Single payer/socialized heath care vs private vs combined
Single payer/socialized heath care vs private vs combined
Heavy question, I know. This is not intended to be political, please leave “taxes/government evil” out of it, I’m interested in a pragmatic view.
Infamously the US has mostly private health care, but we also have Medicare and -aid, the ACA, and the VA.
Most other nations have socialized health care in some format. Some of them have the option to have additional care or reject public care and go fully private.
Realistically, what are the experiences with your country’s health care? Not what you heard, not what you saw in a meme, not your “OMG never flying this airline again” story that is the exception while millions successfully complete uneventful and safe journey story. I’m also not interested in “omg so-and-so died waiting for a test/specialist/whatever”. All systems have failures. All systems have waits for specialists unless you’re wealthy, and wealth knows no borders. All systems do their best to make sure serious cases get seen. It doesn’t always work, but as a rule they don’t want people dying while waiting.
Are the costs in taxes, paycheck withholding (because some people pay for social health care out of paychecks but don’t call it a tax), and private insurance costs worth it to you?
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I live under singlepayer health care. I like it, but it does have its downsides. For example, let's say you have something really severe going on, and you'd like to try a hail Mary. Well, you can't, as the only treatments that are available to you are whatever treatments have been deemed effective and reasonably safe by the regulatory agency. Experimentation, in lack of a better word, is a no-go.
I never experienced this as a problem myself, but I can easily imagine that someone could.
So I think the best is to have single payer available to everyone, but with private for profit doctors available if you need or want something a little more unorthodox and you have the means to pay for it.
EDIT: Seeing as I may have come off as a bit gloomy, I think I should list why I wouldn't want it any other way.
- My dad had cancer. Chemo and everything covered.
- My kid broke his arm this spring. The only expense was me buying a sandwich while they inserted a titanium rod into his arm.
- Same kid has ADHD. I can show up to any pharmacy in the country and fetch his meds (stock pending) without paying anything.
- His brother also has ADHD and poor eyesight on one eye. Meds and glasses covered.
- All of my kids were born in a hospital at no expense.
- I didn't learn until last year what the hell "copay" is, and the more I learn about it, the more thankful I am that it's not something I have to think about.
I also live under single payer healthcare, and I have experience with a much lower stakes "hail mary" type event.
A number of years ago, I developed a growth on my eyelid that no one was sure what it was.
We started with the optometrist, who thought it was a duct blocked by dirt and suggested a medicated cleaning regimen where they assumed it occurred. This didn't help.
So I got recommended up the scale to my GP, who took one look at it and said, "Yeah, that ain't right. Here's a recommendation to an eye specialist at the hospital." which took ~1 month to get an appointment.
A month later, I have my first appointment with the eye specialist, who isn't quite sure what it is but knows that it's an internal problem and not a blocked duct. After the third appointment (3 months after the first) she says that she's narrowed it down to either a benign tumour or a blood clot, but isn't confident in her eyelid surgery capabilities and recommends me to an eyelid specialist in a neighbouring province.
6 months after the first optometrist appointment, I have my first appointment with the specialist who identifies it during the appointment as an internal scab that will decompose itself, but the wound isn't healing. He says that surgery is an option, but there's a chance I go blind and a smaller chance that I straight up die. He tells me that I'll come back in 3 months because it's not life threatening, and if it starts getting much worse, we'll discuss removing it.
After an appointment with him every 3 months for almost 2 years, it finally cleared up.
The issue itself was relatively low risk, but it wasn't until 6 months in that it was deemed "not cancer." At every step, the risk was evaluated, and 'hail mary' options were discussed. But they were always discussed as "if it gets worse, we can do this, and the decision is yours". So (at least where I live) there are hail mary options and you can take them, but only if the risk to your health is significant enough that the rewards outweigh the risk.
I was expecting this to be a story of an issue, but this is actually really encouraging for what single payer could look like. The time scale isn't great, but it's pretty comparable to what I've experienced and heard about from friends here in the "efficient" private US system.
Part of the time scale was how low risk the issue ended up being. We knew from the first few months that even if it was a tumor, so there was no "rush" to get me in to see people.
One of the 'mindsets' of single payer is that more severe/risky issues can get fast tracked over less severe/risky ones. Ultimately, all that was happening to me was that my vision was slightly affected (because my eyelid wouldn't open fully). But had it been a tumour, I likely would have been on the surgeons table within a month of them finding out.
If it means anything, my parents have been going to a lot of specialists lately as they age and have had issues, and it's pretty much the same story:
- set appointment with a doc - soonest you can get is in a few weeks or a month
- go see a doc, get a recommendation another doc
- they're full, wait 3 weeks
- huh, maybe this other doc?, etc
And where is this amazing place, so that we may move there?
That's why I feel like there should be both systems. Possibly public and private healthcare, but with the additional requirement that everyone has to have health insurance. Otherwise there's going to be too much of a problem with young people not getting insurance and not paying in. You'll also have NEETs and neckbeards who work 12 hour weeks and aren't paying anything in to the system.