6 ms·
There is a big difference between single-payer and a nationalized healthcare system. In the latter, doctors are government employees. The UK and Canada work tha
by MichaelSalib 14y ago
There is a big difference between single-payer and a nationalized healthcare system. In the latter, doctors are government employees. The UK and Canada work that way, and choose to spend very little money on healthcare. But most peer nations have single-payer non-nationalized healthcare systems and choose to spend more than Canada and the UK, but much much less than the US.
With a single payer, the commercial service objective is warped: patients and doctors are motivated to make care decisions that are inefficient or even harmful, and customer service or premium care for people who want it is eliminated.
See, this is not true at all. Consider the French system. Basic care is provided by a government plan, but doctors don't work for the state and everyone can supplement with private coverage if they want to pay extra.
- tptacek 14y agoSingle payer implies that negotiations, budgeting, and coverage decisions are made by the government, who is the "single payer" the term refers to. That doctors ostensibly work for private companies doesn't ameliorate the Republican concern here.
- MichaelSalib 14y agoBut the existence of the French or Japanese or Dutch healthcare systems do. At some point, empty theorizing has to give way to observation of how these systems actually work in practice. In practice, all of these systems provide care that is much much cheaper than the US system with very high levels of public satisfaction. Also, I think you're wrong in claiming that the Republican party rejects single payer for those reasons. The Republican party loves single-payer healthcare for old people. They expanded the single-payer program for old people massively and they make political hay out of any efforts to reduce its spending.
- tptacek 14y agoThis comment does not respond to the issues I brought up in my comment at all. In fact, my comment ends with "I support single-payer". Did you think I was arguing that it was unworkable? My issue was with the mischaracterization of the Republican position. The Dutch system, for what it's worth, strongly resembles the trajectory we are on with PPACA: guaranteed-issue private health insurance and Medicare.
- jules 14y agoNote, for what it's worth, the Dutch system does not work as well as that of our neighboring countries. Here people often have to wait a long time to have something done, whereas for example in Belgium you are helped much quicker (resulting in some Dutch people going to Belgium for healthcare).
- tptacek 14y agoIt appears that the model for the US more closely matches that of Switzerland, for what it's worth. That might just be me idealizing it, though.
- danielweber 14y agoThere are lots of different systems of health care. Even though in most places the government pays the bill, the method of implementation varies widely.
- arethuza 14y ago"doctors are government employees" Not all doctors in the UK are government employees working in the NHS - there is a private health care system here as well. Nobody makes you go or work for the NHS - but you do have to pay for it - I have private health insurance from my employer (I would never pay for it myself although I could afford it) and I'm quite happy to pay for the NHS. NB My son was born in an NHS hospital, when he has had an accident it's the dedicated NHS childrens hospital he gets taken to, when my wife got seriously injured climbing it was an NHS hospital that treated her - all of which were awesome. The NHS is far from perfect but I like knowing that everyone in this country can get a decent standard of healthcare free at the point of delivery "In Place of Fear": http://en.wikipedia.org/wiki/Aneurin_Bevan http://en.wikipedia.org/wiki/Aneurin_Bevan
- tptacek 14y agoThe entire private health care budget in the UK is £5Bn. The second largest purchaser of private care in the UK is... wait for it... the NHS. The NHS budget is over £100Bn. The government has overwhelming control over the health care market of the UK.
- arethuza 14y agoBut as a consumer of health care in the UK I'm struggling to see what the problem is - the NHS is cost effective and generally available and if you want a slightly nicer room and to jump the NHS waiting queues (which do happen) then you can go private and get any kind of treatment pretty much when you want it.
- ollybee 14y agoMost Family doctors in the UK are self employed anf their surgeries have contracts with an local primary care trust. There are other models as well and big changes in the arrangements this year. The organisation of the NHS is complex (this is not a criticism).
- run4yourlives 14y agoNo doctor in Canada is a government employee. They are all self employed, and some even receive payments privately. The issue you are getting at is that for some (most) services, only the Government can be a "legal" customer.
- jimbokun 14y agoHaving a single "customer" and having a boss is a pretty fine semantic distinction, don't you think?
- run4yourlives 14y agoYes and no. "most" is not equivalent to "all", and there are several private health practices in Canada. http://falsecreekhealthcare.rtrk.ca/ http://falsecreekhealthcare.rtrk.ca/ http://www.csc-surgery.com/ http://www.csc-surgery.com/ There is an ever increasing grey area in Canada with regards to what procedures can be paid for by entities outside of the Government. It was actually recently found unconstitutional to deny someone willing to pay directly their medical services.
- anigbrowl 14y agoThe UK and Canada work that way, and choose to spend very little money on healthcare. And yet going to the doctor or the hospital in the UK is a relatively painless experience, other than in the clinical context.