# Socialized Medicine and Single Payer Systems **URL:** \ **Category:** Great Debates\ **Created:** [August 6, 2012, 6:58pm UTC](https://boards.straightdope.com/t/socialized-medicine-and-single-payer-systems/630644 "2012-08-06T18:58:33Z")\ **Posts on this page:** 20\ **Page:** 10
**Author:** ![tagos](https://avatars.discourse-cdn.com/v4/letter/t/bbe5ce/32.png) [@tagos](https://boards.straightdope.com/u/tagos)\ **Post date:** [August 22, 2012, 2:34pm UTC](https://boards.straightdope.com/t/socialized-medicine-and-single-payer-systems/630644/181 "2012-08-22T14:34:27Z")
> [@adaher](#): > > I never tried to make the case that US health care is better. I was actually trying to point out that the multipayer systems of continental Europe are superior to the NHS model. > > Good luck trying to deny that continental Europe has better health care than Britain. If it’s all the same with you I won’t be trotting around after your goalposts. I’m pretty sure other national schemes variants like the French national health system with its generous combination of state cost reimbursement and mutual not-for-profit, no loopholes, no funny business, low cost supplementary insurance is better than the NHS. I’m assuming you are not so ignorant of the nature of the European mix of state and not-for-profit supplementry insurance that you think they in any way at all like the US system? ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [August 22, 2012, 2:35pm UTC](https://boards.straightdope.com/t/socialized-medicine-and-single-payer-systems/630644/182 "2012-08-22T14:35:23Z")
Because the NHS is the most centralized, directly government-run health care system in the free world. The best system in the world is France’s, and that should be the basis for other countries seeking to model their system after what works. Yet when most activists think about UHC, they think about single payer. ---
**Author:** ![Banquet\_Bear](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/banquet_bear/32/373_2.png) [@Banquet\_Bear](https://boards.straightdope.com/u/Banquet_Bear)\ **Post date:** [August 22, 2012, 2:45pm UTC](https://boards.straightdope.com/t/socialized-medicine-and-single-payer-systems/630644/183 "2012-08-22T14:45:55Z")
> [@adaher](#): > > Because the NHS is the most centralized, directly government-run health care system in the free world. …assertion without evidence. And even if it were true, so what? Based on the available evidence it works quite well, doesn’t it? > [@](#): > > The best system in the world is France’s, and that should be the basis for other countries seeking to model their system after what works. Yet when most activists think about UHC, they think about single payer. I just checked the thread: and this is the very first time you’ve bought up France in this whole discussion. Again: more evidence that you are inventing stuff out of thin air. You are so desperate to make the NHS look bad you will throw anything at it. Now your argument seems to be that the NHS isn’t as good as the French system. I don’t understand why you want it to look so bad. Care to explain? ---
**Author:** ![fumster](https://avatars.discourse-cdn.com/v4/letter/f/e9c0ed/32.png) [@fumster](https://boards.straightdope.com/u/fumster)\ **Post date:** [August 22, 2012, 2:47pm UTC](https://boards.straightdope.com/t/socialized-medicine-and-single-payer-systems/630644/184 "2012-08-22T14:47:31Z")
> [@adaher](#): > > Because the NHS is the most centralized, directly government-run health care system in the free world. The best system in the world is France’s, and that should be the basis for other countries seeking to model their system after what works. Yet when most activists think about UHC, they think about single payer. So someone with an ax to grind couldn’t cherry pick anecdotes from France’s system to make it look bad like they could with the NHS? ---
**Author:** ![tagos](https://avatars.discourse-cdn.com/v4/letter/t/bbe5ce/32.png) [@tagos](https://boards.straightdope.com/u/tagos)\ **Post date:** [August 22, 2012, 3:00pm UTC](https://boards.straightdope.com/t/socialized-medicine-and-single-payer-systems/630644/185 "2012-08-22T15:00:41Z")
The French system is a mix of state funding and compulsory mutual insurance deducted from your pay packet (a tax in fact). It is in essence a single payer scheme like the NHS. Just a better, more generous one with no insurance company sharks swimming in the pool. The Euro schemes are all variants of universal health systems and have infinitely more in common with each other than they do with the universally despised US system ---
**Author:** ![Nava](https://avatars.discourse-cdn.com/v4/letter/n/da6949/32.png) [@Nava](https://boards.straightdope.com/u/Nava)\ **Post date:** [August 22, 2012, 3:02pm UTC](https://boards.straightdope.com/t/socialized-medicine-and-single-payer-systems/630644/186 "2012-08-22T15:02:49Z")
> [@adaher](#): > > I never tried to make the case that US health care is better. I was actually trying to point out that the multipayer systems of continental Europe are superior to the NHS model. > > Good luck trying to deny that continental Europe has better health care than Britain. The Spanish system got fucked up by moving from single-payer to “still the government pays but now it’s regional ones”. Can we go back to single-payer _please_? Oh, you’re not interested in those systems where having multiple payers has fucked things up? Sorry, it’s the one I’m most familiar with! ---
**Author:** ![MarcusF](https://avatars.discourse-cdn.com/v4/letter/m/67e7ee/32.png) [@MarcusF](https://boards.straightdope.com/u/MarcusF)\ **Post date:** [August 22, 2012, 3:05pm UTC](https://boards.straightdope.com/t/socialized-medicine-and-single-payer-systems/630644/187 "2012-08-22T15:05:45Z")
> [@adaher](#): > > Because the NHS is the most centralized, directly government-run health care system in the free world. The best system in the world is France’s, and that should be the basis for other countries seeking to model their system after what works. Yet when most activists think about UHC, they think about single payer. Wow! I must apologise - there was me thinking you were opposed to universal health care. Now I realise it is only the NHS model you are opposed to. So, can we have a clear statement that the US would be better off if it introduced a health care system on the French model? ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [August 22, 2012, 4:41pm UTC](https://boards.straightdope.com/t/socialized-medicine-and-single-payer-systems/630644/188 "2012-08-22T16:41:16Z")
> [@Banquet\_Bear](#): > > …assertion without evidence. And even if it were true, so what? Based on the available evidence it works quite well, doesn’t it? Hardly an assertion, common knowledge. Do you actually not know about any health care systems other than the US and Britain? Canada, Australia, Taiwan, and the United Kingdom have single-payer health insurance programs. These programs provide universal health care. Single-payer healthcare may be operated in a number of ways. \*\*In some cases doctors may be employed, and hospitals run by, the government as in the United Kingdom. \*\*Alternatively the government may purchase healthcare services from outside organizations. This is the approach taken in Canada. Now it says, “Some cases”, but fails to list any other nation where doctors are directly employed by the government. This, as far as I know, is unique to Britain. > [@](#): > > I just checked the thread: and this is the very first time you’ve bought up France in this whole discussion. Again: more evidence that you are inventing stuff out of thin air. You are so desperate to make the NHS look bad you will throw anything at it. Now your argument seems to be that the NHS isn’t as good as the French system. I don’t understand why you want it to look so bad. Care to explain? Why do so many commentators want the US system to look so bad? Then you have your answer. I did not single out France specifically for praise, but I have mentioned the superiority of multi-payer systems over single payer systems regularly. ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [August 22, 2012, 4:47pm UTC](https://boards.straightdope.com/t/socialized-medicine-and-single-payer-systems/630644/189 "2012-08-22T16:47:51Z")
> [@MarcusF](#): > > Wow! I must apologise - there was me thinking you were opposed to universal health care. Now I realise it is only the NHS model you are opposed to. > > So, can we have a clear statement that the US would be better off if it introduced a health care system on the French model? Swiss model would be best yet. 🙂 But the French model would work too, provided we have a low floor. French citizens have to pay an average of 30% of costs out of pocket as a co-pay. UK health care is free at the point of service, no? The co-pays seem to make all the difference when it comes to avoiding overwhelming the system. ---
**Author:** ![Jas09](https://avatars.discourse-cdn.com/v4/letter/j/d07c76/32.png) [@Jas09](https://boards.straightdope.com/u/Jas09)\ **Post date:** [August 22, 2012, 4:49pm UTC](https://boards.straightdope.com/t/socialized-medicine-and-single-payer-systems/630644/190 "2012-08-22T16:49:06Z")
> [@adaher](#): > > Now it says, “Some cases”, but fails to list any other nation where doctors are directly employed by the government. This, as far as I know, is unique to Britain. This is also the case in the United States. The VA directly employees its providers. ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [August 22, 2012, 4:50pm UTC](https://boards.straightdope.com/t/socialized-medicine-and-single-payer-systems/630644/191 "2012-08-22T16:50:53Z")
We do have single payer systems that cover subsets of our population: the poor, veterans, and the elderly. ---
**Author:** ![Jas09](https://avatars.discourse-cdn.com/v4/letter/j/d07c76/32.png) [@Jas09](https://boards.straightdope.com/u/Jas09)\ **Post date:** [August 22, 2012, 4:58pm UTC](https://boards.straightdope.com/t/socialized-medicine-and-single-payer-systems/630644/192 "2012-08-22T16:58:07Z")
Right, and the difference between Medicare/Medicaid and the VA is exactly what you are describing - the VA is like NHS, Medicare/Medicaid is like Canada/France (in loose terms). ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [August 22, 2012, 5:00pm UTC](https://boards.straightdope.com/t/socialized-medicine-and-single-payer-systems/630644/193 "2012-08-22T17:00:11Z")
Yes, and Obamacare is a lot like Swiss health care. So we’re just doing the whole health of nations experiment right here at home.🙂 For what it’s worth, I think Medicare should be scrapped and everyone should just be under Obamacare. ---
**Author:** ![Jas09](https://avatars.discourse-cdn.com/v4/letter/j/d07c76/32.png) [@Jas09](https://boards.straightdope.com/u/Jas09)\ **Post date:** [August 22, 2012, 5:01pm UTC](https://boards.straightdope.com/t/socialized-medicine-and-single-payer-systems/630644/194 "2012-08-22T17:01:55Z")
> [@adaher](#): > > Yes, and Obamacare is a lot like Swiss health care. So we’re just doing the whole health of nations experiment right here at home.🙂 So true. > [@](#): > > For what it’s worth, I think Medicare should be scrapped and everyone should just be under Obamacare. Which, somewhat ironically, is the Ryan proposal. Except, of course, he’d get rid of Obamacare for everybody else… ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [August 22, 2012, 5:04pm UTC](https://boards.straightdope.com/t/socialized-medicine-and-single-payer-systems/630644/195 "2012-08-22T17:04:13Z")
Which means there could be a compromise in there. Obamacare itself is very flawed, but the basic outline is sound and as has been pointed out, supported by conservatives. It’s some of the specifics that cause problems: the subsidies are too generous and the HHS has too much power to impose mandates that increase the cost of insurance. ---
**Author:** ![amanset](https://avatars.discourse-cdn.com/v4/letter/a/8dc957/32.png) [@amanset](https://boards.straightdope.com/u/amanset)\ **Post date:** [August 22, 2012, 5:14pm UTC](https://boards.straightdope.com/t/socialized-medicine-and-single-payer-systems/630644/196 "2012-08-22T17:14:03Z")
> [@adaher](#): > > \*\*In some cases doctors may be employed, and hospitals run by, the government as in the United Kingdom. \*\* Pretty sure that’s the way we do it in Sweden for the most part. A lot was made of S:t Görans Sjukhus in Stockholm being the first privately run emergency hospital in Sweden. I believe a region’s Landstinget employs doctors, nurses etc in most hospitals. [http://www.saco.se/Yrken-A-O/Lakare/](http://www.saco.se/Yrken-A-O/Lakare/) > [@](#): > > Flertalet läkare i Sverige (ca 80 procent) är anställda av landsting och kommuner vid sjukhus och vårdcentraler Translates as: "The majority of doctors in Sweden (around 80 percent) are employed by the county council and communities in hospitals and GP surgeries. " So do we (Sweden) have crap healthcare too? ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [August 22, 2012, 5:19pm UTC](https://boards.straightdope.com/t/socialized-medicine-and-single-payer-systems/630644/197 "2012-08-22T17:19:17Z")
Sweden has great health care. I also notice that Sweden charges co-pays, so maybe the centralization is less the issue than the fact that lack of co-pays is overburdening the NHS. ---
**Author:** ![Czarcasm](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/czarcasm/32/4050_2.png) [@Czarcasm](https://boards.straightdope.com/u/Czarcasm)\ **Post date:** [August 22, 2012, 5:22pm UTC](https://boards.straightdope.com/t/socialized-medicine-and-single-payer-systems/630644/198 "2012-08-22T17:22:21Z")
> [@adaher](#): > > Sweden has great health care. I also notice that Sweden charges co-pays, so maybe the centralization is less the issue than the fact that lack of co-pays is overburdening the NHS. That would depend on how high a co-pay it is, wouldn’t it? ---
**Author:** ![amanset](https://avatars.discourse-cdn.com/v4/letter/a/8dc957/32.png) [@amanset](https://boards.straightdope.com/u/amanset)\ **Post date:** [August 22, 2012, 5:29pm UTC](https://boards.straightdope.com/t/socialized-medicine-and-single-payer-systems/630644/199 "2012-08-22T17:29:16Z")
> [@Czarcasm](#): > > That would depend on how high a co-pay it is, wouldn’t it? > **[1177](https://www.1177.se/)** > > På 1177.se finns information och råd om hälsa, sjukdomar och hur du kan må bättre. Hitta vård. Logga in för att till exempel boka tid, förnya recept eller läsa din journal. The maximum payable is 1100 SEK/year. A visit to the GP (“Besök hos läkare på vårdcentral/husläkarmottagning”) is 200 SEK. ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [August 22, 2012, 5:37pm UTC](https://boards.straightdope.com/t/socialized-medicine-and-single-payer-systems/630644/200 "2012-08-22T17:37:14Z")
Any co-pay at least prevents people from going in when they don’t need the care. And that’s a preferable way than the triage system you have to use when there are no co-pays. France and Sweden do not have significant wait times, do they? Canada and Britain do. The lack of co-pays is evidently the cause of the delays in care. [Previous page](https://boards.straightdope.com/t/socialized-medicine-and-single-payer-systems/630644.md?page=9) [Next page](https://boards.straightdope.com/t/socialized-medicine-and-single-payer-systems/630644.md?page=11)