12 ms·

This is why single-payer is the only way to go. There has to be some panel of disinterested experts evaluating the cost/benefit of a given treatment for a give

This is why single-payer is the only way to go. There has to be some panel of disinterested experts evaluating the cost/benefit of a given treatment for a given illness, backed up by the buying power of something really huge. Yes, that's "death panels" to you Tea Party members following along at home. Of course that wouldn't prevent any doctor and patient from doing whatever they wanted, at their own expense.

vkou 13y ago
That's not even in the problem - if the doctor disagrees with the prescribed treatment plan, they have enough leeway to prescribe some other solution, that they believe to be better. The advantage of single-payer, is that he will not have a profit motive to do so. And monopoly bargaining power on the side of the public.
- mhb 13y ago
  The advantage of single-payer, is that he will not have a profit motive to do so According to the article (Physicians in general aren’t allowed to refer their patients for treatment in facilities that they also own), that's also generally true in the existing system except for some exceptions. In particular the one cited in the article.
kiba 13y ago
The first rule of politics is that unintended consequences abound. That isn't to say that a single-payer is better or worse, but we should be methodical and careful when considering wholesale replacement of the incentive structures.
- gopher1 13y ago
  Well, the great thing about single-payer is you have the rest of the industrialized world to learn from. The pitfalls are not entirely unknown.
waffle_ss 13y ago
Hopefully these won't be the same disinterested experts that granted the contracts to build healthcare.gov.
jasonlotito 13y ago
Except having a single-payer system doesn't mean you'll have a panel of disinterested experts evaluating the cost/benefit of a given treatment. This isn't speculation, either. I've experienced the results of a "panel" going against the consensus of experts. It's the reason we left Quebec to come to the US, as at the time (2011) Quebec's policy for children with Autism was horrific. It hasn't changed.
- patmcc 13y ago
  What was their policy? And why did you leave to the US as opposed to another province?
  - jasonlotito 13y ago
    Basically, they didn't believe that early intervention was a priority. You can search for Autism problems in Quebec, specifically Montreal, and read lots of stories regarding that. As for moving to the US, two reasons. 1) Wait times in other provinces were much longer than we wanted to wait. Even going the private route in Quebec would have mean a year and a half (that was on top of the year we had already been waiting). In the PA, we got more help for my son's Autism in the first 2 weeks than we had the entire time up in Quebec. 2) I'm American, and because of that, my sons are also American. Note, I don't pretend that this means the US health care system as a whole is better, or that Canadian health care is worse. However, my experience with a child with Autism in Quebec is not unusual, and my recommendation to parents with Autistic children in Quebec is to leave.
    - patmcc 13y ago
      Thanks for your reply, that's very informative. I'm Canadian (BC) and like to keep an eye on the health care system as my parents are aging and I'm looking to have kids soon. Glad to hear you found treatment for your son, and best wishes for the future.
Symmetry 13y ago
I don't think single payer, per se, would do anything to help with this. The parts of the US healthcare system that are single payer, Medicaid and Medicare, suffer from this just as much as the rest of our system. Having a government run healthcare system like Great Britain's would solve the problem, but it could do that with or without single payer. In fact, Singapore has had quite a bit of success combining a semi-government run hospital system with private payment for healthcare.
MrZongle2 13y ago
Yes, that's "death panels" to you Tea Party members following along at home. Well, now that you've put it that way, the idea of a government-led panel -- rather than the family -- deciding that Grandma is too old to bother treating sounds so much better.
- steven777400 13y ago
  Very disingenuous. It's a matter of a government-led panel allocating government funds. If the family wants to keep treating Grandma indefinitely, that is absolutely their right ... if they do it on their own dollar. The "death panel" bit is just the question of how long the government would have continued to pay benefits.
  - nsxwolf 13y ago
    We're not always talking about vegetables on life support here. There's a lot more to care of the elderly. My 93 year old grandfather recently got a hip replacement and he's doing great. Would he have received that hip under the ACA? Recall that a woman asked Obama a similar question and he said maybe she should just take a pill.
    - steven777400 13y ago
      Who paid for that hip? If he did, or you did, or any other private party did; then it would work exactly the same! The question here (death panels) is only about what the government would have paid for. Since the government has finite money, it must decide what it will and will not pay for. There is not enough money to pay for everything. Decisions must be made.
      - nsxwolf 13y ago
        We could have a situation where it's possible that you were paying for a plan that would pay for your hip, but the government decides to dissolve that plan and force you to buy a new plan that's not allowed to pay for your hip.
gojomo 13y ago
Medicare is essentially single-payer for old people, yet it's identified in the article as part of the problem. Like other government programs, it's so much better at measuring inputs (amount spent and procedures performed) than outputs, that there's an institutional bias in favor of overspending and overlooking corruption. ("Oh, no, that's not 10% more fraud and inefficiency this year, it's reaching 10% more of the needy.") There's only one other sector of the US economy that's "single-payer": military procurement. And that's not known for its spending efficiency, either. So it's not simply "single-payer" that magically saves money, but the specifics of the incentive system that's set up, and the other precedents from American federal governance are not positive. Thank you for acknowledging that the main mechanism that a federal medical buyer monopsony (aka nationalization/single-payer) could use for cost-control is, essentially, "death panels" who say no to many treatments currently performed. But can the American political system embrace that step, or will it wind up with single-payer without cost-controls? We wind up with the kinds of giant federal programs that can make it through the political system, and get implemented by the bureaucracy... not the kinds of idealized programs existing only in advocates' minds. Finally, in single-payer systems, getting "whatever you want" done "at your own expense" is often effectively prohibited. For example, when the official system has particular limits (like price controls, limited participating providers, or waiting lists) for a covered procedure, it has often been illegal, in US Medicare or Canada's programs [1], to purchase that same procedure out-of-pocket/out-of-system for a negotiated price. Once you've nationalized, there's even a certain logic to such prohibitions: the system is straining under budget caps, and you can't risk the wealthy siphoning off capacity/copayments that could help support the common base. [1] http://www.cato.org/publications/policy-analysis/freedom- http://www.cato.org/publications/policy-analysis/freedom-
- drzaiusapelord 13y ago
  A cato link isn't convincing. Its an extremely biased source. Cato can't stand that the single payer works in the rest of the world.
  - gojomo 13y ago
    Your glib bias-accusation is unimpressive and unresponsive: Cato cites verifiable details about the particular point I was making, that single-payer systems often do "prevent any doctor and patient from doing whatever they wanted, at their own expense". Similar to the claim that under ACA, no one would lose a plan they liked [1], the claim that single-payer will still allow full freedom to work outside the system is a pre-implementation falsehood used to build support. Hell, it's even in the name: "single-payer". You have to crack down on competing payers, or your price leverage slips away, and voters stuck in the single-payer system get angry that they're facing the political cost-benefit rationing that others aren't. None of the other-country "single-payer"-ish systems cover even 1/4th the population size of the US. If single-payer can work so well for cost-control in the US political reality, why doesn't it work for Medicare, and the Defense Department? [1] http://networkedblogs.com/Qy7JI http://networkedblogs.com/Qy7JI
pbreit 13y ago
I don't think single payer is the right answer especially for the USA. The US has a much stronger bent towards freedom, independence and self determination. I think some sort of hybrid, a la France, is more appropriate.
- patmcc 13y ago
  Not being able to quit your corporate job because you desperately need the health insurance is a really interesting kind of freedom, independence and self determination.
  - bdcravens 13y ago
    Calculated risk assessment isn't the same thing as lack of freedom. I have cystic fibrosis, so I've been making those decisions for a long time. (100% freelancer here)
  - pbreit 13y ago
    Not sure how that's relevant to single-payer or not. Obamacare is not single-payer and addresses that issue.

vkou 13y ago

That's not even in the problem - if the doctor disagrees with the prescribed treatment plan, they have enough leeway to prescribe some other solution, that they believe to be better. The advantage of single-payer, is that he will not have a profit motive to do so. And monopoly bargaining power on the side of the public.

mhb 13y ago
The advantage of single-payer, is that he will not have a profit motive to do so According to the article (Physicians in general aren’t allowed to refer their patients for treatment in facilities that they also own), that's also generally true in the existing system except for some exceptions. In particular the one cited in the article.

kiba 13y ago

The first rule of politics is that unintended consequences abound. That isn't to say that a single-payer is better or worse, but we should be methodical and careful when considering wholesale replacement of the incentive structures.

gopher1 13y ago
Well, the great thing about single-payer is you have the rest of the industrialized world to learn from. The pitfalls are not entirely unknown.

waffle_ss 13y ago

Hopefully these won't be the same disinterested experts that granted the contracts to build healthcare.gov.

jasonlotito 13y ago

Except having a single-payer system doesn't mean you'll have a panel of disinterested experts evaluating the cost/benefit of a given treatment. This isn't speculation, either. I've experienced the results of a "panel" going against the consensus of experts. It's the reason we left Quebec to come to the US, as at the time (2011) Quebec's policy for children with Autism was horrific. It hasn't changed.

patmcc 13y ago
What was their policy? And why did you leave to the US as opposed to another province?
- jasonlotito 13y ago
  Basically, they didn't believe that early intervention was a priority. You can search for Autism problems in Quebec, specifically Montreal, and read lots of stories regarding that. As for moving to the US, two reasons. 1) Wait times in other provinces were much longer than we wanted to wait. Even going the private route in Quebec would have mean a year and a half (that was on top of the year we had already been waiting). In the PA, we got more help for my son's Autism in the first 2 weeks than we had the entire time up in Quebec. 2) I'm American, and because of that, my sons are also American. Note, I don't pretend that this means the US health care system as a whole is better, or that Canadian health care is worse. However, my experience with a child with Autism in Quebec is not unusual, and my recommendation to parents with Autistic children in Quebec is to leave.
  - patmcc 13y ago
    Thanks for your reply, that's very informative. I'm Canadian (BC) and like to keep an eye on the health care system as my parents are aging and I'm looking to have kids soon. Glad to hear you found treatment for your son, and best wishes for the future.

Symmetry 13y ago

I don't think single payer, per se, would do anything to help with this. The parts of the US healthcare system that are single payer, Medicaid and Medicare, suffer from this just as much as the rest of our system. Having a government run healthcare system like Great Britain's would solve the problem, but it could do that with or without single payer. In fact, Singapore has had quite a bit of success combining a semi-government run hospital system with private payment for healthcare.

MrZongle2 13y ago

Yes, that's "death panels" to you Tea Party members following along at home. Well, now that you've put it that way, the idea of a government-led panel -- rather than the family -- deciding that Grandma is too old to bother treating sounds so much better.

steven777400 13y ago
Very disingenuous. It's a matter of a government-led panel allocating government funds. If the family wants to keep treating Grandma indefinitely, that is absolutely their right ... if they do it on their own dollar. The "death panel" bit is just the question of how long the government would have continued to pay benefits.
- nsxwolf 13y ago
  We're not always talking about vegetables on life support here. There's a lot more to care of the elderly. My 93 year old grandfather recently got a hip replacement and he's doing great. Would he have received that hip under the ACA? Recall that a woman asked Obama a similar question and he said maybe she should just take a pill.
  - steven777400 13y ago
    Who paid for that hip? If he did, or you did, or any other private party did; then it would work exactly the same! The question here (death panels) is only about what the government would have paid for. Since the government has finite money, it must decide what it will and will not pay for. There is not enough money to pay for everything. Decisions must be made.
    - nsxwolf 13y ago
      We could have a situation where it's possible that you were paying for a plan that would pay for your hip, but the government decides to dissolve that plan and force you to buy a new plan that's not allowed to pay for your hip.

gojomo 13y ago

Medicare is essentially single-payer for old people, yet it's identified in the article as part of the problem. Like other government programs, it's so much better at measuring inputs (amount spent and procedures performed) than outputs, that there's an institutional bias in favor of overspending and overlooking corruption. ("Oh, no, that's not 10% more fraud and inefficiency this year, it's reaching 10% more of the needy.") There's only one other sector of the US economy that's "single-payer": military procurement. And that's not known for its spending efficiency, either. So it's not simply "single-payer" that magically saves money, but the specifics of the incentive system that's set up, and the other precedents from American federal governance are not positive. Thank you for acknowledging that the main mechanism that a federal medical buyer monopsony (aka nationalization/single-payer) could use for cost-control is, essentially, "death panels" who say no to many treatments currently performed. But can the American political system embrace that step, or will it wind up with single-payer without cost-controls? We wind up with the kinds of giant federal programs that can make it through the political system, and get implemented by the bureaucracy... not the kinds of idealized programs existing only in advocates' minds. Finally, in single-payer systems, getting "whatever you want" done "at your own expense" is often effectively prohibited. For example, when the official system has particular limits (like price controls, limited participating providers, or waiting lists) for a covered procedure, it has often been illegal, in US Medicare or Canada's programs [1], to purchase that same procedure out-of-pocket/out-of-system for a negotiated price. Once you've nationalized, there's even a certain logic to such prohibitions: the system is straining under budget caps, and you can't risk the wealthy siphoning off capacity/copayments that could help support the common base. [1] http://www.cato.org/publications/policy-analysis/freedom- http://www.cato.org/publications/policy-analysis/freedom-

drzaiusapelord 13y ago
A cato link isn't convincing. Its an extremely biased source. Cato can't stand that the single payer works in the rest of the world.
- gojomo 13y ago
  Your glib bias-accusation is unimpressive and unresponsive: Cato cites verifiable details about the particular point I was making, that single-payer systems often do "prevent any doctor and patient from doing whatever they wanted, at their own expense". Similar to the claim that under ACA, no one would lose a plan they liked [1], the claim that single-payer will still allow full freedom to work outside the system is a pre-implementation falsehood used to build support. Hell, it's even in the name: "single-payer". You have to crack down on competing payers, or your price leverage slips away, and voters stuck in the single-payer system get angry that they're facing the political cost-benefit rationing that others aren't. None of the other-country "single-payer"-ish systems cover even 1/4th the population size of the US. If single-payer can work so well for cost-control in the US political reality, why doesn't it work for Medicare, and the Defense Department? [1] http://networkedblogs.com/Qy7JI http://networkedblogs.com/Qy7JI

pbreit 13y ago

I don't think single payer is the right answer especially for the USA. The US has a much stronger bent towards freedom, independence and self determination. I think some sort of hybrid, a la France, is more appropriate.

patmcc 13y ago
Not being able to quit your corporate job because you desperately need the health insurance is a really interesting kind of freedom, independence and self determination.
- bdcravens 13y ago
  Calculated risk assessment isn't the same thing as lack of freedom. I have cystic fibrosis, so I've been making those decisions for a long time. (100% freelancer here)
- pbreit 13y ago
  Not sure how that's relevant to single-payer or not. Obamacare is not single-payer and addresses that issue.