Precisely.
A little bit. Let’s imagine something like Medicaid, except it covers everyone in the USA. Then we get as much health care as the system is willing to pay for. Medicaid doesn’t pay for a whole lot. Its reimbursement rates are so low that many people “covered” by Medicaid struggle to find a doctor or specialist who will take them.
You’re not copying anything. You’ve got a part-way fudge.
Single payer does not just change who pays the bill. It reduces costs in several ways.
It eliminates, or at least reduces, the use of ERs for things that can be handled less expensively in doctors’ offices.
It eliminates the insurance middlemen, who serve no purpose other than to skim profits off of the healthcare money flow. This isn’t just a matter of replacing insurance bureaucrats with government bureaucrats. Insurance companies take profits that a government system wouldn’t have to. Insurance companies create redundant bureaucracies, both within themselves, and in the hospitals and doctors’ offices that need extra staff just to handle the insurance paperwork.
Regarding health savings accounts. They’re great for people who have the spare income to put into such accounts. What happens to those who don’t? They end up in the ER either for minor issues or for major issues that would have been minor if they’d been able to see a doctor when the problem first arose.
Swing and a miss. Suppose you put money into an HSA for 20, even 40 years. Do you think there’d be enough in your pot for long term care, should you need it? Or if you developed a chronic condition such as diabetes, the cost of managing that would take a serious dent out of your HSA. Suppose your catastrophic health insurance decides that you don’t really need that heart transplant? You’re still at somebody’s mercy, and if I had to pick between a government bureaucrat and an insurance flunkie whose job security is based on how many people he denies claims for, I’ll go with the bureaucrat.
“health care decisions are left to patients”- when wasn’t it left to patients?
" competition works to keep prices low for everyone" No it wouldn’t. There is a shortage of doctors in the US. No matter how you pay for it or who pays for it, it’s a seller’s market.
Are we supposed to accept this on faith? The UK spends less on health care in total - including private supplemental coverage - than the US spends on health care administration. Your health care dollars do not, by and large, go to pay for your health care. They go to pay a byzantine network of administrators whose primary job is to figure out ways to avoid paying for your health care.
We already have catastrophic coverage and tax free health savings accounts. Medical pricing transparency would be nice, but it’s not much help to those who require emergency care or who are already in a hospital and have no choice of provider (who represent the bulk of all healthcare expenditures.)
I believe it can be both at the same time. The NHS certainly receives leaner funding than the health care systems of most European countries. At the same time, it squeezes an impressive amount of results out of those pounds.
There are units used to measure this. DALYs, disability-adjusted life years. It measures healthy years lost to disability or ill health. Or HALE, healthy life expectancy, which adjusts for time lived in poor health. You can use these measures for the comparisons you want.
The estimated contributions of higher physicians wages to US excess costs is 5 %. Higher drug costs is 6 %. The big drivers of extra costs are medical and administrative waste.
There are 600 000 people working in medical insurance in the US. Most at very good wages. The amount of financial work performed in the US healthcare system, like billing, liasing with insurance, credit-checking, is also immense. Anecdotally, I’ve heard of US hospitals that have more employees dealing with bills than they have beds. What is more, there are large amounts of duplication of work going on due to the many different systems used. That is the administrative waste.
The medical waste is over-provision or under-utilization of services due to the nature of the system. (Fragmented and generating profit through provision)
The US spends more to cover just over a quarter of its population than Canada does to cover all its population.
Taxes are already being paid to fund Medicare, Medicaid, VA, childrens, IHA etc. Note that due to the way the US system is set up, these groups generally consist of by far the most expensive patients. The ones being covered by private insurance are the ones young and healthy enough to work. In the US taxes already pay for the most expensive patients.
I can’t open that document, but I believe the eligibility of Medicaid means that “people on medicaid” consists of a vastly more unhealthy group than “people without insurance” Was this corrected for?
In any case, the US expereince does not seem to be set up in such a way as to avoid most of the essential US flaws -lots of systems overlapping each other, lots of gatekeeping.
Singapore’s system is also single payer, it is a variety on the NI model. Compulsory savings funded by payroll deductions. With withdrawal limits. From a European viewpoint, it restricts your freedom a lot.
It should also be noted that the UK and Canadian systems do outperform the US, so they cannot be that awful.
Well, I found this online and skimming over it I’d say it’s fairly representative of the conservative issues with single payer health care:
Good luck with that.
Contrary to the popular believe, I’m not a conservative, so grain of salt wrt my answer here. Do I object to a single payer health care system? No, not really. My problem is that, to me, the plans and goals as seem ill defined, as do the budgets and costs. Show me a road map to get us from what we have had in use for decades to the new system, show me exactly what the actual fixed end goals are as well as the intermediate milestones, and what the real, actual non-fantasy costs are going to be not just overall but on the various tax payer brackets. Don’t tell me trite bullshit about how this works in Europe or elsewhere, as to me that’s meaningless…show me how it would and can work HERE, and how we get there from where we are at, and what it’s really going to cost. Show me the projects of medical resources verse requirements if we go to a single payer system, and how they are projected to change during and after the switchover has happened. IOW, show me the project plan for this, the costs, the stake holders and the details.
I think we COULD do this, but I think that a lot of the detail tends to get glossed over, that the goals are ill defined and that there really is no over arching plan…or if there are those things they are being hidden or de-emphasized because those making them know there would be distasteful aspects that people wouldn’t go for. I also think that a lot of folks handwave away just how difficult such a change would be to an entrenched system like we have in the US. Getting from the system that people in this country are generally used too to a system they aren’t familiar with at all, for the most part (even folks who THINK they know what other countries are doing and admire their results) is going to be hard, and convincing especially conservative types to buy off on a radical change (something they would be opposed to regardless because it IS a radical change) is going to take quite a bit of effort.
No, in order to believe that single payer will reduce the cost of health care to something like Canada’s cost per capita, you just have to believe that the US can implement the same funding model and the same cost control structure.
“Catastrophic health insurance” and health savings accounts is just one small step removed from not having health insurance at all, the very problem that we’re trying to get away from, which still afflicts some 40+ million uninsured and much larger numbers whose insurance sucks. And I think the idea of the awesome invisible hand of the free market keeping prices low is an idea whose credibility has worn thin to the point of fairy dust. There’s lots of competition right now – between providers, between insurance companies. And what has that got you? By far the highest costs in the world, and rising faster than almost anywhere else.
I think there are really 3 main reasons:
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It’s essentially wealth redistribution, like DrCube points out, and the basic concept is that you should be able to spend YOUR own money on YOUR own health.
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Distrust of government and a belief that anything the government does is de-facto more shoddy and less efficient than the private sector can.
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There’s a big belief that it’ll reduce choice and prevent people from making their own decisions about their own health care. This isn’t so important among the younger set, but the old-timers take this very seriously.
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A fear that their treatment will be driven by financial bottom-lines and/or political agendas, and not by sound medicine, and that they won’t get much say in it as a result. This is similar to, but not quite the same as #3.
“you just have to believe that the US can implement the same funding model and the same cost control structure.”
Exactly, if the US could implement the same cost control structure as Canada, why has it not done so? The US government pays the same percentage of GDP on healthcare as the Canadian government, yet covers only half the medical expenses of its citizens. How is the governments supposed to suddenly get great at controlling the cost when it has twice the people depending on it? Most of the people moving from the private system would be middle class and above people used to getting whatever medical care they want and would raise cain if their care is diminished in quality.
The problem we are trying to get away from is the high cost of medical insurance. Just as single payer will not automatically decrease medical expenses neither does insurance. Every mandate that increases what insurance covers also increases the cost of that insurance. More expensive insurance means fewer people buy insurance. If the problem is people being uninsured than coverage mandates are a cause of the problem and not a solution.
There is plenty of competition in the medical field but it is not in the realm of price. I choose the gas I buy based on price and so competition keeps the price of gas low. I have no idea how much my doctor visits cost my insurance and choose my doctor on convenience and quality. This is why the US has four times the MRI machines as Canada per capita. Procedures such as LASIC and tooth whitening are not covered by insurance and compete on price which is why the price of LASIK has fallen by over 70% since it was introduced and why I get postcards in the mail weekly advertising cheap teeth whitening treatments.
LASIK and tooth whitening are covered by many vision and dental plans. In any event, you are glossing over the reason they are not covered by all of them: they’re wholly elective procedures which are clearly distinguishable from most forms of medical care.
In terms of health-care outcomes, single-payer is relatively mediocre due to it often being lacking in funding. Of course it would be an improvement over what we have now but that’s not difficult.
This is why I advocate strongly for the implementation of the German model. Single-payer is dead on arrival in the United States while the Bismarck model is the basis for ACA and further expansion.
Kinda like the scandal in pre-2014 America, where many people died while waiting for medical services - because they couldn’t afford insurance.
Inaction can and does kill too.
Because there are a lot of entrenched interests that profit of the current system.
And Single Payer is more effective because it is universal.
No insurance to decide who is covered, what is covered, discuss with the provider what will actually be paid. Its all covered. No bureaucracy dealing with bills and coverage in the hospital, everyone is covered, its paid for, move on. No bureaucrats getting in the way of treatment. Funding is sluiced to doctors to allocate based on medical needs, not ability to pay, or profit from the procedure.
You can’t add single payer to the current system. It wouldn’t be single payer, just another level of duplicate work. You’d have to replace the current setup of government healthcare to free up the funds.
And the outcry…Obamacare would be a wet firecracker in comparison.
One thing Europeans just don’t get in these debates: Americans are scared of not having healthcare. It is a realistic fear for an American. It actually happens. To Europeans , that fear is like being afraid of Goblins. Its not something you worry about in the modern age. In these discussions, the people who fear not getting healthcare are always American.
1- Unless you’re Bill Gates, you don’t have enough money for every potential health issue that you could have. If you’re middle class and get in a serious car accident, you’d run through anything you could have saved in an HSA in days if not hours if not minutes. All of us are potential recipients of the common resources.
2- We can’t base policy on the false beliefs of the ignorant.
3- Again, we can’t base policy on someone’s misunderstanding. The current system limits your choice to what your insurer is willing to cover.
4- Again, we have it now. Every insurer has scores of people whose sole job is to look for ways to deny coverage, plus a bullpen of high priced lawyers who can and will kick your ass in court if you decide to sue.
This country’s fear of single payer is largely driven by industry propaganda. The attitudes are being shaped by special interests rather than facts.
Those special interests create those fears and then cite those fears as reasons not to implement single payer.
Like so much else in this country, policy is driven by wealthy special interests rather than by what’s best for the people.
Really? :dubious: ‘We’ seem to do this literally all the time, so I think your use of ‘can’t’ is based on your own ignorance and false believe (or, that you really didn’t think this through before answering…for example, have you seen any nuclear reactors being building the US lately? Have you notice the recent measles outbreak?)
I’m sure you know that term is often used as an exhortation, meaning “shouldn’t”.
That’s the dilemma with representative government. Policies are ultimately determined by the beliefs and fears of the populace and those beliefs and fears can be manipulated by someone who has the resources to do so.
The answer is to educate the populace regarding the facts, but that’s difficult when rhetoric is easy but facts take time to explain.