A description of single payer care in the UK.

Both our president and our Senate Majority Leader, Harry Reid, have said what they really want is a single payer health system.  That’s what most liberals want; Obamacare is just a stepping stone.  They have to wreck our current system, put medical insurance companies out of business, and wait for the collapse of Obamacare before they can impose it.

What would single payer consist of?  The best systems to look at are in Canada and the United Kingdom.

The National Health Service in the UK is one of the oldest such systems on the planet, having come into being right after World War II, about 1948.  It works as follows:  Any permanent resident can apply for an NHS card.  With a card, most health services are free.  Medical costs are paid by the government, however there is a tax on income called National Insurance, which is automatically deducted.  Everyone receives the same level of service.

There are some fees for prescribed drugs, with exceptions for children and people over 60.

The NHS provides essential primary, in-patient hospital, long-term, ophthalmology, and dental care.  It also provides ambulance service and supports mental hospitals.  There is some private practice, which may be used to provide less essential services (such as dentistry, plastic surgery, circumcision, etc.) or to reduce waiting times.  Private care is paid by the patient out-of-pocket or from private insurance, and is used by about 8% of the population, according to Wikipedia.  Link: UK National Health Service.

Why wouldn’t we want this in the US?  First of all, the system is run by politicians and bureaucrats. They decide the level and quality of care, as well as compensation models for hospitals and medical staff.  It appears to be a constant struggle in the UK.  They often don’t cover dentistry because they can’t hire enough dentists, and some dentists see private patients only.  

Wait times for diagnostic tests, elective surgeries, and specialist appointments are reported to be much longer in Canada and the UK than in the US, however wait times to see a primary care physician are comparable.  The US (probably—I can’t confirm this) has better and more expensive diagnostic equipment.

The structure of the NHS is interesting.  They contract with hospitals and treatment centers, who almost always hire physicians and pay them salary, often with incentive bonuses for the numbers of patients seen.   Hospitals are usually operated by trusts.  Primary care physicians, dentists, and optometrists are usually self-employed and contracted to the NHS.   

Doctors are paid somewhat less in the UK than in the US, but the hospitals or the NHS are responsible in cases of malpractice. 

In 2009 there were about 1600 NHS hospitals and 50 treatment centers in the UK, employing about 1.18 million people, according to Wikipedia.   This system treats the UK’s 65 million people.  The US would have far more for 305 million people.

To be fair, I should mention that Wikipedia reports a high degree of satisfaction in the UK with the NHS medical care.  Of course, it’s mostly free.  But, according to the CIA World Factbook, the average life expectancy at birth in the UK is 1.4 years greater than that of the US. 

Let’s suppose for a minute that Obama and Reid get their way: the US goes to a single payer system much like that of the UK.  What changes should we make?  Remember, I try to be logical; politicians never are.  So here’s how I’d do it:

First, eliminate Medicare; Medicaid; Tri-Care (for active and retired military, and their dependents; Indian Health Service; VA hospitals; and Federal Employees Health Plan.  No more special plans for Congress and other high officials, other than perhaps the president. Any insurance companies left would specialize. We would initiate a medical insurance premium which everyone would pay on income or profits.  There would be no exemptions and all medical care would either be private (not paid under the plan) or under the single payer plan.

The Department of Health and Human Services would negotiate with all hospitals and medical care facilities for their remuneration, and would have to hire or contract with doctors and other medical staff.  Each person who wants into the system would have to obtain a Health Card.  (Illegals shouldn’t receive them.)

The UK has a document which spells out hospital and physician responsibilities, covered illnesses and procedures, and patient’s rights, appeal procedures, and so forth.  We’d need the same thing.  Stir for twenty years and medical care in the US might be back where we were before Obamacare.

Canada’s system is similar to that of the UK.  Link: Health care in Canada.