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CMV: The US couldn't successfully implement a single-payer health care system (self.changemyview)

steelerfaninperu3∆ が 投稿

A lot of people suggest the US adopt a single-payer health care system, often mentioning Canada, Australia, Europe, etc...

My take on this has always been that it'd be impossible mainly for 3 reasons. Disproving these would be delta-worthy for me.

  1. Our population is just too big to micro-manage this way.

  2. Due to our diversity, a single-payer system would be more complex. So many languages to navigate for one. A huge variety of genotypes means more complexity when dealing with genetic disorders and complicates tissue donation. Geographical differences make providing coverage in specific places challenging, as well as presenting budget issues. Regional political variations limit certain possibilities (like more abortion clinics).

  3. The government is not very efficient in general when it comes to managing large business-like operations. The Post Office and Amtrak come to mind as services which could still be industry leaders but have been surpassed by private businesses.

I'd really like to know if it's feasible to install a single-payer system in the states because I think it would be good for people but I don't see it as viable. I'd like to come around, CMV

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[–]lonelyfriend16∆ [スコア非表示]  (0子コメント)

Good question! I hope we can avoid the obvious political reasons that make it difficult to implement this system.

First, let use remember that Canada, UK, Australia - the Anglo-sphere have more in common with the US than other countries. This is important. Let us also remember that Canada, was a late adopter of universal health care - and it started with a single province and then was modified for the whole country.

Second, let us also remember, that Taiwan has a single payer healthcare system. It was actually model (and against lol) the US system - it is based on the US Medicare system except expanded for coverage of all citizens. I think it includes dental.

I just want to give a quick "global" background for a preliminary understanding that other countries had barriers and managed to create systems through a one payer system.

1) Your population isn't too big. For a one payer system, there would still be ways to manage heathcare delivery. Canada is a huge country - as you know - and it manages to provide efficient healthcare delivery by using several mechanisms. a) Canada as a country doesn't do shit except ensure drugs are safe, First Nations has access, army has access to health, etc. They give money (Social-Health transfers) to the provinces and they provide health. If anything, by removing delivery by provinces - you can probably make Canada even better - but that requires a PhD dissertation on Federalism and quality healthcare.

Easily, the US can implement a model similar to this - by creating organizations through medicare that directly deal with healthcare delivery services in regions. Speaking of regions, in order to mobilize inefficiencies in the system, you can create Regional Health Authorities to help "micro-manage" and integrate services. They would probably be intra-state.

Also - remember that healthcare delivery is still private often!

2) Language, etc, is not really an issue. It just means that the government can ensure that private agencies have language/multicultural services before getting contracts. There are many ways to roll it out.

Also, the US is not really that complex genetically. I mean, England is Caribbean, African, Indian, East Asian, etc. Canada actually has two official languages, and First Nations are a priority for healthcare delivery. I don't mean to minimize your concern, but I feel it is a non-issue and one that is work-able!

3) Although many people hate medicare - it actually is efficient. It may be much more efficient than the private sector. For one, it is most likely the leading source of quality improvement. In order to receive medicare, you have to roll out inter-operable health informatic systems, you have to ensure you practice evidence based medicine. Remember, healthcare is a system - that is homecare, LTC, hospital, physio, nurses, physicians, etc - the government is just inherently in a better position to coordinate them.

This is why the US is over-paying for medical care - healthcare is just different than the post office or trains. It requires regulation and government oversight.

[–]kobyashimarooned [スコア非表示]  (0子コメント)

Our population is just too big to micro-manage this way.

How do single-payer systems micro-manage? Getting ill works the same way as before, but the government pays instead of insurance (essentially the government supplies universal insurance for most illness types). Many places still have private insurance if you want various benefits in relation to your care, as well as coverage for items which may not be covered by the single payer system [change depending on place - but things like dental, or alternative medicines].

Due to our diversity, a single-payer system would be more complex. So many languages to navigate for one. A huge variety of genotypes means more complexity when dealing with genetic disorders and complicates tissue donation.

The US isnt any more diverse than a typical first world nation (particularly the other "immigrant nations" - CAN, NZ, AU. Also some parts of europe with long traditions of migration).

Geographical differences make providing coverage in specific places challenging, as well as presenting budget issues.

Central Australia (far more remote than any part of the contiguous US) uses the not-for-profit Royal Flying Doctor Service to provide emergency medical assistance in remote areas beyond the reach of government services.

Regional political variations limit certain possibilities (like more abortion clinics).

Australia has differing abortion laws in each state, just means that different requirements are in place depending on where you are.

[–]EctMills1∆ [スコア非表示]  (0子コメント)

The post office was successful until the Postal Accountability and Enhancement Act was passed requiring them to prefund employee pensions on a massive scale not seen in any private business. Last I heard it was still up in the air how bad the problem is and if the law is being implemented correctly but the post office has been seeking a more reasonable regulation. I suppose the situation could be spun either way but the bottom line is a successful large business model is possible, it just might be a good idea to keep Congress away from it.

[–]Bodoblock16∆ [スコア非表示]  (0子コメント)

  1. The EU has 503 million people and every member nation has universal healthcare. Could we not set up a system on a state by state basis if a federal basis were not possible?

  2. Again, a state by state basis solves this. Besides, there aren't that many languages we have to navigate. Most immigrants speak English. Many nations in Europe navigate multi-ethnic, multilingual parts of their society into their healthcare system. Canada is also a very multiracial country that executes universal healthcare well.

  3. Just because public service is not profitable does not mean it isn't a needed good. The US military is top of the line - unrivaled around the world. American public education like the University of California are unparalleled in their academic excellence among public peers. The list goes on.