single-payer system ... singled out

[Rolfe]

It's the doctors who prescribe the drugs, and they have departments full of people dedicated to making sure they get paid for that drug. (And if they don't, then most practices just eat the loss.)

Think about it--the practice has to fight to get paid for it, and probably won't recover all of the cost.

[....] There's [....] the write off...

.... there are teams of people working [....], writing off huge amounts, absorbing costs....

My practice just decided to write off several dozen million dollars of costs because we don't want to pass them on to the patients.

I felt guilty about not having addressed this before the weekend.

Tragic Monkey seemed resentful that he was being branded mercenary and uncaring. I don't really know where he got that idea from, because nobody thinks that. However, what he repeatedly says about practices writing off costs rather than pass them on to the patients really needs to be acknowledged.

They shouldn't have to do that! They should not be commercially disadvantaged because of their care for their patients' straitened circumstances.

This is in fact one of the extra advantages of universal healthcare we haven't really touched on. The providers get paid for what they do, because the money isn't coming either from the patients directly, or from an insurance company with an incentive not to pay out. Medical practices are not put in the position of feeling obliged to act as unfunded charity help for their patients.

Good on Tragic Monkey's employer. And on the (I'm sure) many other US medical practices that are prepared to swallow some costs out of sympathy for the patient. As a vet, I've been in the same position myself - sometimes you know that client doesn't have the money, and your professional ethics don't allow you to send the animal away untreated. I'm very pleased, however, that my human-medical colleages in this country do not ever find themselves in that position.

Rolfe.

 

[Oliver]

To be fair, at least from my point of view, none of the arguments presented so far are intended to be an argument against the UNS systems most of these silly people have grown up with their entire lives (and who really know of nothing else), but only to be an argument against the US government running such a system (especially when we know just how badly the US government can screw up anything it touches [see Amtrak and Medicare and Medicare and AIG and Chrysler and GM and ...])

... the Military, and USPS, and Fire Departments, and 9-1-1, and Road Building&Maintenance, and Police Departments, and ...

 

[ARubberChickenWithAPulley]

... the Military, and USPS, and Fire Departments, and 9-1-1, and Road Building&Maintenance, and Police Departments, and ...

If we're being accurate, of the ones you listed, the only ones the U.S. government actually runs are the Military and USPS, and some policing functions (FBI, ATF, etc.). Even then, with the military, it runs most but not all of it (e.g. National Guard).

 

[Architect]

But they are still public sector. Or is it only the Federal Government that can't run the proverbial in a brewery?

 

[Architect]

Now I'll come back to your linked scandals in a bit, but a quick question first. In framing a response I'm looking into similar scandals in the US, i.e. not disputing that serious problems occur but investigating the extent to which they occur in other systems.

Do you agree that this is a fair path to tread?

Well, Ziggy?

 

[Oliver]

If we're being accurate, of the ones you listed, the only ones the U.S. government actually runs are the Military and USPS, and some policing functions (FBI, ATF, etc.). Even then, with the military, it runs most but not all of it (e.g. National Guard).

Well, the Government doesn't own/run AIG and Chrysler and GM, either. Nor would they run the whole health system in the US in case of UHC.

 

[Architect]

And, of course, AIG/Chrysler/GM all managed to go tits-up whilst in the private sector.

 

[Oliver]

And, of course, AIG/Chrysler/GM all managed to go tits-up whilst in the private sector.

But, but, but ... the Government did nothing to prevent them from getting in trouble.

 

[ARubberChickenWithAPulley]

And, of course, AIG/Chrysler/GM all managed to go tits-up whilst in the private sector.

Exactly. That's the whole point (and why I favor a multi-tiered UHS rather than single-payer): if a private company does a horrible job, I can decide to do business with someone else. I can (and did) decide not to purchase from Chrysler or GM. As did millions of others. And the companies went under as a result.

If the government does a horrible job, well... we can try to force reform through the electoral process. But ultimately, I can't just take my business elsewhere.

Of course, I am fully in favor of UHC, just not a single-payer one, so your comment probably wasn't aimed at me to begin with. But people who are skeptical of any UHC system typically level their skepticism most strongly at the Federal government controlling things, which is why I pointed out that most of the services Oliver listed aren't Federally controlled.

 

[Architect]

Exactly. That's the whole point (and why I favor a multi-tiered UHS rather than single-payer): if a private company does a horrible job, I can decide to do business with someone else.

Well, we can judicially review 'em or vote for a party which undertakes to run it better. But hell, I've no objection to a mixed system if you can get it to work....

so your comment probably wasn't aimed at me to begin with.

Correct; it was a response to Balrog's hit and run post.

 

[Rolfe]

Would "single-payer" necessarily equate to single provider? I could imagine a situation where the government was responsible for paying for citizens' healthcare, but where a number of competing providers were involved in delivering it.

Rolfe.

 

[Darat]

Would "single-payer" necessarily equate to single provider? I could imagine a situation where the government was responsible for paying for citizens' healthcare, but where a number of competing providers were involved in delivering it.

Rolfe.

Don't forget that effectively happens over here, with the contracting out of services, medical and support. My most recent MRI-scan was actually done by a private clinic but paid for by the NHS.

 

[Rolfe]

Yes, but I'm not sure we actually have as much choice of which provider to use as the original poster seemed to want. We can choose which NHS facility we want to treat us, but we can't choose to use a private facility paid for by the NHS in preferance to an NHS facility (although the NHS may choose to treat us in that way).

I don't see why that choice couldn't be factored into a "single-payer" system if that was the political will, however.

Rolfe.

 

[Distracted1]

Is it just me, or is there a big contradiction on the side of the Politicians who argue that there should be no "public option" in Obamas health plan. These people are also critics of government inefficiency and incompitence- the private sector, so they say, can always do a better job. So what are they worried about?

-If the private sector does a better job of things, then it can hardly be afraid of competition from the Government, which always makes a mess of things. So why be afraid of a public option.

or

-The government is able to provide health care in a more cost-effective manner, in which case it seems single-payer or even "socialised medicine" would be a logical imperative.

I don't see how one can have it both ways.

 

[Oliver]

Is it just me, or is there a big contradiction on the side of the Politicians who argue that there should be no "public option" in Obamas health plan. These people are also critics of government inefficiency and incompitence- the private sector, so they say, can always do a better job. So what are they worried about?

-If the private sector does a better job of things, then it can hardly be afraid of competition from the Government, which always makes a mess of things. So why be afraid of a public option.

or

-The government is able to provide health care in a more cost-effective manner, in which case it seems single-payer or even "socialised medicine" would be a logical imperative.

I don't see how one can have it both ways.

Well, the "Gov sucks, Private Sector rules"-phrase is a typical Republican reaction to Dem's plans to divert from the fact that ...

A. Government part of Healthcare means competition
B. And because of that, Private Sector is afraid

There are many Government-run systems around the world that are cheaper, more effective and cover ALL of their citizens at the same time. And many of those Universal Healthcare Systems do indeed have the private insurance sector as well at the same time.

You will probably find this introduction quite helpful and interesting concerning the Healthcare outside the US:

PBS FRONTLINE:
Sick around the World

 

[elbe]

Is it just me, or is there a big contradiction on the side of the Politicians who argue that there should be no "public option" in Obamas health plan. These people are also critics of government inefficiency and incompitence- the private sector, so they say, can always do a better job. So what are they worried about?

-If the private sector does a better job of things, then it can hardly be afraid of competition from the Government, which always makes a mess of things. So why be afraid of a public option.

or

-The government is able to provide health care in a more cost-effective manner, in which case it seems single-payer or even "socialised medicine" would be a logical imperative.

I don't see how one can have it both ways.

I believe the base argument is that once the government gets their paws in the health care industry they will pass laws that only allow inefficient state health care so they can better control everyone's lives.

 

[Professor Yaffle]

Hey Rolfe, Architect et al. You are needed in another thread:

http://www.internationalskeptics.com/forums/showthread.php?t=146171

I'm just too, too, tired.

 

[Architect]

I believe the base argument is that once the government gets their paws in the health care industry they will pass laws that only allow inefficient state health care so they can better control everyone's lives.

Not that this happened is, say, the UK or other countries where we still have the choice.....

 

[volatile]

Hey Rolfe, Architect et al. You are needed in another thread:

http://www.internationalskeptics.com/forums/showthread.php?t=146171

I'm just too, too, tired.

Two: http://www.internationalskeptics.com/forums/showthread.php?p=4834731#post4834731

Hit-and-run posting - when they get out-thought in one thread, they move on to another one to repeat the same crap again and again.

 

[Rolfe]

Two: http://www.internationalskeptics.com/forums/showthread.php?p=4834731#post4834731

Hit-and-run posting - when they get out-thought in one thread, they move on to another one to repeat the same crap again and again.

I'd seen the first, but not the second. As far as the first is concerned, we're back to - "let's just sort out Medicare", rather than devising a new system that will eliminate the need for the complications Medicare entails, and "doctors will be paid a pittance", without enquiring about levels of remuneration enjoyed by doctors in other universal healthcare systems (must phone up my friends and angle for that invitation for a yacht trip, now the weather is getting nice....)

The second? Well, at least it's an actual medical anecdote he's come up with. Last time (Jerome) it was a botched financial transaction that was proof the government shouldn't be allowed to run pay for medical care.

Rolfe.