Canada's Single-Payer Health Care

[Michael McAllister]

I have only heard about Canada's health care through anecdotal accounts.  While I have seen charts from economists suggesting that it is much more cost-effective than the United States, there has also been a common theme of fear of scary socialism, particularly among older individuals who conflate it with communist Russia.  A similar plan is being proposed by presidential candidate Bernie Sanders.

 

As a disabled person, I have government insurance essentially.  The issue is in the U.S. that medical professionals also deal with many other insurance companies.  Medicare/Medi-Cal recipients are turned away because of this.  My previous pharmacy (Walmart) wouldn't fill my prescription as they no longer accept Medicare.

 

Unfortunately, I don't travel much so it's not likely that I will ever be able to experience the difference first-hand.  There are wait times for elective surgeries.  That much I know, but what exactly is defined as an elective surgery?

[ShiftHitTheFan]

Well, for the past month I have been in and out of the hospital constantly due to extreme inflammation of the small intestine / apendix. I actually had to withdraw from school for this semester due to lack of energy  (and the fact I had missed a month of practical classes). If I was in the States, I know I would be in debt. 

 

Hospitals here are usually slower to process from the ER than in the States, and usually have a good wait time. If it's not acute pain, expect to wait a couple hours before seeing anybody. A lot of ER departments are understaffed around  here, so there is always a bit of confusion there.

 

I would say here in Ontario, the hospitals are basically the same, just slower, and accept your healthcard instead of a Credit card for payment. ( it's basically like a driver's license, but for your health records)

 

The cost is there, and our taxes are higher.  But I don't mind that because I KNOW that if I ever get hurt, I WILL be able to go to a hospital and receive propercare. I personally feel that Canada is one of the best countries in the world for healthcare and services.

[Michael McAllister]

How are the primary care clinics?  At least for me, I don't need to go to the hospital that often.  When I get sick, it's usually taken care of through a general practitioner.

[Okjoek]

I have to admit Canada is looking more and more attractive a place to be. Not sure I would ever follow through, but it is always an idea that's available. I mean it is just across the lakes from me. I just hope I never have to move just to escape such rampant social inequality and unrighteous policies. I'm rooting for Bernie too so we can have great qualities you speak of like the healthcare, but our political system is very rigged to prevent the right things from happening.

[ShiftHitTheFan]

1 hour ago, Michael McAllister said:

How are the primary care clinics?  At least for me, I don't need to go to the hospital that often.  When I get sick, it's usually taken care of through a general practitioner.

How it works is that for acute pain, you go the the ER. For other things, it's private. So family doctor / dentist. Different for each business.

 

For doctors notes and simple stuff, you go and visit your family doctor. Most doctors work together to make a central office. It's free for us patients, but they charge the government for their work. My last doctors note for work was $20, as a flat fee. They all usually have small fee's to deter everybody for coming in for every brise and cut.

 

There are also walk in clinics in larger cities for people who don't have a family doctor, but I have no experience with those. Basically the same as a private office I guess.

 

 Dentistry is usually not covered completely, so you still have to pay for checkups and general cleaning, but any larger medical stuff is covered. For example when I had my wisdom teeth removed, the total cost was $4000 aprox. But we only had to pay about $300 due to government and work benefits in the end. Cleaning usually is $100 twice a year.

[Mug]

Just saying, anything is better than America's system.

 

I'm not even going to argue for the UK's system because whilst it is worlds ahead of America's, it's still not perfect.

I reckon the best one is France's one. They pay more there for it (11% GDP) vs UK (9%) and it's mostly a private system. Thing is that it's a private system done right; with perfect competition. No-one can compete with the US for the quality of care received because it's so ridiculously expensive but the French system combines the best of both worlds and gives you amazing quality of care at a reasonable price. Also, the poor don't pay for it so that's even better. The lack of competition and regulation in the US system means that you're paying so much more, 20% of your GDP goes towards healthcare. That's outrageous. Something must be done and quickly.

 

I think the trouble with the NHS was that it was a complete experiment with almost no precedent. When it was introduced it made the mistake of basically trying to replace all healthcare rather than plugging the gaps. This resulted in huge expense to the British taxpayer. What should've been done is setting up the NHS gradually. Whilst I support Bernie Sanders, he clearly needs to look back at history and the mistakes that were made. Gradual reform of healthcare is much more effective than immediate reform. What really needs to happen in the US in my opinion is this:

• Profits of healthcare companies limited to 0.5% and a windfall tax (excess profits turned over to the government)
• Government should control the bargaining of drugs etc, creating a single government body for negotiation of all medical supplies.
• Maximum percentage administration cost applied - lowering administration costs
• Maximum rates for particular care - e.g. in the UK a doctor's appointment cost just £20, similar maximum fees should be applied in the US.
• Requirement for healthcare providers to not pay dividends or be listed on stock markets
• Laws against the consolidation of healthcare to promote monopolistic behaviour
• Anti-discrimination laws for providing healthcare to minorities, the elderly and the disabled
• Healthcare should be considered a public service in a greater way in law
• The right to receive affordable healthcare should be written into the constitution

I reckon by implementing those, America would have a much easier time providing healthcare it its citizens and it'd be much more affordable to people. Government regulation of a service as important as healthcare isn't socialism, it's common sense.

[beebskadoo]

@nicehat I choose you!!!

this is a thread tailor made for your skills!

[Michael McAllister]

5 hours ago, Mug said:

Just saying, anything is better than America's system.

 

I'm not even going to argue for the UK's system because whilst it is worlds ahead of America's, it's still not perfect.

I reckon the best one is France's one. They pay more there for it (11% GDP) vs UK (9%) and it's mostly a private system. Thing is that it's a private system done right; with perfect competition. No-one can compete with the US for the quality of care received because it's so ridiculously expensive but the French system combines the best of both worlds and gives you amazing quality of care at a reasonable price. Also, the poor don't pay for it so that's even better. The lack of competition and regulation in the US system means that you're paying so much more, 20% of your GDP goes towards healthcare. That's outrageous. Something must be done and quickly.

 

I think the trouble with the NHS was that it was a complete experiment with almost no precedent. When it was introduced it made the mistake of basically trying to replace all healthcare rather than plugging the gaps. This resulted in huge expense to the British taxpayer. What should've been done is setting up the NHS gradually. Whilst I support Bernie Sanders, he clearly needs to look back at history and the mistakes that were made. Gradual reform of healthcare is much more effective than immediate reform. What really needs to happen in the US in my opinion is this:

• Profits of healthcare companies limited to 0.5% and a windfall tax (excess profits turned over to the government)
• Government should control the bargaining of drugs etc, creating a single government body for negotiation of all medical supplies.
• Maximum percentage administration cost applied - lowering administration costs
• Maximum rates for particular care - e.g. in the UK a doctor's appointment cost just £20, similar maximum fees should be applied in the US.
• Requirement for healthcare providers to not pay dividends or be listed on stock markets
• Laws against the consolidation of healthcare to promote monopolistic behaviour
• Anti-discrimination laws for providing healthcare to minorities, the elderly and the disabled
• Healthcare should be considered a public service in a greater way in law
• The right to receive affordable healthcare should be written into the constitution

I reckon by implementing those, America would have a much easier time providing healthcare it its citizens and it'd be much more affordable to people. Government regulation of a service as important as healthcare isn't socialism, it's common sense.

To give you an idea of our spending:

 

[Michael McAllister]

It's scary that we spend so little on science...

[nicehat]

As a dual citizen thats lived in both countries, single payer indeed seems to have its advantages on the surface. 

 

For example, according to the world health organization: 

 

 

The US has a life expectancy 4 years less than Canada, yet we have 7% more expenditure of our GDP. So why dont we just switch over? 

 

Single payer although effective in Canada, might have limitations in terms of scalability and scope. For example, there are more people in California than there are in Canada. What works for 35 million Canadians may not be effective for 320 million Americans. With this greater population comes greater challenges in terms of demographics and expensive morbidities that hit americans much harder than canadians per capita. 

 

Single payer isnt all that great either. Other than longer wait times for things like elective surgeries (non emergency related), there are also issues with supplying quality physicians. Canada's doctor-patient ratio is among the worst of any industrialized nation: with just 2.2 physicians per thousand people, it ranks 24th out of 28 OECD countries. Among the G8 countries, Canada ranks dead last when it comes to physician supply. This is precisely why its so hard to see a doctor in Canada. The reasons for their shortages are a bit out of scope for here, but Primary Care Doctors are in immense demand especially in rural areas of this country. That means that you need to promote doctors to go into primary care rather than specialize. This can only be done through incentives like a competitive market place which wont exist in single payer. Speaking of rewards, Doctors wont be incentivized to provide above average care if the pay scale is uniform. You will get the bare minimum of care possible, and that isnt going to go down easy here.

 

There are also other financial difficulties. The government would have to restructure medicare and medicaid into a single regulated pool. Regulated pools of money means decisions are made into what treatments are paid for and what arnt. The almost reflexive poor public opinion produced words like "Death Panels" and were thrown around in lieu of the affordable healthcare act. It were these sentiments that brought about the fall of the much anticipated "public option" which would act as the default health net for those that did not/could not afford private insurance, yet did not qualify for medicare/medicaid. It was a beautiful solution to include those left out of the system. When the public option was marketed in democratically held congress alongside state exchanges + national exchanges + medicare/medicaid, spineless democrats basically caved for the minority republicans in fear of being seen as "too social". 

Other than requiring taxes being hiked across all incomes, single payer also means that doctors get paid less. Which isnt possible because it takes alot of student debt to be a doctor in the first place (speaking from experience). Now you can mandate higher levels of care for less (which is what the affordible care act does), but it means more government involvement which is something americans want less of. With reports of Medicare remaining solvent through 2030, what we unequivocally need are not band-aid money infusions from congress, but a fundamental change. For starters, a public option that runs beside national private insurance exchanges if you can afford it and want all the fixings. This will increase competition among insurers and include people into the private market who are closer to the poverty line. The public option should be paid into by everyone which means higher taxes (suck it up america you greedy bastards), and will include those that are left out of medicare/medicaid (people just above the poverty line). All of these things would also stop this:

 

 

 

 

 

[Michael McAllister]

Why would there need to be multiple insurers for competition?  Pharmaceutical companies and private practitioners would compete, no?  US administrative costs are crazy because health care is commodity here.