Asymmetrical Information

Amen, sister. No society on Earth is able, and will never be able, to provide access to the best technology to all those who perceive that they would benefit from such access. Attempts to do so will prove to be prohibitively expensive, which is why single-payer countries have political bodies which limit the supply of such technology. There ain't any way around scarcity, particularly in how scarcity applies to cutting-edge technology, and there ain't any way to avoid rationing of what happens to be scarce. Is the current regime for providing health care in the U.S. ideal? Far from it, and any changes which could encourage the consumers of health care goods and services to behave more like consumers of other types of goods and services would likely be helpful. To suggest, however, that there is some political, centrally-planned solution to the problem of the fundamental scarcity of leading edge technology is misguided at best, demagoguery at worst.

How 'bout price fixing by medicare?

Oh, single payer could make health care cheaper, I don't doubt. First-- smaller labor costs, as happens in most countries with single payer. Doctors' salaries would decrease, and reimbursements would fall into the Medicare range. Second-- much smaller malpractice costs, as the government would now be losing the money, and a bunch of Dems would change their tune. Third-- rationing of health care to prevent "wasteful" operations on the public dollar. Fourth-- the decreased spending and profits would decrease the rate in medical technology and medication improvements, thus decreasing the rate of growth of spending.

So, yeah, single payer could easily cut costs by worsening the care available, and I think almost certainly would if implemented. Not sure if people want that, though.

Medicare also rations supply; if a 67 year old wishes to have more occupational therapy than the central planners allow, for instance, the 67 year old pays out of pocket, if he or she doesn't have long term care insurance.

If single-payer won't make it cheaper, how come Europe gets the same results from health care we do for half the cost?

Yes, some of that is due to free US research they get, but enough to make up a 2x difference?

Why, no -- they also pay their doctors less, make more liberal use of cheap foreign health care workers, buy their medical equipment and prescriptions at close to marginal cost, ration care, use configurations like open wards that won't go over well here, and do fewer defensive procedures because patients can't recover non-economic damages and the doctors/workers themselves often aren't liable.

Since the primary objection of most Americans to the current system is the rationing of care by HMO's, they are unlikely to find their lot improved under a single-payer system. And there seems to be a very large free-rider effect that would either cause Europe's costs to rise, or R&D to essentially shut down.

O.K., so health care will always be expensive, it is also our most precious commodity; one so precious that expense needs to be put in perspective.
One thing that single payer would accomplish is access to everyone for rudimentary procedures. Not only is this desirable as a society, but the effect would be to curtail extraordinarily expensive emergency room visits after a relatively simple ailment becomes acute because of lack of care. Furthermore, treating rudimentary ailments would have the effect of knowing that the person standing next to you has less probability of having a communicable desease; which is even more desirable than money.

Wrong, Jason. Europe does not get the "same results from health care for half the cost." Only the UK has half the cost, and they get much worse results. The others spend more than half, although less. The US ranks first in patient satisfaction, however. (I need to go dig up those BBC articles.)

There's big cost savings at only a small cost in quality care loss if you just refuse to have your national health service pay for experimental and new treatments. And that's what those countries do-- it's not just savings from not FUNDING research, it's savings from not USING research. Lord knows that US insurance companies are often reluctant to pay for treatments that they think are experimental-- but European governments are certainly worse. And with single-payer, there's no second option.

Yes, you've covered alot of what Europe does that the US does not. I am not convinced, however, that many people would not accept those restrictions (others can augment their care and offset those costs with private funding).
One thing you did not mention, in Great Britain, at least, they have "well pay." Similar to the perk in many companies, in England the government will actually send you a check if your allotable health services are less than your contributions. Keeps the unnecessary visits to a minimum.

But people have access to rudimentary procedures now. No one is denied emergency care in this country.

Precisely Jane, but as I previously alluded to, emergency care is monumentally more expensive than office visits. So much so, that in some hospitals, unpaid and unbillable emergancy care is bringing down the bottom line of hospitals to untenable levels.
Certainly allowing hospitals to triage emergency cases and treat only those necassary could be one of the reforms that would accompany single payer that would make the system work.

"Better, more costly technology"...in every other industry, new technology has tended to *reduce* costs. A 777 costs a lot more than a DC-7, but its overall productivity is a lot higher. If a CAT scanner catches problems earlier, it should reduce the total cost of dealing with them.

There's one other major cost factor in the medical field: the class structure that exists in the labor force. There are *doctors* and there are *nurses*, and there is a huge gap between them in terms of pay, social status, and decision-making authority. In every other industry that I can think of, there is more of a gradation of levels of responsibilities, rather than this binary split.

The difference, David, is that in health care people wish to have the equivalent of a new aircraft model developed annually, with the right to use it.

> I am not convinced, however, that many people would not accept those restrictions (others can augment their care and offset those costs with private funding).

We don't have to imagine how Americans would react to such restrictions, we can look at how they do react to them. Where? In many HMOs.

Why will their reaction be different if the restrictions are imposed by a govt agency?

David, to some degree you are correct about the hierarchy. I suppose you aren't familiar with Physician's Assistants (PAs), or Nurse Practioners, though? The point has some validity, though. The AMA acts as a very powerful union on behalf of doctors, constricting the supply of doctors through medical school. The government would undoubtedly break the power of the union, as it's good at that.

TonyB, you're calling for giving hospitals the right to refuse emergency care to those that seem not to need it. In general, both of you are calling for rationing care. People don't like rationed care; they don't like being refused when they want to go to the doctor or the emergency room. If and when insurance companies try it, there's a huge outcry against it. (And usually legislation forcing them not to, which of course increases cost, though it is was people seem to want.)

Over the long run, medical technology advances are cheaper. Over the short run, they aren't. Plus, even though the technology advances make getting to a certain age, or over a certain disease cheaper, people don't stop with that, of course. They want to stay well forever, be protected from the new disease. Hard to blame them. If people still died of smallpox, polio, and the measles, there would be less cancer. Some cancer treatments give you additional days or years of life that wouldn't be possible at all without them-- but they're more expensive than the nothing that existed before.

Only the UK has half the cost, and they get much worse results.

What's the UK's lifespan? France, Germany? Yes, the US suffers a bit here from immigration, but not that much.

Since the primary objection of most Americans to the current system is the rationing of care by HMO's, they are unlikely to find their lot improved under a single-payer system.

Maybe the primary complaint of people who have health care; the complaints of the people who can't afford insurance are a bit different.

Currently, health care is rationed by income, and the current system apparently has significant inefficiencies that aren't present in the single-payer systems.

Lets not forget that medicare, medicaid,full coverage attached to group health options increases demand. What have we done to increase supply? Restrict immigrant MD's, restrict medical schools, limit non MD services, demand that MD's prescribe medicine, fail to create and use automated histories etc. etc.

You're assuming that financing preventive health care causes the poor to stop using emergency rooms. While that seems logical, apparently it doesn't work out that way; pilot programs aimed at switching the uninsured from emergency care to preventive medicine have failed miserably.

Yes, Jason, people who don't have insurance do have different priorities for laws. (Most of them; there's always a handful of young ones who don't believe that they'll ever get sick.) For them, laws that mandate certain features in coverage (must cover birth control, must cover at least X days after pregnancy) are bad, since they increase the cost of the cheapest coverage. I'm not sure that everyone understands this, since the same people who push to cover more of the uninsured or have single payer also push to increase the mandates on insurance.

It's also unfortunate that Congress several times passed amendments to allow individuals to deduct health payments just like corporations do for group policies, yet that every time such an amendment was passed, it was on a bill that Clinton vetoed. I'd like to see it get done now.

The deduction is significant since, after all, Medicaid does exist. (So the people who wouldn't benefit from a deduction generally have Medicaid.) Furthermore, no hospital in the country can refuse emergency treatment to anyone. Of course, from that it does seem obvious to try to replace some of those emergency visits with more efficient preventative medicine.

The problem is, as Megan aludes to, it doesn't seem to work. Some people just don't like doing the day to day things to take care of their body; they wait until something goes severely wrong. Then again, plenty of people do that with their diet, being malnourished or fat despite the easy and cheap availability of healthy foods.

Could I perhaps suggest that there might be some slight effect from the greater use of preventitive medicine in some European countries? A visit to a doctor for a check-up today can often help avoid a costly inpatient treatment tomorrow, and since poor Americans will tend to have free access to the second but not the first, I would guess that there is a substantial source of inefficiency here.

By the way, I would just point out that the UK does still manage to carry out some small amounts of medical research, although obviously 45 years of socialised medicine mean that our researchers have to do it by candlelight and use beer bottles for microscopes.

I thought beer bottles were for binoculars. Shows you what I know.

No one is saying that the UK is doing no research, but you've moved your pharma and most of your medical equipment industry over here, and your research docs are following; every year there's a net drain of research scientists from pretty much every country in Europe.

Probably if there were single payer, there would be some greater use of preventative medicine. But the assumption up until now has been that folks who are using the emergency room are doing so because they don't have alternatives, which at least in the programs I heard about, turns out not to be the case. If we take the evidence of those programs, the trivial amount saved by decreased emergency care would be vastly outweighed by the enormous costs of single payer.

It is instructive, I think, that all the single payer systems put them in place when medicine could really do very little for patients. I just don't think you would find Americans supporting the kind of care they'd receive under a single payer system, and I think a whole lot of doctors would quit if they had to amortize their lifestyle at the pay rates of British doctors.

The more medical care that is available and the cheaper it is for the individual, the more "sick" people there will be. And the more people go to the doctor, the sicker they will get. Don't believe it? Look at the statistics for the death rate decreases during doctors' strikes. The medical con game is the biggest murderer in our society. Medical care should be extremely expensive to the individual, hard to find and hedged about with every restriction possible. That's the only way to true health.

If we take the evidence of those programs, the trivial amount saved by decreased emergency care would be vastly outweighed by the enormous costs of single payer.

Something I never see factored into single-payer cost/benefit estimations is increased earnings from those who can then afford medical coverage. I'd imagine the statistical effect on lifetime earnings of "no medical care until retirement" is pretty damn significant.

Mmmm. . . that's just not the reality of health care in this country. There are undoubtedly people being undertreated because they can't afford it, but my research doesn't indicate it's widespread. There are confounding issues, like unwillingness to seek care, that make it hard to judge those kinds of numbers.

Defensive medicine results, in large measure, from uncertainty about the standard of care.

While we are not sure a single payor system is best, it does have the advantage of establishing a bright line standard of care.

Tests or procedures not covered by the plan are not required by the standard of care.

The degree of savings from that aspect of a single payor system depends, of course, on one's view of how much defensive medicine is actually practiced and the amount that is actually a result of fear of liability.

in some instances, such as canada, single payer is exactly that: no one, by LAW may pay for any covered procedure (outside of worker's comp)... and experimental procedures cannot be paid for as they're not approved... canadians who want better care go: to the US!...

also, remember what service you get from government agencies: health care will come to br more lik the dmv/irs... very fun!

> Something I never see factored into single-payer cost/benefit estimations is increased earnings from those who can then afford medical coverage. I'd imagine the statistical effect on lifetime earnings of "no medical care until retirement" is pretty damn significant.

Probably, at least in many cases, but it may well be the case that an individual would get a positive return by paying this expense but society wouldn't. (Society doesn't receive the full benefit of individual earnings.)

There was a recent study published in Britain that concluded that Kaiser HMO in the US provided better care at about the same cost as Britain's NHS. An amusing comparison given that the supporters of single-payer like to demonize HMO's.

There was a recent study published in Britain that concluded that Kaiser HMO in the US provided better care at about the same cost as Britain's NHS.

I'd imagine so, seeing how they can pick-and-choose their customers, unlike the NHS.

An HMO can pick-and-choose its customers? Wow. Mine can't. Must be a California thing.

They certainly do when the HMO customer isn't through an employer. For example, an acquitance of mine in MO has a son with diabetes, and he's able to get coverage in spite of not having a traditional full-time job. However, he says that *no* HMO will cover - they simply refuse to do it because of the diabetes.

Excuse me, I'm being slightly inaccurate, here's a quote:

I can't get group rates. In fact, I can't even get private insurance as an individual for my eldest son, who is diabetic. Every private insurer in the state of Missouri simply will not even offer him insurance.

Tragic, but unless you can get under a large-corporation umbrella, that's just how life is. The reality is, HMOs keep the average cost down by burdening the few expensive patients over an entire group who get charged a rate that's keyed to yearly expenditures. If everyone's kid had diabetes, the benefit of having an HMO for a parent with a diabetic kid would be effectively negated. This may be an argument for nationalized healthcare, but I shudder to think of revisiting that whole mess.

For me, this is a factor in making a decision about where I'm going to work. Others might have different priorities.

How much does it cost to have an emergancy room visit. Why should we have to pay

How much does it cost to have an emergancy room visit. Why should we have to pay

How much does it cost to have an emergancy room visit. Why should we have to pay

How much does it cost to have an emergancy room visit. Why should we have to pay

How much does it cost to have an emergancy room visit. Why should we have to pay

How much does it cost to have an emergancy room visit. Why should we have to pay

How much does it cost to have an emergancy room visit. Why should we have to pay

How much does it cost to have an emergancy room visit. Why should we have to pay

How much does it cost to have an emergancy room visit. Why should we have to pay

How much does it cost to have an emergancy room visit. Why should we have to pay

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