Except for dental care, that is essentially what we have in Canada (in Quebec anyway, each province has its own rules). Doctors who are in the system (nearly all) have to accept what the province pays them with no copay or deductibles. Doctors outside the system (a few) cannot collect anything from the province (there is an exception in case a doctor comes on a medical emergency). There can be long wait times for elective procedures, but emergencies are treated immediately. It costs something like 47% of our provincial budget and is well worth it.
Incidentally, one province (Saskatchewan) started this on its own quite successfully and then the federal government mandated that every province do so. I doubt the US Federal government could do that, so it would have to be a national system.
I would say it’s the other way, Hari - the federal government in Canada didn’t mandate that the provinces provide medicare; it lacks the power to compel the provinces to do something.
Rather, the feds offered lots of money to the provinces to provide medicare. And didn’t refund any taxes to provinces that didn’t sign on, so if they didn’t sign on, they would essentially be subsidising the health care for citizens in other provinces. The US federal government could take a similar approach, not trying to run the health care system in the 50 states, but offering them money to do it by a UHC system.
Nobody objects to it, but Republican governors were dead set against expanding it, and the House Republican healthcare bill would have cut Medicaid funding substantially.
Hard to find a direct quote, but here is one from here:
We’ve fought this ignorance before. The Board’s motto—“It’s Taking Longer Than We Thought”—is quite an understatement.
Despite its lower funding, users of the VA medical system are about as satisfied with their care as are insured customers of the U.S. private health system. One can find problems in either system; which problems you write or read about are a function of political agenda.
So I’d like a cite for the “problems we’ve had with VA medical system in the US”. Credible cites, please — Nobody doubts that the Google search “Republicans say VA is a pile of shit born in Kenya” will get hits.
Medicare fraud is not people pretending to be old to get free coverage. It is people setting up clinics or using existing doctors to bill Medicare for procedures that were never performed. Medicare fraud is currently thought to be more than the combined state budgets of Virginia and Nebraska. Quadrupling the size of the program would likely make it even harder to monitor fraud and would likely mean Medicare fraud of at least $250 billion dollars a year.
This is yet another example of what might be called the fallacy of false extrapolation that we hear so often from the American right when expounding on universal health care. The fallacy always takes the form “we have problem ‘X’ with the present health care system, so if we had UHC problem ‘X’ would be proportionately worse”. The root of the fallacy, of course, is that moving to a coordinated universal system mitigates many of those problems.
The most egregious such fallacy is the one that just linearly extrapolates total costs by simply adding in the extra number of presently uninsured, completely ignoring the significant cost saving that arise, not just from savings in administrative costs, but from the opportunity to monitor and regulate provider fees. The fallacy about fraud is less egregious but similarly overlooks crucial structural differences in UHC.
There has never been any evidence, for instance, that health care billing fraud exists in Canada at anywhere even remotely close to the levels experienced in the US. There are probably many reasons for this, but arguably the most important one is that an integrated single payer that pays for all medically necessary services has unique opportunities for fraud detection by systematic analysis of billing patterns.
Most provinces use a combination of fraud control measures including random audits, verification with patients, data mining, and activity pattern analysis. The province of Ontario maintains a Provider Payment Unit responsible for this monitoring, and contracts out investigations to the health fraud unit of the provincial police force. Over the course of 15 years, between 1998 and 2013, the fraud unit investigations found only 1800 cases serious enough to secure convictions, which resulted – over those 15 years – in just $9 million in restitutions, out of a total Ontario health care budget that currently exceeds $55 billion a year. In the smaller province of Manitoba, health care fraud recoveries have averaged on the order of some $250K annually. With systematic detection of large-scale fraud and serious impact to a doctor’s practice that discourages petty fraud, fraud just isn’t that big a problem.
Seriously, you weren’t aware of the problems with the VA? You weren’t aware that Veterans Affairs Secretary Eric Shinseki was fired over it along with close to a thousand other people?
If that’s an argument against single payer, then an argument for it is the absolutely world-class care that active-duty military receive (seriously – when I was in the Navy, making appointments and getting good quality care was incredibly easy and essentially free) is just as much, if not more, an argument for how good entirely government-run health care can be, when run well. A well run government health care system can be great. A poorly run one will be crappy.
This is an example of the “wishing away” fallacy. The discussion is about Medicare, not the Canadian system. Therefore what the Canadian system does is not relevant. Medicare has a huge problem with fraud and will continue to unless those running it commit to ending the fraud. The problem is not that Medicare is not big enough to monitor fraud, it is already much bigger than the Canadian system but those in charge have not changed the program to end the fraud. There is no reason to think that they would do so after the program is quadrupled in size. Ignoring this is just wishing the problem away.
How many active-duty military are retired, or have chronic health problems? The characteristics of the populations being covered make more than a little difference.
Administrative costs for Medicare are not significantly lower than for private insurance; they are just accounted for differently.
As far as monitoring and regulating provider fees, doctors and hospitals already lose money on 65% of their Medicare patients. So if we implement MfA, we either raise taxes to cover the shortfall (if we don’t allow the two-tier system against which you have already argued), or health care providers need to reduce salaries, fees, costs of equipment, pharmaceuticals, nurses and technicians’ salaries, etc., by about a third, or go out of business. And we can’t just raise taxes on the rich - there aren’t enough rich to tax.
Of course, doctors graduate from medical school with significant debt, and reducing their compensation will mean it is that much more difficult to pay back the debt. We could subsidize medical school, which means even more taxes.
It can be done, I suppose. The problems are that it is unavoidable that taxpayers will have to pay more, health care consumers will get less, and health care providers will have to reduce what they charge. No one will be happy. And that is a best-case scenario.
I’ve noticed in the past in these discussions that all evidence that supports the benefits of universal health care is deemed irrelevant by those who oppose it. I provided a real-world example of a UHC system with very low rates of fraud, and an explanation for why an integrated universal system can have a much better handle on fraud detection than today’s Medicare, which is an almost mind-bogglingly complicated system of partial coverages and intertwined shared obligations. You just continue to insist that Medicare will always have big fraud problems because it has those problems today. This is just like insisting that UHC will always have big cost problems because US health care has big cost problems today, despite the fact that UHC does a far better job of cost containment everywhere in the world without exception.
I believe this has been shown to be false, but to the extent that Medicare’s administrative costs are higher than single-payer, see above – Medicare is an inordinately complicated system because it’s inherently limited, partial, and intertwined with private insurance. Administrative costs are obviously going to be far lower with straightforward universal single-payer, unless you want to argue that an army of actuaries that assess and rate individual risk and another army of claims adjusters that scrutinize every single claim and all the paperwork associated with that gargantuan overhead comes absolutely free, because*** none of that exists in single-payer*** – not to mention yet another army of administrative personnel in doctors’ offices whose sole job is to interface with insurance companies so their employers get paid, which is also non-existent in single-payer.
As per the cite I provided earlier, the administrative overhead alone that you claim doesn’t exist has been estimated to exceed $500 billion annually. To put it another way: the administrative waste in the US health care system – the total waste that is equivalent to throwing bushels of money out the window – is almost ten times the total Ontario health care budget that provides full health care coverage free of any extra cost for 15 million people. If I don’t seem to like health insurance companies very much it’s because the only word that covers that magnitude of profligate waste of national treasure is “obscene”.
Yet another misleading argument that assumes that the costing and overhead structure in UHC would be the same as the present system, an assumption belied by the fact that every UHC system in the world has only a fraction of the per-capita cost of the broken and uncontrolled system in the US. Doctors in Canada are paid only a fraction of the fees they’re paid in the US for the same services, yet far from “losing money”, they manage to be about as wealthy as you’d expect doctors to be in a first-world nation. Why? Because they always get paid for services with neither hassles nor collection overhead, and they never get stiffed either by patients or their insurance companies.
No it doesn’t - I said explicitly that taxes would have to rise and/or services and overhead reduced.
Medicare currently causes health care providers to lose money most of the time, is running out of funding, it has the same administrative overhead as private insurance, but if we implement it for everybody then all those problems go away because it’s bigger.
Buy at seven, sell at five, make up the difference on volume.
I can’t tell if you didn’t understand what I said or just choose to intentionally misrepresent it. Wasteful overhead doesn’t go away “because it’s bigger”. Wasteful overhead goes away because it’s universal, and therefore structurally different.
Once you’ve achieved universality you have major cost control breakthroughs on many fronts and hugely streamlined the whole system. I’ve described all this (just above, but in fact, also many times in many threads) and I’m not going to repeat myself again. I really think you just fundamentally don’t understand how single payer works. I also think that some conservatives have a kind of mental block that tells them that anything so ideologically alien to them couldn’t possibly work.
Illness is a punishment from God.
You sinned and offended God and that is why you are sick.
I (a God-Fearing person with no interest in the well-being of others) do not want to pay for your sins.
Also, on a more dis-interested note. Many, many Americans just don’t give a single solitary c#@p about their health until they need to.
I don’t believe any of the above, but I find this to be a very common mindset amongst the conservative-minded folk.
Or alternatively, we could just do the mirror image of the insurance industry:
Allow severely sick people to administer a program where they evaluate and choose whether a given former health-insurance employee qualifies for re-training and unemployment income.
If not, it’s “oh, so sorry, I know you are going through a tough time and needed a job (kidney) to live, but your unemployment agency didn’t courier form 2027G to our moonbase office in time, and we just can’t cover this claim.”
If the sick folk decide enough of them DON’T qualify, they get fat bonuses for being fiscally conservative and making the hard decisions that keep the enterprise afloat. It’s win/win!
This isn’t remotely a common argument. I’m sure someone actually believes it for their religious purposes but not as public policy.
This isn’t remotely a common argument. I’m sure someone actually believes it for their religious purposes but not as public policy.
This isn’t remotely a common argument. I’m sure someone actually believes it for their religious purposes but not as public policy.
Most people in the world have trouble seeing 10% (for example) of their income go away for the possibility of using it maybe in 20 years, especially if money is tight now and your kid need diapers now.
You DO believe it is a common argument.
Mops people who don’t want MFA is their inability of choosing what they want and taking on themselves the risk/reward equation they want. Obama said “you can keep your plan if you like it” and then they didn’t. Some people like high-deductible plans some don’t. Also, the “government waste” argument is common.
“Punishment from God” is very rare.
You are completely wrong about what “most people in the world” seem to want. If “most people” didn’t want universal health care they wouldn’t vote for governments that establish it and they wouldn’t have it and they wouldn’t be happy with it. But they do, and they are, in every civilized country in the world. Except in the US where insurance lobbyists and their Republican servants have brainwashed a significant segment of the population into believing that “socialized medicine” isn’t in their best interests.
Actually, complicated risk/reward “equations” isn’t what anybody really wants or needs in health care. What people really want and need is to receive quality health care when they are sick, simple as that. And they want those quality services delivered efficiently, at the lowest possible cost. That’s just what they get in every country in the world, where health care is delivered at a fraction of what it costs in the US. If that’s “government waste”, you should want some of that! The only thing your “risk/reward equations” do is make medical costs the #1 cause of bankruptcies in the US.
Used to be, the jury was still out, but widespread public health works! Even the poorest of countries benefit to the extent they are capable of implementing it. If for no other reason than one simple fact: many of the medical crises that demand massive interference start as things that demand only an informed opinion.
The investment return ratio on public health is a thing that would send the most ruthless capitalist into spasms of glee if it were money rather than people.
It is why notorious radicals like Otto von Bismarck supported it, healthy people are productive workers and better soldiers. For all of conservative’s postures of being hard-nosed realists, they are markedly invulnerable to fact. It is by its very nature so positive that not even the dull thud of bureaucracy can kill it. The craven lust for profit will, or course, kill it in its tracks. Naturally, that is their preference. Thick as a brick and not as buoyant.
