If the U.S. decided to go with a full blown national healthcare system where taxes paid medical for everyone would private insurers be free to charge whatever they pleased to those who chose private healthcare options, could they pick and choose clients based on any criteria they chose?
It would entirely depend on the universal healthcare model chosen by the US government and state governments. There’s no one way to provide UHC.
It depends on the system. A lot of western nations have a hybrid system where public health care covers everyone, but you can buy private insurance on top of it.
However the regulations governing private insurance can vary from nation to nation.
If the US went with a system that allowed private insurers to do whatever they wanted, then private insurers would be able to do whatever they wanted. If the US went with a system that completely banned private insurance, then private insurance would be completely banned. Either of these is possible, or many possibilities in between. You haven’t told us which sort of system you’re asking about.
Notably, Medicare works this way. Basic coverage pays 80% of allowable expenses and “Medigap” supplemental plans cover much or all of the remainder. What’s covered is pretty much fixed according to Medicare rules. There are also more or less private (more or less private because there’s government contribution) “Medicare Advantage” plans that replace one’s Medicare plan and can have premiums lower than traditional Medicare, as low as zero.
Private healthcare in the UK is not regulated for price. There is enough competition to keep them on their toes and of course, they have to compete with the ‘free’ NHS.
The answer is yes. You can now wait the rest of your life to see if I’m correct or not.
In Canada basic medical service is free. You can buy insurance to cover the rest. I have such a policy and it covers chiropractic, footcare, a few other things I have never used and–the only reason I keep it since I don’t believe it pays to keep it otherwise–illnesses outside of Canada. A neighbor suffered a heart attack while visiting the US and the insurance paid to med-evac him to Canada because it was cheaper for them than paying for US care.
In Switzerland and other places (but I know about Switzerland) the medical insurance is private but, by law, non-profit and coverage is universal.
Follow up question re:Canadian health care. I’ve always wondered about this. Years ago I lived in Grand Forks, ND. Winnipeg, MB was 2 hours north. There were (and I assume still are) tourist-type buses that would come to Aurora hospital in GF on a regular basis. I figured it was Canadians with enough money to skip the wait times and get care faster. Or that there were different treatments available in the US (though that doesn’t make much sense since it seems Canada is much more progressive in what’s allowed medically.)
And how would Canadian health insurance work in the US? Is is accepted? Lower rate of coverage? Seriously, they had busloads coming in every week. Any help understanding?
I expect it would mainly be people who could afford to pay to skip the wait time for various things, or who were willing to pay for an expensive and non-covered treatment.
around 1/3 of Americans are already on government healthcare - medicare, medicaid, VA, federal workers and military. That’s around 100 million people.
But in most cases – at least with Medicare – it’s only partial coverage as the patient has to come up with copays that can be substantial, or payments after Medicare limits such as maximum hospital stays have been exhausted, and Medicaid additionally tries to recoup its expenditures. Patient costs are minimal to non-existent under most UHC schemes; in Canada, provinces choosing to receive federal health care funding (they all do) must pay 100% of all costs associated with medically necessary procedures.
I did not say it was universal , just government run. If they were to go to a full universal model they could expand medicare to everyone and change it or do something a lot different.
I have heard of cross-border medical care like this in remote border areas where US medical facilities were much closer than Canadian ones, but this doesn’t seem to be the case for Grand Forks which is no closer to border communities than Winnipeg. Canadian health insurance generally won’t cover such medical tourism except by prior arrangement for specialized procedures unavailable anywhere else.
The odd thing about it is that medical tourism has actually been going the other way, too: it’s big business in Canada and a lot of it comes from the US – ironically, the article cites Manitoba as a medical destination for many residents of Minnesota and North Dakota.
One thing I found that may be of interest is this ten-year old article about a cardiac diagnostic clinic that had been kicked out of Manitoba and was operating in North Dakota and attracting clientele from Manitoba. It’s not clear why it was kicked out but I suspect for violations of health care law by taking cash for medical treatment.
The article quotes the clinic’s owner citing the alleged difficulty and wait times of getting the same cardiac diagnostics done in Manitoba, but having been through both symptomatic and asymptomatic followup cardiac diagnostics myself (albeit in Ontario, not Manitoba) the private clinic owner’s story of the horrors of Manitoba health care (after he was kicked out and his business closed down) sounds like it should be treated with considerable skepticism.
Insurance markets are generally regulated, and if the health insurance market contracted because it was now only profitable to sell insurance which would supplement public cover, there is no reason to think that the insurance would suddenly become unregulated.
But of course we can only guess at what the regulation might be. Insurers would not be free to “pick and choose clients based on any criteria they chose”, if only because things like discrimination on the grounds of race, sex, etc would be forbidden in insurance in the same way that they are forbidden in other business sectors. But they might still have a considerable degree of freedom to sell on whatever terms they chose. Or, they might not. We can’t know until the situation arises, and a regulatory framework for supplementary health insurance is put in place.
Medicare Advantage plans can have a $0 premium, but you still pay the standard Medicare Part B premium $134/month to the government (usually out of your SS check). Drug coverage and other things like vision may be covered.
Copays and coinsurance are generally, but not always, lower than the standard 20% of Part B. However, Advantage programs are run by an insurance company. Meaning you are possibly in a narrow PPO network or HMO rather than just picking any provider.
One reason the insurance companies can do this is because the federal government actually pays them more per enrollee than the typical cost of a regular Medicare enrollee.
Thanks for the reply wolfpup. I was thinking it had to be something either cardiac or oncology. Yet another follow-up question though. And this is a general question to everyone. If Canada has “National” health care, why would it matter if it’s in Manitoba, Ontario or British Columbia? Not to denigrate Canada or any other country with a national system (and I’ve come to believe it’s probably best for the US), why would it matter what province you’re in? And yes, I realize this might be getting into GD territory. Apologies if getting too deep for GQ
That question can be answered quite factually and is not in any way controversial or GD territory. Each of Canada’s provinces and territories has its own health care system, independently funded and administered. However, with the spread of universal health care across Canada, it became perceived as an important national value, and in 1984 a framework of federal standards called the Canada Health Act was enacted. Reflecting the rights of provincial autonomy, the CHA is not mandatory, but is a condition of receiving federal subsidies for provincial UHC programs should provinces choose to adopt them. Every province and territory has opted in, and therefore every one conforms to the CHA framework on such matters as 100% payment by the public plan, no extra-billing of patients permitted, and no private insurance allowed for medically necessary procedures. So the “Canadian health care system” is a set of independently administered systems that conform to a national framework of basic standards.
Because we don’t have a national system. The federal government does not regulate health care and does not provide health care. What it does is provide money. It sets the basic terms for Medicare - if a province wants federal money, it has to agree to the basic principles of the Canada Health Act like universality and portability. All provinces have agreed to those terms so they get the federal money.
But we have 13 health care systems: 10 provinces and 3 territories. Each of them has broad discretion how to structure their health care systems, administration, hospitals, compensation for doctors (who are independent contractors, not employees of the Government) and pay rates for nurses, lab techs, etc. There can be considerable variation in delivery and emphasis from province to province.
Ninja’d by wolfpup!
Ah. OK, I thought Canada had National Health Care, didn’t realize it was subsidies to the provinces insuring. That clears it up a bit for me. Thanks! 