With all this talk about healthcare I thought I’d delve into it a little..
There are a few ways that single-payer can work, but at its core it is the government paying for healthcare services through revenue generated via taxation.
Put another way, people who live in a country pay into a pot of money through their taxes. The government then takes this pot of money and pays drugmakers, healthcare facilities, and doctors.
One of the hallmarks of a single-payer system is the ability for the government to have more control over prices.
For instance, in many single-payer systems, the government can negotiate prices for prescriptions drugs since it controls the purse for much of the spending. This makes sense because in the case of the UK, nearly 80% of the healthcare spending comes from the government. So if a drug is not bought by the government, it almost totally closes off the market to a pharmaceutical company. This gives the government a lot of bargaining power.
Payments to healthcare providers, prescription drugs, and other aspects of the system are all subject to price negotiation with the government in single-payer systems.
Across different countries, however, it can take different forms.
Canada’s single-payer system is mostly run by provincial and territorial governments, but is funded heavily by the federal government. The federal government also sets baselines of standards for care at the provincial level.
Healthcare spending per capita (2014): $4,728
Out-of-pocket spending per capita (2014): $644
Percent of GDP spent on healthcare (2015): 10.1% (11th-highest among OECD)
Percent of healthcare costs from the government: 69.8%
The UK technically has four different national healthcare systems, one for each country that makes up the union, but the general construct is known as the National Health System.
Within the NHS, there is a system of smaller community health boards that help ensure that national standards for care, cost, and efficiency are maintained.
For patients, the NHS is generally “free at the point of use,” meaning that when you go to a hospital or doctor’s office there are no bills or co-pays.
The UK pays for all this using both a specific national insurance tax on people making more than £157 per week and general tax funds to provide 98.8% of the funding for the NHS. The other 1.2% is paid for by out-of-pocket costs for things like prescriptions and dental care. The cost of co-payments for the out of pocket procedures are set by the NHS.
Healthcare spending per capita (2014): $4,094
Out-of-pocket spending per capita (2014): $586
Percent of GDP spent on healthcare (2015): 9.8% (13th-highest among OECD)
Percent of healthcare costs from the government: 79.5%
Taiwan’s healthcare system is run through the National Health Insurance Administration and features a premium-based system different from Canada and the UK.
Instead of money taken out of annual taxes, Taiwanese make monthly premium payments based on their payroll income and nonpayroll income. There are also taxes on tobacco and lottery winnings that add money to the system. Premium payments are split between employers, the government, and individuals with adjusted rates based on income levels.
Put another way, instead of taking a chunk of money from overall taxes into the system, the Taiwanese pay a monthly fee from their paychecks that goes directly into the pot.
There is some co-payment and co-insurance that fall on citizens, but these levels are capped based on criteria like the type of sickness or the length of stay in a hospital.
There are two types of coverage in Germany: statutory health insurance (SHI), aka sickness funds, and private health insurance (PHI).
As a way to think of it, the SHIs are more like the single-payer government-funded plans like the UK and Canada, while the PHIs operate like the US system. Since there are two groups, this means the country does not qualify as single payer.
SHIs are made up of nonprofit firms that compete to sign up Germans, funded through a premium-based payroll tax split between the worker and their employer and taxes in the German Health Care Fund. SHI insurers are then reimbursed by the government on a risk-adjusted basis (meaning those that have sicker customers get more, while those with a healthier pool get less). There are some co-payments for care under an SHI, but these are fairly low. For instance, co-pays for prescriptions range from five to 10 euros.
Healthcare spending per capita (2014): $5,119
Out-of-pocket spending per capita (2014): $664
Percent of GDP spent on healthcare (2015): 11.1% (4th-highest among OECD)
Percent of healthcare costs from the government: 74%
On cost, here’s an article I found. Most of the articles I have found read a lot like this though some seem to think that single payer will drive down the overall quality of care. Some seem to think it will never happen because of the pressure doctors,for profit hospitals, drug companies and insurance companies that have a vested interest will fight to keep it the same as it is now.
Thanks to a landmark study in 2013 by Gerald Friedman, Professor and Chairman of the Department of Economics at the University of Massachusetts, we have a solid financial analysis of the costs and benefits of a single-payer national health plan. With NHI, $592 billion would be saved annually by cutting the administrative waste of some 1,300 private health insurers ($476 billion) and reducing pharmaceutical prices to European levels ($116 billion). These savings would be enough to cover all of the 44 million uninsured (at the time of his study) and upgrade benefits for all other Americans, even including dental and long-term care. A single-payer public financing system would be established, similar to traditional (not privatized) Medicare, coupled with a private delivery system. Instead of having to pay the increasing costs of private health insurance, so often with unaffordable deductibles and other cost-sharing, patients would present their NHI cards at the point of service without cost-sharing or other out-of-pocket costs. Care would be based on medical need, not ability to pay.
They’re kidding right…What qualifies Nikki Haley as Sec State…Of course I could ask what qualifies anyone in the WH circus.
This is your Friday open thread…Fire away!
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