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> "Furthermore, we estimate that ensuring health-care access for all Americans" From many anecdotes I've read about medicine in socialized countries, it's unwi

> "Furthermore, we estimate that ensuring health-care access for all Americans" From many anecdotes I've read about medicine in socialized countries, it's unwise to assume that having insurance is the same as access. Many procedures are made unavailable due to being considered cost effective by The Single Payer, and the wait time for specialists can often be long. Further, what counts as "costs" in US health industry is kind of funny - health care providers have a book-price that is often inflated, so that insurance companies can claim to their customers (mostly employers) what a good job they do in reducing costs. For the opposite perspective, some of these points are discussed in much more detail in these two recent EconTalk episodes: * https://www.econtalk.org/marty-makary-on-the-price-we-pay/ https://www.econtalk.org/marty-makary-on-the-price-we-pay/ * https://www.econtalk.org/keith-smith-on-free-market-health-care/ https://www.econtalk.org/keith-smith-on-free-market-health-c...

notatoad 7y ago
>Many procedures are made unavailable due to being considered cost effective by The Single Payer whether the insurance is coming from a single payer or a private company, access to health care does not mean unrestricted access to any medical procedure you want. Private insurers also deny treatments that aren't considered to be cost effective.
- Loughla 7y ago
  That's what I've never understood about the arguments against single payer: >You can't pick your own doctor I already can't. If they're in network, I'm good, but if they're out of network - like my doctor was - then I have to find a new one. >You can't pick your treatments My spouse was denied medication by an insurance company because it was too new. So. >You don't get to have all the healthcare you want I already have to have pre-approval for anything up to and including emergency surgery according to my annual medical contract. So that's out the window, too. And I have good insurance through a respectable company who may or may not have a name that rhymes with smue-smoss smue-smield. Not sure what other arguments there are.
  - noodle 7y ago
    > Not sure what other arguments there are. The one I've heard the most lately is that "people like their existing insurance companies", which I think is an almost absurd thing to say on its face. But its probably just a way to say "people don't like change" that doesn't get insurance companies or "people" salty about it.
    - jkingsbery 7y ago
      I've never heard that - I don't know anyone who likes their insurance company. I have heard some people say that in the current system that there might in theory be some competition, although in practice government rules mean that there isn't really much competition. Most people I've heard want to go the other way from single payer, and increase competition for insurers.
      - noodle 7y ago
        > I've never heard that - I don't know anyone who likes their insurance company. I've never heard any normal citizen say that. I was mostly commenting on current politicians saying that to justify their stances. For example: "One hundred sixty million people like their private insurance" - Joe Biden, Nov 21 2019 "You don't start out by saying I've got 160 million people I'm going to take away the insurance plan that they love." - Michael Bloomberg, Feb 19 2020 etc
    - AcerbicZero 7y ago
      I don't know if I could say I "liked" my insurance company, but I can say with a great deal of certainty that my interactions with my insurance company are orders of magnitude more frustration free (enjoyable seemed like too much of a stretch) than any of my mandatory interactions with State/Federal government. My worst interaction with an insurance company in my entire adult life was being billed in an annoying fashion and having to sit on hold for half an hour to get it fixed. Compared to just my last trip to the DMV the insurance company is already pretty far ahead. For completeness sake, I'm actually not particularly opposed to re-working the healthcare system. While I lean strongly libertarian, I'm pragmatic enough to understand the current half commie, half free market health care system is entirely untenable, and I seriously doubt it will be acceptable to move in the free market direction anytime soon.
- jkingsbery 7y ago
  I don't disagree with that. But if the medical industry has a certain amount of bandwidth, moving to a different organization for compensation won't increase access as the paper suggested, it will just re-organize who gets access. Maybe that is a good thing on the balance, but it seems like it will come without trade-offs.
  - tialaramex 7y ago
    There undoubtedly will be trade-offs. For example it'll be harder to exploit the working poor which is a very important benefit rich Americans rely on today. One side effect that might be popular on HN is entrepreneurship is less scary if the society you live in has promised it won't just let you die because you dared to strike out on your own rather than sticking close to the big corporation that provides affordable healthcare to its employees. But your "bandwidth" analogy seems confused. What is "bandwidth" here? Because lots of American medical professionals seem to insist they spend a lot of effort on things that aren't healthcare - things which are unnecessary in single payer systems. If the US redirects all this healthcare "bandwidth" to actually delivering healthcare, that's a bunch of extra healthcare delivered, not just re-organizing who gets access.
markroseman 7y ago
Yes, in a properly functioning universal healthcare system, wait times for specialists can be longer for things that are less urgent. First priority is those with the most medical need, not whoever steps up to pay to play.
- bduerst 7y ago
  It's still comparable with the hybrid system in the U.S. too - i.e. outpatient surgery procedures can take months no matter which system.
  - ameister14 7y ago
    Perhaps, but I believe the averages are significantly lower in the US - Canada publishes theirs, you can check it.
    - adamch 7y ago
      Is this confounded by the number of Americans would _want_ treatment, but can't afford it or can't access it via their health insurance?
    - markroseman 7y ago
      Is that when you omit infinity from the calculations in the US...?
  - pfarnsworth 7y ago
    I got an MRI within a day and CT scan within a day as well. I got an endoscopy within 5 days. My friend waited 4 months for her MRI to diagnose gallbladder stones. The same friend has to wait 2 years for autism therapy for their children. The waiting times for specialists in Canada are in the months. When I lived in Canada, it was practically impossible to find a GP in downtown Toronto that was taking new patients. Yes, I didn't have to pay much for health care (I remember having a health care tax in Ontario) but it wasn't a bed of roses either. I'm a lot happier with Kaiser in California than any treatment I received in Canada.
burkaman 7y ago
> Many procedures are made unavailable due to being considered cost effective by The Single Payer, and the wait time for specialists can often be long. Right now, many procedures are made unavailable due to being considered "elective" or "cosmetic" or "out of network" by The Private Insurer.
- ameister14 7y ago
  Here's a study of wait times in the 80's: https://www.nejm.org/doi/full/10.1056/NEJM199410203311607 https://www.nejm.org/doi/full/10.1056/NEJM199410203311607 here's an article talking about wait times growing since then:https://globalnews.ca/news/930260/medical-wait-times-have-doubled-in-the-last-20-years-report/ https://globalnews.ca/news/930260/medical-wait-times-have-do...
nkassis 7y ago
The same problem you describe exist in the us system as well. Wait times are also shorter when people are cost prohibited from seeking certain services.
cotillion 7y ago
I live in a universal health care country. I also had a private health insurance thru my employer which guaranteed specialist care within a certain time. The universal health care means that the extra insurance was not very expensive at all since it only covered the speedy access part. If you have money capitalism will always ensure you have speedy access to healthcare.
- tialaramex 7y ago
  In Britain part of the reason it's cheaper is that the public system handles everything that goes wrong. So private healthcare is only doing routine stuff even though that's the cheap bit. When a patient in the operating theatre at the boutique private hospital collapses or stops breathing or whatever, they don't have an in-house team to fix that, they'll deliver first aid (admittedly they'll be better at it than a lay person who took a two day course months ago) until the public system's ambulance takes the (likely unconscious) patient to a public hospital's emergency reception which can take proper care of them. Many of the doctors are the same people but even if the private hospital had the right people, and the right equipment it doesn't want the liability.
ipython 7y ago
The part I don't get about this argument is - who is outlawing the ability for physicians to practice privately? I would expect that there would be concierge-style medicine available to those who choose to pay out-of-pocket for it. You want to contract with the world-class researcher to perform an experimental surgery that is unavailable through the public system? Sure, pay the money and we'll take care of you.
- jkingsbery 7y ago
  I'm not an expert, but my understanding is that it is common in single-payer system to outlaw at least some forms of private practice, see for example: http://www.canadian-healthcare.org/page6.html http://www.canadian-healthcare.org/page6.html > In addition to public health care providers such as primary care doctors and hospitals, many private clinics offering specialized services also operate in Canada. Under federal law, private clinics are not legally allowed to provide services covered by the Canada Health Act. One of the EconTalk links I posted above has an interview with someone who started a hospital that takes no insurance, and the total payment for a procedure is less than the co-pay for a procedure at hospitals that take insurance (or at least, that's their claim), and their cited cost was much more than 13% less than the study claims can be done. In that interview, he discussed how people had problems getting basic procedures done in a timely and affordable fashion at other hospitals.
  - refurb 7y ago
    Canada forces physicians to choose - work in the public system or work in the private system. You can't do both.

notatoad 7y ago

>Many procedures are made unavailable due to being considered cost effective by The Single Payer whether the insurance is coming from a single payer or a private company, access to health care does not mean unrestricted access to any medical procedure you want. Private insurers also deny treatments that aren't considered to be cost effective.

Loughla 7y ago
That's what I've never understood about the arguments against single payer: >You can't pick your own doctor I already can't. If they're in network, I'm good, but if they're out of network - like my doctor was - then I have to find a new one. >You can't pick your treatments My spouse was denied medication by an insurance company because it was too new. So. >You don't get to have all the healthcare you want I already have to have pre-approval for anything up to and including emergency surgery according to my annual medical contract. So that's out the window, too. And I have good insurance through a respectable company who may or may not have a name that rhymes with smue-smoss smue-smield. Not sure what other arguments there are.
- noodle 7y ago
  > Not sure what other arguments there are. The one I've heard the most lately is that "people like their existing insurance companies", which I think is an almost absurd thing to say on its face. But its probably just a way to say "people don't like change" that doesn't get insurance companies or "people" salty about it.
  - jkingsbery 7y ago
    I've never heard that - I don't know anyone who likes their insurance company. I have heard some people say that in the current system that there might in theory be some competition, although in practice government rules mean that there isn't really much competition. Most people I've heard want to go the other way from single payer, and increase competition for insurers.
    - noodle 7y ago
      > I've never heard that - I don't know anyone who likes their insurance company. I've never heard any normal citizen say that. I was mostly commenting on current politicians saying that to justify their stances. For example: "One hundred sixty million people like their private insurance" - Joe Biden, Nov 21 2019 "You don't start out by saying I've got 160 million people I'm going to take away the insurance plan that they love." - Michael Bloomberg, Feb 19 2020 etc
  - AcerbicZero 7y ago
    I don't know if I could say I "liked" my insurance company, but I can say with a great deal of certainty that my interactions with my insurance company are orders of magnitude more frustration free (enjoyable seemed like too much of a stretch) than any of my mandatory interactions with State/Federal government. My worst interaction with an insurance company in my entire adult life was being billed in an annoying fashion and having to sit on hold for half an hour to get it fixed. Compared to just my last trip to the DMV the insurance company is already pretty far ahead. For completeness sake, I'm actually not particularly opposed to re-working the healthcare system. While I lean strongly libertarian, I'm pragmatic enough to understand the current half commie, half free market health care system is entirely untenable, and I seriously doubt it will be acceptable to move in the free market direction anytime soon.
jkingsbery 7y ago
I don't disagree with that. But if the medical industry has a certain amount of bandwidth, moving to a different organization for compensation won't increase access as the paper suggested, it will just re-organize who gets access. Maybe that is a good thing on the balance, but it seems like it will come without trade-offs.
- tialaramex 7y ago
  There undoubtedly will be trade-offs. For example it'll be harder to exploit the working poor which is a very important benefit rich Americans rely on today. One side effect that might be popular on HN is entrepreneurship is less scary if the society you live in has promised it won't just let you die because you dared to strike out on your own rather than sticking close to the big corporation that provides affordable healthcare to its employees. But your "bandwidth" analogy seems confused. What is "bandwidth" here? Because lots of American medical professionals seem to insist they spend a lot of effort on things that aren't healthcare - things which are unnecessary in single payer systems. If the US redirects all this healthcare "bandwidth" to actually delivering healthcare, that's a bunch of extra healthcare delivered, not just re-organizing who gets access.

markroseman 7y ago

Yes, in a properly functioning universal healthcare system, wait times for specialists can be longer for things that are less urgent. First priority is those with the most medical need, not whoever steps up to pay to play.

bduerst 7y ago
It's still comparable with the hybrid system in the U.S. too - i.e. outpatient surgery procedures can take months no matter which system.
- ameister14 7y ago
  Perhaps, but I believe the averages are significantly lower in the US - Canada publishes theirs, you can check it.
  - adamch 7y ago
    Is this confounded by the number of Americans would _want_ treatment, but can't afford it or can't access it via their health insurance?
  - markroseman 7y ago
    Is that when you omit infinity from the calculations in the US...?
- pfarnsworth 7y ago
  I got an MRI within a day and CT scan within a day as well. I got an endoscopy within 5 days. My friend waited 4 months for her MRI to diagnose gallbladder stones. The same friend has to wait 2 years for autism therapy for their children. The waiting times for specialists in Canada are in the months. When I lived in Canada, it was practically impossible to find a GP in downtown Toronto that was taking new patients. Yes, I didn't have to pay much for health care (I remember having a health care tax in Ontario) but it wasn't a bed of roses either. I'm a lot happier with Kaiser in California than any treatment I received in Canada.

burkaman 7y ago

> Many procedures are made unavailable due to being considered cost effective by The Single Payer, and the wait time for specialists can often be long. Right now, many procedures are made unavailable due to being considered "elective" or "cosmetic" or "out of network" by The Private Insurer.

ameister14 7y ago
Here's a study of wait times in the 80's: https://www.nejm.org/doi/full/10.1056/NEJM199410203311607 https://www.nejm.org/doi/full/10.1056/NEJM199410203311607 here's an article talking about wait times growing since then:https://globalnews.ca/news/930260/medical-wait-times-have-doubled-in-the-last-20-years-report/ https://globalnews.ca/news/930260/medical-wait-times-have-do...

nkassis 7y ago

The same problem you describe exist in the us system as well. Wait times are also shorter when people are cost prohibited from seeking certain services.

cotillion 7y ago

I live in a universal health care country. I also had a private health insurance thru my employer which guaranteed specialist care within a certain time. The universal health care means that the extra insurance was not very expensive at all since it only covered the speedy access part. If you have money capitalism will always ensure you have speedy access to healthcare.

tialaramex 7y ago
In Britain part of the reason it's cheaper is that the public system handles everything that goes wrong. So private healthcare is only doing routine stuff even though that's the cheap bit. When a patient in the operating theatre at the boutique private hospital collapses or stops breathing or whatever, they don't have an in-house team to fix that, they'll deliver first aid (admittedly they'll be better at it than a lay person who took a two day course months ago) until the public system's ambulance takes the (likely unconscious) patient to a public hospital's emergency reception which can take proper care of them. Many of the doctors are the same people but even if the private hospital had the right people, and the right equipment it doesn't want the liability.

ipython 7y ago

The part I don't get about this argument is - who is outlawing the ability for physicians to practice privately? I would expect that there would be concierge-style medicine available to those who choose to pay out-of-pocket for it. You want to contract with the world-class researcher to perform an experimental surgery that is unavailable through the public system? Sure, pay the money and we'll take care of you.

jkingsbery 7y ago
I'm not an expert, but my understanding is that it is common in single-payer system to outlaw at least some forms of private practice, see for example: http://www.canadian-healthcare.org/page6.html http://www.canadian-healthcare.org/page6.html > In addition to public health care providers such as primary care doctors and hospitals, many private clinics offering specialized services also operate in Canada. Under federal law, private clinics are not legally allowed to provide services covered by the Canada Health Act. One of the EconTalk links I posted above has an interview with someone who started a hospital that takes no insurance, and the total payment for a procedure is less than the co-pay for a procedure at hospitals that take insurance (or at least, that's their claim), and their cited cost was much more than 13% less than the study claims can be done. In that interview, he discussed how people had problems getting basic procedures done in a timely and affordable fashion at other hospitals.
- refurb 7y ago
  Canada forces physicians to choose - work in the public system or work in the private system. You can't do both.