# 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:** 8\ **Page:** 7
**Author:** ![Northern\_Piper](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/northern_piper/32/5304_2.png) [@Northern\_Piper](https://boards.straightdope.com/u/Northern_Piper)\ **Post date:** [November 13, 2015, 9:31am UTC](https://boards.straightdope.com/t/wouldnt-switching-us-healthcare-to-a-canadian-system-lower-the-debt-faster-than-anything-else/736747/121 "2015-11-13T09:31:56Z")
> [@Grim\_Render](#): > > Thank you. Is there an estimate of how much time gets spent on this ? I am in the private sector in Norway and we use about four days for one secretary in a year. I’m just speculating, but I would think ti would be an ongoing process. At the clinic I go to, the doctor enters the details of the consult into their computer system right then. I don’t know if that entry automatically includes the payment codes for submission to the provincial medicare plan, but if not, the clinic support staff would have to add the codes and submit it to the provincial medicare. I would think it would be more efficient if that was done on an ongoing basis, each week or even each day, by computer, to keep the payments flowing, rather than only each month. However, this is one of the features of our single-payer: I as patient/consumer don’t know how the system works, because I’m not involved in that payment process in any way. ---
**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 13, 2015, 3:34pm UTC](https://boards.straightdope.com/t/wouldnt-switching-us-healthcare-to-a-canadian-system-lower-the-debt-faster-than-anything-else/736747/122 "2015-11-13T15:34:55Z")
> [@Grim\_Render](#): > > Assuming a smooth switch to a Canadian-style system is managed -and I admit that is a pretty huge assumption- Canadian administration costs are about 31 % of US ones. And the US spends about 33 cents out of each health care dollar on administration, 1 000 billion. So that is 700 billion. > > Medical waste and inefficiency are generally listed as the second biggest cost-adder, and is very close, so figure another 5-600 billion there. > > Of the remaining amount, a lot would be made up out of health care insurance overhead -admittedly the line between that and administrative waste is pretty blurry- and lower cost for prescription drugs. Now, I don’t actually believe that the full amount could be reached, because some of that money gets spent due to factors in the US that is not directly related to the health care delivery system. Factors such as higher salaries for medical staff, tort and defensive medicine. > > However, it does not seem unrealistic to project savings on the order of 1 200 - 1 500 billion. You are overstating the administration savings, but that is at least something. The medical waste and inefficiency is just pie in the sky. If medical waste and inefficiency were easy to identify and eliminate, it would already have been eliminated. The US government already pays as much for healthcare as Canada does. If they could run healthcare efficiently they already would. Healthcare insurance overhead reduction is counting the reduction in administrative costs twice. As I said, the only area of actual reduction is administrative overhead and the rest is to be accomplished through the magic of government efficiency. > [@](#): > > No -the fraud is about **billing**. Emphasis mine. Which we hardly do. Over here, if you work in government healthcare, you don’t bill anyone. The patient comes in, you pull out the patients file, you do what seems medically appropriate, the patient leaves, you update the journal and put it back. > > There is no billing. I realize this may be hard to wrap ones head around from the perspective of the US system. Think of it as similar to the high school system, but with more labs and a better pupil-teacher ratio. > > (Caveat - the private healthcare system here does bill, and there are co-pays through the public system. These are on the order of 10 - 50 per visit and capped at 300 per year. Normally they are paid in cash, possibly coins.) > > I don’t really imagine the Canadian system is that different, perhaps posters from there can enlighten us? How much billing goes on in the Canadian system? > > And medically unnecessary work -you know, you don’t get to **bill** for it. You are on a salary. That makes it much harder to do any fraud. You don’t seem to understand how billing in Canada works. The doctors report how many patients they see and what procedures were performed on them. Then the government cuts them a check based on a price schedule for each procedure. This is exactly how Medicare works. The fraud is doctors billing the government for patients they did not see and procedures they did not perform. > [@](#): > > Whereas the default elsewhere is that everything is covered unless specifically excepted -no negotiation- and there is no fee for services. No negotiation. So no. > > Once again, I don’t think you understand how a NI or Beveridge type UHC system works. Just mentioning billing and negotiation… these are huge areas of the US system, and they are such small parts of these systems as to be negligible. That is kind of the point I have been trying to make. Every healthcare system has to negotiate what it pays for and how much it will pay for each procedure. The difference in single payer systems is that the negotiation is done nationally instead of for each insurance group. > [@](#): > > This is actually a legitimate issue with the choice of Canada as a system to emulate, and how to implement that. One of the reasons Canada’s system is not normally considered the best system for the US to switch to. > > Of course, as I read it, this thread is about the hypothetical of the US already having switched to the Canadian system, so reasons why it wouldn’t really belong in a different thread. > > Well, no again. Reimbursement of medical staff is really not a larger factor in healthcare costs, and I’m really not sure how you can reason that speed of adopting new technologies is a big factor. > > Doctors salaries are really not a big cost-driver. What drives costs is the number of administrative jobs doing billing, negotiating, liaising, credit-checking, filling in forms, chasing down payment, etc, who represents a huge expense by their sheer numbers. And who don’t exist in other jobs. > > Look, lets go with the high school metaphor: > > Other countries run health care systems similar like the US does high schools. They are publicly financed institution, with public employees working there, and buildings and equipment bought by some layer of the government. Almost all countries also have a few private schools for parents who can pay and feel their kids are better off there. > > They teach a central curriculum covering all the major subjects. The students and parents don’t get billed. No-one negotiates. > > The US healthcare system works like the parents have to pay for each lesson, or buy a plan that covers some subjects at a co-pay for each lesson. With no central curriculum, one school may not do maths, another may not do English. And you are not enrolled in any particular school. There are no set fees, its all negotiable. Parents much be credit-checked, billed, payments agreed on and chased down. > > That metaphor actually undersells the chaos of the US system because it does not cover all the interactions between the financers and providers in the US system. So your solution is like secondary education in the US which produces mediocre [results](https://www.washingtonpost.com/local/education/us-students-lag-around-average-on-international-science-math-and-reading-test/2013/12/02/2e510f26-5b92-11e3-a49b-90a0e156254b_story.html) at [high](http://www.cbsnews.com/news/us-education-spending-tops-global-list-study-shows/) prices. While the current system is more like the US college system which is really expensive but is universally acknowledged as the [best](http://www.thebestschools.org/features/100-best-universities-in-world-today/) in the world. ---
**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 13, 2015, 3:35pm UTC](https://boards.straightdope.com/t/wouldnt-switching-us-healthcare-to-a-canadian-system-lower-the-debt-faster-than-anything-else/736747/123 "2015-11-13T15:35:58Z")
> [@Grim\_Render](#): > > Thank you. Is there an estimate of how much time gets spent on this ? I am in the private sector in Norway and we use about four days for one secretary in a year. My dad had a full practice back before computers were the norm. It was maybe a day or two’s work per month to get everything in order, just some simple tabulating and maybe a couple extra forms if he had out of province patients. Nowadays I’m sure it’s dead simple with electronic submissions. ---
**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 13, 2015, 3:45pm UTC](https://boards.straightdope.com/t/wouldnt-switching-us-healthcare-to-a-canadian-system-lower-the-debt-faster-than-anything-else/736747/124 "2015-11-13T15:45:36Z")
> [@jasg](#): > > It would have been interesting to see your cites on these figures but since you did’t give any, I found one for the first claim. > > The Medicare part A 9 vs 67 billion dollar claim was made by Jim DeMint in a 2013 WSJ piece where he compared original pre-Medicare estimates in 1965 without any inflation adjustments. The Washington Post [fact-checked](https://www.washingtonpost.com/news/fact-checker/wp/2013/10/21/jim-demints-claims-about-medicare-cost-estimates-from-1965/) and awarded its coveted “Three Pinocchios” rating. > > Worse yet for DeMint, those figures were first used by Ross Perot in a 1994 debate with Al Gore. At that time, the claim was thoroughly debunked by Robert J. Myers. Who was the long-time Social Security actuary who developed the original estimate for the House Ways and Means Committee. > > I agree that estimates are hard to make, eapecially about the future (thanks Yogi!) but unless you have better cites these appear to RW talking points. The original numbers did not account for the inflation of the 1970s and are thus understated. That is part of the danger of making predictions, but that is precisely the prediction they made. My point is that you should be very skeptical of cost estimates. However if you make the appropriate adjustment for inflation and pretend that they ignored inflation then the new prediction is 37 billion compared to the actual cost of 67 billion. They were still 30 billion dollars off or 45% off. ---
**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 13, 2015, 4:14pm UTC](https://boards.straightdope.com/t/wouldnt-switching-us-healthcare-to-a-canadian-system-lower-the-debt-faster-than-anything-else/736747/125 "2015-11-13T16:14:36Z")
> [@Salvor](#): > > For the record, I’m not tied to a specific UHC scheme, just something different from what we have. > > And the singapore example should be fascinating to many people, both liberals and conservatives. > > [Singapore: A Fascinating Alternative To The Welfare State](http://www.forbes.com/sites/johngoodman/2015/03/31/singapore-a-fascinating-alternative-to-the-welfare-state/) > Conservatives tend to like it as it’s an alternative to the welfare state, but that forced savings is still a government mandated imposition on people. Instead of having the government divy up the funds, it forces people to be financially responsible with their savings. The home ownership stats are phenomenal, I had no idea they were over 90% home owners. > > And the exact numbers I mentioned were not right, 20% personal savings, and 16% from the employer to get to a total savings of 36% (where some of that can be used for home purchases ?!? built in good behavior for financial stability ) > > But the employer does not negotiate directly for health insurance like the US model, it and the people use their own funds they are FORCED by the state to withold to pay for healthcare in terms of out of pocket expenses, and they are mostly insured for catastrophic coverage with the incidentals taken care of by the fund. > I would not mind that system, hell, if that kind of model could help allow more people to own homes, even better. But you see, I’m flexible, I am open to virtually anything that works, I don’t start from the outset trying to “conserve” what we have and presume that it’s better than all the other alternatives. > This is what we need to get conservatives on board doing, taking a good hard look. When I hear them talk you’d think the status quo was just fine with what we have. They will come up with endless problems with the alternatives of foreign powers and spend no time on our own systems faults, or better, do a comparison to see if the alternatives offer a better combination of perks compared to what we have. > > Avik Roy - a conservative healthcare policy writer sounds FAR closer to Ezra Klein in this one on one talk, but hearing him on conservative talk radio he just highlights the flaws with the alternatives to what we have, and never makes a credible case that we’d be BETTER off switching to something different. > > This is an absolute disgrace, we have to find a way to get the message out to the potty trained conservatives. He's one of them when you sit him down away from the peanut gallery of "government bad" zombies. But when they discuss things it gets dumbed down the point of a cartoon discussion. > > I don’t know if a Singaporean system would be the best system to transition to, I do think path dependence matters in terms of easing the transition, but conservatives are missing in action on these discussion aside from REPEAL OBAMACARE. And replace with the free market (translation, let the market decide, and if you are broke and dying, tough - We don’t CARE if there is a better way - if there is a single drop of government blood in a proposed solution it’s off the table). Who designed our current system? Liberal politicians. The reason we have health insurance through our employers instead of buying it like other types of insurance is that government imposed wage caps during WW2 made it tax advantageous to buy it through your employer. When McCain proposed ending this Obama attacked him for trying to raise taxes. Medicare and Medicaid were both designed and implemented by Johnson as part of the Great Society. Health providers have teamed up with legislatures in every state to ban low cost health insurance. The reason we have such an awful system in the US is government intervention. One doctor who is a famous blogger researched some prices “The closest RiteAid to my office charges $4 for a 30-day supply of Celexa 20 mg. The local CVS sells the same amount for $19.79. The local Walgreens sells it for $24.99. And the local KMart will sell it to my patients for the low, low cost of $88.15.” There is no other market where a store can sell the exact same item for 20 times what another store does. This is because the current system is not designed for cost efficiency or quality outcomes. It is designed to insulate people from the cost of healthcare. Since no one is actually paying for Celexa out of pocket, they go to the pharmacy that is closest. Since no one competes on price, then prices keep going up. Contrast this with plastic surgery. From 1992 to 2005 overall prices for all goods in this country went up 39%. Medical prices during that same period went up 77% and prices for plastic surgery went up 22%. That is what happens when consumers are empowered to shop for their medical services. The fundamental problems about are current system, employers buy insurance not consumers, third party payer means no incentive to control costs, and too much government involvement in what insurance has to cover. Yet every liberal proposal doubles down on these problems. They all seek to further disempower the consumer. And all conservative solutions are met accusations of not caring if people die. ---
**Author:** ![Really\_Not\_All\_That\_Bright](https://avatars.discourse-cdn.com/v4/letter/r/e8c25b/32.png) [@Really\_Not\_All\_That\_Bright](https://boards.straightdope.com/u/Really_Not_All_That_Bright)\ **Post date:** [November 13, 2015, 4:19pm UTC](https://boards.straightdope.com/t/wouldnt-switching-us-healthcare-to-a-canadian-system-lower-the-debt-faster-than-anything-else/736747/126 "2015-11-13T16:19:20Z")
There haven’t been any conservative solutions, except for high deductible plans with health savings accounts. ---
**Author:** ![Salvor](https://avatars.discourse-cdn.com/v4/letter/s/b5e925/32.png) [@Salvor](https://boards.straightdope.com/u/Salvor)\ **Post date:** [November 13, 2015, 5:49pm UTC](https://boards.straightdope.com/t/wouldnt-switching-us-healthcare-to-a-canadian-system-lower-the-debt-faster-than-anything-else/736747/127 "2015-11-13T17:49:38Z")
> [@puddleglum](#): > > **Who designed our current system? Liberal politicians. The reason we have health insurance through our employers instead of buying it like other types of insurance is that government imposed wage caps during WW2 made it tax advantageous to buy it through your employer.** When McCain proposed ending this Obama attacked him for trying to raise taxes. > Medicare and Medicaid were both designed and implemented by Johnson as part of the Great Society. Health providers have teamed up with legislatures in every state to ban low cost health insurance. **The reason we have such an awful system in the US is government intervention.** > One doctor who is a famous blogger researched some prices “The closest RiteAid to my office charges $4 for a 30-day supply of Celexa 20 mg. The local CVS sells the same amount for $19.79. The local Walgreens sells it for $24.99. And the local KMart will sell it to my patients for the low, low cost of $88.15.” > There is no other market where a store can sell the exact same item for 20 times what another store does. This is because the current system is not designed for cost efficiency or quality outcomes. It is designed to insulate people from the cost of healthcare. Since no one is actually paying for Celexa out of pocket, they go to the pharmacy that is closest. Since no one competes on price, then prices keep going up. Contrast this with plastic surgery. From 1992 to 2005 overall prices for all goods in this country went up 39%. Medical prices during that same period went up 77% and prices for plastic surgery went up 22%. That is what happens when consumers are empowered to shop for their medical services. > The fundamental problems about are current system, employers buy insurance not consumers, third party payer means no incentive to control costs, and too much government involvement in what insurance has to cover. > Yet every liberal proposal doubles down on these problems. They all seek to further disempower the consumer. And all conservative solutions are met accusations of not caring if people die. Not all markets behave the same way. The plastic surgery market is more akin to the beauty supply market or the the market for cars or high end laptops. If the price really does get too high, people can and will either choose to not get it at all, or get a more basic version of it in the case of a car. Plastic Surgery mainly differs in that there are not the same degree of different tiers of products from the low end to the high end like laptops or cars, but the purchase decisions are not about life and death. Now time to answer. Do not run away, do not go on a tangent, answer this one question here and now. Do YOU think that the standard healthcare market functions (or would function if you got your fantasy system) NO DIFFERENTLY in theory or practice than the markets for non life and death goods? Because I don’t. The leading cause of bankruptcy in the US is not people running up their credit cards to purchase big screen tvs, it’s medical expenses. People choosing to pay bills to keep getting treatment and medications for their spouse, parent, child. And if the cost gets too high? Some might even mortgage the house to get the cash for a treatment to save their child, and if the financial burden is too high? If the choice is between a chance at saving the family members with bankruptcy, or more financial solvency and letting them die, people often break towards LIFE over DEATH if they are able. It is a rape of all sense and logic to presume that this market is no different from buying disposable goods that does not carry the same stakes, unless there is other stuff done on the back end like Singapore with savings accounts MANDATED by the state. And another thing I wanted to touch on that I found instructive in your response that I just made bold. This line of logic right there is the core of flawed broken logic liberals in the US have to deal with when discussing ideas with American conservatives. Did you and others see the flawed logic on display right there? You point out that liberals were the cause of our current employer based healthcare system. I AGREE !!! It was done to try and prevent wage inflation by offering what at the time were low cost benefits as an alternative incentive to work than higher wages. From that what is the lesson YOU take? That conservatives take? Government meddling caused the problem, ergo government is the problem and not part of the solution. My take? Bad government policy helped cause the problem, good government policy could help fix the problem. The baggage you and other conservatives carry about government clouds all reason. I don’t think people in other countries fully appreciate the brick wall we have to deal with in the US. Bad policy decisions does not imply government should get out of the business of policy making, it means you try to craft better policy. Why is it that you assume that because liberals made a mistake in government policy 50+ years ago that any policy using government as a tool they make today is intrinsically harmful? It would be one thing if we had no other data points, but we DO, we have DOZENS, SCORES of other UHC systems setup around the entire world, virtually ALL of them offer lower cost, and virtually all of them produce results as good as ours or better in total (don’t you dare take one sliver of a metric in the overall picture and from that extrapolate that x system is worse - it’s a lazy move that is the definition of an argument in bad faith). We have CONCRETE EXAMPLES of BETTER government policy producing better results, and yet you still trot out liberals and government causing the issue, and STOP there, as if no time has past, as if nothing new has been learned in DECADES. Multiply this logic by TENS of MILLIONS of Americans and you will begin to see the struggle. The refusal to look at actual data reminds me of dadt. It was conservatives lying in print and on air about unit cohesion, a made up euphemism about their true issue (we don’t like \*fags \*and don’t want to be around them, and if we find out we are near one, THEY need to leave because of MY personal issues with them). But the argument never went away, even after nations around the world like the UK, and the Israeli Defense Force allowed gays to serve openly with no effect on “unit cohesion” like the conservatives were trotting out, they kept the same line. They never changed in congress, they had to be beaten with a super majority, and that was the rarest of all moments after the Iraq war failures and the financial crash that allowed that to happen. We can’t wait for the stars to align to get rid of these conservatives, we need them to become better, stop arguing in bad faith and deceiving themselves about what they are really against and really for. I am not sure they would be for government policy even IF they were convinced it worked better, because of an aesthetic preference for less government involvement. It’s like the national Bank with Biddle before Jackson killed it. ---
**Author:** ![Bookkeeper](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/bookkeeper/32/281_2.png) [@Bookkeeper](https://boards.straightdope.com/u/Bookkeeper)\ **Post date:** [November 16, 2015, 9:54pm UTC](https://boards.straightdope.com/t/wouldnt-switching-us-healthcare-to-a-canadian-system-lower-the-debt-faster-than-anything-else/736747/128 "2015-11-16T21:54:36Z")
One aspect of the Canadian model that might make it more palatable in the US is that there is no national health care system as such. What we have is the federal government agreeing to extensively subsidize individual provincial health care systems if they meet a specified national minimum standard. Private insurance (or Medicaid-style low-income subsidies) is still available to cover the costs that the government plan doesn’t cover, but the big-ticket costs are all part of the basic provincial plan. With a similar individual state-based health care and federal subsidy system in the US, different states could have different health care details, but with a common minimum standard. The residents of each state could decide what, if anything, they wanted the state to cover over and above the minimum. [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=6)