# Wouldn't Switching US healthcare to a Canadian system lower the debt faster than anything else? **URL:** \ **Category:** Great Debates\ **Created:** [November 5, 2015, 7:00pm UTC](https://boards.straightdope.com/t/wouldnt-switching-us-healthcare-to-a-canadian-system-lower-the-debt-faster-than-anything-else/736747 "2015-11-05T19:00:38Z")\ **Posts on this page:** 20\ **Page:** 2
**Author:** ![halman](https://avatars.discourse-cdn.com/v4/letter/h/5f9b8f/32.png) [@halman](https://boards.straightdope.com/u/halman)\ **Post date:** [November 6, 2015, 12:39pm UTC](https://boards.straightdope.com/t/wouldnt-switching-us-healthcare-to-a-canadian-system-lower-the-debt-faster-than-anything-else/736747/21 "2015-11-06T12:39:41Z")
> [@Tom\_Tildrum](#): > > Vermont tried to switch to single-payer but had to give up because it was too expensive. There are a lot of path-dependent elements like doctor compensation and hospital design that would not go away with a switch to single-payer. Look at the difficulty Congress always has with setting reimbursement for doctors under Medicare, for instance. The US now controls the growth of its health-care costs as well as most other Western nations, but it’s stuck with higher numbers because costs increased more in the past. > > Also, the cost savings of single-payer are somewhat overstated; taking Medicare as an example, much of the cost of collecting “premiums” is off-loaded to the IRS, and the costs associated with fraud enforcement to the Justice Department. Vermont is a rather small population to make a single payer system work. You need a large population so that the costs are spread out. Each individual pays in a small amount, and the system pays for the care everybody needs. Your provider is not part of a ‘network’ or ‘care group’, they just are reimbursed by the government. The U.S. is very inefficient in providing health care. For the amount that is spent in this country on health care every year, every person in the country could see a doctor two or three times in other systems. And that is not the total, because that figure does not include all health care insurance fees. What healthy people are paying into the system is not usually included in the amounts that are publicized. The concept of collecting ‘premiums’ in a single payer system does not make sense to me, as it would be part of the tax structure. I see health care as taking care of the productive capacity of the country, the same as investing in maintenance for an assembly line or a factory building. People are what actually create wealth, so keeping them fit and healthy is in everyone’s best interest. ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [November 6, 2015, 12:47pm UTC](https://boards.straightdope.com/t/wouldnt-switching-us-healthcare-to-a-canadian-system-lower-the-debt-faster-than-anything-else/736747/22 "2015-11-06T12:47:00Z")
Canadians provinces do it. The individual provinces are not very big. Vermont is even smaller, of course, but I’m not sure that 1 million is the critical mass, whereas 600,000 is too small to be viable. Canada started health care in one of its least populated provinces after all, and its success is what led to Medicare. Vermont had ambitions of doing something similar and it failed due to the fact it’s 2015, not 1970. ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [November 6, 2015, 12:49pm UTC](https://boards.straightdope.com/t/wouldnt-switching-us-healthcare-to-a-canadian-system-lower-the-debt-faster-than-anything-else/736747/23 "2015-11-06T12:49:19Z")
Does anyone here know when the last single payer system was established? I think it was Canada’s, and a lot has changed in the health care market since then. BTW, California, a state the size of France population–wise, has passed single payer bills and had them vetoed by Arnie. Mysteriously, they stopped trying to pass single payer once Jerry Brown took office. What happened to their balls? Did they use the single payer bills just to excite liberals but didn’t actually want them to pass? ---
**Author:** ![MrQwertyasd](https://avatars.discourse-cdn.com/v4/letter/m/9d8465/32.png) [@MrQwertyasd](https://boards.straightdope.com/u/MrQwertyasd)\ **Post date:** [November 6, 2015, 2:46pm UTC](https://boards.straightdope.com/t/wouldnt-switching-us-healthcare-to-a-canadian-system-lower-the-debt-faster-than-anything-else/736747/24 "2015-11-06T14:46:33Z")
> [@XT](#): > > As a moderate, at least in my own mind, I think it should be a high priority, yes, regardless of the above. Our system is definitely broken. It should be fixed. Even if, in the end, we don’t save any money, we will have a system that will scale to our needs in the future, and one that will be much more efficient and fair, I suppose, to everyone. So, to me, that makes it worthwhile to do. Zizek would heartily approve. ---
**Author:** ![MrQwertyasd](https://avatars.discourse-cdn.com/v4/letter/m/9d8465/32.png) [@MrQwertyasd](https://boards.straightdope.com/u/MrQwertyasd)\ **Post date:** [November 6, 2015, 2:57pm UTC](https://boards.straightdope.com/t/wouldnt-switching-us-healthcare-to-a-canadian-system-lower-the-debt-faster-than-anything-else/736747/25 "2015-11-06T14:57:20Z")
> **[Why Obama is more than Bush with a human face | Slavoj Žižek](https://www.theguardian.com/commentisfree/2012/nov/13/obama-ground-floor-thinking)** > > Slavoj Žižek: Ground-floor thinking can give Obama lift-off. His reforms have already touched a nerve at the core of the US ideological edifice > [@](#): > > Obama’s healthcare reforms effectively deliver a large part of the population from the dubious “freedom” to worry about who will cover their illnesses. Being able to take basic healthcare for granted, to count on it like one counts on water or electricity without worrying about choosing the supplier, means people simply gain more time and energy to dedicate their lives to other things. The lesson to be learned is that freedom of choice only functions if a complex network of legal, educational, ethical, economic and other conditions is present as the invisible background to the exercise of our freedom. This is why, as a counter to the ideology of choice, countries like [Norway](http://www.theguardian.com/world/norway) should be held up as models: although all the main agents respect a basic social agreement and large social projects are enacted in a spirit of solidarity, social productivity and dynamism are at extraordinary levels, contradicting the common wisdom that such a society should be stagnating. ---
**Author:** ![clairobscur](https://avatars.discourse-cdn.com/v4/letter/c/839c29/32.png) [@clairobscur](https://boards.straightdope.com/u/clairobscur)\ **Post date:** [November 6, 2015, 2:59pm UTC](https://boards.straightdope.com/t/wouldnt-switching-us-healthcare-to-a-canadian-system-lower-the-debt-faster-than-anything-else/736747/26 "2015-11-06T14:59:45Z")
> [@adaher](#): > > It’s a non-issue when you’re born into a UHC system. It’s a huge issue when transitioning. > . It’s a non-issue in both cases. It’s a non issue because there’s no reason why an UHC system, whether already existing or newly implemented, would prevent you from picking and/or keeping your family doctor. ---
**Author:** ![CarnalK](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/carnalk/32/486_2.png) [@CarnalK](https://boards.straightdope.com/u/CarnalK)\ **Post date:** [November 6, 2015, 3:34pm UTC](https://boards.straightdope.com/t/wouldnt-switching-us-healthcare-to-a-canadian-system-lower-the-debt-faster-than-anything-else/736747/27 "2015-11-06T15:34:51Z")
> [@adaher](#): > > BTW, California, a state the size of France population–wise, has passed single payer bills and had them vetoed by Arnie. Mysteriously, they stopped trying to pass single payer once Jerry Brown took office. What happened to their balls? Did they use the single payer bills just to excite liberals but didn’t actually want them to pass? Googling shows that the last one, SB 810, died on 3rd reading in 2012 and as far as I can see was introduced in 2009. The ones before that passed in '08 and '06. I don’t think it’s particularly mysterious that they didn’t try a fourth time yet when they didn’t have the votes with this senate makeup. ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [November 6, 2015, 3:46pm UTC](https://boards.straightdope.com/t/wouldnt-switching-us-healthcare-to-a-canadian-system-lower-the-debt-faster-than-anything-else/736747/28 "2015-11-06T15:46:02Z")
> [@clairobscur](#): > > It’s a non-issue in both cases. It’s a non issue because there’s no reason why an UHC system, whether already existing or newly implemented, would prevent you from picking and/or keeping your family doctor. And specialists? ---
**Author:** ![puddleglum](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/puddleglum/32/137_2.png) [@puddleglum](https://boards.straightdope.com/u/puddleglum)\ **Post date:** [November 6, 2015, 3:53pm UTC](https://boards.straightdope.com/t/wouldnt-switching-us-healthcare-to-a-canadian-system-lower-the-debt-faster-than-anything-else/736747/29 "2015-11-06T15:53:05Z")
Where does the savings come from? If you changed to a UHC system tonight doctors and nurses would still want to get paid tomorrow. Patients would still want the same level of service. Pharmacists, laboratories, and hospitals would still demand payment. The only way to reduce costs in UHC would be for congress to pass a bill either dramatically cutting the amount of healthcare services people could get or dramatically cutting the amount of payment providers get. Look at the history of the Medicare doc fix to see what happens when you try to cut provider’s payments. Politically, cutting the amount of services people could get would be even harder. ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [November 6, 2015, 3:56pm UTC](https://boards.straightdope.com/t/wouldnt-switching-us-healthcare-to-a-canadian-system-lower-the-debt-faster-than-anything-else/736747/30 "2015-11-06T15:56:52Z")
Someone can correct me if my guess is wrong, but I’d guess that Britain and Canada started out paying market rates to providers and then simply allowed payments to increase at a slower rate than elsewhere. ---
**Author:** ![XT](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/xt/32/456_2.png) [@XT](https://boards.straightdope.com/u/XT)\ **Post date:** [November 6, 2015, 4:03pm UTC](https://boards.straightdope.com/t/wouldnt-switching-us-healthcare-to-a-canadian-system-lower-the-debt-faster-than-anything-else/736747/31 "2015-11-06T16:03:24Z")
> [@puddleglum](#): > > Where does the savings come from? If you changed to a UHC system tonight doctors and nurses would still want to get paid tomorrow. Patients would still want the same level of service. Pharmacists, laboratories, and hospitals would still demand payment. > The only way to reduce costs in UHC would be for congress to pass a bill either dramatically cutting the amount of healthcare services people could get or dramatically cutting the amount of payment providers get. Look at the history of the Medicare doc fix to see what happens when you try to cut provider’s payments. Politically, cutting the amount of services people could get would be even harder. I’d say it’s more efficiencies in the system, less paperwork and admin costs and volume discounts. Large companies in the US pay less for medical than smaller or medium sized companies because of these things, after all, so it most likely is the same with a UHC system. ---
**Author:** ![CarnalK](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/carnalk/32/486_2.png) [@CarnalK](https://boards.straightdope.com/u/CarnalK)\ **Post date:** [November 6, 2015, 4:10pm UTC](https://boards.straightdope.com/t/wouldnt-switching-us-healthcare-to-a-canadian-system-lower-the-debt-faster-than-anything-else/736747/32 "2015-11-06T16:10:22Z")
> [@adaher](#): > > And specialists? You have choice there as well. However one of the ways costs are lowered (I believe this is true in many UHC systems) is that your GP acts as a “gatekeeper” - you require his recommendation for seeing a specialist. ---
**Author:** ![Shodan](https://avatars.discourse-cdn.com/v4/letter/s/9f8e36/32.png) [@Shodan](https://boards.straightdope.com/u/Shodan)\ **Post date:** [November 6, 2015, 4:51pm UTC](https://boards.straightdope.com/t/wouldnt-switching-us-healthcare-to-a-canadian-system-lower-the-debt-faster-than-anything-else/736747/33 "2015-11-06T16:51:46Z")
> [@halman](#): > > Someone is currently paying huge sums for healthcare in the U.S., so much so that nationalizing the health insurance industry would still be cheaper over ten years than continuing with the current system. Emergency room care to the uninsured is paid for by higher room rates, care costs, supplies charges, etc. The private sector has been absorbing these costs for some time. Single-payer does not reduce these costs; it shifts them from higher prices for the insured to higher taxes for the 54% of the US who pay taxes. > [@](#): > > Something which the conservatives have glossed over is that when you have national health insurance, your family doctor goes on treating you, he just gets paid by the state instead of by your insurance company. That is what I mean. If the state pays your family doctor the same as your insurance company, you don’t save any money. As mentioned, if we want to reduce health care spending, we have a choice between reducing payments to health care providers, or rationing care. Simply changing who pays for it doesn’t reduce anything. We have done this discussion before. Obama promised that Obamacare would reduce the average family’s premiums by $2500 a year. [They didn’t](http://money.cnn.com/2015/10/27/news/economy/obamacare-premiums/). What will we do next -[the notion that we will save a lot of money with preventative care](http://www.reuters.com/article/2013/01/29/us-preventive-economics-idUSBRE90S05M20130129)? Regards, Shodan ---
**Author:** ![MrQwertyasd](https://avatars.discourse-cdn.com/v4/letter/m/9d8465/32.png) [@MrQwertyasd](https://boards.straightdope.com/u/MrQwertyasd)\ **Post date:** [November 6, 2015, 5:19pm UTC](https://boards.straightdope.com/t/wouldnt-switching-us-healthcare-to-a-canadian-system-lower-the-debt-faster-than-anything-else/736747/34 "2015-11-06T17:19:31Z")
> [@puddleglum](#): > > Where does the savings come from? By not giving money to CEOs to eat from gold plates on private jets flying to their new yachts ? ---
**Author:** ![XT](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/xt/32/456_2.png) [@XT](https://boards.straightdope.com/u/XT)\ **Post date:** [November 6, 2015, 5:53pm UTC](https://boards.straightdope.com/t/wouldnt-switching-us-healthcare-to-a-canadian-system-lower-the-debt-faster-than-anything-else/736747/35 "2015-11-06T17:53:32Z")
> [@MrQwertyasd](#): > > By not giving money to CEOs to eat from gold plates on private jets flying to their new yachts ? Which might save millions…maybe even hundreds of millions (doubtful, but what the hell). And be a drop in the bucket. ---
**Author:** ![CarnalK](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/carnalk/32/486_2.png) [@CarnalK](https://boards.straightdope.com/u/CarnalK)\ **Post date:** [November 6, 2015, 6:24pm UTC](https://boards.straightdope.com/t/wouldnt-switching-us-healthcare-to-a-canadian-system-lower-the-debt-faster-than-anything-else/736747/36 "2015-11-06T18:24:52Z")
> [@Shodan](#): > > As mentioned, if we want to reduce health care spending, we have a choice between reducing payments to health care providers, or rationing care. Simply changing who pays for it doesn’t reduce anything. No, as mentioned by XT above you can save money through effeciencies and volume discounts. In addition to the bargaining power of being the sole legal buyer. And rationing care probably wouldn’t be that bad an idea in some cases. We don’t need an MRI for every belly ache. > [@](#): > > We have done this discussion before. Obama promised that Obamacare would reduce the average family’s premiums by $2500 a year. [They didn’t](http://money.cnn.com/2015/10/27/news/economy/obamacare-premiums/). Obamacare isn’t single payer so that’s kind of irrelevant. ---
**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:** [November 6, 2015, 6:44pm UTC](https://boards.straightdope.com/t/wouldnt-switching-us-healthcare-to-a-canadian-system-lower-the-debt-faster-than-anything-else/736747/37 "2015-11-06T18:44:58Z")
> [@puddleglum](#): > > Where does the savings come from? If you changed to a UHC system tonight doctors and nurses would still want to get paid tomorrow. Patients would still want the same level of service. Pharmacists, laboratories, and hospitals would still demand payment. > [@Shodan](#): > > Single-payer does not reduce these costs; it shifts them from higher prices for the insured to higher taxes for the 54% of the US who pay taxes. I don’t think you two understand where the US extra costs originate. You both seem to assume that the US system already operates at the same cost efficency as the other nations systems. That is very far from the truth I am afraid. The excess costs in the US system originate from the following sources, in order: Excessive administration and bureaucracy. This is the 800-pound gorilla. In the US, there is a vast number of people who deal with billing, credit-checking, liasing and negotiating with insurance companies, chasing down payments, and filling in forms to the insurance companies. As far as I know, there are no standard of forms, coverage or prices. This also leads to a lot of duplicate work. Some hospitals, I am told, have more people working these jobs than they have beds! This is a major expense of the American system. Other systems just don’t have these jobs. At all. When a patient comes into our office, we pull out his journal, and when he is done we put it back updated. Thats it. Next is medical waste and inefficiency. Two hospitals on different city blocks can both have MR-machines, CT-scanners, specialised technical staff, and use them maybe 1/3 of their potential time. The US system also encourages profitable surgery and interventions that don’t actually improve outcomes. Then there are medical insurance. Even discounting the for-profit companies profits, there are over 600 000 people working in medical insurance in the US today, at generally very good salaries. Other nations mostly consider this a pointless middleman, and don’t have anyone like that. Below that there are minor issues. Defensive medicine, stuff done just not to get sued. Tort and malpractice insurance. Higher salaries for physicans. None of which are very large drivers of costs compared to the top three. You are assuming that the only change is going to be in where the money comes from. But the current US system shovels so many layers into the mess, that just managing the interaction between them is a massive amount of work -often duplicated over and over again- that other systems just don’t have. The cost of this then manifests in price markups -outpatients, for example is particularily visible in comparisons. ---
**Author:** ![eschereal](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/eschereal/32/18939_2.png) [@eschereal](https://boards.straightdope.com/u/eschereal)\ **Post date:** [November 6, 2015, 6:58pm UTC](https://boards.straightdope.com/t/wouldnt-switching-us-healthcare-to-a-canadian-system-lower-the-debt-faster-than-anything-else/736747/38 "2015-11-06T18:58:59Z")
> [@puddleglum](#): > > Where does the savings come from? Primarily insurance profits. Insurers have had ridiculous overheads, to the extent that less than half a dollar spent on premiums actually ended up involved in medical care for anyone. Obamacare requires insurers to spend at least 80% of their take on care services. Government run Medicare, being not-for-profit, has overhead in the neighborhood less than 1% (more than 99% of Medicare revenue goes to actual medical care). Fucking wasteful, inefficient government bureaucracy. ---
**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:** [November 6, 2015, 7:47pm UTC](https://boards.straightdope.com/t/wouldnt-switching-us-healthcare-to-a-canadian-system-lower-the-debt-faster-than-anything-else/736747/39 "2015-11-06T19:47:21Z")
> [@adaher](#): > > Given what Americans expect from health care, we would probably save some money, but still have the most expensive single payer health care system in the world. You do realize, you could have the most expensive single payer system in the world, and still save more money each year than you current military budget? > [@Tom\_Tildrum](#): > > Vermont tried to switch to single-payer but had to give up because it was too expensive. Problem with Vermonts attempt, as I understand it is that it would not be single payer, it would have resulted in a uniquely American setup with all the American cost-adders- Basically, you’d still be having all the public and private systems and just added one more on top of them. Of course that wouldn’t result in any savings. To get a single payer system, you’d have to take the money currently going to Medicare, Medicaid, VHA, Indians etc, and make a single system out of it. > [@halman](#): > > Vermont is a rather small population to make a single payer system work. Single payer seem to work quite well in Iceland (300 000 people) and the Faroes (50 000 people). > [@adaher](#): > > Does anyone here know when the last single payer system was established? I think it was Canada’s, and a lot has changed in the health care market since then. Don’t quote me, but I think it was Taiwan in 1995. I’ve heard good things about their process of investigating other systems, and looking for good features while discarding poor ones. NI system. > [@adaher](#): > > Someone can correct me if my guess is wrong, but I’d guess that Britain and Canada started out paying market rates to providers and then simply allowed payments to increase at a slower rate than elsewhere. Actually, I’d suspect it was more at least in the UK. Bevans stuffed mouths with gold after all. > [@Shodan](#): > > As mentioned, if we want to reduce health care spending, we have a choice between reducing payments to health care providers, or rationing care. I think it bears repeating that other first world nations manage to provide healthcare to everyone, while spending far less money and most getting better results than the US. I’ve seen no convincing argument that the US is immune to the laws of economics. > [@MrQwertyasd](#): > > This is why, as a counter to the ideology of choice, countries like Norway should be held up as models: although all the main agents respect a basic social agreement and large social projects are enacted in a spirit of solidarity, social productivity and dynamism are at extraordinary levels, contradicting the common wisdom that such a society should be stagnating. [Why Obama is more than Bush with a human face | Slavoj Žižek | The Guardian](http://www.theguardian.com/commentisfree/2012/nov/13/obama-ground-floor-thinking) I think I should add that in healthcare in Norway we have a considerable amount of choice. ---
**Author:** ![puddleglum](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/puddleglum/32/137_2.png) [@puddleglum](https://boards.straightdope.com/u/puddleglum)\ **Post date:** [November 6, 2015, 7:49pm UTC](https://boards.straightdope.com/t/wouldnt-switching-us-healthcare-to-a-canadian-system-lower-the-debt-faster-than-anything-else/736747/40 "2015-11-06T19:49:42Z")
> [@eschereal](#): > > Primarily insurance profits. Insurers have had ridiculous overheads, to the extent that less than half a dollar spent on premiums actually ended up involved in medical care for anyone. Obamacare requires insurers to spend at least 80% of their take on care services. Government run Medicare, being not-for-profit, has overhead in the neighborhood less than 1% (more than 99% of Medicare revenue goes to actual medical care). Fucking wasteful, inefficient government bureaucracy. In order to reduce the amount spent on healthcare in the US to the average of other countries the US would have to cut 1.7 trillion dollars. Total profit from the five largest health insurance companies amounts to about 12 billion dollars. If you generously figure the rest of the insurance industry makes 8 billion in profit, then removing all the profit from the insurance industry would save 20 billion dollars. That is 1% of the savings needed. [Previous page](https://boards.straightdope.com/t/wouldnt-switching-us-healthcare-to-a-canadian-system-lower-the-debt-faster-than-anything-else/736747.md?page=1) [Next page](https://boards.straightdope.com/t/wouldnt-switching-us-healthcare-to-a-canadian-system-lower-the-debt-faster-than-anything-else/736747.md?page=3)