My friend, you’ve been sold a story about Canadian healthcare that is a complete lie. It’s a province-based system that is in complete shambles. Just look at what Doug Ford, the premier (equiv. to governor) of Ontario has done: https://www.ona.org/news-posts/20221124-healthcare-union-sos/
What would likely work the best in the US is a system akin to Australia’s. It’s federal-based, and is a combination of public and private. Private health insurance still exists to cover “gap” fees and similar, but, similar to medicaid, low/no-income earners don’t pay. America is already doing most of this, but nationalising most hospitals would be required, as well as forcing private health insurers to divest ownership of other medical clinics. This would be to eliminate the inane “in-network” crap, which we don’t have in Australia (for the most part).
Doctors here aren’t employed by the government like with the NHS in the UK either. They’re able to run private clinics, and can charge above the government “bulk-billing” rebate. That government rebate is set nation-wide for all services in a master price-list, and is always paid out for those services whether the patient has private health or not. Then the provider and insurance negotiate for what is paid above and beyond that only. This gap fee can be paid directly by the patient, or by private health insurance. Clinics generally waive these fees for both disability and aged pensioners.
It’s far from perfect, but I think the US would need to follow a system like this. Otherwise doctors, used to a certain wage and lifestyle, would likely revolt in some fashion.
Alberta adopted this model and saw an increase in public health wait times and a sharp increase in the required government spending required to run the public system.
Creating a two tiered system means that it bleeds doctors, nurses and admin into the private sector which is fundamentally at odds with the philosophy that everyone deserves the right to life sustaining care. If the rich want to dodge the cue then they can quite frankly afford the plane ticket. If the system is being undermined by politicians - oust the politicians. Let them know that that system is of the highest priority and should be first to see reinvestment.
But we should all be aware that Canada is one of the most challenging landscapes for delivery of any kind of health care. We are diffuse over a large landmass and the commitment to the system means that if you live in a remote place 2 hours away from the nearest surgery then the government is on the hook to spend an outsized amount of budget to uphold the commitment of care for you. The temptation to cut corners is always there and each Provincial trust is its own battleground. That we have the level of service we do is a credit to the efficacy of public health systems… Which means upping the costs to create competitive private sector development hurts us all.
It may be a step up for Americans to have any system at all as a right to health safety net but it’s a sharp step down for anywhere running a full public system.
The point of my comment is that doing it that way would be far more likely to actually be supported in the US politics, given the current state of their system. It feels like so many people there want to skip straight to single-payer. Having that goal is counter-productive, it’s never going to happen.
This take really completely misses the point of my comment. US doctors still make much more money than UK ones who work under the NHS. Obviously insurance companies and hospital administration make the vast majority of it. They can safely be ignored if you were transitioning the system, as they provide literally no value. If you try and pay all the doctors less though, and they revolt, you won’t have anyone to do the actual work.
My doctor wants me to come in monthly just to see him for 5-10 minutes just so I can get refills. The price is over $200, but I only pay $65. Plus the cost of perscriptions. Over the course of a year I am paying over a weeks pay just so I can have meds.
My friend, you’ve been sold a story about Canadian healthcare that is a complete lie. It’s a province-based system that is in complete shambles. Just look at what Doug Ford, the premier (equiv. to governor) of Ontario has done: https://www.ona.org/news-posts/20221124-healthcare-union-sos/
What would likely work the best in the US is a system akin to Australia’s. It’s federal-based, and is a combination of public and private. Private health insurance still exists to cover “gap” fees and similar, but, similar to medicaid, low/no-income earners don’t pay. America is already doing most of this, but nationalising most hospitals would be required, as well as forcing private health insurers to divest ownership of other medical clinics. This would be to eliminate the inane “in-network” crap, which we don’t have in Australia (for the most part).
Doctors here aren’t employed by the government like with the NHS in the UK either. They’re able to run private clinics, and can charge above the government “bulk-billing” rebate. That government rebate is set nation-wide for all services in a master price-list, and is always paid out for those services whether the patient has private health or not. Then the provider and insurance negotiate for what is paid above and beyond that only. This gap fee can be paid directly by the patient, or by private health insurance. Clinics generally waive these fees for both disability and aged pensioners.
It’s far from perfect, but I think the US would need to follow a system like this. Otherwise doctors, used to a certain wage and lifestyle, would likely revolt in some fashion.
Alberta adopted this model and saw an increase in public health wait times and a sharp increase in the required government spending required to run the public system.
Creating a two tiered system means that it bleeds doctors, nurses and admin into the private sector which is fundamentally at odds with the philosophy that everyone deserves the right to life sustaining care. If the rich want to dodge the cue then they can quite frankly afford the plane ticket. If the system is being undermined by politicians - oust the politicians. Let them know that that system is of the highest priority and should be first to see reinvestment.
But we should all be aware that Canada is one of the most challenging landscapes for delivery of any kind of health care. We are diffuse over a large landmass and the commitment to the system means that if you live in a remote place 2 hours away from the nearest surgery then the government is on the hook to spend an outsized amount of budget to uphold the commitment of care for you. The temptation to cut corners is always there and each Provincial trust is its own battleground. That we have the level of service we do is a credit to the efficacy of public health systems… Which means upping the costs to create competitive private sector development hurts us all.
It may be a step up for Americans to have any system at all as a right to health safety net but it’s a sharp step down for anywhere running a full public system.
The point of my comment is that doing it that way would be far more likely to actually be supported in the US politics, given the current state of their system. It feels like so many people there want to skip straight to single-payer. Having that goal is counter-productive, it’s never going to happen.
Its not the doctors who are reaping the benefits its the insurance companies and hospital administration that make most of the money
This take really completely misses the point of my comment. US doctors still make much more money than UK ones who work under the NHS. Obviously insurance companies and hospital administration make the vast majority of it. They can safely be ignored if you were transitioning the system, as they provide literally no value. If you try and pay all the doctors less though, and they revolt, you won’t have anyone to do the actual work.
My doctor wants me to come in monthly just to see him for 5-10 minutes just so I can get refills. The price is over $200, but I only pay $65. Plus the cost of perscriptions. Over the course of a year I am paying over a weeks pay just so I can have meds.