Path: number1.nntp.dca.giganews.com!internal1.nntp.dca.giganews.com!border2.nntp.dca.giganews.com!nntp.giganews.com!cyclone1.gnilink.net!gnilink.net!news.glorb.com!postnews1.google.com!not-for-mail
From: jonathansmith99@yahoo.com (Jonathan Smith)
Newsgroups: alt.cancer.support, alt.support.diabetes, fidonet.diabetes,
misc.health.diabetes, talk.politics.medicine
Subject: Re: Single Payer Universal Health Care
Date: 26 May 2004 07:07:02 -0700
Organization: http://groups.google.com
Lines: 143
Message-ID:
References:
NNTP-Posting-Host: 198.182.177.3
Content-Type: text/plain; charset=ISO-8859-1
Content-Transfer-Encoding: 8bit
GMT)
NNTP-Posting-Date: Wed, 26 May 2004 14:07:02 +0000 (UTC)
Xref: number1.nntp.dca.giganews.com alt.cancer.support:834
alt.support.diabetes:314575 fidonet.diabetes:369 misc.health.diabetes:290854
talk.politics.medicine:99348
Alan Mackenzie wrote in message news:...
> Jonathan Smith wrote on 25 May 2004 13:26:16
> -0700:
> > Alan Mackenzie wrote in message
> > news:...
> >> Jonathan Smith wrote on 24 May 2004
> >> 19:24:20 -0700:
> >> > trexo@encompass.net wrote in message
> >> > news:...
> >> >> In alt.cancer.support Evelyn Ruut wrote:
> >> >> > Make a single payer universal health care system and all the
> >> >> > prices will go down.
>
> >> >> There is NO free lunch. Name a 'single payer' system that doesn't
> >> >> have shortages and long delays for complex treatments such as surgery,
> >> >> etc.
>
> >> > I'd even be impressed if she could name one where there isn't a waiting
> >> > list for simple things like diagnostic xrays and specialist referrals.
>
> >> Funny, that. Last Monday (8 days ago), I fell off my bike and landed
> >> heavily on my ribs. Last Tuesday, on waking up, the pain was still
> >> significantly above what wasn't worrying, so I visited my Doc. He said,
> >> better get those ribs (and left-hand middle finger) X-rayed. I was back
> >> in that Doc's surgery little more than an hour later, carrying an
> >> enveloppe with the requisite X-rays. Luckily, nothing was broken.
>
> >> I'm not sure what you people mean exactly by a "single payer" system.
>
> >> Here in Germany,
>
> > Germany is NOT a single payer system.
>
> What does "single payer system" mean?
One payer - typically the central government - for all medical
services.
> > It is a employer mandated insurance system funded by employer
> > contributions through a system of private (quasi-private) insurance
> > carriers (Krankenkasse) and delivered through a primarily private
> > delivery system on a fee for service or local budget (depending on
> > provider type) basis.
>
> >> health insurance through the "Krankenkassen" is compulsory for people
> >> earning less that a fairly high threshold (around 4,000 Euros/month).
> >> The premium paid depends only on one's income, and is around 14% of
> >> salary (with a maximum corresponding to that ~4,000 Euro threshold),
> >> half of it being paid by the employer.
>
> > It is an employment tax - on the employer. The 7% metric is one of
> > convenience for accounting. There is an upper limit - the most you
> > will pay is 250 Euro per month. If your earnings are under 1000 Euro
> > or so a month, you get a subsidy.
>
> >> The unemployed and poor are not excluded. This system works very
> >> well, despite the recognised inefficiencies and, to some extent,
> >> corruption.
>
> > The system works well BECAUSE it is NOT single payer. In the US, the
> > poor are not excluded. The unemployed are not excluded either - there
> > is COBRA.
>
> Who is/would be the "single payer" in the US?
There is a system of care financing provided to the elderly called
Medicare. Tis is the closest model of single payer in the US.
> >> High earners may stay in the normal Krankenkassen insurance scheme, or
> >> they may opt for private insurance, or even decide to pay for
> >> treatment as they need it. Having opted out of the Krankenkassen,
> >> they may not later rejoin them, since the Krankenkassen operate on the
> >> basis of people "overpaying" when young and healthy and "being
> >> subsidised" later in life when no longer so healthy.
>
> > No, that is not exactly true.
>
> How not? Apart from people opting out, it is entirely true.
The premiums paid are based on income and age at enrollment. It is
not a medical savings account.
> > However, the equilibrator is, once you go private, your annual premium
> > is determined by the age cohort premium for the age at which you
> > entered the system. In other words, as long as there is continuity of
> > coverage there's no change in premium (other than for inflation).
>
> >> The system has recently been "reformed" (worsened, I would say) in
> >> that patients now have to pay a 10 Euro charge per quarter on visiting
> >> a doc., and have to pay fairly hefty prescription charges (10% of the
> >> cost, min. 5 Euros, max 10 Euros, but never more that the retail cost
> >> itself). Sadly, the government didn't have the resolve to tackle the
> >> inefficiencies and corruption in the various medical and insurance
> >> systems. Maybe that will come.
>
> > In Germany you have one of the more functional and equitable systems
> > of health care financing. You also have some of the best quality care
> > and excellent access. You also have the same set of problems that
> > other systems face - you are spending a lot of money for this and the
> > amount you spend keeps going up.
>
> Very true.
And it isn't a single payer system.
> >> I would not swap this system for anything the USA currently offers, and
> >> would be very wary of moving there, even were I completely healthy.
>
> > The system you describe IS the system that 163 million Americans have.
>
> Is it not the case that leaving a job in the USA typically imperils one's
> medical insurance?
Not necessarily. In fact, it is quite rare though politically it is a
big to do. There is a system of COBRA which provides for health care
insurance continuation for 18 months. Most people who switch jobs do
so in a much shorter period. As long as you keep up with the premiums
you are fully covered. Once you start in your new position, you
become eligible for the plan there and there is a smooth transition.
> > Private insurance with premiums funded by contributions from
> > employees and their employers with comprehensive cover, nominal cost
> > sharing, and excellent access and outcomes.
>
> The essence of the system in Germany is that it is comprehensive,
> encompassing everybody. Also that what one pays is dependent only on
> one's means, not on one's health.
The positive part of the German system is not the funding - however,
what is good is that the top end earners pay more, but not
proportionately more. With a cap of 3500 Euro or so of income liable
to the 7% tax, the costs are reasonable. In the absence of the cap,
it would be a draconian redistribution of wealth.
> The population of the USA is a good
> deal higher than 163 million, isn't it?
Yes - 40 million are elderly and are covered under Medicare. Another
40 million or so have public sector insurances - VA, DoD, or Medicaid.
And the last 40 million have no health care INSURANCE. That makes
283 million Americans.
js
|