The standard case for a single-payer health insurance system is pretty well known. Anyone can get care without courting financial ruin. Monumental personal decisions, like when to have a child or whether to leave or take a job, no longer hinge on the whims of an employer or the dysfunctions of the private insurance market. Surprise hospital bills, endless phone calls with insurance companies, juggling premiums, copays, and deductibles — all will be things of the past.
The case against single-payer often boils down to a single word: rationing. When critics peddle scare stories about Canadian or British “waiting lists,” they’re trying to conjure images of scarcity and austerity — the social-democratic equivalent of Soviet bread lines.
The truth, of course, is that you only have to look around to see that health care in America is already rationed. Try finding an in-demand specialist willing to take your “bronze-tier” insurance plan, or paying for high-priced specialty prescriptions out of pocket. Health care rationing is a fact of life in this country.
But there’s another important point to be made about single-payer and “rationing”: in many places around the world, national health insurance not only isn’t austere — it’s downright luxurious.
A Card up Their Sleeve
Americans, with our predatory health care system, can be easy to impress. The simple fact that the French can visit any health facility in the entire country, for example, seems astonishing. No provider is out of network, because there’s no such thing as a network. Instead, there’s a universal public insurance system that can’t turn applicants down, can’t terminate insurance, and almost never denies claims.
In France there’s no such thing as a deductible: insurance kicks in from the first euro billed. Since there’s no need to hire people to rifle through reams of paperwork and make judgment calls about denying claims and refusing coverage — and because the system has no stockholders to pay dividends to — the French insurance system spends next to nothing on paperwork.
Prices for treatments are fixed, and cost the patient next to nothing. For Americans accustomed to the need to change doctors every time they change plans, change plans every time they change jobs, and navigate things like claims denials, unpredictable charges, and endless paperwork, it seems extravagant.
But the conveniences don’t stop there. Since French providers aren’t carved up into networks, the government is able to issue what’s called a carte vitale, or “life card,” to all legal residents over the age of 15. With the patient’s permission, the card contains centralized information on the patient’s every medical visit, treatment, prescription, surgery and so on, going back to 1998. (Children’s records are stored on a parent’s card).
The physician inserts the carte vitale into a card-reader and the patient’s medical records pop up on a screen. Not only does it help doctors offer informed care, but it makes billing simple and eliminates much of the nightmare of transferring medical records. The physician logs the treatments, hits a button, and then waits roughly three days to be paid.
When doctors go on house calls, they take a portable card-reader with them. That’s right — in France they make house calls. Patients can request one anytime by calling a round-the-clock national hotline. The visit costs just thirty-one euros. (...)
Will You Still Feed Me?
Long-term care is another area where universal health care systems deliver the goods. Eight million Americans require long-term care services, most of them elderly. As many as two-thirds can’t afford to buy long-term care insurance, and Medicare doesn’t cover extended stays in nursing homes. Without coverage, the price of assisted living is comparable to private college tuition. As a result, many middle-class Americans’ best hope of affording long-term care is becoming eligible for Medicaid, which requires selling off assets and then draining nearly all personal savings to meet means-tested criteria. (...)
Japan implemented its long-term care insurance system when policymakers realized that changing family structures and rapid aging meant that relying on informal care would inevitably lead to a crisis like the one currently facing the United States. They made the choice to socialize care to avoid the dystopian scenario of millions of neglected, impoverished elderly moldering in underfunded institutions — preciselythe scenario that American conservatives equate with public care systems.
In a study of long-term care insurance recipients, one regular at a Japanese senior community center said, “Since I’m injured and can’t move as well, I used to just lay there, stare at the ceiling and listen to the radio, and feel the changing of the seasons. Then someone from the Hana House recommended to me if I would like to go to the day services.” He described becoming active in crafting workshops at the center, which he claims increased his mobility. “Because of this place I’ve become a lot healthier.”
“First and foremost,” said another survey respondent, “I feel a sense of safety.”
The case against single-payer often boils down to a single word: rationing. When critics peddle scare stories about Canadian or British “waiting lists,” they’re trying to conjure images of scarcity and austerity — the social-democratic equivalent of Soviet bread lines.The truth, of course, is that you only have to look around to see that health care in America is already rationed. Try finding an in-demand specialist willing to take your “bronze-tier” insurance plan, or paying for high-priced specialty prescriptions out of pocket. Health care rationing is a fact of life in this country.
But there’s another important point to be made about single-payer and “rationing”: in many places around the world, national health insurance not only isn’t austere — it’s downright luxurious.
A Card up Their Sleeve
Americans, with our predatory health care system, can be easy to impress. The simple fact that the French can visit any health facility in the entire country, for example, seems astonishing. No provider is out of network, because there’s no such thing as a network. Instead, there’s a universal public insurance system that can’t turn applicants down, can’t terminate insurance, and almost never denies claims.
In France there’s no such thing as a deductible: insurance kicks in from the first euro billed. Since there’s no need to hire people to rifle through reams of paperwork and make judgment calls about denying claims and refusing coverage — and because the system has no stockholders to pay dividends to — the French insurance system spends next to nothing on paperwork.
Prices for treatments are fixed, and cost the patient next to nothing. For Americans accustomed to the need to change doctors every time they change plans, change plans every time they change jobs, and navigate things like claims denials, unpredictable charges, and endless paperwork, it seems extravagant.
But the conveniences don’t stop there. Since French providers aren’t carved up into networks, the government is able to issue what’s called a carte vitale, or “life card,” to all legal residents over the age of 15. With the patient’s permission, the card contains centralized information on the patient’s every medical visit, treatment, prescription, surgery and so on, going back to 1998. (Children’s records are stored on a parent’s card).
The physician inserts the carte vitale into a card-reader and the patient’s medical records pop up on a screen. Not only does it help doctors offer informed care, but it makes billing simple and eliminates much of the nightmare of transferring medical records. The physician logs the treatments, hits a button, and then waits roughly three days to be paid.
When doctors go on house calls, they take a portable card-reader with them. That’s right — in France they make house calls. Patients can request one anytime by calling a round-the-clock national hotline. The visit costs just thirty-one euros. (...)
Will You Still Feed Me?
Long-term care is another area where universal health care systems deliver the goods. Eight million Americans require long-term care services, most of them elderly. As many as two-thirds can’t afford to buy long-term care insurance, and Medicare doesn’t cover extended stays in nursing homes. Without coverage, the price of assisted living is comparable to private college tuition. As a result, many middle-class Americans’ best hope of affording long-term care is becoming eligible for Medicaid, which requires selling off assets and then draining nearly all personal savings to meet means-tested criteria. (...)
Japan implemented its long-term care insurance system when policymakers realized that changing family structures and rapid aging meant that relying on informal care would inevitably lead to a crisis like the one currently facing the United States. They made the choice to socialize care to avoid the dystopian scenario of millions of neglected, impoverished elderly moldering in underfunded institutions — preciselythe scenario that American conservatives equate with public care systems.
In a study of long-term care insurance recipients, one regular at a Japanese senior community center said, “Since I’m injured and can’t move as well, I used to just lay there, stare at the ceiling and listen to the radio, and feel the changing of the seasons. Then someone from the Hana House recommended to me if I would like to go to the day services.” He described becoming active in crafting workshops at the center, which he claims increased his mobility. “Because of this place I’ve become a lot healthier.”
“First and foremost,” said another survey respondent, “I feel a sense of safety.”
by Meagan Day, Jacobin | Read more:
Image: Jan Steen, circa 1660
