# UHC: Has to be affordable, high-quality, and also \*not\* have long wait times **URL:** \ **Category:** Great Debates\ **Created:** [February 22, 2019, 6:16pm UTC](https://boards.straightdope.com/t/uhc-has-to-be-affordable-high-quality-and-also-not-have-long-wait-times/830033 "2019-02-22T18:16:52Z")\ **Posts on this page:** 20\ **Page:** 15
**Author:** ![PatrickLondon](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/patricklondon/32/4422_2.png) [@PatrickLondon](https://boards.straightdope.com/u/PatrickLondon)\ **Post date:** [March 6, 2019, 2:25pm UTC](https://boards.straightdope.com/t/uhc-has-to-be-affordable-high-quality-and-also-not-have-long-wait-times/830033/281 "2019-03-06T14:25:46Z")
But if there’s a perceived need to tempt doctors into a UHC system, how much would it cost to pay off all or part of their medical school loans in return for agreement to stick to a standard rational tariff (and maybe X years’ service in an under-doctored area )? ---
**Author:** ![wolfpup](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wolfpup/32/10618_2.png) [@wolfpup](https://boards.straightdope.com/u/wolfpup)\ **Post date:** [March 6, 2019, 4:39pm UTC](https://boards.straightdope.com/t/uhc-has-to-be-affordable-high-quality-and-also-not-have-long-wait-times/830033/282 "2019-03-06T16:39:59Z")
> [@JcWoman](#): > > I didn’t read the whole quote because I stopped at this one which is silly. Today with our ridiculous insurance system doctors have to bill (made up numbers for illustration) $500 for an office visit because they know the insurance company will refuse to pay $400 and the patient is only required to pay a $20 copay. It’s common knowledge that they never get paid their full amount. Medical provider price inflation is in part due to this - doctors trying to be compensated as much as they can because they have to fight tooth and nail with the insurance providers whose sole motive is to not pay out. > > So in a single payer system as I understand it, there is no silly[Chargemaster (rack rate)](https://thehospitalleader.org/18816-2/) so medical providers don’t have to play silly games to fight the insurance companies. There is one price list for all treatments with realistic/reasonable prices and doctors never have to wonder if they’ll get paid or get screwed. Sounds to me more like the transformation that doctors would have to go through is an increase in confidence that they’ll be paid and a steadier income stream. I agree with all of this, and you’re exactly right about the single payer price list. Literally. Here in Ontario there is a document called _Schedule of Benefits: Physician Services Under the Health Insurance Act_ that sets out the procedure codes and exact fees for all medical procedures in the province. The one I have is a few years old, and contains 728 pages of detailed pricing information, setting out exactly what every doctor gets paid as full payment for every procedure. There’s no mystery about it. And yes, the claim that Brooks is making there is absurd. So he thinks doctors will revolt if their gross income goes down by 30% while their overhead expenses including medical losses go down by 40%? Maybe, but only if they’re very bad at math. 😃 Of course in practice those relative percentages may be different; generally speaking medical fees are very much lower in Canada while doctors’ average net salaries are also lower than their US counterparts, but only moderately so. Most think it’s worth it to be able to devote their time to medical practice instead of insurance bureaucracy. I’ve met a number of excellent doctors here in Ontario who came from the US, including some leading specialists. They’re glad to be here and we’re glad to have them. ---
**Author:** ![Red\_Wiggler](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/red_wiggler/32/13190_2.png) [@Red\_Wiggler](https://boards.straightdope.com/u/Red_Wiggler)\ **Post date:** [March 6, 2019, 4:40pm UTC](https://boards.straightdope.com/t/uhc-has-to-be-affordable-high-quality-and-also-not-have-long-wait-times/830033/283 "2019-03-06T16:40:20Z")
> [@PatrickLondon](#): > > But if there’s a perceived need to tempt doctors into a UHC system, how much would it cost to pay off all or part of their medical school loans in return for agreement to stick to a standard rational tariff (and maybe X years’ service in an under-doctored area )? Yes! When (if) we devise single payer, we should make it a policy to never lose a talented potential health care professional because of personal affordability. The cost of the training tab would be peanuts relatively and the gain huge for all of us. ---
**Author:** ![survinga](https://avatars.discourse-cdn.com/v4/letter/s/cab0a1/32.png) [@survinga](https://boards.straightdope.com/u/survinga)\ **Post date:** [March 6, 2019, 6:40pm UTC](https://boards.straightdope.com/t/uhc-has-to-be-affordable-high-quality-and-also-not-have-long-wait-times/830033/284 "2019-03-06T18:40:29Z")
> [@wolfpup](#): > > Oh, FFS! [Do you think I imagined all this?](https://boards.straightdope.com/sdmb/showpost.php?p=21517514&postcount=265) :rolleyes: Let me repeat exactly what I said in that post, once more: > > She was in her 90s at the time, and rather than sending her to long term care, I took her into my own home, so I assure you that I know everything that went on, and she sure as hell wasn’t paying anything for this extensive home care, and neither was I. > > We got this support through an agency of the Ministry of Health that was called CCAC at the time (Community Care Access Centres) that apparently has since been rolled into the Local Health Integration Networks – [more info here](http://healthcareathome.ca/central/en/Getting-care/Getting-Care-at-Home). > > Quite frankly I’m not about to go to the bother of registering with a British journal to get access to a paywalled article so they can explain to me how my own health care system works with respect to something that I’ve had extensive direct personal experience with. We didn’t pay a dime for any of the services I described. And this went on for years. > > Correct, he is completely wrong. My mother’s experience was similar to yours. Your own experience is not dispositive of the questions. I have had good experience in the US healthcare system, and you don’t seem to be impressed by my very good experience in the system. So, why should I assume your experience is indicative of all of Canada, when other sources are describing problems that you don’t have in your own experience? The article I provided was not behind a pay-wall. It required a sign-in, but it was free. Anyway, here’s another link. Home Health Care requires private funding, at least for some in Canada. > **[Home care | Healthcare Funding](https://healthcarefunding.ca/home-care/)** > > Home care includes both home health care services (e.g., nursing, rehabilitation, and social work) and home support services (e.g., bathing, housekeeping, and meal preparation) delivered to people living in their homes (McGrail et al 2008). Home care... So again, there are holes in Canada’s healthcare system that have to be plugged by private dollars. I’m not saying that makes the system bad. But it’s not the panacea you make it out to be. There are sub-groups in Canada that have a hard time paying for their healthcare, and some sub-groups that don’t do well in health outcomes. You might not like me pointing it out. But that doesn’t make you right. ---
**Author:** ![wolfpup](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wolfpup/32/10618_2.png) [@wolfpup](https://boards.straightdope.com/u/wolfpup)\ **Post date:** [March 6, 2019, 7:33pm UTC](https://boards.straightdope.com/t/uhc-has-to-be-affordable-high-quality-and-also-not-have-long-wait-times/830033/285 "2019-03-06T19:33:18Z")
> [@survinga](#): > > Your own experience is not dispositive of the questions. I have had good experience in the US healthcare system, and you don’t seem to be impressed by my very good experience in the system. So, why should I assume your experience is indicative of all of Canada, when other sources are describing problems that you don’t have in your own experience? Because the claims that you were making are subjective judgments about your degree of satisfaction, whereas the things that I’m telling you – and that others are telling you – _ **are objective evidence of full coverage for services that you claimed were not covered** _, that’s why. I even pointed you to a government website describing some of those covered services. I wasn’t making a claim about all of Canada, as each province’s health system is different under the general requirements of the Canada Health Act. I only know firsthand what is covered in Ontario, and you are just flat-out wrong about home care. I also believe the most other provinces have similar services, though I’ve never looked at the details. But you’re reading these generic reports and either through misinterpretation or inappropriate extrapolation reaching the wrong conclusions and spreading misinformation. With respect to Ontario, at the very least, you’re wrong, period. I think part of the disconnect here is due to the following: “_Home care services are not publicly insured through the Canada Health Act in the same way as hospital and physician services. In Canada, most home and community care services are delivered by provincial, territorial and some municipal governments._” [Cite](https://www.canada.ca/en/health-canada/services/home-continuing-care/home-community-care.html). Translation: Provincial governments are not obligated to provide home care under the CHA, but most or all of them do anyway. It’s like my drug coverage, which you also claimed I didn’t have – it’s covered by the same health card, but technically at some level in the upper echelons of the Ministry of Health comes out of a different program budget than primary health care. That doesn’t mean I don’t have it! The other part of the disconnect in this conversation is that people who are sufficiently incapacitated to require home care services may have a wide array of needs, some of which they may indeed have to pay for themselves (hence, “private money”). For instance, if they’re bedridden and can’t prepare their own meals, but still insist on living at home, then there is either a real cost incurred in providing them, or an imputed cost ascribed to the services performed by someone like a family member. None of which has a damn thing to do with the fact that very extensive home care services are provided in Ontario, contrary to your claims. I didn’t just read about it, I lived it for many years. Please stop trying to tell me how my own health care works! You’re wrong. Give up, already. ---
**Author:** ![survinga](https://avatars.discourse-cdn.com/v4/letter/s/cab0a1/32.png) [@survinga](https://boards.straightdope.com/u/survinga)\ **Post date:** [March 6, 2019, 8:27pm UTC](https://boards.straightdope.com/t/uhc-has-to-be-affordable-high-quality-and-also-not-have-long-wait-times/830033/286 "2019-03-06T20:27:28Z")
> [@wolfpup](#): > > Please stop trying to tell me how my own health care works! You’re wrong. Give up, already. I’m not telling you how your own healthcare works. But if I was, that would be no different from you telling me how mine has worked in multiple threads over multiple months, even though I keep telling you my experience is very different, as well as the experience of almost everyone I know. What I’ve said is that Canada has problems in their healthcare, too. I’ve backed it up with links. Here’s another, this one focused on how some Canadians have issues with oral health: > **[Overall health includes oral health: Should dental be part of universal...](https://www.cbc.ca/radio/thecurrent/filling-in-the-gaps-dental-care-in-canada-a-special-edition-of-the-current-1.4421567/overall-health-includes-oral-health-should-dental-be-part-of-universal-health-care-1.4421599)** > > Dentists are divided on whether universalizing dental care is the way to fix problems of inadequate and inequitable coverage. Quoting from the link: \*An estimated 20-30 per cent of Canadians have great difficulty getting access to dental care. According to a 2014 report by the Canadian Academy of Health Sciences, about six million annually avoid the dentist because of the cost. \* Here’s one related to vision insurance: [https://www.sciencedirect.com/science/article/pii/S0008418217306087](https://www.sciencedirect.com/science/article/pii/S0008418217306087) Quoting from the link: _Significant disparities exist in eyeglass insurance coverage in Canada. Individuals with low levels of income and education, and the self-employed, seniors, immigrants, nonwhites, and residents of Quebec had less coverage. Studies are needed to understand whether these disparities contribute to the visual impairment burden in Canada._ I think you paint a misleading rosy picture of Canadian healthcare. ---
**Author:** ![LAZombie](https://avatars.discourse-cdn.com/v4/letter/l/b38774/32.png) [@LAZombie](https://boards.straightdope.com/u/LAZombie)\ **Post date:** [March 6, 2019, 9:00pm UTC](https://boards.straightdope.com/t/uhc-has-to-be-affordable-high-quality-and-also-not-have-long-wait-times/830033/287 "2019-03-06T21:00:24Z")
> [@JcWoman](#): > > Today with our ridiculous insurance system doctors have to bill (made up numbers for illustration) $500 for an office visit because they know the insurance company will refuse to pay $400 and the patient is only required to pay a $20 copay. It’s common knowledge that they never get paid their full amount. Medical provider price inflation is in part due to this - doctors trying to be compensated as much as they can because they have to fight tooth and nail with the insurance providers whose sole motive is to not pay out. > . Then why do medical professionals put up with this abhorrent behavior? Why don’t they refuse to accept insurance from companies that play games? I own a business. If I have a client that plays games with paying me, I simply stop doing business with them. One would think the free market would be begging and providing a business arrangement in the private sector that was cost efficient and hassle free. ---
**Author:** ![wolfpup](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wolfpup/32/10618_2.png) [@wolfpup](https://boards.straightdope.com/u/wolfpup)\ **Post date:** [March 6, 2019, 9:09pm UTC](https://boards.straightdope.com/t/uhc-has-to-be-affordable-high-quality-and-also-not-have-long-wait-times/830033/288 "2019-03-06T21:09:03Z")
> [@survinga](#): > > … > > I think you paint a misleading rosy picture of Canadian healthcare. It seems that if you get hammered on false or misleading claims on one topic, you just bounce over to a completely different topic. I believe this is the classic definition of the [Gish gallop](https://en.wikipedia.org/wiki/Gish_gallop). I didn’t claim the health care systems in Canada are “rosy”. I don’t think that’s a recognized term in health care economics, anyway. I claim that, on balance, for the vast majority of people, the health care system in any province is orders of magnitude superior to the clusterfuck in the US. I claim that the majority of Canadians recognize this fact, to the extent that any hint of moving toward a more “American style” of coverage would be political suicide for any party including conservatives. People would revolt. And I think there’s an important lesson to be learned from that. With regard to the latest off-track trot in your current Gish gallop, dental care is in my view a genuine gap in our UHC coverage, although it’s only a gap in terms of ordinary dental care and not certain dental surgery procedures. I think we need to close this gap, which is just a matter of putting the appropriate amount of additional money into the system, and that will probably eventually happen. The interesting thing about this is that since I’ve had supplemental private insurance to cover dental during most of my working life, except the years that I was a freelance consultant, I have personal experience dealing with private insurance, even up here in “rosy” Canada! And I will be delighted to tell you just how it worked: The cost of every dental procedure involved about 20% or 25% co-pay, sometimes as much as 50%. My dentist sometimes had to apply for pre-approvals. I once had a claim denied for a crown because the insurance company claimed that according to the submitted X-rays, “patient already has one”. The dentist had to refile the claim with a note to the effect that “Listen, morons: that thing in the X-ray was the temporary that I put in!” Later on, a friend of mine, dealing with that same dentist, eventually left him because the dentist became so negligent about doing his paperwork that my friend never got compensated for his claims. So let me say this: \*\*I thank God that I don’t have to deal with my primary health care the way I had to deal with my dental insurance! \*\* ---
**Author:** ![survinga](https://avatars.discourse-cdn.com/v4/letter/s/cab0a1/32.png) [@survinga](https://boards.straightdope.com/u/survinga)\ **Post date:** [March 6, 2019, 9:13pm UTC](https://boards.straightdope.com/t/uhc-has-to-be-affordable-high-quality-and-also-not-have-long-wait-times/830033/289 "2019-03-06T21:13:20Z")
> [@JcWoman](#): > > I didn’t read the whole quote because I stopped at this one which is silly. Today with our ridiculous insurance system doctors have to bill (made up numbers for illustration) $500 for an office visit because they know the insurance company will refuse to pay $400 and the patient is only required to pay a $20 copay. It’s common knowledge that they never get paid their full amount. Medical provider price inflation is in part due to this - doctors trying to be compensated as much as they can because they have to fight tooth and nail with the insurance providers whose sole motive is to not pay out. > > So in a single payer system as I understand it, there is no silly[Chargemaster (rack rate)](https://thehospitalleader.org/18816-2/) so medical providers don’t have to play silly games to fight the insurance companies. There is one price list for all treatments with realistic/reasonable prices and doctors never have to wonder if they’ll get paid or get screwed. Sounds to me more like the transformation that doctors would have to go through is an increase in confidence that they’ll be paid and a steadier income stream. In aggregate, we know that doctors will get paid less in single-payer than they are currently. That’s actually one of the “selling points” that M4A advocates have. ---
**Author:** ![JcWoman](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/jcwoman/32/2889_2.png) [@JcWoman](https://boards.straightdope.com/u/JcWoman)\ **Post date:** [March 6, 2019, 9:18pm UTC](https://boards.straightdope.com/t/uhc-has-to-be-affordable-high-quality-and-also-not-have-long-wait-times/830033/290 "2019-03-06T21:18:40Z")
> [@LAZombie](#): > > Then why do medical professionals put up with this abhorrent behavior? Why don’t they refuse to accept insurance from companies that play games? I own a business. If I have a client that plays games with paying me, I simply stop doing business with them. One would think the free market would be begging and providing a business arrangement in the private sector that was cost efficient and hassle free. Well, all the insurance companies play games. Wolfpup and I have both mentioned several times in this thread that any one service provider needs to be able to deal with tens of insurance companies and thousands of insurance plans (since each insurance company offers many thousands of different plans that all have different coverage). It’s not really that they’re playing games. It’s just that their reason for being in business is to make a profit which is counter to the doctor’s reason for being in business (to care for people). I have heard of a few doctors who have switched to cash-only services but I don’t know any personally. I think they’re rare. My guess is that if you don’t take insurance, the only other option available is to accept only cash and the majority of patients can’t afford to pay cash. In other words, our awful system has everything so locked down that individual providers can’t even escape it. ---
**Author:** ![Irishman](https://avatars.discourse-cdn.com/v4/letter/i/b487fb/32.png) [@Irishman](https://boards.straightdope.com/u/Irishman)\ **Post date:** [March 6, 2019, 9:40pm UTC](https://boards.straightdope.com/t/uhc-has-to-be-affordable-high-quality-and-also-not-have-long-wait-times/830033/291 "2019-03-06T21:40:19Z")
> [@clairobscur](#): > > Someone pointed out once at a peculiarity in American life expectancy that could be noticed in mortality tables by age. Although the average life expectancy in the USA was lower than in most other western countries, it was catching up at older ages. The life expectancy at 70 (IIRC) was about the same in the USA, and life expectancy at 80 was higher. Which meant that the extra deaths in the USA were happening when people were still relatively young, for whatever reason. One possible explanation - the people dying younger are the ones that can’t afford health care, so the ones that are living are the ones who can afford to get it, thus they have the same survival rates as the countries where it is provided gratis. **survinga** , it’s doubly interesting that the problems with Canadian health care you list are with vision and dental coverage. First, because those are items that in the U.S. are typically covered separate from general health care, so it’s not like we have it any better. And second, because the problems you list come from those being covered by private health plans, _not_ the public health service. So if Canada actually covered them like they do general health, they would have fewer problems. That doesn’t make a strong case for keeping private health insurance in the U.S. ---
**Author:** ![nelliebly](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/nelliebly/32/5422_2.png) [@nelliebly](https://boards.straightdope.com/u/nelliebly)\ **Post date:** [March 6, 2019, 9:46pm UTC](https://boards.straightdope.com/t/uhc-has-to-be-affordable-high-quality-and-also-not-have-long-wait-times/830033/292 "2019-03-06T21:46:35Z")
> [@survinga](#): > > In aggregate, we know that doctors will get paid less in single-payer than they are currently. That’s actually one of the “selling points” that M4A advocates have. That’s not quite true.[A study published by the NIH](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3110239) examined 150 years’ worth of Canadian academic studies, government reports, census data, tax stats, and surveys and found that physicians’ net income actually _ **increased** _ as a result of medicare. Bolding is mine. > [@](#): > > The results show that Canadian doctors enjoyed a windfall in earnings during the early years of medicare and that, after a period of adjustment, medicare enhanced physician income. Except during the windfall boom, Canadian physicians have earned less than their American counterparts. Until at least 2005, however, the medical profession was the top-earning trade in Canada relative to all other professions. > [@](#): > > But fees are only tangentially indicative of earnings. For instance, **Canadian physicians have lower practice expenses** for a variety of reasons, including the lesser costs of billing, administration, and malpractice coverage. > [@](#): > > Canadian physicians are well paid and …medicare did not diminish their earnings. Rather medicare resulted in an initial, brief windfall of high earnings, even when compared with US data. The windfall was followed by a period of readjustment. Subsequently, **Canadian medicare has maintained physicians as the top-earning professional group in that country.** > [@](#): > > Notwithstanding the temporarily reduced rate of change in their earnings, physicians constituted the top-earning profession in Canada every year from 1958 forward and into the present. \*\*Their average net income increased at a rate that consistently outstripped that of all citizens: 1200% versus 676% over 4 decades. The ratio of physician income to that of all Canadians was higher than before medicare, ranging between three and five-and-a-half times with an overall upward trend. \*\* To sum up: you’re wrong. ---
**Author:** ![doreen](https://avatars.discourse-cdn.com/v4/letter/d/858c86/32.png) [@doreen](https://boards.straightdope.com/u/doreen)\ **Post date:** [March 6, 2019, 11:48pm UTC](https://boards.straightdope.com/t/uhc-has-to-be-affordable-high-quality-and-also-not-have-long-wait-times/830033/293 "2019-03-06T23:48:13Z")
> [@JcWoman](#): > > I have heard of a few doctors who have switched to cash-only services but I don’t know any personally. I think they’re rare. My guess is that if you don’t take insurance, the only other option available is to accept only cash and the majority of patients can’t afford to pay cash. In other words, our awful system has everything so locked down that individual providers can’t even escape it. It really depends on exactly what you mean by “cash only” - Doe it means the doctor isn’t part of any networks, or that the patient pays upfront and waits to be reimbursed\* or does it mean the doctor won’t even fill out a claim form? [These](https://www.physicianspractice.com/search/solr/cash%20and%20carry) articles are interesting. He says his overhead is so low because he doesn’t have to deal with insurance at all- and some of his patients have insurance. Sure, costs have gone up since he wrote the articles- but that just changes some of the specific numbers. It doesn’t change the fact that his office had two physicians , a nurse practitioner, one full time and two part-time assistants. While my doctor’s office has a doctor , an NP , 4 medical assistants, three people at the front desk , two in billing an office manager and a practice manager. Plus an outside billing agency. - Which is how my dental insurance always worked since my dentist was not a participating provider. I paid him whatever he charged, he completed my claim form and eventually the insurance paid me the standard payment for xrays or whatever. ---
**Author:** ![doreen](https://avatars.discourse-cdn.com/v4/letter/d/858c86/32.png) [@doreen](https://boards.straightdope.com/u/doreen)\ **Post date:** [March 6, 2019, 11:58pm UTC](https://boards.straightdope.com/t/uhc-has-to-be-affordable-high-quality-and-also-not-have-long-wait-times/830033/294 "2019-03-06T23:58:07Z")
- Hit submit accidentally \* It really depends on exactly what you mean by “cash only” - Doe it means the doctor isn’t part of any networks, or that the patient pays upfront and waits to be reimbursed\* or does it mean the doctor won’t even fill out a claim form? [These](https://www.physicianspractice.com/search/solr/cash%20and%20carry) articles are interesting. He says his overhead is so low because he doesn’t have to deal with insurance at all- and some of his patients have insurance. Sure, costs have gone up since he wrote the articles- but that just changes some of the specific numbers. It doesn’t change the fact that his office had two physicians , a nurse practitioner, and one full time and two part-time assistants. While my doctor’s office has a doctor , an NP , 4 medical assistants, three people at the front desk , two in billing , an office manager and a practice manager. Plus an outside billing agency. Dr Forrest can see 16 patients per day ( not sure if that’s per provider or total) while my doctor sees about 30 patients a day himself and I assume the NP does about the same. - Which is how my dental insurance always worked since my dentist was not a participating provider. I paid him whatever he charged, he completed my claim form and eventually the insurance paid me the standard payment for xrays or whatever. ---
**Author:** ![survinga](https://avatars.discourse-cdn.com/v4/letter/s/cab0a1/32.png) [@survinga](https://boards.straightdope.com/u/survinga)\ **Post date:** [March 7, 2019, 3:04am UTC](https://boards.straightdope.com/t/uhc-has-to-be-affordable-high-quality-and-also-not-have-long-wait-times/830033/295 "2019-03-07T03:04:02Z")
> [@wolfpup](#): > > It seems that if you get hammered on false or misleading claims on one topic, you just bounce over to a completely different topic. I believe this is the classic definition of the [Gish gallop](https://en.wikipedia.org/wiki/Gish_gallop). > > I didn’t claim the health care systems in Canada are “rosy”. I don’t think that’s a recognized term in health care economics, anyway. I claim that, on balance, for the vast majority of people, the health care system in any province is orders of magnitude superior to the clusterfuck in the US. I claim that the majority of Canadians recognize this fact, to the extent that any hint of moving toward a more “American style” of coverage would be political suicide for any party including conservatives. People would revolt. And I think there’s an important lesson to be learned from that. > > With regard to the latest off-track trot in your current Gish gallop, dental care is in my view a genuine gap in our UHC coverage, although it’s only a gap in terms of ordinary dental care and not certain dental surgery procedures. I think we need to close this gap, which is just a matter of putting the appropriate amount of additional money into the system, and that will probably eventually happen. > > The interesting thing about this is that since I’ve had supplemental private insurance to cover dental during most of my working life, except the years that I was a freelance consultant, I have personal experience dealing with private insurance, even up here in “rosy” Canada! And I will be delighted to tell you just how it worked: > > The cost of every dental procedure involved about 20% or 25% co-pay, sometimes as much as 50%. My dentist sometimes had to apply for pre-approvals. I once had a claim denied for a crown because the insurance company claimed that according to the submitted X-rays, “patient already has one”. The dentist had to refile the claim with a note to the effect that “Listen, morons: that thing in the X-ray was the temporary that I put in!” Later on, a friend of mine, dealing with that same dentist, eventually left him because the dentist became so negligent about doing his paperwork that my friend never got compensated for his claims. So let me say this: \*\*I thank God that I don’t have to deal with my primary health care the way I had to deal with my dental insurance! \*\* No, I’m sticking to the topic. And why are you talking about Canada switching to the US system and discussing how people would react? I’m not talking about changing Canada’s system. I don’t want to change your system. You just changed the topic yourself into something I’m not even talking about. But for some reason, you are HELLBENT on wanting to change our system. You repeatedly, over and over and over, criticize US healthcare system, and flippantly dismiss anything I bring up from my 50+ years of experience with it, and talk about how great Canada is. So, I decided to look a little harder at Canada, and it’s clear that it’s not as good as you’ve said in the past. Everything that I’ve said, I’ve backed up with links. You may or may not like it. But what I’ve said about Canada and healthcare is true. ---
**Author:** ![survinga](https://avatars.discourse-cdn.com/v4/letter/s/cab0a1/32.png) [@survinga](https://boards.straightdope.com/u/survinga)\ **Post date:** [March 7, 2019, 3:17am UTC](https://boards.straightdope.com/t/uhc-has-to-be-affordable-high-quality-and-also-not-have-long-wait-times/830033/296 "2019-03-07T03:17:29Z")
> [@nelliebly](#): > > That’s not quite true.[A study published by the NIH](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3110239) examined 150 years’ worth of Canadian academic studies, government reports, census data, tax stats, and surveys and found that physicians’ net income actually _ **increased** _ as a result of medicare. Bolding is mine. I don’t care about any studies of Canada and their doctor’s pay. That’s not relevant to what will happen in the future in the US, and our doctors post-M4A. I’m talking about single-payer in the US. Doctors will get less pay if we switch to single-payer. How much less is still a question. Some will be fine with it. Others will not. Many will support single-payer, and some will not. But it’s well agreed that doctor pay, in aggregate, will come down in single-payer. [https://www.politico.com/agenda/story/2017/10/25/doctors-salaries-pay-disparities-000557](https://www.politico.com/agenda/story/2017/10/25/doctors-salaries-pay-disparities-000557) > **[Would a Single-Payer System Require Painful Sacrifices From Doctors?...](https://www.nytimes.com/2018/06/08/business/would-a-single-payer-system-require-painful-sacrifices-from-doctors.html)** > > Income growth for many doctors would be constrained by switching to single-payer health care. But research on happiness suggests that there would also be many compensations. > **[Home](https://www.healthleadersmedia.com/finance/ama-president-its-still-no-single-payer)** > > Looking for the latest pharma news & health care news in the healthcare pharmaceuticals industry? Subscribe & be updated on all the health care news! ---
**Author:** ![PatrickLondon](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/patricklondon/32/4422_2.png) [@PatrickLondon](https://boards.straightdope.com/u/PatrickLondon)\ **Post date:** [March 7, 2019, 5:18am UTC](https://boards.straightdope.com/t/uhc-has-to-be-affordable-high-quality-and-also-not-have-long-wait-times/830033/297 "2019-03-07T05:18:50Z")
> [@LAZombie](#): > > Then why do medical professionals put up with this abhorrent behavior? Why don’t they refuse to accept insurance from companies that play games? To do this effectively, they would need to act collectively and en masse. Indeed, I can’t help thinking that that would be the key to developing a workable UHC system in the US: get the clinical professionals to design it. ---
**Author:** ![Grim\_Render](https://avatars.discourse-cdn.com/v4/letter/g/a87d85/32.png) [@Grim\_Render](https://boards.straightdope.com/u/Grim_Render)\ **Post date:** [March 7, 2019, 8:49am UTC](https://boards.straightdope.com/t/uhc-has-to-be-affordable-high-quality-and-also-not-have-long-wait-times/830033/298 "2019-03-07T08:49:36Z")
> [@survinga](#): > > In aggregate, we know that doctors will get paid less in single-payer than they are currently. That’s actually one of the “selling points” that M4A advocates have. I think we know nothing like that actually. [The highest wages for doctors are in UHC countries](https://www.careeraddict.com/top-5-countries-with-the-highest-paid-salaries-for-doctors). Switzerland and Luxembourg. Ireland is only slightly behind the US. Transitions to UHC systems historically have yielded great leaps in revenue for doctors, who have had their mouths stuffed with gold, as the man said. Any adequate UHC setup should also free up funds about equal to the economy of about the 12th biggest economy in the world or so, so there should be surplus resources. So no, I think indications lean heavily the other way. ---
**Author:** ![LAZombie](https://avatars.discourse-cdn.com/v4/letter/l/b38774/32.png) [@LAZombie](https://boards.straightdope.com/u/LAZombie)\ **Post date:** [March 7, 2019, 3:25pm UTC](https://boards.straightdope.com/t/uhc-has-to-be-affordable-high-quality-and-also-not-have-long-wait-times/830033/299 "2019-03-07T15:25:19Z")
Questions: Could Medicare sell policies? Has anyone proposed lowering the eligibility age gradually? ---
**Author:** ![GIGObuster](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/gigobuster/32/421_2.png) [@GIGObuster](https://boards.straightdope.com/u/GIGObuster)\ **Post date:** [March 7, 2019, 3:52pm UTC](https://boards.straightdope.com/t/uhc-has-to-be-affordable-high-quality-and-also-not-have-long-wait-times/830033/300 "2019-03-07T15:52:57Z")
> [@survinga](#): > > No, I’m sticking to the topic. And why are you talking about Canada switching to the US system and discussing how people would react? I’m not talking about changing Canada’s system. I don’t want to change your system. You just changed the topic yourself into something I’m not even talking about. > > But for some reason, you are HELLBENT on wanting to change our system. You repeatedly, over and over and over, criticize US healthcare system, and flippantly dismiss anything I bring up from my 50+ years of experience with it, and talk about how great Canada is. So, I decided to look a little harder at Canada, and it’s clear that it’s not as good as you’ve said in the past. > > Everything that I’ve said, I’ve backed up with links. You may or may not like it. But what I’ve said about Canada and healthcare is true. And yet, thanks to cost, I do not have dental insurance. I have to say my escape hatch is that I travel to the old country for that and to also get affordable lab work now even with the regular health care from ACA and the health care of the workplace of my wife will not be offered until a year has passed. What you said implies a better dental and health care in America, but that is not quite the case. > **[About Dental Plans & Care - National Association of Dental Plans](https://www.nadp.org/about-dental-plans-care/)** > > Featured content Why Dental? The value of dental benefits and maintaining oral health. Learn More Understanding Dental Benefits Who has dental benefits today? What are the different dental benefit products available? What do plans normally cover?... While you say that 20-30% have difficulty getting dental care in Canada in the USA 23% (out of 77%) do not have dental care even with ACA added (before ACA it was worse, and worsening now thanks to the sabotage the Republicans are doing with the ACA now) I think you are ignoring furiously that \*\*wolfpup \*\*has already reported that Canada is not perfect, and even the British system that looks better has flaws too, but they are very good compared to the irrational health care that we have in the USA. Dental care? Sure, there are similar problems in Canada as in the USA but the latest from Canada are proposals for the government to take care of the issue by expanding coverage for dental care, meaning that in the near future the USA will be once again pondering why in developed nations like in Canada they can do it better, and in dental care too. [Previous page](https://boards.straightdope.com/t/uhc-has-to-be-affordable-high-quality-and-also-not-have-long-wait-times/830033.md?page=14) [Next page](https://boards.straightdope.com/t/uhc-has-to-be-affordable-high-quality-and-also-not-have-long-wait-times/830033.md?page=16)