We don’t experience that as a problem: mainly because private hospitals find it more profitable to focus on the relatively easy business that the NHS doesn’t cover (cosmetic surgery, for example), or relatively routine elective procedures: that doesn’t require as much capital investment. NHS hospitals can take individual private patients. Private hospitals don’t do accident and emergency, or much in the way of very advanced medicine.
Indeed one of the periodic grumbles about the practice of sub-contracting relatively routine NHS operations to various other providers, in order to produce some sort of innovation and competition, is that it suits some politicians to belabour them for expensive inefficiency by comparison with the private providers, but the NHS has to be staffed and equipped to pick up the pieces when things go wrong in the private sector.
But the history is different: most hospitals in the UK were only too glad to be nationalised in 1946-48, but I imagine that would be virtually impossible in the US today.
Well… it’s not so much that it can’t work, but that due to various cost and price distorting mechanisms, it doesn’t work.
I do agree that to some degree, there would be a price floor that below which, providers would have to be supplying sub-standard care. It does cost money to run an office/clinic, keep it properly disinfected, supplied and staffed, and that cost is essentially overhead for every patient’s visit cost. Same goes for stuff like lab work- it costs some basic amount just to have the infrastructure in place to collect and process samples in a timely fashion, including the delivery vehicles, the reagents, the measuring equipment, lab techs, etc…
But… right now, the problems are that insurance payments and stuff like Medicare/Medicaid distort what the actual prices are, as do requirements that doctors provide medical care regardless of ability to pay. So what you end up with is doctors/hospitals/clinics doing some pretty interesting pricing gyrations to try and charge insurance as much as they can, and people who pay cash even more, in hopes of making up for each other, and they also don’t take certain insurances because it’s not profitable for them, or they limit how they can treat their patients, or whatever. All of those are things that artificially distort the market. There are certainly others, but I suspect that they’re the biggest two.
Yes, it was imposed on him just like every other state and federal government tax, fee, levy, and charge that he already pays (and in the US of A that is a lot of fees, mind you). Or are you telling me he sat down with the government, out in the log cabin that he built with his bare hands, sat with his rifle across his knees, and negotiated how much his drivers license renewal fee would be? Because he’s such an independent guy. He pays his own way, never asks for favors and never gives them. He earns the money that his family needs, except when his daughter got leukemia and he couldn’t quite afford that much care. So she died. But lets not talk about that because no one tells him how to spend his money!
I guess not though. I guess he just went down to the DMV and paid the damn government mandated fee like fucking everyone else does. He probably had a conniption about that too right? Because it’s money that HE EARNED but it’s going to other people beside him and his man*!
*He was gay in my imaginary scenario because gays play justified outrage better that straights.
My core argument in a nutshell, that I’ve argued here and in numerous other threads on this topic, is that there are intrinsic reasons that it can’t work that way for the majority of the population, in respect to medically necessary procedures. The most basic reason is that most aspects of medical care are just simply essential, a matter of moral imperative and quality of life and alleviation of pain and suffering if not actual life and death, and that includes not just obvious emergencies but the basic human right to ongoing regular medical care. And that goal is, and always will be, at odds with the goals of insurance as a business to make money and minimize payouts. The fact that the industry used to refer to any sort of payment for health care as a “medical loss” should tell you all you need to know about the nature of the problem. The enormous inefficiency of such a system is just an added reason for getting rid of it.
Sure, but those are just routine medical costs, incurred and paid for in single-payer and equivalent UHC systems all over the world. It has nothing to do with the enormous waste incurred in private health insurance.
Well, providing medical care regardless of ability to pay is kind of a central goal, but I agree that it’s totally dysfunctional when such a requirement is clumsily and ineffectively bolted on to an already broken system. In single-payer and its equivalents there is a streamlined and efficient process for ensuring that everyone is covered and there is usually some type of uniform community-rated system of premiums, usually combined with tax-funded subsidies and indexed to income.
Any mass purchase of anything distorts what actual prices are, in a certain sense of distort.
Could you link to the requirement that all doctors take patients regardless of the ability to pay? I believe this is true for ERs, but the first thing I did when my wife went to the hospital for an operation was to show my insurance card and pay the co-pay. I suspect that if I said I couldn’t pay we’d have been heading home, since the problem was not life-threatening.
For emergency care, they do have a duty, if not a legal requirement, according to the AMA.
My point was that insurance companies serve to insulate consumers and providers from each other; providers charge and insurance companies pay higher rates than they could if people were paying out of pocket, and there’s little shopping around to be done if you’re locked into an insurance plan.
As an end consumer, you have little visibility into actual pricing, and no ability to negotiate, and as a provider, you generally aren’t collecting your money from your actual patients, so there’s no price-related competition driving your prices down.
Some of that goes on between the insurance companies and the providers, but it’s not nearly so direct as more normal retail type sales.
^^
All of the above is true, but if I may respectfully offer the opinion of an outsider who is accustomed to single-payer in another country, this seems to me to be falling into the understandable trap of trying to adapt the familiar – namely, rationalizing a way for the free market to better handle the inherent moral and legal issues around the necessity of health care, and from my perspective that is never going to solve the real problems. Because as I keep saying, the insurance free market will never be compatible with the moral imperative of essential health care, ever.
The real solution to cost issues is not for the guy about to have a heart attack to shop around for the best deal on cardiac surgery or bring his friend in for a 2-for-1 deal (this week only!) – the real solution that works everywhere else is to have the government or a government-empowered agency negotiate a uniform fee schedule with the providers, in conjunction with a system that guarantees full payment, under a UHC system with uniform community-rated premiums. In such systems people are not only NOT cost-driven – that is, they don’t make medical decisions based on cost – but they never even know the cost, because it never concerns them. And yet it works just fine, costs on average are half of what they are in the US, over-utilization problems are fewer, and outcomes are the same or better.
You’ve made some valid points here and some paranoid ones. However, they are not relevant points to what I asked for (recycling your quote):
Most of what you’ve argued is that a lot of money gets wasted. No doubt that’s true, but it doesn’t address the question of whether actual innovation would decline if the U.S. switched models. I think the closest you’ve come is this:
Not terribly well-supported. More importantly, if we’re talking about switching models, I think you need to address how this affects the innovation you currently believe to be coming out of hospitals and medical schools. Particularly since hospitals are getting a lot of blame for rising healthcare costs. In theory, any real changes to the system would significantly impact the economics of hospitals.
More generally, I have read a lot of the thread, but not all. As someone who has never favored anything like “socialized” medicine, I will say that I find Wolfpup’s arguments in favor of a single-payer system to be the most convincing I’ve seen, pretty much ever. If we do, in fact, want universal health care, I think he’s made a pretty good argument that single-payer is the least destructive. That is to say, no UHC system is going to be a free market, but if we want to have one, this seems to leave the most “vestiges” of a market in place. If there’s a chance to have UHC and still get some/any of the benefits that markets provide, this is probably it. And that’s probably as close as you’ll ever get me to come to “blessing” a UHC model.
He’s largely correct. Healthcare spends billions on lobbyists, as do health insurance companies. They’re all eating from the cash cow, and don’t want the free ride to end.
It would be fairly easy (as these things go) to implement UHC; simply expand Medicare. The infrastructure is in place nationally.
Hospitals and ERs charge the uninsured far more than the insured, because their insurance contracts prevent higher charges. The contracts do not allow hospitals to charge insured patients for each band-aid and IV line. If a patient is not insured, you can bet that they’ll get a charge for every band-aid, IV line, emesis basin, and corn plaster on the nurse’s foot.
It’s actually completely meaningless, however you adjust it. I hold 4 patents (no shit), for 2 different systems. They’re registered with USPTO, and also with EPO. I actually registered the US ones first, purely because it was most likely market someone might try to copy the systems in.
You register a patent to ensure you’re not copied in the market where that patent office operates. It doesn’t have anything to do with where the work was done. The US also has the distinction of having one of the most easy to game systems (see Amazon’s patenting of one-click for an example) with the most easy to litigate courts for possible infringement, hence the whole patent trolling industry that’s popped up there.
An actual example from such a socialist system might make things clearer: I live in the Netherlands where I pay 62 euros a month for my health insurance. My deductible is 875 euros a year. If I were interested in insuring anything extra, such as dental care, I’d be hard pressed to find an insurance which would cost me more than an extra 50 euros a month. At that point I would be insured for absolutely everything our health care system has to offer, up to and including acupuncture. The health care system in the Netherlands is seen as extremely good. So what are we doing that couldn’t be duplicated in the US?