Poll results, and a question about healthcare

February 28, 2020 • 8:00 am

On February 26, the night after the Democratic debate in Charleston, South Carolina, I urged readers to discuss the debate in the comments. And so you did, to the tune of—as of today—193 comments.  While nothing is ever settled in these discussion, nor do opinions ever coalesce around a single one (we are, of course, diverse and largely irreligious, which means cat-herding), it’s fun to sound off.

Here are the results of the two polls, both about The Bern. In the first one, a bare majority of readers felt that Bernie would wind up as the Democratic nominee. Many were undecided.

In the second poll, most people (the figures are almost identical to those above) felt that Bernie could NOT defeat Donald Trump. I was surprised, as I thought most people would think that Sanders could beat Trump. In fact, that’s my own view, but I’m not a pundit.

I still have no favorite candidate in the race, and no idea for whom I’ll vote in the primary. (I’m voting by mail).  Nobody inspires me with as much enthusiasm as I had for Obama in the 2012 and 2008 elections (or George McGovern in 1972, which was a complete Democratic disaster). So be it; I’ll still go with whom the convention chooses to run against Trump.

Here is a question for foreign readers who live in countries with single-payer health care. My own view until now has been for the government to pass a single-payer option like Medicare, so that everyone is covered, and must be covered, but also to allow coexisting private insurance.

One reason I feel this way is that almost everybody I know who lives in countries with universal government health care—and those include Canada, the UK, New Zealand, and Poland—has resorted to going to private doctors some of the time because of a) their higher quality and, more important, b) the speed: you seem to have to wait long times under government systems. Often government doctors are very good, but the waiting times, to my friends, seem intolerable.

An example: I had an inguinal hernia last year, and a friend in New Zealand had one at roughly the same time. His was painful; mine was not. I could have gone without treatment, as it wasn’t immediately dangerous, but as I was going to Antarctica, my doctor advised me to have the repair operation beforehand, for if the hernia became strangulated when I was on a boat in Antarctica, I would probably die. (Strangulated hernias must be operated on within a day or so.) Strangulations are rare, but do happen. I called the belly doctor and he said he could operate on me in three weeks. And so I got operated on and completely fixed.

My friend in New Zealand is, as far as I know, still waiting, and says he is in pain. He may wait two years, as I recall, because the government healthcare system can’t fit him in before then.

This is also the case for friends in some of the other countries I’ve mentioned: long waiting times for non-life-threatening operations, even when you’re in pain or debilitated during the waiting period. This is, in fact, why private healthcare coexists alongside government healthcare in those countries.

When readers say they favor a single-payer procedure, do they want the complete elimination of private healthcare and private insurance? Based on my experience, and that of other people I know, that does not seem optimal. Even those people who tout and are proud of their government healthcare seem to resort to private doctors when the crunch comes. Sander, however, seems to favor the complete elimination of private medical insurance and non-government healthcare.

Weigh in below. If you live in a “single-payer” country, have you ever gone to a private doctor? If so, why?


110 thoughts on “Poll results, and a question about healthcare

  1. I have no health care insight.

    As for Sanders : my 2 cents is : the apparent success of Sanders is only that. I suspect that his opponent in The White House has every reason to want Sanders on the big election because he is – again, no evidence – guaranteed to lose, in the way Clinton was fated to lose. Certainly there are geeks behind the scenes calculating all this stuff with data inaccessible to e.g. 538.

    1. What the current occupant in the White House wants or thinks is not a guide to reality.

      The Orange Menace thinks coronavirus is going to disappear in April. He’s not rational.

      1. Yes

        But what I mean of course is that he pays geeks to figure out this stuff for him, and on top of that, Trump has a way of sniffing out weaknesses in his enemies, in a particular way that benefits himself. He doesn’t “think” per se, but simply bulls his way through.

        1. Geeks did a great job predicting a huge defeat for Trump in 2016! Anti-establishment populism may win in 2020.

  2. Rod here in Canada.
    our system is provincially run but largely paid for by the Federal government through transfer payents.
    I was diagnosed as needing a hip replacement inmid 2017, with surgery tentatively scheduled for early 2018.
    It was done Jan 24 2018, home in 3 days.
    The surgery was covered completely including a few followup prescriptions.
    Rehab therapy however was not, but my retiree insurance plan covered a maximum of about C$1000 which was enough to see me through the worst of it.
    I sprung for my own walker which I needed for a few weeks and subsequently sold.

    Out of pocket…..maybe a hundred C$.

    Verdict: well treated, very competent and attentive medical staff.
    Crap hospital food….. ther e is a reason why there is a Tim Hortons near every Canadian hospital.

    1. I beat you by one year. I had my hip replaced in 2016 and my experience with the Candadian health care system in this regard was positive even the food was acceptable. The surgery and hospital stay was excellent. Public physio was excellent as well. When I thought more physio was beneficial, I opted to seek out private physio which was a complete and utter sham. I can’t begin to imagine the cost of surgery for hip replacement using private medicare.

    2. Also is Canada.
      I had knee replacement surgery in 2012. Diagnosed in late January, surgery in early April. So, little over 2 month wait.
      In hospital for 3 days. Excellent surgeon, excellent care. Food so-so, but I didn’t feel much like eating anyway.
      Cost to me of surgery & hospital: $0.
      After care cost (Physio): $0
      Cost of prescription medication (which I took for about a month) was negligible, as I had a plan through work. Probably cost me $10 altogether.
      A walker, raised toilet seat, cane was all supplied by my local Civitan club. These items are donated to the club. You borrow them, then return when you’re finished.
      So total out-of-pocket cost of my surgery: around $10.
      How’s my knee now, 8 years later? Fantastic.

    3. I know 3 people at work with hip replacement surgery and also my own GP! My former manager is right now recovering at home with his second hip replacement surgery, my current director just had the surgery and a colleague just had it as well. No wait for them – they got it right away except for my director because she waited too long because of just bad decisions and it became an emergency. My doctor decided to get his surgery done in Montreal because there were some new procedures they were doing there. I imagine Ontario will just pay for that through OHIP as the cost shouldn’t be any higher than Ontario.

    4. As I understand it, most doctors in Canada are in private practice, it is the payment system that is socialized. Also, about 30% of health costs are not covered under Canadian Medicare, including out-patient pharmaceuticals, but Canadians carry private supplemental insurance to cover that.

      1. Depends what you mean with private practice. The doctors are paid through the government. Some doctors run their own practice (GPs, specialists) while others work out of hospitals (specialists) or in consortiums of some sort. Coverage varies from province to province as the provinces govern their own health care so what is covered is different. I can only speak to Ontario (OHIP). Here is what OHIP covers: https://www.ontario.ca/page/what-ohip-covers

          1. I don’t think any doctor is a government employee. They are hired by the hospital or they have their own practice. They simply bill the government agency (in my province, OHIP). I think all western socialized medicine works like this.

    5. Canada here, too. I go private for blood work. It is only $10, no wait, and if I went the public route I’d have to pay for parking anyway. I also have insurance through work that covers prescriptions and luxuries like physio.

      As for “private doctors,” I’m not sure they exist here, in the sense of the question being asked. Maybe MDs who practice cosmetic surgery could be called so?

      In the US, quality private care is an excellent option for those who can afford it. This is not really in question. Certainly, there are plenty of anecdotes where people in public systems have to wait for elective procedures. There are also plenty of anecdotes of people in the US with private insurance who are denied elective procedures, if their insurer deems them unnecessary.

      The question of whether private healthcare and private insurance should exist is an ideological one, not a practical one. I don’t really care, as long as all people get the care they need. As for how it is provided, it’s not hard to look around at the evidence and see what works, and what is cost-effective.

      1. I go to LifeLabs for bloodwork which is covered and you can get your results online. LifeLabs has pretty much taken over all the labs in Southern Ontario. I wish they did more like ultra sound. I go to another lab for imaging and they are right next to LifeLabs. That imaging lab is god awful and I end up going elsewhere (further away) for my imaging.

        1. “…Canadians carry private supplemental insurance to cover that.” Not so. Lots of Canadians have no private insurance. Most of my family in fact.

          1. You must’ve meant to put this on another comment since I never said that. I grew up without insurance as I’m from the working poor so I me and my screwed up teeth are very familiar with what wasn’t covered by OHIP.

  3. “… you seem to have to wait long times under government systems.”

    In the UK at least one does tend to have long waiting times for non-urgent things that can be left, such as hip-joint replacements.

    Thus, some people in the UK do go private for non-urgent “quality of life” things, though not for urgent, life-threatening things. You don’t get better quality care going private (it’s usually the same doctors anyhow), but you do get quicker care.

    Demand has to be controlled somehow, and in a state-pays system that pretty much has to be by waiting times.

    1. Yeah, I was just thinking that, in any system with finite resources (such as reality), there are going to be relative barriers to access. So the question is, would we all rather have a system where the sorting is due to urgency (a form of the medical triage seen in any emergency room) or sorting due to financial status. The former just seems the better choice, all else being equal.

    2. UK NHS user, never been to a private doctor but I know some who have.
      In some cases they may have done so believing the quality would be better, which doesn’t mean it was though.
      I do know of atleast two people who’s private Doctors have redirected them to the NHS when it has been apparent how serious their conditions have been.
      Generally here the long wait times are for less serious issues, small comfort if you are in pain I know.
      My father has just finished a course of radiotherapy on the NHS, no waiting he for it. It was started as soon as they felt he was fit enough following some surgery, surgery that was concidered life saving and happened within 48hr of referral.

  4. Whether or not Bernie can defeat Trump is a wonderful debate for pundits. It justifies their existence. I read such discussions primarily for amusement because nobody can predict what will happen if Bernie gets the nomination, certainly not a sure thing, but we’ll know a lot more after Super Tuesday. Here’s a column in today’s NYT where Steve Phillips makes the argument that Bernie can defeat Trump.


    In the meantime, also at the NYT today, David Brooks goes on a rant about how Bernie is no better than Trump. His true conservative colors are shown as he makes a false equivalence between the two. He doesn’t seem to grasp that Bernie won’t undermine democracy and that his programs (such as Medicare for All), whatever you may think of them, have virtually no chance of passing Congress. It seems that for Brooks, Trump may not be that bad after all.


    1. I don’t think I can bring myself to read that. Brooks is sometimes quite reasonable and has interesting insights, but from what you describe, I think he’s talking through his hat (while sitting on it).

  5. Bernie has two great features: He’s a proud Jew, and he’s a proud Socialist.

    And this backwards country will sink him for it.

  6. I have lived all my life under the National Health Service but I can *just* recall how my parents were pleased at being able to go to a General Practitioner without having to pay a bill.

    Otherwise the NHS is ‘good in parts’. You get reasonable service (mostly) reasonably quickly (often) without paying at the point of use.

    I have used private health care (provided through my employment contract) when I wanted an investigation into a symptom. I got to see a consultant the following week on an evening of my choice, all tests done then and there.

    But I have also gone to my NHS doctor with a persistent cough and arrangements were made for me to have a chest Xray at the local hospital the same morning.

    But sometimes the NHS is a production line and if you suffer from maladies that cross several medical specialities you can receive disjointed attention (e.g. my mother-in-law).

    So, overall I would like private health care to be available for those time when the NHS care stutters.

  7. Yes, I have used the private system in the UK; it’s the sensible thing to do for non life threatening issues. I’ve had operations for sports injuries and physio on the private. I think all the ‘private’ consultants I’ve used also worked for the NHS, so I’m not sure the care is of a higher quality – but the rooms are better! Maybe I move in rarefied circles, but I think most people do this, with employer or private insurance.

    Apart from anything else it takes some strain off the health service for those who haven’t got private cover. The argument could be run that stopping the private supply completely would free those resources to help the NHS deliver the care to those in need more equitably. I’m open to that, but in the current climate there’s absolutely no chance of that happening nor the NHS being funded adequately, so we are stuck with using the system as best we can.

    1. I’d have thought that only a minority in the UK have private insurance or employer-provided private cover.

      I don’t have either, but I did go private once (for a minor but irritating issue, for which the NHS waiting time was 10 weeks for a consultation, whereas a private consultation — same doctor! — was 5 days later at the cost of £120).

  8. One health care point I’d like to add :

    There are “urgent care” facilities open now that didn’t exist many years ago. I think the way they operate is different from conventional doctor’s offices, such that the point is to be seen within a few hours, and without an emergency room charge. The increase of these facilities near me anyway suggests that a large demand is being met.

  9. I live in the Netherlands with basic medication under a compulsatory scheme for everyone and additionals as fysiotherapy and how much fysiotherapy under various private insurance. Private hospitals however seem to cater only to vanity patients.

  10. Taiwan has an excellent health care system (single payer). My wife (who is a Taiwan citizen) has signed us up (we plan to retire there). Her mother had life-saving treatment that was better than I’ve seen in U.S. The system is not perfect, to be sure. The main complaint is that doctors do not make a lot of money.

  11. I am in Australia and also have private health insurance.
    I may let that lapse or minimize it soon, as I have retired and it is pretty expensive, and the basic Medicare that covers everyone does cover most things, although waiting may be a problem, although that New Zealand case seems extreme.
    GP’s here are a combination of basically free, where the Dr or Clinic will bulk bill as they say. As far as I can tell there isn’t much difference between Dr’s who do this and ones that charge a fee, although you would tend to get a bit more time when paying a fee. Which could be about 50 dollars. I do go to a Dr that charges fees but I also used to a bulk billing doc and don’t see much difference.

    As for surgery, I have been in hospital twice. One was a motorbike accident that was covered under compulsory insurance and the other for a subdural hematoma.
    I was told, seeing as the SH was an emergency that I would get the same treatment whether I used my Private or Medicare. I use my Private to help the hospital out.
    So, I think emergencies may be all covered similarly.

    Private Health insurance often covers other aspects such as medication, rehabilitation, prosthetics etc but I don’t know how one would fair under Medicare alone.
    Our PBS subsidizes most essential drugs so for most people that shouldn’t be a problem.

    I have a problem with my wrist from an old motorcycle accident and that is the main reason I have kept my insurance as there are waiting lists for nonessential surgery.
    I also think that the specialists that I have seen, about my wrist and tinnitus have responded better to me having private insurance.
    I also had another issue, an endocrine issue where I had to see specialists and use some moderately expensive meds.
    In this instance, I think private insurance helped considerably.
    So, for GP’s you don’t need private. For specialist non-emergency situations private is better.
    For various ancillary medical needs private is better.
    For dental, private is the only real option for coverage.

    At the moment, if you can afford private, it is better. You get a choice of doctors to a degree. Better rooms in the hospital probably more prompt treatment.

    I have been meaning to sit down and analyze my actual needs versus the benefits of Private to see if I actually need it.

    But, if you want quick good treatment for nonemergencies private is the way to go.
    It is expensive, for a reason.

    1. I understand, courtesy of the Guardian’s “First Dog on the Moon” yesterday – https://www.theguardian.com/commentisfree/2020/feb/28/private-health-insurance-is-in-crisis-help-help, that Australian private insurance is running into difficulties because young people are not buying it. This is the classic insurance problem: those who think they might need it (high users/old folks) buy it, but those who don’t think they will use it (young people) don’t buy it – result, costs go up. Obamacare tried to avoid this by imposing a tax penalty on those who didn’t buy, but that was struck down.
      If “Medicare for all” means no private insurance, I think it would be a very hard sell here in the US; but if it means what many Medicare patients actually have – which is Medicare optionally supplemented by private insurance that offers choices and other benefits, I’d see that as a very good thing.

      1. Private insurance has been running into that problem for a long time.
        I don’t take much notice so I don’t really know.
        I do have to do a proper cost benefit analysis soon.

  12. I’m a UK resident and have only ever used the NHS. My experience of it, and that of my family, have been very good on the whole (between them, close family members have had operations including hip replacement and an appendectomy, plus investigation of heart palpitations) and except for my son, who was born in Spain, why children were born in NHS hospitals.

    It annoys me that the private sector cherry picks easy and safe medical procedures, leaving the NHS to deal with the complex and difficult ones. And if anything goes wrong in a private operating theatre, it will be the NHS Accident and Emergency service that has to deal with the consequences.

    1. “It annoys me that the private sector cherry picks easy and safe medical procedures, leaving the NHS to deal with the complex and difficult ones.”

      Why? Even if they only do the easy and safe procedures, they’re still reducing demand on the NHS. For every person who goes private, the NHS queue shortens by one.

      1. Sorry, I didn’t make my point very clearly. I was referencing medical procedures that are outsourced to the private sector and paid for by the NHS under tendering processes introduced under the Conservative / Lib Dem coalition government, and which are skewed against in-house NHS bids.

        1. Although the biggest increase in NHS tendering-out was under Blair and Brown. I’m not against it in principle, though particular deals may be poor ones.

  13. The only advantage in UK to private medicine is speed of access to elective i.e. non-urgent surgery. However, that comes with disadvantages too including private hospitals which are less good with fewer emergency facilities and a disconnewct between post-operative care if that is need on the NHS. Even though I could afford private care for some non-essential procedures I would still prefer to be treated by the NHS. As far as Brits of most political persuasions are concerned any country without a system providing free care for all remains uncivilized.

  14. Nobody inspires me with as much enthusiasm as I had for Obama in the 2012 and 2008 elections (or George McGovern in 1972, which was a complete Democratic disaster).

    Yeah, there weren’t that many of us who voted for George McGovern — a decent and honorable preacher’s kid off the Dakota plains who, as the 24-year-old captain of a B-24 Liberator had flown 35 missions over the flack-filled skies of Germany in WW2, and who, for his efforts, got slimed by Nixon’s henchmen as the candidate of “amnesty, acid, and abortion” (which, gotta admit, sounded like a pretty solid political platform to the then-teenaged me in 1972).

    Still, it was a proud moment — owing to the happy coincidence that the 26th Amendment had lowered the national voting age to 18 a few months earlier — that I got to cast my first presidential ballot against that rotten sonuvabitch Dick Nixon.

  15. Canadian here with plenty of experience between me and my family in the Health Care in Ontario. My dad and I have both had cancer. There was no delay in our treatment. Many of my American friends were surprised at this because they are fed stories about Canadians dying waiting for treatment. My dad and I both have yearly check ups – my dad gets a full scan and I get mammograms then a meeting to go over the results. I was discharged from my surgeon this year because it had been 5 years for me and now my GP will handle the scheduling and review of the mammogram results.

    My mom has a chronic breathing problem. She has been to hospital several time for emergencies and the care varies more from hospital to hospital than through the system. She has regular appointments and after care.

    I’ve also had referrals to rheumatologists that happened in a matter of weeks for my on going achilles problems. I had MRIs that were scheduled for migraine management that also happened in a matter of weeks.

    I know that very rural areas have more issues because access is a problem however a family friend with prostate cancer who lives way up north in Ontario is able to receive treatment in a more urban centre in Sudbury without delay.

    Not all things are covered however and the government has clawed back coverage in my lifetime. Dental was never covered, pharmacare doesn’t exist for people under retirement age and over 21. Optometrist coverage only goes up to some youthful age of 21 or so then kicks in again after 65. I have cataracts so the government pays for me to have those monitored yearly so I’m an exception. When I need to have my cataract surgery, the government covers the basic lens replacement buy I need to pay for the better measurements etc. out of pocket if I want them.

    Where I see we need better work in our health system is elder care. There are public facilities but they are somewhat shitty & often home care isn’t available. Elderly people end up in hospital because there aren’t enough public beds and that makes everyone miserable. The government new this was going to happen for ages as our life expectancy increased and the baby boomer generation aged but they didn’t prepare for it.

    The government also pays for all mandatory vaccinations including the flu shot.

    The way we implemented the system in Canada (and it wasn’t that long ago – mid to late 60s) is we did it provincially first and offered the government system along side private systems. People found the public system so good they stopped using the private one.

    “Here is a paragraph Americans may be interested in reading from an American who came to Canada to work in the tech industry. Read the paragraph titled, “The Doctor Will See You Now”.

    1. I’m also Canadian and am about to find out about wait times.

      On New Years eve I dislocated my shoulder while on a holiday in Costa Rica. (Good story involving a 57 year old man thinking he can climb down a cliff, and a family from Ottawa who rescued him when he learned he could not)

      I had it reset in a local clinic in the town I was staying near. On my return to Canada I went to see my family doctor in order to get a referral for an X-ray to see if it was set properly. I had the x-ray within a couple of days of seeing my GP. Based on the x-ray I was sent for a CT scan and referred to a sports medicine ortho guy. I had the CT within 10 days and saw the ortho 2 days later. He referred me for an MRI and to see a surgeon.

      I had the MRI within 10 days or so and am now waiting to see the surgeon.

      So far I have paid nothing other than the parking at the hospital when I went for the x-ray. I have been going to a physiotherapist which is covered by the private health insurance I have.

      I was supposed to see the surgeon March 2, but that was bumped until March 16. We shall see.

      1. I have to give my GP the name of a ortho surgeon for my damn Achilles. My podiatrist recommended him but I just am very worried about the surgery.

        The cost of parking is horrendous in Ontario. It’s often outsourced my the hospital to for profit companies and it’s a barrier to health care. I find it criminal.

        Good luck with your consult and your surgery of you need it.

        1. Thanks.

          Actually here in Kingston the parking is not bad. The hospitals don’t have their own lots, so when you go you use the city lots and pay city parking fees.

          My Mom was in a hospital in Edmonton about 10 years ago at the parking there was really expensive!!

        2. I drove myself to the emergency room when I had my subdural hematoma.
          I had tried several doctors and optometrists because I had weird symptoms but they all missed it.
          Anyway, I was really at the end of my tether with terrible weird headaches and changes of focus in my eyes and an inability to think so I drove there, in the evening and parked in the car park, a private run thing.
          It turned out, after a ct scan that I needed some holes drilled in my head, pronto, so I was stuck there for a few days.
          I mentioned the parking and the hospital staff seemed to think I would be able to get an exemption or something.
          Nope. I forget what it was but it was over a hundred dollars.
          But, at least I could drive there and did get a park.
          We have pretty good public transport but in my state, I don’t know if I could have managed it. But it is the only viable way if you don’t have someone to drive you and pick you up.

          I am thinking of dropping my private cover. Medicare will look after most things and because I am old now and retired I think I get concessions and stuff. I have to get organized and look into it properly.

          1. I think you’ll still want the supplemental insurance. It doesn’t cost that much and is very helpful if you encounter the inevitable ravages of non-youth.

        3. Also, it’s funny that dental is left out of the equation for some reason.
          I have used my private cover for quite a lot of dental work, although there is still some cost to me and a limit on how many things one can get done each year.
          There are rumors that dental may be put under medicare but I don’t know if it is any more than that.
          I suppose with dental there is a lot of overlap with cosmetic value, which perhaps shouldn’t be covered.
          But an abscess or big cavity up the back is definitely a medical thing.

          1. Yeah I think it’s a combination of expense and a tradition of just thinking it wasn’t important when they first enacted it. Some candidates here have run on universal dental care but they didn’t get in. Another vital one left off is mental health care. You have to pay out of pocket to see a psychologist unless you are referred by a doctor because you are suicidal or there is another dire situation. It’s often an emergency and there is still a wait list.

          2. Yeah I think it’s a combination of expense and a tradition of just thinking it wasn’t important when they first enacted it. Some candidates here have run on universal dental care but they didn’t get in. Another vital one left off is mental health care. You have to pay out of pocket to see a psychologist unless you are referred by a doctor because you are suicidal or there is another dire situation. It’s often an emergency and there is still a wait list.

  16. Oh and I forgot to say that with the US population I think a public health system would be the best in the world. You have a huge tax base so a tiny increase in taxes would easily make a great system. Like Australia, Canada has a small population (the population of California) in a vast huge country where everyone lives along the edge (Canadians mostly live where it’s habitable near the south which is along the US border). So it takes all of us working to pay for the standard of living we have. Yet we do it. So imagine what America could do! And NZ – a small population (but luckily in a small country that is all habitable) provides health care to visitors if they get in an accident and they have a very high standard of living!

    1. Jeff Bezos, Bill Gates, and Warren Buffet are holding all our money. If we could shake some of that lose, we’d could get started on a nation health service.

    2. NZ provides healthcare to accident victims as part of a general scheme to foreclose accident liability litigation. Totally non-USian, where we have the right to sue anyone for anything (not necessarily with any great chance of success), but very sensible.
      On the medical care side, my personal experience is very old, but care was fine. Care for my parents was excellent, though my mother had private insurance which enabled her to have a couple of operations at a time and place more of her choosing (though in one instance she had the op postponed because the surgeon had to do emergency surgery at the public hospital).

      1. Yeah my old auntie (in her 90s) had breast cancer in NZ back in the 60s & she’s still alive & in good health so it can’t be bad. My nana didn’t have a very good doctor but she lived out in the sticks so that was more her issue.

  17. My take on Sanders is the old joke “If you’re not a socialist when you’re twenty, you haven’t got a heart. If you’re still a socialist when you’re forty, you haven’t got a brain.” I’d add, if you’re still a socialist when you’re nearly eighty and the Democratic nominee, it means Trump wins a second term.

    1. From the outside looking on I suspect that Trump would find campaigning against Sanders the easiest.

      People that ‘naturally’ vote for Trump are not going to vote for Sanders. Some people that would normally vote for the Democratic alternative may not vote for Sanders. Trump wins.

      It will all hang on the size of the ‘Anyone but Trump, except for Sanders’ vote.

      1. It is a tautology that it will all hang on the “Sanders vote”. Assuming he’s the candidate, what else could it hang on? An “Anyone but Trump” vote is a Sanders vote. Assuming he’s the candidate, of course.

  18. Under the M4A plan that I imagine, every resident and citizen of the US would be covered, but private insurance would be an add-on. That way, the public system would avoid the problem of adverse selection (healthy people opting out), but those who want to be covered for non-essential or faster services would have that option.

    1. This interview, https://omny.fm/shows/the-pat-thurston-show/february-27-2020-medicare-for-all, was conducted by Pat Thurston with Jamie Court, President of Consumer Watchdog, focusing on Bernie Sanders and M4A.

      This is a segment from an AM talk show but they’re not all right wing and stinking like the Limburger (or left wing and insufferably doctrinaire). This is an eclectic talk show, I have the greatest respect for Pat Thurston, the host. I found the discussion enlightening and encouraging but I’m still gathering information and haven’t yet come to a conclusion.

      Consumer Watchdog website https://www.consumerwatchdog.org/our-team.

  19. I’ve lived in the U.K. all my life and I have relied on the National Health Service with just one exception. In the early 2000s I was waiting for the NHS to schedule an operation for a minor and non-life-threatening condition. After three months, I used the private medical insurance provided by my employer to get the problem sorted out privately — by the same consultant that I’d seen on the NHS, to the surprise of both of us!

    But lest you take that as criticism of the NHS, I should add that the NHS has treated my wife (who is American) for cancer twice in the 25 years we’ve been married, and on both occasions the treatment was prompt, efficient and delivered by kind, humane, compassionate nurses and doctors. I do not believe that she would have received better treatment under private healthcare, in the UK or the US.

    As a socialist, I consider the NHS to be one of Britain’s proudest achievements. I wouldn’t ban private healthcare, but I *would* want to fund the NHS well enough that nobody would ever want or need to go private.

    1. I am also from the UK, and went through cancer treatment on the NHS. Various family members of min have had private treatment for non-life threatening issues because the waiting time is indeed less. I especially endorse the final paragraph of the above comment.

    2. I completely agree with David’s comments. My missus and I, our four children and (so far) three grandchildren were all born under the NHS, and we have all had exemplary service from it.

      The NHS has some well-known problems: overcrowding in A&E, some dodgy maternity and mental health services, almost no dental services, and so on. This is partly down to underfunding and partly to the inefficiency inherent in any large bureaucracy, There are also local funding issues and shortages which mean that some services (eg IVF treatment) in effect end up being rationed. And there is often not enough coherence between the health and social care systems. Against that, the NHS screening processes are excellent: I get called in for regular checkups for my high blood pressure and for symptoms of bowel and prostate cancer, and my wife has regular breast, bowel and cervical checkups.

      The NHS doesn’t do everything, but it does enough, indeed more than enough. I might add that it treats those at the other end of life with care and compassion.

      Sorry for such a long post.

  20. I’m really sorry about your friend, Jerry. I can see why it’s important to have choices, and it’s unfathomable that anyone should be denied the choice. I’m fortunate that the NHS has acted so quickly with my recent health issues. There is a “two-week rule” with issues such as mine and luckily, I will be having surgery in about two weeks.

  21. I am a Portuguese-Canadian. Born in Portugal and lived there until I was 25, then Spain for 6 months, US (Arizona) for 6 years and now Canada for 11. Most of my life, I’ve lived under single payer systems and have always been happy with the care I’ve had.
    In your post you said:
    “One reason I feel this way is that almost everybody I know who lives in countries with universal government health care—and those include Canada, the UK, New Zealand, and Poland—has resorted to going to private doctors some of the time because of a) their higher quality and, more important, b) the speed: you seem to have to wait long times under government systems.”
    It is my impression, I may be wrong, that the Canadian system simply does not accept private doctors (except dentists, ophthalmologists, and maybe a few more). So, you really cannot go to a private doctor. For me it has been no problem at all, but I may have been lucky. I’ve been to the emergency room and have been very happy with the care I’ve received.
    All of that being said, having lived in the US for six years, I think the system would really not work in the US. The country prides itself of it’s exceptionalism. Almost like that is a defining characteristic of the country. Though I feel like that is a wasted opportunity (why not learn from others), I get the impression that Bernie’s argument that his proposals are not radical (they are not) because they work in most industrialized wealthy countries, will not hold water because the “smirky” response will be: but we are different here; we do things our own way.
    Just my two cents.

    1. That’s my impression as well re: private doctors. Even ophthalmologists bill the provincial health care plan. I remember there was a big kerfuffle years ago when the government (conservative at the time) discussed brining in a private option and most didn’t want that because they felt it would mean the government would starve the public system so that everyone would have no choice but to go to the private one and that it would mean haves and have nots.

        1. Oh sure, we can go to whatever country we want but it’s not really an option that I’m aware of in our own country. It may vary from province to province but I’ve never met someone who has gone to a “private GP” for example

          1. No, I don’t think you can pay privately for services covered by Medicare in Canada. If you could, people would jump the line, if there is one. I do not know how the private option works in NZ.

              1. This is the consensus I’ve read. One can hold private insurance (particularly for when leaving the country) but not have a privately-billed practice. (There was a clinic skirting this in Alberta and one in Quebec, as I recall.)

                The sad thing is that sometimes people think they should hold private coverage when visiting other *provinces*, because of the price differential possibility. IMO this should just be “eaten”, but that’s hard. (My parents used to do this when visiting my sister or I in Ontario from Quebec.)

              2. The provinces should just have a buddy system where they pay but it’s never that easy I guess.

        2. True, but that is not the same as the New Zealand example that Jerry brought up where inside the country there is a private option.

  22. Reiterating what I said last time in light of continuing market free fall: Trump’s only hope of re-election hinges upon the stock market not doing exactly what it’s doing right now. There is a near zero chance that this administration finds a clue and starts taking the emerging pandemic seriously until it is far too late. Trump and his circle of moronic sycophants truly believe that they can bluster, lie, and browbeat the markets into staying up, and they very evidently cannot.

    Given that my only conclusion is that people who think Trump’s got an easy path to re-election have not been paying the slightest bit of attention to current events and simply assume that things will be the same in eight months when they’re not even the same as last week.

        1. Yeah I’ve decided not to until next year. I put my investments this year into a 1 year GIC. Sure the rate is crap but it’s not less than nothing either.

  23. In Canada, private doctors aside (they’re not allowed to practice in every province), our federally-mandated health care needs to be supplemented by private insurance for dental work, optometry, and many prescription drugs. And that’s leaving out less essential services that most private plans cover like therapeutic massage, podiatry, sleep apnea,and some elective procedures. And that’s to say nothing of the complete bunk like chiropractic, homeopathy and other SCAM treatment coverage that unfortunately is also included in popular supplementary plans.

    When advocates of Medicare for All talk about eliminating private insurance, I have to wonder why they can’t see a place for it.

  24. A problem with the single payer argument in this country is that it focuses on paying less for services instead of focusing on paying for and promoting less costly services. We concentrate on how we pay vs what we should be paying for. Single payer is not a healthcare system – it’s mostly a business administration methodology.

    Optimum care is ultimately the least expensive care. A system built around the optimization of care (a system built on access, best practices and process improvement) will be the least expensive in the long haul. There are many ways this can be done (far too many for a comment). Foremost is reducing barriers to seeking care at the earliest possible point or aggressively pursuing prevention strategies. As in any cost benefit curve for any industry, early intervention is associated with better outcomes at lower cost.

    Care optimization (early detection and intervention) is highly dependent on access. Single payer may reduce access by restricting fees for entry level services. This is counterproductive. To have a true national healthcare system we have to focus on creative ways to expand access.

    1. Yes and it would be good to talk about the selfishly good reason for people to receive preventative care – because they can work and pay taxes instead of needing other tax services. I’m sure there are lots of stats about this. Even if someone tried to dispute this with their own “facts” it would appeal to the working poor who just want to work, contribute, and be healthy and that’s who you need to win over to vote.

  25. I’m an American living in England. I’m over 70 so I get both NHS care over here and Medicare in the States. The difference?
    Yes- significantly longer wait times in the UK but the quality of treatment once given in my experience is much the same. The NHS is far from impersonal as is often claimed. I needed a pacemaker fitted this year…. as an ardent scuba diver only one model is tested and qualified for diving (and not the regularly fitted model). They fitted the diving one as a favor… for which I am incredibly grateful.
    I can’t believe that universal healthcare is possible in the USA. Britain formed the NHS by essentially producing a governmental takeover of the medical profession and most medical facilities (yes there is a small private sector still. For decades they have thus controlled the cost base. The USA has a massive cost base in facility and even higher cost base in medical staff commitments. It is an unaffordable acquisition, and an almost unaffordable insured-cost basis. Bernie is either financially incompetent or just making up a fairytale.

  26. My experiences of the NHS in the uk are all good. In fact, faultless. Granted on these occasions you can definitely say it was lifesaving. No expense seemed to be spared or test ignored. I was in awe at the sheer amount and quality of technology brought to bear to ensure I survived, as you can see I have. The nurses and doctors were beyond reproach. I still have frequent checkups to I stay well.
    I don’t doubt that everyone’s experience might not the same but I can only speak for myself and how I found it. I doubt I could have got better anywhere. And I feel very fortunate we still have our NHS.

  27. My biggest fear about medicare for all is the path to get there. As shown in other countries it can work but they had decades to adapt. I am not interested in risking my family’s health in a trillion dollar program which will have major SNAFUs. I remember the Obamacare rollout not to mention being laid off because a private company went bankrupt when they bit off more than they could chew.

    I totally support a small state or two near DC (e.g. Maryland, Delaware) trying it out with as much federal advice and money as needed. It might work or it might fail but it will be small enough that we can help the people who have problems. If it works reasonably well we can scale to nationwide over a decade or two. If it doesn’t, we can learn our lessons and try something else.

    I live in Oregon and from our Cover Oregon fiasco, I know that Oregon will screw it up.

    1. We’ve had decades to adapt, too, but just haven’t bothered to get started. We could have extended Medicare by now, a year-by-year reduction in the age at which you qualify. It could have been acomplished long ago. The fears you reflect can, and have, produced immobility on the issue for many decades.

      1. Indeed and when universal healthcare began in Canada, people had already died and become bankrupt. That immediately stopped. No one died because of the introduction of universal healthcare but many died without it.

        1. If I understand correctly, Canada’s started over 50 years ago when medical care was much simpler – no complicated forms, no computers, no internet, fewer diagnostics tests, etc. It’s not really a good comparison but it would certainly be wise to look at the Canadian (and other countries) transition for lessons.

      2. The fact that we haven’t started is part of the point I was making. I want to start with baby steps not great leaps. I am skeptical of the result but, since I am not happy with the current system, I think a small experiment is appropriate. If it works in an affordable manner, I would be thrilled and we should scale up gradually.

        In my perfect world, we would try a few several different approaches in different states and see what works and what doesn’t but that is not in the cards.

        1. The problem with “baby steps” is that they are very easily rolled back to square one. One might say that the ACA was a baby step. And it has been under attack and has been rolled back ever since.

          Extending Medicare, an already existing and successful system, is the only way forward, IMO. Unfortunately there’s considerable disagreement about what M4A actually is. My own definition is “What people 65+ have now, made available to everyone else”. For the life of me, I don’t understand why that is so threatening to so many.

          1. Yeah I figured your Medicare shows a lot of data you can use to prove it works. Why not expand that and see how that goes?

          2. IMO, the good thing about baby steps is they are easy to roll back. I am an engineer and we build prototype units. We improve what works and throw out the failures.

            If M4A works in one state (after working out the kinks), we can gradually expand it to the rest of country. If it totally fails, we can try something else. If it is somewhere in the middle, we can have a more informed discussion about what to do next. Or we could let different state do different things.

            I am not fundamentally oppose to M4A but I am opposed to trying to revamp 20% of the economy overnight.

  28. I currently live in the US, but as a young child I had extensive experience with hospitals in China (thanks to asthma). It was almost 30 years ago and hospitals were all state-owned. There was no wait, even for non-emergencies. But the doctors had a LOT of patients to deal with; they’d send you off to the pharmacy (also state-owned and part of the hospital) or to further check-up in 10 minutes. (My experience, anyway.) My month-long stay in hospital cost my parents perhaps several hundred 1990s US dollars out of pocket. I think their income was somewhat below the median among urban residents, but they could afford that without much strain.

    The Chinese system has undergone some major reforms since then, but my last trip to a state-owned hospital a few years ago didn’t feel any different. Still no wait, still cheap, and the doctors are still seeing too many patients. There are private hospitals in China now, but I have never visited one.

  29. I live in Canada, and have lived in both Ontario and British Columbia. I would rather have universal health care, such as we have, than the system the U.S. has.

    If it is an emergency, wait times will vary depending on the severity of the problem. Life threatening injuries are treated immediately, and the wait increases depending on the number of people waiting, and the urgency of their problems. The most I’ve ever had to wait was a couple of hours.

    Waiting for a specialist can take longer. I’ve had to wait a couple of months for some minor surgery, but the problem wasn’t an emergency, just an inconvenience.

    Family doctor appointments are usually easy to get within a day to a week or two, but there are walk-in clinics that you can go to for same day service.

    I haven’t had any serious conditions, so I can’t speak to wait times for that, but I would much rather wait than risk having to sell my house to pay for medical treatments.

  30. I was on vacation in NZ (from the US) and developed a torn retina. This must be treated more or less immediately or you risk losing sight in the eye. I went to a hospital in Aukland and was treated the next day. If I was a citizen it would have been free, I think. As it was, they only charged me $3000 which was eventually mostly covered by my US insurance. In the US the surgery would cost from $5,000 to $10,000 in which case it would be important to have insurance coverage.

  31. Writing this from Australia.
    A few years ago I had a lump in my belly pushing out nearly an inch high by two inches long and VERY tender. My GP said hernia. I drove myself to the nearest public hospital where they took one look at it and booked me in on the spot for surgery. Part of my bowel had pushed right thru the peritoneum (is that strangulated? I can’t remember). By late arvo it was done and dusted and I was discharged the next day. All taken care of by Medicare, our NHS.
    While elective (non urgent) surgery can have you waiting for years if you don’t have private health insurance, Medicare will get you sorted immediately in an urgent situation such as mine. For me that’ll do but we do have the option of going private.

  32. “Sander, however, seems to favor the complete elimination of private medical insurance and non-government healthcare.”

    Sanders has never said he will eliminate (nor reduce nor convert) non-government healthcare, if we are talking about private doctors, hospitals, dental offices, etc. Surely it’s a mistake to interpret Sanders’ proposal as favoring ‘socialized healthcare’ along the lines of the NHS. Did I miss some new proposal?

    He definitely will eliminate private insurance, which I favor, even if just for the precedent it sets that health insurance is not up for grabs as a profit-making enterprise. Profit-makers do have a tendency to spread in invidious ways once they get a foothold in an industry. I wonder why the option of increased training of nurses and investing in more medical students is not the clear solution to any long-term shortages in the provision of care that arise. Am I missing something there too? My impression is the number of doctors, at least in the US, is kept artificially low for purely class interests (AMA being the main culprit, as regards their setting the rules for accreditation).

  33. Note that these are more impressions than iron-clad statements of fact.

    In Finland people with regular income tend to take every day health issues (fevers, aches and pains, doubts, etc.) to the private healthcare system because it is faster. This is often covered by the workplace. You could take any issue to the public side but you would end up physically queueing at the hospital for 6+ hours if your situation isn’t deemed urgent (and many do if they can’t afford the few hundred euros).

    For major issues (operations, serious illness), the public healthcare system is the way to go, with the most experience, specialization, equipment, etc. Usually the private side refers you to the public side for anything even moderately serious. I am not quite sure how fast it is, never having dealt with it myself, but speed is affected by urgency. An acquaintance had a lump found on his testicle on the private side and was operated on by the public side a week or at most two later.

    I have used the public dental care system exclusively. Going in for check ups, they schedule me in around 6 months after signing up. For urgent issues you can make an emergency appointment with same-day treatment but some queuing.

    Having just had a baby, I can say that the birth related public healthcare is fantastic, before, during and after birth for both mother and child.

  34. I live in Canada where we have a single payer healthcare system that is under constant attack from CONservatives who want to open the market for private insurers and private clinics. We have private insurance as an option to cover things like a private hospital room or other luxury items, but basic medically necessary treatments are all covered. Pharmaceuticals and dental care are not covered and there is along running and so far unsuccessful campaign to get those things covered as they can be a real threat to the health of people who can’t afford dental care or necessary medication. Other civilized countries which do cover everything enjoy a higher quality of life and longer average lifespans than Canada and of course, much better outcomes than prevail in the US where average lifespan is decreasing and infant mortality is increasing as more and more people fall out of the middle class and into the under- or un-insured underclass.

    1. “Pharmaceuticals and dental care are not covered and there is along running and so far unsuccessful campaign to get those things covered as they can be a real threat to the health of people who can’t afford dental care or necessary medication”

      Yes, when I visit some rural areas in the US, I’ve seen people with ugly looking teeth, often missing teeth. They never go to a dentist except for the ultimate extractions that accompany years of gum disease. This can’t be good for the overall health of these people. Once basic medical coverage is achieve that should be the next step.

  35. I’m an American (double nationality) living in France — for 50 years! Outside public hospitals, doctors here are doctors, all private, in a sense. There are three categories: Those who charge what the Sécurité Sociale demands, those who practice a limited additional charge, and those who are totally outside the system. Most generalists are in the first category, most specialists in the second. I have no experience with the third group. If I see a doctor in the first group, I pay nothing. In the second, I pay the additional fee (dépassement).

    Hospitals are similar, public or private, completely reimbursed or partially. I spend 10 days in a public hospital for a prostetectomy and paid for nothing but the telephone. (This was before mobile phones were common.) Ditto for all the tests preceding the operation.

    I find the system works quite well, except for one thing. Doctors are becoming rarer. Curiously, specialists, who charge more, have the longest waiting time. Most ophthalmologists have a 4-6 month waiting period, cardiologists much shorter, dentists several weeks. And doctors are retiring without replacement, so the situation will certainly get worse before it gets better. I don’t know to what extent this is due to the government’s insistance that the social security system is in debt or to the limits on fees which irritate doctors who want to get rich. In my opinion, if you want public health, the government finds the funds — if necessary, by not purchasing another nuclear submarine. But I begin to digress…

    In brief, I think the system is potentiallly excellent, but in deep trouble for lack of political will.

  36. I was surprised, as I thought most people would think that Sanders could beat Trump.

    There’s a subtle distinction between that and the question you actually asked. My answer to the question “can Bernie win?” is different to my answer to “will Bernie win?” They are yes and don’t know respectively.

    Setting aside his age, Bernie seems (from the far side of the Atlantic) to be one of the very few candidates who is able to generate some real enthusiasm and you are going to need that to get everybody who is against Trump to go out and vote against him.

    Unfortunately, Bernie seems to have some baggage that Trump could exploit. One of these bags is the word “socialist”. Americans seem to have a childish antipathy towards that word that I don’t understand. Bernie’s not actually a socialist but merely labelling him as such seems to be enough to persuade people to vote for a corrupt lying incompetent sex criminal instead.

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