Taxes are not “insurance premiums.” The government may sort of use that term, but it’s dishonest. “Insurance premium” is a term of art with a specific meaning; it’s a regular payment you make in exchange for being in possession of an insurance policy, which creates an asset (income) and corresponding liability (risk of payout) in the insurer’s balance sheet.
Ontario’s “Health premium” is absolutely not an insurance premium, it’s a tax. It’s not a debatable point. A person who does not pay it still gets the insurance, and the insurance you get doesn’t correspond to how much of it you pay or if you pay it at all, because eligibility for OHIP isn’t based on whether you paid it.
Having said all that, the point about what single payer or some hybrid system would cost the USA is rather incontestable; it would cost nothing as compared to the current situation, and would probably save quite a lot of money. Well, it might cost a lot in the very short term as things changed, but down the road it’d be a significant savings.
Right now the average U.S. citizen pays more tax than the average Canadian does for government-run or government-insured health care. That was, incidentally, also true before Obamacare, except when the Canadian dollar was unusually high against the U.S. dollar. Frankly, that’s scandalous.
The problem is that Americans are used to a certain standard of care and that politically it would be difficult to accept less from a new health care system. In comparison to Canada a studyby the Commonwealth fund found that America had a much more expensive and much less equitable system, but that Canada scored worse in quality of care and timeliness of care. It would be a very hard sell to voters to switch to a Canada style system if it meant slower and worse care.
Once again, the results that one gets from the American system are not good on the whole, trying to defend it for specifics actually does point on the areas that need to be maintained, but still it does not lead one to support the whole deal.
Canada does has issues, but the point of the article (yes, that was the one you cited) is that even Canada is better that the USA overall.
It’s anecdotal, but I feel it’d be interesting here to relay the tale of my best friend, whom I will call “Scott,” because his first name is Scott.
Scott is a natural born American citizen whose parents moved to Canada when he was an infant, and so he spent his first 30 years of life as a Canadian, becoming a citizen. He then moved to California to get a job in Silicon Valley - he was a pretty easy recruitment target, still being an American citizen, yes you can be both - and has done extremely well for himself since 2000 moving up to senior management with two very high profile, name brand tech firms. So Scott has pretty sweet private insurance. He and his family are fine.
Scott will, absolutely without hesitation, tell you the U.S. health care system is stupid junk and that some form of single payer should be adapted tomorrow; his saying on the matter is “just make the minimum age for Medicare zero years old.” He doesn’t want private insurance entirely eliminated - he’d prefer a hybrid system like most rich countries have. France and Germany are interesting examples. (Most Canadians don’t realize this but their health care system is actually quite odd; most industrialized countries aren’t like us.) But he’ll tell you night and day that universal health insurance as a basic, underlying system is something the USA needs yesterday. Incidentally, Scott was a Reagan Republican all the way who now identifies as a “blue dog Democrat” because he thinks today’s Republicans are all insane, evil Christian theocrats, except for Donald Trump, whom he feels is clearly insane and evil but definitely not Christian.
Again, it’s an anedcote, but he’s a guy who has lived a long time in both countries and who personally would derive no benefit at all because his private insurance is excellent.
Pretty much exactly my situation. My own insurance is excellent, and while I do think I’d derive benefit from a saner health care system I doubt it would be as good as what I currently have access too, I think we need to seriously reform the system. I think that a single payer system that is a hybrid is the way we should do that. I just don’t know what it’s going to take to actually make it happen since it’s difficult to extrapolate in most people’s heads from where we are today to what it would be like under a single payer system (it’s VERY different than the model the US has had for over half a century now) and how to make them understand the aggregate costs verse individual costs (my own anecdote about this…trying to convince our administration that spending half a million dollars on a new phone system was better than paying $350k a year for 7 years on a lease, or why spending $580 a month on a MOE circuit was superior to spending $109 on a T1, because they weren’t counting the cost of the T3 as an aggregate and trying to look at it circuit by circuit). Also, frankly, American’s as a people have a thing about government that simply doesn’t seem to be the case in most other countries, and it’s something we’d have to overcome to go down this path…and something I don’t see us overcoming any time in the near future.
I have long postulated that what y’all really need is for Oprah and Bill Gates and Warren Buffet to get together and start a health care cooperative. Not for profit, single payer ish style. Means tested for insurance rates. People would sign up in droves, don’t you think?
Could offer a premium plan for the wealthy, that could surely undercut the insurance companies. Could set up an encouraging employer/employee cost sharing system maybe even.
I know you’re wondering where is the incentive for the doctors? I firmly believe that Drs, more than anyone want everybody covered, a single set of rates and forms, no more fighting insurance companies to get paid, no jumping through 100 hoops.
It wouldn’t begin as universal, but you could use it as the seed to take you in that direction.
Why not some home grown philanthropy to lead government where it can’t seem to get to?
If that were actually the case, and not just a talking point that has been repeatedly debunked on this board.
Make Medicare universally accessible, and you will not simply scale up the numbers there - a far lower percentage of those it covers will be old and sick. But there’s no reason to expect its 3% overhead to be much higher, even with higher volume. And the rates, like Social Security’s, can be adjusted and progressivized and de-capped and base-broadened etc. - and still have a much lower bottom line than the for-profit, bonus-ridden private system. Oh, it can still be available, it will just have to become competitive somehow - but the ideologues take it as a matter of faith that it inevitably will, so no problem.
To hear them tell it, they’d get to spend more time being doctors and much less time arguing with bureaucrats who have an incentive not to pay up.
You do grasp that the US ‘standard’ is what it is because every single aspect and item generates profit - the extra scans, the extra days in hospital, the extra consultation - bogus nonsense designed to line someone’s pockets.
If you could show that Americans lived longer that would help, but they live shorter lives.
Like everyone else here will point out, single payer is one mechanism where medical price inflation could be halted. The government, as the only game in town, save a small amount of very wealthy people, can just pay cost for any care given. It could force nonprofit hospitals to pay their administrators reasonable salaries. It could force drug companies to accept the prices it is willing to pay. It could open up additional medical school seats - the thing is, far more people have shown the academic capability to become doctors than have ever been accepted to med school. This has been true for many decades now - there’s an artificial shortage of doctors that is one reason they can charge so much. There are plenty of Americans who would be willing to attend medical school and earn a steady $130k a year for the rest of their working lives.
Is there really an issue with timeliness? On several occasions, when I’ve expressed my view that a single-payer system would be superior to what we in the US have now, I’ve heard some variation of “Well, my cousin’s sister-in-law lives in Canada, and she has to wait WEEKS to see the doctor.”
Which baffles me, because for nonemergency kinds of things, I and just about everyone I know here in the US have to wait weeks to see the doctor. My PCP always has a wait of two or three weeks to get in. When I had a suspicious mole on my arm, I waited five weeks to see the dermatologist. My BIL had to wait about six weeks to see a neurologist about his dementia. Etc., etc.
I’m fortunate enough to be covered now by a pretty good insurance plan provided by my husband’s employer. We pay about $6000 per year for the plan; the employer pays about $12000. (Well, not really – in both cases of course it’s tax deductible, so our cost is more like $4500.)
If we no longer had to pay that premium, but our taxes went up that $6000, my husband’s take-home pay would be the same. Why would I complain about paying higher taxes?
As several posts have shown, the potential cost of a single-payer system (we used to call that socialized medicine; why did the name change? ) can be ameliorated by rationing the care in some fashion. Of course, methods of care rationing are potentially controversial. At some point, they tend toward creating a pool of haves (those who can pay for extra care) and have nots (those who can’t).
California’s proposed plan tried to avoid any rationing. That’s similar to California’s workers’ compensation laws, which establish that the prima facie indication of “reasonableness” in necessary medical care is the opinion of the treating physician. Can’t tell you the number of cases I had on behalf of employers or insurers where we had to go to great lengths to turn off medical care spigots involving doctors (especially chiropractors) who were willing to treat a patient ad infinitum for “chronic” issues. Then, of course, there’s the impact of malpractice case law/statutes on the willingness of a doctor to require extensive testing. It makes un-rationed care very expensive.
The only flaw is that technically you’d have less “choice”.
I mean, right now, you have a choice between a shit sandwich and a bullshit sandwich. You will not really know ahead of time if blue cross or Anthem or whatever is actually going to be better for you, and in the case of employer provided insurance, you don’t have a choice anyway.
Similarly, right now, if you want a treatment your insurance company won’t pay for…well, ok, generally you are screwed. Only 1-5% of Americans even make enough to have a chance of being able to pay out of pocket for some major treatment that isn’t covered.
Anyways, the perception is, if the government controls insurance, getting issues handled will be like going to the DMV or social security office. Mildly unpleasant and you won’t have any other options.
And if the government ran healthcare, it might be like that DMV or post office. Pretty good actually, but parts of it would be shabby.
I think that varies a lot by area. If I wait weeks for an appointment, it’s because my availability doesn’t synch with the doctor’s- for example, he or she may have morning or early afternoon appointments next week, but I make an appointment three weeks down the road because I want a 5 pm slot. I am trying very hard, but can’t think of a time in the past 30 years where I have **had **to wait a more than week for anything- mammograms, sonograms, x-rays, outpatient surgery, an angiogram , a colonoscopy. No matter what it was , I was always offered an appointment within a week. And for the radiology stuff, I am frequently offered an appointment the next day. I have often wondered exactly how much it costs to have so much extra capacity that I can get a next day mammogram.
Basically, a form of public option, but a national one. It wouldn’t displace anyone who didn’t want to be displaced. Its sponsors are optimistic that it would shrink the private insurance market down to nearly nothing, but of course that depends on the performance of Americare, which would presumably be set up as a GSE like Fannie Mae. Plus we Republicans would demand real competition, which means that if it fails, there is no bailout.
The attraction of Americare is that it doesn’t force people out of their private insurance, and it doesn’t cost taxpayers much. Instead of taxes, you’d just pay your premiums to the national system directly. Unless you’re poor, in which case it would be free. The only taxpayer money needed would be for care for the poor, most of whom are already covered by Medicaid and SCHIP, so not much extra revenue is needed.
So, just like Medicare, except No New Taxes! And it’s a new, parallel system, not just an expansion of an existing, well-functioning one. And it doesn’t have Obama’s name on it, which is really the key point.
The term was created by the Republicans and the AMA to oppose Medicare, by bringing in the Commie-fear that was still prevalent at that time among their constituents. They stopped using it when their own voters came to see through the scare tactics and strongly support it.
You knew that, right? And you’ve heard Reagan’s recording saying “We are going to spend our sunset years telling our children and our children’s children, what it once was like in America when men were free”, haven’t you? And, most of all, you can see that history repeating itself today, can’t you?
If this part is true, then it may well be the worst characteristic of all in our current ridiculous system. Losing qualified medical practitioners simply because of personal finances is inexcusable.
) can be ameliorated by rationing the care in some fashion. Of course, methods of care rationing are potentially controversial. At some point, they tend toward creating a pool of haves (those who can pay for extra care) and have nots (those who can’t).