What would a single payer system look like?

allnurses Guide · Jan 24, 2016

This November 2013 opinion piece explains a lot.

The real fix for Obamacare's flaws: Medicare for all
... With all the ACA's highly publicized snafus, and less discussed systemic flaws, there's no reason to welcome the cynical efforts to repeal or defund the law by politicians whose only alternative is more of the same callous, existing market-based healthcare system.
US nurses oppose the rollback and appreciate that several million Americans who are now uninsured may finally get coverage, principally through the expansion of Medicaid, or access to private insurance they've been denied because of their prior health status.
At the same time, nurses will never stop campaigning for a fundamental transformation to a more humane single-payer, expanded Medicare for all system not based on ability to pay and obeisance to the policy confines of insurance claims adjustors...
... The (ACA) law actually further entrenches the insurance-based system through the requirement that uncovered individuals buy private insurance. It's also chock full of loopholes.
Some consumers who have made it through the website labyrinth have found confusing choices among plans which vary widely in both premium and out of pocket costs even with the subsidies, a pass through of public funds to the private insurers...
... The wide disparity between the healthcare you need, what your policy will cover, and what the insurer will actually pay for remains.
Far less reported is what registered nurses increasingly see â€“ financial incentives within the ACA for hospitals to prematurely push patients out of hospitals to cheaper, less regulated settings or back to their homes. It also encourages shifting more care delivery from nurses and doctors to robots and other technology that undermines individual patient care, and that may work no better than the dysfunctional ACA websites....
... Without the imperative of prioritizing profits over care, Medicare for all streamlines the administrative waste and complex insurance billing operations endemic to private insurance. That waste is a major reason why the US has more than double the per capita cost of healthcare of other developed nations, yet lower life expectancies than many.
Medicare for all eliminates the multi-tiered health plans that plague both the individual and group insurance markets that are tied to the girth of your wallet not your need for care. Class, gender, and racial disparities in access and quality of care vanish under Medicare for all...
http://www.theguardian.com/commentisfree/2013/nov/27/obamacare-flaws-medicare-for-all

loriangel14, RN · Jan 24, 2016

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

Plus I work in rehab floor so many people are admitted and stay for physio as long as they need to. Once they are fully rehabbed they are discharged home. It's fully covered.

TriciaJ, RN · Jan 25, 2016

How would the system deal with individuals who do not care about their health? Is there any incentive to having good health? Would this system ultimately be cheaper? I have read mixed reviews. As a young healthy adult it would be nice to not have my money go towards a high deductible plan. I personally would rather have useable insurance. Would having this sort of system ensure that copays and FSA and HSA wouldn't be needed? How would things like acupuncture, chiropractic, or massage work? I was reading how the wait time for surgery in Canada is about 4 weeks. Would this be realistic for a US system?

The wait times depend on surgery type and geographic location. Just like they do in the States. Typically only medical care is paid for; optometry, dentistry, chiropractic, etc are typically self-pay, depending on the province. The overall costs are much cheaper, because there is no such thing as indigent care, so hospital bills are not inflated to cover uncollectibles.

There is no competition so there is no Press-Ganey. Health care dollars are spent on health care, not spiffy lobbies, fountains, etc. When my family member was in the ICU in Canada, he got state of the art care; the family waiting room was dismal. When my partner has surgery here in the States, the visitor accommodations are always lovely. But that has to be paid for and adds to the overall cost of healthcare.

Canadians are free to move around Canada without worry about how they are going to have health care. They can even be between jobs and not worry about health care. Americans always have to take into consideration what kind of health care will be available if they change jobs or relocate.

Pros and cons both ways. Lots of negative propaganda here in the States about Canadian health care. Canadians are often shocked at how much Americans pay for the same quality of care.

toomuchbaloney · Jan 25, 2016

The wait times depend on surgery type and geographic location. Just like they do in the States. Typically only medical care is paid for; optometry, dentistry, chiropractic, etc are typically self-pay, depending on the province. The overall costs are much cheaper, because there is no such thing as indigent care, so hospital bills are not inflated to cover uncollectibles.
There is no competition so there is no Press-Ganey. Health care dollars are spent on health care, not spiffy lobbies, fountains, etc. When my family member was in the ICU in Canada, he got state of the art care; the family waiting room was dismal. When my partner has surgery here in the States, the visitor accommodations are always lovely. But that has to be paid for and adds to the overall cost of healthcare.
Canadians are free to move around Canada without worry about how they are going to have health care. They can even be between jobs and not worry about health care. Americans always have to take into consideration what kind of health care will be available if they change jobs or relocate.
Pros and cons both ways. Lots of negative propaganda here in the States about Canadian health care. Canadians are often shocked at how much Americans pay for the same quality of care.

Comparing health outcomes suggests that the quality of care is not the same.

TriciaJ, RN · Jan 26, 2016

Comparing health outcomes suggests that the quality of care is not the same.

Do you have some good studies on outcomes? I'd love to see them.

allnurses Guide · Jan 26, 2016

Do you have some good studies on outcomes? I'd love to see them.

From 2013:

Americans have worse health than people in other high-income countries
On average, Americans die sooner and experience higher rates of disease and injury than people in other high-income countries, says a new report from the National Research Council and Institute of Medicine.The report finds that this health disadvantage exists at all ages from birth to age 75 and that even advantaged Americans -- those who have health insurance, college educations, higher incomes, and healthy behaviors -- appear to be sicker than their peers in other rich nations...
... The report examines the role of underlying social values and public policies in understanding why the U.S. is outranked by other nations on both health outcomes and the conditions that affect health. For example, Americans are more likely to engage in certain unhealthy behaviors, from heavy caloric intake to behaviors that increase the risk of fatal injuries, the report says.The U.S. has relatively high rates of poverty and income inequality and is lagging behind other countries in the education of young people...
http://www.sciencedaily.com/releases/2013/01/130109124235.htm

This was 2007:

Health outcomes often better in Canada than U.S.: review
The death and disease rates for patients in Canada are the same or lower than those for people with similar diagnoses treated in the United States â€” even though per capita health-care spending is higher south of the border, a study suggests...
Health outcomes often better in Canada than U.S.: review - Technology & Science - CBC News

A systematic review of studies comparing health outcomes in Canada and the United States
A systematic review of studies comparing health outcomes in Canada and the United States | Guyatt | Array

toomuchbaloney · Jan 30, 2016

It is hard to ignore that in 2006, the United States was number 1 in terms of health care spending per capita but ranked 39th for infant mortality, 43rd for adult female mortality, 42nd for adult male mortality, and 36th for life expectancy.3 These facts have fueled a question now being discussed in academic circles, as well as by government and the public: Why do we spend so much to get so little?

MMS: Error

XNavyCorpsman · Feb 4, 2016

Lets just set the record straight......Single Payer is so astronomically expensive it will never happen in the US. I am not saying I am for or against single payer, but we could NEVER afford to implement the Single Payer system here in the US.

Editorial Team / Admin · Feb 4, 2016

Lets just set the record straight......Single Payer is so astronomically expensive it will never happen in the US. I am not saying I am for or against single payer, but we could NEVER afford to implement the Single Payer system here in the US.

Really? It's already happening- Medicare has lower overhead costs than private insurance. Again, cutting out the middleman (private insurance company) = cutting costs.

toomuchbaloney · Feb 5, 2016

Lets just set the record straight......Single Payer is so astronomically expensive it will never happen in the US. I am not saying I am for or against single payer, but we could NEVER afford to implement the Single Payer system here in the US.

What we do right now is one of the most expensive ways to provide health care to the American population and the access is poor.

Tenebrae, BSN, RN · Feb 5, 2016

Worse. This is the same system Canada uses and sometimes you have to wait for years for surgery or necessary procedures. Government red tape will come into play as someone up there in Washington decides if you need or do not need a procedure. Yes, there will be little to no cost. Yes, you will sacrifice quality and quantity.
Teri, RN, BSN

I had a GI bleed a few years ago, got in for the urgent gastroscopy within the week.

I had a patient who needed urgent surgery, first for a fractured long bone, secondly for the wash out out the dehisced wound.

Not bad for a single payer system.

loriangel14, RN · Feb 5, 2016

I had a patient undergo surgery less than 24 hours after being diagnosed with a brain tumor. Radiation in less than 10 days. And she won't lose her house.