There is one huge Constitutional problem with pure single payer system. Under a pure single payer system, only the government is allowed to pay for health care. Therefore, if the single payer system refuses to pay for a procedure, then it is effectively banning that medical procedure.

There is a Supreme Court decision about banning desired medical procedures...Roe vs. Wade. Would a single payer system that would effectively bans abortions be constitutional? If you say no, then a pure single payer system is probably unconstitutional.

No, that's not how any of the various single payer's system in all other industrialized countries besides the US work. You don't have to participate. But legal procedures that work are all covered (including abortion, and best of all birth control which is the best way to prevent the need for abortions). You're free to seek medical care outside the system. That's how Medicare works, by the way..... Please educate yourself, there is so much crazy notions out there I'm afraid people only realize how much they need health care when they get ill but by then if the system isn't changed, it's going to be too late.

Now why do you suppose the anti-choice people are so opposed to health care reform?

Mnz: "Would a single payer system that would effectively bans abortions be constitutional?"

You know part of the opposition to health care reform is that it seeks to resume covering birth control and abortion for women on Medicaid, procedures that were been no longer covered under pressure from the extreme right?

Mnz: " There is one huge Constitutional problem with pure single payer system. Under a pure single payer system, only the government is allowed to pay for health care"

THERE IS NO SUCH THING ANYWHERE IN THE WORLD AND NO SUCH THING IS PROPOSED IN THE US.

By the way, under a single payer system doctors have a lot more say than they do when dealing with private insurers. When dealing with a government run program, they can vote if they don't like it, they can enlist their patients' help (and they do it in Canada), they can respond with adds and letters to the editor and yes, with science and bringing to the fore their patients' needs. A single payer system doesn't come between a doctor and her patients, but private insurers whose primary goal is to make money off the patient sure do.

kati, note the term "pure single payer" (i.e., no one else is allowed to pay for care but the government). Very few countries have a pure single payer. I think Canada came the closest of any Western country.

Regarding Canada, they banned the purchase of private health care for procedures covered by their public health plan. As a result, people were forced into the public system (and long waiting lists) for procedures such as hip replacement. One Canadian man became frustrated waiting an sued for the right to seek private care. He won in 2005. As a result, Canada has had to move further away from the pure single payer model. Here is a link.

If a relatively pure single payer system cannot survive Constitutional muster in Canada, I am pretty certain it wouldn't survive here.

The decision actually highlighted that some Canadian governments were not doing enough to fund public health, rather than causing some kind of exodus to private health care.

There's no "pure single payer" system in Canada and there never was. You can pay for your own procedures if you find a hospital and someone to do them. Or you can go to another country. (by the way, their constitution is not the same as ours! You know, they have a parliamentary democracy, etc. And in their Bill of Rights they included the right of access to health care --how barbaric!)

Waiting lists for surgeries in Canada are no longer and often shorter than in the US. Every friend I have in Canada who have needed surgeries have not waited as long or waited about the same time as we do in the US. A friend of mine needed bypass surgery in BC (British Colombia, a.k.a. a Canadian province on the west coast! --sorry, I'm not sure you're up on your geography) and my husband needed one in the US at the same time. They both had to wait one month to get it. But if my husband hadn't had insurance, he simply wouldn't have gotten that surgery. We don't have 50,000 $ laying around to pay for it. Even so, we had to take a loan for the large deductible and it took us years to pay for it, while our Canadian friend didn't pay anything (of course Canadians pay premiums for their insurance, just as we do for Medicare, but the premiums are much lower, because the pool is so much larger and not limited to elederly people). As for emergency surgeries, they are done immediately in Canada, while they might simply not be done in the US: ER are only required to give you immediate care but hospitals don't have to admit you and surgeons don't have to operate on you if you or your insurance can't pay them.

If you don't have insurance, as millions do and the number is drastically growing with growing unemployment, you just don't get surgeries when you need them. To come back to the bypass surgery example, if you have heart pains and it turns out you actually need bypass surgery, you'll be stuck with just meds unless you can affford at least 50,000$. Of course once you have a heart attack perhaps 6 months or two years later you'll be taken to the ER and supposing it takes you 2 weeks to die, that will cost a lot more to the tax payers than a timely surgery would have.

And then in our country you also have the cost of preventable disability. If you have a bad heart and can't afford surgey, then you wont be able to work and pay taxes. You'll become disabled and after a year or two of waiting (if you live that long!) you'll get approved for Social Security Disability. You'll get a lump sum from social security for the years since you put in your application and waited, you'll get social security payments as if you had kept on working till 65 at the same salary you had when you became disabled, and you get Medicare and then and only then you get your surgery, but by that time the damage will be so great that you might be disabled for the rest of your life and drawing social security all the years before you reach 65.

But in Canada or other single payer system or whatever system insures access to health care for everyone, it might never have gotten to the need for bypass surgery. With regular doctor's visits (in the US, if you're not insured you're not going to pay $200 for a physical if you feel fine) high cholesterol would have been caught and treated before it did its damage. Or perhaps you could have gotten a stent, a much cheaper procedure. Treatment doesn't always work, but it works enough time to greatly diminish the need for expensive surgeries and disabilities.

Canadians live longer than we do, and the cost of their health care system (adjusted for population number) is less than our own, just as it is in all other countries where there is universal access to health care. Dont you feel even a little bit embarrassed that the US ranks only 36th in the world in life expectancy (same rank as Serbia)!

I suspect you're very young and/or healthy and you've never had to deal with private insurers jerking you around when you're ill, or with the lack of insurance. I'm on Medicare now, and it seems like heaven compared to the private insurers I've had in the past: I can now chose my own doctors, hospitals and specialists which you cannot do with private insurers. Major surgeries get approved in 24 hours and emergency ones in 30seconds --what a contrast to when I had to rely on private insurers in the US who seemed intend on slowing down whatever approval they were requested probably hoping that you'll die before the surgery so they can keep all the profits they made from your years of paying premiums and give them to their CEO as part of his 50million yearly bonus!

wayhey1:

The decision actually highlighted that some Canadian governments were not doing enough to fund public health, rather than causing some kind of exodus to private health care.

Sure, there was no exodus. However, there was a finding that their interference with private payment of care was unconstitutional.

kati, Canadians do face substantial wait lists.

If you want to use anecdotes, I went to college with Canadians in the US. One guy had been put on a two year waiting list in Canada for knee surgery. When he came to the US and was covered under the university health plan, he got his knee surgery in the US within a month.

Or you can refer to the court case that I just presented to you. As a result of their single payers wait lists, their restrictions on private care was struck down.

MnZ,

First, the court decision only affects the Province of Quebec, at least in the immediate term.

Second, the decision was based on the fact that it went against Quebec's own Act of 1975 (Quebec Charter of Human Rights and Freedoms). In theory, one could change the Act, but this is obviously not a reasonable approach.

Third, the decision had a minimal impact in practice (as someone else explain above). Bill 33 was introduced following the decision. This Bill states that a medical provider can offer his or service for a fee, but has to totally opt out of the public system. Since all Quebec residents already pay for medical coverage via the taxes they pay, nobody is rushing around to pay additional fees to get access to a private medical service. The same thing for medical doctors, they would have to have a lot of patients in order to do better financially as private medical provider than being part of the public system.

MnZ,

I guess it all depends on the type of knee surgery your friend wanted/needed. The Canadians are among the cutting edge for evidence-based care, whereas in this country we still lag a bit. For instance, arthroscopy for meniscus tears does not show much long-term benefit, so in Canada this wait list might be longer for a reason - to see if it improves without surgery. In the US, if you have the cash you can usually find someone to do the surgery for you.

One of the problems with the current planning we are doing is that we are nowhere near the capacity of primary care physicians needed to start any kind of universal health care. Until we start equilibrating payments so that primary care physicians do not have to schedule 40 patients in an 8 hour day to make ends meet, not enough medical school graduates will fill this important need for universal health care.

Why do Americans find it so necessary to outright lie about the Canadian heath care system, something they have no experience of?

I'm Canadian. I have NEVER had to wait to see a physician. Not once. I can count on the fingers of one hand the number of times I've had to go to emergency rooms - because I didn't have to wait to see a doctor, and because there are walk-in clinics everywhere that can handle anything most emergency rooms do on a regular basis. No one in Canada has to sit in a crowded emergency room for hours because they have the flu.

I've had six knee surgeries, two of them major, for a genetic condition called patellar femoral syndrome. I got to choose my orthopaedic surgeon and hospital, have the surgery and all of the physiotherapy, and go for all of the follow up appointments and NOT ONCE was I asked for money by anyone. There are no co-pays. If I had tried to have the surgery here in the States, my insurance company would have refused to pay for it. I was in constant pain, but not "disabled enough" for them to pop for it.

My mother-in-law became ill, saw her doctor the same day, had a colonoscopy the following afternoon and was in surgery 48 hours later. She spent three weeks in hospital healing and has to have colonoscopies every six months for the rest of her life. She can have these colonoscopies in any province she happens to be living in at the time without restriction. She has never and never will be asked for money at any time.

So, I call bullshit. You have no idea what you're babbling about. Your health care in the States is already rationed by call center idiots and administrators who don't give a rat's ass if you live or die as long as it doesn't affect their share price.

I cannot say I'm an expert on the Canadian system, but I expect Messy's right.

And she is absolutely right that "rationing" is what's routinely practiced by the for-profit US companies. Heck, those companies maintain huge bureacracies whose only purpose in life is to seek out ever more arcane ways of DENYING the services their members have paid them to provide!

It's rather galling to see the word "rationing" applied to proposed healthcare reforms as though it were a completely new and bizarre concept, unique to non profit insurance providers.