I have some questions about single-payer healthcare.

[Dawgs]

Can you guys help me out?

1) How will insurance companies be affected by a single payer system?

2) Will millions of jobs by insurance companies and other administrative positions be lost?

3) Who will pay for the single payer system? Will it all be through taxes, potentially higher ones, or will businesses and individuals still pay as they do now?

4) How will it affect the kind of care we receive when we go to the doctor or hospital?

5) What are some "good" reasons for NOT going with a single pay system?

I've already done a little research, so please don't just send me a link. I'm interested to see what you guys think, and know, about a single payer system.

:hi:

[pnutbutr]

1. I suspect

1)Insurance companies will be severely downsized and start providing additional coverage policies to cover what the universal system does not.
2)Maybe not millions but yes, jobs will be lost.
3)Everyone through additional taxes.
4)Should be the same if not better but that's something we will have to find out if/when it happens and will be based on many variables.
5)The potential for number 4 to go badly.

[WyLoochka]

2. There are no "good"

reasons for not going single payer. Every reason is based on an ideology and that ideology is based on an idea that is bogus.

The insurance companies would be cut out and have to return to focusing on property and casualty where smaller, segmented risk pools actually work.

[MercutioATC]

6. Actually, lack of consumer choice is a good reason.

I'm a member of FEHBP. I get to choose between 18-20 different plans.

Every year during open season, I evaluate my likely medical needs for the coming year and choose a plan that best fits those needs. Some years, I may choose a more expensive plan with better vision and dental coverage. Other years, I opt for one of the less costly plans.

Expanding FEHBP would be easier than creating an entirely new system and, while it's not perfect, it's had most of the bugs worked out of it. Combined with the fact that it would preserve consumer choice, that's my choice for a national health plan.

[BR_Parkway]

3. Is this for a school project or are you simply trying to make a

negative case for single payer all in one post?

1) Insurance companies will continue to profit by being paid to assume our risk if we wreck our car, burn our house down or sink our boats. Not whether the decision to pay for someone's open heart surgery will affect their quarterly bonus.

2) Any displaced workers at one firm should find a suitable position working for the single payer entity - doubtful much paperwork goes away in this process

3) Number of options 1) if they raise my taxes by 10% a year, I'll save over 75% of what I currently pay in premiums. They'd have to more than double the amount I pay for it to cost me more than I currently pay

4) No, in fact it might improve it - current decisions are made based on what costs will be recovered - a constant guessing game as for profit insurance companies constantly try to deny payments based on their need for profitability.

5) Can't think of any, but interested to see what other's opinions on this are.

[Dawgs]

7. Not a school project and NOT trying to make a negative case for single payer.

They are just questions. Yes, they might be 'devils advocate' type questions, but I have no agenda when asking them.

I'm generally for single-payer healthcare. I just want to make sure that I'm 100% informed when promoting this idea to others.

[ayeshahaqqiqa]

4. As I understand it

1. Insurance companies will be out of the loop, except to provide coverage for health areas not covered by the government plan. This would be coverage for certain specialties, perhaps certain types of healing modalities--it will depend upon what eventually is covered by the government plan.

2. I am sure that a certain number of jobs will be lost in the insurance industry, but I don't think all of them will--see my first answer. But since I have friends in the insurance industry who lost their jobs due to outsourcing, I'm wondering how many of the lost jobs will be lost by Americans.

3. As I understand it, health insurance will be paid for through payroll taxes, as Medicare is now. I would expect to see the % of income used for this tax to double--which still makes the tax a lot less than what is deducted for Social Security.

4. This depends upon how the law is written, but I would say it would open up the field of doctors from which you can choose. Right now, many insurance companies won't pay for services rendered "out of network". I would hope that the government would allow a person to go to any MD.

5. The reasons for not going with single payer would depend largely upon how the law is written. If it is written to constrict the type of care covered (such as not covering chiropractic services), it won't be a good law. If it is written in such a way as to dictate the kinds of medicine a doctor can prescribe (for example, insisting a patient be given Drug X despite the fact that the doctor has found that the patient has an allergic reaction to Drug X), then it would be a bad law.

[Astrad]

5. I live with a single payer system so I'll give you my view

1) Government becomes the insurer so there would be no private insurers except perhaps for extended benefits
2) Yes but not millions I believe the number is in the hundreds of thousands
3) Generally paid through taxes. You could have a specific health care tax levied on individuals or businesses but in most jurisdictions it's paid for out of general revenue.
4) Some aspects would improve, some might deteriorate. In general the speed of care might be affected. You may wait longer for specific treatments (though not necessarily) Generally places with socialized health insurance have better health outcomes then those that don't. You still get to choose your own doctor.
5) There is no 'cadillac' care. If your doctor orders an MRI you won't get it the next day. You won't have hospitals that look like fine hotels.

Hope that helps!

[Dawgs]

9. It does help. Thank you.

:pals:

[TBF]

10. #5 - That is the one that freaks out a lot of people here in the states -

they want to choose their own doctors, and some want to pay for their own care (if they're able) and are willing to pay more. In Canada are you able to do that? Do doctors/hospitals accept private payment as well or do you have to go through the government system?

Sort of like schools - you can go to the public schools or choose to pay more for private schools of your choice...

[elocs]

15. 2 points: Choosing your own MD; private insurance under universal health.

One of the last times that I actually had health insurance the company was sold and the new owner switched health care providers to where I had to go to their specific clinic/hospital if I wanted full coverage. Given that, I could not truly choose my doctor because he was with the other clinic that was not their preferred provider. This was a doctor that I had seen for 30 years, one who once called me at home on a Sunday morning when he noticed my bp was high when I had it checked the previous Friday. If I could have afforded to continue seeing him I would have, but as it was I had to pick out a new doctor who was not my real choice. COBRA is a joke too since when I did not have a job there was no way I could afford to pay the monthly premiums.

I heard a radio discussion about countries with universal health care and it said that people in those countries were free to purchase private insurance if they wished more expanded or quicker coverage. I suppose it is like people who believe private schools are better than public ones and choose to send their children there. Even so they are still required to pay the taxes to support the public schools even if they are not using them.

[Astrad]

19. Canada is a bit unusual in that private care is not allowed

Canadians who want to pay for it because they want it faster or believe it is better elsewhere go to the US. Other countries with public health care like France and the UK allow private care as well although I believe doctors who work privately cannot bill the public system - they require you to be either public or private but not a bit of both.

[TBF]

24. I suppose the theory would be that if everyone is required to use it the rates

are the lowest possible with having such a big pool. I guess I don't feel strongly about how they do it here, as long as everyone has health care (including preventative things because it's so much cheaper than fixing things after the fact... ). I was just curious as to how it works elsewhere, and what people like/dislike about different systems.

[walkaway]

8. As to #4

50,000,000 Americans will actually be able to make an appointment with a doctor or be treated in a decent hospital, have access to preventative care and early detection of cancer and other deadly conditions.

How's that for different?

[Bonhomme Richard]

11. Maybe we should let the Insurance companies run it BUT..

1. They have to become non-profits.

2. The cost, to the government per person, can not be higher than the highest cost in Europe. (I think Norway pays the most per person at $6500.0 which I understand is about $1500 less than we are already paying here)

3. Everyone is covered for standard medical procedures, plus prescriptions.

[Hoyt]

12. Some good questions.

I doubt anyone knows what will happen or how it will work out in the long run. If you assume the politicians can develop a rational plan, it still has to be put into operation. But, here are some thoughts while I try to wake up and get going.

I'm assuming "Medicare" will be part of the model for a single payer system --

1) I think "insurance" companies -- who administer and pay physician, hospital, etc., claims under Medicare -- would continue to do that. These companies have been fulfilling that function for decades and most have subsidiaries that are claims administrators, rather than in the insurance business.

2) Well, you wouldn't need sales folks (but there are other types of insurance most sell anyway, so they'll survive). But, you'd still need the claims administrative people (even if they went to work for some big government agency, which is unlikely in the short run). Hopefully, we would not need the "executives" whose main function has been to dream up creative ways to take our money and shift it away from direct health care.

3) Obviously, we will pay in one way or the other. It will not be free. I suspect income taxes would be a big part of the financing mechanism. I suppose you could charge "premiums" based upon one's ability to pay considering income, family size, etc.

4) It will have enormous impact on the system (especially in the long run), mainly to adsorb more people who delay or just don't get care right now. Over time the system will in a lot of ways become like an assembly line for routine type care. That sounds "cold", but if more people can get care, outcomes are better, etc., it's OK with me. We need a more organized, efficient health care system, not just one that has evolved to chase the money. The Marcus Welbys have been tough to find for years.

5) I'm not sure there are any "good" reasons for not going single payer if the system is designed properly, administered properly, the government is answerable to people, etc. Those are big "ifs", but the current system fails a lot of people and leaves a lot of gaps. And it just costs too much. I'd rather have the basic design of the system managed by elected government officials than some greedy, callous executives answering to stockholders . . . . . . Just like under Medicare, you would still choose your doctors, hospitals, etc. Most would be privately practicing and I actually think consumer choice would increase (especially for those who don't have any choice right now because they can't afford care).

How it ultimately shakes out, is just a guess. I hope -- and think Obama and his advisers -- will do the research to get us started in the right direction. That's what I voted for in November. I also hope future administrations, Congress, Lobbyists, etc., don't screw it up for the wrong reasons. I know that's a whole lot of "hoping", but the current system ain't rational.

It's also possible to accomplish a lot of the above without going straight to a single payer system. But, I feel we need to go ahead, take the medicine and get it evolving.

[Dawgs]

13. Great response. Thank you.

:pals:

[Bluenorthwest]

17. Good points...

number 3 contains one of my large worries. "Family size". Who defines family? The families themselves, or the religionist dogmas of others?

[Hoyt]

18. That one is simple.

Screw the religious dogma, right wing propositions, etc. But, I hear you.

[happyslug]

20. Who cares how you define a "Family" under Universal Care?

If you are not a member of family A, you are in your own family or Family C, which is also covered. Under universal care EVERYONE is eligible, eligibility does NOT depend on how the term family is defined, all you have to be is a covered individual.

Under the law today, the term Family is defined by the Insurance company unless the state or federal government says otherwise (and even then it tends to be Insurance Company defined more then State or Federal Government Defined). Religious dogma comes into play today more then in a Universal System, for the simple reason under a Universal Medical system if you are NOT a member of one family you are still eligible as your own family. The medical benefits are the same under either case.

[Hoyt]

21. You have to determine the monthly "premium."

Since it ain't free, I think there would be some kind of income test determining what people pay.

A single person who makes $30K a year might pay one thing. A two or more person "family" making $30K would pay significantly less (with subsidies making up the rest where necessary).

Of course, one could structure it in any number of ways.

[happyslug]

27. Generally the rule is a percentage of income

Generally around 10%, if your income is zero, 10% of Zero is Zero, thus you paid the full amount. From what I have read most Universal plans depend on a 10% tax on income paid by employers (Self-employed will have to pay the 10% themselves). Notice that is how it is to be paid NOT who is covered. Coverage will be universal, whether you paid into or not. Thus family status is NOT important. Only Income is and that is already taxed thus we know how much money will be captured by any payroll tax.

[Bluenorthwest]

28. Ummmm...

Under a single payer, universal plan, we'd not have to care. But if this is going to be a mandated purchase of premium based policies, with the price set according to 'family income', then it is most certainly important that people get to define what is a family, and that religious bigots not be allowed to treat some households as 'less than a family'.
The tax code is not fair now. Paying more because Gov Kaine is a prig with an atavistic religion where his mind should be is not my idea of a good time. It is that tax code that defines, more than any other element, who is equal and who is not.
You are assuming a Universal, tax based system without individual premiums based on 'family income'. That would be my choice as well, for all the reasons you state. But what they are talking about is not that, so much as a mandated purchase. With a mandate to pay, the question of who is legal family is very important.

[Ms. Toad]

14. #4

Sort of...

I have a complex insurance plan that permits me to choose full coverage (in plan), parial coverage (in a related plan), or even less coverage by going to anyone I want to see.

My daughter is currently in college without a car. The closest full coverage lab is 20 miles away from her. I am 60 miles from her. That means a 160 mile drive (plus all that time) every time she needs labwork to obtain full coverage. The closest partial coverage lab is within walking distance. After a deductible, I pay a 10% co-pay.

She has been having labwork every 1-2 weeks since the middle of January. I have yet to get a single bill from either the lab or the insurance company. I spent over two hours talking with 5 institutions a month after the first labwork was done (my primary insurance, the related plan, a management company for the related plan, the walking distance lab, and the independent cost setting entity associated with the walking distance lab). None of them alone, or in combination, can tell me the cost of the tests she over a month ago, which need to be repeated - or could give me an estimate of the newer tests (which she had for the first time a week before these conversations.

If the test is a $120 dollar test, the decision to send her to the walking distance lab at 10% is a no-brainer. If the test is a $1000 test, at 10% the question is a lot closer - but NO ONE can tell me. The best I have been able to do is to find mail-in labs on-line which offer similar tests (can't tell if they are exact because there is a complex set of interrelated numbers I don't have access to to match them up), and hope that they are not off by a factor of 10.

So...single payer should eliminate that complication to obtaining treatment. I would be able to spend my time concentrating on health - rather than on which facility to send my daughter. That, alone, would improve health care.

[Dawgs]

16. Great point. Thanks.

:pals:

[ROFF]

22. My experiences as a Canadian

1) How will insurance companies be affected by a single payer system?
They can offer coverage for other things like Prescriptions, Dental, Ambulance, Private rooms, Glasses, Home oxygen, etc

2) Will millions of jobs by insurance companies and other administrative positions be lost?
A single payer system has fewer needs for paper pushers. Funds are transfered electronically, only one set of forms are used.

3) Who will pay for the single payer system? Will it all be through taxes, potentially higher ones, or will businesses and individuals still pay as they do now?
Through taxes. But this is cheaper in the long run as when you buy a car or lawn mower (for example) You are not paying for the health care of others.

4) How will it affect the kind of care we receive when we go to the doctor or hospital?
It is better. The government has a vested interest in seeing that the patient is cured the first time.

5) What are some "good" reasons for NOT going with a single pay system?
In Canada when a Conservative government gets into power, they try to "tweek" the system so it doesn't work quite as well.

I've already done a little research, so please don't just send me a link. I'm interested to see what you guys think, and know, about a single payer system.

A little background.
I live in Saskatchewan, the "Home" of Medicare in Canada. We got free Hospital care in the late 40's and free Doctor care in 1962. I use the word "free" to mean that when I last had a major medical event (surgery for a kidney stone in 1981) all it cost me was for TV in the hospital room.

What is missing from most discussions on this subject is the change of attitude that happens. For example no Canadian is forced into bankruptcy because of medical bills. Medical treatment need not be postponed. Plans can be made without worrying about sudden expenses. I retired in 1999 at the age of 53 partially because I knew I would be covered. The peace of mind that this engenders has a value that is hard to quantify. It evens out expenses for business. It is cheaper to set up a plant in Canada because you do not have to pay for health care for your employees. All employers are on the same level unless they want to offer benefits as listed in my answer to your first question.

I hope that this helps.

[ROFF]

23. More thoughts

I don't usually reply to my own posts but the Missus had supper ready.:loveya:

The government (single payer ) has a vested interest in the health of its citizens. An ecological hot spot could cost it a lot of money. Also smoking and obesity programs are available to whoever needs them. I have diabetes type 2 and "they" track me so it does not get out of control. That is a good thing actually. Going for a checkup every six months is probably good for me.

The government wants to treat a condition as soon as possible because it is cheaper that way. And also to make sure that the treatment is as complete as possible. Repeat visits are costly.

The government administrators purchase supplies for many hospitals and can get lower pricer due to volume purchasing. There is no profit motive. Drugs are purchased based on volume basis.

There are no $10,000,000.00 salaries, corporate jets, country club memberships, stock options or forgivable loans in the system. My taxes actually go to health care.

I wonder how much Americans pay in taxes AND health care insurance compared to what Canadians pay in taxes? I suspect that the total sum is less for Canadians.

Remember that Canada is a larger country with about 11% percent the population of the US. This means that a larger percentage of the population of Canada is not near health care services. And our climate can kill you ( winter ).

[TBF]

25. Thanks for weighing in with both posts - I found them very interesting. n/t

[Hoyt]

26. Great post, Roff

Your last point is particularly interesting. Some folks don't realize they are one illness, and/or a job/insurance loss, away from bankruptcy.

You hear a lot of criticism about the Canadian and British system, but I don't see many people giving it up.

[many a good man]

29. You forgot the biggest question re: "rationing"

All public systems face this question: how much to cover and how much will it cost?

Single payer means there is a single buyer of basic health care services. That gives it enormous leverage in controlling costs.

It also has the power to define what is included in basic coverage (standard formulary). It can know that x number of people require y number of procedures every year and that the total number of labs, doctors, MRIs, etc. mean that there will be a wait of z number of weeks.

Right wingers call this rationing and use its specter to instill fear. IMO that is the farthest thing from the truth.

Basic health care coverage under a single payer system is the most democratic method conceivable. Government sets a budget for health care and sets the tax rate accordingly. If the people decide they want to wait four weeks instead of six weeks for some elective surgery, experts can look at the facts and tell us how many more billions that will cost. The American people can then vote, through their representatives in Congress, on whether it's worth it and raise or lower taxes accordingly. The people decide.




Health care for people not for profit!

[Hoyt]

30. That sums it up nicely.