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Old 5th November 2019, 05:27 PM   #146
Norman Alexander
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Originally Posted by Segnosaur View Post
This depends on how the system is implemented, but I suspect that doctors 'adding fees' (in order to cover expenses like malpractice insurance, or anything else) would be considered illegal. That's the way Canada does it... everything (at least in terms of basic medical coverage, not including dental/eye care) is covered by the government program.

Buy it is still a cost that impacts health care. That was the point of my earlier post: That there are costs that will not be impacted by a switch to single payer unless other changes are made.
I understand. In Australia we "copied" the Canadian model because it was a good fit. But it is not pure single-payer for everything. Ours is a single-payer for basic coverage grafted to optional private coverage for the rest.

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Yet you still made that argument, without clarifying what that impact would be.
As we both know, the specifics of the positives and negatives could take volumes to cover. I think we are limited to 65536 characters here on the forum.

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A happy medium that allows treatment or diagnostics within a few days is superior to a months/years long waiting list.
Agreed. In Australia, a fairly broad diagnostic service industry has sprung up to meet the demand for this sort of thing. They are private businesses, but they are recompensed to a large extent by government out of the health budget. Most major suburbs and towns have such a centre. Not all are fully stocked with everything. But the vast majority of common diagnostics, usually blood-work, X-ray and CAT scan, can be done. So delays in getting diagnostics is more a matter of being able to access one of these centres, i.e. proximity, as no doubt you have in Canada. But rarely does the queue for services exceed a few days.

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I never claimed that waiting lists were due to negligence or lack of empathy.

But, here in Canada it is due to a combination of slow government response and a need to fulfill multiple priorities that also include non-medical needs (such as basic infrastructure, defense, policing). Plus, the priority of the patient may not necessarily line up with the priority of the officials making the health care decisions.
Do doctors in Canada really have to bow to the will of the faceless Ottawa wonk? I suspect they will get patients into diagnostics and procedures as soon as they can.

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Again, the issue is if people push for single payer because "gee wiz, its cheaper" then they will have to justify how people may have their health care treatments delayed.
I think that is too narrow a view. In the USA, while services may be readily available on demand, we see frequent reports that many people do not avail themselves of it due to cost factors. Posters here bitch about how ACA has made it even more expensive! If they are out of work, or even if they have low incomes, they could have no effective insurance, or insurance that does not cover their needs. So the cost of a CAT-scan or MRI would not be covered. So they have no choice - they cannot afford their necessary care. It doesn't matter if the Rolls Royce on sale is silver or gold if you have only a dollar to spend on food this week.

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Yes, 2 examples. I gave those specifically to personalize the type of situations find themselves under, so that hopefully people recognize that "Waiting lists? No big deal" is a foolish argument.
I agree. It is a foolish argument...that I never made. They will happen; it's not good; the issue needs addressing. I hope you can kick some butt in Canada about it (I have Canadian friends). But being on a waiting list of any length is better than not being on a waiting list at all.

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But here's the thing: keep in mind that many (probably most) people DO have health insurance of some kind. And those people can often get better treatment (read: faster service, better tools) than people in places like Canada.
The news we hear is that is not the case. It would be more accurate to say "Most employed adult people have health insurance of some kind". That's not the same as in Canada.

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Now, the problem when people discuss health care is that not everyone agrees on the same terms. To many, "Single payer" simply means "universal". To others, Single payer is a lot more focused: it means no private insurance at all; everything is covered by the government program. (This appears to be what Sander's plan is. I'd have to look at Warren's plan in more detail to see if it is the same.)
Could not agree more. But mostly because the terms being thrown around by the GOP have become pejoratives. Anything they don't like gets labelled "SOCIALISM!!TM" and is to be expelled like the Devil himself.

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I think the U.S. system needs to be reformed. But I think going to a true 'single user' system is a mistake. The best health care systems are the ones that merge private and public systems.
Also agree.

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If you tell people who do have coverage "Your own health care and that of your family will get worse, so that some unnamed person might be better off", you might have a hard time getting broad public support.
But they are willing to throw huge amounts of federal taxes into a big pot to fund their military in exactly the same way a unified public health system would require, even though they won't get a personal soldier to come defend their private property.

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But when it does happen, the patient has no options. (Well, unless they're rich enough to become a medical tourist).
There's that issue again - cost!

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Yes, I know its covered now. That's why I said "There was a point" where treatment was not provided in Ontario. It was an accepted treatment in the United States, but the government here said "Nope".

The fact that the government finally adopted it doesn't change the fact that there was a time period when it didn't cover the treatments.
We have a similar issue. Our government often waits to see if new treatments are proven and popular in the USA before providing support here. It's simply cost - they aren't prepared to run testing regimes parallel to the US ones when they can get the same outcomes by just waiting and watching over the Pacific.

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Again we have to deal with what exactly 'single payer' means. Universal coverage but with private options for better service? A public option to cover those that private health care missed? True single payer with no private options at all?

The only western country that has adopted a 'no private insurance' scheme (like the one pushed by Sanders) is Canada, and we generally rank near the bottom of various health care rankings. The better options mix private and public in various ways, and usually end up better off for it.
Australia is such a mix. It has its issues though. There's a constant shift of the balance between coverage under the general health scheme, the cost to the taxpayer, and the benefits of private health insurance/care. It's complicated...

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When it comes to basic health care (i.e. not including drugs, vision, dental) Canada comes closest to a "true" single payer. And our system falls behind other countries.

Strangely enough, I have no problem getting fast treatment for vision or dental. But then those are paid for by private insurance. What are the odds?
Same here. Because they are paid-for private services that make a profit. So they should deliver. Yes, I do understand that is what medical care is supposed to be about, and that's why the US mode is to expect good medical care because of the profit motive. The problem is that the profit becomes more important than the customer. If the customer is not profitable, they will prefer not to service them.

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Well, that is the line that Sanders seems to be pushing [all public only].

From: https://www.cnn.com/2019/07/03/polit...ity/index.html
Under the Sanders proposal, private health insurance companies would be eliminated. Every resident would be covered by a single government insurance program that would pay the entire cost of almost every health care service and product...

Its a plan that goes beyond even what Canada offers.

And then there is Warren's plan:

From: https://www.businessinsider.com/what...dustry-2019-11
Private insurance would be eliminated. Warren argues that would save hundreds of billions of dollars in administrative spending, and relieve patients of the hassle of dealing with their insurer.
  • Americans would no longer have to worry about reaching their deductibles or whether their doctors are in their insurance network.
  • They'd pay no premiums and have "virtually no" out-of-pocket costs, according to Warren. They'd have expansive health benefits, including long-term care, audio, visual, and dental.
  • They'd also have no choice about any of this.
The first 2 points may sound great. The last point may cause some problems.
Indeed. From a broader perspective, it gives the GOP a point to lever the clarion accusation of "SOCIALISM!!TM" come election time.
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