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Old 4th November 2019, 11:07 AM   #132
Segnosaur
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Originally Posted by Norman Alexander View Post
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My concern is that people are looking at the greater health care costs in the U.S. and assuming single payer health care will fix the problem without looking at exactly [i]why[i] those costs are higher.
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So what other costs are there? Well there is:

- Malpractice insurance and lawsuits. Those can be quite pricey. In some countries, there may be limits as to how much settlements can be. As a society, does the U.S. want to set similar limits (with the knowledge that people who are the victim of malpractice may not get proper reimbursement.) Note that I'm not saying it is the only reason for the higher costs, just a contributing factor
That's a doctor-related issue, not a medical care related issue.
That's an irrelevant distinction. Any costs related to malpractice insurance need to be covered by whatever fees the doctor or medical institution charges.
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I'm sure doctors can organise such insurance and coverage outside of any public medical care system. They certainly seem able to do that in other countries.
Yes, but those other countries often have ways to limit malpractice payouts and insurance... limits on payments, rules about how lawyers are paid, etc.

The point is that if you go to a single payer without changing the malpractice laws, your costs may still be higher than they could be.
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- Over-capacity. For example, the United States has more MRI machines per capita than most other countries. What this means is that if a person wants/needs quick treatment, they can get it. (Compare that to Canada, where waiting lists are legendary.) A single payer system might reduce the overcapacity but at the risk of introducing waiting lists.

Woah. "Legendary Canadian waiting lists" are a far more complex situation than is generally understood.

But to keep it simple, ELECTIVE procedures, i.e. procedures that do not prevent a relatively normal life meanwhile, may indeed have longer wait times for exactly the same equipment types than for URGENT requirements. In short, wait queues are constantly re-prioritised depending on need versus availability. There will always be a balance required, and there are ongoing arguments as to what is elective and what is urgent.

What is misleading are the reports about AVERAGE wait times for procedures. They are quite misleading as they do not take the balance into account, they are just stats (did you know, on average, most humans have less than two legs?). These reports are usually produced by organisations with interests in the field, so reader beware.

Suffice to say, in Canada, if an MRI is needed urgently, you will get it urgently.
Ah yes, the most crappy argument that was ever put forward, but which keeps getting repeated over and over again. "Be happy with waiting lists because at least you will be treated quickly if its an emergency". Its a bogus argument, because it ignores the real pain and suffering that can result from being stuck on a waiting list (not to mention it can also lead to premature death, even if its not an emergency).

Let me give you some real life examples...

I have a cousin. He injured his shoulder (possibly a rotator cuff injury). He finds it very painful for him to raise his arms, but has to suffer though because his job involves physical activity. He was stuck on a waiting list for several months to get an MRI for a proper diagnosis. To you his pain and suffering doesn't matter because "gee wiz if its an emergency he'll get treated". Its not an emergency. He's suffering. If he were in the United States he probably would have had an MRI within a week.

Here's another example that's a bit more personal... I may have sleep appnea... I often stop breathing at night. Its a condition that has been linked to an increased risk of Stroke or heart disease. I mentioned it to the doctor over 6 months ago, but they have yet to find a slot in a clinic to do a proper sleep study. So while it is not an emergency per se, it still may shorten my life. (I do believe there can be waiting lists in the United States, but those waiting lists are much shorter.)

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2933773/

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- Use of new technology and/or heroic measures. I know that I sometimes hear of Canadians getting treatment using new techniques that are simply not available in Canada. But such cutting edge treatment can be expensive. A single-payer system may seek to limit such treatments in the interest of saving money, but for a person who will now be subject to alternative treatment, they will be less satisfied.
Actually, no it won't limit such procedures.
Actually yes, yes it does.

In Canada, what treatments are provided/funded are determined by the government, which is sometimes slow to react and often has different priorities.

Let me give you an example: There is a genetic diseases called Fabry's disease which can cause serious health problems (including heart and kidney problems). There was a point where treatment was not being provided in Ontario, despite the fact that such treatment was being done (and covered by many user's insurance) in the United States.

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In fact it encourages them if the cost factor is less or zero issue. It's also less stressful for the patient. They don't have to panic about "Is my kidney transplant going to bankrupt me and my family?! What about getting the insurance policy to play along with this! SO MANY phone calls to make!!" The worry becomes more about "Will I be OK?"
I do not doubt that knowing you will be covered by insurance (regardless of your employment situation) is a good thing.

What I am complaining about is people who ignore or hand-wave away all of the possible problems involved with various alternatives.

And let me make a prediction... if the Democratic party does decide to push a true single-payer (i.e. no private insurance) option in the next election, you will see a rush of right-wing newscasters to Canada to point out every patient who has ever been on a waiting list, in an attempt to say "See? This is what the Democrats want for your health care!"
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