As per my post above, effectively they are. The key defining attributes of what we practically mean by “single-payer” are universality, community-based rating, and regulated common services for all. Basically you know you’re on the right track if Republicans start calling it “socialist communist government-run health care”. 
I don’t how there can be competing insurance companies, none with a majority market share, and that’s single payer. You are changing the plain meaning of the English words “single payer” to mean “universal coverage.”
If the Republicans start calling it “socialist communist government-run health care,” but it really is a mix of government, non-profit, and profit – both on the insurance side and the care side – there is a politically realistic possibility of convincing political moderates that the Republicans are wrong. Conceding that a proposed system is single payer, when (if it has the slightest chance of passage) it isn’t, is a political mistake, in addition to being a factual one.
Europeans who pay attention to health care policy certainly do not consider the difference between single payer, in fact, and what you call single payer, to be insignificant. For example:
As for whether single payer is better, I’m not sure and doubt it is of overwhelming significance. I am sure that I want universal coverage, and that I want hospitals to compete for my patronage.
The conversation is never about healthcare reform, always about insurance reform. Most general medical care in the US is performed by Docs working in sweatshop conditions too impoverished from their education to do anything but work for a for profit corporation that limits them to 5 minutes with a patient and stacks their patients to the point we’re always left sitting in a stupefying waiting room 2 hours past our appts. And most of this medical care could be better dispensed by clinicians, but our culture has set Docs up as demi-gods and made something magical of mundane medical knowledge so they can keep charging our asses off for care below average. We can never have affordable good quality medical care if our idea of reform is subsidizing the insurance industry.
Obviously, single-payer is the best, but the OP has eliminated that.
The next best choice that I see as a future addition to Obamacare is one that was in the original plan: the public option.
This would basically allow people to choose to join various public health care plans as an alternative to an insurance company plan, for example, Medicare, the VA Medical system, or the military TriCare.
Thesse systems are all existing large, multi-state systems, and could expand to handle additional patients. They would gain an influx of new paying customers, many of them fairly healthy. The additional funds would make each of these systems stronger. They would be competition to the existing insurance company/hospital system (and to each other), which should result in reduced prices & better service. (Medicare is already the most cost-effective system, though not always the most customer friendly. But they’ve never had to be concerned with that; their customers didn’t have the option of choosing a competitor. When they do, that will change.)
Finally, I think this might be the easiest enhancement to Obamacare to enact in Congress. Republicans should like the free-market competition aspect; Democrats should like the public aspect of it. Each of these systems, while daunted by the possible sudden addition of many new patients, should see the additional funds and the expansion of their system as positive growth. Probably the only opposition would come from the insurance companies & private hospitals, who would see this as competition cutting into their business. But they might also think they could use this to ‘encourage’ their expensive patients to switch to a public system, thus dumping them elsewhere. Other opposition might come from drug companies, medical device suppliers, etc., who would dislike having to negotiate prices with these large systems.
Just to deal with that last sentence for starters, let’s not confuse competition in the provider system (something I agree is beneficial) with single-payer or its equivalents. Indeed single-payer as I know it in Canada gives me complete freedom to choose any provider I want, because there’s no such thing as “out of network” – every doctor and every hospital is, by definition, part of the network.
But back to the topic of what single-payer is. The point I’m trying to make is that how the system is managed is a lot more important than whether there’s one or ten or a hundred actual payers – and the key elements are not just universality but also a common rate structure and common services. You mentioned Germany, Switzerland, and the Netherlands. Your link in the last post was about the Netherlands, and yes, I acknowledge that the Netherlands system is rather a convoluted mess, although they do have fairly tight regulation that strives to achieve uniformity. Switzerland goes a lot further and establishes a national standard for health care services, though there is some (not a lot) variability in rates. Germany has pretty much standardized both services and the community-based rate structure in the statutory system, so I would argue that Germany functions as de facto single-payer in that all-important sense, with Switzerland and the Netherlands somewhat less so.
And just as a side note to that, I find it interesting that Germany’s stronger conformance with single-payer principles gives it the lowest costs of those three countries – about the same as in Canada – whereas Switzerland and the Netherlands are among the most costly within OECD nations, excepting of course the US which is a huge outlier on the cost scale.
Maybe I can further illustrate the point with a sort of analogy. When Ontario first introduced its single-payer system many decades ago, it didn’t initially have the payment systems needed to support it on the necessary large scale – the accounting systems and the systems that, back in those days, physically printed the checks. So it contracted that service out to existing health insurers who were well equipped to do it. They were no longer allowed to sell insurance for medically necessary procedures, but they were happy to take the government’s money to run payment systems. Suppose for the sake of argument there were a dozen or more companies doing this, so that who a doctor or hospital got their check from depended on their geographic location. That would be a system with a dozen different “payers”, but no one could reasonably argue that this wasn’t really single-payer.
I don’t recall a single person that got sick on purpose.
We need to figure out how to cover everyone, in their specific circumstance.
Here’s an overview…
5 tier health care.
1: Invalid/Special Needs/Illegals = Government Paid
2: Retired = SSI/Medicare Paid
3: Unemployed/Disability = Unemployed Insurance Paid
4: Employed = Employer/Employee Paid
5: Business/Owner/Rich = Personal Paid
There’s more to it but, that’s the basic idea.
Yes, all of us pay for everyone, but still keep it dissected between private and public insurance. Allowing private insurance to profit and have enough taxes/dues into the system to pay for the Government Heath Care section.
No one will do this cause there’s no earmarks for congresspeople to get their cut or omission from it all. :rolleyes:
Aside from the fact that in my view “tiers” for basic essential health care are contrary to the most basic principles of human rights, the problem with your proposal is that the government ends up with the elderly and relatively sickly who need the most costly health care (1 & 2) and private funds support the young and healthy (4 & 5). The latter is a business that the insurance industry would love, and would make out like bandits – which come to think of it is pretty much what they already do.
There’s just no getting away from the fact that the most cost-effective system for basic essential health care has been proven to be one that has a single rate structure spread over the entire population. Fragmenting it even more seems to me to be counterproductive.
I think I mean it comes from the same pool of money, just separated accordingly.
Also fix the dam cost of things to a cash value price, for those who may still pay cash for service, and stop inflating one thing to pay for another.
I don’t know if single payer is innately the best system. Nations have a variety of different systems and they all keep their prices at 8-12% of GDP. Israel has a multi payer system and they only spend 8% of GDP on health care, Canada has single payer and they spend 11%. So multi payer can be cheaper than single payer.
Yes, that is indeed repeating what I said–the important factor in a national healthcare scheme is not whether it is single payer or not.
No, it is actually pretty similar to the American model. You’re confusing your opinion on the American model’s “reason for being” with the structural reality of the model.
Incorrect history of Germany mixed with opinion on the American system. Social welfare in Germany roughly goes back to the age of Bismarck, which roughly coincides with our post-Civil War era date-line wise, it doesn’t go back “centuries” unless you intend that word to mean “less than two.”
There’s no such thing as de-facto vs some other single payer, a system is single payer or it’s multi-payer.
Relevance?
This is patent nonsense. The geographical proximity of the American healthcare system has no ability to unwrite Canadian laws.
And what does that again, have to do with defining single payer? What a long incoherency your post was.
This. If you want to make health care more affordable, there are three major aspects:
More health care workers (physicians, nurses, lab techs, etc.)
More affordable training and less debt for health care workers
Get rid of the intermediate profit center that is for-profit health insurance.
We’ve been talking about the third while neglecting the first two.
I don’t see how debt could explain why our health care system is so expensive. Assume 20,000 physicians graduate medical school each year. Give each of them a $200,000 graduation bonus (which would cover tuition and books, and then some) and it adds up to 4 billion a year. That doesn’t being to explain why our system is a trillion dollars more expensive than other OECD health systems. You could do the same with other medical professions with less of a graduation bonus (maybe $50,000 for each nursing student) and it still adds up to less than 1% of the excess cost of our health system.
And doctors are pressed for time, but part of that is because our health administration is so shitty that they have to fight insurance companies constantly. Clinical time is wasted on administration.
But yes, doctors are overrated in my experience.
Number 4 needs to end. Your employer should not in any way be involved in your healthcare insurance. They shouldn’t choose your insurance. It should be completely separate from your place of employment. If you like Kaiser but your employer doesn’t offer it, you are out of luck. For most people, their employer does not negotiate or choose insurance companies for your home owners insurance, your vehicles, etc. Health insurance should be the same way.
Our model of employer funded health care is outdated.
As for the third, don’t half or more employed Americans have the option of choosing a non-profit plan, often Blue Cross (although I know that not all Blue Cross plans are non-profit)? Now, I’d favor encouraging non-profit operators through means such as requiring the insurer to prominently advertise its profit margin. Zero is good
As for the second, sounds good. I am willing to pay slightly higher taxes for this.
As for the first, it depends on the worker. US health care is AFAIK unique in that most physicians are specialists. If you have more family practice docs, they will take the extra time to do tasks that, in the US, might be handled by an expensive cardiologist or sleep medicine specialist. But if we train more cardiologists and sleep medicine docs, it is hard to see costs coming down.
As for more nurses, it again probably depends on the type of nurse. In my experience, nurse practitioners are rather quick to insist on a specialist checking up on, for example, a wound, that a family practice doc, or internal medicine primary care doctor, might handle themselves more cheaply. Maybe this will not be so true now that the required US nurse practitioner training time is being increased. My point isn’t that nurse practitioners are bad, but that you can’t get European health costs with the American specialist-centered model.
Re claim in my last post that American medicine has too many specialists in general, and cardiologists in particular, a study supporting that idea just appeared in JAMA:
http://archinte.jamanetwork.com/article.aspx?articleid=2038979
It seems to me the German model in some respects may actually be superior to single-payer (at least measured by health outcomes) and I find it unfortunate that this model has been little discussed by American progressives when such a system is much more doable and palatable to Americans than a British-style NHS.
What are the defining and unique characteristics of the German system? I thought when Taiwan was building their system they looked at the German system where people can opt out of the public system and found it lacking, so when Taiwan build their system from scratch in the 90s they created a single payer system.
The Israeli system is a multi payer system that only costs 8% of GDP. There is probably something to learn from them.
Singaopore.
Or ultimately just allow a bit of free market, there were so many fixes beyond ACA that could have been attempted but for ridiculous American goverment.
Yea, that will really go over well with the GOP’s base, not to mention its Medicare-aged campaign contributors:
The Singapore health care system may be the best soak-the-rich innovation since sliced bread, but it’s one of those hard-to-swallow-good-for-you things, like changing the national language to English, that you can’t do in a democracy.
Heck, in the United States, our government isn’t even strong enough to force Americans to use the metric system. And you think we are going to pay down the deficit by cutting off Medicare from the affluent elderly? And how will it go over that health savings accounts will be mandatory? (I can’t find what Singapore’s typical penalty is for not making your contribution, but if a Singaporean, I wouldn’t want to risk it.)
Lee Kuan Yew, the retired autocrat Joe Biden calls the wisest man in the Orient (!!!), says our inability to adopt unpopular means of pumping up GNP shows democracy is a mistake. But as someone who has been known to chew a stick of gum, I say phooey to that.
What are these unpopular means of pumping up GDP that Lee Kuan Yew was referencing? That would be interesting to hear. Did he mean something like higher taxes for higher spending on infrastructure, science and/or education; harsher drug laws or something else?
Singapore is an outlier on health care, their system is only 4-5% of GDP which probably makes it the cheapest developed system on earth. I have no idea how they do it.