# Socialized Medicine and Single Payer Systems **URL:** \ **Category:** Great Debates\ **Created:** [August 6, 2012, 6:58pm UTC](https://boards.straightdope.com/t/socialized-medicine-and-single-payer-systems/630644 "2012-08-06T18:58:33Z")\ **Posts on this page:** 20\ **Page:** 3
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [August 7, 2012, 7:21pm UTC](https://boards.straightdope.com/t/socialized-medicine-and-single-payer-systems/630644/41 "2012-08-07T19:21:00Z")
> [@fumster](#): > > If only we had a system in place where people could choose representatives that could make decisions on things like healthcare and could replace them if they were unhappy. I know that is just crazy talk though. > > Luckily, in the private sector we are able to buy enough stock in a company so that we can get a voice. I figure if 100,000 of us on this board each put up $500 we can get a 1% share of CIGNA By now you should know that governments are not actually accountable. The problems with the NHS are well known, and no one ever gets punished for it because no one is ever responsible for it. You should be thankful for villainous insurance companies. It gives you someone to blame. Once the government takes over, you won’t know where the villains are. Or, as many do, you could just decide everything is peachy because it just has to be. ---
**Author:** ![Nava](https://avatars.discourse-cdn.com/v4/letter/n/da6949/32.png) [@Nava](https://boards.straightdope.com/u/Nava)\ **Post date:** [August 7, 2012, 8:29pm UTC](https://boards.straightdope.com/t/socialized-medicine-and-single-payer-systems/630644/42 "2012-08-07T20:29:33Z")
In answer to 1), I’ve never been in a country that had a single-payer system which forbade private systems. Are there any? ---
**Author:** ![foolsguinea](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/foolsguinea/32/14751_2.png) [@foolsguinea](https://boards.straightdope.com/u/foolsguinea)\ **Post date:** [August 7, 2012, 8:31pm UTC](https://boards.straightdope.com/t/socialized-medicine-and-single-payer-systems/630644/43 "2012-08-07T20:31:56Z")
I’ve been Medicaid, and it’s not that great. There are a few things it covers and a lot of things it doesn’t. Medicare is better. But I think if we consolidated them and expanded eligibility,\* eventually\* we could have a good system. ---
**Author:** ![fumster](https://avatars.discourse-cdn.com/v4/letter/f/e9c0ed/32.png) [@fumster](https://boards.straightdope.com/u/fumster)\ **Post date:** [August 7, 2012, 9:18pm UTC](https://boards.straightdope.com/t/socialized-medicine-and-single-payer-systems/630644/44 "2012-08-07T21:18:52Z")
> [@adaher](#): > > You should be thankful for villainous insurance companies. It gives you someone to blame. Once the government takes over, you won’t know where the villains are. Or, as many do, you could just decide everything is peachy because it just has to be. I’m waiting any day now for the revolution that replaces elected govt with corporate rule. That will be so much better. ---
**Author:** ![RickJay](https://avatars.discourse-cdn.com/v4/letter/r/bb73d2/32.png) [@RickJay](https://boards.straightdope.com/u/RickJay)\ **Post date:** [August 7, 2012, 9:19pm UTC](https://boards.straightdope.com/t/socialized-medicine-and-single-payer-systems/630644/45 "2012-08-07T21:19:21Z")
> [@Nava](#): > > In answer to 1), I’ve never been in a country that had a single-payer system which forbade private systems. Are there any? Canada. ---
**Author:** ![fumster](https://avatars.discourse-cdn.com/v4/letter/f/e9c0ed/32.png) [@fumster](https://boards.straightdope.com/u/fumster)\ **Post date:** [August 7, 2012, 9:32pm UTC](https://boards.straightdope.com/t/socialized-medicine-and-single-payer-systems/630644/46 "2012-08-07T21:32:08Z")
> [@adaher](#): > > Better results in areas that are influenced by things other than health care. bring up a statistic that is wholly due to health care, such as cancer survival rates, and the UHC systems suffer badly in comparison. And yet we are worse on survival rates after liver and kidney transplant. But cherry picking data is not the best way of comparing outcomes, is it? ---
**Author:** ![leahcim](https://avatars.discourse-cdn.com/v4/letter/l/b4bc9f/32.png) [@leahcim](https://boards.straightdope.com/u/leahcim)\ **Post date:** [August 7, 2012, 9:36pm UTC](https://boards.straightdope.com/t/socialized-medicine-and-single-payer-systems/630644/47 "2012-08-07T21:36:31Z")
> [@RickJay](#): > > Canada. Technically Canada does not prohibit private health care, at least not under the Canada health act. Some provinces do, however, prohibit private health insurance from covering things covered by the provincial plan, or having private insurance pay more for a given procedure than the provincial plan does, or to have physicians work with both the public and private system simultaneously. Stuff that makes it difficult to operate 90% within the public system but make extra money by doing some things privately, but nothing that would prohibit an American-style private system from springing up if the public system was failing hard. ---
**Author:** ![clairobscur](https://avatars.discourse-cdn.com/v4/letter/c/839c29/32.png) [@clairobscur](https://boards.straightdope.com/u/clairobscur)\ **Post date:** [August 7, 2012, 9:56pm UTC](https://boards.straightdope.com/t/socialized-medicine-and-single-payer-systems/630644/48 "2012-08-07T21:56:04Z")
> [@adaher](#): > > There’s also an information disparity. US insurance is perceived as awful because since no one knows what is covered and what is not, doctors and drug companies advertise freely.Whereas if a drug is denied to a whole country due to cost concerns, then the public of that country probably will never even find out about it " I don’t know how common it is, but in my country, adds for drugs are banned except in medical journals. So, the public never finds out about _any_ drug. Anecdotically, two consequences of this : -If a drug is advertized on TV, you can tell it’s quack medecine (typically homeopathy), not a real drug. -If there are suddenly adds about a medical condition that aren’t government-sponsored, you can tell there’s a new drug, significantly better than existing ones for this condition (that’s what happened for instance with Viagra and more recently for some eye issue). The pharmaceutical company wants you to tell your doctor about your condition. ---
**Author:** ![Voyager](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/voyager/32/133_2.png) [@Voyager](https://boards.straightdope.com/u/Voyager)\ **Post date:** [August 7, 2012, 10:09pm UTC](https://boards.straightdope.com/t/socialized-medicine-and-single-payer-systems/630644/49 "2012-08-07T22:09:51Z")
> [@clairobscur](#): > > I don’t know how common it is, but in my country, adds for drugs are banned except in medical journals. So, the public never finds out about _any_ drug. You mean that in your country I wouldn’t find out about the perils of toenail fungus and restless knee syndrome? :eek: ---
**Author:** ![Voyager](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/voyager/32/133_2.png) [@Voyager](https://boards.straightdope.com/u/Voyager)\ **Post date:** [August 7, 2012, 10:11pm UTC](https://boards.straightdope.com/t/socialized-medicine-and-single-payer-systems/630644/50 "2012-08-07T22:11:57Z")
> [@adaher](#): > > You should be thankful for villainous insurance companies. It gives you someone to blame. Once the government takes over, you won’t know where the villains are. Or, as many do, you could just decide everything is peachy because it just has to be. Insurance companies operate for the benefit of their owners, not their customers. If they can exclude someone who will lose them money, they will. If you object to that, you must be some kind of a socialist. ---
**Author:** ![DrCube](https://avatars.discourse-cdn.com/v4/letter/d/a3d4f5/32.png) [@DrCube](https://boards.straightdope.com/u/DrCube)\ **Post date:** [August 7, 2012, 10:26pm UTC](https://boards.straightdope.com/t/socialized-medicine-and-single-payer-systems/630644/51 "2012-08-07T22:26:01Z")
> [@adaher](#): > > Pricing isn’t rationing. [Here](http://www.outsidethebeltway.com/elementary_economics_the_price_as_a_rationing_mechanism/) [are](http://wps.prenhall.com/bp_casefair_econf_7e/30/7932/2030637.cw/index.html) [three](http://glossary.econguru.com/economic-term/price+rationing) sites which beg to differ, and so does my economics professor. Price is absolutely rationing. And it is the best way to ration scarce goods and services. (Which is every good and service, by the way.) Unfortunately, price signals have been eliminated from health care since long before any of us were alive. It’s either for-profit insurance companies turning down every person and procedure they can, or the government trying with at least some sort of oversight to make sure poor people don’t die in the streets or go bankrupt from medical bills. Now, the government can (and has and probably will) fuck this up, but it is still better than the alternative. I was originally a UHC skeptic, but now I see it falls squarely into the same category as courts, police, and other services that only work well when everyone is covered. I’m not a fan of government, but if you want to provide services to _everybody_, currently I don’t think there are a whole lot of other options. ---
**Author:** ![RickJay](https://avatars.discourse-cdn.com/v4/letter/r/bb73d2/32.png) [@RickJay](https://boards.straightdope.com/u/RickJay)\ **Post date:** [August 8, 2012, 3:06am UTC](https://boards.straightdope.com/t/socialized-medicine-and-single-payer-systems/630644/52 "2012-08-08T03:06:45Z")
> [@DrCube](#): > > [Here](http://www.outsidethebeltway.com/elementary_economics_the_price_as_a_rationing_mechanism/) [are](http://wps.prenhall.com/bp_casefair_econf_7e/30/7932/2030637.cw/index.html) [three](http://glossary.econguru.com/economic-term/price+rationing) sites which beg to differ, and so does my economics professor. > > Price is absolutely rationing. You will please note that all your cites use the clunky term “price rationing” While I agree pricing is, logically a form of rationing, one has to be fair here and note that in economics, the word “rationing” is a term of art that specifically means an artificial restriction of demand below the market-clearing price. So what adaher said is technically true, in the strict sense of that particular definition of the term. ---
**Author:** ![PrettyVacant](https://avatars.discourse-cdn.com/v4/letter/p/49beb7/32.png) [@PrettyVacant](https://boards.straightdope.com/u/PrettyVacant)\ **Post date:** [August 8, 2012, 7:14am UTC](https://boards.straightdope.com/t/socialized-medicine-and-single-payer-systems/630644/53 "2012-08-08T07:14:19Z")
> [@adaher](#): > > [BBC NEWS | Health | Q&A: The Herceptin judgement](http://news.bbc.co.uk/2/hi/health/4684852.stm) You’re citing an article from 6 years ago. That aside, the context here is, one the one hand, the NHS’s refusal to play the pharma game and to require value for money. NICE also requires more evidence than is commonplace in the USA. On the other, the pharma company has a desire to recoup as much of its research costs as it can as quickly as it can e.g. from the early payers. Fwiw, what we now know about the drug you cited from 2006: > [@](#): > > Repeated, large-scale studies show that it is usually necessary to treat between 25 and 100 patients to prevent a single death during the next two to four years.[22] [23] For each life saved, between ten and 25 patients will develop heart disease; despite effective treatments, some of these patients will die from heart disease. Which, of course, means the drug companies sell even more of their products - and the game continues: > **[Trastuzumab](https://en.wikipedia.org/wiki/Trastuzumab)** > > Trastuzumab, sold under the brand name Herceptin among others, is a monoclonal antibody used to treat breast cancer and stomach cancer. It is specifically used for cancer that is HER2 receptor positive. It may be used by itself or together with other chemotherapy medication. Trastuzumab is given by slow injection into a vein and injection just under the skin. > Common side effects include fever, infection, cough, headache, trouble sleeping, and rash. Other severe side effects include heart fail... ---
**Author:** ![Filbert](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/filbert/32/3433_2.png) [@Filbert](https://boards.straightdope.com/u/Filbert)\ **Post date:** [August 8, 2012, 10:32am UTC](https://boards.straightdope.com/t/socialized-medicine-and-single-payer-systems/630644/54 "2012-08-08T10:32:23Z")
> [@drewtwo99](#): > > Specifically, he says that it is documented that Britons who have dementia, Alzheimer’s and similar elderly problems have to be taken care of mainly by family. That’s a little misleading- yes, early care is normally at home until behaviour becomes difficult, but there’s a fairly wide range of benefits and respite care available, and subsidised admission to a care home is based on medical need. Charges for residential care are dependent on individual ability to pay, and the guidelines should prevent a surviving partner from being left with a bill that would leave them in financial difficulty- if a partner is still living in the house it’s disregarded as an asset, for example, and only half of a couple’s savings can even be considered. Personally, I’ve never heard of anyone who wanted to get someone into residential care for age-related conditions, but couldn’t manage it for financial reasons. I’ve heard complaints about the standard of elder care in some places, but not the availability. ---
**Author:** ![Quartz](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/quartz/32/267_2.png) [@Quartz](https://boards.straightdope.com/u/Quartz)\ **Post date:** [August 8, 2012, 11:35am UTC](https://boards.straightdope.com/t/socialized-medicine-and-single-payer-systems/630644/55 "2012-08-08T11:35:14Z")
Let me give a personal example of health-care rationing under the NHS. About 15 years ago - so before Labour’s reforms - I was in discomfort and found that all 4 of my wisdom teeth were impacting. So I was referred to a surgeon. I was told that I would have to wait 6 months. I was not in agony; I did not require immediate care. There were others with more urgent needs. Fortunately I was able to pay to have it done privately, so didn’t have to wait. OTOH a colleague who needed immediate attention got it that day. ---
**Author:** ![PrettyVacant](https://avatars.discourse-cdn.com/v4/letter/p/49beb7/32.png) [@PrettyVacant](https://boards.straightdope.com/u/PrettyVacant)\ **Post date:** [August 8, 2012, 11:43am UTC](https://boards.straightdope.com/t/socialized-medicine-and-single-payer-systems/630644/56 "2012-08-08T11:43:03Z")
Sorry, 15 years ago … you saw a private dentist? ---
**Author:** ![fumster](https://avatars.discourse-cdn.com/v4/letter/f/e9c0ed/32.png) [@fumster](https://boards.straightdope.com/u/fumster)\ **Post date:** [August 8, 2012, 3:06pm UTC](https://boards.straightdope.com/t/socialized-medicine-and-single-payer-systems/630644/57 "2012-08-08T15:06:27Z")
> [@Quartz](#): > > Let me give a personal example of health-care rationing under the NHS. > > About 15 years ago - so before Labour’s reforms - I was in discomfort and found that all 4 of my wisdom teeth were impacting. So I was referred to a surgeon. I was told that I would have to wait 6 months. I was not in agony; I did not require immediate care. There were others with more urgent needs. Fortunately I was able to pay to have it done privately, so didn’t have to wait. OTOH a colleague who needed immediate attention got it that day. Let’s turn this in to a Fox commentary: “For 15 years, Great Britain’s National Health Service has done nothing about Quartz’s severely impacted teeth. Instead they chose to treat others (cue pictures of non-white people) who had not purchased health insurance of their own.” ---
**Author:** ![Budget\_Player\_Cadet](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/budget_player_cadet/32/205_2.png) [@Budget\_Player\_Cadet](https://boards.straightdope.com/u/Budget_Player_Cadet)\ **Post date:** [August 8, 2012, 5:58pm UTC](https://boards.straightdope.com/t/socialized-medicine-and-single-payer-systems/630644/58 "2012-08-08T17:58:57Z")
> [@Quartz](#): > > Let me give a personal example of health-care rationing under the NHS. > > About 15 years ago - so before Labour’s reforms - I was in discomfort and found that all 4 of my wisdom teeth were impacting. So I was referred to a surgeon. I was told that I would have to wait 6 months. I was not in agony; I did not require immediate care. There were others with more urgent needs. Fortunately I was able to pay to have it done privately, so didn’t have to wait. OTOH a colleague who needed immediate attention got it that day. Yep. And if you were poor, you would have had the choice between 6 months (potentially less time if your situation worsened) or _never_. ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [August 9, 2012, 10:51am UTC](https://boards.straightdope.com/t/socialized-medicine-and-single-payer-systems/630644/59 "2012-08-09T10:51:52Z")
> [@DrCube](#): > > [Here](http://www.outsidethebeltway.com/elementary_economics_the_price_as_a_rationing_mechanism/) [are](http://wps.prenhall.com/bp_casefair_econf_7e/30/7932/2030637.cw/index.html) [three](http://glossary.econguru.com/economic-term/price+rationing) sites which beg to differ, and so does my economics professor. > > Price is absolutely rationing. And it is the best way to ration scarce goods and services. (Which is every good and service, by the way.) Unfortunately, price signals have been eliminated from health care since long before any of us were alive. It’s either for-profit insurance companies turning down every person and procedure they can, or the government trying with at least some sort of oversight to make sure poor people don’t die in the streets or go bankrupt from medical bills. > > Now, the government can (and has and probably will) fuck this up, but it is still better than the alternative. I was originally a UHC skeptic, but now I see it falls squarely into the same category as courts, police, and other services that only work well when everyone is covered. I’m not a fan of government, but if you want to provide services to _everybody_, currently I don’t think there are a whole lot of other options. Your appeal to authority fails to refute common sense. If pricing is rationing, then the word ‘rationing’ has no meaning. Everything is already rationed. Rationing, as the term is generally used, means centralized control of supply and limits on how much any one person can buy, even if they have the money to buy more. Wikipedia defines it as “the controlled distribution of resources”. Prices are not controlled, varying prices are what happens when a market is allowed to function normally. ---
**Author:** ![Budget\_Player\_Cadet](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/budget_player_cadet/32/205_2.png) [@Budget\_Player\_Cadet](https://boards.straightdope.com/u/Budget_Player_Cadet)\ **Post date:** [August 9, 2012, 11:26am UTC](https://boards.straightdope.com/t/socialized-medicine-and-single-payer-systems/630644/60 "2012-08-09T11:26:53Z")
> [@adaher](#): > > Your appeal to authority fails to refute common sense. If pricing is rationing, then the word ‘rationing’ has no meaning. Everything is already rationed. Rationing, as the term is generally used, means centralized control of supply and limits on how much any one person can buy, even if they have the money to buy more. > > Wikipedia defines it as “the controlled distribution of resources”. Prices are not controlled, varying prices are what happens when a market is allowed to function normally. Yes, but here’s the thing: that “common sense” is just splitting hairs. Yes, I suppose health care isn’t really “rationed” in that sense in the USA’s system. It doesn’t mean that everyone has access to it or can buy it. That’s because, when you stop splitting hairs, everything _is_ rationed. But you are correct in assuming that that makes no sense in the context of the OP’s argument on rationing. That said, there’s not true rationing _there_ either, as the market is still able to supply private health care in essentially every circumstance – all the public health care does is offer a basis for those in need. [Previous page](https://boards.straightdope.com/t/socialized-medicine-and-single-payer-systems/630644.md?page=2) [Next page](https://boards.straightdope.com/t/socialized-medicine-and-single-payer-systems/630644.md?page=4)