Understand the big picture
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| Published: | 2013-Dec-19 |
| Last Updated: | 2015-Jan-21 |
| Principal Writer: | Barry Shatzman |
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American Health Security Act
2013 (S-1782)
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What is this about?
Imagine this...
You go to the doctor. You get the care you need. Maybe you get a prescription. Or a more serious treatment. But there's one thing you won't get. A bill.
An insurance company didn't pay for it. The doctor isn't even in your provider network. That's because there are no insurance companies. There is no provider network. You chose this doctor from every available nearby doctor.
But here's the amazing part. If you lived in any industrialized country other than the United States, you wouldn't have to use your imagination. That's just the way health care works there. It's called universal health care, and the U.S. is the only industrialized nation in the world that doesn't have some form of it for all of its citizens.
How is this different from our current system?
In one sense, little would change under a universal health care system. You would go to their private doctor or dentist just as you do today. If you need drugs or more specialized care, your doctor would write the prescription or refer you to a specialist.
There are a few differences. For one thing, you would be free to choose your doctor and dentist, without having to worry about whether they are in your network. But the biggest difference would come at the end of the whole process, when you skip the visit to cashier, or wait for that surprise bill to come in the mail. No need for that, since there's no bill.
And you wouldn't pay monthly premiums to an insurance company.
So who pays the doctor bill?
Doctors and other health care providers don't work for free, of course. So where would the money to pay them come from?
In order to answer that, it's important to understand how health care is paid for today. In most cases it's in one of the following ways...
o You pay premiums to an insurance company, which in turn pays part of the cost of your treatment
o The government pays your health care providers for the services they provide to you.
This 2-minute video explains it...
This is important, because whether you call it an out-of-pocket expense, an insurance premium, or a tax, the issue isn't whether you pay for health care. You do. The issue is how much you pay and what services you get for that money.
So how would Universal Health Care in the US be paid for?
There are several ways to implement a system of Universal Health Care. The type that has been proposed in Congress and by several states is known as a Single-Payer system.
Think of a single-payer system as one in which your doctor and other providers are paid by an insurance company. Only instead of hundreds of insurance companies and thousands of plans throughout the nation, there is just one insurance company and one plan for everybody. That "insurance company" would be an agency of the federal government.
Your premium would be paid through a tax, rather than you writing a monthly check to an insurance company.
Comparing the systems
How would health care under a Universal Health Care system compare to today's system...
o You would not need to worry about whether a particular doctor or hospital is included in your provider network. Because there would be only one insurer, there would be one nationwide network including virtually every doctor and hospital.
o When you visit the doctor (or hospital), you would not need to fill out forms related to your insurance plan. Everyone would be covered exactly the same.
o Virtually the entire cost would be covered. You would not be responsible for a copayment, deductible, or coinsurance.
o You no longer would need to spend time each year researching insurance policies and filling out forms. And there would be no deadlines. You automatically are covered. It's that simple.
Stress-free insurance (and cheaper too)
Under today's system of private insurance companies, applying for insurance every year involves more than just time. It involves a gamble - one that could turn out to be costly.
If you buy the least expensive policy, an unexpected illness or accident could cost you thousands of dollars in out-of-pocket expenses that would have been covered by a more expensive policy.
Or you might want to play it safe, by choosing a more expensive policy that would cover much of your costs if you get sick or have an accident. But if you stay healthy throughout the year, you might have paid thousands of dollars more than you needed to.
Under a Universal Health Care system, you won't have to gamble on something as important as health care. Your "premium" depends only on your income, and you are covered for everything.
Why could a single-payer system save money?
Having the federal government acting as the insurance company opens up several areas where costs can be reduced.
A single insurance company would be in a strong position to negotiate lower prices with hospitals, prescription drug suppliers, and other health care providers. And the fact that this insurance "company" is the government, the benefits of those savings would go to you, rather than into the pocket of an insurance company executive. And if that "company" doesn't negotiate lower prices? You can hold your elected representatives accountable with your vote. Today's insurance companies are accountable only to their shareholders.
It would cost doctors less to provide care because their offices would not need to deal with many insurance companies - for both pre-authorization of treatments and payments. A study published in Health Affairs (Aug 2011) showed that doctor office staffs in the U.S. spend more than 20 hours each week dealing with insurers. Office staffs in Canada - which has a single-payer system - spend less than 3 hours. Overall, doctors' offices in the United States would save more than $25 billion every year under a single-payer system.
Notes
Why would the network include most, but not necessarily all providers?
Health care providers could choose to remain outside of the system. But because most people would use providers within the system (since they've already paid for it), virtually all doctors would become part of the system - creating a virtual nationwide network.
Why not all costs?
A single-payer system might not include unnecessary services such as a private hospital room. Patients would be responsible for such costs.
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