In my family’s recent trip to a single-payer country we learned some of the good and bad of the system. While the U.S. consumes roughly 18% of its gross domestic product (GDP) on healthcare, it appears that no single-payer country spends more than 12% of their GDP. If you catch a simple bug (which we did), single-payer works great. You show up at the clinic. They are efficient and the experience is painless (although, through connections we did skirt some of the aggravating wait times). And at the end of the 3-hour ordeal, the cost to a non-citizen was relatively similar to what the urgent care experience would have cost in the United States. To a local national – free.
But, the nurse practitioner (my understanding is there aren’t a lot of doctors in this bare-bones healthcare environment) was complaining about being able to afford the basic comforts, like a new pair of hiking boots. Single-payer healthcare is not a get-rich-quick scheme for practitioners. And there was a great deal of turnover, so establishing a doctor-patient relationship would seem problematic.
And then there’s Merv – the driver. Merv was espousing how great healthcare is in his country and how it’s free. Except about 10 years ago when, in a physical exam, the doctor discovered suspicious nodes in his throat. He was told that he could get on the queue and wait for the next available biopsy appointment or pay $3,500 for private care. He chose to get on the list – but a week later decided to borrow the money and go to a private practice doctor. The news back from the doctor was positive, and he had a good laugh 19 months later when he got a letter from national health declaring it was his turn for his biopsy through the normal process he bypassed. A 19-month wait to see if he had cancer. Not sure of the survival rate on that.
Oh, and his stiff shoulder – it doesn’t bother him that much unless he has to reach over his head. He is waiting for those x-rays. He hopes to have them within the year.
Our healthcare system has flaws, but clearly some aspects should be preserved. I was discouraged by Health and Human Services’ (HHS’s) recent decision to slow down the pace of movement toward risk-based contracting; I thought this was going to push our healthcare system in the right direction. The evolution of healthcare is fascinating to watch.