It’s single-payer for a narrow segment of health care. It doesn’t cover doctor visits, prescription drugs, tests, physical therapy, or really anything other than hospitalization/rehab/nursing home care. Furthermore, it only covers the first 60 days of in-patient care, so inpatient stays beyond that: are $335 per day or 60-90 days, and a whopping $675/day–$20,000 per month–after that.
So let’s call it what it really is: single-payer limited hospital/rehab/nursing home coverage. Calling it single-payer healthcare is inaccurate and misleading.
Too bad you don’t have a cite, because I have a lifetime of experience with single-payer in Canada and no such phenomena have occurred in my direct or indirect experience, because the critical determinant in successful health care is triage so that treatment is provided commensurate with the degree of urgency, and in my experience it always has been, and always with an abundance of caution when the level of urgency is unknown. Also in my experience, when one hears about these kinds of wait times from critics – and wait times do exist – the critics always seem to forget to mention that the procedure in question was elective and non-critical.
I have no idea about the specific situation you’re referring to in Sweden, but my guess is that since some types of prostate cancer are frequently very slow growing – indeed so slow that in some cases the best recommendation is not to treat it at all – that this anecdote is a mischaracterization of that type of situation. In any case, there are wait times of some kind everywhere, and it’s only a function of funding level and not something intrinsic in single-payer. What single-payer UHC does do is make health care accessible to everyone. That’s a feature, not a bug. I don’t know about you, but I don’t want to live in a country where I get slightly faster access to non-critical care because other people with more critical needs don’t get access at all, and die because of it.
That’s total bullshit, and it’s bullshit on several levels. First of all, there’s absolutely nothing about the fact that the government is paying for or subsidizing public health care that has anything whatsoever to do with the market for medical goods and services. As a matter of fact, it tends to increase the size of that market. It’s true that many medical innovations come from the US, but that’s just because the US is a large country with a strong technology base – it sure as hell has nothing to do with the private health insurers, who are basically useless parasites.
The other level on which this is bullshit is that pharmaceutical and medical technology innovations come from all over the world, and some of the most prominent innovators in many of these areas are not American. For example, here are the largest providers in the field of advanced diagnostic imaging in the world – things like MRI machines and related technologies – and their nationalities:
Fujifilm Holdings - Japan
GE Healthcare - headquartered in the UK
Siemens Healthcare (Germany)
Philips Healthcare (Netherlands)
Shimadzu Corporation (Japan)
Toshiba Medical Systems (Japan)
Carestream Health (US)
Hitachi Medical (Japan)
Hologic (US)
Esaote (Italy)
Among the top 10 diagnostic imaging innovators, only two are American (or three if you count GE’s UK subsidiary), and except for GE they’re mostly small players in this market.
So you say. Much of the world says otherwise.
Why is it not realistic? I’ve often described the single-payer health care system where I live as providing unconditional payment for all medically necessary services on the fee schedule, regardless of cost. Which is a critically important aspect of health care, because a system that denies payment when you need it the most is not a working system at all. So why, then, is our system not bankrupt from multimillion dollar procedures? It’s not hard to guess the answer. Because the system is supported universally by the entire population, and most people are reasonably healthy, and those with conditions that are very expensive to treat are proportionately very rare. Ironically, it’s the private insurer, whose entire business is geared to minimizing medical payouts by scrutinizing individual claims, who is likely to balk at a costly medical payout. Single-payer structurally doesn’t do this at all.
Well, how about that, that isn’t true either! Which is to say, for most of us they usually are commodities, but if the lack of either causes undue suffering, or has any risk of becoming life-threatening, then civilized societies can and do come to the aid of the afflicted. Civilized societies don’t let their citizens starve to death in the midst of plenty, and they don’t cut off electricity in the dead of winter, or at any time when it may cause hardship due to poverty without offering assistance and alternatives. Health care, moreover, is unique because costs aren’t predictable, and some of us who are less fortunate may have very costly needs due to disease or accident, and so it makes sense for reasons of both civilized compassion and cost-efficiency to treat all medically necessary health care as a public service, funded from some combination of tax revenues and common community-rated premiums.
Each and every one of your points sounds like it was dredged up from AHIP propaganda rather than a balanced assessment of how health care systems really work.
survinga, are you saying that Medicare covers everyone over 65, and that there is no coverage provided by other services, such as VA or private insurance?
Because if there are other payers for those over 65, Medicare is not single payer. It is a payer for a broad range of people, but it would just be one payer amongst others, not single payer.
This is not accurate. Medicare covers doctor visits (Part B), prescription drugs (Part D), tests (Part B), physical/occupational/speech therapy (Part B), and has very little coverage for nursing facilities.
There is extensive cost sharing in all parts of Medicare. That part is unfortunately true.
No. An analogy would be does every child have a right to free K-12 education? The answer in the U.S. is overwhelmingly YES. However this does not mean there are not budget constraints on the amount of money spent on this education.
It’s quite fine for me if there is also a private medical system where you can buy this multimillion dollar procedure to extend your life a few weeks (or a supplementary insurance policy where you buy coverage for this).
You implied that Medicare is very expensive, and low quality, so I was asking compared to what? Having no or very bad insurance? Maybe. But my Medicare payments are about 1/5 my COBRA payments from before I turned 65, and those benefited from having the advantage of being negotiated by a very big company. And my benefits are better. And COBRA was a lot cheaper than what I could have gotten from the marketplace. I personally put a lot into the Medicare system when I was working, but it is still a bargain.
Would your force young people to buy this? If not, it won’t work. If so, you have private Medicare, which would not have the clout to enforce good prices - and which would be subject to providers going broke.
The wait time in the link I just gave is for treatment, not for seeing an oncologist. Here is the data for Canada, which is a lot shorter.
I can’t find similar data for the US - but remember, there are plenty who might avoid treatment because of cost.
The rest of this **wolfpup ** covered. I don’t know if Medicare is really single payer or not (looks that way to me) but as far as I can tell it works great.
It would work even better if we got the costs down in the rest of the system which isn’t single payer.
However most of the rest of the cost of hospital stays can be covered by Medigap policies, which are not all that expensive even for the best. I’ve paid under $20 for drug copays in a year and a half (I take cheap ones, luckily) and nothing for doctors visits, including my cardiologist.
The most popular Medigap, Plan F, averages over $300 a month. The second most popular, C, averages over $400 a month. Medicare Part B premiums are at $134 a month.
The median income on Medicare was $26,200 a year, or about $2200 per month, in 2016.
Medigap does not cover prescription drugs. I don’t think they are even grandfathered in from when they were last available to be sold.
That’s odd. Why is C more expensive than the better F? And my premiums for plan F are $149 a month.
Medicare Part B is just what you say.
Medicare Part D is $32 a month, btw.
Compare that to the $861 a month I was paying COBRA. Which had higher copays.
The really poor can still get Medicaid.
I agree that a single payer UHC system funded by general revenue, like Canada, would be better. But given the cost of healthcare and insurance in this country Medicare is still a bargain.
Premiums for MediGap vary by state (and even county).
Without MediGap, you pay 20% of all charges - with no OOP max. To avoid that, Medicare Advantage can be quite a bit cheaper or no cost at all - but you are turning over control to an insurance company. You are usually faced with narrow networks and specialist pre-approvals and all the joy of an insurer getting to control your treatment instead of your physician.
…I didn’t pretend to be bothered by your ad hominem attacks. I didn’t accuse you of being selfish. I most certainly didn’t accuse you of being a liar. I asked you a specific question: you still haven’t answered it.
I won’t remember you when we engage in future threads. I can barely remember people I’ve interacted with in real life. But its awesome that apparently I now have my own personal nemesis. I’ll do my best to live up to my new status as “arch-villain”, even though “when we meet again” I won’t have a clue as to who you actually are.
It didn’t answer your question because the ACA (and I know I’m preaching to the choir), while something we should protect in the short term because it’s better than nothing, is something that needs to go away in the long term because it’s not good enough.