Single Payer Health Care
I happen to think that the best way for the U.S. to go is toward a Single Payer health plan. The idea that people go bankrupt over health care costs, that people die because their insurance will not pay for the treatment that they need, irks the hell out of me. And both have happened within my own family. Also, the limitations of only being able to see doctors within your own health plan (ala Kaiser) is beyond stupid. If everyone in the United States were automatically covered, just by virtue of being a citizen, then I am sure that we could bring costs down, that yes, our taxes would go up, but the bureaucracy of our current system makes insurance premiums sky high anyway, and they just keep going up. At a speed that is impossible to maintain.
Obama wants some sort of compromise plan, where the Government insures those who cannot afford to buy coverage on their own, or who do not have coverage through their employers. But I suspect that many people who will not be eligible for the ‘free’ coverage will still not make enough to buy coverage on their own. I know my mom, impoverished though she was, did not qualify for medicaid or medical, because she had over $2000 in the bank, or something like that. Never mind that she very often wasn’t so ‘rich’, and that $2000 in the bank would not have come close to paying for the services she would have needed had she lived.
But people talk about the horrible bureaucracy, about how having the government will make things much worse, etc. Worse than insurance companies telling you one thing and then doing another, promising to cover procedures and then not doing so. Or perhaps worse than losing coverage because your illness means you cannot afford COBRA coverage, and getting stuck with huge bills. Or worse than having cancer, and fighting with the insurance company about who will pay the bills, and ultimately dying without getting treatment, while you’re waiting for your insurance to step up.
Sorry, I feel strongly about this. All I’m hearing is arguments from people here in the United States, worried that if our system becomes like that in Canada or Europe, we’ll all die miserable slow deaths that could have easily been avoided, or perhaps we’ll all go completely broke because the increase in taxes is so much higher than the average $5,000 or $6,000 per family, per year today (and that’s not counting the employer portion of insurance premiums, which I believe is around $12,000 per family per year).
The issue, in my mind, is money for the insurance companies. A single payer plan would put them out of business, and a lot of very wealthy people would lose their fortunes. Also, a lot of insurance company employees would lose their jobs. Perhaps some of them, or most of them, could get government jobs, administering this single payer health plan.
I’d like to hear from any readers in Canada or Europe, readers who enjoy the benefits of, and/or suffer the issues of, nationalized health care. Is it perfect? I am positive that it is not. But would you happily switch over to a plan like we have in the U.S., if you were given the option?
17 Comments
Violet
I’m Canadian. My kids are Canadians. My husband is American (but is in the process of becoming a Canadian citizen) and has now experienced both systems.
I believe that there is no such thing as a “perfect health care system” – in part, because there are so many variables – but I do believe that what we have here, in Canada, is as close to perfect as I’ll ever experience. I wouldn’t trade for the US-style in a million years – and I’m a healthy, middle class woman.
When I am sick, or my kids, or my husband (who was granted health care coverage as soon as he filed his papers to stay in Canada), we go to the doctor – – and that’s how it should be. Ditto for the hospital or emergency department in more urgent cases. It doesn’t matter whether I’m employed (or not), wealthy (or not).. we just go.
To me, the measure of a good health care system is how it treats the poorest of the poor. Those without resources or advocacy. The wealthy will always find a way to pay for the treatment they need and the middle class will sell their homes/cars and get a line of credit to finance their treatment but.. what about those with no money and no assets and no credit?
In Canada, depending on your location, there are long waits for some (non-emergency) procedures, yes. There are doctor shortages in rural communities (same as in the US). And you still have to advocate for your own, and your family’s, care like anywhere else in the world.
This is my doctor’s office: http://newvisionhealth.ca/ Every service on there is available to me for “free” via my provincial health care plan. There are many other health-related services (MRI, ultrasound, blood work, etc) that I can be referred for – for “free”. And it doesn’t matter who I am or how much money I make.
Phew, now I’m just rambling! I’ll leave you with this article: http://www.denverpost.com/opinion/ci_12523427
simon
The UK system is far from ideal, but I’ve also used the Italian and Belgian systems, both of which are pretty damn good. Would I prefer to switch to the US system? NO WAY. Didn’t you see Michael Moore’s “Sicko”?
Kinga
Would I want the US system? No way. I was raised in Canada and now live in Poland, but I’ve lived in the UK, too. None of those systems are perfect: there are long waiting lists to see specialists, operations have a certain waiting time, etc. But it’s comforting to know that, if any of my family need urgent medical care, they could get it without the family going broke. I’m always surprised that Americans have such a confusing and expensive health care.
Chrissy
I’m in Canada and though I think there can be some improvement in our health care system, I am thankful that I live Canada. We are fortunate enough to be able to see a doctor when we’re sick and our medicare coverage takes care of a lot of the necessities.
When I went into premature labour at 26 weeks with Little One, I was air-lifted by air ambulance to Toronto and spent a few weeks on hospital bedrest there. She was born in Toronto and stayed in the NICU for 2 months. Hubby and I thought about all the equipment, medication, staff, procedures, and so on that would have cost us thousands and thousands of dollars to keep our preemie alive.
I can tell you that I cried and cried when I thought about what would have happened if we hadn’t been living in Canada. She would not have survived. We would not have been able to pay for the medical care and for the hospital fees on our own.
Everyone always complains about the government here, and like I said, there’s always room for improvement, but really…we are so lucky to have the health care we have.
P.S. Have you ever seen the Denzel Washington movie “John Q”? My little brother was in that movie. Anyway, that movie (though I know it’s fiction), made me really thankful that we don’t live in a country where if we don’t have the funds to pay for hospitalization or medical procedures, our loved ones are left to die. It just seems so unjust. I know life isn’t fair, but like one of your commenters said, “the measure of a good health care system is how it treats the poorest of the poor”.
Wow! Sorry for the LONG comment, J! Thanks for the thought provoking post.
Starshine
I don’t think we have a great system here, but when I hear that in Canada or the UK, I might have to wait to see a specialist, that makes me happy with what I have.
Donna
Our system here is broken. It needs to be changed/fixed/ whatever you want to call it. It is no longer for the people, but for the insurance companies to make money. Yes, I am bitter. As newly unemployed, I’m going thru the whole COBRA thing. Without the recent gov’t subsidy, Spence and I wouldn’t have insurance coverage as I wouldn’t be able to afford almost $800 a month to keep it (which is pretty crappy to begin with, but at least it’s something) – I’m unemployed for christ’s sake! Sure, I got a severance package and qualify for unemployment, but that is supposed to go for food, shelter, necessities, not health insurance premiums. My subsidy only lasts for 9 months…here’s hoping I’ve got a job with very good benefits by then cos if I don’t we’re screwed.
I’ve overheard many conversations on the bus and the train. People for and against the changes. Mostly against, saying Obama is just trying to bring in socialism. Well, you know what? No matter who is President, something needs to be done and so far Obama is the only President we’ve had in a long time with the balls to even try to fix the system. I say GO FOR IT Mr Prez, something needs to be done – should have been done a LONG time ago…
Jimmy
Very enlighting post. Gosh? I’m agreeing with a liberal? Somebody shoot me please!
I guess I have never given this much thought because I have always been fairly healthy and have health insurance provided by my employer?
J
Jimmy, you’re agreeing? Someone bring me my smelling salts! 😉
I think those of us who are healthy and with insurance don’t think too much about it, except when our premiums go up beyond affordability, I guess. But I had an uncle (great uncle, actually) who had cancer, and HAD INSURANCE, but they were slow and didn’t want to authorize treatment, and he died. That’s a broken system, in my book. And what happened to my mom when she had her hysterectomy back in ’05 was just stupid. Stupid insurance company, stupid stupid stupid.
TomCruise
This is what I posted on BristishExpats!
http://britishexpats.com/forum/showthread.php?t=610564&highlight=Medical+health+care+in+Oz+compared
The system in Australia is a combination of public and private system .
You are not compelled to have private insurance and indeed most Aussies don’t have one I think. However, due to the taxation system, it is better to get private insurance if the family income is above a certain threshold (currently at 150K).
Private insurance is however very affordable (approx 3k/year for a family of 4). However, as someone pointed out earlier, it does not cover everything. For example, it will only cover visits to private hospital emergency rooms if you get warded. If not, it is not covered. Coming from Canada where the system is entirely public and being used to overcrowded emergency rooms, I am happy that an option for private hospital ER exist in Australia.
As for the GP and specialist doctor visits, private insurance is no good (That is how they keep the cost down. It is one of the significant difference with the American private insurance schemes). However, there are 2 kinds of GPs here. The bulk billing type and the private billing type. The bulk billing types are usually new practice, new doctors, doctors who have relocated or doctors with practices in low-income neighborhoods . A visit to a bulk billing GP cost nothing as they bill everything to medicare. It is approximately $35 for a routine visit. However, a visit to a private billing GP will cost $50-60 . You will have to pay the surgery from your pocket . Out of this, you will get approx $35 back from medicare (it is easy to get the refund… You just need to supply a receipt from the surgery). Some surgeries allow you to lodge the claim automatically from their office . For others, you will need to visit the local medicare office to get the money back (immediate refund). The number of bulk and non bulk GPs vary according to the economic condition as well. Right now, the trend is to bulk bill due to the economic condition. People are cutting down on their visit to the doctor due to the economic hardship and hence with less patients, more doctors are forced bulk bill to attract enough patients. (It is basically economics here. usually, once a new doctor has built up the practice, they go private).
However, most non-bulk GPs have a policy to bulk bill children. seniors and people on pension cards (Please note that in other countries pension card holders are also called welfare recipients. There is another group called “aged pensioner” which is different ).
As for drugs, most drugs are subsidized by govt (pbs) with PBS drugs NOT costing above $33 for a month’s supply. However, for the non subsidized ones (usually latest drugs, etc), insurance (with pharmacy benefits) will pay any amount above $33. To protect against high drug cost, there is also the pbs safety net.
You can read about it here…
http://www.medicareaustralia.gov.au/…/msn/index.jsp
http://www.medicareaustralia.gov.au/…thresholds.jsp
http://www.medicareaustralia.gov.au/…cripts/pbs.jsp
(Similarly there is a medical safety net)
For any major surgery, this is where private insurance will help most. It will cover almost all costs. Those without the private cover, there is the public hospital. However, you will be prioritized in the public hospital and depending on the condition, there may be a waiting list. Of course if the condition is life threatening, there is no waiting list. The best hospitals (mostly public hospitals) are found in the capital city (e.g. Brisbane) or beside major teaching hospitals. Even in the capital cities, only a few hospitals are centers of excellence. They employ the best specialist and have the latest equipment. The public regional hospitals and the non centres of excellence hospitals in the cities are a little stretched for resources. There usually sits a private hospital beside a public hospital (probably a marketing thing).
In summary, the system is not that costly as in the U.S (due to a variety subsidy schemes and due to the availability of medicare for all). Public system is probably a bit stretched but that is where you also find the latest and best . I like the private hospital option that is always available.
Hope this helps.
jacksmith
AMERICA’S NATIONAL HEALTHCARE EMERGENCY!
It’s official. America and the World are now in a GLOBAL PANDEMIC. A World EPIDEMIC with potential catastrophic consequences for ALL of the American people. The first PANDEMIC in 41 years. And WE THE PEOPLE OF THE UNITED STATES will have to face this PANDEMIC with the 37th worst quality of healthcare in the developed World.
STAND READY AMERICA TO SEIZE CONTROL OF YOUR NATIONAL HEALTHCARE SYSTEM.
We spend over twice as much of our GDP on healthcare as any other country in the World. And Individual American spend about ten times as much out of pocket on healthcare as any other people in the World. All because of GREED! And the PRIVATE FOR PROFIT healthcare system in America.
And while all this is going on, some members of congress seem mostly concern about how to protect the corporate PROFITS! of our GREED DRIVEN, PRIVATE FOR PROFIT NATIONAL DISGRACE. A PRIVATE FOR PROFIT DISGRACE that is in fact, totally valueless to the public health. And a detriment to national security, public safety, and the public health.
Progressive democrats and others should stand firm in their demand for a robust public option for all Americans, with all of the minimum requirements progressive democrats demanded. If congress can not pass a robust public option with at least 51 votes and all robust minimum requirements, congress should immediately move to scrap healthcare reform and demand that President Obama declare a state of NATIONAL HEALTHCARE EMERGENCY! Seizing and replacing all PRIVATE FOR PROFIT health insurance plans with the immediate implementation of National Healthcare for all Americans under the provisions of HR676 (A Single-payer National Healthcare Plan For All).
Coverage can begin immediately through our current medicare system. With immediate expansion through recruitment of displaced workers from the canceled private sector insurance industry. Funding can also begin immediately by substitution of payroll deductions for private insurance plans with payroll deductions for the national healthcare plan. This is what the vast majority of the American people want. And this is what all objective experts unanimously agree would be the best, and most cost effective for the American people and our economy.
In Mexico on average people who received medical care for A-H1N1 (Swine Flu) with in 3 days survived. People who did not receive medical care until 7 days or more died. This has been the same results in the US. But 50 million Americans don’t even have any healthcare coverage. And at least 200 million of you with insurance could not get in to see your private insurance plans doctors in 2 or 3 days, even if your life depended on it. WHICH IT DOES!
Contact congress and your representatives NOW! AND SPREAD THE WORD!
God Bless You
Jacksmith – WORKING CLASS
Simone
I have nothing to compare the NHS to having only lived in the UK, but I thought i would try and describe it based on my experiences.
Here the NHS covers everyone for just about all medical care and its totally free at the point of use. So to see your doctor, even at night or a home visit, all hospital treatment, maternity, district nursing care, physiotherapy etc all free.
The only thing there is a charge for is when your GP prescribes medicines and that charge is around £6 (but free to those in hospitals) and even then things like contraceptives are still free to everyone and of course there’s no charge on medicines for children, the unemployed and to those with certain medical conditions.
Things like Pap smears, mammograms and now bowel cancer screening are also free. Babies and the elderly are encouraged to have regular check-ups again all free. Help stopping smoking and in some cases counselling (if your GP refers you) all free, even slimming world and gym vouchers can be given out by your GP.
Full time nursing home care e.g for the elderly can be free however it is means tested – those with a large amount of savings e.g several thousand pounds (Id guess over eight) or a lot of money tied up in property are expected to contribute.
The NHS used to have a reputation for long waiting lists e.g to see a hospital consultant or for an operation and to some extent that is still there – however there has been efforts in recent years to rectify that.
Now if your GP gives you an urgent referral to hospital you can expect to see a consultant within about two weeks. All hospitals have rating systems and sometimes its possible to choose which hospital you go to.
For a non urgent referral you may have to wait longer but you do have an option of paying a small amount to see the consultant privately sooner and still have the actual treatement e,g an operation paid for by the NHS. (My other half did this for a hernia operation.) Everyone is also entitled to a second opinion from a different doctor for free if they want to.
Sometimes (worringly) very expensive drugs arent funded or it takes a while for them to be funded by the NHS, things like new cancer drugs, however there is always an chance to appeal this or pay privately or try and get on a clinical trial. (We do have private healthcare companies to)
Now of course the NHS isnt actually free, everyone with an income pays a tax called National Insurance which I think funds the NHS and also social security benefits, it depends how much you earn but for someone earning £20,000 their monthly contribution would be £130.90 this goes towards NHS care, and I think unemployment benefit and housing benefit, and a pension when you reach retirement age (currently around £95 a week) even if you havent worked for several years you still get these things. But it’s all funded by the same National Insurance tax.
Its not perfect of course, some areas have better hospitals than others and I have heard that the system in France is much better than the NHS but then they pay far higher taxes towards it.
Going back to my grandfathers childhood when we didnt have an NHS and everyone had to pay to see a doctor, you had to be very sick to get taken to see a doctor, he actually had siblings die in childhood because they didnt get medical treatment quickly enough and I wonder if this is because his parents couldnt afford it.
I cant imagine how people who arent working e.g those on uneployment benefit and housing benefit in the UK who barely get enough money to pay their rent, bills and buy food would cope if they had the added expense of monthly health insurance – I guess they would let it slide and hope they dont get ill.
I would love to live in the US one day, but I do wonder what people do when they retire or if they lose their jobs to pay for healthcare?
Chrissy
Yes, sometimes you have to wait to see a specialist, but we have been very lucky to not have to have experienced that. My father had a heart attack and a stroke in the span of a year (yes, in the same year!) and he received the best care possible. He is followed up by his family doctor (regularly) and his heart specialist every six months.
My parents have coverage and a good insurance plan. Hubby and I are both self-employed (Hubby being a farmer and me being an ESL teacher). We do have insurance, but not significant enough to have paid for all the care and treatment our daughter needed in the NICU for her first 2 months of life if we had to pay for it on our own. Everything was covered by our OHIP (our provincial health care). I am so thankful that we have the health care system we do here in Canada.
This is such a great post, J. I think my husband may want to pop over here and leave a comment 🙂
Chrissy's Husband
While there are problems in some areas with OHIP (our provincial health care system, that varies somewhat among the different provinces in Canada), generally speaking it is a very effective program for all income brackets.
Yes, there are delays in some services, but there are delays in the States too. It’s just that if you offer enough money, you get in front of the line.
Here in Canada, we WILL receive treatment and not be denied by whether we have gone over the limit on our insurance or they don’t cover that illness, etc.
For some things we do have private insurance that we pay out of our pocket for like MRI clinics. Generally, we have a good thing going here though.
Chrissy's Husband
One more thing is that we (Chrissy and I) live in a remote part of Canada. Perhaps that is why we don’t have exceedingly long waits in the hospital waiting room?
OmbudsBen
J, add my strongest possible agreement to your post. Further, I think the lack of affordable health care in our country is barbarous.
We simply are not as civilized as the other industrial nations.
The right-wing has nothing bur fearmongering to protect the profit-taking of pharmaceutical and health insurance companies (some of which is plainly immoral); that and to slander people like Michael Moore. But he simpy speaks the truth when he shows Canadian and French systems (so far more humane than our own!) juxtaposed against the horror of the wealthy USC hosptial taking a confused, disabled old woman in he robe and slippers and dumping her on the street outside a homeless shelter. In this instance, America has no shame.
Thansk for an excellent post.
Wanderlust Scarlett
It’s highway robbery and it’s wrong. I think we should absolutely go to a system where the government covers all of the citizens. We’re expected to support a government who won’t care for all of the people who maintain it?
Stupid is absolutely right.
Scarlett & Viaggiatore
dadwhowrites
For all of its faults and waste, I’ll take the NHS anyday. At least every citizen gets a fighting chance of healthcare regardless of income – what’s so wrong about a society that tries to keep all its people healthy regardless of income or social status? And I’ve never been convinced that by the time you’ve added up state and Federal taxes, the US is that much cheaper to live in than the UK.