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I read this as “single player”.
I’m all for single payer in the US but this diagram is a bit misleading.
- There’s still a program receiving government funding (e.g. Medicare).
- There’s still admin and billing (for the government program).
What I assume you’re really gutting are profits and shareholders for insurance companies. (Good, because healthcare in my opinion should not be a profit driven business in any respect.)
What I fear, however, is who is in power at any given time might change the care you receive if such a system isn’t setup with safeguards and ironclad mandates.
For instance, Republicans would absolutely attempt, through legislation, executive order, and the courts, to implement an effective federal ban on abortion or healthcare for trans and LGBTQ groups by changing how/if a single payer system would cover these services.
I would also be worried about the public availability of coverage data such that lists of frequent providers for these services are easily obtained and become a tool for harassment by religious zealots.
Or, imagine an anti-vaxxer put in charge of the program during the next pandemic.
How do other countries deal with these issues? Or, have politics become so broken in the US that this is a somewhat uniquely American problem?
It is a bit simplified but it is much more streamlined than the insurance system outlined.
The UK model is single payer. The government pays the money into a national body like NHS England (or NHS Scotland etc) and it distributes money. The internals of the system itself are complicated (there are commissioning groups, acute hospitals, mental health services, dental services, public health services etc) and have overhead as with any organisation.
But there are not multiple government health organisations or paying systems - there is a single national tarrif for what each part of gealthcare costs and that money is distributed down to the providers like hospitals and GPs/family doctors. 2/3 of the cost of Healthcare is staff wages; it’s people intense.
No insurers, no billing agencies or debt collectors. Essentially there are not 3rd party businesses creaming off money for doing little more than handle the money. More of the money goes directly to healthcare rather than intermediaries. The infrastructure and administration within the system such as commissioning groups etc have fixed costs - none of it is run for profit.
In terms of government control - that is a concern but US politicians already heavily interfere in the system. Abortion is a good example of that. What you don’t get is Healthcare businesses of various types interfering in government.
The real issue for a single provider system is the staff - wages are kept down as its a national system. That causes strife if wages of pushed down too much. So you do get unions exerting pressure on government. I see that as a good thing but your mileage may vary.
Also if there is under investment then that can severely hamper the system - we have that problem in the UK - demand is going up as the population ages, but the politicians won’t make the hard choices of taxing the elderly to support expanding the Healthcare system.
I would earn far more in my specialty in the US. However even so I much prefer the UK system. I don’t want us to go down the route of the very broken US system. However there are public system with insurance models that do seem to work well - Australia and Canada have good reputations both in terms of cost, efficiency and pay for staff etc.
Essentially Universal Healthcare should be the aim, and it doesn’t necessarily have to be a single payer system to work. But single payer systems can work.
Canada deals with some of those problems by having a separation of state and medicine similar to our separation of state and church.
For example, I think we are the only country in the world with no abortion law. It’s a medical procedure, so it’s left to the medical community to develop standards of care and standards of practice.
It’s not perfect, but it’s worked out quite well since the 1980s. There were some major cases that led to our abortion laws being struck down by the courts and no government has yet had the courage to introduce new legislation of any kind.
That sounds really nice. We should try separating the state from medicine in America. Heck while we’re at it we could separate the state from religion
the reality of a “single payer” system is not usually that the government pays for everything: public health will keep you alive, but if you want to be comfortable (eg private room, skip a queue: it’s not nice, but private surgeons still exist and use public services) then you can go private either through insurance or paying outright…
insurance usually also covers what we in australia call “extras” and that’s a whole category of private health (ie things not on medicare that everyone gets)… this is things like dental, massage, optical, etc
don’t get me wrong, this is STILL far superior to the shit show in the US, but it’s NOT simpler from a moving parts perspective - it’s MUCH more complex, just every day people neither have to worry about or pay for that complexity most of the time
skip a queue
If everyone skips a queue you will get another queue
