Universal Healthcare

Great Debates
41

Single payer health care is no doubt the cheapest, but supporters rarely acknowledge the tradeoffs.

What we spend to cover just the elderly, Canada spends to cover their whole population. So in theory, we should be able to just extend Medicare to all, but not increase spending. It should be obvious how we would accomplish that, and once you think about what it would take, you understand the tradeoffs clearly. Some of it would be done through price controls, but much of the savings would come from delaying access and avoiding purchases of costly medical equipment. For example, until recently most Canadians did not have access to PET scanners. Access has been expanded since 2005, with a total of 22 now available. Proton beam therapy, a superior alternative to chemo for the treatment of some cancers, is also mostly unavailable. As of the end of last year, only 161 Canadians had been treated using this breakthrough technology, compared to nearly 30,000 Americans.

http://ptcog.web.psi.ch/ptcentres.html

Some single payer supporters get defensive when these tradeoffs are brought up, but I’m not trying to trash single payer. Just want to take it off the pedestal that its supporters put it on. There is no free lunch. Every system has its disadvantages.

42

That’s certainly true. However, the administrative costs of our existing system are the killer. I did some napkin calculations in a prior thread and demonstrated that we spend more on health care administration than the UK spends on all healthcare spending.

43

Currently the US pays 30 cents on every healthcare dollar to support the system. A system which costs almost double other similar nations, and only covers over half the people. In Britain, they pay 5 cents of every healthcare dollar to support the system, half what the US pays, all up, and covers everyone. In Canada, it’s about 5 cents. It just makes sense that it’s cheaper to cover people’s insurance premiums, where needed, instead of paying all of the uninsured’s actual healthcare costs.

A lot of people do see it as evil, to limit access to health care resources, not by need, but by wallet size, which is effectively what the US system does, extremely inefficiently and at twice the cost of other industrialized nations. Clearly that argument means nothing to you. Bully for you. Not everyone shares your attitude to the sick and destitute.

44

Wallet is a limiting factor in universal health care too, it’s just the national wallet is the limitation as opposed to the individual wallet.

Now administrative costs, what does that entail? Single payer is undoubtedly cheaper on administrative costs, our own Medicare is pretty cheap that way. But how does the US system compare to the more numerous multi-payer systems like Germany and Switzerland? Especially since that’s the model we’re going for with the ACA?

45

Not sure. I couldn’t find as many English-language sources for other countries.

46

That’s the same problem I run into. Sucks that the Anglosphere is mostly single payer, while the non-English countries are more often multi-payer. Makes it hard to research beyond basic statistics. We do know that multi-payer systems get better health care outcomes, while costing a little more.

47

Cite for this statement please?

48

Of course there is a tradeoff. But, adopting single-payer does not mean we have to spend the amount Canada spends. Canadian health care is particularly under-funded, and some of those dollars really have to stretch for the country’s vast area and low population density. Canada’s health care system is not highly-ranked in the world. Opponents of UHC love to cite Canada because it’s one of the worst examples.

Of course, no system is perfect. But we should be looking at France, Italy, Spain, and Japan, moreso than Canada.

49

I support UHC not only because of the moral issue or the cost savings issue, though both are important – I also support it because our current system creates massive inefficiencies in our economy, decreases job options for everyone, and essentially wastes lives.

For example, health care being tied to jobs means that people are less mobile in their work. It increases the risk substantially to innovate and create new companies, because entrepreneurs quitting their jobs lose their health care, and the cost to pay alone is extremely expensive (and with pre-existing conditions, even more so, or may be completely unattainable). People who otherwise would retire or care for family can’t afford to do so because of the health care issue, so new graduates or people hoping to move up are stymied. It creates stagnation.

It also creates dependence and poverty. I’m a single person working for a living at a modest income who has insurance. However, insurance doesn’t cover a lot of medical expenses. If I become extremely ill, I can expect thousands of dollars in expenses in the first year alone. There is no aid available to me even if I can’t afford this, due to my income, so I either go into debt if the expenses become too high or I’m forced not to get care. If I can’t get loans, I get denied care (except emergent, stabilizing care). My health becomes worse because of that, so now I can’t work, but I still can’t get aid because I have some assets (a home, a car). So now I have to spend away everything until I am destitute. Only then can I get medical aid or other financial assistance, making me a dependent of the state. Of course, should I get better and want to work part-time, for example, now that I’m capable of working again, this may disqualify me for aid as well, making it difficult for me to rejoin the workplace again. Even if I can work full time, it may be very difficult without my car and with a home address in a poor neighborhood (or hell, an institution). Now we all have to pay taxes to support me at a very low income and quality of life because I couldn’t get the care I originally needed, paying far more in the process, not to mention the human cost.

It’s not as if there’s much I can do to prevent this. Even after insurance, it’s not unknown for serious illness to cost many tens or hundreds of thousands, far above my ability to save for the purpose at my income. Any middle class person, let alone the poor, is only an illness away from destitution. Even with family support – how many families could cover $500,000 or $1,000,000 of medical expenses over a year or two? It’s a terrible system.

50

I assume the cost issue is uncontroversial, so I figure you’re asking for outcomes. While I don’t believe life expectancy is much of a factor in judging a health care system, I’ll start there:

Switzerland, with a system quite similar to our own new ACA, has the highest life expectancy in Europe. Japan, the highest life expectancy country, uses an employer health care system, with a national system backing it up for those without insurance or a job. THe co-pays are very high, 30% of costs are out of pocket:

Cancer survival rates are a better way to judge actual health care, and there, Britain’s NHS is dead last. Wait times matter, apparently, and one of the ways NHS saves money is through fewer diagnostic tests. All those tests add up. Canada does much better. The best universal health care system in that regard is Japan, followed by France. France is also a multi-payer system and in most rankings has the best health care system in the world:

51

That’s why I give great consideration to the World Health Organization stats that compare health and cost between all nations. By looking at which populaces live longer and spend less, it gives us something to weigh against what we are doing, or not doing well enough, here at home in Canada. By comparing, we can learn how to improve what we have.