in the UK and Canada, but then went off to California. He came back in a few years. “Some things are more important than money” was how he summarised his support for single-payer. ---
**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:** [November 29, 2018, 7:55am UTC](https://boards.straightdope.com/t/medicare-for-all-single-payer-system-pros-cons-versus-our-current-system-and-other-systems/824968/79 "2018-11-29T07:55:27Z")
> [@Northern\_Piper](#): > > Depends on the doctor. Our paediatrician trained in the UK and Canada, but then went off to California. > > He came back in a few years. “Some things are more important than money” was how he summarised his support for single-payer. Most US doctors are really and truly fed up dealing with insurance companies. For some, a partial solution is to join [high-priced “concierge” medical services](https://www.nytimes.com/2017/06/03/business/economy/high-end-medical-care.html), some retire or find other careers, others just leave. My mother’s cardiologist was American ex-pat. My own family doctor has diplomas from various US medical schools so I assume is also from the US, but I’ve never discussed it. In terms of hard numbers, [here’s a WaPo article from 2011](https://www.washingtonpost.com/blogs/wonkblog/post/meme-busting-doctors-are-all-leaving-canada-to-practice-in-the-us/2011/06/03/AGVdAuHH_blog.html?noredirect=on&utm_term=.8e60f351dca8). The chart illustrations appear to be no longer available but the interpretive text is there; bottom line is that in a survey of 11 countries, the US is tied in last place with Germany for worst doctor satisfaction, and although doctors migrate between the US and Canada in both directions, the net migration is _ **from** _ the US _ **to** _ Canada. The article dispels the myth that “doctors are leaving Canada in droves” because of cost controls or anything else. Doctors in Canada generally earn less than in the US, but have far fewer expenses and their fees are paid pretty much automatically and in full. ---
**Author:** ![survinga](https://avatars.discourse-cdn.com/v4/letter/s/cab0a1/32.png) [@survinga](https://boards.straightdope.com/u/survinga)\ **Post date:** [November 30, 2018, 12:00am UTC](https://boards.straightdope.com/t/medicare-for-all-single-payer-system-pros-cons-versus-our-current-system-and-other-systems/824968/80 "2018-11-30T00:00:25Z")
> [@wolfpup](#): > > It’s also, incidentally, an example of why health care reform has to be managed in a holistic, systematic manner, and why piecemeal solutions or so-called “incremental” solutions generally won’t work. The ACA has been very successful in getting millions insured, and cutting the nationwide uninsured rate to less than 9%. It did all of this without impacting the vast majority of insureds in the employer-based area, and it appears that health care costs grew more slow after implementation of the ACA than before. It’s not easy to draw a strict causality, but it did include some items to slow the cost growth in medicare. I think the performance of the ACA, while not perfect, has been better than “won’t work”. The ACA was designed as an incremental change, and it’s done tremendous good for millions. And in the US, the only way forward is incrementalism, because huge leaps like single-payer aren’t politically possible, among other problems… [Previous page](https://boards.straightdope.com/t/medicare-for-all-single-payer-system-pros-cons-versus-our-current-system-and-other-systems/824968.md?page=3) [Next page](https://boards.straightdope.com/t/medicare-for-all-single-payer-system-pros-cons-versus-our-current-system-and-other-systems/824968.md?page=5)