By NextBestFitRewrite insurance & benefits law
Duplicative private insurance
Can people buy private insurance that covers the same services UHP covers, to get faster or more private care?
If insured people can buy their way to the front of a shared queue, providers shift time toward them, as happens in Germany (private patients get specialist appointments faster) and Australia. That recreates today's two-tier access with different labels. Canada's ban preserves equity but, combined with low capacity, produces long waits. The plan pairs the ban with a care guarantee: if UHP misses its maximum wait, it pays for care at any provider, including opted-out providers, at up to 150% of UHP rates.
Ban duplicative coverage + care guarantee (chosen)
Single tier for covered services. UHP must meet maximum waits or pay for care elsewhere.
- +Keeps all physician capacity in the shared system
- +Wealthy and politically influential patients share the same queue, which creates political pressure to keep it short
- +The wait-time guarantee creates a financial incentive for UHP to fund capacity
- −People with job-based coverage lose their price-based priority Their elective specialist waits are likely to lengthen during the transition.
- −Restricts a voluntary transaction This is likely to be litigated (Chaoulli v. Quebec struck down a similar ban in 2005 because waits were unreasonable).
- −Cash-only concierge practices will grow anyway Physicians can opt out entirely.
Precedent: Canada (Canada Health Act plus provincial bans); Denmark, Norway, and Sweden's treatment guarantees.
Allow duplicative coverage (Australia/UK/Germany-style two tier)
Anyone can buy private insurance for faster elective care at private hospitals.
- +A pressure valve: people who can pay don't wait, which shortens the public queue somewhat
- +Keeps a large private insurance industry and its jobs
- +Brings private capital into hospital capacity
- −Two-tier access by income is formalized In Germany, privately insured patients wait markedly less for specialist appointments.
- −Physicians split time between tiers, and the public tier gets less
- −Weakens middle- and upper-class political support for funding the public tier
Precedent: Australia (about 45% hold private hospital cover, encouraged by the Medicare Levy Surcharge); UK (about 13% hold private medical insurance); Germany (about 11% in substitutive PKV).
Allow it after a capacity threshold
Ban during the transition; allow it automatically once median waits meet targets for two years.
- +Ties the pressure valve to evidence
- −The threshold becomes a political football
- −Creates an incentive for the private sector to lobby against meeting targets
- The ability of people with means to buy faster elective care for covered services inside the U.S. without leaving the system.
- Private insurers' supplemental-market revenue for duplicative coverage.