Alan Mackenzie <
[email protected]> wrote in message news:<
[email protected]>...
> Jonathan Smith <
[email protected]> wrote on 26 May
> 2004 07:07:02 -0700:
> > Alan Mackenzie <
[email protected]> wrote in message
> > news:<
[email protected]>...
> >> Jonathan Smith <
[email protected]> wrote on 25
> >> May 2004
> >> 13:26:16 -0700:
> >> > Alan Mackenzie <
[email protected]> wrote in message
> >> > news:<
[email protected]>...
> >> >> Jonathan Smith <
[email protected]> wrote on
> >> >> 24 May 2004
> >> >> 19:24:20 -0700:
> >> >> >
[email protected] wrote in message news:<iessc.-
> >> >> >
[email protected]>...
> >> >> >> In alt.cancer.support Evelyn Ruut <mama-
> >> >> >>
[email protected]> 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.
>
> >> What does "single payer system" mean?
>
> > One payer - typically the central government - for all
> > medical services.
>
> OK.
>
> >> > 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.
>
> It's a tax on both parties.
It's a payroll tax, in that you are correct. From the level
of the employee, it has a cap which makes it a lot less
progressive and the cap is such that even at the highest
incomes, the cost is reasonable. I define reasonable as a
cost not to exceed the actual value of the benefit to the
individual.
For the corporation, it is a percentage of payroll and as
such is similarly non-progressive to the extent that
companies hire people across income ranges. The cost to the
firm are independent of the income or profits of the firm.
> >> >> 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.
>
> What I don't see is why it makes an enormous
> difference whether there is a single payer, or several
> parallel payers.
With several (or in your case potentially hundreds) patients
and firms have choices. It requires the insurer to be
responsive. It also gives providers choices allowing them to
maintain some freedom and flexibility regarding their
working conditions and income.
> Surely the principles governing the collecting of
> contributions and providing the services is more important
> than whether there's a single government agency, or 20
> funds in parallel (much as in Germany at the moment).
No - the principles of competition and choice are more
important than giving a select body of legislatures a huge
amount of money to play with.
> >> >> 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.
>
> No. If we're still talking about Germany, the
> contributions are dependent only on current income. It's
> much more like a tax than an insurance. The unemployed
> paid nothing, (or very close to nothing, I'm not sure).
> Thus young healthy people typically pay in their 14% (half
> from employer, half from themselves), yet don't use
> medical services at all (except, possibly, for their
> children). 40 years later, they'll be using masses of
> these services, yet be paying in very little in
> contributions. It works out, sort of, in the long run.
You are right - I was, incorrectly, referring to the opt out
population which you already excluded. My apologies.
> >> > 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.
>
> Again, what difference would it make if it were? The
> Krankenkassen are very tightly regulated on how they take
> contributions and what they must pay out.
American insurers are tightly regulated as well. The point
remains - there are more than one and they must compete with
each other for business.
> They're much more like government agencies than insurance
> companies. What difference do you think it would make to
> Germany if there were only one Krankenkasse?
You would have a single payer and patients and providers
would not have a choice. The UK NHS would no longer have a
place to send their overflow patients. The accessibility and
quality of care you currently receie would decline. The
amount of money spent would go up. Providers would drop out
of the system and lines would form.
> >> >> 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.
>
> Hmmm. Only for 18 months? So somebody who loses his job,
> say because of injury,
No - in the case of injury, most have disability insurance,
both long and short term.
> is up sheet crick
That would be **** creek
> after 18 months? How much are COBRA contributions,
> compared with the money the injured person receives from
> the public social fund?
Short term disability is usually 70% or more of salary while
long term generally is 60%.
> >> > 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.
>
> Draconian? Or Utopian? ;-)
Draconian.
> >> 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.
>
> OK, thanks!
Face it - you are fortunate in Germany to have a system
that allows universality in coverage and choice in
selecting coverage.
We, in the US, are likewise fortunate that most have
coverage and choice in coverage. What is lacking in the US
is the unversality of it and that is best solved by giving
access to the current structure, not by changing the entire
structure.
js