The reason why health insurance costs more in the US is because insurance companies have to negotiate directly with hospitals and pharmaceutical companies (something that doesn’t occur in other countries) and the government doesn’t set/control the prices (and the market doesn’t set them either because insurance companies in the US are in a weak negotiating position).
A single payer system just sets rates and pays for everything, it doesn’t guarantee good delivery of care. So, simply having a single payer system is not going to magically solve health care problems. Don’t get me wrong, I would prefer universal health care (two tier- not single payer), but too many people that want it don’t seem to understand that in and of itself it will not solve everything.
I like the idea of the two-tier model and think it will work better in the US, as we already have the framework for it. We already have government provided healthcare here, all we need to do is expand it to make it available to everyone with a public option for insurance. I think that a two-tier system would be more accepted by more people here in the US. A mixed delivery system would provide more patient choice, and Americans like to have choices.
Actually, quite a few countries that have universal health care don’t just have a single payer system.
- Single Payer: UK, Canada, Finland, Iceland, Norway, Italy, Sweden, UAE; 2) Two Tier: New Zealand, Australia, France, Denmark, Netherlands, Hong Kong; 3) Insurance Mandate: Germany, Switzerland, Austria, Belgium, Greece, Belgium, Luxembourg.
The confusion with health care models is that there is overlap between them, so many countries have some aspects of various models. Europe varies greatly.
France is considered to have a two-tier system, as well as the Netherlands. I think they are both good examples of two-tier systems that work well. With a two-tier system, the government provides a basic minimum level of insurance care for everyone, but supplemental health insurance can be bought, or even fees for extra services. There are public and private hospitals and physicians. It’s a true mixed delivery model (which I think fosters more competition for providing better care). Depending on the country- the public health care in this model can be equal to the private health care in quality and access- however- variance in one direction or the other can also occur (it can be worse in poorer countries).
While, technically the UK can also be considered a two-tier system, the private options are not nearly as utilized by the public, so it actually is more indicative of a single payer system than other countries, in practice. The UK is considered single payer because the government provides all insurance and pays all expenses. When the government pays for absolutely everything, fewer people will seek to take advantage of private hospitals and physicians.
TL;DR version: Single payer = government pays for
everything and you can also buy supplemental; Two-tier = government pays for
basic minimum care/coverage and you can buy supplemental or pay extra fees; both = have public and private hospitals and doctors available