The majority of single payer systems don't outlaw private care. There are private hospitals in the UK for example.
Single payer is about removing insurance companies from the process (saving money), standardising care (saving money, improving outcomes), collective bargaining for drugs (saving money), providing a base level of care to all (saving money and improving QOL). But it doesn't usually forbid spending money on private care.
As a result single payer results in similar outcomes for vastly less public money, and almost zero private money spent on healthcare.
Thing is a good public option decimates the market for advanced private care of the level you have in the US.
Here in Norway the private health providers that do exist mostly deal with low-investment, low-asset, high-return cases. They will look into your psoriasis but ain't going to treat your cancer.
Fortunately the advanced care in public system is great. Still it's not unheard for patients that can afford it to go to the USA for specific treatments.
> decimates the market for advanced private care of the level you have in the US.
> Still it's not unheard for patients that can afford it to go to the USA for specific treatments.
They're often getting very expensive, but not very good, treatment that do not lengthen life nor improve quality of life. Sometimes these treatments reduce length of life or quality of life.
No, I'm talking specifically about things like bleeding edge treatments for late cancer stages accessible only in top U.S. hospitals. Treatments that are still in trials or just approved and not available in Norway yet.
Sometimes they would work and sometimes they wouldn't, but in Norway your option then is basically arranging your own funerals.
In fact a single payer system alongside private insurance works really well to keep the private insurance providers honest. Up against a single payer one of their primary value add for most people isn't even better health care per se but better customer service, faster appointments, clear and helpful advice, etc. This is a good deal for the NHS as well because they still get your tax contributions but the private system takes some of the load off them.
In theory I'm mostly a Friedmanite. I think he has good reasons for preferring private enterprise for most thing. In theory private enterprise should be able to provide better health care than a public system as well. The problem is politics, lobbying and market distortions always introduce complications and obstacles. Health care is one of those markets where the resources and incentives on the provider side just overwhelm the ability for private individuals to get a fair deal.
I'm very glad we have the NHS over here, yes it has inefficiencies and weaknesses but compared to the horror show in the US I think it's far preferable.
Ideally though, all private healthcare would be banned.
Aside from ideological concerns about not giving the wealthy an unfair advantage, this has pragmatic benefit in ensuring that the public healthcare system is up to standard.
That is, if the wealthy and powerful are forced to use it too, it means they have skin in the game and won't just use their power to run it into the ground in pursuit of profit or from lack of concern for others.
Interestingly, private healthcare isn't banned in Canada but in in reality, there's virtually none of it. The system is designed so that the public sector doesn't subsidize a potential private sector, and without those subsidies, nobody's interested.
Personally, I agree with you. Private healthcare should be abolished entirely.
In the UK, about 10 percent has private insurance, but nearly all private plans are 'top up' type plans where the assumption is that you usually rely on the NHS first, but ask for a private referral if you need a specialist or procedure there's a wait for.
As a result they're generally pretty cheap.
In effect you're paying to jump queues for a limited resource.
Disagree on private healthcare being abolished. If people want to spend their own money outside the single payer system, why not let them? It doesn't absolve them of contributing to the public system, so the public system benefits when they decide to go outside it.
And in Canada, there isn't much private healthcare because of the way Medicare is set up. A doctor has to choose - practice in the public system or the private system - they can't do both.
As a result, you have a handful of doctors who do private with the majority in the public system. For certain procedures there is actually a lot of private healthcare in Canada. Take a look at MRI's. Instead of waiting 2 or 3 months for an MRI you can pay $300 and get one this week and send the results to your doctor.
It varies from province to province [0]. What you're saying is true in some provinces but not all. However, even in the provinces without material barriers, no private sector exists. The article actually provides some solid theories.
Your information about MRI waiting times isn't accurate in general - or rather paints only part of the picture. Even with the COVID situation happening now, in Ontario... Patients who should be scanned immediately receive a scan, immediately. Patients who should be scanned within 2 days are in fact scanned within 2 days. Patients who have a target of 10 days for a scan wait closer to 18 (but 53% are scanned within the SLA). Patients who have a target of 28 days wait closer to 90. [1].
If you don't need one now, you're wasting capacity by getting one now. This capacity should be allocated 100% to the public sector on a need basis. That would reduce wait times for all priorities. This is in fact what the British Columbia government did [2] to excellent effect [3].
"For the 90th percentile wait times, the improvements are even more significant. Province-wide, wait times went from an average of 221 days to 161 days."
That's a success? Waiting half a year for an MRI?
Come on. I'm Canadian and know plenty of Canadians. Wait times are one of the major issues in Canada. Yes, if you don't need it right now, you wait - sometimes years. But sometimes you need it in the next few weeks and you wait months.
90th percentile wait times for the lowest priority class - anyone who needs an MRI badly gets one immediately - literally, immediately, you walk into the next room. I’ve seen it happen to family. Yes it could be better still, yes it was improved by having the province purchase private facilities, and yes an improvement is a win.
The challenge with transparency like this is you see a number like that and freak out. The reality is need based triage works and plays a huge role.
Their goals are likely a few months, due to low need. Not every MRI needs to happen right right now, and that attitude is part of why there are wait times and shortages in the US too. Still cold and should be better!
"217,500 Canadians left the country for health care in 2017, according to Statistics Canada. If those travelling with the patients are included in the count, the total rises to 369,700 people."
In your link, US is even lower. So if someone praises Canadian system in comparison to US one, it is still correct.
It is absurd to show link that ranks Canada higher then US despite having problems and then proceed to ... call US the best. Also, Americans near border travel to Canada to buy drugs pretty routinely despite it being illegal.
I know dozens that went to the US for treatments. Some even took out second mortgages because it was a choice between languishing on a waiting list with a heart condition that can kill you, or getting it fixed next week.
I suspect their new insolvency created a different kind of heart condition.
One way of deriving this is the cost of an average hip replacement in the US is $100,000 USD ($128K CAD) - how many Canadians have a spare house kicking around to finance a hip? Probably not that many.
Further, this paper, [1] and this write-up [2].
If you actually read the policy brief on which your article was based [3] you'll find a few interesting things. For one, they acknowledge that this travel includes traveling for non-covered procedures like cosmetic plastic surgery. It also implies snowbirds are not covered in this data, but then acknowledges in the next line that they probably are too but they don't have actual breakdowns other than their own "knowledge" that people are leaving due to wait times.
"The federal agency wasn’t able to provide a breakdown of patients seeking medically-necessary procedures and those leaving Canada for cosmetic surgery." This feels like important information to know.
I find this paper incomplete and un-compelling.
With that said I did find this statement in the second street brief pretty funny: "While health care debate in Canada often focuses on comparing our current system with the United States, readers should note that the Commonwealth Fund report ranked the United States 11th out of the 11 countries it examined."
> Private healthcare should be abolished entirely.
Wouldn't this mean using the police to arrest people if, e.g. a person got a doctor to look at them or suggest a treatment for a condition and it wasn't something that had gone through government channels?
But if you refuse to pay the fine on the grounds that you consider it unethical to withhold medical care from someone who requests it, you’d still be subject to incarceration?
Replying here because rate limiting, and I find this conversation interesting :)
> it may not be a legal defense but it is absolutely a moral defense.
I suppose that's so.
> I just want to make it explicit that you agree with the criminalization of healing people without permission.
By framing your reply as "criminalization of healing people without permission" you have baked in a lot of unstated assumptions:
1. The person doing the 'healing' has met your personal standard for a 'healer' - in this case foreign experience. Without licensing, I could, with no experience whatsoever, just cut you open and go to town. You would die, and then what? Who's liable? What if I get half way through and then realize that Milton Bradley's Operation is not a replacement for Grey's Anatomy and you are rushed to a real hospital?
2. You assume the 'healing' is successful. Does it become butchering if I fail to do so?
So, to that end, while I may not agree with all aspects of licensing physicians (for instance, I'm with you on the foreign degree and experience limitations) I believe that on the whole it does more good than harm.
I will therefore be explicit and say, yes, I do "agree with the criminalization of healing people without permission [of competent authorities]," even if I do not today agree with all of their requirements, however I reject your framing.
> The person doing the 'healing' has met your personal standard for a 'healer' - in this case foreign experience.
I'm not imposing my standards for a healer on a sick person in his personal quest for a healer.
> Without licensing, I could, with no experience whatsoever, just cut you open and go to town.
Indeed, you could do the same thing absent a license in a regulated regime, and also you could get a license and kill me on purpose and say it was an accident or unfortunate outcome. What the requirement for a license does is create a class of people who are approved healers, and criminalize medicine outside of that state-sponsored context.
> You would die, and then what? Who's liable?
You'd be liable, just like you would if there were licenses and you either had one or did not. Or are you referring to the fact that physicians are shielded from liability if they meet industry accepted standards of care?
> You assume the 'healing' is successful. Does it become butchering if I fail to do so?
I don't assume that. I'm just referring to the telos of the act. You're allowed to give people free tattoos. You're not allowed to give them a tattoo if you claim it is medicine. It doesn't matter if its a drug or whatever. The intent to heal is what's criminalized here.
> So, to that end, while I may not agree with all aspects of licensing physicians (for instance, I'm with you on the foreign degree and experience limitations) I believe that on the whole it does more good than harm.
The problem arises when you enforce your values on other people who do not share those values because of your belief that "on the whole it does more good than harm."
> I will therefore be explicit and say, yes, I do "agree with the criminalization of healing people without permission [of competent authorities]," even if I do not today agree with all of their requirements, however I reject your framing.
Thanks for your reply and thanks for engaging my perspective directly :)
This situation exists today. Let's say I'm a physician, with experience from a foreign country and a years-long unimpeachable track record. What I don't have is a US degree or residency. I'm 100% going to prison if I perform a surgery in my van. Licensing and various other requirements are imposed on physicians in order to practice lawfully. One of those requirements would be not to accept direct payment for services outside the public system. If you do, then you are practicing without a license, and whatever comes of that comes of it. Likely a fine, or license suspension or if you continue to defy the law, prison.
Your argument that "you consider it unethical to withhold medical care from someone who requests it" is not a defense today for practicing medicine without a license, and in my scenario, that would not change.
> This situation exists today. If I'm an physician, with experience from a foreign country and a years-long unimpeachable track record. What I don't have is a US degree or residency. I'm 100% going to prison if I perform a surgery in my van.
I agree and this is terrible.
> Your argument that "you consider it unethical to withhold medical care from someone who requests it" is not a defense today for practicing medicine without a license,
it may not be a legal defense but it is absolutely a moral defense.
> in my scenario, that would not change.
I just want to make it explicit that you agree with the criminalization of healing people without permission.
Thank you for the information - it is interesting to learn of a case where discouragement and disincentivisation, in lieu of abolishment, has turned out to be a reasonable and pragmatic secondary option.
Single payer is about removing insurance companies from the process (saving money), standardising care (saving money, improving outcomes), collective bargaining for drugs (saving money), providing a base level of care to all (saving money and improving QOL). But it doesn't usually forbid spending money on private care.
As a result single payer results in similar outcomes for vastly less public money, and almost zero private money spent on healthcare.