6 ms·

A family friend, who was at the time the chief neurosurgeon of a significant Canadian hospital, pointed out once back in the late 80s, "America will never make

by tbihl 10y ago

A family friend, who was at the time the chief neurosurgeon of a significant Canadian hospital, pointed out once back in the late 80s, "America will never make single payer work because you won't be able to place a cut off where you stop paying to delay death." And of course it's completely true. The claim that there wouldn't be any "death panels" was of the most damning aspects of the legislative battle, because it proved that no one wanted to let reality in.

vidarh 10y ago
Reality, of course, being that the US has death panels: Insurance providers, so the argument was idiotic to begin with. The difference is that with most socialised systems there are two system in parallel: A public system whose priorities set based on measured impact, rather than by . E.g. in the UK, a separate agency develops guidance independently that measures how treatments affect "quality adjusted life years". And a private system, whose priorities are, like in the US, based on how deep your pockets are. For the vast majority the public system is the only one they use, but about 10% pay for private insurance. In practice this acts like a good indicator: If takeup goes up it means more patients believe NHS care is slipping and makes them feel they need to "top it up". If prices goes up (private insurance here is exceedingly cheap, since most providers are based on you going to the NHS first and then referring you privately if you e.g. don't get to see a specialist within X days) it's an indicator the providers see NHS as deteriorating (causing more claims from their customers). The US could do the same - continue to allow private healthcare, but cover a certain level of treatment via a public system.
- ruste 10y ago
  Except you can sue your insurance provider if they deny you coverage for something that they're obligated to cover. You wouldn't be able to sue the government. Edit: Let me also add this; when you sign up for health insurance you're entering into a contract with the insurer. They have to be up front about what they're providing and it's your obligation to understand what you're buying. With the government you don't get that. You get whatever the vanilla flavour of healthcare coverage is today. There's no contractual obligation, only whatever the government says is right today. You don't get a guarantee. Because there's no contract you can point to, even if you're legally allowed to sue (and I don't think you are.) you won't have a case to stand on.
  - vidarh 10y ago
    Yes you can. In the UK people sue the government, or specially the NHS, over treatment decisions all the time. Including over things like denied coverage of specific drugs etc. (usually when there's no proven benefit from a given drug). And as I pointed out: If you think they are too strict, then you can pay for a private insurer to cover things the NHS doesn't cover or won't do fast enough for you.
    - ruste 10y ago
      >In the UK
    - danielweber 10y ago
      In Hillary Clinton's proposed health care plan in 1993, no, you weren't allowed to sue. You could get an appeal from a Board, but that's it. The proposed legislation explicitly said there could be no other review. Note that this is a very good cost containment strategy. Note also that this can probably not reduce patient outcomes at all. Note also that it is extremely unpopular.
  - st3v3r 10y ago
    "Except you can sue your insurance provider if they deny you coverage for something that they're obligated to cover. " With what money? And furthermore, what good will that do if you die before the trial is over?
    - ruste 10y ago
      You can have the procedure done then sue them when they won't pay for what they're contractually obligated to. You don't generally get a hospital bill until the procedure is done.
      - dagw 10y ago
        Will a hospital even perform the procedure if the insurance company has said no and they know the patient will never be able to pay for it?

by tbihl 10y ago

vidarh 10y ago

Reality, of course, being that the US has death panels: Insurance providers, so the argument was idiotic to begin with. The difference is that with most socialised systems there are two system in parallel: A public system whose priorities set based on measured impact, rather than by . E.g. in the UK, a separate agency develops guidance independently that measures how treatments affect "quality adjusted life years". And a private system, whose priorities are, like in the US, based on how deep your pockets are. For the vast majority the public system is the only one they use, but about 10% pay for private insurance. In practice this acts like a good indicator: If takeup goes up it means more patients believe NHS care is slipping and makes them feel they need to "top it up". If prices goes up (private insurance here is exceedingly cheap, since most providers are based on you going to the NHS first and then referring you privately if you e.g. don't get to see a specialist within X days) it's an indicator the providers see NHS as deteriorating (causing more claims from their customers). The US could do the same - continue to allow private healthcare, but cover a certain level of treatment via a public system.

ruste 10y ago
Except you can sue your insurance provider if they deny you coverage for something that they're obligated to cover. You wouldn't be able to sue the government. Edit: Let me also add this; when you sign up for health insurance you're entering into a contract with the insurer. They have to be up front about what they're providing and it's your obligation to understand what you're buying. With the government you don't get that. You get whatever the vanilla flavour of healthcare coverage is today. There's no contractual obligation, only whatever the government says is right today. You don't get a guarantee. Because there's no contract you can point to, even if you're legally allowed to sue (and I don't think you are.) you won't have a case to stand on.
- vidarh 10y ago
  Yes you can. In the UK people sue the government, or specially the NHS, over treatment decisions all the time. Including over things like denied coverage of specific drugs etc. (usually when there's no proven benefit from a given drug). And as I pointed out: If you think they are too strict, then you can pay for a private insurer to cover things the NHS doesn't cover or won't do fast enough for you.
  - ruste 10y ago
    >In the UK
  - danielweber 10y ago
    In Hillary Clinton's proposed health care plan in 1993, no, you weren't allowed to sue. You could get an appeal from a Board, but that's it. The proposed legislation explicitly said there could be no other review. Note that this is a very good cost containment strategy. Note also that this can probably not reduce patient outcomes at all. Note also that it is extremely unpopular.
- st3v3r 10y ago
  "Except you can sue your insurance provider if they deny you coverage for something that they're obligated to cover. " With what money? And furthermore, what good will that do if you die before the trial is over?
  - ruste 10y ago
    You can have the procedure done then sue them when they won't pay for what they're contractually obligated to. You don't generally get a hospital bill until the procedure is done.
    - dagw 10y ago
      Will a hospital even perform the procedure if the insurance company has said no and they know the patient will never be able to pay for it?