That’s not how it works. Rather, there’s uniformity in coverage, so doctors and nurses know what they can give patients and what they can’t. For example, in the US, a cancer patient may be recommended proton beam therapy instead of chemo depending on the type of cancer, but also on the quality of their insurance. In Canada or Britain, it’s chemo for everyone except for a select few who are particularly likely to benefit. And until like, this year, those people had to leave the country to get the therapy(although NHS paid for it, IF they qualified. Kinda like an insurance company).
Per capita, Japan has more proton radiation therapy sites than the US. Canada has sites. So do France, Germany and England.
I get your argument, but for many of us it is a small price to pay to know that a small number of highly expensive treatments might not be covered (emphasis on might) in exchange for an affordable system that covers everyone considering that in the US people line up for hours to get free health care done ad hoc in barns and fields. In the UK they have the NICE program where you need to show 35,000 pounds per quality adjusted life years for a treatment to be valid. And some end of life cancer treatments will not be covered (100,000 pounds in drugs for 6 months of life would not be). But I think the program will cover the first 35,000 worth of the drugs even if they won’t cover the full price.
I would expect him to be a divorced former President.
Japan has multi-payer. Shortages are primarily an aspect of single payer setups.
The willingess to take less is commendable, but unnecessary. THe preference for single payer over multipayer is 99% ideological, which is why single payer systems have mainly been instituted by ideological parties with admitted socialist leanings. The desire was less to deliver health care to vulnerable populations than to remake society in their desired image. Whereas the German, Swiss, and Japanese systems were simply a desire to get people health care.
Um…why?
Single payer does have a lot of ideological force behind it, and lots of OECD nations have a variety of functioning plans not based on single payer. But it doesn’t really matter if you have a public payer/public provider, or public payer/private provider or private payer/private provider system. Almost all OECD nations with well regulated UHC systems cover everyone for 8-11% of GDP (for whatever reason the asian nations cost less than european systems, usually only 6-8%. I wonder why). However when Taiwan designed their health system in the 90s to make it as efficient as possible they found single payer the best method of funding.
What is the argument that single payer leads to shortages? Are you saying that in a multipayer system like in Germany, Israel or the Netherlands if one provider offers shoddy service people can just switch to a new plan whereas in Canada that isn’t an option? It sounds plausible but I really have no idea how it plays out in real life.
I don’t think his wife likes her role very much. Her comment about being a single mother. And the body language and little jabs at him when they are together.
I used to think it was the competition, which appeals to my conservative instincts, but I have to reluctantly conclude now that it’s government regulation. The government can be vigilant about regulating private companies when it is motivated to do so, and in UHC systems government regulate private insurance very well. YOu just don’t see the kinds of abuses that you see here. However, the government does not regulate itself very well at all, and there are always enough ideological voters attached to the idea of single payer that they’ll forgive its failings in the name of egalitarianism. So single payer systems created bad incentives for the government, while multi payer systems create good incentives.
Imagine if Britain was multi-payer, and NHS was merely one HMO of many. THe public and the media would be throwing the ultimate hissy fit about its evils and demand that the government rein in its abuses. And it would get results. But since NHS isn’t part of a multi-payer system, the criticism of its performance is always tempered with, “Yes, it has its faults, but we’re committed to the model.” But without the threat of the model changing, there’s no incentive to make it better.
I can understand your arguments, but is there a meaningful quality difference between nations with single payer (Canada or Taiwan), or single payer you can opt out of (Germany) or multipayer (Netherlands or France)? The UK has problems but that is probably because it is underfunded, they spend a thousand less per capita than much of Europe. I don’t think that is due to the payer method as much as underfunding.
Point is, I can see the validity of your argument but I don’t know if it plays out that way, or if there are noticeable differences between the nations with UHC depending on whether people can opt out of the funding method. I don’t know if Canada’s system (I don’t think you can opt out of the public system there, not sure) is really much/any worse than Germany or Japan.
A single payer system you can opt out of like Germany or maybe Australia may be ideal from the argument of using competition to drive up quality and drive down prices, but I remember watching a documentary on William Hsiao where he said in designing the Taiwanese system this method didn’t work (I think the healthiest opt out, which creates underfunding methods for the public sector, something like that).
The Taiwanese system was also designed to encourage competition by medical providers to provide higher quality care at a lower cost. So there is that aspect too, we don’t have that much at all in the US.
I’m just going by the incentives. I see how the media covers NHS problems vs. how the media covers private insurance problems. I also see how much better the government regulates others than itself. You lose all accountability when the government is in charge of all medical decisions. there’s no appeal once they’ve decided you aren’t getting treatment.
There’s also the tort factor that ruins incentives. In multi-payer systems, if your doctors or a hospital screws up, you get compensation. Sometimes bigtime compensation. In Britain, I’ve read about the kinds of compensation people get for malpractice or outright neglect. A few thousand bucks and a promise that it will be investigated. That’s the cost of making doctors and nurses into government employees. They become as accountable as government employees.
Not exactly pertinant to the thread at large, but I thought I’d mention this recent survey to suggest that this is no longer the case…
It’s all about personal perception (age is just a number etc..), and I’d suggest Obama is a guy who doesn’t see himself as being old.
Single-payer works in Canada, and I’ve never encountered even a suggestion before that multi-payer would improve that system.
… until he starts looking at photos of Sasha and Malia at the start of his Presidency.
Inertia is powerful. Just as Canada is unlikely to go multi-payer, multi-payer systems do not go single-payer.
You have American UHC now, and it is what it is. This is the model we’ll have for the next 100 years, at least.
Or himself. He did go gray mighty fast!
I personally think you will see a lot of variance at the state level over the next 20 years. Even if the ACA remains the federal law, a lot of states are going to experiment the way Vermont is to find better ways to provide UHC. I wouldn’t be surprised of states like CA, IL, PA or NY end up expanding on Obamacare to make it stronger (public options and medicare buy ins, reimportations, stronger regulations, bulk purchases, comparative effectiveness, QALY rationing, transparent pricing, etc). I don’t know if any will enact single payer like Vermont, but they could change their programs fairly drastically if they think it will save money.
Health care is reaching a point where it actually is a genuine crisis that can’t be ignored or politicized anymore. Budgets are getting wrecked, the economy is slowing and tons of people are miserable because of our failed system. The inertia is going to have to give soon. If the ACA can’t slow the rate of medical inflation, it is going to have to be drastically changed or replaced. Universal coverage is secondary to affordable coverage.
Canada has had some political pressure to allow people to opt out of the public system. I don’t know what happened with that though.
That is to say, what will be his superpower when he joins the X-Presidents?
I don’t know what this has to do with Obama’s post-presidency phase, but…
You do know there’s a private health system on top of the public one, right? And that people can and do buy private health insurance, or get it offered by their employer, right? And yet the British people generally love the NHS, right?
And you also know that the UK has already seen what happens when public monopolies are broken up (see most recently the breakup of British Rail) and sold off to the private sector with exactly the kind of rationales and assurances you give above, and that those rationales and assurances have largely turned out to be horsepuckey, right?
You owe me a new Dr Pepper and a shirt
He would be great!