UHC: Has to be affordable, high-quality, and also *not* have long wait times

[Northern_Piper]

@Spoons

I think this point is lost on many of our American friends, mainly because they simply cannot conceive of an insurance system that does not have functionaries and bureaucrats investigating claims. Yet the fact remains that if a qualified physician orders a treatment in Canada, that treatment is paid for, without being investigated by a non-physician bureaucrat.

Northern Piper, I believe it was you who once posted the differences between Canada’s single-payer model, and a traditional insurance model. As I recall, it was quite informative. Could you do the same again in this thread, just as a reminder to all?

Is this the post you were thinking of? I was comparing the situation of Tee, an American poster, and me.

With single payer health plans, whither insurance companies?

@Northern_Piper

The uniform fee schedule doesn’t mean that it’s an insurance system. It means that it’s a set fee-for-service, paid by the provincial medicare commission to the doctor.

Here’s why it’s not insurance, compared to the US model, which is insurance.

US: Tee goes to a doctor or a hospital. They provide Tee with medical services. Tee owes them that money. Tee is covered by insurance. Tee’s insurance company pays the medical bills on Tee’s behalf, to the extent those bills are covered by Tee’s insurance policy. Things that aren’t covered, Tee has to pay himself (e.g. - one of the doctors who had involvement in Tee’s care isn’t in his insurance company’s approved network).

…
Canada: Piper goes to a doctor or a hospital. They provide Piper with medical services. Piper does not owe them any money. Piper is a resident of the province and covered by medicare. The provincial medicare commission owes the doctor or hospital for Piper’s care. The provincial medicare commission has a set fee schedule for all medical charges and procedures. The provincial medicare commission pays the doctor and hospital in full for the the medical charges and procedures. Piper is not on the hook for any of the charges.

It’s not an insurance system in Canada. I pay no premiums, I’m not liable personally for the cost of the care, and I have no contractual relationship with the provincial medicare commission. The provincial medicare commission is liable directly to the doctor and hospital and pays directly, not on behalf of me. It’s a government service, paid out of general tax revenue, not an insurance system.