How would we make an excellent universal single payer

[mahina]

Last edited Thu Jan 14, 2016, 03:02 AM - Edit history (2)

System?

(I'm removing a para about my local Canadian mates as it apparently makes people lose their reason.)

If we do go to single payer, which I've advocated forever, how would we keep or improve the quality of care?

Hope you have some ideas.

PS to clarify, I think that universal single payer will already be a vast improvement on our current system.

[Kalidurga]

1. Mobile Clinics

more neighborhood clinics. CVS has Minute Clinics have all pharmacies do the same. My neighborhood grocery has a pharmacy and possibly enough room to run a small clinic where they could take care of something like a strep test and other illnesses where all that is needed is antibiotics or pain meds.

[pnwmom]

2. That is a big issue. We simply don't have enough primary care doctors to go around and we need to

start at the medical school level in encouraging more doctors to go in that direction.

[randys1]

28. Higher education is included the way healthcare is, step one. We stop paying

specialists 5 times what a GP makes, to discourage all new docs wanting to be specialists. Maybe 3 times as much is enough.

All physicians are required to participate in the system as well as all hospitals which are now non profit in my scenario.

Becoming a physician is very difficult even if it didnt cost a penny, so at a minimum we reomve the cost issue and in return they are required to participate in our system and while you wouldnt regulate what they make, per se, we would revamp the system so you dont have GP's barely getting by and heart doctors with 4 houses.

[mahina]

40. Wow, good ideas.

Mahalo.

[Docreed2003]

51. Please show where the majority of specialists are making 5x's the salary of primary care physicians

While your point is correct that primary care physicians should be better reimbursed, I think your numbers are a bit off. Most specialists that I know are making 2-3x not 5x's the salary of a primary care physician. Likewise, most specialists are spending 2-5 or more years in training compared to three years for Family Practice, Internal Medicine, and Pediatrics.

That being said, in the current medical environment, all physicians, but in particular primary care, are required to work longer hours and see more patients just to make a living, either to justify their salary from hospital employers or to pay bills for those in a self employed practice. The root problem is not physicians or physician reimbursement. The real issue is the amount of money, and obscene is too nice of a word, that insurance companies are making on the back of patients.

[lancer78]

68. Getting med schools

to accept more students so the prices that doctors charge are not over-inflated because of a lack of demand would be a start.

[1939]

3. Very easy

Make it completely fee-for-service with absolutely no managed care or capitation. Doctor doesn't get any money out of you until he sees/treats you. Increase fees for primary care and reduce fees for specialty care. Incentive fees for rural care and impoverished inner-city care (Okay Doc, you can make this much in suburban LA, this much in Manhatten or you could make this much more in Nowhere, North Dakota or East Bumfuck, West Virginia.)

[Warren Stupidity]

4. Oddly even when Canada was governed by a right wing party for 8 years, there was no

effort at all to abolish their system. Canadians must keep all of that dissatisfaction out of their politics and use it only to complain to people south of their border.

Do you use our healthcare system? You've never had to wait for an appointment? You've never had your care 'managed' by an insurance company?

[laundry_queen]

6. Yeah

they must not complain to each other either, because as a Canadian, I never hear about these complaints from friends and family either. They must save it all up for their special American friends. Because we all know how much Canadians love to bash their health care to Americans. lol.

[Bettie]

9. The Canadian friends I have

are just fine with their system. They think our system is barbaric, because it pushes people into bankruptcy simply for getting sick.

[mahina]

16. I think our system is a human rights violation.

Barbaric is exactly the word.

My question remains though.

[Zorra]

59. Same thing with me. I ask them if they like their health care system, and

they say, "Of course, what's not to like, eh?

It's free."

[mahina]

17. Why so snarky?

Rough day?

Yes, I use our health care system.

[mahina]

23. Say what?

You are calling me a liar?

Oh brother. You are so off-base. Bye now.

[polly7]

25. I already explained down-thread. nt.

[mahina]

26. Hadn't seen it yet. Thank you for clarifying.

[Warren Stupidity]

36. Because I simply don't believe you.

And I note you haven't answered two simple questions about our current system.

Ever wait for an appointment?
Ever have your care managed by an insurance company?

We have rationing of access to services and procedures here too. However our rationing is done, for everyone in the private system, by for profit insurance companies.

Universal health care would add the less than 10% of the population that is currently uninsured. I don't think that is going to overwhelm the system. Many of those people are already using the system, just not through primary care.

You might have to wait a bit longer for non emergency primary care appointments until the increased demand is met by an increased supply of primary care physicians.

[mahina]

38. Sorry you don't believe me.

Aloha.

[polly7]

5. Oooooohhh, finally - the truth!!! Our system is a fucking disaster!!

Please send help .......... quick!


We're dropping like flies up here!




P.S. I call bullshit.

[mahina]

15. You think I'm not telling the truth about advocating for universal single payer?

Wrong.

Peace.

Incidentally, I was hit by a car on a 1000 mile bike ride and was hospitalized in Sherbrooke.
Finished the ride.

No bill. Thanks Canada.

[polly7]

18. Nah ......... I'm calling bullshit on these supposed hellish wait times for appointments.

eta: glad you didn't have to wait around too long for treatment and could finish your ride! Doesn't sound like it really 'sucked' for you?

[mahina]

24. No, it was excellent.

There must be data out there that would answer the question. I'll go look for it on google scholar and leave you to enjoy.

[polly7]

27. You do that.

I've worked in hospitals, nursing homes and with different ambulance services for many, many years and have been an advocate from the beginning of serious illnesses for family members and friends for many more. I KNOW exactly how long wait times are, and yes, your implication they're horrific and make our system 'suck' is absolutely fucking false. I can come up with a hundred personal and professional examples but you're on a mission, so why bother?

Now go google, maybe you can come up with something.

Glad you enjoyed our system. How did you not have to pay anything though?

[mahina]

29. Jesus. I never said your system sucks.

I was on an Outward Bound summer adventure. Maybe they dealt with it, though I don't know why they would.

The only mission I'm on is to learn and try to help. Peace out.

[ljm2002]

7. My experience in talking to a few Canadians...

...about their health care system is different from yours. The ones I have spoken to love it, and the claims I have heard is that the only long waits are for elective procedures.

Beyond that, I ask you: would you rather have to wait for care, or just not get any at all? Because with our system, there are many, many people who simply forego care altogether since they either aren't insured, or their insurance is so minimal that they cannot afford any care at all, what with their deductibles and co-pays.

Bottom line is, our system already sucks, a lot more than a universal care system would suck. All these fears about how much worse it would be, fail to acknowledge how deeply horrible it is right now for the majority of us.

[mahina]

30. I completely read you and agree.

[mac56]

42. As I have said many times, I know many people who would give anything

to be on a waiting list for medical care.

[Cassiopeia]

8. Funny, all of the friends and family I know in Canada rave

about how great and efficient the medical system is. For some it is the one reason they will never leave Canada.

[Amimnoch]

10. Increased University, Charity, and free clinic support/spending

which to a fair extent would come naturally with single payer. The quality of care at those facilities would likewise inrease because they will actually get funding from helping people.

Simultaneously, and less talked about, we need to attack the roots of the problem:
1. Increased pharmaceutical research with cost controls, profit margin restrictions.
2. Path to medical professionalism for the best and brightest of the underprivileged school system. Reward the best performers coming from the poorest schools with assisted scholarships/advanced medical training placement in everything from nursing, PA, GP's, and specialist Dr.'s. With this assistance and path to success tie into it a public service at fixed income requirement for so many years post course completion. i.e. Someone sent to 2 year nursing has to spend 2 years post grad at a government fixed income level that's still reasonable to the training. The higher the level of medical education the more years of post grad service, but also the higher wage for those years. Say you have an area where a MD Podiatrist averages $150,000/year. Pay the program $100,000/year and require so many years of service.

My thought for this program is something close to what the military already does. Puts people through nursing, or medical school on a scholarship then they must serve the military for so many years at a lower income level than if they were in private practice.

1. we need single payer. 2. we need the facilities/hospitals/clinics. 3. we need the trained professionals (with the bonus of a path to success for those with the least privilege)

[mahina]

19. Good ideas!

Mahalo.

[tazkcmo]

11. It sucks because

We don't have it. I wait months for a VA appointment even after the increase in medical personnel Sen. Sanders was able to secure. A wait of just one month would be an improvement. Before that, I was waiting with no end in sight.

[mahina]

20. Read you on the VA.

Before he died my Dad was receiving care there.

He was helped by some amazing human beings who changed his life and mine. How they survived in the system there I'll never know. Good luck tazkcmo.

[Cal Carpenter]

12. What quality of care? Like the highest infant mortality rates

this side of the 3rd world? Look, for most people in the US, waiting a little too long for an appointment is the least of their health care worries. If you are one of those who manages to get what you need affordably and promptly, consider yourself lucky.

Looking at measurable public health outcomes, we have among the worst quality of care among our so-called peers.

Nations with single-payer or other versions of universal health care have significantly better outcomes when it comes to real, measurable benefits, despite the anecdotes of some people you know.

If you don't believe that to be true, why ever would have 'advocated forever' for something you think will lower quality of care?

[mahina]

21. Again.

Sigh.

Anyway, I don't work in the field. I don't know about the outcomes you mentioned, though I'm glad to hear it.

If you think it sucks where you are, try it out here in the middle of the Pacific one day. Ye Gods.

[tkmorris]

13. The Canadian system DOESN'T suck

In fact, Canadians seem to think it's pretty awesome. This has been shown again and again to be true. I have to wonder why you think otherwise.

[mahina]

39. I never said it does.

Thanks though.

[Orsino]

14. We already have single-payer, twice.

VA and Medicare work. It's just a matter of summoning the political will, i.e., money, to make them work better. That'll take a major rebuke/reset of the Republican Party.

We'll get everyone on Medicare incrementally, through a gradual lowering of the qualifying age or disability threshold--to give us time to come up with jobs or guaranteed income for all the displaced insurance workers.

[hunter]

31. Difficult to imagine how it could suck any worse than what my wife and I have experienced...

At one point my wife's COBRA ran out after just as we were nearing bankruptcy, our credit rating in the toilet.

Then she was uninsurable. After a few months of terror she was accepted to our state's high risk insurance pool.

"Obamacare" may have helped, but this was before Obamacare.

Even good medical insurance in the U.S.A. sucks if something too serious happens.

It won't protect you from shit falling out of the sky; in fact it will throw more shit at you.

Most people who think they have good medical insurance are misinformed, deliberately so.

[mahina]

32. This kind of nightmare for so many of us is why we need universal single payer now.

I completely agree with your points. Thanks for making them.

[mucifer]

33. Hate to sound cold but we can't offer everything to everyone.

People should not always have the option of going on ventilators if they are declining rapidly and there is no cure for their disease. Yes, there are some exceptions. But, ventilators don't cure end stage tumors. I also don't think every newborn no matter how premature or how little they weigh should be given the option of aggressive treatment. In many single payor countries they don't allow the family to dictate all situations the way they do in the United States. The costs at end of life here are insane compared to most other countries and the quality of life in an ICU on a ventilator is not great.

In my opinion every hospital should a designated amount of hospice beds for families who don't want their loved ones to die at home. Many hospitals and hospices have these beds available. I think it should be in all hospital and further education for doctors should be taught at medical school regarding end of life symptom management and comfort care.

I am a hospice nurse so I do have strong opinions about this.

[mahina]

37. What a good idea. Mahalo.

Really appreciated.

How is life as a hospice nurse?

[mucifer]

50. It's very interesting. You learn from people.

[RadiationTherapy]

34. Perhaps healing can be a middle class career with high personal satisfaction

rather than a wealth-generating vehicle.

Also, specialists my need to do some GP work for the common good.

[SheilaT]

35. Amazing. You claim to have friends in Canada who

bitch about how long they have to wait for some appointments, and yet every single person who's responded who likewise has Canadian friends says that is emphatically not the case.

Want to edit your OP?

What needs to be done is to increase medical school capacity. The AMA deliberately limited it back in the 1970's and that started a large outflow of Americans to off shore medical schools.

I suspect there's a similar limitation on nursing schools, just from anecdotal evidence of long wait times for admittance, and the chronic shortage of nurses we have.

So start by increasing those two, make medical school free or nearly so, same with nursing school.

All of the money that currently goes to the salaries of the CEOs and upper management of the insurance companies would probably pay for free medical school alone.

[Jim Beard]

58. not to mention foregion students who go back to their country after taking away a slot

in school for someone who is going to stay in America

[Nye Bevan]

41. "Take it from an American - Britain's NHS is as good as it gets"

http://www.democraticunderground.com/10026674096

[mahina]

44. Great info, thanks Nye Bevan.

Lots of interesting comments. Cracked up about the Stephen Hawking one.

[haele]

43. Sounds like your friends are rural, not urban.

A couple friends in BC have complained about waits and having to go over 100 miles to Vancouver or Victoria if they don't want to wait due to the limited capabilities of where they lived.

But when I told them my husband (disabled) and I still have to wait 3 - 4 months even for evaluation tests and for the insurance to "authorize" a particular procedure or test, they stop complaining about the suck of single payer. At least they get seen, even if they have to schedule time off from work to go 50 miles to the nearest clinic with CAT/MRI capabilities for an non-emergency procedure, and there's always access to their doctor in a day or so if they ever need follow-up to emergency or urgent care.

Last year, I had to wait three weeks for my doctor to have an opening after I had a medical problem. No appointments available, so I got triage/palliative care for "back pain and extreme stiffness" at the urgent care clinic - but they wouldn't hospitalize me to actually do the testing to make a diagnosis, because hospitalization and diagnosis in an urgent care situation wasn't authorized by my insurance unless a primary care or emergency room doctor (not the urgent care doctor!) authorized it.
So, I would have to pay $250 out of pocket deductible to go to the emergency room, or take the prescribed pain pills and muscle relaxers and wait for two/three weeks and pay $20 out of pocket to see my doctor, just to get the authorization to get further treatment. Since we were between paydays, I waited. Because of the for-profit insurance pre-authorization policies, if I had something like meningitis or some sort of serious spinal problem that could have been found with follow on testing ordered by the urgent care doctor, I could have ended up paralyzed or worse while I was waiting three weeks to see my doctor because I couldn't afford to go to the emergency room.

This will change in two and a half years, when I can apply for Tricare for Life (single payer for an over 60 military reservist retiree) at 1/4 of the current premium, co-pays and deductibles costs I'm paying for myself and my family. And maybe I'll keep a supplemental insurance policy to cover those few things Tricare doesn't cover - which my employer and most others in my field of employment provide for a whopping $40 a month. No question on what is and isn't covered, authorized, or available, and flexibility as to which doctors you can see when.

And that's how they do single payer health care in some parts of Europe and Canada.

My Canadian friends admit that what happened to me wouldn't have happened to them in Canada with single payer.

Haele

[mahina]

45. Holy smokes.

[laundry_queen]

49. As someone who has lived in rural BC

and has needed to make some of those trips, I can also tell you that specialists will go out of their way to clear their schedules to accommodate 'out of towners'. There was very little wait either way.

Here's a story - my second daughter had congenital bilateral trigger thumbs that didn't lock until just after her second birthday. I didn't know what the heck it was at first - I was concerned she dislocated her thumb (it was only one at first) and took her to the family doctor that day (made an appointment, got in same day). He figured out what it was and told me he would get me in with the nearest orthopedic surgeon. Later that day I got a phone call...they had some openings within the next 2-3 weeks, when could my husband get off work so we could make it down - a 5.5 hour drive? We booked an appointment for 3 weeks later. The surgeon saw my daughter, agreed she needed surgery (an outpatient procedure) and said day surgery dates were only every 2 weeks and that they would be in touch with a date. They called us the next day with a surgery date for 2 weeks from that day. They went above and beyond to make sure we got in as soon as possible, even though technically, it's not an urgent matter and is an elective procedure. They even made an effort that our surgery was first thing in the morning so we could 'shop' in the afternoon (we were required to stay in town for the day and meet with the surgeon for a follow up the next morning), seeing as we were from the boonies, LOL.

I live in an urban area now and the longest I had to wait was to see an ob/gyn for an appointment was for an opinion on what to do about my heavy periods as I get older (my medication works fine, I'm in no distress or anything, just my meds might not be a good idea as I get older, it was more of a proactive appointment). I waited 4 months to get in. But that was in a very urban area, in a specialty that is in very high demand currently, for a totally elective appointment. To contrast, it only took me 2 weeks to get into a neurologist to see about my migraines.

Anyway, likely preaching to the choir here, this was more for the benefit of other posters I really feel for you having to deal with all that insurance company bullshit. I'll never forget when I was pregnant with my fourth...one of my online friends was also pregnant with her fourth and she had the same ob/gyn for her 3 previous deliveries. Halfway through her pregnancy, her husband lost his job, thankfully found another one but they had to switch insurance. Her new insurance did not 'cover' her old ob/gyn. She was so upset she had to switch doctors. I was like WTF, what do you MEAN you have to change doctors??? I gave all my american online friends a little lesson about 'choice' in single payer, and how if I wanted to travel 3 provinces over to deliver my baby with my preferred doctor, I could. It opened some eyes, for sure.

[mahina]

63. Thank you for your post.

Very informative and helpful. Nice to meet you!

I lost my ob when he stopped practicing because of death threats from the anti choice loons. He delivered my son and was such an excellent doc.

Better days!

[KentuckyWoman]

56. THIS

We have people in the USA dying because they cannot afford access. Yes, even people with "coverage".

My sister in law buried her brother last month because he had some pain that he was not sure was life threatening and didn't want to end up with the entire cost of emergency room care if it turned out to be a big nothing. So he made a primary care appointment..... soonest was 3 weeks out. He died 2 days after he called to make the appointment.

Blood clot bouncing around in a major coronary artery finally blocked it up and killed him.

You heard that right. If he goes to ER and it's determined to be life threatening then he gets a $250 co pay. If it's determined to be something less insurance covers NOTHING.

[mahina]

64. I'm so sorry to hear it.

What a horrendous loss, my God.

Peace to your family.

Hoping we can move this forward. It's got to change.

[Kermitt Gribble]

46. Never good to form your opinion on anecdotal evidence.

Canadians overwhelmingly support their system.

Also, you're confusing the argument. Quality of care in the US is not questioned and wouldn't be affected by a switch to single payer. How to give everyone access and how to pay for that care is the argument.

[mahina]

47. Points taken

I think there are some really good ideas up thread in any case.

[lumberjack_jeff]

48. Create more medical schools.

Easy.

Care is expensive and waiting is the norm for the same reason: shortage of doctors - by design.

[underthematrix]

52. Obamacare will eventually evolve into a single payer

universal healthcare system but it's going to be a long long process. This is one of the issues I have with Bernie. He has people actually believing, he's going to take office and implement single payer healthcare. Given how he wants to do it would be a fight of epic proportions. Bernie needs to start talking about the process of change. How he plans to get his policies enacted and funded. Bernie needs to start telling the truth.

[Maedhros]

53. Familiarity breeds contempt.

I spent 1991 - 1995 in Alberta. My son was born there. The quality of care was as good or better than any I've had in the United States, I did not experience any extensive wait times or limited care options.

I would not describe Alberta Health Care as "sucking" in any way.

[mahina]

60. I didn't either.

I can see now, several storms down the road, that I should have made that clearer. I never said and didn't mean that the Canadian system sucks, just wondering how we can make a single payer system that is excellent.

[Maedhros]

65. Overhead on private insurance plans is in the 20-22% range,

while that on publicly-administrated plans is 9-10%.

The reality is, pretty much any single-payer plan is better than what we have now.

[Doctor_J]

54. your premise is bullshit

Canadiens love their system, and single payer doesn't suck. My advice is to call limpballs. You and he are in agreement on the subject.

[mahina]

61. Oh fer Christ's sake.

You just have it so wrong. Read the thread.

So long.

[abelenkpe]

55. The quality of care?

Last time I made an appointment with my doctor the wait was two months. In Los Angeles. Maybe you mean how great it is when the doctor comes to tell you your week old 4.5 lb newborn can't stay in NICU because the insurance company won't cover it? Suppose that's fixed now with no more caps, but instead we have a 10,000 dollar deductible. And insurance costs more. And medications cost more. Seriously our system is cruel compared to what they have in the UK, and Canada. We need single payer.

[mahina]

62. I completely agree.

The status quo says their money is more valuable than our lives, and it can't be left to stand.

[EllieBC]

57. Lack of equipment?

The system up here is overall better. But a lack of equipment is a problem. Like MRI machines, specialists, hospital space sometimes....

The overall good is that they don't boot you out because an insurance company is breathing down their necks. I live in North Vancouver. When my oldest daughter was born, she was extremely premature (24 weeks). She had amazing care and has had amazing care ever since. She wasn't sent home at barely 5lb or on O2 like many preemies in the US are. It's awful they do get sent out so soon. But BC Children's Hospital has had a fundraiser going for over 10 years to expand. It's the only 1 of 2 level III NICUs in BC. And the only children's hospital in the province. And it needs a fundraiser? That's not ok. People have to travel from all over the province if they need services from a children's hospital or they need a level III NICU. And I'm sorry but not everything outside of Vancoucer is "rural".

The bad is this: my husband waited 6 months for an MRI for a work injury. Even WCB was complaining (at us like we can control that). Then he had another 5 month wait for surgery. All while we drowned in bills.

So keeping the infrastructure you have with all those clinics and hospitals and imaging centres would be crucial.

I think our system is overall better than yours. But if we had more...stuff...it would be over the moon phenomenal.

[MillennialDem]

66. Canada's health care is pretty crappy as far as single payer goes. We need to

look at some of the European countries with good systems and largely copy them.

[lancer78]

67. My mom

had to wait several months to remove a hernia with 'Murica health insurance. What are your friends saying they have to wait for exactly?

Your friends in Canada have also never had to suffer, or seen anyone suffer for YEARS because they cannot afford treatment.

I am sure that anything that is potentially fatal, like heart attacks, strokes, and aneurisms(sp) are taken care of quickly.

Sorry, but your OP is just parroting a right wing talking point.

[mahina]

69. Oh my God. Again, I am not saying that

Their system is bad. I'm asking how we can build a better system.

After 15 years of DU, 2 reading before posting, I have never been as discouraged with my fellow DUers as I am now. I've found in this thread many of the stereotypical behaviors that we are painted with. In this thread I've been accused of being a liar and not an advocate of universal single payer. I've been for it for the last 25 years. That along with publicly financed elections are the two most needed steps to restore this country in my view, and I've done the work to get us there every step of the way.

It's been a disappointment, to understate.

I wonder if people who make assertions such as yours, and the other similar posts upthread, took the time to read through the thread before making them. I guessing not. If you do so, you will find several posts with excellent suggestions for building an excellent universal single payer system. I hope you take notice of them, as it must matter to you, as it does to me.

It's so easy to slam somebody without listening or in this case reading. Stunning.
I changed my headline and text to try to be clearer. You spend a decade plus on a site and think people get you; mostly, not so.

I won't hold my breath for an apology. Hope you are able to help move universal single payer forward. We need it urgently.

Keep the faith.