(01-29-2019 04:11 PM)RiceLad15 Wrote: I'm admittedly ignorant of the details of a Medicare for All strategy, but what about that policy positions outlaws private insurance plans? Could someone not still pay for insurance that offers different coverage than a sweeping plan?
Thanks for the admission. With respect for your question, it depends on which model system you implement.
If true single-payer (very rare, only Canada among non-communist countries ever had it, and they are getting away from it), then no. Not only can you not have private insurance, but you also cannot pay out of pocket for health care. Single payer means only one entity--the government--can pay for health care (that's why they call it single-payer), and if the government won't pay for it, you can't have it. You pay a doc out of pocket for something the government won't provide, and get caught, he loses his medical license and you go to jail. What actually happens in these systems is you end up with a huge black market, and in recognition of that Canada has loosened the strings quite a bit in recent years (at least in some provinces--the systems are provincial, and the Canadian provinces have far more autonomy than US states).
Single provider (like UK NHS and much of Europe, and what I think most people mean when they say "single payer") means the government has an agency that provides health care directly, with docs paid a salary. In this system private docs are allowed (like Baker Street in UK), but private insurance to pay for visits to such docs may be strictly limited (I think this is the UK case) and extremely expensive, or outlawed altogether. Basically it becomes an out-of-pocket fee-for-service-on-demand system for those who can afford it, and a "free" take-a-number-and-wait-in-line service for those who can't. I have a number of Brit friends who cashed in their retirement or took out mortgages so grandma could get her surgery done privately instead of waiting in the queue. They also go overseas, with France or India being popular destinations, to get it done cheaper than Baker Street. Tony Blair once took flak for saying that they really didn't need to increase the NHS budget as long as they had France.
Wait times vary widely under both single-payer and single-provider because the supply is fixed by the annual budget, whereas the demand can vary up or down. If they over budgeted brain surgery and under budgeted heart surgery, then if you have a brain tumor you get treated straight away, but if you have a heart attack you may have to take a number and come back next year. The strong temptation is to save money by budgeting less that what the actuarial numbers say will be needed (it's called "supply side cost control" in the professional literature) and put people in the queue.
Bismarck (what France has, and what most of the best systems in Europe have) means that you have some kind of "free" system and universal government-funded private insurance (generally obtained through unions or other non-profits) to cover you in that system, and that typically covers somewhere around 70% of health care, but you also have a private "pay" system that operates alongside the "free" system, and you can readily purchase supplemental private insurance to cover use of the "pay" side. Last statistics I saw 99+++% of the French have the basic government-paid insurance (the only exceptions being people in transit in or out of the country) and 90% have supplemental insurance (usually paid by employers) to cover the other 30%. And because most needs are met on the "free" side, supplemental insurance tends to be dirt cheap. Basically, you use the "free" side when you can and go to the "pay" side when you don't want to wait in the queue. Other Bismarck systems vary in the details (as I understand it, Holland and Switzerland don't really have a "free" side, it's all for profit with government subsidized insurance, and in Germany all health insurance providers are run by the
lander (states), and the unlike the Obamacare exchanges, the German exchanges were created as the place to buy insurance from an out-of-state provider).
So the answer to your question depend on what kind of system you have.
Single-payer - total government control, you can't have private insurance and you can't even pay out of pocket.
Single-provider - you can pay out of pocket, but you may or may not be able to get private insurance to cover it.
Bismarck - you can have private care and you can pay for it with private insurance, and private care is an intentional and integral part of the system, basically to control wait times.
