FTR, I’m not arguing against UHC. I’m pointing out things that politicians who are championing it will have to solve and/or address before it’ll be a saleable product to the US populace. Raising taxes and lowering costs is all well and good, but the only costs the general public cares about are THEIR out of pocket costs- in other words, at the end of the year, am I going to pay more or less of the money I worked for on health care?
Most people also don’t care about lowering overhead or whether or not it provides better care to other people. They’re mostly concerned with out of pocket costs and whether or not they’ll be able to visit the doctors they choose/facilities they choose, in a timely fashion. All the rest is noise that they don’t care about. And why would they? It doesn’t affect them.
So politicians, IMO, need to address those things first and foremost to get the population on board- this nonsense of saying “But it’s better!” and then handwaving the rest away isn’t going to cut it when they actually try and pass legislation that requires public buy-in.
Frankly, from your description of your system, I can’t see how anyone can think your system costs less, has more choice, or is more personalized than a single-payer. I’m going to comment on your posts, but not in quote boxes; don’t want any suggestion that I’m tinkering with stuff in quote boxes, per board rules. My comparison is the Canadian single-payer system; can’t comment on how others would work, since I don’t know.
bump: “As US health insurance goes, mine is ok to good. I pay about $600 a month with a 1500 individual/3000 family deductible, so it’s not terribly expensive as such things go.”
My costs are my income taxes. Various studies over the years have shown that the tax levels in Canada and the US are roughly proportionate. I’ve cited them before when this question has come up. When you mention the costs of your health insurance, that’s on top of your taxes, correct? Of which a substantial portion goes to support the health-care industry, higher than any other OECD nation, on a GDP basis/share of public expenditure. You’re also not including the cost to your employer. I realize that you’re replying to the poll, but in any comparison to single-payer, those factors have to be taken into account.
bump: “It’s through a major insurer, so the negotiated rates are pretty good and the network is pretty large.”
My rates are zero, and my network is very large: all doctors and hospitals in Canada, anywhere. My health card is good anywhere in my province. If I’m in another province, I’m still covered by my home province’s system. If my home province has negotiated a reciprocal payment agreement with another province, I just have to show my health card in that other province and don’t pay any cost. If there isn’t a reciprocal agreement, I may have to pay in the other province, but then get fully reimbursed by my home province.
bump: “What I don’t like is the general pain in the ass actions required to navigate the system and get the best outcomes. It’s not unique to my insurance- it’s the way all of them are. They may require a certain test to be run before they’ll ok a different one, even if your doctor has an educated hunch that it’s your gallbladder and not your colon. Or your doctor may want to prescribe you one hypertension medication, but they require them to prescribe some first-line drug off their specific formulary and prove that it doesn’t work before they’ll pay for the second one that your doctor actually wants.”
There are no similar restrictions on a doctor’s professional judgment in the Canadian system. Once a procedure or treatment is on the overall framework agreement between the province and the doctors, any doctor can order a treatment within that doctor’s expertise. There is no government official or insurance adjuster who can second-guess the doctor’s professional judgment.
bump: “Or you may end up in the ER needing emergency surgery and later get a bill finding out that the guy who the hospital assigned to you isn’t actually in-network, despite the hospital itself being in-network.”
No such thing in our system. All doctors in Canada are “in network” to use the US phrase, and there is no billing of patients.
bump: “And having to argue that point with them that you had no choice in the matter- it’s not like you could go home and research and come back a week later for the emergency surgery.”
No equivalent here. Arguing with a faceless bureaucrat of an insurance company in that situation sounds horrible and very depersonalising.
bump: “Or having a test done in an in-network facility for an in-network doctor, and getting a $200 bill, because the price of the test was $750, the negotiated rate was $225, and the insurance portion is $25, leaving you on the hook for the other $200 because your deductible hasn’t been met.”
Tests ordered by a doctor are covered by the provincial medicare system.
bump: “It’s all that crap that drives people insane.”
Certainly can understand that.
But that’s my basic point. If you have that kind of system, single-payer doesn’t cost more, reduce choice, or is more depersonalized. I would say it’s just the opposite: the US system costs more, reduces choices and is more impersonal.
• The most basic point from a health-care perspective is that a doctor in a single-payer on the Canadian model has greater professional discretion to treat patients than do doctors in the US.
• The implementation of a profit motive through giving insurance adjusters the power to veto treatment ordered by doctors reduces doctors’ independence.
• The whole concept of in-network reduces your choice.
• The fact that your health-care is tied to your employer reduces your freedom of employment. Frankly, it sounds like medieval serfs, who were bound to the land of the lord, and couldn’t leave without great personal risks.
• The power of the insurance adjuster depersonalizes the medical care, since ultimately, choice of treatment is not left to you and your doctor; it’s left to a faceless bureaucrat, whose motivation is to cut costs and increase profits.
Here, I’m in full agreement with you. It’s impossible to say in the abstract how much any single-payer system will cost, until you have a very detailed plan. Will it be cost-shared between the federal and state governments? Will there be a payroll tax? How will the payment schedules for doctors be negotiated and by whom? Will there still be a private option?
Those are all key questions, and can’t be answered in the abstract.
And, posters like XT, survinga, shodan and ultra vires have done a very good job over the years of pointing out that one of the high costs of the US system is doctors’ compensation rates. That can’t be changed overnight; it’s a baked-in cost that has to be dealt with. A proposal that cuts their compensation as of X date just won’t fly. Doctors are a well-connected lobby group, and their buy-in is needed. (Aneurin Bevan, the minister in the British government who implemented the NHS, was asked how he got the doctors’ agreement. His reply: “I stopped their mouths with gold.”)
The most that can be expected is a gradual “bending of the curve” to reduce the rate of increase. That’s a long-term change, not an immediate one.
(I won’t originally going to respond to this post, because the thread was a poll of US dopers, but since the thread’s gradually morphed into a a general discussion of single-payer v the US system, I thought I would do so.)
So far the Poll on this decidedly left leaning website is 144 people like or, at least, are satisfied with their Private Healthcare situation vs 43 who are not satisfied with it.
Rather surprising and not a good sign for Single Payer.
Not surprising at all. Ask anyone who has bought a product, and odds are they will be satisfied with it. Endowment effect and cognitive dissonance. If you weren’t satisfied, then you should do something, so to prevent that you tend to feel satisfied.
Plus we don’t know how much respondents used the system. Easy to feel satisfied if all you do is visit the doctor for a checkup or a cold. Big items are the test.
Also, the poll did not include options for public single payer plans, like Medicare. Satisfaction with those tend to be higher than satisfaction with private plans. I had an excellent private plan, but Medicare is even better.
And it also did not include those who can’t afford a plan.
So the results are not that good - not that a poll here means much.
Not necessarily, because the question wasn’t about single payer.
I’m OK with my current insurance but if the US could convert to a system like Canada or the UK I’d go with it in a heartbeat because I believe it would be a much better thing than what I currently have.
Raises hand. Twice. My wife had a stint in ICU with a brain hemorrhage followed by another stay in ICU with blood clots in the lung. Then colon cancer for me 6 years later. BCBS took care of us nicely, though in my case I also had a <$20.00/month cancer policy. I think it passed the test quite easily.
I like some things about my private insurance and hate other things about it.
First, I’m 62 and not employed. There are no good options for insurance. And technically, I don’t have insurance. I have a “health care benefit plan”.
I’ve only used my health care plan once. Basically, the plan gives you a debit card to use for health care, much like some HSA’s. And they have a price schedule based on the going rate in your area.
You go to the doctor and pay on the spot with your card. Then you sent the health plan the bill and you are credited ,according to their schedule, an amount equal to 80% of the going rate. The difference is your coinsurance. But if you can find a lower price for the service, you pay less out of pocket. If you find a really good price for the services, you can pocket the difference.
I like this plan because, even though I’m being reimbursed, the doctor THINKS I’m paying out of pocket. And they don’t pad the visit with unnecessary bullshit. And it gives me cover to question the necessity (and the price) of everything.
Once my annual expenses go over 10K, they reimburse the full value, not 80%. In the unlikely event that happens they will cancel me next year, I’m sure.
I don’t like this plan, though. I just like it better than the other options for me, all which had deductibles of 7500 or more.
What do you mean by ‘took care of us nicely’ exactly? Did they tell you up front what your expenses would be and stick to that, or did you just keep getting bills from various bits of the hospital and it wasn’t entirely clear when you’d be paid up on them? Because I also have BCBS, and for a much less severe procedure (technically surgical, though there was no cutting) I never got a clear answer on what it would cost, and just had bills turn up for a while. I don’t consider the weird non-answer on the cost of the procedures and treatment, or the fact that it cost me a couple of thousand dollars in the end (instead of being, well, insured) to be ‘taken care of nicely’.
I mean that even though I fully expected (and was cool with) having to pay my full out of pocket maximum for my policy that year, by the time the smoke cleared my cancer insurance reimbursed me not only for what I’d paid out of pocket to the hospital and the clinic where I did my chemo, but also made up for my lost wages (I used up all my paid time off the first month I was diagnosed, and missed about 4 days a month for the next 5 months) and many of my day to day expenses that I would have had cancer or not.
I selected: “I have employer provided private insurance – I love it” mainly because I think I am fortunate to have very good insurance when compared to others in the U.S. Nevertheless, it’s overstating to actually say I truly “love it” because of some negatives as well.
I currently pay about $450/month for family health coverage. There are no deductibles for in-network care. Excellent selection of health care providers, because it’s a major insurance complany. Co-pays are minimal (ranging from $20 for office visits to $250 for hospitalization). No charge for preventative care.
My employer plan is better than anything offered at my wife’s work (and she works for the federal government). My 23-year old son is also still on my plan, because my employer’s plan is better than his. (Under the current rules, he will have to switch to his own employer’s plan when he turns 26.) FWIW, my wife is also eligible for Medicare, but she has not yet signed up because my employer health care is better.
My plan has been put to the test: it paid for my wife’s hip replacement and back surgery, and we only paid $250 for each.
Now the negatives: our rates have risen precipitously. We are now paying more than three (3) times what we were paying back in 2012 (which is as far back I have data).
Also, they keep dropping drugs from their formulary, requiring us to repeatedly switch drugs, even ones that we have been using for years (like for hypertension and cholesterol). Also, they refused to pay for a common steroid cream for a severe poison ivy rash I got last year because the urgent care doctor didn’t prescribe some other steroid that they insisted be tried first. (How was the urgent care doctor supposed to know this?)
Finally, I will of course lose all this if I ever leave my job.
But all in all, these are fairly nitpicky stuff in the grand scheme of things. As I stated above, I think our insurance is much better than the average, and fear that any government-run single-payer coverage would be worse than what we currently have. I would therefore support “Medicare, For All Who Want It,” but would not support getting rid of private health insurance – at least for now. My opinion may well change if my health coverage rates get high enough and/or benefits decrease, or if we get switched from a PPO to an HSA/high-deductible plan.