
California considers a single-payer, universal health care plan - HoppedUpMenace
http://www.mercurynews.com/2017/02/17/california-lawmakers-to-introduce-medicare-for-all-health-plan-on-friday/
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johan_larson
The article mentions the Canadian health care system, which I can speak of,
since I live in Canada.

In Canada, most health care is paid for by provincially funded systems which
pay health care providers directly. Here in Ontario, our system is called
OHIP. Canada also places limits on drug prices.

The system is mostly working. If you need routine or critical care, you get
it. But there are some issues. If you need expensive medical care for a
condition that isn't killing you right now -- hip replacements are the common
example here -- you can expect to wait quite a while because only so many
treatments are funded every year. Some people who have such conditions do
travel abroad to have them fixed, at their own expense, but that is quite
rare. Not a lot of people can fork over the six-figure sums for such
treatments out of pocket. I suppose if things started fraying, people would
start buying US medical insurance, but we're definitely not at that point now.

Also, it can be quite hard to get a family physician in small and midsize
towns, because few physicians want to locate there. When I lived in Kitchener,
I called around to some physicians, and they all had one-to-two-year waiting
lists. Fortunately there are plenty of walk-in medical centres, which are
staffed by physicians, and there they'll see you right away.

Generally, my sense is that the Canadian system is working, but there are some
issues.

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seehafer
You've described a system wherein waiting lists are pervasive. Why do you
think it's working?

(This doesn't imply I think the _American_ system is working. On the contrary,
I think it's a mess.)

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johan_larson
"Pervasive" sounds like an overstatement. Most conditions don't have waiting
lists. But a few do.

In the medical field, I don't think it's possible to give people everything
they want, because some people want _everything_ done to keep them alive but
some treatments are horrendously expensive. Any funding system is therefore
going to have some sort of shortfall; someone isn't going to get everything
they want. The best that can realistically be done is to ensure that the
shortfalls between want and get are never too severe, and are generally
distributed in some fair and sensible way. As far as I can tell, the Canadian
system meets those criteria.

To be clear, I do think the Canadian system could be improved. To give just
one example, I think it should be legal to pay for your own medical procedures
out of pocket. If you have the funds to pay the full freight, who are we to
stop you? But that would mean a two-tier system, one for the rich and one for
the rest of us, which is currently politically unacceptable in Canada.

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edblarney
" Most conditions don't have waiting lists. But a few do."

Almost all conditions have delays that are considerably longer than other
systems.

Just getting to see a specialist for something benign can take months.

If you have highly specialized needs (such as a sports injury) - it can be
very problematic.

"I think it should be legal to pay for your own medical procedures out of
pocket. "

Some degree of privatization would be a good start.

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sjg007
Waitlists are a red herring. It'll take 3-6 months here too. people over 65
get them, that's all Medicare. Even if it was regular insurance you'd still
see waitlists for the doctors due to demand.

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bobbington
In general money makes the world go round. It takes a lot of very smart people
working very hard to innovate. That's only going to happen when there is a lot
of money. So I'm not against profit in the medics industry. Without profit, I
think cures would come out much slower becuase smart people would move to make
money elsewhere.

It stinks that health care is so expensive. But by moving to a single payer
system, innovation will be stifled. Temporarily that may be fine, but it's
like killing the goose that lays the golden egg. Innovation will slow and in
maybe 10 years we will be worse off than we were before

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benplant
It seems that you are suggesting that the profits made by insurance companies
is the key factor funding innovation in health care. This might be worth
looking into, but I doubt this is true. It seems just as plausible if not more
so that government grants in a country with single payer health care would
drive innovation. The government would have an interest in both improving the
health of citizens and finding new methods/techniques that reduce the cost of
diagnosis and treatment.

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daveFNbuck
The usual argument is that single payer will be cheaper because the single
payer has a strong negotiating position from which to pay doctors and drug
companies less. The suggestion is that the profits made by drug companies are
a key factor in innovating health care.

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sjg007
Good. It'll be even better if multiple states decide to pool together and go
single payer as well.

