Single-Payer Healthcare: Part I

During the run-up to Obamacare we heard a lot about “Single-payer Healthcare.” With the implementation of Obamacare, such talk slipped into the shadows — but it’s back. Senator Bernie Sanders has started his cries for “Medicare for all,” which was what he called his Single-Payer Healthcare program when he first began to tout it. But it is anything BUT Medicare.

The concept of Single-Payer is amazingly complicated. It is imperative that Americans get familiar with it because what we are hearing from the Left about it is just beginning. Their drumbeat for “Healthcare for all is a right” is just beginning. Those drums will quickly get louder and louder.

What is Single-payer healthcare?

Single-payer healthcare is a healthcare system in which the state, financed by taxes, covers basic healthcare costs for all residents regardless of income, occupation, or health status. The alternatives include “multi-payer” systems in which private individuals or their employers buy health insurance or healthcare services from private or public providers. Single-payer systems may contract for healthcare services from private organizations (as is the case in Canada) or may own and employ healthcare resources and personnel (as is the case in the United Kingdom). “Single-payer” describes the mechanism by which healthcare is paid for by a single public authority, not the type of delivery or for whom physicians work. In contrast, multi-payer healthcare uses a mixed public-private system.

Where does Single-payer Healthcare exist today?

Various nations worldwide have single-payer health insurance programs. These programs generally provide some form of universal healthcare, which is implemented in a variety of ways. In some cases doctors are employed, and hospitals are run by the government such as in the UK or Spain. Alternatively, the government may purchase healthcare services from outside organizations, such as the approach taken in Canada.

Canada

Healthcare in Canada is delivered through a publicly funded healthcare system, which is mostly free at the point of use and has most services provided by private entities. The system was established by the provisions of the Canada Health Act of 1984. The government assures the quality of care through federal standards. The government does not participate in day-to-day care or collect any information about an individual’s health, which remains confidential between a person and his or her physician. Canada’s provincially based Medicare systems are purposefully kept as simple as possible to restrict administrative costs. In each province, each doctor handles the insurance claim against the provincial insurer. There is no need for the person who accesses healthcare to be involved in billing and reclaim. Private insurance represents a minimal part of the overall system.

In general, costs are paid through funding from income taxes, except in British Columbia, the only province to impose a fixed monthly premium which is waived or reduced for those on low incomes. A health card is issued by the Provincial Ministry of Health to each individual who enrolls for the program and everyone receives the same level of care. Virtually all essential basic care is covered, including maternity and infertility problems. Depending on the province, dental and vision care may not be covered but are often insured by employers through private companies. In some provinces, private supplemental plans are available for those who desire private rooms if they are hospitalized.

Cosmetic surgery and some forms of elective surgery are not considered essential care and are not covered. These can be paid out-of-pocket or through private insurers. Health coverage is not affected by loss or change of jobs, as long as premiums are up to date, and there are no lifetime limits or exclusions for pre-existing conditions. Pharmaceutical medications are covered by public funds or through employment-based private insurance. Drug prices are negotiated with suppliers by the federal government to control costs. Family physicians (often known as general practitioners or GPs in Canada) are chosen by individuals. If a patient wishes to see a specialist or is counseled to see a specialist, a referral can be made by a GP. However, specialists care is NOT covered unless deemed essential.

Canadians do wait for some treatments and diagnostic services. Survey data shows of those needing to see a specialist, 89.5% wait less than three months. Of those waiting for diagnostic services such as MRI and CAT scans, diagnostic tests defined as “non-emergency magnetic resonance imaging (MRI) devices; computed tomography (CT or CAT) scans; and angiographies that use X-rays to examine the inner opening of blood-filled structures such as veins and arteries,” 86.4% wait less than three months. Of those waiting for surgery, 82.2% wait less than three months.

Taiwan

Healthcare in Taiwan is administrated by the Department of Health of the Executive Yuan. As with other developed economies, Taiwanese people are well-nourished but face such health problems as chronic obesity and heart disease. In 2002, Taiwan had nearly 1.6 physicians and 5.9 hospital beds per 1,000 population, and there were a total of 36 hospitals and 2,601 clinics in the country. Health expenditures constituted 5.8 percent of the GDP in 2001, 64.9% of which coming from public funds.

The current healthcare system in Taiwan, known as National Health Insurance (NHI), was instituted in 1995. NHI is a single-payer compulsory social insurance plan which centralizes the disbursement of health care funds. The system promises equal access to health care for all citizens, and the population coverage had reached 99% by the end of 2004. NHI is mainly financed through premiums, which are based on the payroll tax, and is supplemented with out-of-pocket payments and direct government funding. In the initial stage, fee-for-service predominated for both public and private providers. Most health providers operate in the private sector and form a competitive market on the health delivery side. However, many healthcare providers took advantage of the system by offering unnecessary services to a larger number of patients and then billing the government.

The NHI is touted around the World by single-payer proponents as being the marquee of all such healthcare systems. In a government-run single-payer system like Taiwan’s, technical health care issues like higher premiums are inherently political issues, tied to the political establishment. In a recent report on PBS, politicians have been wary of increasing premiums since 2002 “because everyone is concerned about courting the voters’ favor.” Unfortunately, NHI needs steady revenue to help cover the cost of the benefits it offers, which are comprehensive. In a 2003 Health Affairs article, it was noted that NHI covers “inpatient care, ambulatory care, laboratory tests, diagnostic imaging, prescription and certain over-the-counter (OTC) drugs, dental care (except orthodontics and prosthodontics), traditional Chinese medicine, day care for the mentally ill, limited home health care, and certain preventive medicine (pediatric immunizations, adult health exams including pap smears, prenatal care, and well-child checkups),” and even “expensive treatment for HIV/AIDS and organ transplants.”

The combination of generous benefits and relatively meager contributions from the insured has created a system where there are insufficient resources left for other aspects of  health care outside of coverage. “There’s very little R&D, according to the PBS report on its Sick Around the World special. The budget just isn’t there…There is no technology assessment, or very little, except for drugs, and there’s just slower overall adoption of new technology… There’s very low doctor-to-population [1.5 for every 1,000 people], nurse-to-population ratios [3.6/1,000]. So overall, Taiwanese feel the tightness everywhere.

United Kingdom

Healthcare in the United Kingdom is a devolved matter, with England, Northern Ireland, Scotland and Wales each having their own systems of publicly funded healthcare, funded by and accountable to separate governments and parliaments, together with smaller private sector and voluntary provision. As a result of each country having different policies and priorities, a variety of differences now exist between these systems. Despite there being separate health services for each country, the performance of the National Health Service (NHS) across the UK can be measured for the purpose of making international comparisons. In 2015, the UK was 14th (out of 35) in the annual Euro health consumer index. It was criticized for its poor accessibility and “an autocratic top-down management culture”. The index has in turn been criticized by academics, however.

Each NHS system uses General Practitioners (GPs) to provide primary healthcare and to make referrals to further services as necessary. Hospitals then provide more specialist services, including care for patients with psychiatric illnesses, as well as direct access to Accident and Emergency departments. Community pharmacies are privately owned but have contracts with the relevant health service to supply prescription drugs.

Summary

Single-payer Healthcare is obviously different from country to country. The commonality is that the federal government of each country that has such a healthcare system is the primary source of regulation and funding. Operating rules, regulations, covered services, etc., vary from country to country.

By now you are probably asking, “What’s the price citizens in these countries pay for coverage?” and “What would single-payer cost in the U.S.?” and “What would coverage be in the U.S.?” As promised, in Part II of this we will answer these three questions in detail tomorrow. You probably will be surprised when you look in.

You may want to forward this segment to people you know or simply share on your social media outlets. You can bet the Liberals in the America are going to escalate their push forward to replace Obamacare with single-payer healthcare. Before the arguments begin — and there will be many and they ALL will be loud and ugly — it would be smart to listen to all of those armed with facts.

You’ll get those facts here.


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