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:<
[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.
>
> >> 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