Romney and Obama are not the only people in US politics. There are multiple proponents of single-payer model (which is obviously modelled along the same lines as in countries where it currently exists), and they keep being elected. Of course nobody would just say "we are going to copy France" - that'd be stupid, US and France are different countries with different traditions, legal systems, economic and political systems, etc. But many politicians I've heard compared favorably health care systems in Canada, UK, France, Switzerland, Germany, etc. to American one and I don't see why they would suffer electorally for it - the idea that American system needs reform is a commonplace among both left and right (they of course disagree as to what kind of reform it needs) and comparing favorably to certain aspects of foreign experience is nothing unexpected - in fact, in this case, there's not much choice to compare - if you want to argue "we want to change it", you'd need examples, and since you won't be able to find enough examples in the US (state experiments don't have enough timespan and may not scale well) you'd have to go international. If you wanted to show, for example, that single payer is a workable model, you won't have much choice but to refer to the experience of the countries where it was introduced.
Right. So you're saying the French single payer system works, with political modification as needed over time.
The issue that might make single payer difficult in America is we don't trust our political system to manage good programs, because the GOP is committed to destroying government (to benefit the super rich) rather than trying to get things done.
Look at Germany and Switzerland. They are quite similar to Obamacare in a sense: Mandatory insurance, multiple insurances, private providers.
If there is no political will to resist there is a good chance the US medical industry would mess up single payer in the same way they messed up the current system .
Single payer is certainly socialized public healthcare, but not all socialized public healthcare is single payer. I think Americans are predisposed to treat it as an either-or because Canada, which is used most often for comparisons by virtue of being the country with which relatively more Americans are familiar, is single payer. However, many European countries aren't, and there's no discernible pattern for countries with single payer being better than other forms of public healthcare.
I think pushing for single payer specifically is one of the biggest mistakes of the American left, because it's that much harder to sell in US due to more restrictions - and that's inherent in the model. If we took something like the German model instead, I think we'd be way ahead by now.
The US system is just mandatory national insurance, which is also the model found in some European countries, for example Switzerland. Single-payer is not the only way to achieve universal healthcare, nor even the only way it's done in Europe.
Maybe it doesn't work as well, but that's down to the details, not because it's inherently different in how it works.
"Single-payer" means one insurance plan for everyone. France, as you know, has multiple plans for its people. So it's not single-payer.
But you are of course correct in France having private doctors and hospitals as well as public hospitals. Speaking as an American, city17 makes the common mistake of thinking that Canada and the UK, the two foreign countries we are most exposed to, are representative of the rest of the developed world. Since both countries have single-payer systems with zero/minimal cost on delivery (and more or less 100% public hospitals in the UK), many Americans think that that's the way all countries' healthcare systems work. They have no idea that a 30% copay is normal in France, or that Germany/Austria/Switzerland/Netherlands all have Obamacare-like mandates to obtain insurance from one of dozens/hundreds of competing plans, or that Australia has a government plan but *strongly* encourages people to get a private plan.
Why is it that when I suggest we emulate Canada's system (which is province-by-province single payer) the Democrats accuse me of being a Ron Paul right-winger (Nooo... not the States!) and the Republicans accuse me of being a socialist (Nooo... not single payer!)?
Not only is the US healthcare system broke and broken, but nobody in power is willing to imagine a solution that might work better (probably because such as system would require tackling the major corporate interests across the board, like big pharma) :-( I wouldn't be optimistic that we'll get things fixed.
But the existence of the French or Japanese or Dutch healthcare systems do. At some point, empty theorizing has to give way to observation of how these systems actually work in practice. In practice, all of these systems provide care that is much much cheaper than the US system with very high levels of public satisfaction.
Also, I think you're wrong in claiming that the Republican party rejects single payer for those reasons. The Republican party loves single-payer healthcare for old people. They expanded the single-payer program for old people massively and they make political hay out of any efforts to reduce its spending.
France and Germany have different cultures as well. Single payer isn’t the difference. We waste a lot of time and money in America on a broken system. That time and money could go elsewhere while encouraging more risk-taking.
I also wonder about non-medical insurance costs and how much that is propped up by high medical costs. Would my business’s general liability or workers comp be half the price if we had single payer? A lot less? After all, most injury claims are for cost recovery.
Perhaps worth noting, France is not a single-payer system. It has nonprofit private insurers, an individual mandate, and no exclusions for preexisting conditions. It adds good electronic medical records and a national price list for medical services.
It seems to be working rather well in a large number of other first-world countries (I'm speaking from experience - I'm British, and my wife is half-French and grew up in France. Now we live in the US where we enjoy just about everything except for the healthcare system).
"single-payer gives consumers no incentive to consume less"
Having been fortunate enough to live in a country with a single-payer system, I never saw the kind of over-consumption you're hinting at.
The problem I have with most politicians is that most changes come with pros and cons. And they completely want to ignore the cons.
Quote from Forbes website:
"The United States remains the world leader in medical innovation, having produced more than half of the world’s new medicines over the last decade. But our edge is slipping away because of crippling domestic regulatory and tax policies.
A new report by Battelle, an international science and technology company, found that other countries are working aggressively to lure research facilities and high-paying jobs away from the United States. They are offering friendlier regulatory policies so companies can get products to patients faster, and they are lowering taxes and offering other incentives to boost private investment in new medicines and medical devices."
I'm not saying a single payer system can't work, just what are the things that need mitigated if it were to come to be.
As a supporter of Single Payer that grew up in a hyperconservative home, this sort of article completely misses the point for those that oppose it.
To a conservative opponent, getting high quality care at a low out-of-pocket cost is a result of health care being a redistributive social good, and "social good" is just code word for "shirking individual responsibility". They look at this situation and this author like they do their proverbial welfare queen...a beneficiary of their taxes.
If we actually want to convince them, we have to prove to them that Single Payer is an objectively more efficient system than insurance. In other words, were the total incurred costs lower than they would be in a our system? Because for them, that's an argument that matters.
Unfortunately even I, a strong proponent of single payer, would find a cross country comparison here to be disingenuous. Because it doesn't matter how efficient the French are at administering health care. What matters is how efficiently we would be at administering it. And hands down, we suck at government administration. Whether it is infrastructure, military, health, or whatever...everything we do costs more and takes longer than other governments doing the same thing.
And this is the major reason why our politics suck IMO. We have one side of the table that is 100% more government because government is awesome, one side that is 100% less government because government sucks, and nobody is arguing that we should be making government more efficient. And so we never get nice things.
Do you really think single-payer healthcare (versus the individual mandate in ObamaCare) was ever going to pass in the US? Obama literally adopted a Republican proposal for how to improve healthcare coverage, and the Republicans have spent every year since railing against it.
As someone who's pretty far to the left, I don't see how a (fiscally) far-left candidate/party would make any progress in the US. The centre is just so damn skewed towards "individual responsibility" and other bullshit that voters apparently love.
I agree with you on the insanity of the current system, but I have two problems that prevent me from believing that single payer is the simple answer to our health care cost problem:
1) "Europe" is not single payer, England is while the two largest EU countries, Germany and France, are not.
2) Medicare is already an enormous single payer system, covering the demographic that consumes the most health care services, and does not have costs anywhere in line with Europe.
So, I think copying Europe would be reasonable, but that maybe it would be better to draw inspiration from one of the non-single-payer systems instead. The results don't seem to be any worse and it seems a bit safer to have more choices.
It is interesting that people go straight to single payer in their mental model when they think of changing the healthcare system. Germany has a multi payer system (although the government does provide a large % of the total funds) that seems to work for them. Why do so many in the US look to single payer systems as the ideal model?
I think it's a bit more complicated than that. It's easy to look at other countries and say, hey, that works there, therefore it will work here. But not all governments are created equal. If the government in the U.S. had a better track record, maybe it would be more palatable. But as is, I don't see single payer being the solution to our problems.
Is there a specific reason you are against non-M4A type systems? As far as I'm aware Germany and France for example have universal health care but not single-payer.
The issue in the US seems to be some people with good jobs have health insurance they're satisfied with, and so don't want radical changes. So it's harder to form a political coalition to change health insurance for everybody, than it is to just fix the situation for people who don't have anything.
I see the article briefly touched upon the American notion of health insurance being tied to employment.
Nobody seems to want to really solve this problem, just band-aids and lip-service. Neither mainstream party would consider a single-payer system, nor direct government negotiation with drug companies.
It's as though the drug and insurance companies are better represented (and have more rights) than its citizens.
Heck, even Medicare is divided into at least four regions to "negotaiate" regional prices.
How do other countries perceive this?
The US falls further and further behind in healthcare and affordable and available high-speed internet. Let's see some real progress.
I don’t think there are many people who think as a whole our system is “reasonable.” Just those that recognize the “be careful what you wish for” possibility. For example, for people who always point out how efficient European single payer health care is and how much money we’d all save if we switched to it: the U.S. government is already spending more per-capita on healthcare (Medicaid, Medicare, VA, etc.) than most European countries pay for single-payer healthcare systems that covers everyone [0]. So switching everyone on private plans (or uncovered) to a single-payer system is mathematically impossible to be even close to as cheap as other countries have it. (When I say per-capita, that means dividing the costs by all residents of a country, not just those enrolled in the plan).
That doesn’t mean it wouldn’t be better than what we have now, but it’s disingenuous when people imply that all it takes is to change the “payer” and we’d magically fall in line with costs seen in Europe. The real issue is many-fold and in order to truly bring costs down its going to take a lot of sacrifices from the provider side as well. Most doctors, nurses, and others in the health care industry in Europe (and other places with single-payer systems) do not earn nearly as much as their counterparts in the U.S.
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