Some pretty good answers here. The non-answers are even better.
The main thing is, the vast majority of POLITICAL attempts to answer this question, have been based on the assumption that the only thing that would be changed, is that instead of hundreds of thousands of insurance companies paying for SOME things, that the Federal government would pay for everything out of tax revenues.
That’s always at least in error, and often an intentionally duplicitous approach. As some have pointed out, current absurd costs are only rarely due to any normal capitalist business model. They aren’t based on actual cost plus needed profit margin, in other words. They are based on heavily manipulated and remanipulated artificial concerns of several kinds.
If we leave all the manipulation and completely illogical systems in place, and simply switch from the many-payer system to a single payer, exactly how that was done, would STILL make for various answers to the question, because WHO pays, and when, and how, would have a variety of effects on final cost. Simple observation: if you allow a business to figure an expense in as a basic cost, such that they will add a profit margin uplift to it before passing it on to their customers, any added cost will grow tremendously before it figures into the final price of the product or service involved.
One of my pet fantasies about regulatory laws, is that one day, someone will realize that if it is written into the law that all penalties for failing to adhere to regulations would be taken directly and ONLY from the CEO and other upper officer personal incomes, I think we’d see a LOT fewer efforts to seek “work arounds” to regulations.
I may have started a thread, but I don’t remember. The first thing we need to do is to decide what we want a healthcare system to accomplish. Single-payer? Private providers? A hybrid system where everyone has single-payer, or the option of single-payer, plus the option of private providers? Do we want a non-profit health system, or a for-profit one? None of that matters until the goal is established. Once the goal is established, we can figure out how to reach it.
I’m ready to hop aboard the single-payer train, as nothing about how health care insurance works currently makes any sense to me. One question I have not seen addressed, however, is what would happen to all the private health-insurance related jobs. I feel like that is probably a lot of people (way more than are currently mining coal) who would be out of work.
Many countries use insurance companies to handle the payment process. The companies are regulated non-profits - but can offer supplemental coverage on the side for things like private rooms, dental or vision coverage.
In the US, Medicare supplement plans work this way as do the German and Swiss systems.
“Single payer” does not have to be the goal, “universal coverage” is the key. Multi-payer backed by the government has worked in Germany for over a hundred years.
The out-of-work people is a feature, not a bug. Bureaucratic personnel costs make up a huge percent of the cost savings, larger than company profit margins and probably larger than negotiated drug costs.
That said, some of them would still find work either in the private or public sector in administering the UHC.
Yes and no. In systems like Canada’s, the single payer (much like your Medicare) publishes a fee schedule, what it intends to pay. It’s a take it or leave it proposition, with one difference - it’s the only game in town. This removes one illogical system problem - the ludicrous fee schedules, where aspirin can cost $100 and tongue depressors are $10 each. Full coverage removes another illogical driver - hospitals are mandated to provide basic services for people who cannot pay, and compensate for that by raising rates for the rest, to $100 per aspirin. And to re-iterate, a lot of the inflated salaries for non-medical staff like CEO’s would disappear, once hospitals are no longer cash cows.
Plus, perhaps it will all be paid out of taxes; but then taxes can go up since nobody will be paying the thousands per year that what, 70% of the population currently pay for insurance, either directly or through their employer.
The problem with NOT paying out of taxes, is how do you make the healthy help pay? With employer plans, they automatically enroll everyone. If it’s voluntary, only people who need it will enroll. So should you fine people who don’t enroll - and then pass that fine on to the appropriate insurance provider? Sounds like tax-enforced enrollment, might as well b taxes.
A big problem of the multi-source insurance system in the USA today is that health care is tied to employment - the classic “golden handcuffs” problem. In a universal system (single-payer or not) people do not have to worry about coverage as a feature of which job they have; plus, it simplifies things for the employer - they are not burdened with an albatross cost, which their competitors might be skimping on. It also avoids that ACA loophole about part-time vs. full time. (Was it Delaware several years ago that had to pass a “large employers health insurance” bill basically saying that large employers - of which Wal-Mart was the only employer that qualified - MUST provide health care, since Wal-Mart was not doing so…)
If you maintain a multi-payer system, and allow private companies to manage it - what is the control? Who ensures everyone signs up and pays up? What’s the differential between each insurance company - price? Coverage - shouldn’t they all have the same? Network - isn’t the whole point that you should be able to see any doctor, not just a select subset? Also, network then would differentiate on how much a doctor is paid, creating another problem as doctors abandon lower-paying plans…
The problem is that true UHC means practical dictatorship in health care; that all doctors are part of the same group and get only the published fee schedule, no extra billing for standard services. All hospitals are run by the state for the efficient allocation of resources. Should a hospital be allowed to buy an MRI if there are plenty in the area and they are already sitting idle too often? (Will it just steal trained personnel from another hospital?) Does the city need another heart surgery treatment center?
(Should point out that published schedules for hospital treatments are such that many private institutions would go bankrupt very quickly, meaning they would then be taken over by the state, which then would subsidize / budget for their extra costs, with funds low enough that many cushy salaries would disappear.)
I suspect it will be a major, untreatable trauma, to drag the current US system into that kind of thinking…
General taxation is one way to pay for it - and certainly is true for single payer. I probably risk derailing this thread with comments on multi-payer so let’s just say that universal single-payer is rather rare. Universal multi-payer systems where general taxation only pays for the poor, elderly or unemployed are more common.
You don’t necessarily have to have total dictatorship and all hospitals run by the state- as long as, one way or another, there are enough within the public/state system to provide a service that enough of the general public are content with. But granted, getting there from here is a difficult proposition.
One place single payer might realize a cost saving would be malpractice insurance, which is one of the contributors to the price of health care. Ob/Gyn specialists often pay yearly premiums in the six digit range, which they have to cover in fees. With single payer, malpractice would probably be handled rather differently, I imagine.
Canada strictly enforces the “no for profit or private medical facilities” rule; otherwise, it’s the thin edge of the wedge. We don’t allow the NHS/Private system that Britain has, to prevent the public side from deteriorating into an expensive but useless mess - there is only one system.
Someone mentioned - if it’s NHS, wait a few months to see the specialist; private pay - come in later this week. Canada does not want that double standard - “I can make more money off you by making you pay extra to skip the line”.
You’re missing the point of single-payer systems. If there’s only one payer, and presumably they publish a fee list, then who will use the private facilities for a premium? Canada, for example, does NOT allow extra billing. The doctor either charges the published fees and gets paid by the province, or good luck finding patients who can afford to pay your fees cash.
Employers don’t have other health care insurers’ plans - that’s the opposite of single payer, and if the state provides, why would a private body need to pay extra? Paying a doctor or hospital above and beyond the published fee just means tax dollars (or single payer dollars) do not do what they are supposed to - cover all costs.
If a private facility accepts patients at the same rate as public hospitals, then it just becomes another facility - plugged up with queues just as long as the other hospitals… unless you suggest a private facility can pick and choose its patients. Imagine the howling that would cause, if a hospital said “we will treat you, we will move you ahead of others in the queue - but not you…” that would have to be done on an equitable basis - need.
now the problem is that the published fee schedule cannot cover the operating overhead of public hospitals, they also receive operating budgets. Without the same, a private hospital could not survive. SO now, you have a facility that is private but expects a government subsidy for operations… that will ALWAYS come with strings attached, and at a minimal number.
but you are truly right, the “getting there” will be the most difficult part. When Medicare was first imposed, by Saskatchewan in the 1950’s, forcing all doctors to accept all patients according to a fee schedule dictated by the province - many doctors in that province went on strike for several months; while doctors of a more humanitarian bent came in and filled in to help force the change. This in a farming province and was back when a rural doctor might sometimes be paid in chickens not cash by poor farm families.
Yes, I was rather taking for granted the NHS model, which is based on block budgeting for the public system, in which the hospitals for specialist care are owned and managed by the system on block budgetting, rather than reimbursement per treatment. There are arguments about whether the option for private treatment in NHS hospitals allows queue-jumping, but the financial incentive to the lead specialist doctor is limited under the terms of their NHS employment contract. Otherwise, it is the same as with you, an entirely private arrangement in an entirely independent hospital. End result: not more than about 10% of care is privately paid-for, and that is mostly for relatively simple and routine operations, and cosmetic surgery (and the NHS picks up the pieces if anything goes wrong).
But that depends on strong national/governmental controls over the contracts and financing of both hospitals and doctors. The only reason there wasn’t the Saskatchewan problem in the UK in 1948 was that the hospitals were on their knees because of the war and its knock-on effects, and mostly only too glad to be nationalised, and the GPs were in the end offered terms they couldn’t refuse - as the minister of the time put it “We stuffed their mouths with gold”.
None of the UHC systems I am familiar with work anything like that. I mean, not remotely. And I would not agree that we do not have “true UHC” in Scandinavia or the UK.
UK? The dichotomy between private and NHS healthcare in the UK is a frequent source of discussion, and specifically the model Canada has sought to avoid. “I can see you in 3 months for the standard fee, or next week for a significant amount more…” That’s a system extremely prone to abuse. So a doctor cannot bill the system for ANY patients (nor can they get reimbursed) if he also performs the same services for a higher fee for any patients covered by the provincial plan. It’s all-in or nothing.
It’s also a major plus for employers - nobody feels pressured to provide a very expensive health-care benefit to provide what the government is allegedly already providing for free. So there is no parallel for-pay system, except maybe doctors to the 1%, to pro sports teams, etc. - an extremely limited market.
Canada specifically banned extra-billing (“I charge 10% more than the fee schedule, bring your cheque-book”) when it became so widespread that “free” healthcare pretty much had disappeared, well over 50% of doctors in Ontario, for example, extra-billed.
Every so often someone tries to start operating a for-pay-only service such as MRI clinic; the side effect of free medicine is a waiting list. “For $X jump the queue!” Several complaints about this - odds are the techs -if they’re competent- are stolen from the public sector, thus making the wait times longer for others and bidding up the wages on those professionals making overall health costs higher. Then there’s the idea that having money lets you jump the queue - anathema to Canadian values. And the idea that desperate people will then go heavily into debt in a possibly false hope (fueled by the clinic’s marketing?) that this will help solve their medical problems. Canada prides itself in NOT being a country like the USA where sickness can lead quickly to bankruptcy and loss of life’s savings.
My point is that this is not common, nor is it usual. As a setup, it is almost as much of an outlier as the US setup. Saying that “true UHC means practical dictatorship in health care; that all doctors are part of the same group and get only the published fee schedule, no extra billing for standard services. All hospitals are run by the state for the efficient allocation of resources.” is obviously very wrong. There are many ways to deliver UHC, and that particular setup is an outlier.
By far the majority of UHC countries run a public system and has private provision filling in the cracks. There is no call or reason to say that these do not have true UHC.
The notion that this would mean that “desperate people will then go heavily into debt in a possibly false hope (fueled by the clinic’s marketing?) that this will help solve their medical problems.” is, I am sorry to say, almost as remote from reality as the US rightwing representations of UHC systems.