6 ms·

The majority of single payer systems don't outlaw private care. There are private hospitals in the UK for example. Single payer is about removing insurance com

The majority of single payer systems don't outlaw private care. There are private hospitals in the UK for example. Single payer is about removing insurance companies from the process (saving money), standardising care (saving money, improving outcomes), collective bargaining for drugs (saving money), providing a base level of care to all (saving money and improving QOL). But it doesn't usually forbid spending money on private care. As a result single payer results in similar outcomes for vastly less public money, and almost zero private money spent on healthcare.

arcticbull 6y ago
Indeed, and I retract my final sentence.
- fraggle_sock 6y ago
  Ideally though, all private healthcare would be banned. Aside from ideological concerns about not giving the wealthy an unfair advantage, this has pragmatic benefit in ensuring that the public healthcare system is up to standard. That is, if the wealthy and powerful are forced to use it too, it means they have skin in the game and won't just use their power to run it into the ground in pursuit of profit or from lack of concern for others.
  - arcticbull 6y ago
    Interestingly, private healthcare isn't banned in Canada but in in reality, there's virtually none of it. The system is designed so that the public sector doesn't subsidize a potential private sector, and without those subsidies, nobody's interested. Personally, I agree with you. Private healthcare should be abolished entirely.
    - chordalkeyboard 6y ago
      > Private healthcare should be abolished entirely. Wouldn't this mean using the police to arrest people if, e.g. a person got a doctor to look at them or suggest a treatment for a condition and it wasn't something that had gone through government channels?
      - lazyasciiart 6y ago
        Perhaps at an extreme point, but most white collar crime is dealt with by fines and licensing rather than arrests and jail. E.g minimum wage laws.
        chordalkeyboard 6y ago
        But if you refuse to pay the fine on the grounds that you consider it unethical to withhold medical care from someone who requests it, you’d still be subject to incarceration?
        arcticbull 6y ago
        This situation exists today. Let's say I'm a physician, with experience from a foreign country and a years-long unimpeachable track record. What I don't have is a US degree or residency. I'm 100% going to prison if I perform a surgery in my van. Licensing and various other requirements are imposed on physicians in order to practice lawfully. One of those requirements would be not to accept direct payment for services outside the public system. If you do, then you are practicing without a license, and whatever comes of that comes of it. Likely a fine, or license suspension or if you continue to defy the law, prison. Your argument that "you consider it unethical to withhold medical care from someone who requests it" is not a defense today for practicing medicine without a license, and in my scenario, that would not change.
        chordalkeyboard 6y ago
        > This situation exists today. If I'm an physician, with experience from a foreign country and a years-long unimpeachable track record. What I don't have is a US degree or residency. I'm 100% going to prison if I perform a surgery in my van. I agree and this is terrible. > Your argument that "you consider it unethical to withhold medical care from someone who requests it" is not a defense today for practicing medicine without a license, it may not be a legal defense but it is absolutely a moral defense. > in my scenario, that would not change. I just want to make it explicit that you agree with the criminalization of healing people without permission.
    - vidarh 6y ago
      In the UK, about 10 percent has private insurance, but nearly all private plans are 'top up' type plans where the assumption is that you usually rely on the NHS first, but ask for a private referral if you need a specialist or procedure there's a wait for. As a result they're generally pretty cheap. In effect you're paying to jump queues for a limited resource.
      - uzakov 6y ago
        I don't know if you live in the UK but I can share my 2 cents: UK NHS systems isn't exactly what many Americans picture it.
    - fraggle_sock 6y ago
      Thank you for the information - it is interesting to learn of a case where discouragement and disincentivisation, in lieu of abolishment, has turned out to be a reasonable and pragmatic secondary option.
      - arcticbull 6y ago
        Looks like I forgot to link you to the write-up (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC80881/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC80881/) but I suspect you'll find it interesting!
    - refurb 6y ago
      Disagree on private healthcare being abolished. If people want to spend their own money outside the single payer system, why not let them? It doesn't absolve them of contributing to the public system, so the public system benefits when they decide to go outside it. And in Canada, there isn't much private healthcare because of the way Medicare is set up. A doctor has to choose - practice in the public system or the private system - they can't do both. As a result, you have a handful of doctors who do private with the majority in the public system. For certain procedures there is actually a lot of private healthcare in Canada. Take a look at MRI's. Instead of waiting 2 or 3 months for an MRI you can pay $300 and get one this week and send the results to your doctor.
      - arcticbull 6y ago
        It varies from province to province [0]. What you're saying is true in some provinces but not all. However, even in the provinces without material barriers, no private sector exists. The article actually provides some solid theories. Your information about MRI waiting times isn't accurate in general - or rather paints only part of the picture. Even with the COVID situation happening now, in Ontario... Patients who should be scanned immediately receive a scan, immediately. Patients who should be scanned within 2 days are in fact scanned within 2 days. Patients who have a target of 10 days for a scan wait closer to 18 (but 53% are scanned within the SLA). Patients who have a target of 28 days wait closer to 90. [1]. If you don't need one now, you're wasting capacity by getting one now. This capacity should be allocated 100% to the public sector on a need basis. That would reduce wait times for all priorities. This is in fact what the British Columbia government did [2] to excellent effect [3]. [0] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC80881/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC80881/ [1] https://www.hqontario.ca/System-Performance/Wait-Times-for-Diagnostic-Imaging https://www.hqontario.ca/System-Performance/Wait-Times-for-D... [2] https://globalnews.ca/news/4481951/b-c-to-purchase-two-private-mri-clinics-to-reduce-wait-times/ https://globalnews.ca/news/4481951/b-c-to-purchase-two-priva... [3] https://globalnews.ca/news/5256655/wait-times-mri-procedures/ https://globalnews.ca/news/5256655/wait-times-mri-procedures...
        refurb 6y ago
varjag 6y ago
Thing is a good public option decimates the market for advanced private care of the level you have in the US. Here in Norway the private health providers that do exist mostly deal with low-investment, low-asset, high-return cases. They will look into your psoriasis but ain't going to treat your cancer. Fortunately the advanced care in public system is great. Still it's not unheard for patients that can afford it to go to the USA for specific treatments.
- DanBC 6y ago
  > decimates the market for advanced private care of the level you have in the US. > Still it's not unheard for patients that can afford it to go to the USA for specific treatments. They're often getting very expensive, but not very good, treatment that do not lengthen life nor improve quality of life. Sometimes these treatments reduce length of life or quality of life.
  - varjag 6y ago
    No, I'm talking specifically about things like bleeding edge treatments for late cancer stages accessible only in top U.S. hospitals. Treatments that are still in trials or just approved and not available in Norway yet. Sometimes they would work and sometimes they wouldn't, but in Norway your option then is basically arranging your own funerals.
- kritiko 6y ago
  https://www.aleris.no/en/cancer-center/cancer/ https://www.aleris.no/en/cancer-center/cancer/ "Aleris’s Cancer Centre (Aleris Kreftsenter) provides a complete range of diagnostic tests and therapies for most types of cancer. We offer the latest cancer drugs and innovative treatments, such as immunotherapy, before they are available in public hospitals."
simonh 6y ago
In fact a single payer system alongside private insurance works really well to keep the private insurance providers honest. Up against a single payer one of their primary value add for most people isn't even better health care per se but better customer service, faster appointments, clear and helpful advice, etc. This is a good deal for the NHS as well because they still get your tax contributions but the private system takes some of the load off them. In theory I'm mostly a Friedmanite. I think he has good reasons for preferring private enterprise for most thing. In theory private enterprise should be able to provide better health care than a public system as well. The problem is politics, lobbying and market distortions always introduce complications and obstacles. Health care is one of those markets where the resources and incentives on the provider side just overwhelm the ability for private individuals to get a fair deal. I'm very glad we have the NHS over here, yes it has inefficiencies and weaknesses but compared to the horror show in the US I think it's far preferable.

arcticbull 6y ago

Indeed, and I retract my final sentence.

fraggle_sock 6y ago
Ideally though, all private healthcare would be banned. Aside from ideological concerns about not giving the wealthy an unfair advantage, this has pragmatic benefit in ensuring that the public healthcare system is up to standard. That is, if the wealthy and powerful are forced to use it too, it means they have skin in the game and won't just use their power to run it into the ground in pursuit of profit or from lack of concern for others.
- arcticbull 6y ago
  Interestingly, private healthcare isn't banned in Canada but in in reality, there's virtually none of it. The system is designed so that the public sector doesn't subsidize a potential private sector, and without those subsidies, nobody's interested. Personally, I agree with you. Private healthcare should be abolished entirely.
  - chordalkeyboard 6y ago
    > Private healthcare should be abolished entirely. Wouldn't this mean using the police to arrest people if, e.g. a person got a doctor to look at them or suggest a treatment for a condition and it wasn't something that had gone through government channels?
    - lazyasciiart 6y ago
      Perhaps at an extreme point, but most white collar crime is dealt with by fines and licensing rather than arrests and jail. E.g minimum wage laws.
      - chordalkeyboard 6y ago
        But if you refuse to pay the fine on the grounds that you consider it unethical to withhold medical care from someone who requests it, you’d still be subject to incarceration?
        arcticbull 6y ago
        This situation exists today. Let's say I'm a physician, with experience from a foreign country and a years-long unimpeachable track record. What I don't have is a US degree or residency. I'm 100% going to prison if I perform a surgery in my van. Licensing and various other requirements are imposed on physicians in order to practice lawfully. One of those requirements would be not to accept direct payment for services outside the public system. If you do, then you are practicing without a license, and whatever comes of that comes of it. Likely a fine, or license suspension or if you continue to defy the law, prison. Your argument that "you consider it unethical to withhold medical care from someone who requests it" is not a defense today for practicing medicine without a license, and in my scenario, that would not change.
        chordalkeyboard 6y ago
        > This situation exists today. If I'm an physician, with experience from a foreign country and a years-long unimpeachable track record. What I don't have is a US degree or residency. I'm 100% going to prison if I perform a surgery in my van. I agree and this is terrible. > Your argument that "you consider it unethical to withhold medical care from someone who requests it" is not a defense today for practicing medicine without a license, it may not be a legal defense but it is absolutely a moral defense. > in my scenario, that would not change. I just want to make it explicit that you agree with the criminalization of healing people without permission.
  - vidarh 6y ago
    In the UK, about 10 percent has private insurance, but nearly all private plans are 'top up' type plans where the assumption is that you usually rely on the NHS first, but ask for a private referral if you need a specialist or procedure there's a wait for. As a result they're generally pretty cheap. In effect you're paying to jump queues for a limited resource.
    - uzakov 6y ago
      I don't know if you live in the UK but I can share my 2 cents: UK NHS systems isn't exactly what many Americans picture it.
  - fraggle_sock 6y ago
    Thank you for the information - it is interesting to learn of a case where discouragement and disincentivisation, in lieu of abolishment, has turned out to be a reasonable and pragmatic secondary option.
    - arcticbull 6y ago
      Looks like I forgot to link you to the write-up (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC80881/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC80881/) but I suspect you'll find it interesting!
  - refurb 6y ago
    Disagree on private healthcare being abolished. If people want to spend their own money outside the single payer system, why not let them? It doesn't absolve them of contributing to the public system, so the public system benefits when they decide to go outside it. And in Canada, there isn't much private healthcare because of the way Medicare is set up. A doctor has to choose - practice in the public system or the private system - they can't do both. As a result, you have a handful of doctors who do private with the majority in the public system. For certain procedures there is actually a lot of private healthcare in Canada. Take a look at MRI's. Instead of waiting 2 or 3 months for an MRI you can pay $300 and get one this week and send the results to your doctor.
    - arcticbull 6y ago
      It varies from province to province [0]. What you're saying is true in some provinces but not all. However, even in the provinces without material barriers, no private sector exists. The article actually provides some solid theories. Your information about MRI waiting times isn't accurate in general - or rather paints only part of the picture. Even with the COVID situation happening now, in Ontario... Patients who should be scanned immediately receive a scan, immediately. Patients who should be scanned within 2 days are in fact scanned within 2 days. Patients who have a target of 10 days for a scan wait closer to 18 (but 53% are scanned within the SLA). Patients who have a target of 28 days wait closer to 90. [1]. If you don't need one now, you're wasting capacity by getting one now. This capacity should be allocated 100% to the public sector on a need basis. That would reduce wait times for all priorities. This is in fact what the British Columbia government did [2] to excellent effect [3]. [0] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC80881/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC80881/ [1] https://www.hqontario.ca/System-Performance/Wait-Times-for-Diagnostic-Imaging https://www.hqontario.ca/System-Performance/Wait-Times-for-D... [2] https://globalnews.ca/news/4481951/b-c-to-purchase-two-private-mri-clinics-to-reduce-wait-times/ https://globalnews.ca/news/4481951/b-c-to-purchase-two-priva... [3] https://globalnews.ca/news/5256655/wait-times-mri-procedures/ https://globalnews.ca/news/5256655/wait-times-mri-procedures...
      - refurb 6y ago

varjag 6y ago

Thing is a good public option decimates the market for advanced private care of the level you have in the US. Here in Norway the private health providers that do exist mostly deal with low-investment, low-asset, high-return cases. They will look into your psoriasis but ain't going to treat your cancer. Fortunately the advanced care in public system is great. Still it's not unheard for patients that can afford it to go to the USA for specific treatments.

DanBC 6y ago
> decimates the market for advanced private care of the level you have in the US. > Still it's not unheard for patients that can afford it to go to the USA for specific treatments. They're often getting very expensive, but not very good, treatment that do not lengthen life nor improve quality of life. Sometimes these treatments reduce length of life or quality of life.
- varjag 6y ago
  No, I'm talking specifically about things like bleeding edge treatments for late cancer stages accessible only in top U.S. hospitals. Treatments that are still in trials or just approved and not available in Norway yet. Sometimes they would work and sometimes they wouldn't, but in Norway your option then is basically arranging your own funerals.
kritiko 6y ago
https://www.aleris.no/en/cancer-center/cancer/ https://www.aleris.no/en/cancer-center/cancer/ "Aleris’s Cancer Centre (Aleris Kreftsenter) provides a complete range of diagnostic tests and therapies for most types of cancer. We offer the latest cancer drugs and innovative treatments, such as immunotherapy, before they are available in public hospitals."

simonh 6y ago

In fact a single payer system alongside private insurance works really well to keep the private insurance providers honest. Up against a single payer one of their primary value add for most people isn't even better health care per se but better customer service, faster appointments, clear and helpful advice, etc. This is a good deal for the NHS as well because they still get your tax contributions but the private system takes some of the load off them. In theory I'm mostly a Friedmanite. I think he has good reasons for preferring private enterprise for most thing. In theory private enterprise should be able to provide better health care than a public system as well. The problem is politics, lobbying and market distortions always introduce complications and obstacles. Health care is one of those markets where the resources and incentives on the provider side just overwhelm the ability for private individuals to get a fair deal. I'm very glad we have the NHS over here, yes it has inefficiencies and weaknesses but compared to the horror show in the US I think it's far preferable.