What would a single payer system look like?

Fiona59 · Feb 29, 2016

Bluntly put, Canada and European nations believe in the grater good. Shared care and responsibility. America seems to be all about the individual and a model of I'm fine, and my neighbour can fend for themselves

twozer0, NP · Feb 29, 2016

I like to think of single payer as if Comcast was the only cable provider...

ProgressiveActivist, BSN, RN · Mar 1, 2016

I

ProgressiveActivist, BSN, RN · Mar 1, 2016

Medicare for all is not a radical idea in nearly every other industrialized country in the world.

yukonriver · Mar 1, 2016

Great dialogue all! It is important for us to understand and respect each others ideas and opinions. It feels as though this country is very angry anymore. Political differences should be discussed and not slandered. Our politicians have been an excellent example of this. As health care providers we should set the example of what to do. Let's have respectful discussions.

I currently work in a government run, Medicaid/care facility and my position was created under Medicaid expansion. Mental health and substance abuse care is free, and that is good. Also, clients don't bother to show up for their appointments, because it is free! A waste of money for our organization. If it is free, where is the commitment to show up for your appointments, show up on time, and take better care of yourself. Healthcare is free, so you can overeat, smoke, relapse on drugs and healthcare will be there for you, it is free! What will happen to the personal ownership in maintaining a healthy quality of life, if it is free?

In my organization the quality of our health care services has dropped because of the overwhelming number of people on Medicaid. We don't have enough staff to properly provide treatment in substance abuse and mental health care. Our appointments are stretched out to every three to four weeks and our therapists are burned out. Where is quality in that? I guess something is better than nothing. Quality vs quantity? A question for all of us to think about.

Thank you for listening.

ProgressiveActivist, BSN, RN · Mar 1, 2016

In Fact, Argue Experts, Sanders''' Medicare-for-All Numbers "Do Add Up"

In the NHS, providers are incentivized through bonuses to keep their patients healthy. There is a big focus on or education and wellness.

People do have the right to make bad lifestyle choices.

According to this, the US squanders 430 billion healthcare dollars a year on unnecessary paperwork and insurance company profits.

That money could be better spent fixing our broken mental health care system.

yukonriver · Mar 2, 2016

What are the bad consequences?

loriangel14, RN · Mar 2, 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

Under a single payer system it is not the government deciding your care.

ProgressiveActivist, BSN, RN · Mar 6, 2016

MrNurse(x2), ADN · Mar 8, 2016

One visual: Veteran's Admisitration

MunoRN, RN · Mar 8, 2016

One visual: Veteran's Admisitration

I'm not sure how you think the VA represents single payer, the VA is government run healthcare delivery, which is a very different thing from single payer.

Pediatric Critical Care Columnist · May 29, 2016

NurseFifty made a statement that access to health care is tied to a Social Security number, but Canada doesn't have those, we have Social Insurance numbers; And it's not true that access to health care is tied to them; it IS tied to a provincial health care number, in Alberta we call them Universal Lifetime Identifiers. Newborns who haven't had their births registered are still able to access required care... I'm sitting next to one of them as I type.

MunoRN mentioned BC sending patients to California for cardiac surgery. Not true. They send their complex cases to Alberta. The Mazankowski Alberta Heart Institute provides cutting-edge cardiac surgical care to thousands of patients of all ages every year, as does the KC Hui Centre at the Royal Alexandra Hospital. The pediatric cardiac ICU at the Stollery Children's Hospital in Edmonton has the best outcomes in North America for pediatric cardiac surgeries over several metrics. None of those families receives a bill for this high-quality care. Patients from all over Canada have their surgeries at the Stollery and the cost of their care is billed to their province of origin.

If there is only a single payer system, would there be as much "business" in healthcare?

There definitely IS less "business" involved here in Canada. Most physicians however do have private practices that require administrative supports and someone to keep track of billing. It's illegal to advertise pharmaceuticals direct-to-consumer and physicians are not really allowed to advertise their services either unless they're providing purely elective treatment (think Botox for wrinkles - Botox for spasticity is covered).

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?

While we want to be seen as meeting patients' satisfaction it's not the driver of our work. The best outcome for the patient is.

Would having a single payer system being more transparency to the actual costs of healthcare?

There was a time when some of the provinces would send out statements of health care expenditures to patients, partly to show what health care actually costs and partly to ensure the care billed for was actually delivered. The administrative costs of this program were determined to be poor value so they stopped doing it. Occasionally the topic comes up but typically dies on the vine.

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.

Supplemental insurance, as stated above, is to cover the things the province doesn't. Most employers provide this coverage at low cost. It pays for vision care, dental care, prescription drugs administered at home, semi- or private hospital accommodations (although many hospitals only have at most 2 patients per room except when on over-capacity protocol), ambulance charges, durable aids like crutches ad wheelchairs and so on.

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.

Not so. I've had several hospitalizations in the past several years, surgeries, diagnostic imaging and many, many labs. I've never been asked to fill out a satisfaction survey. Hospitals have capital budgets that cover the day-to-day costs of running the facility; physicians bill on a fee-for-service basis, labs bill the province based on volumes of tests - a fee schedule is readily available on request. The care I receive is no better or worse than any other person with my health issues.

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.

When more than 30% of all dollars spent on "health care" goes to administration - insurance companies, billing offices, pushing paper around ad infinitum - how can the cost of implementing a single payer, which would eliminate most of that waste, be more expensive than what you're doing?

I'd also like to clear up the piece of misinformation that keeps popping up when universal access and single-payer systems are discussed. The government DOES NOT DECIDE WHO GETS CARE, OR WHAT CARE THEY GET. The government also does not dictate who provides your care. If I don't like my family doctor, I can pick someone else. If I see a surgeon for a consult and decide I don't like his or her bedside manner, I can ask for a referral to someone else. And I will. My husband and son also have chronic health issues - my son's from birth -that are very well looked after. There are worse things than a single-payer, universal access health care system.