5 People from Around the World Share What it’s Like to Have Single-payer Healthcare

30703799_1511615715634749_8690206414615871488_nAs I prepare for my vacation through Europe I thought that I would review a sample of what other people around the world feel about the single-payer health care system. As we consider the single-payer health care delivery system I thought that those already living with such a system deserve to be heard, especially as the Democrats rev up the mid-term election rhetoric to include the healthcare system, Obamacare, and a single-payer system.

Chris Weller wrote that the United States is the only wealthy, industrialized country that lacks universal healthcare. The U.S. Supreme Court’s recent ruling on Obamacare subsidies kept the program rolling, and Sen. Bernie Sanders was totally celebrating.  Still, the independent from Vermont who is running as a Democrat for president told ABC News host George Stephanopoulos that the nation was far from out of the woods on health care.

“We still have 35 million Americans without insurance,” Sanders said on June 28, 2015, during an interview on This Week. “We need to join the rest of the industrialized world. We are the only major country on Earth that doesn’t guarantee health care to all people as a right.”

We wanted to check Sanders’ claim that the United States is “the only major country on Earth that doesn’t guarantee health care to all people as a right.”

This is a common theme for Sanders but the words he used this time muddied his message on two fronts — which countries and what guarantee?

A spokesman for Sanders, Michael Briggs, said Sanders was referring to nations that make up the Organization for Economic Cooperation and Development. We’re not sure Sanders made that entirely clear (for instance the OECD doesn’t include China or Russia, which many people would consider a major country), but we’ll put that aside for the moment.

Anyway, Briggs directed us to a 2014 OECD report that found only two member countries, the United States and Mexico, lack universal health care coverage.

“However, Mexico passed a law in 2004 with the goal of establishing universal coverage, and they’re currently at 90 percent,” Briggs said. “The ACA was never intended to establish universal coverage, and according to the January CBO estimate, 90 percent is about as good as it’s going to get.”

We checked and Briggs is close to his numbers. In Mexico, as of 2013, public insurance reached about 86.7 percent of the people. That’s actually not much different from where America stood if you combine public and private coverage. The figure in the United States was 84.9 percent.

However, in 2015, the CBO estimated that 89 percent of American residents — excluding undocumented immigrants — have coverage. The number drops to 87 percent if you include undocumented residents.

The median income in Mexico is so low, about a third that in the United States, that some would not group it with the stronger OECD countries. In fact, Mexico is often referred to as an emerging or developing economy as opposed to an industrialized or developed one

Some proponents of the US model say this increases people’s level of choice, allowing citizens to pick the plan that is right for them.

Advocates for a single-payer model argue government-funded care significantly reduces cost and provides a stronger social safety net.

Business Insider spoke with a handful of people around the world to find out how single-payer actually shakes out.


What’s it like living in a country with single-payer healthcare?

In Canada, doctors have waiting lists and the process is more like getting into a country club where you have to be recommended by other members. Once I finally got “inside” the system, I was pleasantly surprised.

The wait to see my doctor is never more than a few days, but referrals to specialists can take a bit longer. Special equipment, like MRI machines, always have a waiting list and work around the clock, so it is not unusual to get an appointment a month or two out, with a middle of the night time slot. It is a little strange to drive an hour to a hospital, which seems deserted at 2 a.m. and find the radiology waiting room packed.

What do you really like about it? What do you think people might overestimate?

Aside from some system glitches, I would say that Canadian healthcare, like an American HMO, works pretty well most of the time, especially if you don’t get sick!

I have had my Canadian medical coverage since 2012, and the biggest challenge has been getting the US to acknowledge it is real.

Can you share how much you pay in a typical month for your healthcare?

In Ontario, there is no monthly out of pocket cost, though each province is different. We do carry an additional plan, which covers prescriptions, massage etc.

– Heidi Lamar, business owner, dual citizenship in the US and Canada

United Kingdom

What’s it like living in a country with single-payer healthcare?

Basically, it’s a lot easier. You don’t worry about healthcare, ever, for any reason. It’s just there. Like the police or the fire department. There are no bills, no paperwork, no deductibles, no insurance companies to deal with, no “patient statements,” no risk of going bankrupt if you get the “wrong” disease.

What do you really like about it? What do you think people might overestimate?

Brits over-estimate how good the care is going to be for non-serious conditions. The NHS is geared toward preventative care and emergency care, so if you have a non-serious condition, like tinnitus, for example, you are going to wait many weeks to see a specialist. Your treatment will be free, but the wait might be a couple of months.

Can you share how much you pay in a typical month for your healthcare?

Zero. My only costs are: over the counter medicines like aspirin and allergy meds, which cost the same in the UK as they do in the US. If you go to the doctor (free) and need a prescription there is a token prescription charge, which is £8.60 ($11.17) per drug.

– Jim Edwards, Editor-in-Chief, Business Insider UK


What’s it like living in a country with single-payer healthcare?

Life is much easier when your healthcare is covered without thinking about it. I have lived many years in a country where people have to choose whether they have or don’t have coverage for their health. Single-payer healthcare is easy and fair, providing basic security for all people regarding their health.

More specifically, what do you really like about it? What do you think people might overestimate?

I think healthcare is one of the basic public services together with education, dental care, and childcare that belongs [to] all citizens. I think there is enough evidence to show that when people have access, or sometimes responsibility to take care of their health, it will be cheaper for the society and those who pay taxes for in the long run.

I also like a public healthcare system that provides all mothers with free pre- and post-natal health care and parental leave for both parents – that is one way to reduce problems with newborns’ health.

Can you share how much you pay in a typical month for your healthcare?

In total, for most people who are employed, the healthcare is about 2.5% of taxable income. That is shared between employer and employee in a rate of 1% to 1.5%, respectively. Unless a person has an optional private healthcare plan, no other payments are necessary.

– Pasi Sahlberg, Director General, Centre for International Mobility


What’s it like living in a country with single-payer healthcare?

In [Australia], you know, if you get sick you can be treated. We have a system called Medicare. Basically, you get your Medicare card and you can go and see a doctor. Some doctors charge premiums on top of Medicare. It basically means that if you are sick in any way the public system will find a way to treat you.

The doctors won’t always be the best in their field and there will also at times be waiting lists, but overall it’s pretty good.

What do you really like about it? What do you think people might overestimate?

One observation is that [in the US] when you visit a doctor you have a nurse and a doctor in the room. We don’t have that. One doctor, in and out much faster and more efficient. We also don’t have teams of admin people working behind the counter. I would think this drives [US] costs up and is why everything costs so much.

Can you share how much you pay in a typical month for your healthcare?

It’s possible to pay zero for healthcare in Australia. It’s a little extreme, but it is possible.

– David Boldeman, Account Director, Business Insider


What’s it like living in a country with single-payer healthcare?

I love living in a country with publicly-funded, universal healthcare, paid for by government taxes. I especially like the fact that every Icelandic citizen, irrespective of his or her economic status, has the same healthcare coverage.

What do you really like about it? What do you think people might overestimate?

What I like about universal healthcare is that it gives you peace of mind.

The shortcomings we have do not stem from the single-payer model, but from the fact that the government needs to spend more on healthcare – that is, build additional hospitals and nursing homes, improve and subsidize mental health care, and reduce out-of-pocket expenditures, particularly for marginalized populations.

Can you share how much you pay in a typical month for your healthcare?

I do not know how much my family and I pay per month for healthcare. That in itself says a lot; the typical Icelander does not have to fret over healthcare costs as a critical part of the family budget.

In the Icelandic system, the government pays 80 to 85% of all healthcare expenditures, funded by taxes. The rest is mostly paid for through service fees.

  • Gummi Oddsson, Sociology Professor, Northern Michigan University

Why the left is betting on single-payer as their litmus test

With the mid-term elections on the horizon and the pollsters predicting a possible shift of the majority to the Democrats, they could be in charge of getting their wishes, either back to Obamacare or a single-payer system of some type. Gregory Krieg analyzed the left’s rationale for the single-payer system. (CNN)When Sen. Bernie Sanders hit the road in July to gin up resistance against Republican efforts to raze Obamacare, he delivered a two-part message: First, protect the current law. Second, push on and make the case for a single-payer system, or “Medicare for all.”

Recently, at the Democratic Socialists of America national convention in Chicago, delegates and observers buzzed about that budding campaign to organize and rally for single-payer legislation on the federal level.

Those discussions were a break from the mainstream discourse on health care right now, which tends to fixate, appropriately enough, on how the GOP’s “repeal and replace” pledge failed, the fixes required to sustain the Affordable Care Act, or the contours of Sanders’ forthcoming “Medicare for all” legislation.

But there is an additional dimension on the left, which increasingly views health care policy as a beachhead — one they are now well-positioned to capture — from which to launch a wider effort to promote socialist ideas to more diverse audiences. What’s feasible or not, in the current climate, and how to tinker with the equation, is essentially beside the point.

Democratic Socialists are taking themselves seriously. Should Democrats?

“We chose that issue for a reason: it will help mostly working people and marginalized people more than everyone else,” DSA’s Jess Dervin-Ackerman, an organizer with DSA East Bay chapter in Northern California, told me at this past weekend’s convention. Her colleague, Jeremy Gong, tagged it to abortion rights, saying, “This is an economic issue in addition to an issue of gender. We need to create a universal, single-payer health care system that guarantees abortion access to all women, everywhere, with no questions asked.”

Health care is where the grassroots energy is, organizers in Chicago agreed, and for new recruits, the hard work of canvassing is brightened by the opportunity to sing the single-payer gospel. The resulting surge in recruitment, Dervin-Ackerman said, has the knock-on effect of getting activists off social media, an often unproductively exhausting medium, and plugged into their actual communities.

On the broader left, taking into account Democrats of all stripes, single-payer is increasingly popular. A recent Pew survey found 52% support for the policy among Democrats, a nearly 20-point spike in a little more than three years. The number jumps to 64% when narrowed to self-described liberal Democrats.

Untitled.litmus test for single-payer.1

Public support for ‘single payer’ health coverage grows, driven by Democrats

The outlook is much less rosy when Republicans are thrown into the mix. Nationally, only 33% support single-payer. But that number is 12 points higher than in 2014 and approximately three in five Americans, across partisan lines, now say the federal government should be responsible for “ensuring health care coverage for all Americans.”

But as gun control activists are keenly aware, it takes more than positive polling to drive legislation. The reality of national politics today, in which Democrats are out of power and on the defensive in Washington, means that single-payer is a nonstarter in the House and Senate. Even then, top officials on Capitol Hill remain cautious. Senate Minority Leader Chuck Schumer only recently conceded the policy was “on the table,” while Nancy Pelosi, his counterpart in the House, has been less willing, even rhetorically, to entertain it.

The left, though, is seizing on that lack of direction — and a diminished incentive for the party to act given its inability to move legislation — by working to make health care the defining issue in Democratic politics. The absence of actionable legislation also provides space for litmus testing potential allies. Potential 2020 primary candidates are facing them, along with party leadership up and down the midterm ballot, from city council candidates to gubernatorial and congressional hopefuls.

Most politicians are, of course, constitutionally uncomfortable offering categorical answers to yes-or-no questions, especially when the queries center on issues that can divide public opinion. The Democratic Party establishment is currently mired in a fight over whether support for abortion rights should be a litmus test for potential candidates. Unsurprisingly, party leaders with a mandate to win back power oppose it. California’s lame-duck governor, Jerry Brown, in an appearance Sunday on NBC’s “Meet the Press,” made an appeal for Democrats to open their ranks.

“The litmus test should be intelligence, caring about, as Harry Truman or Roosevelt used to call it, the common man,” Brown said. “We’re not going to get everybody on board. And I’m sorry but running in San Francisco is not like running in Tulare County or Modoc, California, much less Mobile, Alabama.”

But the left is betting that, at this early stage, single payer — as an overarching priority if not a singular concern — represents the best vehicle to proactively address all those issues in vast swaths of the country historically unwelcoming to mainstream liberals.

“Every social and economic crisis presents in the hospital,” said Bonnie Castillo, health and safety director for National Nurses United, the first national union to back Sanders’ 2016 primary run. “Nurses care every day for people harmed by environmental pollution, climate change, the opioid epidemic, malnutrition, homelessness, joblessness, inadequate mental health care services. Health impacts everything, (which is) exactly why Medicare for all should be a priority for every Democrat.”

The message is resonating with elected officials, like California Rep. Ro Khanna, a pro-Sanders Democrat from Silicon Valley who supported policy during his insurgent run in 2016. Speaking on Tuesday, he framed single-payer as a job-creating mechanism.

“There are a lot of entrepreneurs and tech leaders who say their biggest disadvantage competitively is the cost of healthcare. It’s not tax policy, it’s not wages, it’s health care costs,” Khanna said. “So you have the moral argument for it, but it’s also something that you can get business leaders and technology leaders excited about.”

I thought that next week I would try to reveal how an American would describe our health care system to our foreign neighbors.

And remember, if you get a chance to read our new book: The Search for Excellence in Clinical Practice, Published by Sentia Pub.

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