I understand your point about Medicare for seniors, but the same would have applied if she was 60. To counter your point 2, if the US took the profit portion out with single payer, they wouldn’t need to spend so much.
The big difference in Canada is that you can’t go around the system and say “I’ve got the cash,I’ll pay for it myself”. Medicare is not single payer, it is just that all covered people have the same payer. Single payer is Canada covers almost everyone.
But some systems do allow people to spend more privately for better care. The UK and Australia for example. And both those systems are, like Canada, half as expensive as the American system.
IMO the issue in America isn’t single payer. The issue is that our system is run horribly by plutocrats and politicians beholden to those plutocrats who ensure nothing is done to address our broken system. The netherlands has a multi payer system. Canada has public payer, private providers. The NHS has public payer and public provider. In Australia you can buy private coverage above and beyond the public system, in Canada (AFAIK) you cannot. Germany has endless payers, the UK has one.
But they all spend half what we do and have better health outcomes because unlike our system, they are all run with the goal of providing high quality care to everyone at a low price. The US system is designed to use regulatory capture to make private industries rich.
And restricted even in urban areas. I did not sign up with Medicare Advantage because none of the (private) plans available to me at the time included my doctor. People in HMOs are restricted to doctors practicing in that HMO, and when you choose a PPO system, like I had before going on Medicare, you are restricted to doctors in the system and have the GP as a gatekeeper. Why, BTW, I see as a good thing.
In fact PatrickLondon could be describing my US system - except that I pay a lot more.
And we have the jolly surprises such as finding out that the anesthesiologist being used for your operation is not in the network, so you get hit with a gigantic bill.
Unless you’re very rural, there’s normally some choice; even living in a village of 2000 people, we had several options, in nearby small towns/neighbouring villages. My friend that lives in the middle of nowhere on a hill farm may only have one option, but it’s very common for even larger villages to have two doctors’ surgeries, sometimes even right next door to each other.
For specialists, supposedly, when referred by your GP, you get given a list of the available options and you can pick from the list (at least in a non-emergency situation). However, I don’t know what everyone else’s experiences of this ‘patient choice’ initiative are, but I’ve yet to see a list with more than one option, even when living in one of the largest cities in the UK. Cynically, I suspect it’s of more use for skewing the waiting list stats, as you’re not officially waiting for any one specialist until you’ve ‘chosen’ that specialist. Maybe in London or for commoner conditions people get a real choice, I don’t know.
I know I’ve posted this before, but regarding wait times, as a personal example of how the waiting times can be highly misleading, the one time I had in-patient surgery, I was told the waiting list was 8-10 weeks, and given the choice between staying and having it that day or coming back in the morning, as the most severe case on the list.
Mistakes happen and the system is always stretched, but the system is intended to stop people waiting for treatment that risks death or further damage. You see what looks like unacceptable wait times for serious conditions, but that doesn’t always reflect the reality.
The Health Maintenance Act, passed in 1973, under Nixon, (as a favour to friend/supporter Edgar Kaiser), permitted medical insurers, clinics, hospitals and Drs to operate as ‘for profit’, instead of as service orgs. Until this legislation that was not permitted.
Guess who received the first federal subsidy to implement this ‘advance’?
That’s right, Kaiser Permanente!
Depends entirely on the circumstances. My own experiences in recent years are
(a) GP’s referral for X-ray when I had a sciatica meant turning up at the local centre with the request form, no appointment necessary - went next day, no great queue, in and out in half an hour
(b) GP’s subsequent referral to vascular specialist ( as I was anxious about a localised leg pain on top of the sciatica) offered a choice of four hospitals - I chose the one with the shortest wait times and easiest journey (which also has the best reputation) - all sorted within three weeks
(b) GP’s referral for ultrasound meant waiting to be notified of an appointment at the main local teaching hospital (no choice) - it was all done in a fortnight
(c) GP’s referral for endoscopy - which he had hoped the ultrasound would obviate - required second opinion by the local NHS organisation, but it all went through -again, notification by the local teaching hospital and no choice; if memory serves, the total time to completion was no more than four weeks, and I was given on the spot a printout of the report to my GP (complete with pictures of my innards)
(d) GP’s referral to liver specialists for a second check on abnormal blood tests: no choice, just waiting for the local teaching hospital to come up with an appointment: again, all done in three weeks, though the follow-up reporting back was very old-fashioned and paper-based.
Of course London is notoriously better supplied than some other parts of the country…
I wonder if our waiting times reflect a cultural tendency to “watch and wait”, which may or may not be influenced by a desire to minimise costs, or just to avoid over-medicalising and over-treatment.
(PS - all my issues have settled down and all is well now)
Remember, it wont be “free”. You just pay for it a different way.
How much would it cost in the USA if the whole country went over to a single payer and how would we pay for it?
I read somewhere like $1.4 trillion for the Bernie Sanders plan. He proposed a higher general income tax, a tax on employers, and a higher tax for the rich.
But then, Sanders also promised free college education for all.
All those things wont be cheap.
How would we pay for them?
How are we paying for what we have now? It would need to be instead-of, not on-top-of. Turn my insurance premium paycheck withholding into a health care tax paycheck withholding, take out the cut that is for the purpose of private stockholders’ profit and the redundant processing overhead, I should be able to handle it. I already pay my share of taxes for Medicaid and Medicare and the VA.
But the big failure of nerve when talking about US health coverage has been that it is perceived that the continued permanence of the existent for-profit care models and insurance carriers as they stand is non-negotiable.
We take the money we’re currently spending privately on health care and spend it on taxes instead.
As well as the public money you’re already spending on healthcare.
The public money spent on health care in the US is a greater percentage of GDP than the public money spent in Canada and the UK, as percentages of their respective GDPs.
It could be a re-allocation of public money already being spent, rather than new public money being allocated.
If that is the case, it will never happen. It has to be UHC (not necessarily single-payer), Not both.
The argument I’ve heard is about 60% of health care spending is public, 20% is private insurance, 20% is out of pocket.
With single payer health care would be cheaper hopefully, so assume 90%. Keep the 60% in taxes, and replace 25% with public spending (maybe keep 5% out of pocket for things not covered by medicare for all like untested, OTC, elective or cosmetic procedures).
That would mean we need 4.5% of GDP in new taxes to fund single payer (25% of 18%). Thats about $850 billion a year. We could get that via a mix of payroll taxes and progressive taxes on investments and income.
I said the same thing on the previous mega-thread that I’m about to say here. And this is not popular on this board:
With the US’s political situation, I doubt we will ever have full single-payer. And even if we did, it would likely be an inefficient mess, with all the compromises and horse-trading it would take to make it a reality in this country.
On top of that, 3 out of 4 people in the US like the healthcare they are getting. And about half of the country are getting their insurance through private sources, typically their employer. I’m in that last group, and I like the insurance I get through my employer and don’t want to lose it to be replaced by “God knows what single payer” that our broken political system would develop.
And I don’t want the Republicans to ever be in charge of my healthcare if we went to single payer, because they’d try to rip it to shreds. Under the current patchwork quilt that we have in the US, they can only target this or that sub-group, not the full system.
Finally, our system currently has about 91% of America covered with some sort of insurance. We should take the path of least resistance to get to 100% covered. And that would mostly be from expanding medicaid & making the ACA exchange plans more rich in subsidies for the middle to lower-middle class.
In any event, UHC should be the goal, using the mix of private and public insurance that has existed for decades in this country, and not single-payer (which will never happen in any event).
And recent observation shows, one of our political factions wants to avoid even THAT, and “rip to shreds” any possibility of moving in that direction.
First, 70% of Americans support Medicare for all. Cite.
People like most things they are used to. Why do people stay in jobs they don’t like and where they are underpaid, even in a good economy?
If you phrase the question “would you like your health care at half the cost” you might get a different answer.
And people on Medicare are more satisfied than people covered by private employers. Cite.
The real problem I think is the lies Republicans tell about single payer plans, and the refusal to acknowledge how inefficient our system is. I haven’t seen a “they are different from us!” note in this thread so far (really, Canadians?) but I’m sure it will be coming.
It would cost about half of your current total costs.
Currently, you pay over 18 % of GDP for healthcare. About half and half public and private, results are below average and you fail at the basic task of covering everyone. So 9 % of your costs are public as it is. Its even worse if you look at it in terms of dollars per citizen, because you are among the top nations for GDP per capita, so percent of gdp actually undersell how much you spend. There are in fact few nations who spend as much in total, public private and out-of-pocket, as your government spend on health care. (Switzerland, Norway and Luxembourg of the top of my head)
Given that you are not unfamiliar with basic economics and have numerous large advantages in the economics of scale, there seems no obvious reason beyond corruption for you to have above average costs.
From a certain perspective it will actually be free, or a bit cheaper than that. Currently the fraction of your population that are taxpayers pay more than other nations taxpayers towards health care, while receiving no healthcare for the money. Get something where you currently get nothing and that is in practice free.
True, but the Medicaid expansion & ACA exchange is heavily affected by states. So, there are enough states that are moving positively in the direction of more coverage. Maine, Nebraska, Idaho & Utah are examples of states that are expanding Medicaid soon. Virginia is expanding Medicaid, too. Nevada & New Mexico are looking at the possibility of a medicaid buy-in option. Some states, such as New Jersey, are re-implementing the individual mandate. I think the states are going to move us in the direction of UHC quicker than we can get nationwide single-payer. Incrementalism is often the best way.
Here’s a more recent cite (yours was from 2015), where 77% of the overall public sees their own healthcare as good or excellent:
Americans are largely positive about the quality of the healthcare they receive: Three-quarters of employed Americans (75%) said the healthcare they received was “excellent” or “good” in Gallup’s last survey on the issue, in November 2017. There is little difference between U.S. workers and the overall public, among whom 77% rate their personal healthcare as “excellent” or “good.”
Republicans lie about alot of things. Healthcare is one issue among many. But as long as they have either the White House or one of the houses of Congress, they can effectively block single-payer from ever happening. The focus needs to be on getting the individual states to move toward UHC within the system we already have. That’s the political reality of America.
The ACA has made tremendous progress toward UHC, as we were 16% uninsured in 2010 and are now 8.8%. Here’s the link:
If it were implemented as originally envisioned, we would easily get below 5% uninsured, and could then strengthen the subsidies enough to get to full UHC.
Health care, which isn’t the same as health insurance.
I’m content with the health care I get, but my insurance is garbage. Its not the same thing.
Your link also says the following.
About three quarters of Americans feel the US health care system is in a state of crisis or has major problems.
You made some good points about single payer. I also worry what happens if the GOP gains political power when we have single payer. Will they disband or destroy it? Put a poison pill in it so it collapses? I’m sure they will try.
But the % of Americans who are content with their health insurance keeps dropping. Copays, deductibles & premiums keep going up while coverage keeps going down. People are being asked to spend $1000 a month on garbage insurance that probably won’t cover them anyway if they get sick.
Even if we can’t get single payer on the federal level, we need programs to reduce costs and lower the indivduals health care costs. It isn’t sustainable. As it stands, the average retiree spends 40% of their social security check on health care not covered by medicare. By 2030 it’ll be 50%. Then you have all the money spent privately on top of it when you are working. The average American cannot afford $200,000-300,000 privately for insurance and medical care over the course of their lives (that figure doesn’t include medical care covered by employers or covered by public health systems, which adds another 500k or so to lifetime medical spending).
If you earn $50k a year for 40 years (age 23 to 63), that means you earn 2 million gross. Add in taxes and you’re down to about 1.5 million. The public are being asked to spend 200-300k out of pocket on medical care not covered by medicare or private insurance, insurance premiums at work, copays, deductibles, etc. over the course of their lives from age 23 to death. That is almost 1/5 of your entire life’s earnings after taxes. It isn’t sustainable, and that number grows every year.
The system is rapidly headed for collapse.
See what you think of Matt Yglesias’s argument here. In a nutshell, he argues that a “big, dumb” government program like M4A would be safer from interference because it wouldn’t require cooperation from regulatory agencies the way ACA does. It’d just keep cutting checks unless actual future GOP legislators could find the cojones to alter or repeal it. The history of Social Security suggests radical change would be difficult.
Yglesias doesn’t think this is ideal, by the way, just that it’s the only realistic path once the Democrats have power: