If we ever got the public option/single payer health insurance passed, what about co-pays?

[BoWanZi]

My wife has a huge amount of health problems. Well maybe not a huge amount but a lot that require lots of trips to the dr and lots of meds. The part that kills us are the co-pays. Co-pays for a healthy person aren't that bad but for someone like us, they hurt like hell. She is on like 15-18 different meds a month, has at least 2-3 dr appts a month, and ends up at the hospital about once a year or two.

We are sinking fast because of co-pays. I am on cobra right now due to losing my job 10 months ago and that is killing us as well but my parents are helping a little bit what they can.

So if the public option/single payer ever came to fruition, would that make co-pays go away finally?

I hate co-pays and wish they would go away!!!

[LiberalFighter]

1. I would say it would be similar to Medicare if any.

[enlightenment]

2. I think single payer probably would.

That's the idea of 'free at the door' - your cost comes from your monthly payments into the system. I suspect there would be co-pays for meds, but presumably, since the government would be negotiating with pharma (and for once, would have an incentive to keep costs down) that those wouldn't be extraordinary.

The public option was a sop tossed out (and withdrawn) to the single payer advocates. It's not the same thing at all.

[BoWanZi]

3. I really don't understand the difference between public option/single payer

I do not have a good understanding of all the different terms. Too much information overload causes an easily confused Bowanzi. Could you explain the difference in a nutshell?

[enlightenment]

4. I am hardly an expert, so I expect I'll be smacked around . . .

but my understanding is:

Public Option: essentially, a non-profit, government-offered (and administered, like Medicare) health insurance plan. It would have been offered through the 'Exchanges' in competition with other, approved, private insurance plans. Sort of a cross between single payer and the nasty mess we have now.

From the patient perspective, this would still be a form of insurance that they would have to pay for, independently (write a premium check every month). It would probably have required co-pays, etc, just like other low-cost insurance.

Single payer, which is common in every other civilized nation on the planet, comes in different varieties - some are pure government run programs (like the NHS in the UK) and some look more like what the Public Option would have been, with the difference that the competition - if it exists - is all non-profit, not private (for-profit).

In a true single-payer system, you don't pay at the point of service. You pay through fees/taxes/contributions (call it what you want - it comes out of your pay each month) that are charged on a sliding scale depending on your income. Most countries have a cap beyond which you are no longer charged (or not charged more). When you get sick, you go to the doctor, give them your 'card' proving that you are a payee into the system, and they treat you. From the patent perspective, that's pretty much it.

Of course it's more complicated than that, but that's my understanding. You - as an individual - still pay for access to health care, but in a true single payer system, the pool is so large that it is not only much more cost effective but also allows the access to be relatively painless for the user, rather than having to prove they can pay each time they need treatment.

[jtown1123]

9. If look at places like England, their copays for drugs are only 4pounds. For seniors, they are 0

Not sure about doctors visits but I don't think there are copays. I imagine with the risk spread around between everyone from the very healthy to the very sick, costs would lower considerably.

[hedgehog]

5. Th etheory behind a co-pay is that it keeps you from running to the doctor

for each and every little thing, thereby saving the system money. My question is, who has the time to keep running to the doctor? If someone keeps going to the doctor, it's generally because they have an undiagnosed illness, oftentimes depression.

So IMO, the co-pay is counterproductive, in that it deters some people who need to see a doctor sooner rather than later.

There was an article in the New Yorker by Atul Gawande

http://www.newyorker.com/reporting/2011/01/24/110124fa_fact_gawande

suggesting that a lot of health care costs come from a small number of people. He suggested that the way to reduce costs for these people is to give them focused, coordinated care to diagnose and treat their problems.

[Fumesucker]

6. Copays are only counterproductive if you are a patient or possibly a provider..

If you are an insurance company then copays are a godsend..

[suffragette]

7. HR 676 is an example of single payer which does not have co-pays

http://www.johnconyers.com/hr676faq

H.R. 676, also called the United States National Health Insurance Act, is a bill to create a single-payer, publicly-financed, privately-delivered universal health care program that would cover all Americans without charging co-pays or deductibles. It guarantees access to the highest quality and most affordable health care services regardless of employment, ability to pay or pre-existing health conditions.

~~~
What health care services are covered?
The program established by H.R. 676 will cover all medically-necessary services without charging co-pays or deductibles. The services covered will include: primary care; inpatient, outpatient and emergency hospital care; prescription drugs; durable medical equipment; hearing, dental and vision care; chiropratic treatment; mental health services; and long-term care.

[hedgehog]

8. Would the cost of administering co-pays be higher than the amount of money brought in?