Single payer verses

[Pharaoh]

a universal healthcare system like Canada's. What is the difference?

I don't like the term single payer, I'm not sure what they really mean by that.

Regulated healthcare for all. I'm all for that.

[Oregone]

1. Canada is single-payer for medical services

It means a single public owned insurance entity that pays for medical services. Their adminstrative overhead is 1.3%

Each province has their own system. In BC, it is like $50 bucks a person, and $108 a whole family in monthly premiums. No copays. No deductible. All doctor visits, hospital visits, necessary procedures, etc, covered.

Dental/vision is multi-payer, private-market (unless you are below poverty). They have catastrophic single-payer for drugs. Private insurance to supplement public single-payer plan is about $100 a month for a whole family.

IOW, $200 max a family in Canada for the best insurance covering everything.

[patrice]

2. Single Payer refers to how money is processed in response to claims on the system.

Presently, each insurance company and every insurance company product have pretty much unique claims & payments procedures. This requires that all "health" "care" providers maintain the overhead associated with staff to figure out how to get paid and for what. Insurance companies also have to maintain the overhead associated with claims:payment processors.

In a Single Payer system, as I and friends of mine http://www.pnhp.org/ envision it, all "health" "care" providers remain private, all "health" insurance providers remain private too, but the government becomes the conduit by means of which claims and payments are processed, just as the government currently does in Medicare and Medicaid. Removing the overhead of maintaining claims:payment processing will reduce costs for both "health" "care" providers and "health" insurance companies. Reduced costs will be passed on to consumers and also allow health care providers to improve services. This approach will cost "health" insurance companies some jobs, which is unfortunate, but all of us are being told to adapt professionally. Look at how layoffs in IT and the auto industry have been met with exhortations for people to re-train. Also, why should insurance companies be supported by Socialism and other jobs left to dog-eat-dog capitalism?

One of the things I like best about getting the maximum amount of cost cutting available to us under a Single Payer system is that such deep reductions in overhead will make it possible for us to consider expanding services covered to cover truly preventitive and complementary medicine and therapies.

[Oregone]

3. ""health" insurance providers remain private too"

WTF, thats crazy talk. There needs to be a single health insurer, and a single payer in a single-pay system (like Canada). You need a single publicly owned institution to pay for and cover all citizens.

[patrice]

4. SP is not a Public Health Insurance Company:

http://www.pnhp.org/publications/proposal_of_the_physicians_working_group_for_singlepayer_national_health_insurance.php?page=3

The Effect on the Insurance/HMO Industry - The insurance/HMO industry would have virtually no role in health care financing, since public insurance administration is more efficient, and single source payment is the key to both equal access and cost control. Indeed, most of the extra funds needed to finance the expansion of care would come from eliminating insurance company overhead and profits, and abolishing the billing apparatus necessary to apportion costs among the various plans.

So the financing would be from private individuals buying private insurance for which claims and payments are processed by the government.

[patrice]

5. I stand corrected:

http://www.pnhp.org/publications/liberal_benefits_conservative_spending.php

The Physicians for a National Health Program plan would cover all Americans under a publicly administered, tax-financed national health program (NHP). A single public payer would replace the present array of more than 1500 private insurers, Medicaid, and Medicare. A unitary program could initially pay for expanded care out of administrative savings without adding new costs to the overall health care budget and would establish effective mechanisms for long-term cost control. Although consolidation of purchasing power in a public agency may cause apprehension among some physicians, the program could free them from the myriad administrative intrusions that currently plague the practice of medicine.


STRUCTURE OF THE NHP

We have previously described the design of the NHP in some detail.7, 8 It would create a single insurer in each state, locally controlled but subject to stringent national standards. States could experiment with the precise structure of the single insurer. Some may place it within a government agency, while others may choose a commission elected by the citizens or appointed by provider and consumer interests.

Everyone would be fully insured for all medically necessary services including prescription drugs and long-term care. Private insurance duplicating NHP coverage would be proscribed, as would patient copayments and deductibles. Physicians and hospitals would not bill patients directly for covered services. Hospitals, nursing homes, and clinics would receive a global budget to cover operating expenses, annually negotiated with the state health plan - based on past expenditures, previous financial and clinical performance, projected changes in cost and use, and proposed new and innovative programs. Itemized patient-specific hospital bills would become an extinct species. No part of the operating budget could be diverted for hospital expansion, profit, marketing, or major capital acquisitions. Capital expenditures approved by a local planning process would be funded through appropriations distinct from operating budgets.

Fee-for-service practitioners would submit all claims to the state health plan. Physician representatives (probably state medical societies) and state plans would negotiate a fee schedule for physician services. The effort and expense of billing would be trivial: stamp the patient's NHP card on a billing form, check a diagnosis and procedure code, send in all bills once a week, and receive full payment for virtually all services - with an extra payment for any bill not paid within 30 days. Gone would be the massive accounts receivables and the elaborate billing apparatus that now beleaguer private physicians. Alternatively, physicians could elect to work on a salaried basis for globally budgeted hospitals or clinics, or in health maintenance organizations capitated for all nonhospital services.