There’s a bit more to it than this, related to the effect of health care outcomes on the cost of providing health care.
In the US, clients who are known to be able to pay subsidize those who are not able to pay. This is because of a law that requires hospitals to provide emergency care to anyone regardless of means.
However, emergency care is actually one of the most expensive types of health care to get. For a fewreasons:
By the time a problem is bad enough to warrant care at the ER, it’s become really serious and requires a lot of hands on deck to manage
As an example, consider asthma. An asthma attack will require at minimum, one nurse, a doctor, and possibly a respiratory therapist. In extreme cases, it will require an entire critical care team and crash team.
By contrast, if you deal with asthma early, it can usually (usually, mind you - some folks like me have more tetchy asthma) be managed with twice-a-year doctor’s or nurse practitioner visits.
By the time a problem is bad enough to warrant care at the ER, it usually requires a lot more physical resources than it would have if caught and treated early
Still on the asthma example: Treating an asthma attack in the ER requires IVs, a spirometer, usually a nebulizer, sometimes BiPAP or intubation with life support
By contrast, all but the most severe cases of asthma can usually be managed with light-to-moderate doses of inhaled controller medicine the patient can self-administer, with reliever medicine as needed.
By the time a problem is bad enough to warrant care at an ER, it often has become complicated by other problems as well - that is to say, it’s no longer one problem, but three or four problems in one.
Still on the asthma example: Common complications of asthma attacks include chest infections (pneumonia, etc), pneumothorax (i.e., ruptured lung), collapsed lung, respiratory failure, and in extreme cases, heart problems, brain damage, or death. Plus, living with untreated asthma causes physical symptoms including fatigue and weakness that can lead to poor performance and difficulty living a full life, as well as chronic stress that contributes to asthmatics having higher risks of mental health troubles including depression and anxiety. For me as well, bad asthma kills my appetite, which means I also tend to suffer from malnutrition when my asthma is severe and uncontrolled.
By contrast, if asthma is treated early and monitored properly, your risk of these complications is severely reduced. The most common complication of treated asthma is oral thrush, which is caused by not rinsing your mouth well after taking your controller medicine.
Chronic conditions especially tend to result in a lot of repeat visits to the ER if someone cannot afford maintenance health care, making chronically ill patients much more expensive in a mixed-model system like the US as compared to a single-pay system like Canada or the UK.
All of that ^^^ is to say that the way the US currently delivers health care to its poorest citizens is literally the least efficient way you possibly could do it, which means it’s the most expensive. US critics of single payer systems are right about one thing: Someone has to pay for the ER visits of poor people who can’t pay themselves. In the US, it’s everyone else, and that’s part of why hospitals hyper-inflate the cost of things like bandages and medicines (the other part is price-fixing and profit-seeking).
What US critics don’t realize - or refuse to acknowledge, depending on the critic - is that single-payer systems aren’t as expensive because not as many people get to the point of needing emergency care. And, furthermore, those who do don’t tend to get to that point as often. Part of how single-payer systems save money is by trying to catch problems as early as possible, before someone shows up at the ER on death’s doorstep. Is it perfect? No. But does it help? Hell yes.
Again working off the asthma example because that’s what I’m familiar with: When my asthma got bad and I was going to the ER on a regular basis, the single-payer system in my province recognized I was an ER “frequent flyer” because of my poor asthma control. So I was referred to a specialist by my doctor (note: I had to do nothing in way of paperwork or approvals to get in with the specialist, and I did not have to fight with an insurance agency that I really needed a specialist. My doctor had complete authority over whether I got the referral) and an asthma education clinic (likewise) for more in-depth instruction on how to manage my asthma. The specialist identified the cause of my poor control (an allergic asthmatic with a severe cat allergy living with two cats isn’t exactly the best arrangement for health… The specialist was able to diagnose my allergy and that led to me needing to find new homes for my cats because my cat allergy is so bad that owning cats could literally kill me) and the asthma education clinic taught me tools to compensate for the fact that my breathing had been shitty for so long I’d literally forgotten what good breathing felt like and didn’t know how to recognize when I was getting bad until it was an emergency.
In the US system, because I would not have been able on a grad student’s salary to pay for a specialist, I would’ve continued getting sicker and sicker and costing hospitals more and more money for more and more ER visits until such time as my asthma became disabling and I got Medicare or an attack finally killed me.
In the Canadian system, everyone saved money by having me get the care I needed when it first became apparent I needed it, not when my condition progressed to the point of permanent damage. I saved money on taxes and missed work time. The single-payer system saved money by having to pay for way fewer ER visits. And other taxpayers saved indirectly by not having to pay as much for my care. While I haven’t been able to completely avoid the ER since completing the education course and seeing a specialist, I’ve gone form having twice-monthly ER visits to averaging an ER visit once every two years or so, six years on.
In Canada, an average asthma attack ER visit costs the province about 75K Canadian. The cost of visiting a specialist and my asthma education was about 6K Canadian. By sending me to a specialist and asthma education clinic and enabling me to cut down on my ER visits by well over 90%, the province saved itself over ten and a half million dollars in the six years since I was referred to the education clinic. That’s for one person.
And that is the unspoken difference between a single-payer system and a profit-driven mixed-model system like the US. Single payer systems are motivated to improve health care outcomes in order to save money. The US system has no such motivator, because what they lose on ER frequent fliers they can just make up on everyone else.
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