Question on health care

[alcibiades_mystery]

Has any country ever transitioned from a mature, capitalist-based health insurance system to a nationalized single-payer system? If so, what was the character of the transition from the one to the other? How long did it take to establish the single-payer logistics, and what was the method of providing care in the interim?

I'm asking this honestly. What are the parallel case examples?

[Warren Stupidity]

1. Great Britain, NHS, 1948. nt

[alcibiades_mystery]

6. Can you fill me in on details of Great Britain's pre-NHS health system?

How many were covered by health insurance? What was the character of the transition? What happened to the insurance companies that previously covered people?

Details would be appreciated. I think it's important that we understand the logistics of these transitions.

[Warren Stupidity]

2. US 1965 Medicare (65+ only). nt.

[alcibiades_mystery]

8. How many seniors were prviously covered by insurance?

What was the insurance coverage like? What was the effect of moving covered seniors from insurance to Medicare? What were the logistics of the change?

[Warren Stupidity]

3. France, Public Health Care System, 1945, nt.

[alcibiades_mystery]

5. France had a mature health insurance industry in 1945?

Wow. I'd love to hear about it.

[alcibiades_mystery]

12. History of the Transition in France

An excellent summary of the transition to the current French system. NOTE: While the system was put in place in 1945, there had been a previous government system in place as early as 1930. Moreover, 99% coverage was not established until 2000!

An interesting lesson.

http://abriefhistory.org/?p=400

[Warren Stupidity]

4. Taiwan, NHI, 1995. nt.

[alcibiades_mystery]

7. Details please

[alcibiades_mystery]

10. Actually, it turns out less than half of Taiwanese were covered before the transition

I would say that at least puts some strain on the parallel case, since that would translate into roughly 150 million uncovered Americans (or about 100 million more than are currently without coverage). The Taiwan example is good, but I think you'd agree that moving from no coverage to coverage is somewhat easier than moving from majority-private (if utterly unacceptable) coverage to single-payer coverage constitutes a different problem. To say nothing of the population differences. For this reason alone, I'd suggest that Taiwan didn't have a mature, capitalist health insurance system prior to the transition, since majority coverage would be one of my conditions for maturity. (That Taiwan was essentially on war footing and economy well into the 1980's would be another indication of the same, but is unnecessary to demonstrate at this point).

[trocar]

9. I don't know where

to put this link, but I think it's great

http://www.nytimes.com/2009/07/31/opinion/31krugman.html?ref=opinion

[alcibiades_mystery]

11. But here's the key line (and goes to medicare statement above, as well)

"Before Medicare was established, more than 40 percent of elderly Americans lacked any kind of health insurance."

This is one of the big issues, I think, in the transition. It's easier to move from no coverage to coverage than it is to move from bad private coverage to good public coverage. It's a massive logistical problem. I would, of course, love to see it happen. I've yet to see good explanations of HOW it would happen, and every parallel case argument I see has this same defect: it posits a population of largely uncovered persons. That is, they posit a non-mature insurance system as evidence. I think that's a big issue.

I'd like to see Krugman work out the problem of transition from a mature private health insurance system to a single-payer system. Quite frankly, I don't think it's ever been done, but I'm waiting for evidence to the contrary.

[Warren Stupidity]

13. right now 50 million americans lack health insurance of any kind

all of our 65+ are on single payer - around 43 million people. Medicaid covers around 49 million low income people. That 50 million represents a huge chunk (around 25%) of the remainder, those not covered by either single payer 'socialized medicine' system, and nearly half of our population is not covered by private insurance. Many of those within the private system are enrolled in crap-care programs that provide very little in terms of actual insurance for either routine care or critical care. So keep looking for reasons why this cannot be done in our system based on artificial distinctions. By the way calling our system 'mature' is a joke. It is disfunctional.

[alcibiades_mystery]

15. I'm looking for ways it CAN be done

Nice knee-jerk, though. I've yet to see a mature discussion of the logistics of moving that many people from private to public care. I'd love to see it. I just think you need a transition plan, and I don't think you have one. As for "mature," it doesn't mean good, as I've said I think clearly throughout this thread. It means well embedded, which is a characteristic utterly lacking in any of the examples you cited above (and refused, apparently, to provide any further discussion of upon questioning). Only because you want to "fight" about this would you read it as "good." I don't want to fight. I want to see the plan. Maybe five steps toward single payer, with a timeframe. Why you would take such a request as hostile in any way is a mystery to me. It's a standard feature of any proposal, policy or otherwise.

[Hamlette]

20. you've actually hit on why it has been so difficult in the US

and what I've been thinking and trying to talk about. No country went from a strictly private system to a state system in one step. Medicare and VA doesn't count as it is no avail to all. That's why I don't freak out at "public option" instead of "single payer". My husband (good liberal like us) read an article (probably in New Yorker?) making that argument. It said it will be very difficult to get the public to go along with single payer because it is so different. He said the article said European countries developed government health care modeled on what they had at the time which is the best way for us to do it.

If you want, I can ask him where he read the article.

[grantcart]

14. Approaching the question a little bit differently this is what I found:

Are there any political parties anywhere in the world that have some type of national health care that want to change to our system?


The answer is no.


Going through the policies of 60 other major political parties in all the different democracies I could not find a single instance of a political party that wanted less government in their health care.

Details here:

http://journals.democraticunderground.com/grantcart/188


This held for very conservative parties in England and Canada, for example, that consider their single payer systems, national treasures.


The big difference between the US and other democracies is that here the question is "Is national care workable". Everywhere else the question is "What is moral". Once the moral question has achieved a national concensus then there was little obstacles for a single payer system.

In the US we find it very difficult to achieve at consensus on obvious moral questions until after the fact. The struggle for voting rights legislation is an example. At the time it was very controversial and now it is accepted by all parties. Same is true for Social Security or Medicare.

Once we pass health care with a public option the moral imperative will become more widely accepted and we will eventually be able to rationally talk about a true single payer system.

It seems to big a step to take all at once.

[alcibiades_mystery]

17. I have no doubt that single-payer is a much better system

I agree with that wholeheartedly. I also think it can be done, contrary to the nasty assertions of another poster above. I do, however, think the transition to single-payer is a lot more complicated than some people seem to believe, and that is the nub of the problem.

[grantcart]

19. I agree - it is not possible, short of systemic collapse - for the US to take

such a large step at one time.

Even such modest reforms like SS took place during times when an unusual amount of power was invested in a single man, FDR.

The reality is that other systems that have made the change have all been parlimentary democracies that concentrate all legislative and executive power into a single party, single administraion.

Our system divides executive and legislative and then gives the minority a near veto power in the Senate. It makes sweeping changes almost impossible.

That is why the public option is so important - it gives us a pathway to single payer.

[Mass]

16. Not sure for Canada, but for all other examples given, the answer is probably NO.

Most of these systems were built either on a situation where nothing existed or where there were non profit co-ops that evolved in a national system.


This said, it may be time for the US to say honestly that most of the population is not covered, because between those who are not covered and those who only have catastrophic insurance, insurance with huge out of pocket expenses, or just insurances that cover very little, it is the situation.

[alcibiades_mystery]

18. This is a good point