I am looking for and not finding a country that did away with universal coverage once they achieved it. It's almost like they have mature adults who trust government to take their tax money and deliver services they promise. Here the right's incessant anti-government propaganda has been very effective in making people believe tax is theft and public goods and services are evil.
This article fails to highlight that these universal healthcare systems that took a few years to pass were all put in place 60-80 years ago. The US has had the example of the rest of the developed world for decades to see the benefit of universal care. This article could just as easily have been written as the US has been resisting universal healthcare for far longer than it took these countries to pass it. Hilary Clinton's first term as first lady in '92-'96. Nearly 25 years ago!
It's also worth noting that in every case cited here doctors opposed universal healthcare. In the States the healthcare system lobbies DC more than any other sector and this is not just big pharma and insurance, its also doctors lobbies. When will it be time to implicate the astronomical sums of money doctors, particularly specialists, make in the US as one of central problems in American Healthcare?
The universal health care system in Australia is now so entrenched that, every now and then, a ratbag extreme right wing politician suggests dismantling it. He or she is immediately shouted down. The right wing Federal Government in Australia knows they will immediately lose power if they dare to pursue it. All 25 million Australians shrink in horror at the US system, which they regard as the 'worst case' scenario. The American system is only possibly good if you have an employer who provides good health insurance coverage. But what if you lose your job? No cover. That is also where the US needs universal health cover.
You all should see how fast my snowbird sister and brother- in law wintering in Florida skeedaddled for the border when their travel insurance carrier threatened to cut them off due to Covid-19.
So what is the message here? That we -- the only country left out -- should expect that it would be many, many years before we could catch up with the rest of the developed world? Maybe never? Should we even TRY to cut into the enormously rich and powerful insurance companies? They'd never let us insure people in a national program -- paid for through our taxes? Does our present plight make sense to an older man, for instance, who needs surgery and -- insured or not -- doesn't want to bankrupt his family? It's been shown that 25% of Americans decline treatment for fear of bankruptcy -- or losing what they'd hoped to leave their children. I have that fear myself. We have a great many people who are afraid to go to the doctor. Is there something terribly wrong with Bernie Sanders' work to provide Medicare to all of us? Now that the major media, including the NYT, has soundly defeated that plan -- what next? Maybe it's strictly up to the corporate world and its media? And nothing can happen here?
1
I am 100% in favor of universal healthcare and 0% in favor for Medicare for All. This article explains my lack of support.
The timeline for implementation by the proposals currently before Congress are utterly irresponsible, un-achievable, and doomed to failure. The economic repercussions of wiping out the entire Insurance industry would be devastating. Getting a measure through to implementation with that industries resistance, and survive a multitude of court challenges is naive. (e.g., ACA)
As did Canada, we need to look at it as a 10 year plan to gain by-in and another 10 years to make it work. We in the United States do not have 10 years of consistent will power.
However, if the Dept of HHS were to enable individual states to experiment with models with much greater freedom we could, like Canada, build the model that other States would adopt, eventually allowing for Federal implementation. Let States like CA, WA, and others to be the Saskatchewan for the U.S.
1
To paraphrase JFK, "...We choose to establish a national single payer medical insurance system in this decade..., not because [it is] easy, but because [it is] hard; because that goal will serve to organize and measure the best of our energies and skills, because that challenge is one that we are willing to accept, one we are unwilling to postpone, and one we intend to win..."
It is the worthy cause for which we willingly spend ourselves.
1
Very interesting article. Personally, I liked Pete Buttigieg's plan for Medicare For All---Who Want It. It wasn't an all or nothing plan and didn't strive to terminate health insurance all at once, but to let people decide if they wanted to join Medicare or keep their insurance. Buttigieg was a much better mouthpiece for his plan than Bernie is for his all or nothing plan.
Health care is big business in many cases. An example: HCA Healthcare operates 184 hospitals and 2000 sites of care, like free standing ER, surgery units etc.
HCA Healthcare is #67 on the 2019 Forbes 500 list.
Healthcare should not be a big money-maker. Few people object to Doctors and other healthcare workers making a good living - they work hard.
Mostly the huge medical expenses are from hospitals, pharmacy, and medical equipment.
The GOP will never willingly provide healthcare coverage for all.
1
Note that these programs were enacted when each nation had a much more ethnically homogeneous population. Would they pass today?
We have 325 million people. I’m for it. Can we actually do it?
Well, well, well. It has taken the NY Times more than a year since the intense debate on single payer has been happening to discover that there were big fights among the English Speaking Countries about whether and how to get to Medicare for All.This is, of course, a travesty. All the trauma about radical Bernie -- who has NEVER called for expropriating the capitalists -- has been a big argument over whether FDR -was a socialist or a capitalist who was just trying to save the system. The media and the rest of the mainstream already have confused everyone including Elizabeth, and Amy. Now it turns out that the road to single payer is not one straight line, but a fight for rights which will give everyone an opportunity for security in maintaining their health. Now that we have a national health emergency, the top 20% or 30% of our country who have "good" health care will see how the rest of the country has been living since the end of WWII. The real class divisions in this country are not only about college or owning a home, but about whether families can afford to get sick or send their kids to get an education after high school or go to a high school that will teach them to read and write and think, do math and appreciate culture. No kid can learn if she is worrying about whether there is enough money for food or enough quiet to do her homework. Normal for most of the people in America is a world that Covid-19 has brought to the fortunate.
4
But the US has been “trying” at least since the Truman Administration.
Interestingly, the development of the modern “public relations”(propaganda) industry in the US was shaped by the battle to defeat Truman’s proposal almost as much as it was shaped by the experiences of mobilizing for the two twentieth century world wars.
The propaganda is so powerful because it is incessant and ubiquitous. But it is also easy to see through. How can they say WE “can’t afford it” when every other advanced nation has had it for decades? And how can they say WE “can’t afford it” when THEY can spend OUR money to bail out Wall Street again and again AND AGAIN?
7
@Joseph F. Panzica Exactly! Through the years we have heard this familiar and hated phase from republican do nothings speaking for us: “The American people don’t want ________(fill in with whatever would greatly improve lives). They do NOT speak with authority or knowledge of what WE really want.
I’m a New Yorker who went to Toronto for a job and stayed for 20 years. During my first week in Canada I went with my wife and two young children to OHIP (Ontario Health Insurance Plan) headquarters to get our wallet-sized plastic OHIP cards. In all our years in Canada we had no other engagement with the medical bureaucracy. The cards entitled us to free medical care anywhere in Canada.
Canadians choose their doctors freely, just as Americans do. We received medical care as advanced and professional as in the U.S. The big difference for the consumer is that there is no private medical insurance. In Ontario the single-payer – OHIP – pays all doctors and hospitals for their services. There is an annual premium, geared to income and paid through income tax. For a $60,000 a year earner it’s $600 Canadian ($US 450). There are no deductibles, no co-payments, no out-of-network doctors, no medical bankruptcies and no surprise bills. In fact, patients see no bills at all. All payments are solely between OHIP and the doctors and hospitals.
For businesses large and small there isn’t the cost and headache of dealing with health insurance companies. For individuals there is no need to worry about continuing coverage if you change jobs or become unemployed. There is no distinction in coverage between people under or over 65. Everyone is covered. Canada has its class distinctions, like revery where else, but not for medical care.
16
I can never understand why people think that their health insurance (purchased privately or through a corporation health plan) guarantees that they will always be able to use the doctors, clinics, or hospitals that they prefer.
All of these plans are based on Networks of health care providers who have signed contracts to accept a certain fee from the patient and insurance company. They also can bill patients for extra costs that the insurance does not cover.
However if a provider leaves the network (and many of these leave and join other networks regularly), the patient's insurance will no longer cover the cost of a visit or treatment because the provider has become and Out-of-Network provider.
People then have a choice. Choose a new provider (doctor, dentist, clinic, hospital, etc) or bear the full cost of treatment yourself.
So the argument that Universal Health Care will restrict your health care choices is bogus. This so-caled threat is one that everyone with private or work related insurance faces everyday as companies try to decrease cost and increase profits.
What Conservatives and Fox News fail to tell you (as they demonize Universal Health Care), people who are covered by these non-government plans are just a "few dollars of profit" away from loosing the wonderful health care providers they are so intent on keeping.
9
in response to @Gabe Colaccino
While I am in favor of universal healthcare and anticipate that ultimately the U.S. will have a single payer, gov't run (in some fashion) program, it is naive to believe that a gov't plan will not be driven by cost. In the case of a gov't plan, cost decisions will be made by Congress or whichever agency administers the plan (e.g., HHS). All of the western gov'ts with universal health plans struggle with the cost of the programs and reduce their cost by either reducing payments for services and drugs or restricting coverage for certain services or drugs. Implementation of such programs in the U.S. will require the same choices to maintain affordability. These are not criticisms, merely reality. Rapid implementation of such a program as advocated by Bernie will be incredibly disruptive and work against universal acceptance of the program. In my opinion, an accelerated incremental approach building on the ACA is preferable and more likely to succeed in building widespread acceptance.
2
@Bob Parker The Nation says it would be a very long road to something like universal care if it was attempted through theObamacare public option. All KINDS of roads to cross if that option were ever to materialize.
It will help if corporate media stop promoting the myth that people like their private insurance. Surveys of Dem primary voters find majorities-- 60%+ support single payer.
The big issue is that Americans are so prone to fear mongering (shelves empty of toilet paper are just the latest evidence of that).
Fear of change across the body politics means we are stuck in this mess.
8
It has been done, ergo it can be done.
2
The UK had an advantage, WW 2 had just ended and a government controlled economy had worked well. So the voters were eager to let the government do things. Churchill was voted out and nationalism of the economy was voted in. All that remains is the NHS after the unions ran the UK into poverty.
1
When the economy goes well, who cares about a health system. But we are now plagued (no pun intended) with a pandemic. And to control it, we need reliable statistics. And the USA does not have a public health system whereby its citizens can get tested without fear as to whom is going to pay for the test. Americans live in fear of going to see their doctors. Even if an American has an excellent company insurance plan, they must kowtow to the insurance company to see if the private plan will pay for the medical procedure. I will be the first to admit that the Canadian plan is not the best in the world or that it can be improved. But my mind is at ease that I can walk or take transit to my nearest hospital, get tested and have to worry who will pay for the test and that the quality of care will not be controlled by some pimple faced MBA crying about profit margins being threatened. And please excuse my naivete but remember the Hippocratic oath. That moral authority is at the heart of all medicine not the vagaries of having a medical system based strictly on profitability. And Americans please stop confusing compassion for a fellow man or woman with socialism. A public health system is respect for our fellow men and women.
16
My take from this is the biggest obstacle is the greed of doctors.
5
@Caded
Ahh, but that is the most encouraging thing about our situation. The medical profession (as in the practitioners themselves) are overwhelmingly in favor of universal coverage. That's because they, just as we patients, suffer terribly under the reign of the insurance companies.
Our biggest opposition is going to be from large hospital conglomerates and the hedge funds that have organized the non-public facing physicians' groups (emergency medical groups, anesthesiologists, radiologists, etc.) that are responsible for the huge out-of-network charges. Oh, and of course the pharmaceutical industry.
We no longer have a health economy based on individuals, we have something like a very bad government health care system with private capital in place of collective government. Displacing that is going to be a really nasty fight.
9
@Caded I think that your comment is an unfair generalization. I worked for 40 years in the health care system, and the great majority of physicians genuinely cared about providing the best for their patients. There are always a few "bad eggs" in every industry. For what they provide, physicians deserve to be well compensated. The problem is not physicians, it is politicians.
2
Physicians for National Health Plan was founded in the US in 1987. Nixon when in office proposed Healthcare for All Plan so we've been at it for a longer time than the three countries you chart.
Kate Wessling, M.D.
6
@Kate Wessling, M.D.
So what is the holdup?
1
While "getting there is half the fun", it is also essential to focus on what happens once you have it. The most fundamental problem with single-payer public health care systems, whatever their other qualities, is the huge disconnect between demand for and supply of services. The demand is driven by demographics, lifestyles and illness profiles, while the supply is controlled by government finances. The twain doesn't meet. Because governments at all levels fear, probably rightly so, that raising taxes to finance increasing demand on public services is politically damaging, health care gets starved of resources, with scarcity, service delay and triage setting in. Bernie Sanders and Michael Moore are completely clueless about issues facing Canada's health care system because of this very basic conundrum that has been growing over decades and is now pretty much unsustainable. There's no question that some kind of mixed private-public approach would provide the most supply and the most flexibility, but it too has design and management issues that need to be addressed for it to work well. The fact is, there is no perfect system and no easy answers, so don't let the Sanders-Moore Kool-Aid fool you. Just because you win a battle to build the system doesn't in and of itself make it sustainable.
@Mark But it is the right thing to do. Nothing should prevent going forward and expanding the social welfare for all, not just rich folks living the good life.
Germany's Chancellor Bismark introduced the first universal health care scheme in the 1880's, if memory serves it was called Sickness Insurance Britain's Lloyd George
copied it 30 years later as the National Insurance scheme. NI still exists as the vehicle for pensions and other benefits, the NHS roots are in the NI scheme.
5
A main problem in the US is that healthcare is a political football - one party introduces something like Obamacare and the next party in power trashes it. It's too bad because universal healthcare is worth having.(Operations my spouse has undergone would have bankrupted us in the US.) I've heard the criticism that elective surgeries take forever but I've been told I can get a new knee inside 4 months which doesn't seem that long to me. Also this criticism of not being able to find a doctor falls flat in cities where friends recommend doctors to each other. It is bad in remote areas but even there online help from surgeons and so forth is available.
6
@annberkeley2008 My knee took only three and a half months because the insurance company said I had to try three other procedures (shots) even though my sougen said I definitely needed a new knee yesterday.
1
The irrational opponents of progress must always be dragged kicking and screaming like petulant children off to the bath and bed, but in the end decide it was for the better. If England could create the NHS in the midst of the chaos of WWII (and even I would have said, hey, let's wait til we get one war out of the way), surely we can do it here.
13
So, we are only 50 years behind.
Oh and France has had the metric system for 150 years.
"Americans can always be depended upon to do the right thing---after they have tried everything else".
13
I have great coverage. I'm luck to be a military retiree in a city with excellent medical networks that accept military insurance. I don't necessarily want to to give up my coverage, but I also don't want my fellow Americans going bankrupt because they got cancer or were in a car accident.
8
Amazing. Finally, an article taking a look at the history of the introduction of Universal Health Care.
I write "Amazing" for two reasons, one immediate, one years old.
Immediate: I just got Times Morning Briefing Email and scrolling down saw a montage of the victims of Ethiopian airplane crash. I clicked on that and then the left arrow. There otherwise hidden was this article.
Long term: I have written and had accepted countless comments pointing out that Elizabeth Warren made a serious mistake by not giving a staff member the job of learning about the history and present character of Swedish UHC. She would have learned that private insurance is available in Sweden and would thus not have made the error of getting people upset about not being able to get private insurance.
My 24 years of Swedish UHC have given me everything I need but twice I used my US private insurance to get a second opinion in Sweden, once from a cardiologist, once from a hernia expert.
I actually do not know the full history of the development of Swedish UHC, I just know that it is over time better for ALLl than anything I got in the USA, even on Medicare.
Only-NeverInSweden.blogspot.com
Citizen US SE
6
@Larry Lundgren - If Elizabeth Warren had said: We need UHC in America but we know from studying the history of UHC in several countries - Canada, Sweden, xx - that all we can do for a first term is set that as a goal. Donald Trump will have left our country in such bad condtion that we first must restore, law, truth, science and more. That will take at least the first two years to the mid term.
She could have done that more effectively than Bernie but given that she is female, maybe that would not have helped.
Then we can....
Citizen US SE
1
Will never happen in the US. Too much lobbying power by the healthcare industry, and too much selfishness in the electorate (not to mention racism) to support providing "the others" and "illegals" healthcare.
7
The British still have a 'mixed' system as so most European countries....one can readily go to a private doctor in the UK and elsewhere.
8
People are want to say that we get the leaders that we deserve. In May 2019 Australia voted for a conservative, government that has continually marginalizes the unemployed, the sick, people with disabilities and of course poor citizens. It is in their DNA. Of course they are climate change deniers and are owned by the fossil fuel industries. Sounds familiar? As a country we did not have to vote for these troglodytes but did. The same applies for the US. November is your last chance to stop the rot
11
It's no secret to students of history that national healthcare has been a struggle wherever it was established. Many Canadians, particularly when they are lecturing Americans about their moral superiority, would like people to think they all wake up in the morning naturally wired to do things better than in America.
But the truth is there would be no national healthcare system in Canada if the tax revenue from doing business with the American market weren't subsidizing it. The same can be said of European countries, where they had the resources to do it because the US was subsidizing their defense and the American market was fueling their economies.
Meanwhile there is another story in the NYT about how poorly Canada treats its indigenous peoples. It's long overdue that the bloom is coming off the rose of Canadian exceptionalism.
3
@Chris M This is incorrect, for a number of reasons.
Firstly, in the post-war era until about the emergence of the "Washington Consensus" in the late 1970's there was a broad consensus throughout the west that governments had central organizing role in the provisioning of social welfare - even in the US. The US never made it as far as single-payer healthcare, but even here the outlines of government involvement are quite evident in medicade, medicare etc. This article makes the emergence of single payer in Canada seem like some great struggle of class interests, when it was nothing of the kind. The history of this is quite clear.
Secondly, single-payers systems exist not because of US largess, but because they are demonstrably cheaper and more efficient. Common sense would dictate that the cheapest solution would be the one that would emerge even in the absence of the existence of the US economy. Moral posturing is distasteful, but it isn't necessarily the motivator.
Thirdly, far from being a sugar-daddy to the rest of the world, the US consumes more *from* the rest of the world than it produces. This is the US trade deficit. Americans consume on an annual basis about 600 billion dollars more than they produce.
Finally, while the treatment of native Canadians is a scandal (on par with US treatment of natives in many respects) 100% of native Canadians are covered by the general health care system, as opposed to about 2/3 of US natives under the IHS system.
14
I hope this article gives Sanders supporters well deserved hope. As a voter who is likely to support Biden, I do feel something similar to the universal coverage plans discussed here is in our future, and I expect this may be true for many other Biden supporters. We just are not ready for one big leap. However, with patience and persistence we will get there.
7
@S Baldwin Biden is still bragging about the low-income people who are helped by Obamacare -- some of them, at least, Most still have to sign up with a corporate insurance provider and make monthly payments. Public Option would take another generation, it seems, if it could be worked, at all, into a national program like Bernie recommends.
I'm Canadian and thanks to an American millionaire I've never been concerned about doctor bills. Long before Canada adopted the single payer system, Windsor, Ontario, across the river from Detroit, Michigan, had Windsor Medical. This was a doctor-run, union-supported, system which was launched with seed money from the Rockefeller Foundation. Someone should look into how exactly Windsor Medical worked. Maybe its history holds clues as to how such a system could work and quickly attract the full support of the medical community.
11
It is not accurate that in December 1975 "Months after Medibank takes effect, voters push Labor out of power, electing a more conservative party to the majority." As we Australians learn in school, the Governor General, who represents the Queen, sacked (fired) the Labor government and appointed the conservative opposition as an unelected, minority government until new elections were organised 6 months later. This was the "constitutional crisis," as it had the official head of state fire an elected government.
4
@Michael that's right. I remember. It was a big deal when i was in uni at the time.
3
The December 1942 Beveridge Report was fully endorsed by Winston Churchill in his March 1943 'From the Cradle to the Grave' broadcast. Government set to work on drawing up detailed plans, and in March 1944 Minister of Health Conservative Henry Willink and Secretary of State for Scotland, Labour's Tom Johnson published the 'A National Health Service' white paper that formed the basis of the post-war NHS Acts. NHS GPs (primary care providers) remaining privately owned businesses was agreed in 1943, and enshrined in the 1944 white paper(Separate Practice).
'stuffed their mouths with gold' was Bevan's response (in the late 1950s) when he was asked how he had got hospital consultants onside re the NHS, not doctors in general. 80% of GPs had been contractors under NHIS introduced by Lloyd George in 1911. In 1948 such doctors had a choice of signing up to the NHS, or risk losing patients and capitation fees to those who did. Once one doctor signed up to the NHS, neighbouring practices had to.
Contrary to popular U.S. belief, no private hospitals, nor any other private health assets were nationalised in GB in 1948 (Most pre-NHS hospitals were municipal, the remainder Voluntary (charitable trusts)). There are not, nor have there ever been, any restrictions on private health or private health insurance in the UK. (Aneurin Bevan, the Labour health minister 1945 - 1950 preferred to retain 'personal physician' Sir Daniel Davies rather than register with a NHS GP.)
10
The US cannot afford Medicare for All if we continue to have Military for All. There will never be enough money for both. Time to choose - health security for US citizens or military security for everyone else.
7
@JMWB ...all the money that's currently going into private health care plans will be pooled into a universal pot. There's plenty of money.
5
When I arrived in Taiwan in the 1970s, it had two government-run health insurance systems, one each for public and private sector workers. These were combined and expanded into the current system in the mid-1990s. A recent newspaper report looked back at that time and reminded everyone about the street protests and demonstrations led by those concerned over how benefits and premiums would be changed. Once an agreement was negotiated and enacted, after a couple of years of living with it, people agreed more and more that it was a big improvement, especially as it could be tweaked and adjusted as necessary when any problems became apparent. This latter was possible because there wasn't a political party intent on dismantling it at the first sign of any weakness, as there is in the US.
17
This is all ignoring the fact that these countries started fighting for and building their systems in the years after WW2 when most of them faced significant financial issues. The US currently pays twice as much per person on healthcare as other countries so the funding will not be our issue. The issue will be twofold:
1) private insurance companies will do anything in their power to try to to maintain their control over the healthcare industry. They care far more about their profits than the common good as has been constantly demonstrated.
2) certain members of our government will fight the passing of healthcare reform in the first place and try to enact austerity measures against whatever does pass with the explicit goal of breaking the national system to re-privatize it
We can only hope that people fight for and achieve a nationalized healthcare system or at least a single payer system and that the average American gets to see the value of it as The British have.
16
@Dan The NHS was established using existing personnel and facilities, nothing was built. Pre NHS most GB hospitals municipal, rest voluntary (charitable foundations.) No private hospitals nor any other privately owned health assets were nationalised in 1948.
3
This article is instructive in how difficult it will be to achieve universal health care and lower costs. Every health dollar we spend goes into someone's pocket. Like the doctors in Canada and Britain, our health providers will not accept cuts lying down. It's easy to point to insurance companies and excess pharmaceutical profits as the bogeymen of the system but cutting them down won't be enough. Actual working people like doctors and others will need to earn less money. Good luck with that.
4
@Andrew that’s simply not true. We pay 2x as much per person for healthcare in the US compared to other countries and the insurance industry is extremely profitable. By eliminating the private insurance you also eliminate the money lost to corporate profits and reduce the administrative costs. This will means cheaper care for people and anything medical workers could receive higher wages once the system is in place.
8
@Dan
Dan; the only solution is to nationalize the system.
The word "rationing" is always used by opponents of single-payer healthcare systems. The word triggers off some imagined injustice. Their objection is laughable. Medical resources like doctors, nurses, hospital beds and equipment are finite quantities. Management of their usage is a rationing exercise. Should a few million dollars be spent on treating a handful of patients with rare diseases, or use the same amount vaccinating children and students? Should old frail patients on the verge of death be kept alive with limited resources while younger patients can't afford to fill their prescription? Looking from afar, American's aversion to universal healthcare and gun control are equally baffling.
20
@Observer The UK has age-cutoffs for just about every medical treatment. ie. no IVF after 34, no breast cancer treatment after 70, no dialysis after 65....I'd call that rationing, no?!
2
And it is interesting that the Democratic Socialist, Tommy Douglas, was also a Baptist Preacher. Could one even find a white Baptist minister in the US as progressive? Though I don't accept some Baptist doctrine, there are those, like Douglas, who take the Social Gospel seriously.
12
@Rich
The Baptist Denomination in UK and Canada was/is a very different animal to the current (southern) baptist tradition
6
@Alison Cartwright
Yes, and the Southern Baptists are "The Confederacy at Prayer".
3
Of course! It’s hard to reform capitalism and put human rights above profits. Understanding this simple idea is what made some of us socialists but it seems to be missing in your most recent effort to discourage M4A. Cheers
5
If ladies wore gloves again, it might help against the virus.
4
So why bother doing something better and more effective if it takes effort? /s
4
Tommy Douglas was named "the Greatest Canadian" in a national vote. What does that tell you?
10
America is unique, though, in that we have one political party that simply refuses to acknowledge access to health care as a right rather than a privilege. If you're sick or poor, these politicians openly admit, they think it's your own fault and you are an irresponsible layabout who deserves to die. Our current coronavirus situation illustrates the folly of the GOP position, never mind the inhumanity of it. And many millions of people who have the most to lose at the hands of these ghouls blindly support the party and its platforms. America is unique, IMHO, in the capacity of its citizenry to operate completely blinkered.
18
He's a PhD; why is he referred to as Mr Hacker?
@Dr. George MD PhDs can only use the “Doctor” title legally on college campuses to prevent any confusion with actual medical doctors in times of emergencies.
1
In 1976 I was a legal resident of Norway, which has a form of single payer health care, and I am here today because the health care system gave me the care I needed, and the care I was paying for through my high marginal tax rate.
The feeling that will always be with me, is the gratitude I felt that what I had been paying for was not just for me, but for every Norwegian, regardless of where they lived, and what they could afford. And that was in the days before Norway came upon it's vast oil wealth.
It is hard for me to understand why it is tolerable for Americans to justify and rationalize the withholding of medical care from fellow citizens.
29
There is at least one bright spot in the struggle to drag the U.S. into the 21st Century and enact universal healthcare. The for-profit medical insurance industry has made medical billing so Byzantine and difficult for doctors that they are now some of the strongest supporters of reform.
I occasionally hear comments like "I support M4A. It would be nice to get back to practicing medicine."
14
When medical bankruptcies hit even those with insurance, you know the system is broken and not worth salvaging. No other rich country allows medical bankruptcies, yet we treat them as just poor unavoidable individual misfortunes. Right now I have a "decent" insurance plan. It supposedly has a yearly out-of-pocket maximum. But balance bills do not count towards that maximum. So the surprise bill from an out-of-network anesthesiologist at an in-network facility does not count toward that "maximum." This is true for many plans; which means many of us have no maximum personal outlay; which means we functionally don't have insurance in any true sense of the word. We should stop attempting to do what no other country has successfully done - provide basic coverage with for-profit insurers.
12
@Dan M 85% of the today’s bankruptcies are senior citizens who are unable to pay medical expenses. They save their whole lives and lose it all to one medical event.
3
Fun Fact: Kiefer Sutherland is Tommy Douglas' grandson.
On a more serious note, I am a Canadian who moved to Wisconsin at the age of 49 to be married. I was (and continue to be) absolutely appalled at the "health care" provided in the US. To add insult to injury, I can't count the number of Americans who have said to me "Oh, there's no way the Canadian health care system is as good as you say it is".
29
I cannot understand why most of our discussions on health care--like this one--are caught in the incomplete debate between what we have now (unacceptable), and the dream of single payer "Medicare For All." We hear Senator Sanders on this: "Canada can provide universal health care...the UK can do it. France can do it. Germany can do it. All of Europe can do it." The authors of this piece note, correctly, that "Mr. Sanders is right...But what he doesn't talk about is the excruciating battle they went through to get there."
Which is kind of misleading and incomplete. The UK, Canada, and Australia have single payer, and good for them. But despite Senator Sanders trying to lump them all together, Germany, France, and "all of Europe" do not have single payer systems and their medical care is just as good as the M4All countries. The article could have simply noted that these other European countries have systems a lot like the corporate structured, employer based system that we have in America, but they do it far better.
I don't think we have to choose between the decade of stress that Sanders proposes, and the awful system we have now. I would like what Europe has, a heavily subsidized (through taxes) system that has almost non-existent co-pays and deductibles, with far cheaper prescription drugs and scads of preventative care. There are faster, better and less stressful ways to get to affordable, universal health care, and we should be considering all of them.
10
@Bill D. That's a complete falsehood. There's NOTHING in European healthcare that resembles the US private patchwork. I've lived in many West-European countries, and nobody would allow the greedy anarchy of America's Sickness Industry.
17
If the U.S. had adopted national health insurance in the late 1940s or even as late as the 1960s it would have been much more feasible than it is now. Since then, so much in the health care industry has been put in place in accordance with the system we have that would have to undone with great pain and suffering. Not everything in the way the U.S. system has developed is bad. Far from it. We would have a less expensive health care industry today had we adopted government sponsored national health insurance but with far fewer treatment options.
1
@PWR:
"If the U.S. had adopted national health insurance in the late 1940s or even as late as the 1960s it would have been much more feasible than it is now. "
And yet you can't say why single payer isn't feasible now.
3
My Canadian mum recalls the battles in Canada to get it done. She recalls how a doctor friend of the family was convinced it would beggar him, he thought government managed care would cut his income significantly. But, when it passed, he found that a key benefit was that he knew he was going to get paid 100% of the time from the government and he would never have to accept payment in the form of livestock again (literally, patients would offer up cattle and chickens to settle their bills as they had no money). The doctor became a convert to socialized medicine.
Seems to me we have the whole world to go to school on, we have sharp talented people that can come up with the best system using all the lessons learned from other developed nations deploying some version of universal health coverage. The only thing standing in the way are gigatons of money from the insurance and pharma industries that need the status quo propped up to meet their profit targets. And of course the GOP party will fight it tooth, fang and claw as they have been well paid to do so. We can only hope the rightness of changing our system to respect the human over the dollar can actually occur in our polarized American culture.
21
Not a single person opposing single payer in the U.S. has experienced single payer elsewhere and has had a personal comparative experience. Opposition only comes from those who fear they have something to lose if there is change from the status quo. When listening and, more important, evaluating the pro and con arguments is is important to know how and why the point of view being expressed was shaped. As an 82 year old man who has experienced the U.S. system of employer provided healthcare, individual provided healthcare, the Canadian system of single payer, Medicare, and the hybrid Medicare Advantage, I can say withhout any bias that the Canadian single payer system is the best by far with the hybrid Medicare Advantage a very poor second. I would rate Medicare with GAP insurance third and Medicare forth. Lagging far behind is both employer provided and individual provided healthcare which together are tied for my last choice.
21
Countries that offer national health care expect the United States to come to their military defense should they be attacked. This has allowed them to divert some of the money that they would have spent on defense to other areas, such as health care. If we want to have enough money to operate our own national health care program, we need to first stop spending so much money on defense.
No one knows how much we spend on defense. Audits are not done. The military gets a blank check to spend as much as it deems necessary. When it signs a contract with a company for a new plane, the company knows it can continually ask the military for more money to correct unforeseen problems before the plane can be manufactured. The plane ends up costing many times its initial price. The same is true of other kinds of equipment. It is how the military works. It is seen as having an endless source of money.
Given that our national debt is now $23.2 trillion, we would have to carefully limit the amount we spend on our military before we could offer national health care. We could ask other countries to help pay for military equipment, if they want to continue to depend on us for their defense. Together, we could scrutinize military contracts to make sure we buy only what is needed and get our money's worth of equipment.
1
@ann Your point about over-spending on military production is well taken, but on balance doesn't affect other nations' ability to support their own health system. Health care is always the # 1 budgetary expense in any modern country, no matter what they're buying from US firepower and with US command. So they're prepared to shell out. (Also, the US gains by being the Defense Piper who calls the tune in this set-up.)
11
@ann Thanks for defending us for all these years from countries we didn't really think were a danger like Korea, Vietnam, Iraq, Afghanistan and Syria. It's nice to know that the American taxpayer keeps writing those blank checks to keep us safe. You'd think with all that money that you could actually have won one of those conflicts but no matter; it's the thought that counts!
15
@ann
One major factor you forget in your economic argument is that all these countries with higher levels of universal health care (and government services in general) also have higher levels of taxes (and especially marginal tax rates) to help fund these services.
And the populations are generally quite willing to pay these higher taxes, in return for the security and peace of mind they provide.
6
Perhaps another way to tackle single payer is similar to what John Kerry proposed in 2004. Everyone gets a limited amount of coverage, coverage that includes dental, mental, vision, & hearing coverage, the first $2000 per year for instance. You or your employer can buy private insurance to cover anything over that amount. It's simple to calculate 2K X 300 million people is 60 trillion, not everyone will use all of that. Subtract what we already pay in taxes, reduction in insurance premiums, add in a .02% wealth tax over 20 million, and it should be doable.
The most important aspect of universal healthcare is it is more efficient, cost effective way to insure everyone. Fewer actuaries, accountants, and management in insurance companies who's only purpose is to refuse care to people through abstract contracts. It's the best way to do it, and something most people want.
5
@Gdevo I like it. I've advocated for a two-tier system where initial diagnostic and simple treatments were free (tax supported) and only given in exchange for anonymized data to help the CDC track illness and lifestyle issues. Insurance at the second tier includes public and private options.
@Gdevo $2,000 per year would never even come close to covering even 'limited amount of coverage for dental, mental, vision & hearing....this sort of casual 'it's easy, don't even think about it' attitude is like the same admonitions that Obama /Pelosi's put forth, ie. that every family would 'save $2,500 and you could keep your doctor'. Perhaps if politicians were honest about the issue - the people could make a logical decision?
1
Couldn't the USA learn from the experience of Australia, Canada, and Great Britain? The system is not perfect, especially when it comes to access to specialists, for which there can be linksy waiting times. However, one doesn't have to think about mortgaging the house or the children's future if one is struck with a catastrophic illness.
One significant difference I see is that in those three countries, medicine is considered a service, whereas in the USA, it is considered an industry.
13
@Wdy
People keep talking about lengthy wait times under single-payer. In Taiwan, after my PCP diagnosed a serious condition, it took less than a week to get an appointment with the cardiologist he referred me to, and 17 days to be able to see the specialist in that disease that the cardiologist referred me to. I don't consider that lengthy. Also, a commenter on another article pointed out another kind of "waiting" prevalent in the US---putting off needed care indefinitely because one can't afford it!
8
@Alicia Lloyd Thank you for replying. The delays to which I was referring are for access to specialists for non-urgent situations. Still not great for urgent (which sometimes has a rather loose definition) but in my experience, when needed in the short term, access is there.
2
I have no need for universal health care, because I have it great. My coverage is affordable, comprehensive coverage at a first-rate HMO, both inpatient and outpatient. The provides does this under contract to the federal government.
So why do I favor Medicare for All? Probably that system wouldn't be as good for me as the one I now have. Why am I willing to surrender my excellent health care for a different system?
Being a doctor probably has something to do with it. Providing good medical care is one of my core values. I want to see good medical care provided for everyone in America.
So far, no American system has managed to bring to zero the number of people without insurance or the number who receive unaffordable medical bills. Medicare for All has a good chance of doing that, and providing good care as well.
I want to see it happen.
27
Follow the money to see the difficulty of getting anything done for the good of the vast majority of American people.
11
If nothing else, universal health care in the United States will lower and perhaps even eliminate the smugness of Canadians.
10
The United States has resisted universal healthcare for over 100 years. Theodore Roosevelt first proposed mandatory subsidised health insurance in 1912. His cousin made a failed attempt to provide medical care for the poor 23 years later. Harry S. Truman offered the most comprehensive coverage by way of single payer in 1949 and was naturally red-baited for his audacity. Corporate ownership of American politicians coupled with continued red-baiting have been very effective prophylactics against the horrors of universal health coverage.
10
As an American who now lives in the UK, the NHS is just the gift that keeps on giving. I pay through taxes (thus never feel it), and I have had a major operation on the service. My total cost was a couple of boxes of cookies for the overworked staff on the ward as we left the building. My husband's hip replacement and his mother's, same thing. Prescriptions are subsidised. It gives a person freedom from stress, I have found, even when unemployed. You worry about people getting better, not whether your doctor/surgeon is available on your insurance. You don't think about the cost of the medical care, you just access it when you need it. It is a human right, and one that is very overdue for Americans. I would never trade it back for the US system. I love the NHS for very good reasons. You would too.
36
@SC
I second your emotion as an American/British citizen now living in the uk :)
My daughter was treated for thyroid cancer on the NHS when she was a student and part-time barista. Cost for surgery, radiation, ongoing followup visits and lifelong thyroid medication = £0.
Treatment was world-class.
People here look with horror across the pond and for good reason.
18
is there any country that now has universal healthcare coverage where people want to go back to systems that don't cover everyone? it seems that once the battle is won and people experience universal access to care the arguments against it evaporate
26
Costa Rica, which is by no means a wealthy country, has had socialized medicine since the 1940s. In fact, tourists there are treated by public hospitals which are legally prohibited from charging a fee for emergency services, even if the tourist has insurance. Emergency care is guaranteed to all. All workers and their dependents pay into the socialized medicine system, regardless of their legal status. In fact, it is very easy to get a work permit for a non-Costa Rican worker. If such a worker has to use the public health system and hasn't paid in, their employer is the guilty party and on the hook.
12
One advantage of single payer in the US is that government, rather than insurance companies, would be blamed for the inevitable tax/premium increases and/or rationing of care to reduce costs. The US may have twice the per capita health care costs as other developed countries, but eliminating insurance companies would hardly make a dent in those costs.
People may be mostly happy with Medicare, but that's because they aren't paying the full costs of it. Increasing costs are far outpacing revenues for Medicare and either tax/premium increases or rationing will be necessary to balance revenue and expense.
4
@J. Waddell Ask Gov Cuomo of NY state who is grappling with a $6 billion 'just this year' medicare overrun....it's daunting.
The one big issue we are going to have funding something like this is the overall health of America. We are a very unhealthy country with bad overall health habits. I believe the cost associated with M4A is vastly higher than what we currently are being told.
3
@J
We could tax the junk food supply and subsidize healthy food. We could provide low-cost, healthy meals in our schools, have school gardens, and have children help prepare and learn about food. We could mandate 1-2 hours of physical play/activity a day for all school age children which would be great for their physical and mental health. We could build more bike lanes, pedestrian paths, and public parks. We could fund parental leave and sick leave. We could have pain vacation for all. We could tax companies paying poverty wages to incentivize decent pay. We could stop watching TV and advertisements for things we don’t need and start having meals with neighbors, friends, and family.
A better, healthier nation is possible. The existing system wants us to fear change because they risk losing their profits if we shift from the status quo. M4A is the way but there’s also so much more to be done.
6
When I retired early i was so stupid that i thought i could afford health insurance. I paid $1200 a months and was bankrupt in a year. I was suicidal over the years about health insurance. Literally at my wits end. Endlessly changing programs. I've spent literally months talking on the phone to the NY Health exchange over the years. They hate me. It is more stressful the health insurance debacle in this country than my terminal illness which in comparison i rarely think about.
21
All the more reason to get started ASAP.
8
Unfortunately, Bernie's arguments are drowned out by counter-shouts of "socialist". An optically better model for us would be the Swiss system. The political path to instituting it is recorded in a PBS Frontline documentary. The Swiss are hardly socialists. Another version of interest is the one in Japan. They are culturally attuned to sharing, but again, not socialists.
5
@Arlo "Socialist" comes out of Republican's mouths to retard progress toward better health care. We're already a socialist country in many ways--- especially socialist for corporation (energy, in particular) and two of our medical programs (Indian and Veteran).
12
I moved from the US to Canada more than 40 years ago and, several surgeries and numerous injuries later, strongly support Canadian medicare. But I feel Americans should take the intermediate step of a public option before moving to full single-payer:
1. Canada's system took longer to build than the article states. Extra billing by physicians wasn't banned until the late '80s. That's crucial for providing universal access and will spark a war in the more specialist-centric US.
2. Canada's system is too simple and administratively efficient for Americans who thrive on complexity. US Medicare's complications boggle my mind and , while I understand the political needs behind it, the ACA's Rube Goldberg design sets a bad precedent.
3. While we grumble about access issues that the US right-wing has overblown, Canadians place high value on equal treatment based on need such that ordinary people like my spouse and I have indeed been treated by several of Toronto's top doctors. I doubt American society can really embrace health care based on need, not wealth (or insurance).
4. Tommy Douglas belonged to a political breed that no longer exists here or in the US: pragmatic fiscally prudent democratic socialists. He launched medicare while eliminating Saskatchewan's debt and producing 17 balanced budgets. See https://www.theglobeandmail.com/opinion/tommy-douglas-the-pragmatic-socialist/article4348719/
17
@Old-bald-guy
Isn't Ontario one of the provinces that forbids private insurance coverage for doctors visits and surgeries?
That's outrageous. People in that province are barred from buying better access with their own money. That's unconsionable and will never happen in the USA.
The only way US goes single payer is a system like the UK, where private insurance is still allowed for doctors visits and surgeries.
1
@Diana
Sure. UK system where private surgeons get to use publicly funded facilities.
In Canada, a doctor is free to go completely private but they cannot bill government for anything, have to build their own facilities etc.
Outside of Alberta and Quebec, there are very few private practices. Why would anyone pay twice. Some provincial governments contract certain services to the private sector, but that does not mean privileged access.
3
The Canadian system is admirable but faces an acute problem in the lack of general practitioners. Waiting times are now terrible for basic clinic services and no action is being taken provincially to correct the shortage of GPs. Studies are promised.
4
@D Gurr Thank you for sharing a balanced perspective. I feel as though proponents of socialized healthcare never attack the elephant in the room head on - namely, concerns about wait times and the cost.
1
@D Gurr , Canada has proportionately more GPs than the US: 241 per 100,000 population versus 160. Both countries face GP shortages, but the projected shortage for the US is much greater. The US now makes heavy use of physician's assistants, a concept that hardly exists in Canada.
The US has proportionately more specialists.
6
@D Gurr It's not much better here. Weeks.
2
In Finland citizens have full coverage by public health insurance. But there is also a very large private sector from private doctor's appointment to private hospitals with full services. You can have private insurance policy, and you are also fully covered by your employee, should something happen while at work. Seems that we have many same features as canadians do, except our doctors working in public system, can also work in private sector.
We also have a European Health Insurance Card, which provides us many different immediatly needed health care services in other EU and Eta countries, as well as in Switzerland, for the same price as locals pay.
Reading how ordinary people in USA can't always get any insurance, and hence can't afford medical services, or how people may receive suprise bills of thousands of dollars, or even more for their hospital visits, you can only ask, what makes USA so great for ordinary citizens?
Check out status quo on north side of the border, and it may dawn to you what a really great country looks like!
16
@Rauno Moisander
I agree with you. Finland is a much better system than Canada which bans private insurance for doctors visits or surgeries.
This is a useful article though necessarily simplified since it covers three different countries. I pay into and have benefited from the Canadian (Ontario) system, which also has pharmacare for those over 65. But two points, only one of which is mentioned in the article, do not bode well for a universal single-payer system in the US, however desirable and beneficial it might be:
1. The doctors' resistance in Saskatchewan back in the 60s was quickly overcome. I suspect that many, many doctors in the US (not all certainly) would ferociously resist anything similar in the US. Many/most have huge debts incurred in their studies and, face it, they also have a very deep sense of entitlement. And any serious single-payer system would have to limit their income.
2. I found it odd that nothing in the article even alluded to insurance companies and their likely reaction to any challenge to their control of the US market. Remember the "Harry and Louise" ads from the Clinton era? They would look like endorsements compared to what these companies would unleash -- with gleeful support from their bought-and-sold representatives in Congress,
8
@Steve
Ontario's system would be unconstitutional in the USA. Ontario makes it ILLEGAL to buy private insurance for doctors visits, hospital stays, or surgeries. That will never, ever fly in the USA.
USA may very well get single payer system but it will be the UK's system, never the Ontario system.
2
@Diana In the first decade of the 2000s, the most right-wing government in Canada, Alberta, tried to legislate a 2nd tier, privatized. Because only a PORTION of that was legal, it could not do it easily. Instead of looking for a compromise, and under US influences, it tried to sabotage the entire public health system to undermine that system's credibility.
Within 2 years, the public outcry in Alberta forced the government to go back to supporting the public system. That's what happens when right-wing ideology drives public health policy.
4
Generally speaking the American people hate each other, and everyone else as well, and do not want to do anything for everyone because that would mean helping the people they hate. It is why they elect cruel leaders in both the republican and democratic parties. In addition many people are wealthy or think they will become wealthy and they believe they must conform to the desires of the corporations in order to get ahead, and become wealthy. Our leaders are selected by the cruel and selfish. The US will need to suffer quite a bit more before it will even think of helping others.
We are a dominate and exploit country, we always will be.
The medical industry is going to change in the near future due to the corona virus. There is the potential for there to be millions of deaths among the elderly. If this happens, both the most expensive and profitable patients in the system will be gone. Nurses will be looking for jobs and nursing homes will go bankrupt.
9
@Chris I think people just mistrust the government. This has been the case since Vietnam, and was even more prolific in the Reagan era. Clinton continued this. I think it is clear that people like to blame corporations for failures in health care, but when asked, they don't think the government will do better. It is a paradox for sure. I have no doubt single payer will create winners and losers, but I think the fundamental mistrust of government underlies much of this. Just see failure of Bullet train and recent failure of prop 13 here in CA. strange paradox indeed.
2
it is noted health care is a provincial responsibility under the canadian system. i'm not an expert but certain rules have to be followed to get federal funding and over the years that funding has declined as a % of overall cost. each province has its own system of how much its citizens have to contribute, if anything. also, how the money is spent. for example, ontario might pour more money than alberta into breast cancer. nova scotia might target colon cancer.
the system isn't perfect and most americans on the right often come up with stories that baffle canadians. yes, there can be waiting times that are annoying. however, if there's a serious problem you are treated immediately--in my province at least.
it should be noted tommy douglas became the first leader of the federal new democratic party about 60 years ago.
he was named greatest canadian in a CBC vote earlier this century. he was also kiefer sutherland's materal grandfather and donald sutherland was his former son in law.
13
I, too, lived in Australia at the time Medibank was introduced. It was not free, but coverage was universal. If you went to see a doctor it was $13, or $20 depending on how the doctor billed for reimbursement. Hospitals were free, as I recall. There certainly were no complex undecipherable bills, sorting out of insurance plans and so on. People complain about having to wait for elective surgery, but here, seeing a doctor or having surgery for treatment is not straight forward either.
And now we have the craziness of whether or not testing or treatment is covered for covid-19. People should not have to worry about whether or not they should be tested for an infectious disease. Prevention should not be the privilege of the wealthy.
12
I think the authors should present a follow up article telling us just what is " Universal Healthcare " in those countries , is there parallel private insurance and why so .
2
@PFS Jr. As far as England goes there are three basic reasons for having private health insurance:
1. Self-employed people who fear loss of earnings for even a moderate wait for treatment.
2. More comfortable accommodation in private hospitals.
3. People think that they will get better doctors if they are treated 'privately'.
The amusing thing about 3 is that for a large proportion of the time, it is the same doctors and nurses.
4
@Bill Ellson Thanks for that . I had knee replacement surgery late last year. I had put it off until I could barely walk . I saw a surgeon within 2 weeks of my request , and was operated on 6 weeks later . The surgeon was a busy fellow , and I'm no one special . I wonder if I would get the same in GBR .
@PFS Jr.
Yes, it would be exactly the same.
Your GP in the UK probably wouldn't let you put it off though...
Canadian Medicare began in Saskatchewan, which is a wheat-farming province with a very low population. It had just over 900,000 people in the nineteen sixties, and just over a million today. Its largest ethnic groups are German, English and Scottish. Most of its current population arrived in the early part of the twentieth century.
Saskatchewan also had churches that supported the Social Gospel. Tommy Douglas was a Baptist Minister as well as a democratic Socialist. A “community organizer” in the true sense of the word.
There are lessons here for the United States. The first, perhaps, is that a public health system must arise from the needs of the people, directed by political and spiritual leaders who genuinely value cooperation in the pursuit of common goals, and who work from a consistent moral and ideological perspective. It must begin in a small place and expand outwards, and it must persist for a long time against opposition from entrenched interests.
5
@Global Charm :
In America, cooperation an common goals are liberal dog whisper words for socialism and taking away Freedom. America votes for no common goals, no cooperation, and GOP all the way. That is how to Make America Great Again.
5
@gratis The death of the blue dog democrats after the ACA has eliminated many from the democratic party. Supporting expansion of health care is note enough now. You must now also believe the party line on other issues to include gun control, wokeness, and in some ways the anticapitalist fervor in order to be allowed into the party as a serious contender. Mod dems can win, see 2018. the main issue now is focusing on one thing without the unnecessary baggage of the far left brigade. Average folk will support expansion, if it isn't layered with other positions many find objectionable.
1
Seeing as we been fighting socialized medicine for 10 years already. 65 years really if you count FDR, JFK, and LBJ. One would expect to see some progress. Obamacare was the most epic healthcare failure of all time, not because the law didn't improve healthcare. Obamacare was a failure because Democrats chickened-out when they had the chance. Political will indeed.
Democrats are taking the same cowardly approach again with Biden. Sanders shouldn't have called for the imediately elimination of private insurance. However, that is the necessary end to our health care crisis. He's absolutely correct. Healthcare is a universal American right. The most effective way to guarantee this right is by eliminating profit incentives.
Naturally people who profit from profit incentives are annoyed. That doesn't disprove the validity of single-payer as a right.
6
@Andy - the ACA has dramatically reduced the number of uninsured citizens. At age 62, I'm able to to leave a job I despise and move to the Midwest without fear of going without health insurance - I can buy a policy on the ACA exchanges there. Every program could be improved, and hopefully the Dems will tweak the ACA to improve it. How, exactly, did you arrive at your assessment that the ACA is "the most epic healthcare failure of all time"?
5
“There’s no reason except for political will that it couldn’t happen.”
As if this is just an inconvenience. The ACA was passed and the Dems were wiped out in the next election because of it.
2
@Lee Herring - And the GOP was wiped out in the 2018 midterms because of their assaults on the ACA. People want access to healthcare! Period. The Republicans ignore that at their peril.
2
Americans still think they are the best, have the best, and perform the best.
It's hard to learn from others when your vision is so narrow.
19
When those countries built those systems medical care was way more affordable and there was no massif computer systems to gather in depth financial and operating data. So they were somewhat flying blind. Today, the cost of care in the US is out of control and unsustainable and we can study the financial and operating performance of the numerous countries that do have universal healthcare. It wouldn't be easy but very possible to study them all and design the best and most appropriate universal healthcare system for the US. All we need is the will and the moral fortitude to do it.
5
The most significant improvement in health care, the one that would lead to the biggest increase in average lifespan of a country's residents, is not "premium" care (as some commenters purport), it is the everyday availability of a doctor's visit when one is sick, the possibility to go to the hospital when you are injured (even slightly), and regular health checkups and tests, especially important as you age. When these are free, or at least inexpensive, you appreciate how universal health care is desirable.
11
Britain´s NHS is not comparable to what the House of Representatives´ Medicare for All, or Sanders´ Medicare for All bills lay out. The NHS does not provide insurance, it provides care -- doctors and all health care PROVIDERS are employees of the state. That would not be the case with M4A.
Canada and Australia didn´t already have Medicare, Medicaid, or Trinity Care for veterans; they didn´t have infrastructure already in place.
These are only some of the issues this article doesn´t touch on. The U.S. Senate plan (Sanders´) would transition people in over several years, during which no one would have anything taken them but, instead, would receive expanded benefits. The same is true for the House of Representatives´ plan sponsored by Pramily Jayapal.
Americans should go online and read those plans to form their opinions. Britain, Canada and Australia are not the only countries with single payer universal coverage. More importantly, it comes down to a question of values and priorities. We have the money. The question is do we spend it on nuclear weapons (we probably have enough already), do we want to keep subsidizing a for profit insurance industry or do we decide that everyone, including the homeless and potentially homeless, like the school psychologist in that article, should be able to go to the doctor and get the care they need when they need it. We just have to decide. Things will only keep getting worse until we do. There really is no tooth fairy.
9
@JJ
Thank you. You are very right. There is a deep spiritual cost to our society by not caring for our neighbors. Like you said, “We just have to decide.”
1
@JJ NHS GPs, dentists, dispensing pharmacists and opticians are, and always have been, profit making businesses supplying their services under contract, not employees.
Your article ties the fortunes of Australia's Whitlam government way too tightly to the universal health care program his government introduced, Medibank. I lived in Australia during his government and the period after, including the revival of the program with Medicare. Whitlam was elected in 1972 for a number other important reasons also, not least the promise to withdraw Australian troops from the Vietnam War. His remark quoted here, about "crash or crash through", was not about the healthcare program, but in response to a government budget crisis in which the opposition gained control of the upper house of parliament and "blocked supply" to force an election. The following Fraser government coalition of more conservative parties wanted to cut many of Whitlam's policy changes, but those cuts grew more and more unpopular, such that the next change of government reinstated Whitlam's idea in the Medicare form. Since then there has been broad public and bipartisan support for Medicare's universal health insurance in Australia, not least because of the alternative US example of out of control costs, etc. By the way, Medicare used to cover all Australians medical expenses globally, not just in Australia, but global coverage was removed due to the hugely expensive charges for any medical treatments undergone in the US. (Indeed, you neglect to mention a huge comparative factor here, in that costs per procedure, prescription etc. are far greater in the US than in Australia.)
9
Missing from this article is what was the cost of healthcare per individual prior to the implementation of single payer? Our current system using insurance companies to collect premiums, set the rules for care, and remit payments to providers, is overly expensive. Restricted only by the rules of the ACA, the limit on administration is capped at 20%. As a comparison, Medicare takes 3% of the premium dollar for administration.
If we had a functional government which cared more about the health of the citizens and less about getting re-elected to Congress with monies contributed by lobbyists for the healthcare industry, then perhaps we could make some progress towards universal coverage.
Unless and until the general population erupts at the ever increasing cost of obtaining healthcare coverage, the saga of medical bankruptcies, rising infant mortality rates, and deaths attributed to untreated health problems, we cannot expect the status quo to change.
9
@allen roberts That 3% is incorrect. Front office staff of the billing practices now do all of the administrative work for Medicare and Medicaid. Billing is not as easy as it seems. Medicare will streamline admin, but absent a national medical record, it will still require significant administrative costs. Let us not forget that Medicare requirements for 5 billing levels of visit for payment or different reimbursement rates for ER, hospital, etc is part of the problem. If we could eliminate the amount of fluff needed in our charts for reimbursement, we could also save on admin costs.
@allen roberts That 3% is incorrect. Front office staff of the billing practices now do all of the administrative work for Medicare and Medicaid. Billing is not as easy as it seems. Medicare will streamline admin, but absent a national medical record, it will still require significant administrative costs. Let us not forget that Medicare requirements for 5 billing levels of visit for payment or different reimbursement rates for ER, hospital, etc is part of the problem. If we could eliminate the amount of fluff needed in our charts for reimbursement, we could also save on admin costs.
This article neglected to say that both Canada and Australia have tight controls on who lives in their countries. With the exception of refugees, most immigrants have had education, language fluency, and are either in an advanced educational program or have a way to support themselves. Immigrants are not signing up for welfare.
Britain voted for Brexit largely because so many poor, undereducated people had moved there and were receiving government services.
Countries with national health care systems cannot afford to offer care to every migrant who manages to cross its borders.
11
@ann Wrong information on so many points.
14
@ann
Nor do they choose to afford a $1.5 trillion war machine.
12
@Rico
Canada has the opposite approach to immigration than the one used here. It chooses 2/3’s of its non-refugee immigrants on their merits. Merit points are awarded for an advanced education that would help the Canadian economy, for fluency in English and/or French, and for an overall ability to assimilate.
In contrast, the only criteria the U.S. uses for 2/3's of its legal immigrants is kinship. (Both countries allow an immigrant to bring in a spouse and children. Kinship refers to extended family members such as an immigrant’s siblings, cousins, etc.)
The result of our different immigration systems is that the vast majority of Canadian immigrants pay hefty taxes (or will be able to do so once they finish their graduate studies) to help support the national health service ); whereas many of our immigrants pay little to nothing in taxes
If foreigners cross from the U.S. into Canada at an official gateway to request asylum, Canada tells them that they have to apply first apply for asylum to live in the U.S. If the foreigners' requests for asylum in the U.S. are turned down, and they then request asylum from Canada, Canada refuses to give them a full asylum hearing, and there is little chance that asylum will be granted.
Canada strictly limits who can live there.
1
A useful summary but it misses out in failing to mention that Canadian Medicare is NOT universal. The Canada Health Act, the Federal enabling legislation, covers doctors' visits and hospital treatment only. Implementation is left to the Provinces and Territories which are free to "list" or "de-list" other services. Ontario, for example, "de-listed" chiropractic treatment some years back. Medicare does NOT cover pharmaceuticals, physiotherapy, cosmetic surgery (in most cases) or dental (unless it is surgery performed in a hospital). These services remain a patchwork of private insurance through work, union or personal purchase as well limited subsidies at the Provincial level. Is the Canadian system perfect? By no means, but any suggestion to restrict or abolish is political suicide. There is currently a debate over expanding the system to dental and pharmaceuticals but the outcome is not guaranteed.
I am old enough to remember the debates around the introduction of Medicare. Tommy Douglas, now seen as something of a Saint, was given the moniker "Tommy the Commie" at the time. The Government of Alberta was deeply opposed to the single payer system but actively encouraged everyone take out private insurance and even subsidized the premiums for those with low incomes. This all came to an end with Medicare.
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@Bob Do you know whatever happened to Tommy Douglas after the passing of the medicare initiative?
1
@Bob
Or eye/vision care.
There are two main issues with converting to a national health care program: One, how to provide quality, universal BASIC health care. No one wants basic, everyone wants premium. That means cost explosion. The article about other countries doesn't mention the difference between BASIC and PREMIUM (you have to pay for this level of care). The second issue is cost control and management. HUGE problem in the USA where everyone wants to charge more.
So the transition issues need to be incremental, perhaps starting with a public option and limits on tax deductible /cadillac plans. Without limits to costs, Medicare for all will bankrupt the country and fail. miserably and quickly.
2
This is an important article. In many ways, the push for universal health coverage parallels the space program of the 1960's. JFK pledged that we would reach the moon by the end of the decade, and amazingly, we did. But we didn't reach it the next day, and there were a lot of misfires and disasters until the final achievement. And that was merely rocket science! Health care, which is all about human beings, is much harder. Universal coverage is the goal to aim for; it didn't happen overnight in other countries, and it won't happen overnight here. But it can and should happen. Maybe within this decade. That's what sensible political leaders should be pledging.
11
“We choose to go to the Moon in this decade and do the other things, not because they are easy, but because they are hard, because that goal will serve to organize and measure the best of our energies and skills, because that challenge is one that we are willing to accept, one we are unwilling to postpone, and one which we intend to win, and the others, too.”
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@kitINstLOUIS
Did anyone ever figure out what "the other things" were? Did we ever do them?
Publicly funded healthcare has to fill a void; as long as the majority of taxpayers are 'covered' by an expensive private system that hasn't yet bankrupted them, many will have some fear of transitioning.
The successful public systems, e.g. Canada and France, actually have thriving private insurance companies in the equation; very expensive optional treatments, dental surgery, experimental drugs, etc. may not be totally covered. In theory, the healthcare is a public resource, so is managed as such, with triage and an idea of avoiding waste and even quotas; however, there's NO quota on life-saving intervention. For those over 65, ambulance service is free.
There's even room for the rich to get treated all alone in private hospitals. The noise against public healthcare is scare-mongering by vested interests.
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@Tara I don t see Canadians flowing the Mexican dental system. I do see Americans. Americans are losing great opportunities to change HC system. The US is getting weaker.
3
California attempted to pass single-payer with Prop 186 back in 1992. Let's try again next year, nationally, by getting Senator Sanders to convince President Biden.
8
The article mentions that the public in countries that have adopted universal healthcare love their universal healthcare system, but fails to mention that the per capita cost of healthcare in those countries is less the one half the per capita cost of healthcare in the United States.
14
Why do we think there's a doctor and nurse shortage in our country? Why do we think the doctor and nurse burnout and suicide rate is escalating beyond control?
We've over-burdened our doctors and nurses with an outlandish amount of digital and ordinary paperwork. My doctor spends 70% or more of her time on paperwork. Think about that. She can only spend 30% of her time with her patients.
We need to find a happy medium where we relieve our doctors and nurses of this insane amount of form-filling paperwork, whether digital or not.
Now is the time to implement a healthcare system that covers everyone and isn't influenced by greed from middlemen, PBM's, or Big Pharma.
From cradle to grave, we should all be covered at no expense to us, paid by taxes, and executed by happy, healthy doctors and nurses.
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@Pamela L. I believe in public healthcare, but I wouldn't go so far as to say that a government run program is the way to reduce paperwork and bureaucracy!
1
@Andy
The U.S. Spends $2,500 Per Person on Health Care Administrative Costs. Canada Spends $550.
Headline from
Time Magazine
By Abigail Abrams
January 6, 2020
(online)
I would like to read a history of our healthcare system. It is my impression that after the war, President Truman tried to initiate a healthcare for all system but the American Medical Association got together with the health insurance companies to develop the system that we currently have.
4
@Nick
History.net has a pretty detailed article about the politics that arose surrounding Truman's proposal. I'm not enough of a historian of that subject to confirm all details are accurate, but it is a relatively detailed account.
That account verifies your comments about the AMA opposing the proposal by labeling it as essentially "communism" that would just be the start of a general communist takeover, and that the foundation of our current health insurance system was formulated as a sort of response or alternative during the same time. (Although the AMA opposed the proposal, there were physicians who supported it.)
5
Above all, we are up against the biggest lobbying forces of the health care and insurance corporations. And the myths that pass for conventional wisdom like the entire op-ed yesterday by Scott Atlas. It’s like we are defending coal as the only, inevitable means of energy while ignoring climate change. Oh, yeah, that’s popular, too...
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I lived in the UK for 9 year and used the NHS when needed. I did not that emergency rooms were not crowded and that people contrary to AMA marketing did not wait months for operations. You can have private insurance in the UK for private hospitals and doctors, which costs a couple of thousand pounds a year. My personal insurance here in the states is $1,200 per month and I was just told that my doctor is no longer in my network.
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In the scheme of these things 12 years (Australia) is actually a very short period of time. The US has been trying to get to universal health care for decades.
Didn't the effort start with Nixon?
5
@Joan
It started with Truman
The ACA was going to cover everyone, but then some Republican governors refused to expand their state Medicaid programs as provided for by the ACA. We just need to fix that, and some other tweaking.
3
@Polaris true but this doesn't address the affordability issue. Even in states that expanded Medicaid, cost is still a big problem. The out-of-pocket maximum for an individual under the ACA is $8150 this year, $16,300 for a family. That is prohibitive for most and therefore reduces access to care.
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@Polaris ... and Medicaid has been shown to be of little help in improving health.
@Polaris
Barack Obama had a mandate, great personal charm and most important, both upper and lower houses of the legislature, including a super majority of Democrats in the Senate. With all that power he could have forced single payer coverage through had he not been obliged to the medical-industrial donors to the Democratic Party. His tinkering with a for profit system accommodate corporate benefactors rendered ACA prohibitively expensive for many Americans.
We have to fix immigration first before we can offer universal healthcare. The tens of millions of illegal immigrants who are already here and the tens of millions (or more) that will arrive here when an open border policy is implemented would bankrupt our healthcare system. Canada has a very strict immigration policy for this very reason. You have to fix immigration first.
8
@Anita In Canada, From what I know, if you can't prove you are Canadian and have a Medical card ( Which you have to show each time), you will be charged for service. As an illegal,you will always get medical attention, but it's still way cheaper than in the USA.
2
@Anita This is not true. Immigrants tend to be younger and healthier than the native population. They use fewer and cheaper health services than the native population. "Illegal" immigrants already shore up Medicare and Social Security through their tax withholdings and don't have access to either those programs. We need far more immigrants to the US because our population and labor force are aging without them. If young, healthy immigrants were allowed to purchase ACA health insurance plans, it would increase the funding pool and decrease the costs for native-born Americans.
3
@Anita There are many terms to describe Canada's immigration system. "Strict" would not be one of them.
1
Speaking from the perspective of one 75-year old Canadian: I have undergone coronary artery bypass surgery, gall bladder surgery, and 3 major eye surgeries in recent years. I am retired and enjoying life, see well, and carry no financial burdens from these treatments. The biggest cost of the heart surgery was the exorbitant cost of parking at the hospital for my wife. In our province of Ontario, seniors pay a $6.11 fee for any prescription with only a $100 annual co-pay and most pharmacies discount the fee to $4.11.
Specialist appointments may take a while unless they are urgent. But I have had no trouble in seeing two different ophthalmologists for 10 years to ensure I have second opinions on my eye conditions. Since we are close to the border I did once cross to the US to get another opinion before my first eye surgery but quickly realized I was wasting my money.
We are served by state of the art hospitals and my ophthalmologist is one of 3 in the world with one of the latest retinal imaging system in his clinic.
Of course none of this is "free", it is all paid from taxes. When I was at peak earning power, I got to an incremental tax rate of 52% on my taxable income. But now that I am retired the average income taxes my wife and I pay on $100k combined retirement income is less than 13.5%, and we have no special deductions. Low wage people who earn less than $30,000 pay little or no income tax at all but get the same healthcare as I do.
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@John G.
I attended a lecture one month ago when an ophthalmologist from Toronto stated that the wait for cataract surgery in Ontario is six months. When he is on call for retinal surgery, he is covering eight million people!
The system we should emulate in the U.S. is France with Holland as a close second. Canadian Medicare is administered on a provincial level and although hospital and doctor bills are covered, some provinces do not cover drugs fully if at all.
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@Bob the Retina Guy, cataract surgery wait times in Ontario vary widely. I waited just two months in 2010. Wait time likely depends on whether the surgery is done by your own ophthalmologist who does other cases too or a surgeon who does only cataracts. As a routine case I was sent to a high-volume surgical unit that does cataracts on an assembly line basis.
Ontario covers drugs for children and those over 65. My out-of-pocket cost is a $100 annual deductible and $4.11 per prescription. A national pharmacare plan is under discussion, but not likely for at least a few years.
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@Bob the Retina Guy
Given that cataracts develop over many years, is 6 months excessive? And that is for the basic IOL covered by the government plan. Clinics offering upgraded e.g. toric IOL's that cost $1,500 and up and are not covered by the plan, seem happy to do them much sooner.
But you have highlighted a real issue with emergency retinal services here, especially outside the major urban centres. It is one of many gaps in our system, which is far from perfect. When I had my first retinal tear on Christmas day, it took 3 days to get the laser surgery I needed.
3
One third of the country is so racist that they’re willing to die for lack of health care rather than enable people of color to receive it.
Another third of the country is satisfied with their insurance, and they’re willing to support a limited government program enabling more people to get insurance.
The final third of the country either doesn’t have access to adequate health care or knows what it’s like to not have that access. They understand that there are millions of people for whom insurance-based care doesn’t work for a variety of reasons, and that the only way a government-run plan would work is if everyone is invested in it and relies on it.
The politicians representing the middle third keep telling the last third that they’re on the same side, and they demonstrate it by calling out the first third for its racism. But what they have in common with the first third is a willingness to let millions die for lack of health care, as well as a habit of calling the last third a bunch of spoiled children for demanding a system in which everyone gets the health care they need.
The middle third is comfortable enough that they’d rather put up with the first third being in charge than have to put up with the last third’s demands to cede some of their privilege. The last third passionately hates the first third but many of them wouldn’t be any better off with the middle third in charge, and being condescended to isn’t much better than being overtly hated.
America.
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@James Jacobs That's about the most realistic and succinct account of the dilemma -- not just healthcare, but housing probably fits the same pattern-- I have ever read. Thank you.
Now, how to break down the barriers between the groups?
I imagine the edges are rather porous, and a great leader could overcome the divisions.
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@James Jacobs More like 80+% of us are satisfied with our coverage. And we don't want to give anything up. That's the rub.
1
@Lee Herring Oh and each third imagines that they represent 80% of the population. They’re so self-involved that they don’t know what it’s like for the other 2/3. And if the other 2/3 are getting in the way of keeping the remaining 1/3 alive and healthy that solipsism has a human cost.
And just maybe the little bit you’re being asked to give up is something you never earned in the first place - you just had it handed to you to in order to keep your third up and another third down.
That’s the real rub.
3
A look back at countries that started single payer in the 1940's. That is all.
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There is nothing like a contagious and dangerous virus that can more make it clear the dysfunctions of US medical coverage. In the US, medical care is not thought of as a societal good. It is thought of as a private market, where, if you have the money you can buy in. You are immune from other people's choices.
With such a contagious disease, you are not immune: your neighbour's health (or lack of) becomes your problem, your family problem.
That is where I am terrified about what the virus will do to the US. The US has been somewhat sheltered owing to its transatlantic isolation, which has slowed down the spread. But, the US is a country where: a substantial portion of the population has no insurance, another substantial one has mediocre insurance and is too scared of medical bills, another does not have sick paid leave, and even those with stronger insurance are facing the uncertainty of co-pay and out of network insurance.
And, 40% of the population now think the virus is a hoax, thanks to Trump and Fox News. And the US has little of the government ability (as in China) to simply shut down entire regions and cities.
The US is a fertile ground for a pandemic. My bet? In 60 days, the US will have far more sick people and deaths than China.
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Big difference between the US and the countries with some form of universal health care is that Americans don't care about each other. It's that simple. We love a white and red striped piece of fabric and the myth of exceptionalism, but we hate each other.
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@Cindelyn Eberts I’m sorry to say that you are correct. We have many of the same problems that you do here in Canada, but support for universal healthcare is broad, deep and sustained.
The have been attempts for years to privatize parts of the system. Solidarity in the general public has beaten back these attempts. A sense of “we are all in this together” has been fostered throughout the struggle to achieve and maintain universal coverage. It is now firmly planted in the Canadian identity as an expression of mutual care for our fellow citizens.
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@Cindelyn Eberts
We have become a country of individuals first, and interest group members second. We jealously guard our rights and nurse our grievances and resentments. In the past week I have witnessed the selfish hoarding of supplies that are thought to protect against the virus outbreak and am not surprised. We are becoming a nation in name only.
I see the roots of this sorry condition in the prevailing doctrine of multiculturalism, inspired by feelings of generosity for our fellow humans but ultimately producing the opposite result. We demonize our past instead of honoring it, its heroes and its myths. If we don't restore our sense of belonging to a nation, one that we take pride in and are willing to make personal sacrifices for its future, we have no hope of ever getting anything like a national health program enacted.
1
@Robert Kraljii Agreed. Even our Conservatives, some of whom wanna privatize heath care in their heart of hearts, know it's poison at the ballot box.
4
As fierce as the opposition was to these efforts to enact healthcare that includes everyone, it will pale in comparison to what would rise here and now. The right wing media and propaganda machine would squash any rational argument and any politician foolish enough to propose the idea.
7
From the Australian perspective we would more and more see that the US is now becoming a failed democracy. The Republican Gerrymanders have seen to that. Perversely the very people that the US electoral system fails the most vote for the GOP...the very party that keeps them down. Only could be explained in the world of Monty Python. It it like some type of perverse Stockholm Syndrome where people vote for politicians that are their worst enemy....unbelievable. As Warren Buffet said there is a class war in America and his class, the rich are winning. In actual fact what America badly needs is a strong dose of Socialism to reverse this. Sadly the average GOP voter do whatever Fox tell them to do. As long as they have their guns, low wages, pickup trucks and woeful health cover they are happy. Deluded but happy.
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Of course. But where was this article a month ago when it was needed? To counterbalance all the pejorative cries of ¡¡¡socialist!!! Amidst the DNC powers that be throwing all support behind their weakest moderate and forcing others to fall in line to get political favors and cabinet positions in the future.
What a colossal disappointment from a promising, crowded field. Exciting young candidates, qualified minority candidates, an entrepreneur pushing new ideas, a poignant highly qualified vanilla guy from Colorado as the opposite to Trump, and two candidates that understand this article and are willing to push for such an important legislative step despite their party and media painting them as aliens.
Nope, give us the guy that failed in 88, was picked as VP to assuage "moderates" in 2008 and embarrasses himself anytime he touches a microphone.
18
It's really very simple; if you want healthcare security just make more money or see if one of these countries will take you in lol. America is for the rich and their fans and if you're neither then you just don't belong. Four more years of Me First!
6
It's really very simple; if you want healthcare security just make more money or see if one of these countries will take you in lol. America is for the rich and their fans and if you're neither then you just don't belong. Four more years of Me First!
The point is that the people and corporations who profit from our current healthcare system will do everything in their power to prevent single payer system because this will dramatically cut their profits and their incomes. Big pharma is sector #1 that will get hosed. Private health insurance companies will just close. Over paid millionaire surgeons and specialists will find their income cut sharply. Today medical spending is 17% of GDP; under single payer, we should cut this to 12% GDP. This means somebody is going to lose 5% of GDP or $1 trillion. So yes there will be conflict and trillions of dollars spent for these greedy sectors to keep their favored status.
12
Big health insurance, big pharna, big medical device, big hospital and medical practice lobbyists buying off all three branches of our divided limited different power constitutional republic of united states is all that stands between the American people and access to quality affordable healthcare as a basic human national unalienable right.
8
I know several Canadians that winter here in South Florida. They do all their medical activity in Florida. Each say the quality of care is better in the US.
3
@JoeGiul Lies, unless they are extremely wealthy. No average canadian could afford regular out of country medical work, least of all in the US.
3
@JoeGiul I think the key words there are, ‘Canadians who winter in Florida.’ These people have money. You can bet if they needed more than a checkup, if they were to need serious medical treatment, they would be running back to Canada faster than you can say “business or pleasure.” Health care in the States might be somewhat better for those who can afford it, but it is certainly worse for those who cannot. End of story.
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@JoeGiul I have met many Canadians who winter at a nice, but significantly less fancy hot springs in Southern California who are appalled by USA medical care.
If they need anything during their winter sojourn, they go to Mexico.
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"Difficult" you say? Watch how difficult it will get when the coronavirus sweeps through America and all of the uninsured start dying in the tens of thousands.
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O.K. Upshot, since you are all about the real numbers, if we paid for universal health care out of what is allocated to the military, how many wars would we be able to afford? None? Good.
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Recommend T. R. Reid's book, "The Healing of America." Especially the chapter on Taiwan.
5
I love my Canadian healthcare system. Had two babies. Cost? $70 as I upgraded to a private room at my small local hospital. Also had a car crash and broken ankle that needed pins installed. Cost of surgery? Zero To really tell the full tale after both babies my husband took 8 months paid paternal leave. We got by on $1800 a month. We love Canada. My kids are now getting a kick a...s education where they are being taught in French. Our southern neighbours are really missing out and for that I feel sorry for them. Great article by the way. Thank you N.Y. Times.
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@Dreena I hear many more stories like that, than I do about the privation and long lines for care. In fact, I don't think I have ever heard a Canadian complain about their health care -- only Americans, citing un-named Canadians, who tell those stories.
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@Dreena Exactly. Ive had two kids also:
My son was a micropreemie born at 1lb4oz. His survival odds were 25% and almost garanteed to be heavily handicapped. The wonderful, efficient, caring team and ethics commitee at the hospital spent hours patiently explaining all of the options, care, what his life might be like, etc. We chose to try to save him. He was in the NICU for 105 harrowing days. It was pure hell. But he had top notch care from the best specialists. Not only did he survive, he is a happy, bright, healthy nine year old today.
The neonatal specialists explained in the states his care would have cost 250k+$, yet in Canada the cost factor was never in the equation. I cannot imagine as a parent of a sick child having to consider cost at all.
My daughter was born via routine csection. Cost to us: zero.
With both kids I shared a year of paid parental leave with my husband. Then they attended an 8$/day high quality public daycare (herein Quebec). And higher education is very affordable, less than 5k$/year.
I cannot imagine living in a rich country that doesnt prioritize healthcare and education, two basic human rights.
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I would suggest taking a closer look at the Switzerland's model of universal health coverage. Of all the European countries, Switzerland is, in my opinion, the most capitalistic one. And their system allows for private hospitals and private insurance companies that offer different coverage policies, this is memdatory, you have to buy into the program. And though it is expensive, it is never as expensive as in the U.S. and for those who can least afford it, there are credits or the like. Funny that Bernie never mentions this country, I would suspect the private hospitals and insurance companies are not what he has in mind.
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@TheresaM That's pretty much ACA. It can work.
The obesity is not an insignificant factor behind costs of american health care.
Obesity lies underneath diabetes, hypertension, cancer and arthritis. diabetes and hypertension are foundations of cardiovascular diseases (heart attack, stroke etc). All the countries you quote are not as obese as the US.
As US health care costs have gone up, so has obesity. Just look at photos taken at an american gathering in 70s and 90s.
Universal health care will be cheaper if people lived to reduce risk of diseases. Universal health care will bankrupt us if every one lives life to the 400 pound fullest.
If every one sets their house on fire, home owners insurance will not be affordable. Any insurance is risk sharing. Only works if most people avoid risks.
Finally, any commodity which is not plentiful and is in high demand - will be expensive (healthcare is an example)
3
@sk Health care in America is expensive because it is NOT a free market.
That is the aspect of it that is never mentioned by the "free market" believers. Medicine is deliberately made anticompetitive by a legal and legislative system funded by rapacious Big Pharma, Big Hospital, Big Insurance.
2
@duncan There are many factors - but obesity is a big one. It is just not being addressed.
1
Interesting piece, but it begs the question: what about every other developed country with universal coverage, that achieved it without going the 'single payer' route? Germany, the Netherlands, Japan, etc. all have models based on multiple payers with strict price controls, that may be more relevant and informative models to changing the US system. Medicare for All is not going to happen, so why are we not talking about major alternatives that *could* happen, instead of settling for trying to restore aspects of the ACA?
7
@Tom
Price controls? Like we have for...?
I can't think of anything more un-American.
@me like we have for Medicare right now, except even lower. Like we had during both world wars, except limited to health care. Like several states have with utility rates. Yeah, it's very "American" to take advantage of the failure of market conditions by price-gouging, right?
If every Congressman (Woman) had to buy their insurance on the open market - and pay $6,000 to 9,000 dollars for a bronze plan then included a $6,000 deductible - debate would quickly end and lobbyists would be ignored and overruled.
Anybody doubt this?
24
@dave levy Actually they all buy it through the Federal Employee Health System just as most of the rest of buy it through our employers' health system or those of us who are retired buy it through the Medicare system (a very small percent buy it individually and the poor get it for free or almost free...).
So what was your complaint again?
And then there's the fact which must not be spoken:
People with employer health insurance are already getting taxpayer-subsidized healthcare. Why should they give it up so "those people" can be covered?
There is as much denial about this as there is about climate change.
The US system would have gotten fixed long ago if people had to buy insurance with after-tax dollars. Would anyone, Right or Left, with employer-based insurance vote for that???
Well, that's exactly what M4A involves...giving up an economic privilege so that others can benefit.
12
We could start by putting all government workers, including congress and the White House on Medicare for all. This should save the taxpayers some money. Have a copay to discourage overuse and draconian penalties for any Medicare fraud.
1
This is interesting look at other countries' single-payer or nationalized systems, but it omits the most important history: the long struggle, so far unrealized, of establishing a social health insurance system in the United States, beginning in the early 20th century! Truman was the first to advocate for it as president, and then Johnson got it passed for the elderly 65 and over. That was quite a struggle, but it established the precedent for the whole population. Why ignore this in your report? We have singe-payer for the elderly, poor adults and children (Medicaid and CHIP), and veterans already. In other words, tens of millions of Americans have single-payer health insurance already! It shouldn't be such a struggle to extend it to everyone. Because of well-financed opposition from entrenched interests, however, I think it will take a state-by-state effort to achieve it.
8
@Loup United States Medicare is not single payer. It is two payer by law and there are four or five payers involved in reality
1
Universal health care is absolutely coming at some point to the US, because we have a runaway train of profiteering that will eventually bring the average person and small business to their financial knees. Already there is a veritable army of Americans out there saddled with outrageous debt so that thousands of specialists, pharma and insurance executives, lobbyists and many others could have three homes and 4 cars. People are connecting the dots. It is going to happen.
9
If anything should convince the nation that it is in everyone's best interest to have universal healthcare coverage, this coronavirus should do it.
Working around the edges, and pacifying for-profit insurance companies, only puts more people at risk since those without insurance are most likely the ones who need to show up to work everyday, sick or not sick. Paid family and sick leave are also sorely needed in this country.
At some point Americans need to stop thinking only about themselves and start thinking about their fellow Americans. "I've got mine and the rest of you are on your own" can only keep a country secure for so long.
20
I am new to Medicare. I researched plans, waded thru countless telephone calls from insurance companies. It was a headache. Everyone I spoke to had a different take and different programs that they were on. I finally chose traditional Medicare with a supplement plan (G). I also have a separate drug plan. The Medicare plan costs me $144.00 per month because I have surcharges due to the fact that 2 years ago, I made 93K. I pay additional 52.50 for plan B and additional 12.50 for the drug plan. This comes out of my social security check. I also pay 131.50 for my secondary, they direct debit me. I also pay 34.60 a month, for the drug plan which I send a check. My co-pay on an annual basis for drugs is 435.00 per year. Medicare co-pay is 185.00 per month. SO I am out of pocket 620.00 before I fill any perscription or a doctor visit. I am not "sick", I have borderline asthma and use Breo which my plan does not cover. The doctor gives me samples. I don't have vision or dental coverage. I cannot afford this. My income now, is just social security. I was told by social security that they evaluate your income taxes on an annual basis before surcharges can be removed. I don't have a pension. I have not started to draw down on 401K monies, which keep declining due to the market fluctuations. I find all of this confusing and you have to reevaluate on an annual basis. Something needs to change, this I know. How do people in their 80's and 90's deal with this?
14
@gracie15 correction, the 185.00 secondary copay is annual not monthly. I pay 131.50 monthly for the secondary.
@gracie15 correction, the 185.00 copay is on an annual basis, I pay 131.50 per month for secondary coverage.
@gracie15 A humble suggestion: Talk to everyone you know and ask them to please consider voting for Bernie Sanders. Biden will change nothing. This is the last opportunity we are going to get for a long time. Best wishes.
2
You have ignored the real start on the NHS in Britain. David Lloyd George started a national health service in 1918. The labour government made changes in 1948. One of these changes was to nationalist the hospitals and GP (General Practitioner) practices. My father was a GP and he had just bought into a practice. Question - When did the NHS offer to repay GPs ? Answer - When they were 65. this was the reason GPs were so against it.
The actual organisation of the service changed very little. The NHS used to keep all records in "Lloyd George Folders". That only changed with computerisation.
The other interesting fact is that the UK health service was not the first health service in Europe. Lloyd George copied the idea from Bismark in Germany.
3
The only way that single payer health care will ever be established in the US is to follow the Canadian example and have a single state make the leap forward. Once other states realize that the people of that state have not only accepted but overwhelmingly support universal healthcare, some will follow and eventually a majority of the states will lead to federal medicare.
16
@Marshall Thompson My personal example of Canadian medicare is that 3 years ago my wife passed away after 45 days in our local hospital where she received compassionate and professional care on every level. Unlike the US where I would have received a 200 page detailed printout of the costs of this care including the number of Kleenex tissues used, I did not get any paperwork whatsoever and did not pay a cent other than whatever share of my annual income tax goes to support medicare for all Canadians.
23
@Marshall Thompson Bernie Sanders' state, Vermont, did that and then quickly decided it was unaffordable (as others point out here, to make it work you need to quintuple taxes or get doctors and medical institutions to take a 40% pay cut)
@Dennis Byron The idea is to have private insurerers take a 100% pay cut so doctors get a raise by not having staff to deal with the insurerers paperwork.
1
Canada, United Kingdom and Australia got Medicare for all because labor and the unions set up social democratic parties. Without those parties, Medicare for all would be a dream like in the USA. In Canada, the medical doctors opposed the health care plan and even went to strike as this paper described. Today Tommy Douglas, the social democratic premier of Saskatchewan, is the only non medical member of the Canadian Medical Association Hall of Fame. He was also crowned the greatest Canadian of all times in 2004 by a popular vote organized by the CBC.
18
@Wilbray Thiffault - true. Australia's excellent Medicare system is down to our visionary labor party.
I support a multi-payor system. Having lived in both Canada and the US there are pros and cons to both systems.
I support the social justice of the Canadian system but admire the US dedication to efficiency and strive for excellence in the US.
The world's best healthcare is in the US and NONE of these organizations are run by a government.
Until the US accepts the cost of a universal healthcare program for all, these ideas are a waste of time and useless political propaganda.
It's like talking about buying a Tesla on a Medicaid approved income.
3
@Brigette Quinn I have experienced neither efficiency nor excellence in the US system. This week alone I have spent two hours on the phone with different providers (doctor and two insurance companies) regarding a routine physical, and have not yet resolved the issue.
I'm not sure on what are you basing your claim of the world's best healthcare, because by life expectancy and outcome based measures, we lag far behind.
The insurance companies control healthcare and profits are their goal, not patient outcomes, and certainly not efficiency.
14
@Brigette Quinn
13 months ago I needed to go to urgent care in another state. They couldn't contact my insurance co, so I had to pay the total bill and was told I'd get a refund when insurance paid their part. After 8 months of periodically calling and getting the runaround I gave up.
The reimbursement check showed up last week.
That is not efficient.
It's also not unusual. I've known others who have received bills 18 months after their treatment. Of course, the patient then has less than 30 days to pay. American health insurance is a nightmare of delays and inefficiency, with surprise billings and constant fear that something unexpected will happen, rendering all your careful health cost research moot.
12
Thank you. As we know, laws come, and laws go, but winning hearts and minds takes time. Fifty states, 10,000 communities -- lots of work to do.
By the way... Loved the musical number at the Olympics.
2
Two factors prevent Americans from adopting systems that seem to be widely beloved and securely entrenched in the countries that have adopted them:
1) relentless propaganda against universal health coverage driven by greedy, self-serving corporations, their political henchmen, and their allies in the medical community; and
2) nationalist pig-headedness driven by our collective need to feel exceptional, different, and better than everyone else even when our social security systems are demonstrably falling apart.
The ACA was only a weak and inadequate beginning (and we saw how difficult that was to push through). We can thank Bernie Sanders and other progressives for pushing the needle a bit further towards a "public option" even if we are still far from "universal coverage." But if centrist democrats regain their hold on the party, it will take a whole lot of agitation to keep the momentum going.
20
Excellent history lesson. Progress is never easy or fast.
It took 600k American dead in the Civil War and a killing of our greatest president Lincoln to save the union and end slavery.
The only sad fact is that you correctly point out it took 10 yrs or so in these countries for it to happen.
In historical times that is a nano second. We have been trying to do it since Teddy Roosevelt, over one hundred yrs. ago.
As Churchill once said and I am paraphrasing him, America always gets it wrong in the beginning but in the end, sooner or later (and it this case later) they get it right.
9
Please keep writing articles as if passing health care for all is inevitable. It sets a good tone.
7
Its worth Noting that Tommy Douglas was chosen by Canadians as the greatest Canadian in their entire history, over many prime ministers and even Wayne Gretzky.
16
it may have taen years in Canada but at least it got done.The U S A have been talking about it for decades.it is also apparent that if you want to do something like UHC do not blindly listen to everything the medical industry((doctors/insurance companies/drug companiess etc) says.
12
The Canadian Medicare system covers all residents for physician and hospital services. It has been a life changer for me as a 50-year patient with chronic severe arthritis leading to non-Hodgkin’s-lymphoma (cancer of the immune system). As a recent retiree from the employee benefits industry, I am not bankrupt from the interventions and ongoing care. There were no charges to me for treatment beyond the taxes. Access was timely and I have received excellent care from specialists, dedicated physicians and medical staff.
I have never had to worry about accessing care anywhere in Canada. I have the ability to choose my family physician, although specialists may be accessed only through a general practitioner; a restriction that has not proven restrictive.
The Canadian group insurance industry supports a strong public health system and has promoted working with it to develop an integrated public/private prescription drug program. Insurance companies are risk averse with the only way to protect themselves being either restrictive policies or high prices (US based approach?).
Canadian employers are not overburdened by the need to educate employees on medical decisions or in-network participants. They tend not to be involved with any medical decision. Medical decisions are made by the physician based on best practices.
I would not trade Canada’s system for the complexity and cost of the US arrangement.
27
All these countries and others with great universal national health insurance also allow private insurance to varying degrees. I cannot understand why Bernie Sanders and Elizabeth Warren are advocating for outlawing all private health insurance, and doubled down on that feature, when it is not a necessary policy for these other countries to achieve success.
Besides being bad policy (the services of government monopolies benefit from competition), it is a poison pill that makes it politically and probably constitutionally impossible to be approved and implemented. Why attach that self-defeating Fox talking point to your policy when it is so unnecessary?
We'll get there quick enough with a Medicare-as-public-option approach that allows private insurance to exist for those who want it.
6
@DLNYC The problem with a two-tier health care system is that the rich will gravitate towards private care and the public option will be for the rest, leaving little incentive for improving the system (legislators will naturally be given private health care and thus have no desire to change anything).
By contrast, in Canada, our legislators must either use the public system or seek private care outside the country - this can be embarrassing as in the case of Newfoundland Premier Danny Williams as people rightly demanded why the local health system wasn't up to the job. As it turned out, Williams could have been treated in Canada.
8
“‘Of course the United States could do this,‘ said Mr. Wright, the history professor at McGill. ’There’s no reason except for political will that it couldn’t happen.’”
Pretty much says it all. We have the benefit of seeing that single payer works better than what we have here. The only reason we don’t have it is because the party who should be leading the fight has no fight in it.
15
Just a couple of comments. 1) Of course it takes a few years to enact, and it should, we need to weigh such bold moves carefully, there are pitfalls. 2) It is clear to all of us that physicians love one thing more than treating our illnesses: money. Why else would they turn to running a business (their practice), than doctoring ? 3) Healthcare needs to be exactly like our public road system: free (except for the occasional bridge, tunnel, and toll road).
9
The United kingdom began implementing health care policies post world war ll. Countries across Europe, as well as Canada and Australia. America, on the other hand, relies on a privatised system dominated by for-profit insurance corporations. As a result, the United States spends more on its healthcare, approximately 17 percent of annual gross domestic product. While millions of Americans remain uninsured.
12
Just as the prospect of progress in this area slips away with Bernie's candidacy, thanks in no small part to the so-called liberal media, we get this little gem of an article. It's almost as though we're being taunted and made fun of by those that don't really want to see such change. The real reason we'll never get healthcare security is because we don't actually have a democracy. Enjoy four more years of trump and your subsequent dictatorship my centrist friends.
16
@NowCHare
I truly hope not. Bernie hasn't given up and hard though it is, neither should we. The 'liberal media' was as shocked as we were when Trump won.
Just as the prospect of progress in this area slips away with Bernie's candidacy, thanks in no small part to the so-called liberal media, we get this little gem of an article. It's almost as though we're being taunted and made fun of by those that don't really want to see such change. The real reason we'll never get healthcare security is because we don't actually have a democracy. Enjoy four more years of trump and your subsequent dictatorship my centrist friends.
8
In Quebec, a right of center government created a commission of inquiry presided by an....actuary. Yep, job 1 is to look at the numbers over a long period. That was 50 years ago.
Later, insurance for medication became mandatory. If you don’t have insurance provided by your employer, you have to join the public system.
We also have parental insurance. It covers parental leave related to the birth or adoption of a child.
Included is subsidized daycare and generous family allowances.
Free schools, cheap colleges and very affordable universities.
A working class paradise? In my humble opinion, around 90% of the people are better of in our system.
22
@Skiplusse "90% better off" is definitely on the low side. Hats off to our Canadian friends.
4
As Canadian expat who is now an American citizen, it is discouraging to see how often I have heard misinformation about single payer from our politicians and many in our media. Most of my fellow Americans are misinformed and victim to the fear mongering and persuasive propaganda of insurance lobbyists and other groups with a vested interest in keeping their profits, and most Americans who are against it have never experienced the benefit of having a universal health system. Companies know that a single payer system will greatly lower costs and cut into their profits. Canada, Australia, the UK and many other countries are somehow managing to afford a universal health system but somehow we are told we cannot. Trillions they say. If you put all the profits, premiums and copays together from all the vested interests, we have more than enough to cover everyone. What they cant afford it to lose their profit margin. Much better to have a not for profit system run by our government, which is US the People.
59
@Costanzawallet So true, and unfortunately not likely to change as long as Americans believe the outright lies and the half-truths peddled by the self-dealers (i.e., those with a financial interest in maintaining the status quo).
13
@Costanzawallet "What they cant afford is to lose their profit margin." Yep. That one sentence sums up the entire issue preventing the USA from having a first-world health care system!
16
Creating universal coverage is less hard when you can learn lessons from others who have done it before you. What is hard is being the pioneer, with no successful plan to emulate.
What is hard is being the country with the highest percentage of GDP going to health care. What is hard is paying big deductibles and co-pays. What is hard is not being able to change employers because of fear of loss of health insurance. What is hard is paying the highest prices in the world to pharma companies who voluntarily charge less in other first world nations.
38
This history of national healthcare is rather misleading. For example, it leaves out the fact that universal healthcare was implemented in Germany in the 1860's under Bismarck. It also fails to point out that the British national healthcare system was essentially created during World War II as part of the nation's war mobilization effort. And while emphasizing the struggle for universal healthcare in Canada during its early years, this essay leaves out the fact that a CBC poll asking Canadians who they believe is the "greatest Canadian of all time" concluded that it was Tommy Douglas, the founder of universal healthcare there.
The essay also fails to point out that, struggle or no, almost every country in the developed world implemented universal healthcare decades ago. And a quarter century ago, Switzerland and Taiwan implemented universal healthcare.
So it's not a matter of "if" for the United States, but when we will overcome Republican Party cruelty and Democratic Party cowardice to finally implement what the rest of the world has and cherishes: universal, affordable, government-supplied healthcare for all.
30
@Sean And the "when" translates into when you have a majority of informed citizens/voters who can tell the difference between charlatans (i.e. any Republican) and the party that truly cares about the general welfare of our populace.
7
The ACA needs to be to temporarily strengthened. This can be done by gradually expanding Medicare to citizens 50 and older, including any minor dependent children. That should lower the risk pool and therefore cost to those utilizing private insurance. Then we just begin to expand Medicare coverage to eventually include everyone. Since I have been on Medicare, my only complaint is the extra cost of my supplement. I was glad I had it though when injured while vacationing in Greece. Medicare didn't cover my hospital expenses but my supplement did at 80%. Of course we are still having to carry separate dental insurance and don't have vision benefits.
10
I grew up in the US and moved to Australia 20 years ago, so I've lived under both systems, and the Australian health care system is vastly better than the US one. The Australian system guarantees a minimum level of coverage for everyone, for almost all health services (with some exceptions for non-essential services, for which 'extras' insurance is available). There is no one who is not covered, and if you want more than the minimum coverage you can pay extra to get it (but even in that case it tends to be affordable). For example, many GPs 'bulk bill', which means that they charge for doctor's visits at the Medicare rate and the patient pays nothing. A person can choose to see a doctor who charges more than the Medicare rate, in which case the person pays the excess themselves (but is always told in advance what the charge will be). If in a given year a person (or a family) ends up spending more in excess charges than a threshold amount (which last year was about AU$2000 for a family of four), the Medicare rebate (that is, the amount covered by Medicare) will go up, to cover most of any further excess amount. The tax rate in Australia is probably higher than in the US because of the Medicare system, but I'm willing to pay it because it is worth it.
37
When you talk about universal health coverage, it is important to remember that these are radically different systems. I think the Canadian system is similar to the NHS, but based on the Times's own reporting the French, German, Australian, Swiss, and Dutch systems are all different, and usually include significant roles for private insurance and private medicine.
I think the article overstates the difficulty of setting up the NHS. Until 1945 there was a war on, so nothing would be done. Labour's 1945 victory gave it the seats to do what it wanted. There were compromises with the medical profession but in the end they could not have stopped the government. The most difficult battles were within the Labour party, getting left-wingers to accept limitations on what was possible.
As for the state of the NHS today, 'beloved NHS' is one of those tropes Americans like to repeat about Britain. In fact, through NHS today is an under-funded, over-used Rube Goldberg contraption that nobody fully understands, that rattles along on the verge of collapse. By most measures: spending; doctors per capita; hospital beds per capita; and measures of care quality it compares poorly to other European systems. Lack of competition has led to explosive growth of administration, now 45% of employment. Need I say how useless those administrators are? Labor discipline is crippled by multiple unions -- fourteen non-medical. It has relied on imports of doctors and nurses since the 1960s.
2
@Jonathan First, the Canadian system is not "similar to the NHS." Canada operates a system in which the federal government sets rates and pays subsidies to medical providers who are privately employed. By contrast, the British system is socialized medicine: all medical providers are employees of the British government's healthcare system.
Second, the NHS is not an "under-funded, over-used Rube Goldberg contraption that nobody fully understands, that rattles along on the verge of collapse. "
The British understand the NHS very well, and the system delivers vastly better outcomes than does America's for-profit system, and it is overwhelmingly supported by the British people.
This is yet another example of right-wing propaganda, and far from the truth.
10
@Jonathan
"NHS today is an under-funded, over-used Rube Goldberg contraption that nobody fully understands, that rattles along on the verge of collapse. "
Please give credit for this situation where credit is due. The "Rube Goldberg contraption" is the brainchild of former Health Secretary Andrew Lansley and was made a reality by the Tory/LibDem coalition government which enacted Lansley's Health and Social Care Act 2012.
The Tories have always hated the NHS and the past decade of underfunding is deliberate.
Now we have brexit and the coronavirus on top of this. The Tories OWN these problems.
The problems the NHS is having are political, not a problem with the model of socialised medical care itself.
It will happen here, but maybe only when enough lives have unnecessarily been lost that the mass of people have been forced to use their brains.
(personal, visceral opinion)
Stephen Rinsler, MD
31
No system is perfect, but there are good models out there for better care and better insurance and cost control than what we have. Given the nature of the U.S. and its strong (if somewhat misguided) faith in private markets and its entrenched system of private insurance and care, the country might well look at the German and Netherlands systems as more palatable models. Both are mixed payer systems that provide universal, affordable coverage. Oh, and in both, care dollars that are burned up in administrative oversight in the U.S. system, are substantially less. The U.S. does not have to start from scratch in building a sane system.
14
@Peter Scott Cameron The Swiss system is also another good example or potential model for the US.
2
Sanders doesn't say that much of US Medicare is currently privatized, through Medicare Advantage (MA). Under MA private health insurers offer plans that cover at least the same benefits as Medicare. 60 million people are currently on Medicare and of those 20m (33%) are covered by MA plans. That number is expected to grow to 41% in 7 years. So, MA is popular. The reason the government decided to outsource to private insurers the providing of Medicare benefits was to keep down cost. MA plans are paid a fixed amount per member per month. It’s up to the plan to figure out how to deliver benefits within that fixed amount. Outlawing private insurance would throw 20m people off their MA plans, and the government will have to deal directly with cost containment.
That same privatization drive is also true for Medicaid. Increasingly, states are moving to managed care, outsourcing the providing of Medicaid coverage to private insurers. Just as with MA, if private health insurance is outlawed, then states will have to deal directly with controlling Medicaid costs.
Finally, there are 28m uninsured people in the U.S. Of those, 15m of those are already eligible for Medicaid but haven’t signed up, 4m are eligible for employer-sponsored insurance but haven’t signed up, 2-3m have incomes exceeding 400% of FPL but can’t afford insurance on the Obamacare exchanges. Much of the remaining 6m are undocumented immigrants. We are therefore close to 100% coverage for US citizens.
4
@HC45701
You’re ignoring the utter unsustainable nature of the current system. We have a system that costs twice as much, doesn’t cover everyone, and delivers mediocre outcomes. In fact, we don’t have a healthcare system, we have a series of patchwork programs that at this point are designed for the maximization of profits.
The real cost issues are the countless middlemen that sit between patients and their doctors. I’m talking about medical device reps (no medical training) making far above six figures, pharma executives, pharma advertisers, heads of billing departments, insurance CEOs, hospital executives, government bans on price negotiation, and I could go on and on.
The number of Americans going bankrupt in part from medical bills often times despite having insurance coverage is not insignificant. These horrors simply don’t happen in other countries with truly universal systems. For example, it is well documented that Medicare Advantage plans are designed to be lower cost while you’re relatively healthy and then have out of pocket costs explode once you’re ill to encourage you shift back to traditional Medicare (once they’ve extracted their privatized profits from our public dollars of course).
15
@HC45701 ,
But FAR from universal disease coverage at a reasonable cost (IMHO).
(1) "Managed" care is managed to provide the biggest profit for the company, not necessarily the best outcome for the patient.
(2) Many people WITH insurance find that its coverage is so incomplete that they cannot afford care anyway.
(3) Medicare (dis)Advantage is subsidized by tax monies to drive people away from "Original" (REAL) Medicare.
We can and need to do better.
8
@HC45701 Your first paragraph is directionally correct but I note the following misinformation
1. Part C health plans, of which Medicare Advantage is the most popular type, is public insurance with private "sponsors"
2. But all of U.S. Medicare as we know it" is also run by private companies
3. All the private companies that run Parts A and B ARE insurance companies (all but one for profit) but most of the sponsors of Part C health plans are not-for-profit integrated health delivery systems and other charities, NOT insurers
4. One of the major reasons that public Part C is so popular (from 0% of the base to 35% of the base in 22 years) is because the Democrats did not read the Patient Care and Affordable Care Act before they voted for it. The Democrats thought they were killing Part C but they left in a feature of the old law that said the amount of the monthly per capita fee is tied to the amount spent the year before on Parts A and B in each county. But they also put in a feature (that most sponsors already followed because they are non profit) that 85% or more of the money has to go for medical services as opposed to overhead. So Part C sponsors have been adding great benefits like dental services and lowering premiums (often to zero) since PPACA
5. The major reason for Part C's popularity is that it has a maximum annual out of pocket spend. Almost no one ever comes near that maximum spend amount but it's peace of mind to know it's there.
A and B lack that protection
As a Canadian I am grateful for the single payer system. When I read of the American health care system, such as in the articles of Elisabeth Rosenthal, I am bemused by the national passivity in the United States that permits a bad system to become progressively worse at tremendous public expense and unnecessary suffering and loss of lives. It is a kind of domestic Afghanistan.
It is sad, that the Democratic Party, which is a party that claims to represent the public interest, as opposed to those of lobbyists, and special interests, has an entrenched leadership that lacks courage, concern and vision. Why are candidates like Elizabeth Warren and Bernie Sanders who advocate for health care for all marginalized and disdained? What kind of sadistic impulse makes Democrats gloat at their failure?
The article describes that introducing universal health care took years of struggle. Has not been this true for abolition, universal suffrage, old age pensions, ending child labour, compulsory education, civil rights, the eight hour day, the freedom of thought and opinion and a free press?
Thank you for this well researched and informative article.
102
@shivayon,
Right on!
The intent of the article seems to me to be to dissuade people from seeking universal disease care coverage.
Why the authors chose to do this puzzles me.
8
@shivayon
The democrats can hardly win control of 1/2 of 1/3 of the branches of government. There is an estimated 5 point handicap on the house races and then of course the senate stands as a wholely different obstacle where democrats win millions more votes to be underrepresented.
Furthermore Obama couldn't even get a public option through with a 20 seat advantage because just 1 democrat out of 60 had an absolute veto on the plan.
Do you really think democrats who agree on 80-90%
of these issues are the problem when republicans vote against them 100% of the time and still control most of the government? We have serious structural problems in our country that extend well beyond healthcare and gridlock our government.
3
@Stephen Rinsler
...because the paymasters belong to the ruling status quo, that has deep corporate pockets to keep the profiteering uninterrupted.
4
Of course, it's hard. Americans have been fighting for universal health care since FDR first proposed it. That's a fairly long battle with way too many dead bodies along the way among Americans with and without our flimsy excuses for employer-based health care coverage. This condescending article only reinforces this newspaper's callous disregard for Americans who want a better America. How dare they!
8
“Today, most Britons revere their National Health Service: One lawmaker has called it the closest thing the English have to religion, ...”
Let those of us in the US pray...
“Dear Bernie, hallowed be thy election, ...”
7
Took the family to Italy last summer. My wife fell off a curb and shattered her ankle in three places. She spent 5 days in the hospital and had the operation to repair ankle. The put a cast in her for the flight home. Total cost? Zero!! She is a dual citizen and just handed the hospital her Italian passport. The care was excellent. There are no Italians dying in the streets as per Americans propaganda! Universal health care, paid leave, nearly free colleges and universities. Americans are blind and totally ignorant. We pay more in taxes when you add up all costs and get nothing in return. I blame the press in this country. Yes, Italy is in a lock down but their citizens are protected. The American worker get shafted. The press needs to expose America for what it is. A bomb making capitalist society that out war above its citizens. Viva Italia!
73
@Unbelievable
Something similar happened to me in the mid '90s. I do not have Italian citizenship but I was there doing a job and got really sick. The (industrial) plant I was working at sent me home and then called a doctor to look at me - it was the 'flu, I was in bed for a week.
I was expecting a bill. I was told the equivalent of "Don't worry about it - it will come out in the wash.".
Apparently it would have been more expensive to put through the paperwork for the bill than the cost of treatment, so they just wrote it off.
16
@Unbelievable
I had a student fall ill on a study abroad trip in Italy. He ended up getting a thorough work up in the emergency room that by my estimate (I’m a MD) would have been about $8,000-12,000 in the US.
At the end of his stay, we inquired about the bill. The discharging doctor and nurse just laughed and told us since he’s young and visiting don’t worry about it. Zero percent chance this would ever happen in the US.
19
@Unbelievable it’s a nice story except that you are mistaken regarding the cost. It is not zero as you claim. Someone else is paying for it, more likely the Italian government via taxation. Thank them for the gift.
1
All the countries mentioned also have private health care available to those who want it. None of them have done away with private health care.
What a lot of people do not realize is that there are several tests and procedures that our current Medicare does not cover, but is covered by private health care.
There is room for both for those that want either or both.
5
@Doug R There is mainly room for those who can afford private care. I suspect that in systems that also have expensive, private care it's is to short-circuit the opposition of the rich and powerful, the people who can afford private care. "OK you rich people, go ahead and pay for extra special care, if what's good for most of the population is not good enough for you because you are so special".
3
Finally. America, quit thinking you are the best in everything. You are not. Your electoral college and gerrymandering are disgusting. Wake up to other nations that lead because you are not.
52
Apparently, our National Health Service came into being largely because the authorities were terrified of the looming threat of socialism. They saw this (and other concessions) as a way of placating working-class people, who expected a better standard of living after fighting and living through World War Two.
10
@Joanne Dean
It's a nice idea, but the Beveridge report was a genuine cross government piece of work that was supported by all parties, including the socialist Labour party.
Glad to see this issue raised. All Western countries to my knowledge have moved to universal healthcare by building on the existing system—which is what the ACA did. Step 1 is to restore the ACA to it’s pre-Trump form. Then, over time out-complete the insurance companies on cost and accessibility. Bernie has no hope of passing Medicare for all in a single stroke, and he is being dishonest when he suggests otherwise.
4
@Paul Don't worry, we get that. Even if we have the goal of a single payer system, we know that there will be a long transition period. But we know that ACA was only a beginning.
3
@Paul Need to do more than restore to pre Trump. Need to remove all of the things the Republicans injected AND get the influence out of it from the insurance and pharma side.
1
One of the biggest reasons it is hard to do here is because many so- called liberals argue against it, or else point to opposition from others as a reason not to fight for it at all. You see this in the primary debates and in the press— we had a lot of questions about how expensive it was and nothing about how the current system is much more expensive.
It might be true that single payer will come incrementally, but many who say that are just using incrementalism as a way of opposing it happening at all.
7
I join others below in complimenting on this timely article - with Medicare for All - in campaign slogans.
I just turned 72 - and for folks my age - which now comprise almost 45% of Americans - a Single Payer is already a reality - Medicare or Medicaid.
And Medicaid covers folks unable to fend for themselves - which are about 10% of Americans.
So, it is about 40% of Americans who are denied this Medicare for all. Yet of these, perhaps 20% have employer provided insurance.
So, at the end of the day, we are looking for changing our medical system - whole sale - on account of 20% of re,aiming Americans.
To me, that's one reason why this single payer will fail as a concept or even a law.
Catering to a small minority - to disrupt what is available for a majority - is a step too far.
And what has now been globally proven is that what works for America definitely does not work for others - including Europeans - our closest brethren.
Equally true, what has worked for small population and largely homogeneous population clusters - will not work for America.
3
@Neil so if "just" 20% of Americans were starving or homeless, that's okay with you, apparently. Nothing to inconvenience the majority.
13
@Neil
15% of Americans are over 65. Not even close to 45%
As far as the dog-whistles about "closest brethren" and "homogeneous population clusters" go, Canada is closer to the US socially than any other country on earth, certainly far closer than any European country, 1/5 of the Canadian population was born outside Canada.
Canada is a lot of things, but a nation of supermen isn't one of them. And yet even Canadians seem to be able to make single-payer work to the broad satisfaction of the general populace.
31
@Neil,
20% is one of every five people.
Yes, they can be ignored, but it isn't a small number if you are one of them (and need care).
In addition, many "insured" individuals still have such high UNcovered disease expenses that they are subject to bankruptcy if they "choose" to accept necessary care.
Ignoring any ethical concerns for our fellow citizens who lack adequate disease care, we should care because we end up having to deal with the costs of emergency department and in hospital care for problems not addressed because the patient didn't have the money.
P.S. I don't think nations with populations of 10s of millions are small.
13
I join others below in complimenting on this timely article - with Medicare for All - in campaign slogans.
I just turned 72 - and for folks my age - which now comprise almost 45% of Americans - a Single Payer is already a reality - Medicare or Medicaid.
And Medicaid covers folks unable to fend for themselves - which are about 10% of Americans.
So, it is about 40% of Americans who are denied this Medicare for all. Yet of these, perhaps 20% have employer provided insurance.
So, at the end of the day, we are looking for changing our medical system - whole sale - on account of 20% of re,aiming Americans.
To me, that's one reason why this single payer will fail as a concept or even a law.
Catering to a small minority - to disrupt what is available for a majority - is a step too far.
And what has now been globally proven is that what works for America definitely does not work for others - including Europeans - our closest brethren.
Equally true, what has worked for small population and largely homogeneous population clusters - will not work for America.
Don't all three countries mentioned (Britain, Australia, Canada) also allow private insurance as long as one pays into the single payer plan? For me, any plan that strips me of the right to buy private insurance (as long as I pay into a single payer plan, too) is a non-starter.
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@Ginny
Disclosure: Dual US/Canada national living in Canada.
Canada does, at least. But it's supplementary. Basic care is a given, but if you have basic care you will get a shared room, certain amenities, and medical treatment.
Blue Cross Canada (for example) will sell you a health insurance package. For that, you get a private room, better amenities, drug coverage, and exactly the same level of medical treatment.
I can't speak for you, but the last time I was in hospital I wasn't there for the food. But if you get desperate you can pick up the phone and Grubhub will deliver to your bed. Don't know if they will in the US.
I get to pick my own doctor, I get to make final call on any proposed treatment, I can show up at the local ER and be seen in less than an hour, I can get an appointment with my GP on a few days notice, I can get an appointment with a specialist fairly quickly.
I live in fear of having to depend on US health care. Single payer works.
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@Ginny
Yes the UK allows you to also have Private Health Insurance if you wish (see BUPA as an example). There are Private Hospitals all over the UK, usually in close proximity to NHS sites. You can also pay directly for private consultations with Dr's, Specialists as you see fit.
Some people get cover with their workplace, some pay direct for it. And its cheap. Why? Because Private doesn't have to cover Emergency Medicine, Pre-Existing conditions (if they choose to), universal coverage and they have the back up of the NHS for when things go really wrong. In business terms there is little risk for them. An example of this would be elective cosmetic surgery, if something goes wrong they wheel you over to the NHS Hospital who do the lifesaving stuff...
And in most Private Healthcare you will be seeing the exact same Dr's as you would be for free in the NHS...they work most of the week in the NHS and a couple of days in the Private Sector...The NHS also contracts Private Hospitals to provide additional capacity when required.
Truth is most people don't bother as there is no need.
And just for US readers....90% of Prescriptions issued in England are Free...The remaining 10% are charged at a flat rate of £9.15 (c$12). Even then if you have to pay and are reliant on multiple prescriptions you can buy a Government Prepayment Card that gives you unlimited prescriptions for a year for £105.90 (c$135)
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@Ginny The answer to your question for Canada is yes. The private insurance covers what it is not cover by the public health insurance.
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Our healthcare system is one of the' crown jewels' of Canada. There are always some issues like waiting times for some procedures or diagnostics but the benefits and security far outweigh the problems. A friend recently received a heart transplant (estimated cost of 1.4 million dollars according to Forbes) by one of the finest transplant teams in the world. Unfortunately he ran into some additional complications resulting in numerous surgeries and extended hospital stays. All costs were covered by the system. He was in grave danger but no efforts where spared and today still here to enjoy life and family. Very proud and fortunate to be born in Canada where healthcare for all is considered a human right in a society that cares for its people.
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@Barry Barry, as a fellow countryman now living in the U.S., there are issues here too with waiting times. There also are issues with waiting hours in emergency rooms at many U.S. hospitals. In the end, the Canadian system is better than the U.S. system for the primary reason you detail: cost; to the patient, to the government, to the economy. If the U.S. opened up Medicare to enrollment in parallel to private insurance, then that enrollment would eventually make private insurance moot as enrollees would soon realize that the taxes to pay for their Medicare coverage that were once premiums, deductibles, copays, and coinsurance would be so much less due to reduced administrative costs and the removal of the profit margin. Hope springs eternal that this will happen sooner rather than later.
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What this article misses is that, at least in the Canadian experience, there was broad public and cross-party support for public health care long before the 1959 Saskatchewan plan was enacted. The Green Book proposals of the late 1940's proposed Federal funding to the provinces, which were followed by grants beginning in 1948 (by a Liberal government) and the Insurance and Diagnostic Services act of 1957 (by a Conservative government.) Adding doctors to the coverage was the logical end of public healthcare, not the beginning. The Saskatchewan doctors strike was relatively trivial in the overall development of what eventually became the system that exists now, and these oppositions never posed a serious threat to it.
The point is: it is hard to believe now, but from the end of the second world war until at least the 1970's there was a broadly and relatively uncontroversial understanding throughout the West that governments, right or left, had a central organizing role in the management of social welfare. In Canada at least, there wasn't some titanic struggle over this basic proposition. Instead, there was largely a long haggle over which level of government the money would come from, how it would be spent, how coverage might differ in different parts of the country, and so on. Without this core understanding, re-casting this history as a clash of interests similar to those in the US right now is very inaccurate.
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@BlogPoster — You are correct in pointing out the moral failure of Americans to recognize health care as a human right.
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@BlogPoster I think that blogposter is correct. I lived in Canada through much of the move toward universal health care, and do not remember a titanic struggle, at least not in Ontario. There was much time-consuming and tedious haggling over the roles of the federal and provincial governments in funding and other matters. But federal-provincial haggling is fundamental to the Canadian system of government and Canadian politics.
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@Historian Time was when even the US was not in the thrall of the peculiar religious notion that government has no role other than cutting taxes, worshipping "job creators", punishing the vulnerable for being vulnerable, and brutalizing criminals. Hard to believe but it's true.
Realizing that once you give something away for free, it's extremely difficult to undo, I propose that any universal healthcare in the USA come with the stipulation that once a person shows up at the doctor's office with a BMI over 30, they're fined $50 and put on notice. From that day, they have 6 months to drop back below a BMI of 30 or they will lose the free healthcare and be required to pay for their own healthcare plan. We need to tame the obesity epidemic in this country and this is one way to do so while maintaining some sane limits on the expenditures of a national healthcare plan. This is also something that could bring more republicans on-board with the idea.
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@Kyle. Well it would not be free. There’d be some form of premium, which could indeed be discounted for people who stay fit, control their BMI, etc. I don’t think penalties would necessarily help but everyone likes a discount.
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@Kyle Have you seen the obesity rates in red states? And universal coverage is not free-never has been. Is this proposal serious?
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@Kyle and next Kyle, you deny health care to people that smoke, then to people that are in unhealthy occupations, then to people who have dangerous hobbies (ie skydiving) then to people who do not eat healthy and so on and so on.
Sorry Kyle, you either treat everyone or you don't. The one thing you don't want is the government deciding who to treat. Healthcare for all means exactly that.
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In June, 2019 D. Trump said that within 30 days he would introduce a "beautiful" new health plan to replace the ACA.
We're still waiting.
The problem is the enormous amounts of money at stake. In the 3 cases documented in this article nothing could be resolved until doctors were guaranteed high incomes. Here we also have insurance, hospital, pharma, and medical equipment and supply executives who will fight tooth and nail to preserve their positions in the top 1 or 2%.
And if we guarantee all that, as the ACA does, we'll still be paying twice as much for health care as any other country.
They are extorting us. There would be nothing unfair about our clawing half that money back.
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@Green Tea Completely agree. While I think doctors absolutely earn their high salaries, after all they commit a decade to study first and should reap the rewards for it, there's absolutely no excuse for pharmaceutical companies making obscene profits from people's illness.
There's a huge difference between both insurance & pharmaceutical companies remaining profitable enough to pay wages, create jobs and keep investing in innovation while ensuring their products remain affordable & accessible, and exploiting the demand to squeeze as much profit for shareholders as possible out of sick people.
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It doesn't help when centrist democrats parrot the line about a single payer system being impossible. Not only is it possible as proven by all the other countries who have adopted it, but it's cheaper than the system we have no and provides better outcomes.
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@todji
If they spent as much time dispelling myths and selling single payer to the voters as they do telling progressives that it’s impossible, we could get it done within a decade.
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@todji the issue is how to get to a single payer system with minimal disruption. A flash cut will not work well given the divisions in the USA. An incremental but determined approach can work. Start with the groups that need single payer the most, prove it works, then move on to cover more groups. I agree we need it, I recommend we do it incrementaly.
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@todji
We might get a single payer system if imperfect messengers Sanders and Warren hadn't poisoned it by saying that private insurance would be outlawed, and doubling down on that when challenged. The successful universal health care insurance in the rest of the developed world allows for varying degrees of private insurance. That's good policy and smart politics. So why scare people away when these other countries have not found it necessary? And, besides the challenges of getting any Congress to pass it, what about the Constitutional challenges of totally outlawing private insurance? These other countries' histories should be a lesson that this will only happen in several hard-fought stages, not in one big inevitable defeat. Reminder: Social Security covered far fewer people when it began in the 1930's.
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One of the first things that should be done here to begin any change is to inform the insurance companies they if they wish to stay in the business, they're now all non-profits with salary caps on executive pay. Yes, there will be those who clamor about markets and such, but the health of a nation and its people should not be subject to profit making. It never should have been.
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Again and again what becomes clear is that the push towards a one payer system is simply the only alternative that some believe exists to respond to total corruption of the system led by moneyed interests. The layers of interested parties that don't want to give up their piece of the pie, will never allow for compromise.
The proof is that no one in government really knows what they are doing in regards to delivery of medical care. The proof is that there hasn't been one honest effort to reduce costs. The most glaring example is the inability to get any true support for Medicare negotiating drug prices. The European Medicines Agency has been operating as an effective review organization for decades and has helped in European common market negotiations. Instead, we are working on reimbursement schemes, and redistribution of preferred risk populations to lower costs for insurers. Unfortunately, as imperfect a solution as nationalized medical care is, that is the path we are on. As long as those in Congress refuse to either offer their own plan, refuse to stop allowing the bribes of lobbyists, or those in the layers of business can't stop siphoning money from the system to the detriment of the insured population; then nationalized medicine, as a dramatic response to the corruption within Congress and business will be the only option left.
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No big surprise that it is doctors who resist the hardest, because becoming a doctor has been a guarantee of a very good income.
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@LO Its thinking like this, devoid of the appetite for data analysis, that keeps pushing the narrative ' if we only ratchet down costs for those greedy doctors, everything will be solved. Unfortunately, when you add up all physicians, all providers, and all clinics, provider services still account for no more than 20% of the costs of delivering care. When you add the additional 10% of costs which is said to arise from defensive medicine due to malpractice insurance costs, the number is even lower. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6179628/
https://www.healthsystemtracker.org/chart-collection/u-s-spending-healthcare-changed-time/#item-nhe-trends_average-annual-growth-rate-for-select-service-types-1970-2018
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@LO I would say the it's the insurance companies that resist the hardest because they have even more money in the game than doctors do, much more time and money to fight with, and most of their "work" would be easier to dispense with.
@LO
The real cost issues are not your doctors but the countless middlemen/system that sit between you and your doctors. I’m talking about medical device reps making the same as physicians (despite no medical training), pharma executives, pharma advertisers, heads of billing departments, insurance CEOs, hospital executives, our government's failure to negotiate drug prices, and I could go on and on.
I went to 4 years of university, 5 years of medical school (did a MPH), and 7 years of residency (where I earned about $60,000 a year and worked 80 hours a week). I will finish all of this training, despite partial scholarships, with about $270,000 in debt. I love my job. I love caring for patient. I want a universal system that doesn't bankrupt my hard-working patients. I've struggled with my own medical bills. But, I just refuse to accept that my colleagues and I are the least-deserving participants in this system.
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With national health care should come a revamping of how medical school is paid for. You can’t ask someone to shoulder all the private costs (that debt and all that risk that comes with it) for little of the private benefit in terms of long run salary and autonomy.
This is true for many fields and a problem with our demand-based tertiary education funding system.
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@Lydia most industrialized countries have free or nearly free colleges and universities. We pay and pay and pay.
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How can you move forward toward full medical coverage for a country and it’s people, when there are little controls left and corporations own the government? I’m for Biden, but, even he is timid about changes in medical coverage. First objective, trump out.
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@David J
The starting salary for an NHS 'consultant' - actually a full time employee, is $115,000 rising over about 7 years (with seniority awards and official bonuses) to about $230,000. The entry qualifications would be Board cert. equivalent and 3 years general hospital training followed by about 5 years specialist training. A small cadre of elite doctor 'Dons' (Mafia rather than academic) hold senior NHS management positions and will earn $350k plus.
These are not bad salaries for the UK (although nowhere near the equivalent of what NHS consulatnts once did earn). Despite this, there are currently acute shortages of medical specialist manpower (across all disciplines and across the whole UK) with many posts outside the big cities being long term unfilled.
Only about 10% of NHS consultants exercise their rights to do private practice. With the increasing Americanisation of that sector, it's, paradoxically, getting hard to make a lot of money there.
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@David J sure, because incremental change has worked so great for us the past forty years. More of the same: nothing.
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@David J
There's an old saying that applies in this case that if you want to eat, first you must get a place at the table.
Trump first, but the Ds must have majorities in the House, Senate, and the state Governorships and Legislatures to affect change. It's not about courage; it's about numbers. Without those majorities, any change could be simply undone by opposition if they get a majority in the federal government, and without the states, any initiative can be buried in lawsuits - again with no actual changed occurring.
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The doctors and health care providers in all those countries weren’t, and aren’t still, making half of what they do here. Specialists start at over $300,000 a year, from internships that paid $65 or $80K. The ‘health care’ executives are a half million plus in compensation. The money is far to great and dwarfs what those countries had or have to fund a protest. Without buy-in from the medical establishment, it won’t be done here. No one has talked about that way yet.
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@Not Pierre And the other half GPs are forced to accept $140k per year which effectively decreases every year with ever more bureaucratic restrictions on how they practice. The public health system is on the edge of collapse.
The COVID-19 crisis is most likely to bring both groups into a rationed partially effective response.
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@Not Pierre. Your point re the compensation for specialists may be applicable to GB, but certainly not to Canada. The average billing of a Family Physician in Ontario was $565,000 and that too a couple of years ago.
Obviously, since these individuals run independent practices, there all the associated costs such as rental, staff, etc., which usually do not exceed 30% of billings resulting in a very comfortable take home compensation.
Specialists, typically earn more than the Family Physicians.
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One looming problem in the US is that few people know what it costs to have health insurance because employers typically pick up most of the tab. What used to be the typical "Cadillac" insurance plan for a family now costs in excess of $37,000. A high-deductible plan (say $2000/$4000) costs in excess of $27,000 and a $5,000/$10,000 plan about $18-22,000. In the not too distant future, as these costs push past $40,000, the system will come crashing down and require a radical departure from our current system which spends 20% of its dollars taking care of people in the last year of life and far too much providing expensive care in the emergency room to the uninsured. The most telling thing is the fact that the health insurance lobby spends more than any other in influencing Congress. Your premium dollars fund this effort. Not to put too fine a point on it, but they are charging you for the privilege of keeping you in thrall to the most expensive health care system in the world.
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@G James thank Youngblood’s for pointing this out. The biggest problem in controlling prices is that the ignorance of them extends to the next layer down. Nobody knows or cares about provider prices because they are rationed through a system centrally planned by insurance companies. What we really need is a socialized system based on free markets, where everyone has an AGI-scaled copay, giving them the same buying power.
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@G James Thank you G James. I would add that every evening as I watch the TV, I am also watching our health care dollars being spent on multi billion dollar (deceptive) ad campaigns for hospitals, dangerous expensive drugs, insurance policies, and lawyers who will make us rich suing the above mentioned venture capitalists. Whoops...what will happen to the media's bottom line if all the ad revenue from "health care" industry (and 2020 elections) were to vanish?
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@G James
Employers are picking up less and less of the tab now. We're paying 2K a month, and while we can still afford that, 2K a month gone to insurance for nothing but a yearly check up and a flu shot means a lot of things we can't spend on in the local economy and a lot less money to save for retirement. Health insurance is sucking the life out of our country.
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I believe incremental steps are the way to go.
For example, lower the Medicare age by one year per year for 5 years.
Raise the Medicare tax by 9 basis points per year over the same time.
At the end of 6 years evaluate the situation.
And, yes I realize this means a 50-year plan to get to universal coverage.
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@TracieBarnes
This would effectively mean Republicans hijacking it at some point of the process, repealing it, and then setting you back to ground zero.
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@TracieBarnes That's a lot more time and study than the USA put into the run-up to the Iraq war, which has been a bit on the expensive side. Trump would have done it again in Iran if Congress hadn't pushed back. Our Commanders-In-Chief are eager to send our young and healthy people to die in order to show how strong our country is and they're willing to spend endless trillions of dollars to do it. Just talk about investing half that sum to keep people well and suddenly panic ensues. The GOP likes to err on the side of killing more Americans. This country isn't capable of a 50-year analysis, as we have seen in the methods the Trump administration has employed to turn every federal agency into the very thing it's supposed to fight against.
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Wonderful, very informative article.
Now, I am not a bad person, but in my heart of hearts, I have found myself looking to a major economic depression as the only way America gets National Health Care, for in that despair, change might be possible.
As it is, the well off see things as a zero sum game, to give health care to the poor, the middle and upper middle class have to lose something, and that they will not vote for.
But in a major depression, when the majority are in the same boat, or soup line...
Hugh
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@Hugh Massengill
Unfortunately, that's not the way it works. During times of economic stress (e.g. Recession, Depression), while the rich are hurt, they aren't hurt as much as the middle class and poor are because 1) their pockets are deeper and are better able to withstand financial stress, 2) the system has been designed (by them) to alleviate their stress as "job creators" that ultimately their have relief that others can only dream of. Those selfsame rich then swoop in, buy up all the distressed properties and assets the former middle class and poor had, then make even more money back once recovery starts through both their own investments (which most of us can't afford anyway) recovery and through selling those previously distressed properties and assets back to us.
Until we break that profit-taking cycle, it's going to continue being a zero-sum game for them.
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@Hugh Massengill
Actually this article, like most from the American media, is deeply misleading, giving the impression that all those countries that have universal health care are single payer. The article mentions Germany but doesn’t inform readers that Germany has the world’s oldest national health care system, created by Bismarck in the late 1800s. That system has always been based on private insurance policies that are bought by individuals or employers. Insurance is strictly regulated by the government.
That “Bismarck” model has been adopted by other countries - Japan, Belgium, Switzerland and the Netherlands. Switzerland reformed its system in the nineties and choose the Bismarck model because transition to that model was less disruptive and could be accomplished more quickly than adopting a single payer model.
All of those “Bismarck” countries have universal, high quality, affordable health care. Belgium and Japan actually pay less per person than does Canada.
http://www.startribune.com/want-a-new-health-care-model-the-germans-do-it-right/411702466/
https://www.uakron.edu/dotAsset/fcb50f80-def3-468b-b4dc-0af21010134f.pdf
The media has promoted a false choice, either/or argument over health care by not informing the us about what systems have been proven to work. Instead of debating the pros and cons of a single vs. multi-payer system, we have been duped into thinking all other developed countries use single payer. This is blatant media malpractice!
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@Theodora30
"Belgium and Japan actually pay less per person than does Canada."
I pay 0 for our universal health care. Do people actually receive money back when they receive heath care in Belgium and Japan?
1
The ACA passed and was pretty unpopular. Until it became popular. The problem for those opposed to a universal health care system in the United States is they don't have a plan to present. Republicans want to eliminate the ACA but never have a plan to offer to take it's place. How do you do the things the ACA does like require coverage for preexisting conditions, make healthcare available to everyone regardless of their ability to pay, and assure that everyone gets the same basic healthcare ( regular physicals, cancer screenings, and prescription drug coverage, for example) and pay for it? The mandate was eliminated. There goes premiums from low cost patients. No one. Absolutely no one argues with having every vehicle in New York, say, needing to be insured. That is a mandate as well. Imagine what your car premiums would be if the only insured drivers in New York were ones who had had accidents. Universal coverage is coming. Not a matter of if, but when. Because the alternative is simply the same 'plan' as what bought us to this discussion in the first place.
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@Walking Man It cost almost $20K for health insurance, but $2K for your car insurance. That’s quite a gap. While I agree with your sentiment, the obstacles are bigger.
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@Walking Man
Perhaps when the Supreme Court strikes down the ACA for good this fall, the Democrats will have no options left but to finally do the right thing and give us Medicare for All.
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@Walking Man The "unpopularity" of the ACA is highly misleading. A large percentage of the people disapproved of the ACA because it did not go far enough. So it's not the ACA that was unpopular, but the fact that it didn't get us to where most Americans want to go: universal government-provided healthcare.
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The time has come for a less expensive and more inclusive healthcare system. Perhaps Medicare for All or something similar will deliver heath for the country and not bankruptcy for individuals.
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@Louis J
Medicare for All won't work becaue Medicare as a program only covers 80% of the bills. That other 20% you have to cover either out of pocket or with supplemental plans either through private insurance or through Medicare itself (and you still pay for out of pocket). Single payer (i.e. Universal Healthcare) is closer to Medicaid for all.
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Where do you begin with criticism of this article's findings:
1. Each country went through this in different generations, each with great differences in terms of what health care could even deliver, and all forty or more years ago
2. Each country instituted a fundamentally and drastically different system from each other (also each is fundamentally and drastically different than the Conyers plan for the U.S., often attributed to Sanders):
-- Britain does not have single payer healthcare insurance; it has nationalized health care (but you can bet the little princes and princesses were not born in it)
-- Canada has the closest thing to Conyers nationalized single payer healthcare "insurance" proposal but it differs in every province (and Canadians have the backstop of running over the northern border into the U.S.... something they do for almost everything, not just health care)
-- Australia has something like current U.S. "Medicare as we know it," which is the furthest thing in the world from single payer healthcare insurance (we on traditional U.S. Medicare almost all have from three or four payers, counting ourselves)
3. All it is going to take in the U.S. is to get healthcare providers and facilities to accept 40%-50% pay cuts. That was probably not an issue in the Outback in the 1980s or in Dudley Doright Canada in the 60s or on a little island off France in the 1940s, with a Victorian class system from the 1890s
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@Dennis Byron As an Australian, I am not very familiar with the term "single payer". Wikipedia says "Single-payer healthcare is a type of universal healthcare that covers the costs of essential healthcare for all residents, with costs covered by a single public system (hence 'single-payer')."
This is definitely the Australian system, although dental care is not included.
Private insurance means certain additional choices are available to the insured. Most surgical procedures undertaken with private insurance include a co-payment, but you don't wait, you get to choose your surgeon, and can use a private hospital, if you wish, or you can us a public hospital.
For emergency medical care, there is not much difference.
Enrolment rates in private insurance are falling since it is in a death spiral: young people don't get value, and as they drop out, their cross subsidies disappear, pushing up the price. The private system is currently kept alive by government interventions.
Primary care is via a "General Practitioner", which is not covered at all with private insurance ... for this, there is no advantage to having private cover.
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@Tim Yes, you are describing the closest thing to the three systems described in the article to current United States "Medicare as we know it." I am not saying they are exactly alike
You may not be familiar with current United States Medicare but it is primarily for senior citizens who pay into separate trust funds their entire working lives via payroll and income taxes and then keep paying premiums once they reach age 65 along with large copays and deductibles and life-time and per-incident limits unless they add private insurance on top. Many typical medical services -- such as an annual physical exam -- are not covered at all
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@Dennis Byron
Dudley Doright Canada...really! The amount of our citizens who cross the border to seek medical care in the US is minimal to say the least...instead of denigrating a country that provides medical care for ALL its people, try fixing your system that provides no or minimum coverage for tens of millions of its people
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