Why can’t single-payer and private insurance co-exist?

[darklordoftech]

Food stamps exist, but I can still buy food using my own money, so why can’t single-payer and private insurance co-exist?

[Mr. Smith]

Food stamps exist, but I can still buy food using my own money, so why can’t single-payer and private insurance co-exist?

They do, in the UK.

All it "end private insurance" usually means is that jobs won't cover you that way, you have to search it out.

[GP270watch]

Food stamps exist, but I can still buy food using my own money, so why can’t single-payer and private insurance co-exist?

That's a bad analogy because your money is provided, backed, and managed by the government and so are food stamps.

 For the analogy to work your money to buy things would be provided by your job and since it's not universal currency would only be accepted at certain places. This is a system that actually existed once and was completely disastrous and exploitive, it was known as company scrip. It's also similar to how private health insurance works where you are limited to obtaining your healthcare "in network".

 Private insurance can exist like elective plastic surgery exists or how you can hire private security even though there are police in your town. But private insurance as it exists in The United States cannot be the primary method of providing healthcare because it does such a poor job of doing so.

[TML]

What single-payer advocates want is not for private insurance companies to disappear completely, but for them to cover only things beyond basic medical necessities (e.g. plastic surgery). They want basic medical necessities to be covered by the government, in order to reduce costs by consumers in the forms of deductibles, copays, network limitations, etc.

[Matty]

The concern is that it would create a two tiered system

[SInNYC]

They can co-exist if private insurance is for non-basics. But it gets really dicey if everybody gets to choose between Medicare and a private option since its much too easy for all the expensive cases to choose Medicare. Rules would have to be made to avoid shunting off the expensive cases to Medicare and complicated rules always lead to complicated loopholes.

BTW, people already have no choice. If your employer has health insurance, odds are that you are required to enroll in the plan unless you are in a spouse's plan. But those complaining about being forced to use Medicare dont complain about this for some reason.

[Beefalow and the Consumer]

1. This model exists in many countries in the developed world.

2. This thread belongs in US General.

[Gustaf]

It does in most places I think.

For the record, the way it works in Sweden is basically that most people don't want private insurance since they don't want to pay for something you can anyway get for free.

However, as in any public system there are issues with the public healthcare system, in particular waiting times. So many people get private insurance so that they can get faster access. But I believe even the private health insurance provided here is a lot cheaper than in the US. It also tends to coexist with the public system in a literal sense.

[AN63093]

8 posts in and no one bothered to point out that it appears the OP does not know what single-payer means.  Based on the other posts in this thread, it would further appear that no one else does either.

Now if the question is "why can't universal health coverage and private insurance co-exist" then the answer is, of course, that there is no reason why they can't.

[GP270watch]

8 posts in and no one bothered to point out that it appears the OP does not know what single-payer means.  Based on the other posts in this thread, it would further appear that no one else does either.

Now if the question is "why can't universal health coverage and private insurance co-exist" then the answer is, of course, that there is no reason why they can't.

 Here is a good primer explaining the differences. I think people on here know the difference so I don't understand your comment.

 source: International Health Systems for Single Payer Advocates


Health care systems in the Organization for Economic Cooperation and Development (OECD) countries primarily reflect three types of programs:

1. In a single-payer national health insurance system, as demonstrated by Canada, Denmark, Norway, Australia, Taiwan and Sweden (1), health insurance is publicly administered and most physicians are in private practice. U.S. Medicare would be a single payer insurance system if it applied to everyone in the U.S.

2. Great Britain and Spain are among the OECD countries with national health services, in which salaried physicians predominate and hospitals are publicly owned and operated. The Veteran’s Administration would be a U.S. single payer national health service system if it applied to everyone in the U.S.

3. Highly regulated, universal, multi-payer health insurance systems are illustrated by countries like Germany and France, which have universal health insurance via non-profit “sickness funds” or “social insurance funds”. They also have a market for supplementary private insurance, or “gap” coverage, but this accounts for less than 5 percent of health expenditures in most nations.

Sickness or social insurance funds do not operate like insurance companies in the U.S.; they don’t market, cherry pick, set premiums or rates paid to providers, determine benefits, earn profits or have investors, etc. In most countries, sickness funds pay physicians and hospitals uniform rates that are negotiated annually (also known as an “all-payer” system). Princeton economist Uwe Reinhardt calls Switzerland’s “sickness funds” quasi-governmental agencies(2). In France, the overwhelming majority of the population is in a single non-profit fund, so many observers consider the French system “single payer.”

There is no model similar to sickness funds operating in the U.S. (3), although they are often confused with the Federal Employee Health Benefit Program (FEHBP), which is simply a group of for-profit private insurance plans with varying benefits, rules, regulations, providers, etc. The 1993 Clinton health plan was an attempt to regulate private insurance companies in the U.S. to behave more like sickness funds, but the insurance industry defeated it.

[AN63093]

OK fine, I take back my comment in regards to you.  But as the OP seems to be conflating a single-payer health system with a program like SNAP and doesn't seem to recognize the rather obvious differences.. well forgive me, but I'm going to be skeptical until proven otherwise.  There are a litany of other inaccurate statements in this thread, and despite your comment that you think people on here know the difference, that has not been my experience- going back years, whenever health care comes up on Atlas, the level of discussion is quite... low.. e.g., I can count on one hand the number of times that someone here actually demonstrated that they knew there was a difference between single-payer and multi-payer (actually I can count it on one finger)… so I feel no reason to abandon my general skepticism.  But I did say "no one".. so I suppose replace that with "no one but GP270watch." 

[GP270watch]

OK fine, I take back my comment in regards to you.  But as the OP seems to be conflating a single-payer health system with a program like SNAP and doesn't seem to recognize the rather obvious differences.. well forgive me, but I'm going to be skeptical until proven otherwise.  There are a litany of other inaccurate statements in this thread, and despite your comment that you think people on here know the difference, that has not been my experience- going back years, whenever health care comes up on Atlas, the level of discussion is quite... low.. e.g., I can count on one hand the number of times that someone here actually demonstrated that they knew there was a difference between single-payer and multi-payer (actually I can count it on one finger)… so I feel no reason to abandon my general skepticism.  But I did say "no one".. so I suppose replace that with "no one but GP270watch."  

 The American public has been brainwashed to believe that a national healthcare system would basically be "food stamps" or a handout. Never mind the fact that our government already spends more money per citizen than other countries that have competent universal healthcare coverage for everybody. The United States spends more money to cover less people, with worse results in many areas, and huge medical out of pocket expenses for the populace and insane debts for many who get sick or have accidents. Add to that the disgusting gaps in coverage depending on your state's politics, your race, gender, employment status, geographic location, chronic illness, age, etc and it's a woefully inadequate system.

[Grassroots]

The concern is that it would create a two tiered system

[GP270watch]

This is the kind of crap the American public has been brainwashed with.

[darklordoftech]

8 posts in and no one bothered to point out that it appears the OP does not know what single-payer means.  Based on the other posts in this thread, it would further appear that no one else does either.

Now if the question is "why can't universal health coverage and private insurance co-exist" then the answer is, of course, that there is no reason why they can't.

Doesn’t single-payer simply mean publicly-funded without a middle-man?

[YE]

The concern is that it would create a two tiered system

[McNukes™ #NYCMMWasAHero]

8 posts in and no one bothered to point out that it appears the OP does not know what single-payer means.  Based on the other posts in this thread, it would further appear that no one else does either.

Now if the question is "why can't universal health coverage and private insurance co-exist" then the answer is, of course, that there is no reason why they can't.

Doesn’t single-payer simply mean publicly-funded without a middle-man?

I prefer to think of "single-payer" as meaning only the government pays for insurance, while a "public option" is an option to buy government insurance. That said, MFA supporters are inconsistent on whether or not people under 65 would pay Medicare premiums, like the elderly do today.

[Indy Texas]

What single-payer advocates want is not for private insurance companies to disappear completely, but for them to cover only things beyond basic medical necessities (e.g. plastic surgery). They want basic medical necessities to be covered by the government, in order to reduce costs by consumers in the forms of deductibles, copays, network limitations, etc.

There is no insurance policy that covers purely elective procedures like plastic surgery precisely because there is no actuarial way to do so.

It would be like if the government offered car insurance to cover accidents and you could buy insurance to cover the possibility that you feel like giving your car a custom paint job or a new set of wheels.

[DC Al Fine]

What single-payer advocates want is not for private insurance companies to disappear completely, but for them to cover only things beyond basic medical necessities (e.g. plastic surgery). They want basic medical necessities to be covered by the government, in order to reduce costs by consumers in the forms of deductibles, copays, network limitations, etc.

There is no insurance policy that covers purely elective procedures like plastic surgery precisely because there is no actuarial way to do so.

It would be like if the government offered car insurance to cover accidents and you could buy insurance to cover the possibility that you feel like giving your car a custom paint job or a new set of wheels.

That's actually a surprisingly common phenomenon in the Canadian private insurance system. In addition to normal medical coverage for things the state system doesn't cover like drugs, most private employer provided plans cover things like massage therapy up to a cap, with the expectation that only some will use it. I get like six massages a year covered by my health insurance

[🦀🎂🦀🎂]

yes, under the British system you can get supplementary private insurance (normally if you want to cut down on waiting times for non-urgent procedures - the NHS has an 18 week waiting list policy, but recently that policy has been abolished for things like cataract removal and hip replacement surgery); it also allows you a bit more choice and private rooms. Even those with private insurance will still go for the NHS in serious emergency situations and chronic diseases like cancer though.

[Santander]

This is the kind of crap the American public has been brainwashed with.

I feel so patriotic when I listen to that.

[Person Man]

This is the kind of crap the American public has been brainwashed with.

I feel so patriotic when I listen to that.

It's like the whitest thing ever.

[Kingpoleon]

A single-payer system would destroy 200,000 jobs, nearly double the federal expenditures (+$2 trillion), and force a million men, women, and children who like their doctor to change their doctor. To pay for it? You would need a wealth tax of 30-40% on those worth over $1 billion. That means if we arrested all the billionaires in the country, seized and sold all their assets at real value somehow, we would have the funds to pay for single-payer healthcare for 3, maybe 3 and a half years.

[Devout Centrist]

Well, it depends on how you define 'private insurance'. Any single payer proposal will include exceptions for religious minorities (Specifically the Amish) and maybe medishare scams providers? Some small private component is likely to remain, but not much.

That being said, what we have right now (a mix of government social insurance/managed care with a large private sector) has led to substantial increases in the cost of care, without any benefit for the consumer.

Private care in tandem with 'Medicare for all who want it' will do nothing to prevent rising costs or medical bankruptcy. Nor will it help the poor, rural communities, or the elderly. Instead, it will build on our existing system and provide marginally better (or worse) outcomes depending on where you live and who you are.

Single payer will guarantee care to the poor, reduce the increasing cost of care, and end medical bankruptcy. While there won't be immediate administrative savings, increases in medical spending will be lower over the course of decades.

[Kingpoleon]

Not everyone who supports universal public coverage buys into the creative fiction that we can do it on the backs of a few dozen billionaires.

Not everyone who supports universal public coverage shares the attitude of Liz Warren liberals that asking the middle class to share in the cost of a substantial new benefit is unreasonable.

Not everyone has been duped into believing that households well into six figures should be treated as hard-strapped folks of whom we must never ask for a penny more in taxes.

Very well. If you doubled the tax brackets of those making above $100,000, that would generate enough revenue to pay for it. Realistically, however, that would raise taxes on many people, ranging from one in four to one in five households, depending on the estimates.