Should the US adopt a single-payer health care system?

[anvi]

No, a Bismarck system is both more efficient and more likely in the current climate.

This. 

[anvi]

The US is the only developed country in the world without universal health care.  It's time for them to catch up to the rest of the developed world.

The U.S. doesn't want any of them foreign ideas.  And I'm with them all the way.  Foreign ideas should be banned.  Take the Ten Commandments, for example. They came from someplace in the Middle East. And so did the gospels. And that there US constitution was based on a bunch of ideas by Scottish, English, French and Dutch eggheads.  Foreign ideas ain't welcome here. 

[anvi]

It is a shame Bismarck just hasn't entered the Progressive political consciousness in the U.S. yet.  It has much of the efficiency and private centers of care delivery and insurance that "Single Payer" largely lacks, but includes the benefits of universal coverage and effective cost containment. 

[anvi]

In Bismarck systems, you have mostly privatized delivery and insurance systems.  Insurance companies are mostly mandated to be non-profit entities and must cover the conditions of those they insure, which is a big difference already.  Insurance is offered through employers, but municipalities, generally, cover those who are unemployed or too poor to purchase insurance themselves.  Opt-outs are often available for the top 10% of income earners so they can purchase plans with wider coverage than standard sickness funds but which are more expensive.  Benchmarks on prices for procedures and medicines are negotiated between government, industry and insurers on a mostly annual basis, but those benchmarks apply, with regard to medicines, to the least expensive but most generally effective medications on the market.  Prices then are not fixed; pharma companies are allowed to charge whatever they want for their meds, but patients are informed by physicians about what sorts of meds are available, and best or adequate, for their conditions and they make choices on what to buy.  The fact that care delivery comes through private hospitals and clinics means wait times and quality of care are generally better than in "national insurance" systems.  Physicians receive their medical educations largely free and don't acquire massive amounts of debt getting their degrees, and tort laws give them broad protections from lawsuits--but these advantages also generally translate into lower earnings for physicians, though their livelihoods are still quite good compared to the average income-earner.  There are therefore mechanisms built into the system for efficient care delivery, multiple mechanisms for cost control, both through negotiation and consumer choice, and also mandates for universal coverage.  Obviously, the system is not perfect--nothing human is--and it requires a broader tax base than exists in the U.S. to support it.  But, given my experiences living in countries with both Bismarck and national insurance models, I think Bismarck works far, far better.  The differences between Bismarck and ACA are fairly dramatic, though.  ACA leaves for-profit insurance in place, it has far fewer mechanisms for cost containment--though it has some--and the insurance system it envisions is still far more fragmented than in Bismarck systems, which leads to dramatically persistent cost-shifting.  On top of that, the "mandate" of ACA is not really a mandate at all, and in the long run will prove completely ineffective in financing health care delivery on the whole.  Don't get my wrong; I'd rather have ACA than not have it--but it is light years away from what can be most effective.

[anvi]

Coverage in Bismarck systems is portable between jobs, as the sickness funds are nationally valid.  Coverage is available to full and part-time workers as well as to guest workers.  Unemployed worker coverage does not change, their premium contributions are paid by federally administered statutory unemployment insurance during the term of unemployment.

[anvi]

Sure, they drive up costs.  Lots of things do.  But countries with Bismarck systems spend between 10-12% of their GDP on health care costs as opposed to the current 17% of the U.S, the the cost increases of the former rise at slower rates on top of it.  I doubt the ACA will hold down health care expenditures in the short or long terms as effectively as Bismarck systems, particularly given the fact that the quantity and quality of cost control mechanisms in Bismarck systems are better than ACA.  Very generic similarities between these two kinds of systems, in my view, don't matter too much when the specifics of each translate into such glaring cost differentials.

The problem is that Bismarck is probably not politically feasible in the U.S. anyway.  Once you decide to make the health care industry a for-profit one, both on the delivery and provider ends, there are too many interests that will fight against fundamental change.  So, something like ACA, but better crafted, and with a less fragmented but still universal coverage system, might be the best we can do here.

[anvi]

I use the term "model" here to refer to what the Bismarck system has accreted into over the decades, not assuming that it was ever formed whole-cloth and emerged fully out of some mythical policy-wonk's head.  Health care systems pretty much always are the results of extended political battles and patchwork legislation that's worked and reworked over time and serve some party's or parties' interests.  It also has lots of local variants depending on where it exists.  The fact that a system which was not originally designed to cover everyone has become one that can means that there is at least hope that non-ideal things, through whatever confused and muddled process, can be made better over time.  If that were never possible, then human beings would be pretty much screwed, because confused and muddled at best is the only way we've ever been able to do anything.