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>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 priva

>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.
    - noodle 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. I think I'd suggest that you ask around your social circle to see if you're the outlier or the standard with your experience. Particularly if you've never had a major unplanned life event that resulted in a large medical bill. I feel like, at least for me, I'd rather have a system that has a constant amount of low grade frustration in it; instead of a system that is smooth sailing while you're healthy and paying, but will throw you under the bus when you actually need them. > 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. My worst interaction was watching a family member of mine begin to actively die and then pass away a few months after insurance decided to stop covering their primary medication - which was literally keeping their disease at bay, keeping them alive. It was too expensive to cover without the insurance. > 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. I'm actually shocked that more libertarians don't take this view. Healthcare is almost by definition not a free market and never will be. You can't make a rational purchasing decision when both parties know the possible outcome of not buying is your literal death (amongst other similar reasons). It's an outlier in the business space that needs special considerations (IMO).
- dx87 7y ago
  I know it's an edge case, but there was that kid in the UK with an easily fixable, but fatal, heart condition. Their health association refused to pay for it because no doctors in the UK knew how to perform the surgery, and they weren't willing to pay for them fly to the USA where there were specialists who could do the surgery. After they started a GoFundMe to pay for the surgery themselves, and there was a lot of press about it, the government finally agreed to pay for it instead of letting the kid die. I've also read a lot of stories from people in Canada and the UK saying that it's almost impossible to get same day medical care, even from a general practicioner. Like, they'll have to call as soon as they open, and hope they aren't already booked for the day.
  - notatoad 7y ago
    >there was that kid in the UK with an easily fixable, but fatal, heart condition i'm curious what story you're referring to. The two that were in the news recently were Charlie Gard and Alfie Evans, but neither of those were heart conditions and neither were easily fixable. They were denied access to treatments that most medical experts agreed would not be effective.
  - jandrese 7y ago
    "Easily fixable" and "no UK doctors knew how to perform" seem at odds with each other.
  - gregmac 7y ago
    > I've also read a lot of stories from people in Canada and the UK saying that it's almost impossible to get same day medical care, even from a general practicioner. Like, they'll have to call as soon as they open, and hope they aren't already booked for the day. It highly depends on the situation. If you're trying to see your family doctor for something routine or non-urgent, yes, it can take a few weeks to get an appointment, as they tend to be booked up. If you have a non-critical issue that needs to be taken care of sooner (eg, an ear infection), many practices run an "urgent care" or "after hours" clinic, and there are also dedicated offices (often co-located with a pharmacy) that do the same. I'm not sure how exactly these work, but they don't cost anything, and you can generally get in within minutes to hours, depending on your situation and how busy they are. If you are in need of emergency care, you go to the ER (and/or call an ambulance), and get triaged. If you are having a heart attack, for example, you will get treatment immediately, but for lesser problems you can sometimes wait several hours. This is also the one case where the system can actually cost you money of-out-pocket, because if you're waiting that long you'll probably want to buy something to eat.
- macinjosh 7y ago
  The whole premise of your argument is that single-payer is not only better than the insurance system (which I would agree is true) but also that it is the only other option. The latter is not true.
- deleted 7y ago
  [deleted]
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.

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.
  - noodle 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. I think I'd suggest that you ask around your social circle to see if you're the outlier or the standard with your experience. Particularly if you've never had a major unplanned life event that resulted in a large medical bill. I feel like, at least for me, I'd rather have a system that has a constant amount of low grade frustration in it; instead of a system that is smooth sailing while you're healthy and paying, but will throw you under the bus when you actually need them. > 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. My worst interaction was watching a family member of mine begin to actively die and then pass away a few months after insurance decided to stop covering their primary medication - which was literally keeping their disease at bay, keeping them alive. It was too expensive to cover without the insurance. > 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. I'm actually shocked that more libertarians don't take this view. Healthcare is almost by definition not a free market and never will be. You can't make a rational purchasing decision when both parties know the possible outcome of not buying is your literal death (amongst other similar reasons). It's an outlier in the business space that needs special considerations (IMO).
dx87 7y ago
I know it's an edge case, but there was that kid in the UK with an easily fixable, but fatal, heart condition. Their health association refused to pay for it because no doctors in the UK knew how to perform the surgery, and they weren't willing to pay for them fly to the USA where there were specialists who could do the surgery. After they started a GoFundMe to pay for the surgery themselves, and there was a lot of press about it, the government finally agreed to pay for it instead of letting the kid die. I've also read a lot of stories from people in Canada and the UK saying that it's almost impossible to get same day medical care, even from a general practicioner. Like, they'll have to call as soon as they open, and hope they aren't already booked for the day.
- notatoad 7y ago
  >there was that kid in the UK with an easily fixable, but fatal, heart condition i'm curious what story you're referring to. The two that were in the news recently were Charlie Gard and Alfie Evans, but neither of those were heart conditions and neither were easily fixable. They were denied access to treatments that most medical experts agreed would not be effective.
- jandrese 7y ago
  "Easily fixable" and "no UK doctors knew how to perform" seem at odds with each other.
- gregmac 7y ago
  > I've also read a lot of stories from people in Canada and the UK saying that it's almost impossible to get same day medical care, even from a general practicioner. Like, they'll have to call as soon as they open, and hope they aren't already booked for the day. It highly depends on the situation. If you're trying to see your family doctor for something routine or non-urgent, yes, it can take a few weeks to get an appointment, as they tend to be booked up. If you have a non-critical issue that needs to be taken care of sooner (eg, an ear infection), many practices run an "urgent care" or "after hours" clinic, and there are also dedicated offices (often co-located with a pharmacy) that do the same. I'm not sure how exactly these work, but they don't cost anything, and you can generally get in within minutes to hours, depending on your situation and how busy they are. If you are in need of emergency care, you go to the ER (and/or call an ambulance), and get triaged. If you are having a heart attack, for example, you will get treatment immediately, but for lesser problems you can sometimes wait several hours. This is also the one case where the system can actually cost you money of-out-pocket, because if you're waiting that long you'll probably want to buy something to eat.
macinjosh 7y ago
The whole premise of your argument is that single-payer is not only better than the insurance system (which I would agree is true) but also that it is the only other option. The latter is not true.
deleted 7y ago
[deleted]

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.