Here are some things in the current system I'm hoping a single payer system would fix:

* I walk in, and they can tell me right away whether I will be billed or not. There's no "we'll see" and then maybe I get a bill in a few weeks.

* I walk in to a different doctor's office and the answer as to whether I'm billed or not is the same as at the other doctor.

* Because of these first two items, I walk in and they can tell me ahead of time what my bill will be.

* We can now replace "walk in" with "check their websites (or call) and comparison shop".

Maybe they can't tell me if my treatment is taxed until I'm diagnosed, but that still gives me the option to find out my bill before treatment. Once I'm diagnosed, if it's non-urgent I can shop around.

Price transparency is non-existent in US healthcare. There's no big mystery as to why that would cause inefficiency and absurd costs.

The fact that there is a need for tools like that demonstrates the complexity of the current system.

Apart from being extremely expensive.

In the current US system, if your employer does not provide (any|sufficient) insurance coverage, you have to get your own and there are a million options all ready to fleece you. It is almost impossible to comparison shop and choose between 100 bad options.

Yes, the mechanics are the same (go to doctor, get a bill), but your purchasing power as individual patient is really small compared to a whole country.

"In the current US system, if your employer does not provide (any|sufficient) insurance coverage, you have to get your own and there are a million options all ready to fleece you. It is almost impossible to comparison shop and choose between 100 bad options."

I've been using the ACA marketplace here in good ol' Alabama, and I've had the opposite problem. There are four choices, all from BC/BS.

Note: I love the ACA. I will fight for the ACA unless and until I'm presented with an actual better option. Prior to the ACA, I had options from other companies, none of which covered my major problem.

I believe we have two choices here in MT (yay it used to be one).

>The main money saver between the types is in system efficiencies like removing overhead

I agree, we should remove the overhead created by the existence of private insurance companies.

And replace it with what? Government has overhead and inefficiencies too.

I know decades of conservative rhetoric say otherwise but governments often run things efficiently and effectively.

Maybe other governments. Medicare has billions in fraud each year. The process for signing up for Medicare and Medicaid can be complicated. If you've ever served in the military or government you know how much waste can be involved.

American exceptionalism is fascinating in that it includes the belief that the American government is uniquely incompetent among developed countries.

The difference is in the NHS everyone is "on the same side", so the amount of bill inflation and money juggling that happens is basically zero.

The NHS does demand management with waiting lists instead. Basically it's amazing for things that can be easily identified and given cheap medication for (insulin, antibiotics etc), amazing for emergencies which can be resolved with surgery, OK (but variable) for obstetrics, does a decent job at screening for common conditions, but tends to leave anything that won't actually kill you to wait.

I've never had to think about billing.

At the same time you can get super-cheap private insurance in the UK because they are effectively a "queue-jumping service" that leaves most urgent and lethal conditions to the NHS and gives you access to private treatments for the things the NHS would put on a waiting list, while cutting their costs by renting excess capacity from the NHS (some private clinics are even run by NHS trusts, as the trusts are allowed to derive some income from private treatments).

I think the best demonstration of the quality of the NHS is that despite the low cost of private insurance in the UK, and despite the fact many companies offer health insurance as a perk, only about 10% of the population has any kind of private cover.

"I must be missing something then."

The part where you are one of the people who doesn't have a card from insurance, Medicare, Medicaid, etc.

Is that a real concern though? The ACA provides income-based funding and expanded Medicaid.

The state I live in did not accept the expanded Medicaid/Medicare funding.

If you earn the poverty level or higher (to a point), you're eligible for subsidies. If you're below that level, you qualify for Medicaid, even without the expansion.

>In the current system you walk in and hand them your card (insurance, Medicare, medicaid, etc) and they treat you. You get mailed a bill later.

The thing you're missing is that the current system in the USA is in no way like this.

That's completely false. I've had to deal with many medical bills in the US last year.

You must have good insurance if you think your experience is typical. Most people aren't so lucky.

You are healthy and not self-employed, I take it.

Do you have insurance? I fail to she how being healthy and not self-employed affects the scenario as described (present card, get treated, recieve a bill).

If you are not self-employed in the US, typically your employer provides insurance coverage, most of which is pretty decent. If you are healthy, it doesn't really matter either way; unless you are involved in a serious accident or something, your interactions with the health system are infrequent and relatively simple.

I have, among other things, asthma. I'm a 1099 contractor; I buy my own health insurance. Prior to the ACA, which people keep threatening to revoke, I could not buy insurance that covered my asthma. I tried. I shopped around a lot. The same company that provided complete coverage at a previous employer had a pre-existing condition rider on the same policy.

After the ACA, my policy now covers my pre-existing condition (Yay!), but I'm paying $750 or so per month for it. If I could not afford $750/month, my options would be considerably narrowed. (And that's before the prescriptions for my pre-existing condition.)

Yes, I go in, I get treated. But my situation demands a pretty hefty bill anyway, or potentially a very large bill. Possibly enough to make me consider not going to get treatment.

I’m sorry you have a chronic illness. Do you understand that this is not about insurance, but about your ability to share the cost of your illness with society?

Plus, $750 per month is not that expensive for healthcare (unfortunately). My wife was paying $600 per month under the ACA and was completely healthy.

Another point is that the people with lower incomes qualify for subsidies under the ACA.

Youve skipped the step for obtaining a card in the first place. Something which is trivial here in Canada (easier than a drivers license, and free).

Also theres none of this in-network vs out of network chaos. Emergency care always covered, doesnt matter where you go.

It feels like youre trying not to understand how a public option could be better.

"It feels like youre trying not to understand how a public option could be better."

This statement assumes a public option (which varies wildly depending on the one) is better.

The parent comment wasn't about a public option or getting a card. It was a complaint that recieving care at a provider is extremely complicated. At that stage of the process, that claim is incorrect.

Insurance companies have web portals that you can comparison shop for providers.

However, if your in-network doctor sends your bloodwork out to a lab that is not in-network, you're now paying a lot more.

Or (until recently), you go in for surgery where the surgeon is covered, but then get billed for an out-of-network doctor that consulted without anyone asking you.

One of the recent situations that I've heard about are nurse practitioners and doctors at your doctor's practice, contracted by your in-network doctor. The person who comes into the room to ask you what you're there about may not be in-network even though the ostensible doctor-in-charge is.

I haven't seen that lab issue. I suppose that could be an issue in specific circumstances.

How am I supposed to do that in the back of an ambulance?

You can't. You should select a plan that covers you at all the local hospitals. If you look it up before hand you can usually specify which hospital you want to go to from memory. I do this not just for the network, but also for quality.

What if you're injured while visiting a different city?

Then you should do research before going or accept that it is an unlikely scenario. This is what people do when travelling, especially internationally. You can also select a plan with the most extensive network to reduce the likelihood.

>In the current system you walk in and hand them your card (insurance, Medicare, medicaid, etc) and they treat you. You get mailed a bill later.

I'm glad we now agree that the current system in the USA is in no way like this.