Not run by the feds, but still nation wide acceptance, which is what is what is important.
If I go to the wrong hospital in my city, my insurance will not cover it, or cover a smaller portion. If I find myself outside of the city, it is unlikely that I will find any in-network hospitals.
It also doesn’t have to actually pay less. It just may pay less per patient.
With less overhead and other bullshit involved in insurance coding wasting a doctor’s valuable time, they would be able to see more patients in a given day.
Also, the doctor’s office may be taking in less revenue, but would be paying out less in labor, not having to pay someone to interface with the insurance company.
Making med school more accessible in terms of availability and cost would also make a dramatic improvement in the number of physicians, as well as their demand for pay.
I would also say that doing some sort of faster track for simple matters would be useful as well. I can go over to urgent care to take care of minor injuries or illnesses, but that still is a bit expensive, a bit of a wait, and a waste of a doctor’s time to prescribe me exactly what I thought I needed. Most small problems can be taken care of by a nurse, or even an orderly, with at most, a teleconference call with a doctor.
The co-pays in Canada’s health care systems can’t get any lower since they’re already $0. The Canada Health Act prohibits any form of extra-billing in any province that accepts federal health transfer payments (they all do). This is something I became personally very grateful for a couple of years ago when I reluctantly dropped into the hospital ER late on a Friday afternoon because I was having annoying chest pains, and ended up with a heart operation and was in the hospital for five days. I’ve always been a big fan of our single-payer health care system, but never more than on that afternoon when I thanked my cardiologist and NP and all the nurses and went home, the experience having cost me not a single penny.
There are supplemental insurance plans available in Canada but for most people they’re generally a minor item, essentially a standard employment benefit that doesn’t really do much. The biggest supplemental coverage item for most people would probably be dental, because ordinary dental issues unrelated to general health are a bit of a gaping hole in Canada’s UHC coverage. Prescription drugs would be another, unless you’re 65 or over. Beyond that it’s a bunch of nickel-and-dime minor items, like eyeglasses and fully private hospital rooms.
Supplemental insurance is quite different in that sense than the kind that would be used with Medicare, where it covers serious inadequacies in Medicare coverage of medically necessary resources, such as a hard limit on annual days of hospital stay. I think the best way to understand supplementary insurance under single-payer is to understand that cost control under single-payer, at least in Canada, is a top-down centrally managed cost regime that operates in the philosophical context that medically necessary health care is a guaranteed human right. Thus, the system controls costs by negotiating and regulating provider fees and by delisting some inexpensive but common coverages like eyeglasses, prescriptions, etc. The converse is that expensive life-saving procedures, lengthy hospital stays, etc. are always unconditionally covered. It’s almost the exact reverse of private insurance, which has a bottom-up cost control model where there’s little they can do systemically about provider costs, but they can carefully adjudicate every single claim and potentially cut down payouts or deny the claim entirely.
Medicare in the US finds itself betwixt and between these two models. On one hand, it’s a government program that constitutes, in process if not in function, a single payer for health care. OTOH, it doesn’t operate in a climate of guaranteed health care for all that is medically necessary, so it has some draconian limitations. That’s where personal funds and/or supplemental insurance comes in.
Employee benefit packages typically include some sort of medical and dental coverage.
The private insurer medical coverage covers some ancillary medical expenses that are not covered by the socialized / single payor medical insurance. For example, here in Ontario the socialized / single payor medical insurance is the Ontario Health Insurance Plan (OHIP). It generally covers hospital and doctor visits, but does not usually cover out-of-hospital medications (there are other programs that assist with this), assistive devices (there is another program that assists with this), or out-of-hospital dental care. These exceptions are big gaps in our health care system that were not big things when the system was created, but are now as health care has progressed.
Private health insurance tends to bundle coverage of these various gaps in our system, plus semi-private or private hospital rooms (so that you end up in a room with two or four people rather than a room with two or four people – the reality is that you get placed in a bed best suited to your medical condition/treatment). It is the out-of-hospital drugs and the dental coverage that attracts most individuals and employer /employee group plans.
What is this private coverage like compared to the USA? Usually it is hassle free and low cost (because OHIP is already doing the heavy lifting), be it paid by an employer via a group plan, or via individuals/families through private plans. Google about for Blue Cross or Chambers Group Insurance if you want particulars on what is covered and what it costs (from what I see of my client’s financial disclosure, typically one or two hundred per month for an individual and roughly double that for a family, bot don’t go to the bank on this because it really does vary greatly depending on what is covered by any particular plan).
I say “usually” hassle free because like any insurance, there are terms, and since the private plans are in the business of making a profit rather than in the business of healing people, they occasionally get stupid. For example: an employer covered me under it’s group plan. The plan stated that it covered endodontics. It then denied coverage when I had a root canal done by an endodontist who only charged the rate of a regular dentist. The plan person said that the coverage only applied if the dentist was not an endodontist. I spoke with their in-house legal counsel who had the cheque issued in full. The firm that I worked for then dumped that insurer and went with a different insurer.
There is nothing to stop doctors in Ontario from providing medical services that are not covered by OHIP. For example, often dermatologists treat people with genuine dermatological issues under OHIP but also privately charge people for eyelid lifts.
The grey area arises when it comes to boutique clinics that charge a few thousand a year per patient to do checkups paid for by OHIP. The benefit for the patients are that they get immediate and frequent service, often including various tests, usually covered by OHIP. When things get complicated, the doctors refer their patients to doctors outside of the clinic. The bottom line is that the boutique clinics’ doctors are funded by OHIP for the OHIP covered services, and are funded by their patients/clients directly for non-OHIP covered services, e.g. counselling. There is concern that this essentially permits line jumping by people who have money.
Take for example myself and one of my friends. We are of similar age, health, profession and activities – basically interchangeable. I do not subscribe to a boutique clinic, but he does.
When either of us actually needs medical attention, we go to our doctors are are attended to forthwith. If either of us would like but do not need medical attention (e.g. an employment), he can pop in to meet with his doctor on very short notice, whereas I have to book an appointment that might have me waiting weeks for an opening unless I explain the reason for the rush to my doctor’s receptionist.
If he gets the urge to have every test under the sun performed on him just in case he might have something, his boutique clinic will comply and usually stick OHIP with the tab. If I get the same urge to be poked and prodded, my doctor will discuss the reasons why with me rather than simply run the test that I request. If there is a medically grounded reason (e.g. time for a prostate exam based on age), the test will be made. If there is no medically grounded reason, then the test will not be made.
When you hear of Canadians regularly going to the USA for health care, often it is for the equivalent of a boutique clinic, for boutique clinics are few and far between in Canada. For example, an orthopaedic surgeon in town keeps telling me to do as he does by spending a few days a couple of times per year down in Minneapolis/Rochester getting thoroughly tested for things that might not normally be tested given my age and health.
It’s too soon to say if boutique clinics will take off in Canada or not, for they drain the public purse over needless tests, and they permit line jumping. The public keeps pressure on the government to not let health care slip; that is a bit part of why we live longer than Americans, live healthier longer than Americans, pay less through the public purse for health care than Americans, and pay less out of our private pockets for health care than Americans. Let’s put it this way: god help any politician who tries to chip away at our socialized / single payor health care. Ask yourself who the greatest American is, for that person probably represents things that are profoundly important to most Americans. Well here in Canada, back in 2004 we actually asked ourselves who the greatest Canadian is, and came up with Tommy Douglas, the founder of medicare (our socialised / single payor health care).
Now here’s the thing. Canada’s heath care is excellent, but as you can see from the above, there are ways that it can be improved. One way we learn how to improve is by looking at other countries, for there are several that have better health outcomes and fuller covered services at even lower cost. We look about, see what other countries are up to, and learn from them, as they learn from us. I caution folks in the USA about being too insular – to special – when it comes to looking abroad at other health care systems. You don’t have to let the world pass you by.
When you come across someone saying it is not possible for the USA to obtain better heath care for less money because reasons, and that other superior performing health care systems are the result of reasons that could never apply to the USA because the USA is special, you’re facing that person’s belief, so don’t expect fact and reason to be persuasive. The belief in god, guns and non-socialized / non-single payor health care runs deep in the USA. Good luck with that.
Okay, that made me laugh. “What’s healthcare like in Vancouver? How about the other city?”
Yeah, that’s pretty much my concern.
Okay, thanks for the response, and I’m glad to learn that you’re prepared for the eventuality of a transition to M4A.
But even if everybody currently in the sales sector of the industry is as sanguine about that outcome as you are, there are still a LOT of non-sales-type positions that are going to disappear; and my sense is that most of them involve skill sets that don’t easily translate over to other industries that would be in a position to absorb them.
It could make the number of coal mining jobs that “disappeared” look like a rounding error.
nm
This is a serious suggestion: all that retraining/structural shifting would be a lot less traumatic if everyone had health care during the process. I mean, right now health insurance is my single biggest expense each month by a significant margin–even when I don’t actually have any bills. If I got laid off, I could make enough at a pretty shitty job to cover the basics of everything else–but I couldn’t cover my family’s health insurance.
Yeah, I just played it straight in my answer to Luci. 
People lose jobs all the time to technological and social changes. It’s been happening for centuries.
That’s not a reason to keep a bad system, because it employs people. In fact, it seems that the number of non-health professionals who are employed by the US health system is one of the major flaws in that system. Advancing the number of jobs who would be lost is not a reason to argue for no change.
The problem is that the top wealth holders and income earners are not paying what they should in terms of taxes. Change the tax code and the average, middle-class American would be able to pay a tax bill that, while probably higher than what they’re paying now, would have something to show for it: the ability to visit their healthcare provider without fear of spending a 2-week paycheck for relatively minor visits, or losing their entire life savings for something more serious that requires an extended stay in the hospital.
The ACA is being undone as we speak, and some of Trump’s policies probably mark the beginning of the end of Obamacare. And in some ways that’s probably not a bad outcome, because Americans will probably only become more leftist on this issue and demand an expansion of Medicaid/Medicare.
I don’t have a sense that there are that many jobs with skill sets that won’t transfer. There will surely be some, but I think the skills are more transferable than you believe. Sure, there won’t be many or perhaps any jobs left that require someone to actually send bills to insurance companies and keep track of whether they are paid- but that doesn’t mean there won’t be a need for someone to read medical records and convert the diagnoses and treatments into a standard code. Utilization review nurses may work for insurance companies or managed care plans - but they are licensed nurses who can also work as UR nurses for healthcare providers or even return to patient care. So can the doctors, as I’m sure the insurance companies employ plenty of them. And of course there are the people in jobs that exist in every sort of entity from government agencies to non-profits- the customer service people who answer the phone, the IT staff, the HR people, finance folks, the administrative assistants and secretaries.
That of course doesn’t mean that everyone whose current job disappeared would quickly get a new one with similar pay - but it’s also unlikely that a UR nurse will earn half (or less) of what he earned at an insurance company if he takes a job at a hospital. My understanding of coal mining jobs is that a large part of the issue is that they are very well-paid compared to to the other jobs a person with a high school diploma might be able to land, so that a laid-off miner might very well find that the only other jobs he’s qualified for pay half as much.
Oh, we’re special alright.