Many Americans haven’t a clue.
I am an American health insurance exile. I live in France. I have to. This month I have been in the U.S. on business for two weeks. When I mention Single Payer, many American faces go blank. But rather than try to find out what it actually is, they resist the very idea and sputter defensive comments about “socialism” and “government control.” That’s too bad. The U.S. government is not trying to inflict something evil on the American people by adopting single payer. It’s only trying to help them get full coverage for a modest premium.
I will try to explain here how it works for me in France. Please read ahead. See how it works and then draw your own conclusions about whether or not you want something like this in the U.S.
Single Payer Health Insurance is (with variations) a system wherein the government owns a health insurance company. Not the ONLY health insurance company. There are many private carriers as well.
In France, just about everybody has the national company because the premiums are fairly based on their incomes. Employers also pay a percentage of our income (publishers, film productions, dance companies as well as businesses). Everybody (even freelance people) is covered. We pay premiums (a percentage of what we make) to the government company every month or maybe every trimester. But, in France, health insurance does not come out of our taxes. Premiums are, in fact, tax deductible.
So everyone pays something different based on his or her family situation (many kids or handicapped etc. would probably pay less) and income. But ... everyone is equally covered.
The care one receives is not based on the amount he or she pays in. But rather care is based on how ill one is. There are nineteen or twenty major diseases (cancer, diabetes, MS etc) which guarantee 100 percent coverage for everything to do with that illness so long as you have it. Otherwise, in most cases, there is what Americans call a co-pay. The government company may pay 80 percent of the twenty-euro doctor visit. But we pay the extra 20 percent out of pocket.
The basic difference in feeling when you live in a place with Single Payer is that you don’t live in fear of yourself or your children or your family members falling ill. If they get sick, they get care. The sicker they are, the more they get cared for.
Logically, when there is a government health insurance company whose job it is to keep people healthy, the government spends lots on encouraging preventive health care. Commercials on TV and ads in the Métro and buses give advice and the phone numbers of free clinics to stop smoking and curb alcohol abuse, etc.
Naturally, too, when a government owns a health insurance company, it wants to save money. How does it save money? By keeping the people healthy. Disallow genetically modified foods. Fewer pesticides and fewer chemicals in the prepared foods and indeed fewer prepared foods. Ads about exercise and ads about careful driving etc abound. The government also control prices on medicines. Nowhere is medicine cheaper than in France. The pharmaceutical companies don’t like this practice. But it’s obliged to accept it. One cannot advertise prescription medication on TV. Only alternatives or homeopathic (comfort) medicines which can be bought over the counter are allowed to be advertised.
Lastly, private insurance companies compete with the government company. Their first job is to absorb the rich people who don’t want to join the national company because paying even a small percentage of their income would be too dear. So rich people often buy private coverage. Secondly, private insurers serve as co-payers. If you have both public and a small private additional policy, the latter will pay the co-pay and sometimes dental and eye care, too. (The government plan pays only a minimum for dental and eye care.)
