# With single payer health plans, whither insurance companies? **URL:** \ **Category:** Great Debates\ **Created:** [May 7, 2017, 9:02pm UTC](https://boards.straightdope.com/t/with-single-payer-health-plans-whither-insurance-companies/786088 "2017-05-07T21:02:04Z")\ **Posts on this page:** 20\ **Page:** 1
**Author:** ![CC](https://avatars.discourse-cdn.com/v4/letter/c/f1d935/32.png) [@CC](https://boards.straightdope.com/u/CC)\ **Post date:** [May 7, 2017, 9:02pm UTC](https://boards.straightdope.com/t/with-single-payer-health-plans-whither-insurance-companies/786088/1 "2017-05-07T21:02:04Z")
I have no sympathy for some of the most heartless and wealthy companies in the U.S. but I wonder what would happen to them if we went to a single payer system? Clearly, if the bill for my visit goes straight to the single payer, that obviates the need for an insurance plan. What are some possible outcomes of single payer plans? Or am I waaaaay oversimplifying the question? ---
**Author:** ![Beren\_Erchamion](https://avatars.discourse-cdn.com/v4/letter/b/90ced4/32.png) [@Beren\_Erchamion](https://boards.straightdope.com/u/Beren_Erchamion)\ **Post date:** [May 7, 2017, 9:03pm UTC](https://boards.straightdope.com/t/with-single-payer-health-plans-whither-insurance-companies/786088/2 "2017-05-07T21:03:47Z")
What happened to slave traders after slavery was abolished? ---
**Author:** ![Johnny\_L.A](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/johnny_l.a/32/1084_2.png) [@Johnny\_L.A](https://boards.straightdope.com/u/Johnny_L.A)\ **Post date:** [May 7, 2017, 9:09pm UTC](https://boards.straightdope.com/t/with-single-payer-health-plans-whither-insurance-companies/786088/3 "2017-05-07T21:09:46Z")
Private insurance companies will still exist, as they do in countries that have universal healthcare. ---
**Author:** ![PastTense](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/pasttense/32/14550_2.png) [@PastTense](https://boards.straightdope.com/u/PastTense)\ **Post date:** [May 7, 2017, 9:15pm UTC](https://boards.straightdope.com/t/with-single-payer-health-plans-whither-insurance-companies/786088/4 "2017-05-07T21:15:59Z")
It could well be a system like the current Medicare system where it is NOT the federal government which actually processes the claims: > [@](#): > > A Medicare Administrative Contractor (MAC) is a private health care insurer that has been awarded a geographic jurisdiction to process Medicare Part A and Part B (A/B) medical claims or Durable Medical Equipment (DME) claims for Medicare Fee-For-Service (FFS) beneficiaries. CMS relies on a network of MACs to serve as the primary operational contact between the Medicare FFS program and the health care providers enrolled in the program. MACs are multi-state, regional contractors responsible for administering both Medicare Part A and Medicare Part B claims. > **[What's a MAC | CMS](https://www.cms.gov/medicare/coding-billing/medicare-administrative-contractors-macs/whats-mac)** > > On this page: What's a MAC and what do they do? A/B MACs Home Health and Hospice Areas (HH+H) DME MACs Relationships between MACs and Functional ContractorsWhat's a MAC and what do they do?A Medicare Administrative Contractor (MAC) is a private... ---
**Author:** ![Wendell\_Wagner](https://avatars.discourse-cdn.com/v4/letter/w/8491ac/32.png) [@Wendell\_Wagner](https://boards.straightdope.com/u/Wendell_Wagner)\ **Post date:** [May 7, 2017, 9:23pm UTC](https://boards.straightdope.com/t/with-single-payer-health-plans-whither-insurance-companies/786088/5 "2017-05-07T21:23:40Z")
Yes, insurance companies will whither . . . or, to be exact, will wither. ---
**Author:** ![CC](https://avatars.discourse-cdn.com/v4/letter/c/f1d935/32.png) [@CC](https://boards.straightdope.com/u/CC)\ **Post date:** [May 7, 2017, 9:28pm UTC](https://boards.straightdope.com/t/with-single-payer-health-plans-whither-insurance-companies/786088/6 "2017-05-07T21:28:18Z")
> [@PastTense](#): > > It could well be a system like the current Medicare system where it is NOT the federal government which actually processes the claims: > > [What's a MAC | CMS](https://www.cms.gov/medicare/medicare-contracting/medicare-administrative-contractors/what-is-a-mac.html) Based on a quick look, the insurance companies (MACs) would appear to exist as not for profit entities. That would mean the industry as we know it would not exist, yes? ---
**Author:** ![Chronos](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/chronos/32/134_2.png) [@Chronos](https://boards.straightdope.com/u/Chronos)\ **Post date:** [May 7, 2017, 9:42pm UTC](https://boards.straightdope.com/t/with-single-payer-health-plans-whither-insurance-companies/786088/7 "2017-05-07T21:42:33Z")
You could still have supplemental insurance that covers cosmetic and other optional procedures. The market would be much smaller, though. ---
**Author:** ![Johnny\_L.A](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/johnny_l.a/32/1084_2.png) [@Johnny\_L.A](https://boards.straightdope.com/u/Johnny_L.A)\ **Post date:** [May 7, 2017, 9:47pm UTC](https://boards.straightdope.com/t/with-single-payer-health-plans-whither-insurance-companies/786088/8 "2017-05-07T21:47:32Z")
> [@CC](#): > > Based on a quick look, the insurance companies (MACs) would appear to exist as not for profit entities. And there’s a problem with this? IMO, Healthcare should not be a for-profit industry. (I work for a non-profit, BTW.) ---
**Author:** ![kenobi\_65](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/kenobi_65/32/13178_2.png) [@kenobi\_65](https://boards.straightdope.com/u/kenobi_65)\ **Post date:** [May 7, 2017, 10:09pm UTC](https://boards.straightdope.com/t/with-single-payer-health-plans-whither-insurance-companies/786088/9 "2017-05-07T22:09:38Z")
> [@CC](#): > > Based on a quick look, the insurance companies (MACs) would appear to exist as not for profit entities. That would mean the industry as we know it would not exist, yes? This is absolutely not the case. A large number of for-profit health insurance companies offer Medicare supplemental, or Medicare Advantage, policies. Granted, they may be limited in how much they make on their Medicare policies by governmental regulation, but that does _not_ mean that they aren’t making any money at it. Most of the big insurance companies\* offer them, including: UnitedHealthcare Cigna Aetna Anthem \*- note that, while they offer these, they may not necessarily offer them in every state. ---
**Author:** ![Canadjun](https://avatars.discourse-cdn.com/v4/letter/c/76d3ee/32.png) [@Canadjun](https://boards.straightdope.com/u/Canadjun)\ **Post date:** [May 7, 2017, 10:19pm UTC](https://boards.straightdope.com/t/with-single-payer-health-plans-whither-insurance-companies/786088/10 "2017-05-07T22:19:40Z")
In Canada you can get supplementary health insurance to cover things that provincial healthcare does not cover; many people have that as a job benefit and others (like me) buy it on their own. Some examples of things you might get supplementary insurance for are prescription drugs, dental, ambulance, psychologist, among others. I haven’t the foggiest idea how you guys would arrange single payer coverage, but I assume something similar would happen. ---
**Author:** ![TimeWinder](https://avatars.discourse-cdn.com/v4/letter/t/bcef8e/32.png) [@TimeWinder](https://boards.straightdope.com/u/TimeWinder)\ **Post date:** [May 7, 2017, 10:20pm UTC](https://boards.straightdope.com/t/with-single-payer-health-plans-whither-insurance-companies/786088/11 "2017-05-07T22:20:43Z")
Also, Universal Health Care of any stripe doesn’t mean “claims magically get paid by unicorn payment robots.” The useful parts of the jobs insurance companies do (acting as a filter for fraud, determining what treatments are coverable and covered, paperwork and record keeping, monitoring of claim histories, regulatory compliance, etc.) will still have to be done; they’ll now just be done for the government (by government employees, contractors, or outsourcing). So the _companies_ may vanish in total or in part (depending on the system created), but the _jobs_ are likely still around. And if jobs are actually lost in the process, that’s a pretty good indication that the free market system was actually less efficient than the government one (by “for-profit” design, probably). ---
**Author:** ![bob\_2](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bob_2/32/3341_2.png) [@bob\_2](https://boards.straightdope.com/u/bob_2)\ **Post date:** [May 7, 2017, 10:49pm UTC](https://boards.straightdope.com/t/with-single-payer-health-plans-whither-insurance-companies/786088/12 "2017-05-07T22:49:13Z")
Even in the UK, with UHC paid for by taxation, there are several health insurance companies - BUPA being the best known. They offer fast track treatment for no life threatening problems that might involve a lengthy wait on the NHS. They offer appointments with consultants at convenient times and if you use their hospitals you will get a private room and probably better food. In general, they don’t cover cosmetic surgery and they don’t do emergencies. Some companies offer discounted health insurance as part of their recruitment incentives. ---
**Author:** ![PastTense](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/pasttense/32/14550_2.png) [@PastTense](https://boards.straightdope.com/u/PastTense)\ **Post date:** [May 7, 2017, 11:29pm UTC](https://boards.straightdope.com/t/with-single-payer-health-plans-whither-insurance-companies/786088/13 "2017-05-07T23:29:43Z")
> [@TimeWinder](#): > > Also, Universal Health Care of any stripe doesn’t mean “claims magically get paid by unicorn payment robots.” The useful parts of the jobs insurance companies do (acting as a filter for fraud, determining what treatments are coverable and covered, paperwork and record keeping, monitoring of claim histories, regulatory compliance, etc.) will still have to be done; they’ll now just be done for the government (by government employees, contractors, or outsourcing). To a certain extent. But with a single payer system you have different doctor payment methods possible other than the very complicated pay for each individual service. For example look at Britain: > **[General medical services](https://en.wikipedia.org/wiki/General_medical_services)** > > General medical services (GMS) is the range of healthcare that is provided by general practitioners (GPs or family doctors) as part of the National Health Service in the United Kingdom. The NHS specifies what GPs, as independent contractors, are expected to do and provides funding for this work through arrangements known as the General Medical Services Contract. Today, the GMS contract is a UK-wide arrangement with minor differences negotiated by each of the four UK health departments. In 2013 6... ---
**Author:** ![Hari\_Seldon](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/hari_seldon/32/5173_2.png) [@Hari\_Seldon](https://boards.straightdope.com/u/Hari_Seldon)\ **Post date:** [May 8, 2017, 12:31pm UTC](https://boards.straightdope.com/t/with-single-payer-health-plans-whither-insurance-companies/786088/14 "2017-05-08T12:31:56Z")
Canada started universal health care in 1970 before medical care got so expensive (and–to be sure–before it got so effective). So health insurance was small potatoes and there was no substantial lobbying against it. My employer had health insurance and it just continued as a supplemental policy. For example, when my son was born it paid for the difference between a ward and a semi-private room (and I paid the difference for a private room, $10/day). Basically, doctors get paid for every medical act, while hospitals get an annual appropriation and manage their own finances. As a result, administrative costs are really low. Surprisingly, because Quebec is a world champion in bureaucracy. My supplemental insurance is not cheap and I never collect my own contribution. The only reason I keep it is that it covers me and my wife in the US. So it is true insurance. There is nothing that happens here that is worth insuring against. ---
**Author:** ![TimeWinder](https://avatars.discourse-cdn.com/v4/letter/t/bcef8e/32.png) [@TimeWinder](https://boards.straightdope.com/u/TimeWinder)\ **Post date:** [May 8, 2017, 3:55pm UTC](https://boards.straightdope.com/t/with-single-payer-health-plans-whither-insurance-companies/786088/15 "2017-05-08T15:55:08Z")
> [@PastTense](#): > > To a certain extent. But with a single payer system you have different doctor payment methods possible other than the very complicated pay for each individual service. For example look at Britain: > [General medical services - Wikipedia](https://en.wikipedia.org/wiki/General_medical_services) Sure, that’s the “the universal version can be more efficient” part. But this is the US: it’s inconceivable that we wouldn’t pick the most complicated, paperwork-heavy, problem laden implementation possible – and it would still be better than what we have now. ---
**Author:** ![Grim\_Render](https://avatars.discourse-cdn.com/v4/letter/g/a87d85/32.png) [@Grim\_Render](https://boards.straightdope.com/u/Grim_Render)\ **Post date:** [May 8, 2017, 4:52pm UTC](https://boards.straightdope.com/t/with-single-payer-health-plans-whither-insurance-companies/786088/16 "2017-05-08T16:52:44Z")
> [@TimeWinder](#): > > Also, Universal Health Care of any stripe doesn’t mean “claims magically get paid by unicorn payment robots.” The useful parts of the jobs insurance companies do (acting as a filter for fraud, determining what treatments are coverable and covered, paperwork and record keeping, monitoring of claim histories, regulatory compliance, etc.) will still have to be done; they’ll now just be done for the government (by government employees, contractors, or outsourcing). > > So the _companies_ may vanish in total or in part (depending on the system created), but the _jobs_ are likely still around. And if jobs are actually lost in the process, that’s a pretty good indication that the free market system was actually less efficient than the government one (by “for-profit” design, probably). I work for private healthcare in Scandinavia. We don’t filter for fraud. We don’t determine what treatments are covered. We don’t monitor claim histories. I have no idea why we’d need to do this stuff. I am pretty sure public healthcare don’t do this either. In general, we provide healthcare in the same way as we provide basic education. Imagine if only the children of insured parents were entitled to education, and every school dealt with claims and bills and negotiations with umpteen non-standardized insurance companies for every class. And imagine if the teachers billed and worked like physicians. The guy who does the shop class is a specialist… does that sound efficient? Not to me. Anyway, there are about 600 000 people working in health insurance in the US. Judging from how its worked elsewhere, most of those jobs would go. You’d keep some insurance for the upper middle class, but most would go. ---
**Author:** ![md2000](https://avatars.discourse-cdn.com/v4/letter/m/73ab20/32.png) [@md2000](https://boards.straightdope.com/u/md2000)\ **Post date:** [May 8, 2017, 4:54pm UTC](https://boards.straightdope.com/t/with-single-payer-health-plans-whither-insurance-companies/786088/17 "2017-05-08T16:54:16Z")
> [@Canadjun](#): > > In Canada you can get supplementary health insurance to cover things that provincial healthcare does not cover; many people have that as a job benefit and others (like me) buy it on their own. Some examples of things you might get supplementary insurance for are prescription drugs, dental, ambulance, psychologist, among others. I haven’t the foggiest idea how you guys would arrange single payer coverage, but I assume something similar would happen. Yes, here in Canada we still have Blue Cross, Manulife, and a number of other such insurance companies. As mentioned, since basica health care is covered, supplementary insurance as a benefit to entice employees to hire on - is usually limited to the not-covered services. I have dental care, prescription benefit (prescriptions here are not covered unless in hospital, or if you have poverty-level income), ambulance coverage, things like chiropractic and massage therapy (to a few hundred a year), and even television rental in hospital. The difference is the insurance companies are a lot smaller, and the CEO can only afford one Bentley, not five plus a Ferrari and a Rolls-Royce. What do you think happens to ticket scalpers when a government outlaws ticket scalping? Same idea. But now, benefits coverage goes back to being an “extra” to attract employees, not a necessity of life. ---
**Author:** ![Omar\_Little](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/omar_little/32/269_2.png) [@Omar\_Little](https://boards.straightdope.com/u/Omar_Little)\ **Post date:** [May 8, 2017, 5:45pm UTC](https://boards.straightdope.com/t/with-single-payer-health-plans-whither-insurance-companies/786088/18 "2017-05-08T17:45:49Z")
In this vein of discussion, we could probably also include MySpace’s re-emergence as a dominant social media site, along with Hillary’s election in 2020. ---
**Author:** ![Nava](https://avatars.discourse-cdn.com/v4/letter/n/da6949/32.png) [@Nava](https://boards.straightdope.com/u/Nava)\ **Post date:** [May 8, 2017, 7:25pm UTC](https://boards.straightdope.com/t/with-single-payer-health-plans-whither-insurance-companies/786088/19 "2017-05-08T19:25:45Z")
In Spain they’re basically a scam. There’s currently a string of cases of people finding out that not only does their private insurance not get them faster service for anything serious (as that goes to the biggest local hospital - which is either public, or privately owned but part of the public network), but it also often covers less than the public insurance rather than more. And yet it’s a growing market, because so many people believe that more expensive will be better. If moron was a deadly illness… ---
**Author:** ![md2000](https://avatars.discourse-cdn.com/v4/letter/m/73ab20/32.png) [@md2000](https://boards.straightdope.com/u/md2000)\ **Post date:** [May 8, 2017, 7:42pm UTC](https://boards.straightdope.com/t/with-single-payer-health-plans-whither-insurance-companies/786088/20 "2017-05-08T19:42:15Z")
You do hear every so often about fraud in the Canadian system… a doctor bills for procedures they did not do. (Hospitals are non-profit and run by the provincial health insurance system so no incentive there). First, the system can catch that quickly if the doctor, say, is billing for several hours more than he should -and to increase their take-home by any significant amount the doctor would have to claim a lot more extra work. With only one provider, it’s easy to aggregate the doctor billings and look for anomalies such as too many claims against one person, or too much work for a day, too many visitors in too short a time, etc. it’s a lot easier than if the doctor in the USA is biling three different insurers for the same time slot. How would they know about the double-billing? BTW, the Canadian system does NOT allow a physician to charge cash for a procedure they also do covered by the health care system. Nor does a patient get reimbursed for such treatment. So the doctor is either strictly in the system for all patients, or has to find only cash-for-treatment patients. No workplaces offer medical insurance to substitute for Medicare. So the only opportunities for doctors are either doctor to the 1% filthy rich, or professional jobs like pro sport team doctors… few and far between jobs. As a result, we don’t end up with the split like the UK between NHS and Private - we’re all in the same boat here. But for the OP - The USA spends more for health care per capita than most other Western countries, while providing crappy service (or none) to a significant part of the population. One reason things are so expensive, is that everyone with insurance is paying for the cushion that allows hospitals to cover the cost of people who show up for treatment but cannot afford to pay the bill. (Plus, buying the Bentleys for the insurer CEO’s). [Next page](https://boards.straightdope.com/t/with-single-payer-health-plans-whither-insurance-companies/786088.md?page=2)