3 ms·

Indeed. One of the core ways single payer systems achieve such great results in terms of bang-for-buck is by not covering treatments that offer bad value for mo

by makomk 9y ago

Indeed. One of the core ways single payer systems achieve such great results in terms of bang-for-buck is by not covering treatments that offer bad value for money, and this is almost certainly not politically viable in the US. For example, I understand the ACA specifically forbids assessing the cost-effectiveness of treatment based on dollars per QALY, which is how the NHS in the UK rations care to reduce costs. It simply does not follow that, because single payer systems offer better value in terms of benefit gained for the dollars spent, those efficiency improvements mean it's possible for everyone to come out ahead. Those last few iotas of healthcare improvement are a lot more expensive than the lower-hanging fruit.

inopinatus 9y ago
This is flat wrong mis-statement of both the facts and the outcomes. The NHS does not assess cost-effectiveness of treatment in the UK in that fashion, and does not deny it on that basis. Cost-effectiveness by QALY is one factor included in assessments by a separate body, NICE, which a) is not part of the NHS and b) does not inhibit NHS bodies from offering any particular treatment. If NICE gives a treatment option the green light, then the NHS trusts are obliged to offer it in applicable circumstances. If NICE does not, then individual (local) NHS trusts can make their own assessment. If there is a local cost constraint, that is considered as a matter of simple necessity. It is a common falsehood often repeated by opponents of single-payer systems that doctors in such systems are directly prevented from offering treatments by faceless beancounters. It simply isn't so. Quite the opposite. The assessors may say "you must offer this treatment". They do not say "you must not". However, QALY itself is IMO a terrible metric mainly because it is sufficiently describable to non-practitioners to become a political football.
- makomk 9y ago
  Part of running an "efficient" healthcare system is that cost constraints are always a factor. Sure, NHS trusts are legally allowed to offer treatments that aren't approved by NICE, but they have piles of money lying around to do expensive things beyond the basics that are required of them at the best of time, and this isn't the best of times - like many countries the UK has a healthcare funding crisis right now. At best, requiring a treatment rejected by NICE leaves your fate up to a postcode lottery where your location determines whether you have access to it. At worst, nowhere will cover it. Also, cost per QALY is one of the main factors NICE uses, and the ACA means it and similar measures cannot be used as any kind of factor at all in the US.
  - inopinatus 9y ago
    NICE was founded to reduce that postcode lottery by creating a base set of what is nationally achievable. Over time, that set grows. It's grossly unfair to misrepresent it as some kind of net-negative body, or to suggest that doctors won't treat a patient. Indeed one of the effects is to encourage research into more affordable treatments. This is in antithesis to the US system where, for example, the drug companies are incentivized to R&D long-term treatments for symptoms, not cures for diseases. I like the incentives that NICE creates instead. Over time, it's a strong net national benefit. The failure to include such a mechanism in the ACA seems more to do with US politics than any intrinsic characteristic of single-payer systems. The NHS has apparently been under-funded for decades, far too long a period to call it a "crisis". I would maintain it is simply grossly inefficient at spending the money it does receive, due to horrible management. Again, this is not an intrinsic characteristic of such systems.
camiller 9y ago
> ACA specifically forbids assessing the cost-effectiveness of treatment based on dollars per QALY, which is how the NHS in the UK rations care to reduce costs. This. And lets put it in concrete terms. If you are 40 and get cancer you get treatment. If you are 82 and get cancer you get pain meds. And there is no US politician that is going to fall on that grenade.

by makomk 9y ago

inopinatus 9y ago

This is flat wrong mis-statement of both the facts and the outcomes. The NHS does not assess cost-effectiveness of treatment in the UK in that fashion, and does not deny it on that basis. Cost-effectiveness by QALY is one factor included in assessments by a separate body, NICE, which a) is not part of the NHS and b) does not inhibit NHS bodies from offering any particular treatment. If NICE gives a treatment option the green light, then the NHS trusts are obliged to offer it in applicable circumstances. If NICE does not, then individual (local) NHS trusts can make their own assessment. If there is a local cost constraint, that is considered as a matter of simple necessity. It is a common falsehood often repeated by opponents of single-payer systems that doctors in such systems are directly prevented from offering treatments by faceless beancounters. It simply isn't so. Quite the opposite. The assessors may say "you must offer this treatment". They do not say "you must not". However, QALY itself is IMO a terrible metric mainly because it is sufficiently describable to non-practitioners to become a political football.

makomk 9y ago
Part of running an "efficient" healthcare system is that cost constraints are always a factor. Sure, NHS trusts are legally allowed to offer treatments that aren't approved by NICE, but they have piles of money lying around to do expensive things beyond the basics that are required of them at the best of time, and this isn't the best of times - like many countries the UK has a healthcare funding crisis right now. At best, requiring a treatment rejected by NICE leaves your fate up to a postcode lottery where your location determines whether you have access to it. At worst, nowhere will cover it. Also, cost per QALY is one of the main factors NICE uses, and the ACA means it and similar measures cannot be used as any kind of factor at all in the US.
- inopinatus 9y ago
  NICE was founded to reduce that postcode lottery by creating a base set of what is nationally achievable. Over time, that set grows. It's grossly unfair to misrepresent it as some kind of net-negative body, or to suggest that doctors won't treat a patient. Indeed one of the effects is to encourage research into more affordable treatments. This is in antithesis to the US system where, for example, the drug companies are incentivized to R&D long-term treatments for symptoms, not cures for diseases. I like the incentives that NICE creates instead. Over time, it's a strong net national benefit. The failure to include such a mechanism in the ACA seems more to do with US politics than any intrinsic characteristic of single-payer systems. The NHS has apparently been under-funded for decades, far too long a period to call it a "crisis". I would maintain it is simply grossly inefficient at spending the money it does receive, due to horrible management. Again, this is not an intrinsic characteristic of such systems.

camiller 9y ago

> ACA specifically forbids assessing the cost-effectiveness of treatment based on dollars per QALY, which is how the NHS in the UK rations care to reduce costs. This. And lets put it in concrete terms. If you are 40 and get cancer you get treatment. If you are 82 and get cancer you get pain meds. And there is no US politician that is going to fall on that grenade.