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How is that "single-payer"? That sounds more like "public option", unless you mean that the NHS has an enforced monopoly on certain aspects of heath care. If

How is that "single-payer"? That sounds more like "public option", unless you mean that the NHS has an enforced monopoly on certain aspects of heath care. If that is the case, then raynier's statistic is still relevant.

AstralStorm 7y ago
The difference is that there is main payer and extra insurance that not everybody has. Or rather, most people don't. Think Medicare but actually cheap and working.
- vonmoltke 7y ago
  Maybe I misunderstand how the UK system is set up. I thought the NHS was not just the payer, but also the provider. How does extra insurance affect services that people go to the NHS for?
  - michaelt 7y ago
    The NHS provides and pays for NHS services. One can also buy medical care privately, outside of the NHS - paid for either with cash, or by private medical insurance (paid for either with cash, or by your employer) Services outside of the NHS may have more luxurious facilities, shorter waiting lists, and more flexible appointment times. Some doctors will do both NHS work and private work. If you need fertility treatment, a physiotherapist to look at your sport injury, speech therapy, or a 10 minute doctor's consultation over video chat at 7pm, the private medical system can provide that. On the other hand, many services are unavailable outside the NHS; there are no private ambulances or accident-and-emergency facilities.
    - vonmoltke 7y ago
      That description makes the NHS sound like a two-tiered system, not a single-payer system. Digging into this on Wikipedia[1][2] and seeing the same health systems referred to as "single-payer" and "two-tier" depending on the context now has me royally confused about what "single-payer" actually means. [1] https://en.wikipedia.org/wiki/Single-payer_healthcare https://en.wikipedia.org/wiki/Single-payer_healthcare [2] https://en.wikipedia.org/wiki/Two-tier_healthcare https://en.wikipedia.org/wiki/Two-tier_healthcare
      - tomp 7y ago
        I don't think that "single payer" means anything concrete at all... it's just a question of, can a "normal person" get most of his potential medical needs covered without paying through the nose, going bankrupt, getting substantially sub-standard service, etc. For example, AFAIK in Switzerland, it's again completely different - everyone is obliged to buy medical insurance (privately, employers cannot offer it), hospitals (and insurance companies) are private, what you get depends on how much you pay (though everyone gets really good care, it's more like, do you share a room with other patients or not), the government covers if you're too poor to pay... Is this single payer or not? It doesn't matter, as long as most everyone is covered and happy. (Admittedly, Switzerland is in a privileged position with high salaries and cost of living, being the world's bank... not sure if other countries can afford to replicate their system.)
tomp 7y ago
Sure, call it anything you want. But by your logic, there's no "single payer" anywhere on Earth because I can always just fly to the US and pay a doctor out of pocket (so I'm the "other payer").
- vonmoltke 7y ago
  No, because the world isn't a single health care market. Our ability to get health care outside the countries of our citizenship or legal residence is limited. Single-payer is only relevant for a single market. How else could you possibly describe it?
steveklabnik 7y ago
The UK isn't the only place that does this. I'm in the US, but my understanding is that the public gets a minimum level of heathcare, provided by the state. You can additionally decide to pay extra money for fancier care if you want more than what you're getting.
- kaibee 7y ago
  > I'm in the US, but my understanding is that the public gets a minimum level of heathcare, provided by the state. You can additionally decide to pay extra money for fancier care if you want more than what you're getting. Sorry if this comes off as snarky but, "fancier care" like, for example, the required dose of insulin? http://nymag.com/intelligencer/2019/07/another-person-has-died-from-rationing-insulin.html http://nymag.com/intelligencer/2019/07/another-person-has-di...
  - steveklabnik 7y ago
    It’s not snarky at all; this is an issue that affects me personally, my partner is type 1 and so I interface with this particularly disgusting aspect of American healthcare all the time. I could rant endlessly about how much of a travesty “care” for folks with diabetes in the US, especially compared to Europe. I think you’ve misunderstood my comment though; I’m saying that’s how it works in many countries, and not in the US. The US clearly does not offer an acceptable base minimum of healthcare to its citizens. (EDIT: It's also a shame you've been downvoted, though, I think that this is a completely reasonable reading of my comment, even though it's not what I meant.) I personally am of the “Medicare for all is not enough” persuasion. I’m left by European standards, and off the charts for the US.
    - RHSeeger 7y ago
      Thanks for the clarification. I misread your comment, too, so odds are it wasn't as clear as it could be.
      - steveklabnik 7y ago

AstralStorm 7y ago

The difference is that there is main payer and extra insurance that not everybody has. Or rather, most people don't. Think Medicare but actually cheap and working.

vonmoltke 7y ago
Maybe I misunderstand how the UK system is set up. I thought the NHS was not just the payer, but also the provider. How does extra insurance affect services that people go to the NHS for?
- michaelt 7y ago
  The NHS provides and pays for NHS services. One can also buy medical care privately, outside of the NHS - paid for either with cash, or by private medical insurance (paid for either with cash, or by your employer) Services outside of the NHS may have more luxurious facilities, shorter waiting lists, and more flexible appointment times. Some doctors will do both NHS work and private work. If you need fertility treatment, a physiotherapist to look at your sport injury, speech therapy, or a 10 minute doctor's consultation over video chat at 7pm, the private medical system can provide that. On the other hand, many services are unavailable outside the NHS; there are no private ambulances or accident-and-emergency facilities.
  - vonmoltke 7y ago
    That description makes the NHS sound like a two-tiered system, not a single-payer system. Digging into this on Wikipedia[1][2] and seeing the same health systems referred to as "single-payer" and "two-tier" depending on the context now has me royally confused about what "single-payer" actually means. [1] https://en.wikipedia.org/wiki/Single-payer_healthcare https://en.wikipedia.org/wiki/Single-payer_healthcare [2] https://en.wikipedia.org/wiki/Two-tier_healthcare https://en.wikipedia.org/wiki/Two-tier_healthcare
    - tomp 7y ago
      I don't think that "single payer" means anything concrete at all... it's just a question of, can a "normal person" get most of his potential medical needs covered without paying through the nose, going bankrupt, getting substantially sub-standard service, etc. For example, AFAIK in Switzerland, it's again completely different - everyone is obliged to buy medical insurance (privately, employers cannot offer it), hospitals (and insurance companies) are private, what you get depends on how much you pay (though everyone gets really good care, it's more like, do you share a room with other patients or not), the government covers if you're too poor to pay... Is this single payer or not? It doesn't matter, as long as most everyone is covered and happy. (Admittedly, Switzerland is in a privileged position with high salaries and cost of living, being the world's bank... not sure if other countries can afford to replicate their system.)

tomp 7y ago

Sure, call it anything you want. But by your logic, there's no "single payer" anywhere on Earth because I can always just fly to the US and pay a doctor out of pocket (so I'm the "other payer").

vonmoltke 7y ago
No, because the world isn't a single health care market. Our ability to get health care outside the countries of our citizenship or legal residence is limited. Single-payer is only relevant for a single market. How else could you possibly describe it?

steveklabnik 7y ago

The UK isn't the only place that does this. I'm in the US, but my understanding is that the public gets a minimum level of heathcare, provided by the state. You can additionally decide to pay extra money for fancier care if you want more than what you're getting.

kaibee 7y ago
> I'm in the US, but my understanding is that the public gets a minimum level of heathcare, provided by the state. You can additionally decide to pay extra money for fancier care if you want more than what you're getting. Sorry if this comes off as snarky but, "fancier care" like, for example, the required dose of insulin? http://nymag.com/intelligencer/2019/07/another-person-has-died-from-rationing-insulin.html http://nymag.com/intelligencer/2019/07/another-person-has-di...
- steveklabnik 7y ago
  It’s not snarky at all; this is an issue that affects me personally, my partner is type 1 and so I interface with this particularly disgusting aspect of American healthcare all the time. I could rant endlessly about how much of a travesty “care” for folks with diabetes in the US, especially compared to Europe. I think you’ve misunderstood my comment though; I’m saying that’s how it works in many countries, and not in the US. The US clearly does not offer an acceptable base minimum of healthcare to its citizens. (EDIT: It's also a shame you've been downvoted, though, I think that this is a completely reasonable reading of my comment, even though it's not what I meant.) I personally am of the “Medicare for all is not enough” persuasion. I’m left by European standards, and off the charts for the US.
  - RHSeeger 7y ago
    Thanks for the clarification. I misread your comment, too, so odds are it wasn't as clear as it could be.
    - steveklabnik 7y ago