Finland: a great example of how there are options outside "single payer"
There's a nice thread on Finnish education policy which had a side comment on Finnish health care. Not wanting to threadjack, it struck me that Finland is a great example of how the focus a lot of us in the US have on the specific model of single payer may be shortsighted.
Finland has a three-tier payment system (so, not single payer). Clinics are paid for by localities, user fees, and national subsidies; this is basically the same thing as the Federally Qualified Health Center model that ACA greatly expanded (the best part of the law, IMO, and a big reason why Sanders ended up supporting it). There are also private clinics which, after certain qualifying processes, can receive subsidies on a cost-construct model. Public financing pays for about 70% of Finnish health care (the rest is user fees), as opposed to about 60% here in the US. I want to stress that: it's not that 10% difference that's killing us, it's the underlying provider model, which single payer doesn't address.
Like anything, it's not without flaws: since localities are both the providers and payers of the lion's share of health care there's not the incentive for cost controls that other models have, and Finnish health care costs have risen faster than the OECD average (though not as fast as ours). But it's a model that has been shown to work well, and it's a model that we're currently expanding. Illegal immigrants are not covered, though IIRC they're moving to add pregnant women and children regardless of their immigration status.
One basic roadblock I see to the US's adopting a single payer system a la Canada is that it required eliminating the private health care market entirely: it is illegal in Canada to receive private payment for a covered treatment to a covered individual. That's what keeps doctors there from saying "I don't accept Medicare" (yes, they call it that in Canada, too; or I suppose since they were first, we call it that in the US, too). That would be an incredibly difficult Rubicon for the US to cross. (For those who ask why single payer couldn't have passed here, that's the big reason: it would have either required that law change, which was an absolute non-starter, or it would have resulted in a lot of doctors simply refusing to take new Medicare patients, which would have been rationing of the worst kind.)
Finland's solution avoids the need to do that: private clinics can still exist but can only receive operational funds at a cost-construct level, ie, the marginal payment the city would have given its own clinic. This still allows private clinics but removes the financial logic behind most of them, and prevent a large enough market for them opening up to have doctors in general flee the state system for greener pastures.
So, anyways, this is a model that we are already expanding and that can be arbitrarily expanded without significant disruption -- existing providers can join FQHCs and existing private and public insurers can pay their user fees.
