If the American political climate demanded major health care reform - will allow any system *except *single payer, that is - what would be the next best alternative?
Frivolous-malpractice lawsuit reform? Rationing? An even more robust version of the ACA?
I believe they tried malpractice reform in Texas and Florida, it didn’t really cut medical spending. The aca was based on Romney care and that didn’t really cut spending in Massachusetts.
You’d probably need price controls, comparative effectiveness research, a public price negotiations system and international competition to drive down prices.
The major problem is obstructionism by the lobbies for the sectors of the economy that most benefit from the status quo, via their paid-for party and media outlets. But that can be neutralized to a large degree by basing the system on something that’s widely liked, and few can be trained to fear. All we really need to do is to phase in expanded eligibility for Medicare, with the supporting taxes made less regressive (raise/eliminate the cap, progressivize the rates, etc.). The system works extremely efficiently, much more so than any private-sector insurance outlet, it’s considered a staple necessity by most Americans, and letting anyone buy into it would be embraced by most as well.
There could still be private insurance if any firms want to try to actually do better than the government, not just say they can. Even the UK has private insurance alongside National Health.
Oddly enough, it’s still single-payer.
“What’s the best non-2.5 solution to an interpolation between 3 and 2?”
Most of the money goes to the chronically ill and the elderly. I vote for death panels.
Also might want to tackle whatever byzantine reason prescription drugs are like $5 in other countries and like $500 here. I’ve read differing accounts.
accidental double post
As far as I can tell, the systems in Germany, Switzerland, and the Netherlands and among the best, and none is single payer.
Now, our youngest son lives in Taiwan, and is highly satisfied with their single-payer system. It’s not that I’m for single-payer, or against single-payer. What I’m against is focusing on something that is highly politically divisive and doesn’t much matter.
Now, universal coverage – that’s important. In Taiwan, not paying your health insurance premiums (as with the Affordable Care Act, there is a sliding scale) is a serious enough offense that violations are rare.
Gradual strengthening of the Affordable Care Act would IMHO give the US a first-world quality health care system.
Well, if by “single-payer” you mean single-payer insurance, I want to say the best alternative is probably public hospitals. Which have some history in the USA, actually.
And they don’t have to be funded by one state agency, so I think that avoids being classified as merely another kind of single-payer. 
Certainly.
Two of the US hospitals that have cured Ebola cases (Bellevue, National Institutes of Health) are clearly public.
If you count hospitals owned by state universities, and I don’t know why we shouldn’t, maybe a quarter of the hospitals on the US News best hospitals lists are public.
Many countries have a mix of public and private but non-profit hospitals. Taiwan does, despite being single-payer. Someone can correct me, but I think the same is true of
Canada.
I think there is a role for competition. And public and private can compete.
I’d hesitate to go to a for-profit hospital except in a dire emergency, but I’m not sure their existence is a major public health problem.
If you don’t want a system that is proven to work in other countries, then all you need is something that is in the best American tradition:
- it provides profits to private companies
- it gives a better service to the rich
If you also want something that:
- is available to all; even those who can’t pay much
- won’t be shot down purely for party political reasons
then you may need a miracle. :eek:
A better analogy would be: “Is there a way to get to Manhattan without driving through the Bronx?”
Magical aliens?
I think you’d need to define single-payer first. There are actually a lot of different healthcare systems around the world, and they have some stark differences between them.
The most successful ones tend to have:
-Control of price, through various mechanisms
-Universal access to care
-System decentralization
There is nothing magical about single payer, and many countries have not gone the single payer route.
The assumption is single payer is the only way to go because it is the only way to truly control provider costs. But that’s a false dichotomy, there are in fact several other ways you can control costs, and countries like Germany for example have implemented such systems.
We can attempt to stop subsidizing other countries’ drugs, enact malpractice reform, continue deporting immigrants (who are statistically more likely to cost more than pay into the system) and make healthcare costs harder to discharge in bankruptcy.
Go east from New Jersey.
International competition. Let foreign countries build hospitals here and treat them like Embassies where foreign law applies. So if Thailand builds a hospital here, and you choose to go there, any legal matter that may arise will have to go through a Thai court… but you’ll get much closer to Thai prices too.
That might take care of lawsuits, drug & diagnostic testing costs but how are you going to get employees to work for Thai wages?
In Canada the majority of hospitals would be regarded as “public” by most standards as they are either run by a board of trustees or by a university or other research establishment. These hospitals get most of their operating budgets from the fees paid by the single-payer system, and some of their capital budget from government grants. For-profit hospitals exist although they are rare. The world-class Shouldice Hospital for hernia repair in Toronto is an example. A large percentage of its clientele are out-of-country and pay cash or use private insurance; Canadian residents get its services at no cost. Along with the fact that virtually all doctors are in private practice, it’s a good example of the fact that a private provider system can coexist with – and is completely decoupled from – a public insurance system.
All of this is correct, yet to my mind oddly misleading. The key to understanding that is in your first sentence, defining what we functionally and practically mean by “single payer”. It turns out that it has very little to do with how many payers there actually are.
The system in Germany, for instance, with its plethora of different insurers and mix of public and private insurance is often cited as being similar to the American model, and something that the US system might achieve with a few tweaks. Nothing could be further from the truth. The German system is based on principles of social solidarity that go back centuries; the American system is based on corporations making money by providing great health care for rich people. The difference, once you delve into the details, is like night and day.
First of all about 90% of the German population is insured by the statutory system of public “sickness funds” which are tightly regulated at three levels – the federal ministry of health, the independent Federal Joint Committee, and the state health ministries. It’s a system in which everybody pays the same, everybody gets the same services, and everybody is covered. This is de facto single payer. It’s just the kind of system that, in the US, brings accusations of “socialism”, “government meddling in health care”, and, of course, death panels! Private insurance is only available to those at a high income level, and because it’s risk-rated, once you opt out of the community-rated public system it’s almost impossible to get back in.
The system in Canada is operationally different, and for good reasons. It was set up as single payer at the provincial level since it was being created from scratch and this was the most efficient way to do it. It operates under federal guidelines to provide uniform national services and as a condition of federal contributions. Among those guidelines is that the patient may not be charged any out-of-pocket costs for medically necessary procedures, and no company may offer private insurance for such services.
The reason for the complete prohibition of private insurance for medically necessary procedures goes back to the history of the first single-payer system in Saskatchewan, in which US insurers and the US medical establishment engaged in the most egregious fear-mongering to prevent it from being enacted. Even today some of the insurers are still around flogging insurance for supplementary services and trying to expand their reach, while for-profit providers are opening facilities like “executive health care clinics” operating in an uncertain twilight of questionable legality, and trying to lure patients to their US facilities. The proximity to the vast US insurance establishment just on the other side of the border is like huge floodwaters just on the other side of a dam – if the dam is breached even slightly, the rest of it will come tumbling down. This is a problem European countries don’t have, not just because of distance but because, as I noted about Germany, because of a fundamentally different social culture. By and large they believe in the health care philosophy that I outlined in the concluding paragraphs of this post, that in any civilized society health care is a basic human right.