Early discharges are a problem in Canada.
This is the first time I’ve ever seen the UK confused with Canada! Granted, we share the same Queen, but still … different sides of the ocean and all that! 
The elderly are a special problem as there can be non-medical lifestyle considerations post-discharge. Even so, here in actual Canada, when my mother was hospitalized and decided it was time to move to a nursing home, she was put on a waiting list and in the meantime moved to the geriatric ward. We eventually convinced her she’d be better off coming to live with us, but otherwise she would have remained in hospital as long as necessary until a suitable nursing home could have taken her, thus assuring continuous care. When she did come live with us, the health system provided free medical equipment, nursing services, and regular visits by a home care worker and a dietician.
That said, the problem of early hospital discharges is more general and greatly exacerbated in the US, in part because of the highly mercenary nature of the whole health care system, because of specifically enumerated limitations, and because of the often exorbitant out-of-pocket costs involved.
My bad. Came up with Canada search term. Point stands though: single payer as much as it has to commend it is not a miracle cure. And contracting for lower fees is not where the big curve inflection comes from.
I do not mean to piss on the Canadian (or UK ������) systems. But advertising a system in their image as Medicare for All is incorrect and selling them with implications of no referrals see who you want and never any problems of the systems squeezing to save money is also wrong. IMHO.
I beg to differ. Why do you think the per-capita cost of health care in Canada is half of what it is in the US? These countries are right next to each other, have almost identical socioeconomic systems and living costs, and the costs of medical equipment and facilities are essentially the same. The major factors are negotiated uniform provider fees and the fact that these fees can be as low as they are because administrative costs are so much lower – in fact most of the administrative complexities encountered in US health care simply do not exist at all in single-payer.
As a physician would you rather bill $100 for a procedure and risk not getting paid at all while having to employ backroom clerks to chase patients and insurance companies, all while dealing with mountains of paperwork and wasting time fighting with insurance bureaucrats yourself, or would you rather bill $50 and be guaranteed full payment with no hassle, no overhead, and no time-wasting frustrations?
Sanders has visited Canada to familiarize himself with the system here and ISTM that it’s fair to say he’s largely modeling his proposal on the basic principles here. I don’t think he’s ever claimed that there are “no referrals” for specialists but we’ve already agreed that this is a red herring that has nothing to do with choice. It’s fundamental to the Canadian system that there are no restrictive “networks” that limit who you can see according to what plan you have. There is only one plan and it covers everyone, for everything that is medically necessary, for all providers, all of whom have the same fees. It’s a win all around in terms of patient flexibility and administrative simplicity. The big problem with it from a private insurer standpoint is it’s hard for an insurer to make money in it. Some of us consider that a feature, not a bug!
Possibly there are areas of human life in which paying a middleman makes sense.
But I’m pretty sure that health care is not one of them.
DSeid forgive me, but I’m not followeing you on this referral thing? Are you saying people on UHC system don’t get to choose their refferal? Or that people who oppose UHC are putting that up as an objection? Or what? 
They, like Americans in many plans, need to have their primary physician send them and cannot just go to whatever sort of specialist they want. When describing that circumstance in America words like “gatekeeper” and “obstacles to care” get used and is often demonized and bemoaned. When the Canadian system is discussed it is directing a patient to appropriate resources …
I read Sanders’s site as implying that the plan would eliminate those sorts of “obstacles.”
The Canadian system is a fine model. But attaching the branding of Medicare to that model is very inaccurate and implying that it does what it does not (and really should not) as its marketing is the sort of misdirection that would bite you in the end.
It’s still unclear whether you agree with these critics or not. And this is a highly distorted description of the reality. The first part of the first sentence – “need to have their primary physician send them” is true but the second part – “cannot just go to whatever sort of specialist they want” is false. No, you cannot demand a referral to a brain surgeon because your toe hurts and your palm reader told you that you might have a brain tumor, but if a specialist is medically indicated you have the right to see any one you want and the single-payer system will fully cover it.
There is nothing evil about the concept of a “gatekeeper” to assure the most appropriate and properly prioritized access to health care services, and every health care system in the world has them. I’ve used that term myself in describing the medical profession in the context of single-payer health coverage. The problem with the private insurance system in the US is that the gatekeeper is an insurance bureaucrat who isn’t interested in the best interests of the patient, but in the best financial interests of the insurance company. A gatekeeper has to be a qualified medical professional completely centered on the interests of the patient and nothing else. That’s what primary care physicians are qualified to do, while insurance bureaucrats have pretty much the opposite interests.
A good example of a gatekeeper in a medical context is the triage nurse in ER, who determines what kind of specialist the patient needs to see, at least as a first evaluation, and what the urgency is. This is very much analogous to what a primary care physician does when it comes to referrals, and I’m frankly astonished that the idea of specialist referrals has to be debated at all. I’m reminded of when a very good friend of mind took her young child to the doctor with some symptoms she was becoming concerned about, and the doctor deemed that she needed to see a specialist – not in the mythical distant future that forms the basis of naysayers’ tales about wait times in the Canadian health care system – she needed to see a specialist right now. And that’s just what was done, the same day. It turned out to be a false alarm and nothing serious but the symptoms very easily could have been extremely serious, and this is how the proper role of “gatekeeper” works, and one of many reasons that the PCP is involved in referrals.
I’ve read the most comprehensive description of Bernie’s plan I could find, and I see nothing misleading in it. With reference to the above comments, it makes statements like these:
Increase Access & Choice: Patients can see the doctors they want, since the “out of network” limitations of a private system will vanish with single payer.
Allows doctors to make decisions in the best interest of patients, rather than based on complex private plans engineered to deliver profits.
No premiums, deductibles or copays for any medical services.
Separates health coverage from employment, so everyone will have more flexibility to change employers, or even consider starting their own business, without the risk and fear of losing their health benefits.
Bernie is proposing a healthcare system like what is found in Canada, Europe, and other developed nations.
… all of which is exactly correct. The only aspect in which branding the plan as “Medicare” might be misleading is that Medicare is a pretty crappy health insurance system compared to most systems in the rest of the world. To my mind Bernie calling his plan “Medicare for All” already gives it a black eye, but it’s still a useful way to convey to the American mindset what it seeks to achieve. What he really should be saying is “It’s like Medicare, only for everyone, and without any of the stupid limitations imposed on it by the insurance lobby”.
I agree with DSeid about the dishonesty of calling thiis single payer bill “Medicare for All”. Why don’t they call it “Medicaid for All”? That would be more accurate. But of course they don’t want to be accurate. They want to dishonestly sell it as something it’s not, and that means we are going to pay the political price sooner or later when people discover what it really is.
From Kimstu’s cite describing how the plan Warren and Sanders (two of the top three in the polls) are pushing could kill 2 million jobs:
She seems to think that’s fine and dandy, and so does wolfpup. And in an abstract sense of economic efficiency, it is good.
But this is not the Wonky Policy forum, it’s the Elections forum. How on Earth could this be good politics? The benefits of eliminating that inefficiency will be diffuse and barely noticeable to average folks, while the pain for those 2 million people, in a demographic that is highly likely to vote, from being out of a job they spent years learning how to do will be intense and focused but reverberate throughout entire families and friendship groups.
Is this still true if we correct for demographic differences between the countries? What if we just compare the educated middle-class folks who are happy with their private employer provided health insurance? Are they living shorter and sicker lives than their counterparts in Canada?
Because that’s much better politics, and Democrats need to learn this more generally, not just about healthcare. They should not be releasing specific white papers every week on this, that, or the other thing. They should be talking vaguely but passionately about vistas of blue skies, amber waves of grain, the greatness of America (“whose greatness comes from the hard-working people who get up every day and do what needs to be done to take care of their families”, yadda yadda), strong leadership for the 21st century, and stirring rhetoric like that. No specifics that give your opponent something to latch on to and attack you for. This is Politics 101!
You know how nobody cares about any job losses when they talk about government programs being cut? Same thing for insurance employees. They have basically the exact same image in the American mind as the Government beaurocrat.
I don’t think many people care in the abstract about coal miners’ jobs getting cut either, but the coal miners do and the people who love them do. Same thing here.
And what do you think they’ll discover? I think they’ll discover that Bernie’s plan – if it could possibly be implemented in the ideal form described – will be exactly the single-payer system they were led to expect. Those who are simply swayed by what something is called instead of what it actually is are the sorts who probably never read the policy proposal and don’t understand the difference between Medicare and Medicaid anyway.
Is it also your contention that the government should have banned automatic telephone switching systems from being introduced into telephone system exchanges because millions of switchboard operators would lose their jobs – fine deserving young women who did nothing wrong? Or that the first automobiles should have been banned to protect horse breeders and buggy manufacturers?
You seem to be ignoring the fact that Canada transitioned from private health insurance to single-payer and somehow we survived. It happened over the course of many years in a series of transitional stages which provided ample time to adjust – the general population greatly welcoming the reforms, and those in the predatory health insurance industry eventually finding honest jobs.
From my recollection of such statistics, probably not. Which is a very good reason why everyone should have the same health care plan as in Canada, or, to put it a different way, everyone should have the same health care plan as “educated middle-class folks who are happy with their private employer provided health insurance” in the US. The latter of which, incidentally, cease being quite so happy with it the first time a major claim is denied and they have to sell their house or declare bankruptcy, or if they lose their jobs.
No, because the demographic that Democrats are targeting are not the kind of morons and indiscriminating ideologues that voted for Trump.
Except for rare pockets, insurance companies don’t make up the soul of a town like the mine in coal country. Really not comparable.
Democrats are not targeting Rust Belt swing voters who chose Trump in 2016? 
That’s news to me, and would be a big mistake.
You’re still trying to make a wonky, utilitarian policy argument. That’s not how politics works, especially here. More’s the pity, because if it did, we could dispense with all the campaign theatrics and just have everyone take their time making a sober, diligent study of each candidate’s record and the white papers of their policy proposals. Maybe in Denmark or somewhere, that’s how it actually works. But we are nowhere remotely near having such a body politic.
wolfpup we’ll need to leave ourselves disagreeing about how accurate the portrayal is in general but this
warrants specific comment.
We agree on the need for primary care provider (PCP) referrals tp specialists. Many do not. PCPs following appropriate guidelines is seen by some as an “obstacle”.
To the comment the PCP following appropriate guidelines applied as appropriate to the specific circumstances is how the gatekeeper function is accomplished in both systems. In both systems the PCP is the gatekeeper and is looking out for the patient’s best interests.
No question that in the US inappropriate referrals are placed as it makes the patient happy. They may get denied and should be. And sometimes the reason for something expensive to be needed outside of the guideline is not immediately clear and requires explanation. How many times in over30 years have I not been able to get my patients the referrals approved that they’ve needed? ZERO. A few time it’s required explanations.
This is the sort of shit that bothers me. The Canadian system is wonderful. Cutting all those administrative jobs saves money and getting to one less complicated system would be great. What is and is not covered on each plan confused even experts.
Creating fictions like that bugaboo to sell it though is wrong.
Meanwhile the practical. Telling Americans that they all have to give up their own eggs that they may like, be it Medicare or private, for the promise of a better omelet for all to come, telling those millions who work for the industry who worry that it might be their job that is cut that it is worth it for the greater good, when the current ACA approach has already been delivering well and could do so much more without GOP kneecapping and some expansions with public options and more… wont sell.
And one of the things about Sanders is that he’s not yet come clean on the cost of his plan. I think people should be more critical of that aspect of his M4A. He’s made the statement that middle class families would save $3,000 under his plan. But studies don’t back him up. And various fact-checkers don’t agree.
"…*Sanders said that multiple studies show that under Medicare for All “average middle-class families will save $3,000 every year.” The studies don’t back him up.
One is based on 2016 numbers that are outdated, especially when it comes to current tax rates. Another deals only with New York state, excluded the high cost of long-term care, and offered a range of possible outcomes.
A lot depends on the actual taxes to raise money, and we don’t have a specific proposal from Sanders.
We rate Sanders’ claim Mostly False."*
If Sanders and Warren were supporting the actual Medicare for All, based on the real Medicare, they would be supporting a basic health program that about 1/3 of people get through a private contractor, via Medicare Advantage plan (like my parents), or where millions purchase a supplement plan on top of it.
I agree with you. Sanders’ label of his plan is just pure politics.
Medicaid for All is more accurate, since the people who have it generally have no co-pays (mostly). But Medicaid isn’t as popular, because it’s a hassle to get enrolled, since it’s means-tested. And a lot of doctors don’t take Medicaid patients, because the reimbursement rates are so low. Some people have it, but can’t see a decent doctor. So, his political side says let’s call it “Medicare”…
That’s one aspect of Sanders’ plan that should be scrutinized. If we throw out our entire system, and replace it with what he inaccurately labels as “Medicare For All”, what would happen to our medical providers?
quoting the link:
*Hospitals could lose as much as $151 billion in annual revenues, a 16 percent decline, under Medicare for all, according to Dr. Kevin Schulman, a professor of medicine at Stanford University and one of the authors of a recent article in JAMA looking at the possible effects on hospitals.
“There’s a hospital in every congressional district,” he said. Passing a Medicare for all proposal in which hospitals are paid Medicare rates “is going to be a really hard proposition.”
Richard Anderson, the chief executive of St. Luke’s University Health Network, called the proposals “naïve.” Hospitals depend on insurers’ higher payments to deliver top-quality care because government programs pay so little, he said.
“I have no time for all the politicians who use the health care system as a crash-test dummy for their election goals,” Mr. Anderson said.*
OK, but it’s still millions of jobs, often that pay a good living wage. If we’re going to get rid of an industry, we need better talking points than they “don’t make up the soul of a town”…that’s extremely weak.
It’s not a talking point, it’s a reason you don’t need a lot of talking points on the issue. Insurance jobs are spread out so they aren’t as much of a concern as a voting block.