Positive conservative views on "single payer" health care

[Shad]

I figure a single payer system, which still allows
private sector service would work best for us.

Well that isn't Canada's system.

 

[Revoltingest]

Well that isn't Canada's system.

It could stand some improvement.

 

[Valjean]

There you go. It's really a systemic problem, not an insurance problem.

If people want affordable healthcare reign those people in.

But it is an insurance problem. My links just point out that insurance isn't the only problem with a business-model healthcare system.

Such a change wouldn't work. There are a lot of facts about the Canadian system never discussed. A lot of issues are unknown outside of Canada. Such a change would have required nationalization of private hospitals which would be a problem for many in principle let alone method used. Private hospitals do not exist here. Few procedures can be legally done outside HC. The short term issues would have been political point hammered into the ground regardless of long term projections.

What facts should we know, and why wouldn't a single payer system work? We already have a single-payer system in place, you know, in Medicare, and our Medicare system hasn't nationalized any hospitals.
Single-payer (NHI model) isn't a socialized (Beveridge) model -- that would be our socialized Veteran's Administration.
Why would such a change require nationalization of hospitals? Canadian hospitals aren't nationalized, and Medicare patients in The States use private hospitals.

Oh. What would work in America?

We already have working NHI and Beveridge models in place, though extending our NHI system would necessitate nationalizing a lot of private hospitals and employees. That would cut a lot of Bankers and billionaires out of the loop, so I doubt true socialization would fly.
An NHI model, like Medicare-for-all, would work, and is very popular with the public. A Bismark model would also work, and wouldn't eliminate the insurance industry as a pure NHI or Beveridge model would.

Outlines of the four basic healthcare models:
Five Countries - Health Care Systems -- The Four Basic Models | Sick Around The World | FRONTLINE | PBS

 

[Shad]

What facts should we know, and why wouldn't a single payer system work? We already have a single-payer system in place, you know, in Medicare, and our Medicare system hasn't nationalized any hospitals.

As the market is still largely control by private rather than the public and/or government. To implement Canada's system most of the private system would need to be close or bought out. There a lot of vested interested to push back against.

Single-payer (NHI model) isn't a socialized (Beveridge) model -- that would be our socialized Veteran's Administration.

Canada's system is socialized. It follow the Beveridge model heavily compared to say the UK which still has a private sector and opt-outs. The government determines what I pay and if I do not I get charged with tax evasion.

Why would such a change require nationalization of hospitals? Canadian hospitals aren't nationalized, and Medicare patients in The States use private hospitals.

As the Canadian government has strict control over the medical industry which does not exist within the US. If you want the Canadian system you have to implement such controls. Medicare is paid into by payroll taxes. Medicare does not provide the coverage the Canadian system does. There are premiums and it only covers about 50% of the cost. Medicare is nothing like the Canadian system.

We already have working NHI and Beveridge models in place, though extending our NHI system would necessitate nationalizing a lot of private hospitals and employees. That would cut a lot of Bankers and billionaires out of the loop, so I doubt true socialization would fly.

Toss in legislation to keep the private market down lest it come back compete with the public system as it is within Canada.

An NHI model, like Medicare-for-all, would work, and is very popular with the public.

Of course it is. Someone else is paying the bills.

Outlines of the four basic healthcare models:
Five Countries - Health Care Systems -- The Four Basic Models | Sick Around The World | FRONTLINE | PBS

This articles is wrong about Canada.

 

[suncowiam]

One perspective on high health care prices (a short read, listing 6 items)....
6 Reasons Healthcare Is So Expensive in the U.S.

Probably another good reason is that the government keeps on shifting it overall healthcare policies and don't give businesses a chance to scale.

 

[Falvlun]

That's a very informative discussion.

I don't know enough to have a firm opinion which I'd prefer outside of knowing that the US system is the worst possible one. I suspect I'd be happy with any other system that could get enacted without the terrible fight we saw when President Obama tried to get a national version of Romneycare passed and the subsequent attempts to destroy it.

I think, perhaps, that fight was needed for a public option to gain momentum.

 

[Falvlun]

Actually rather than focus on who pays as the answer, what I'd like to see is:

• Force providers to set prices just like other vendors do. If I get a fixed price bid to remodel my house, fix my car etc, it's a fixed price bid. That should apply to medical providers with a fixed price for common procedures like knee replacements etc.
• Reward outcomes, not tests.
  
• Allow the government to negotiate drug prices.
• Allow everyone to buy Medicare insurance with prices set at the cost of providing insurance. In other words people pay according to underwriter principles not through taxes. And those that want another health insurance provider have complete ability to choose that provider.

Good suggestions. For me, I think price control is key. It’s ridiculous that you can’t get any clear answers on how much something will cost. Whether you want a purely market driven system or a public system, we need cost transparency.

I’m not sure about “reward outcomes, not tests”. You can be the best doctor in the world, and sometimes your patients will still die. Tests will come back negative, but that doesn’t mean it wasn’t medically correct to order that test.

I think providing Medicare insurance as a purchasing option is a good step. It’s a baby step past Obamacare but not the full leap to single payer. I think such a system would still allow too much inefficiency, since there would still be difference prices for different insurers and different billing systems required. You could also run into the issue where there’s an effective stratification of healthcare, if hospitals refuse to take the Medicare insurance that would undoubtedly pay less. I think another good step would be to disallow for-profit Insurance companies, even for the private guys.

 

[Falvlun]

The UK system is not the most government-centric form of HC, it's Canada's. I wish I had the UK system here.

In the UK system, the government runs the hospitals and the payment. In the Canada system, the government only runs the payment; the hospitals are still private.

 

[Falvlun]

What I hear is that western medicine is not as evidence based as
we like to believe. Treatment decisions still have much art in them,
which results in less than optimum patient care. Insurance companies
use an epidemiological approach to look at a larger picture than
front line physicians see, eg, which hospitals have good & poor
results for which procedures, which procedures work or don't for
which diagnoses.
One thing seems indisputable....the bureaucracy interferes with
efficient & proper care.

I should add that everyone I know in health care analytics is far
to the left of me...all Democrats, & even one socialist. So their
views aren't tainted by opposition to single payer (something
they all favor) or them dang darned commies in DC.

Non-medical people performing non-scientific medical experiments on people to reduce cost (to the insurance company) or increase profits (to the insurance company) cannot, by any stretch of the imagination, be considered quality control.

 

[Shad]

In the UK system, the government runs the hospitals and the payment. In the Canada system, the government only runs the payment; the hospitals are still private.

Nope. You are confusing institutions with hospitals.

 

[Falvlun]

Nope. You are confusing institutions with hospitals.

In general, the government directly provides healthcare in the UK. The government of Canada does not— they only pay for it. That’s literally the difference between a Beveridge model (UK) and a national health insurance model (Canada).

 

[sun rise]

Good suggestions. For me, I think price control is key. It’s ridiculous that you can’t get any clear answers on how much something will cost. Whether you want a purely market driven system or a public system, we need cost transparency.

I’m not sure about “reward outcomes, not tests”. You can be the best doctor in the world, and sometimes your patients will still die. Tests will come back negative, but that doesn’t mean it wasn’t medically correct to order that test.

I think providing Medicare insurance as a purchasing option is a good step. It’s a baby step past Obamacare but not the full leap to single payer. I think such a system would still allow too much inefficiency, since there would still be difference prices for different insurers and different billing systems required. You could also run into the issue where there’s an effective stratification of healthcare, if hospitals refuse to take the Medicare insurance that would undoubtedly pay less. I think another good step would be to disallow for-profit Insurance companies, even for the private guys.

Right now, overtesting is financially rewarded. And of course as you noted, there are always exceptions. But if I take my car to the shop, I pay for a fix.

And any system can and will be abused to some extent.

But for common conditions, the incentive should be to get the patient healthy. Doctors should be rewarded for that and only penalized if they routinely order excessive tests.

When I had a minor stroke, the hospital did 3 tests to locate where it was in my brain. That had zero to do with my treatment in any way I could see. Maybe I'm wrong but why not at least do the most revealing test first rather than three.

 

[Shad]

In general, the government directly provides healthcare in the UK. The government of Canada does not— they only pay for it. That’s literally the difference between a Beveridge model (UK) and a national health insurance model (Canada).

Again an institution is not a hospital.

Canada's model is socialized, not to be confused with socialist. I can not opt-out of my insurance, there are no plan options, my costs do not increase based on my health but the budget determined by government and per-captia. Costs are covered by taxes without any indication on taxes what those costs are. Rates are determined by income and tax brackets not the individuals health and actions.

The use of insurance is a facade. Insurance is about guarding against risk. People are not the same thus the risk factor is not the same. As cost do not increase for the individual but is redistributed to all citizens it is not insurance but universal accessibility under a social program using a common fund. The common fund is the only factor of insurance in the system I live under.

 

[Revoltingest]

Non-medical people performing non-scientific medical experiments on people to.....

You see that going on?

 

[Falvlun]

You see that going on?

What would you call forcing people to try medicine B instead of medicine A prescribed by their doctor? The hope is that a cheaper medicine will do the trick... it’s an experiment forced upon the patient with the goal of reducing cost for the insurance company.

 

[Falvlun]

Again an institution is not a hospital.

But I am talking about hospitals. I don’t even know what you mean by institution.

The UK government literally runs the hospitals. I’m not sure how else to state that. The same is simply not true of Canada.

Canada's model is socialized, not to be confused with socialist. I can not opt-out of my insurance, there are no plan options, my costs do not increase based on my health but the budget determined by government and per-captia. Costs are covered by taxes without any indication on taxes what those costs are. Rates are determined by income and tax brackets not the individuals health and actions.

The use of insurance is a facade. Insurance is about guarding against risk. People are not the same thus the risk factor is not the same. As cost do not increase for the individual but is redistributed to all citizens it is not insurance but universal accessibility under a social program using a common fund. The common fund is the only factor of insurance in the system I live under.

Hey I didn’t come up with the name. It’s not my fault that Canada’s system is called a National Health Insurance system. But I really don’t see why it shouldn’t be called that. It’s essentially Medicare and Medicare is an insurance system.

 

[sun rise]

What would you call forcing people to try medicine B instead of medicine A prescribed by their doctor? The hope is that a cheaper medicine will do the trick... it’s an experiment forced upon the patient with the goal of reducing cost for the insurance company.

I've had that happen to me. My doc prescribed something that would cost me $1400. He went to a drug he thought would not work as well but cost me very little.

It's one big reason I want to either tightly regulate or get rid of insurance companies or at least the system that allows them to do that kind of thing.

 

[Subduction Zone]

I've had that happen to me. My doc prescribed something that would cost me $1400. He went to a drug he thought would not work as well but cost me very little.

It's one big reason I want to either tightly regulate or get rid of insurance companies or at least the system that allows them to do that kind of thing.

The system we now have makes very little sense. Granted, pharmaceutical companies need to be able to earn a profit. But charging exceedingly high amounts of money for the drugs they invent is clearly not the answer.

 

[sun rise]

The system we now have makes very little sense. Granted, pharmaceutical companies need to be able to earn a profit. But charging exceedingly high amounts of money for the drugs they invent is clearly not the answer.

And raising prices beyond bounds for older drugs just because they can should be grounds for a long term in the slammer.

 

[Shad]

But I am talking about hospitals. I don’t even know what you mean by institution.

In Canada hospitals are facilitates which provide the widest range of medical procedures, treatment and care to the public. These owned and ran by provincial and local government. An institution provides limited procedures typically based on one illness or body part. For example cancer or eyes. Each is licensed by government to operate under the Non-Hospital Medical and Surgical Facilities Accreditation Program. These institutions have no ER, no care facilities for in-patient and are out-patient only. Procedures may not be covered by HC at all.

The UK government literally runs the hospitals. I’m not sure how else to state that. The same is simply not true of Canada.

Wrong

Hey I didn’t come up with the name. It’s not my fault that Canada’s system is called a National Health Insurance system. But I really don’t see why it shouldn’t be called that. It’s essentially Medicare and Medicare is an insurance system.

As it a facade to cover up how much control the government actually has over HC. It's no Medicare as Medicare has plans to pick from. Canada has one plan. Pay your taxes and do not ask questions