What would a single payer system look like?

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So as we enter 2016 we have a democratic candidate opting for a single payer system or rather "Medicare for all". Now whether something like this could or should pass, what would the healthcare system look like with this in place. Please note that this is not a political argument as far as democrat vs republican or anything like that. I am simply curious to see how the system would change and if the change would be better, worse, or the same. Please feel free to post your thoughts!

Canada's model would be pretty close to this. From my understanding, healthcare is administered by each province, but funded by the country (ie each province can run it how they choose as long as they are providing "public" healthcare)

This system has some positives and some negatives. Depending on your political views, the subsidization of healthcare can be perceived as a positive or negative, so I won't touch that. One of the biggest positive points is increased employment within the healthcare sector. If more people have access to healthcare, more providers will be required. In turn, wages would likely rise for us.

The biggest downside I can think of is personal accountability. If you decide to make poor choices and either fatten up or / and succumb to "diabeetus," the taxpayer is paying for your bad decisions. This would encourage people to make poor decisions related to their own health. There is also a side effect that a lot of people wouldn't think about. If the obesity or overweight % of population increases, people who like skinny women would plunge into a state of depression because there would be less of them around. The costs associated with depression would also be flung at taxpayers.

Mostly, it is perceived not to work in nations where some of the population are conditioned to act like crabs in a barrel.

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Specializes in Critical care, tele, Medical-Surgical.
Our family has members who receive their health care from Medicare Advantage plans. The PCP gatekeepers have been very good doctors, and my family members have seen a very wide range of specialists, most of whom I would rate very highly. For the most part, my family members have received very good care, and have been happy with their care and with their doctors.
I'm glad. My Dad had a CareAmerica Medicare Advantage plan. He told me his PSA was elevated and the gate keeper decided to wait a year. The next year it was higher.

I told him and my Step-Mom I thought he should see a urologist. The following year his PSA was elevated even more. He said his physician had tried to do a biopsy that came back negative for prostate cancer.

Year after year that doctor, who would have lost some income for referring to a specialist, said there was no need for a specialist. My Dad could have afforded a urologist visit as I suggested, but he trusted his doctor.

At age 78 he fell playing tennis and injured his shoulder. They found cancer in his bones metastasized fro the prostate.

He gave himself a party and four months later was dead. I was blessed to be able to care for him.

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So would we see a change in the way that the healthcare climate is headed towards now? If there is only a single payer system, would there be as much "business" in healthcare? If institutions are getting reimbursement the same would there be less of a push towards customer service and more emphasis on actual care? So for instance would something like having a baby be the same cost at each and every hospital in the country? Would there be a flat rate for each procedure or lab work or anything like that? Would having a single payer system being more transparency to the actual costs of healthcare?

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herring_RN, I'm very sorry this happened to your Dad.

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Specializes in Critical care, tele, Medical-Surgical.

Hopefully with Medicare people wouldn't have been denied medical services. When (if) we achieve Medicare For All all Americans, even the president and members of congress will have the same insurance. (Medicare)

They would have good reason to ensure beneficiaries are not denied needed care.

Cigna Faces Halt in Medicare Advantage Enrollment

Insurer says Centers for Medicare and Medicaid Services found deficiencies in some of its operations

... The federal agency said it had audited Cigna in October and determined that its actions resulted in Medicare beneficiaries being inappropriately denied medical services that should have been covered...

Cigna Faces Halt in Medicare Advantage Enrollment - WSJ

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So would we see a change in the way that the healthcare climate is headed towards now? If there is only a single payer system, would there be as much "business" in healthcare? If institutions are getting reimbursement the same would there be less of a push towards customer service and more emphasis on actual care? So for instance would something like having a baby be the same cost at each and every hospital in the country? Would there be a flat rate for each procedure or lab work or anything like that? Would having a single payer system being more transparency to the actual costs of healthcare?

There may be some cost adjustments based on regional areas but it would be more uniform. I dont really know if it would change the quality of care and take the focus away from costumer service, since one payer is not the same that universal access. The only way that quality care would take the front page of healthcare is if reimbursement was based on outcomes and not on some random survey.

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Specializes in Acute Care, Rehab, Palliative.
So would we see a change in the way that the healthcare climate is headed towards now? If there is only a single payer system, would there be as much "business" in healthcare? If institutions are getting reimbursement the same would there be less of a push towards customer service and more emphasis on actual care? So for instance would something like having a baby be the same cost at each and every hospital in the country? Would there be a flat rate for each procedure or lab work or anything like that? Would having a single payer system being more transparency to the actual costs of healthcare?

Not really. As a Canadian I never see a bill so I have no idea how much things cost.

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Specializes in PACU, pre/postoperative, ortho.
Not really. As a Canadian I never see a bill so I have no idea how much things cost.

Interesting. I was led to believe by a medical device rep from Canada that most Canadians also carry a supplemental policy. For instance, after a minor knee surgery, he stated his PT was only covered by the supplement, not the basic free coverage. Otherwise PT would have been out of pocket for him.

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There may be some cost adjustments based on regional areas but it would be more uniform. I dont really know if it would change the quality of care and take the focus away from costumer service, since one payer is not the same that universal access. The only way that quality care would take the front page of healthcare is if reimbursement was based on outcomes and not on some random survey.

Wait I thought that reimbursment was at least partially driven by outcome. Am I mistaken? And what exactly is the difference between single payer and universal access?

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Specializes in Acute Care, Rehab, Palliative.
Interesting. I was led to believe by a medical device rep from Canada that most Canadians also carry a supplemental policy. For instance, after a minor knee surgery, he stated his PT was only covered by the supplement, not the basic free coverage. Otherwise PT would have been out of pocket for him.

Some people have supplemental insurance but not most. Yes if you were paying something out if pocket you would see the bill but stuff that is covered you never see the bill for. You just give them your health card number.

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Every province has different levels of coverage for different things.

Here in Alberta, there are a specified number of PT sessions provided under the healthcare plan. When you exceed them, you pay out of pocket or if you have extended health benefits you pay and then get reimbursed.

I do know if you go to a PT without a doctors referral there is an assessment fee (usually around $100) and then there is a fee for each appointment made (around $75)

If you want to go immediately and jump the queue, you pay.

Don't know much about hip and knee replacement PT but there is an awesome programme in place while in hospital with exercise sheets sent home

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Wait I thought that reimbursment was at least partially driven by outcome. Am I mistaken? And what exactly is the difference between single payer and universal access?

Well it is partially by outcome, the patient has to be alive and at least free of any nosocomial infections I would say. But a big deciding factor in reimbursement is a survey that the patient receives that is then used to calculate reimbursement, hence the current focus on costumer service at the current moment.

Single payer means that all payment flows through one place, one giant insurer that people belong to. Universal access pretty much means that everyone has access to health care, so they all are part of the insurance system.

For example if you dont have health insure in the US or Medicare/Medicaid you will have to foot the bill for your medical care. While if you were in one of the universal access countries you would just make your appointment and have access to care, simple as that. The only downside is that everyone has to pay more taxes.

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