I’m all for single payer in the US but this diagram is a bit misleading.
There’s still a program receiving government funding (e.g. Medicare).
There’s still admin and billing (for the government program).
What I assume you’re really gutting are profits and shareholders for insurance companies. (Good, because healthcare in my opinion should not be a profit driven business in any respect.)
What I fear, however, is who is in power at any given time might change the care you receive if such a system isn’t setup with safeguards and ironclad mandates.
For instance, Republicans would absolutely attempt, through legislation, executive order, and the courts, to implement an effective federal ban on abortion or healthcare for trans and LGBTQ groups by changing how/if a single payer system would cover these services.
I would also be worried about the public availability of coverage data such that lists of frequent providers for these services are easily obtained and become a tool for harassment by religious zealots.
Or, imagine an anti-vaxxer put in charge of the program during the next pandemic.
How do other countries deal with these issues? Or, have politics become so broken in the US that this is a somewhat uniquely American problem?
Canada deals with some of those problems by having a separation of state and medicine similar to our separation of state and church.
For example, I think we are the only country in the world with no abortion law. It’s a medical procedure, so it’s left to the medical community to develop standards of care and standards of practice.
It’s not perfect, but it’s worked out quite well since the 1980s. There were some major cases that led to our abortion laws being struck down by the courts and no government has yet had the courage to introduce new legislation of any kind.
Considering one entire half of our political establishment is trying to do away with the separation of church and state altogether, I don’t think we’re gonna have a lot of success with that in the near future, unfortunately.
It is a bit simplified but it is much more streamlined than the insurance system outlined.
The UK model is single payer. The government pays the money into a national body like NHS England (or NHS Scotland etc) and it distributes money. The internals of the system itself are complicated (there are commissioning groups, acute hospitals, mental health services, dental services, public health services etc) and have overhead as with any organisation.
But there are not multiple government health organisations or paying systems - there is a single national tarrif for what each part of gealthcare costs and that money is distributed down to the providers like hospitals and GPs/family doctors. 2/3 of the cost of Healthcare is staff wages; it’s people intense.
No insurers, no billing agencies or debt collectors. Essentially there are not 3rd party businesses creaming off money for doing little more than handle the money. More of the money goes directly to healthcare rather than intermediaries. The infrastructure and administration within the system such as commissioning groups etc have fixed costs - none of it is run for profit.
In terms of government control - that is a concern but US politicians already heavily interfere in the system. Abortion is a good example of that. What you don’t get is Healthcare businesses of various types interfering in government.
The real issue for a single provider system is the staff - wages are kept down as its a national system. That causes strife if wages of pushed down too much. So you do get unions exerting pressure on government. I see that as a good thing but your mileage may vary.
Also if there is under investment then that can severely hamper the system - we have that problem in the UK - demand is going up as the population ages, but the politicians won’t make the hard choices of taxing the elderly to support expanding the Healthcare system.
I would earn far more in my specialty in the US. However even so I much prefer the UK system. I don’t want us to go down the route of the very broken US system. However there are public system with insurance models that do seem to work well - Australia and Canada have good reputations both in terms of cost, efficiency and pay for staff etc.
Essentially Universal Healthcare should be the aim, and it doesn’t necessarily have to be a single payer system to work. But single payer systems can work.
Also if there is under investment then that can severely hamper the system - we have that problem in the UK - demand is going up as the population ages, but the politicians won’t make the hard choices of taxing the elderly to support expanding the Healthcare system.
Politicians are drunk on the growing private ‘optional’ sector, letting unequal access creep in through the door they got their muddy feet in. This absolutely has to stop.
We see it here, as some regions take their levy and starve the public system in the hopes of forcing people shell out for the only option in this ‘optional’ alternative.
The NHS is a model of how to do it except any part that even speaks - or offers a business license - to any clinic offering any services which overlap at all with public space. This insidious taint needs to result in jail time for cruelty.
Admin and billing would still exist, but it would be savagely curtailed. We now have to account for every insurance agreement between insurance companies and healthcare systems. These can vary on a hospital by hospital basis causing the incredibly complex system of pricing that are currently used. A single payer system would vastly decrease the need for this administrative overhead. Of course this would result in lost jobs, and an honest assessment of M4A would acknowledge this. Bernie Sanders 2016 M4A bill had funding for the workers having to transition jobs during this change if I remember correctly.
100% agree. However, I try to keep in mind that these are real people with real families doing real work in the ineficient system that we’ve allowed to exist.
Republicans would absolutely attempt, through legislation, executive order, and the courts, to implement an effective federal ban on abortion or healthcare for trans and LGBTQ groups by changing how/if a single payer system would cover these services.
I think they are already doing it now, even solely in states with strong emphasis on privatized healthcare. I think as long as politicians can make law, they can easily sabotage the healthcare system, single payer or not.
How do other countries deal with these issues? Or, have politics become so broken in the US that this is a somewhat uniquely American problem?
I think this is a uniquely American problem, because individual (or small groups of) politicians have enormous power over these kinds of things in our current system. I think the answer is to not allow politicians to directly decide what is and isn’t covered - you leave that up to whatever federal agency is responsible for enacting the single payer system.
What you said about safeguards is true, but removing politicians’ ability to directly control what care is provided would be the first and biggest safeguard I think.
Or, have politics become so broken in the US that this is a somewhat uniquely American problem?
That is a signifigant issue, yes, but the rightwing politicians in a lot of other countries are moving further from the center and are also trying to gut the public health system in favour of privatizing increasing parts of it (to the benefit of their political donors and the companies on whose boards they will sit after they exit politics)
Anyone who wants a single-payer system should be required to be in an HMO for 20 years first.
The fight to get care is crazy, because bureaucrats up the food chain looked at stats and said “you don’t need this care” (because it won’t lower our risk stats). You’re just a number - if the stats say this won’t reduce your risk of dying, or reduce the likelihood of needing further care, welp, too bad.
I’ve been in 2 HMOs over the last 35 years… Same experience in both.
The “problem” in medicine is primarily insurance companies, and secondarily business management approaches that are inappropriate for medicine.
Get those people out of medicine first, or the problems will never go away, regardless of who’s paying.
My fucking coworker got denied coverage to replace his heart monitor that his doctor requested because “he didn’t have a stroke yet.”
The fucking business school shitheads are making medical calls overriding doctors orders because money… Money money money. My coworkers life is meaningless, he’s just “lost profit” to them.
This whole system makes me equal parts disgusted and enraged.
I’m all for single payer in the US but this diagram is a bit misleading.
What I assume you’re really gutting are profits and shareholders for insurance companies. (Good, because healthcare in my opinion should not be a profit driven business in any respect.)
What I fear, however, is who is in power at any given time might change the care you receive if such a system isn’t setup with safeguards and ironclad mandates.
For instance, Republicans would absolutely attempt, through legislation, executive order, and the courts, to implement an effective federal ban on abortion or healthcare for trans and LGBTQ groups by changing how/if a single payer system would cover these services.
I would also be worried about the public availability of coverage data such that lists of frequent providers for these services are easily obtained and become a tool for harassment by religious zealots.
Or, imagine an anti-vaxxer put in charge of the program during the next pandemic.
How do other countries deal with these issues? Or, have politics become so broken in the US that this is a somewhat uniquely American problem?
Canada deals with some of those problems by having a separation of state and medicine similar to our separation of state and church.
For example, I think we are the only country in the world with no abortion law. It’s a medical procedure, so it’s left to the medical community to develop standards of care and standards of practice.
It’s not perfect, but it’s worked out quite well since the 1980s. There were some major cases that led to our abortion laws being struck down by the courts and no government has yet had the courage to introduce new legislation of any kind.
That sounds really nice. We should try separating the state from medicine in America. Heck while we’re at it we could separate the state from religion
Considering one entire half of our political establishment is trying to do away with the separation of church and state altogether, I don’t think we’re gonna have a lot of success with that in the near future, unfortunately.
It is a bit simplified but it is much more streamlined than the insurance system outlined.
The UK model is single payer. The government pays the money into a national body like NHS England (or NHS Scotland etc) and it distributes money. The internals of the system itself are complicated (there are commissioning groups, acute hospitals, mental health services, dental services, public health services etc) and have overhead as with any organisation.
But there are not multiple government health organisations or paying systems - there is a single national tarrif for what each part of gealthcare costs and that money is distributed down to the providers like hospitals and GPs/family doctors. 2/3 of the cost of Healthcare is staff wages; it’s people intense.
No insurers, no billing agencies or debt collectors. Essentially there are not 3rd party businesses creaming off money for doing little more than handle the money. More of the money goes directly to healthcare rather than intermediaries. The infrastructure and administration within the system such as commissioning groups etc have fixed costs - none of it is run for profit.
In terms of government control - that is a concern but US politicians already heavily interfere in the system. Abortion is a good example of that. What you don’t get is Healthcare businesses of various types interfering in government.
The real issue for a single provider system is the staff - wages are kept down as its a national system. That causes strife if wages of pushed down too much. So you do get unions exerting pressure on government. I see that as a good thing but your mileage may vary.
Also if there is under investment then that can severely hamper the system - we have that problem in the UK - demand is going up as the population ages, but the politicians won’t make the hard choices of taxing the elderly to support expanding the Healthcare system.
I would earn far more in my specialty in the US. However even so I much prefer the UK system. I don’t want us to go down the route of the very broken US system. However there are public system with insurance models that do seem to work well - Australia and Canada have good reputations both in terms of cost, efficiency and pay for staff etc.
Essentially Universal Healthcare should be the aim, and it doesn’t necessarily have to be a single payer system to work. But single payer systems can work.
Politicians are drunk on the growing private ‘optional’ sector, letting unequal access creep in through the door they got their muddy feet in. This absolutely has to stop.
We see it here, as some regions take their levy and starve the public system in the hopes of forcing people shell out for the only option in this ‘optional’ alternative.
The NHS is a model of how to do it except any part that even speaks - or offers a business license - to any clinic offering any services which overlap at all with public space. This insidious taint needs to result in jail time for cruelty.
Admin and billing would still exist, but it would be savagely curtailed. We now have to account for every insurance agreement between insurance companies and healthcare systems. These can vary on a hospital by hospital basis causing the incredibly complex system of pricing that are currently used. A single payer system would vastly decrease the need for this administrative overhead. Of course this would result in lost jobs, and an honest assessment of M4A would acknowledge this. Bernie Sanders 2016 M4A bill had funding for the workers having to transition jobs during this change if I remember correctly.
On one hand you’re not wrong, but on the other hand there’s something downright perverse about lamenting the loss of middleman leech jobs.
100% agree. However, I try to keep in mind that these are real people with real families doing real work in the ineficient system that we’ve allowed to exist.
Amazon always hiring. McDonald’s always hiring. Hell just about every service industry employer is hiring here.
I think they are already doing it now, even solely in states with strong emphasis on privatized healthcare. I think as long as politicians can make law, they can easily sabotage the healthcare system, single payer or not.
I think this is a uniquely American problem, because individual (or small groups of) politicians have enormous power over these kinds of things in our current system. I think the answer is to not allow politicians to directly decide what is and isn’t covered - you leave that up to whatever federal agency is responsible for enacting the single payer system.
What you said about safeguards is true, but removing politicians’ ability to directly control what care is provided would be the first and biggest safeguard I think.
That is a signifigant issue, yes, but the rightwing politicians in a lot of other countries are moving further from the center and are also trying to gut the public health system in favour of privatizing increasing parts of it (to the benefit of their political donors and the companies on whose boards they will sit after they exit politics)
Bingo.
Anyone who wants a single-payer system should be required to be in an HMO for 20 years first.
The fight to get care is crazy, because bureaucrats up the food chain looked at stats and said “you don’t need this care” (because it won’t lower our risk stats). You’re just a number - if the stats say this won’t reduce your risk of dying, or reduce the likelihood of needing further care, welp, too bad.
I’ve been in 2 HMOs over the last 35 years… Same experience in both.
The “problem” in medicine is primarily insurance companies, and secondarily business management approaches that are inappropriate for medicine.
Get those people out of medicine first, or the problems will never go away, regardless of who’s paying.
My fucking coworker got denied coverage to replace his heart monitor that his doctor requested because “he didn’t have a stroke yet.”
The fucking business school shitheads are making medical calls overriding doctors orders because money… Money money money. My coworkers life is meaningless, he’s just “lost profit” to them.
This whole system makes me equal parts disgusted and enraged.