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> The former is (to a first approximation) what you get with European-style single payer Aside from the fact that most European countries - even those with gov

> The former is (to a first approximation) what you get with European-style single payer Aside from the fact that most European countries - even those with government-mandated healthcare - do not have single-payer insurance, this is a false dichotomy that ignores the global market dynamics. Just as Medicare in the US could not operate in its current form without the existence of the private market to implicitly subsidize the public system, European countries would have a very different healthcare story in the absence of the US market. Nobody likes to admit it, but there's a reason that the US is the source of over half of all direct biomedical and pharmaceutical research worldwide, including research conducted by European pharmaceutical companies. These companies use sales on the US market as the source of funds for the research that all countries benefit from, and in the absence of the US market, either those costs would be borne by Europe, or that research would simply not happen[0]. They also pull funding from the US market via other, less direct means. Yes, the US system has massive problems, and yes, it could and should be cheaper. But you can't analyze these as binary options in isolation, because they're not binary[1], and they're not operating in isolation either. [0] If you want to make the argument that Europe could come up with a system that pays for this research in the absence of the US market, fine, but then you have to explain both why that would not simply recreate the same expenses, and explain the fact that, so far, that system has not been created even by the European pharmaceutical and biomedical companies. [1] The UK has four main payers; the Netherlands doesn't even have single-payer at all, and so forth.

nostrademons 9y ago
So assume that the U.S. health system goes away and that no further medical research is ever conducted; we're left with whatever the state of knowledge is now, and it'll never get better. This is what I was somewhat obliquely referring to as "some people will die because the person who could've saved them has no incentive to". The question still stands - would you rather live in the world where everyone has access to medical care but it isn't cutting-edge, or one where the very best in care and the very best in research techniques are available, but only for a price? I'm honestly curious about peoples' answers, because it is a dichotomy. Not necessarily a sharp one - you could imagine several intermediate systems in between - but there's a tradeoff between universal access vs. incentivizing further research and new techniques.
- chimeracoder 9y ago
  > So assume that the U.S. health system goes away and that no further medical research is ever conducted; we're left with whatever the state of knowledge is now, and it'll never get better. This is what I was somewhat obliquely referring to as "some people will die because the person who could've saved them has no incentive to". Again, there is no "would you rather". You can't treat these as binary options, and you can't treat these as operating in isolation. They're an array of systems that mutually operate within a global context. There is no answer to that question, because the dichotomy assumes both a binary and isolation. There is indeed a tradeoff between quality and access, and there's a worthwhile and necessary conversation to be had around that. But that's not the same as the difference between the US and the multitudinous systems within Europe (most of which are not single-payer). And it's not the same as the question you opened with.
- electricEmu 9y ago
  Why would there be a dichotomy? Both space travel and the internet come to mind as government funded projects moved the United States into lucrative markets with cutting edge technology. There is no dichotomy between universal coverage and cutting edge technology.
- christophilus 9y ago
  >> no incentive If I see someone drowning, I have no financial incentive to go save them. But I will go save them. Financial incentives aren't the only incentives. They aren't even the best incentives. Why might someone go into medicine and/or research if it didn't pay huge salaries? Maybe because it's meaningful work. Maybe because it brings prestige. Maybe because they enjoy it. Maybe because they care for people. I contribute to open source software and have never been paid a dime, yet you can hardly say that open source software is inferior to proprietary/for-profit software.
jefurii 9y ago
I'd be okay with less innovation if it meant that everybody got decent medical care. Statistically speaking, most people don't die from exotic conditions but rather from mundane things that just need treatment.
DanBC 9y ago
The US payers don't subsidise medical research for the rest of the world; they pay for the vast amounts of advertising that the US companies do to doctors and consumers.

nostrademons 9y ago

So assume that the U.S. health system goes away and that no further medical research is ever conducted; we're left with whatever the state of knowledge is now, and it'll never get better. This is what I was somewhat obliquely referring to as "some people will die because the person who could've saved them has no incentive to". The question still stands - would you rather live in the world where everyone has access to medical care but it isn't cutting-edge, or one where the very best in care and the very best in research techniques are available, but only for a price? I'm honestly curious about peoples' answers, because it is a dichotomy. Not necessarily a sharp one - you could imagine several intermediate systems in between - but there's a tradeoff between universal access vs. incentivizing further research and new techniques.

chimeracoder 9y ago
> So assume that the U.S. health system goes away and that no further medical research is ever conducted; we're left with whatever the state of knowledge is now, and it'll never get better. This is what I was somewhat obliquely referring to as "some people will die because the person who could've saved them has no incentive to". Again, there is no "would you rather". You can't treat these as binary options, and you can't treat these as operating in isolation. They're an array of systems that mutually operate within a global context. There is no answer to that question, because the dichotomy assumes both a binary and isolation. There is indeed a tradeoff between quality and access, and there's a worthwhile and necessary conversation to be had around that. But that's not the same as the difference between the US and the multitudinous systems within Europe (most of which are not single-payer). And it's not the same as the question you opened with.
electricEmu 9y ago
Why would there be a dichotomy? Both space travel and the internet come to mind as government funded projects moved the United States into lucrative markets with cutting edge technology. There is no dichotomy between universal coverage and cutting edge technology.
christophilus 9y ago
>> no incentive If I see someone drowning, I have no financial incentive to go save them. But I will go save them. Financial incentives aren't the only incentives. They aren't even the best incentives. Why might someone go into medicine and/or research if it didn't pay huge salaries? Maybe because it's meaningful work. Maybe because it brings prestige. Maybe because they enjoy it. Maybe because they care for people. I contribute to open source software and have never been paid a dime, yet you can hardly say that open source software is inferior to proprietary/for-profit software.

jefurii 9y ago

I'd be okay with less innovation if it meant that everybody got decent medical care. Statistically speaking, most people don't die from exotic conditions but rather from mundane things that just need treatment.

DanBC 9y ago

The US payers don't subsidise medical research for the rest of the world; they pay for the vast amounts of advertising that the US companies do to doctors and consumers.