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Old 5th November 2019, 04:10 PM   #144
Penultimate Amazing
Join Date: Jan 2002
Posts: 14,912
Originally Posted by Norman Alexander View Post
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.
Possibly. But it will depend on how the system recompenses doctors. Most of them use a "standard fee" approach - a list of common services each with prescribed recompense (in Australia, this list is vast). The doctor may choose to charge the patient more than that amount, but s/he will get back only that amount from the government. The patient effectively pays the difference. So if the doctor wants to add their malpractice insurance costs on top, fine.
This depends on how the system is implemented, but I suspect that doctors 'adding fees' (in order to cover expenses like malpractice insurance, or anything else) would be considered illegal. That's the way Canada does it... everything (at least in terms of basic medical coverage, not including dental/eye care) is covered by the government program.
But that is not an issue for the single-payer system, it is an issue for them.
Buy it is still a cost that impacts health care. That was the point of my earlier post: That there are costs that will not be impacted by a switch to single payer unless other changes are made.
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).
I never said it was a perfect argument. In fact, I made it clear it was over-simplified. Nor is it perfect or an excuse.
Yet you still made that argument, without clarifying what that impact would be.
But no system can afford to have a personal doctor and a fully stocked radiology suite and surgery suite and pharmacy standing by everywhere for every single person in the country.
No, nor is that necessary. A happy medium that allows treatment or diagnostics within a few days is superior to a months/years long waiting list.
I exaggerate to make the point that available resources are scarce and not readily available everywhere, so patient care needs to be prioritised. That's what the waiting lists are, and the process is actually quite complex. Do not for one moment think that people get put on these longer lists because of neglect. Medical staff feel their pain and would love to treat everyone immediately. The reason is simply the lack of resources right now, NOT because some faceless wonk in Ottawa decided a rotator cuff injury is of no consequence.
I never claimed that waiting lists were due to negligence or lack of empathy.

But, here in Canada it is due to a combination of slow government response and a need to fulfill multiple priorities that also include non-medical needs (such as basic infrastructure, defense, policing). Plus, the priority of the patient may not necessarily line up with the priority of the officials making the health care decisions.

Again, the issue is if people push for single payer because "gee wiz, its cheaper" then they will have to justify how people may have their health care treatments delayed.

Let me give you some real life examples...

I have a cousin. He injured his shoulder (possibly a rotator cuff injury)....He was stuck on a waiting list for several months to get an MRI for a proper diagnosis.

Here's another example that's a bit more personal... I may have sleep appnea...they have yet to find a slot in a clinic to do a proper sleep study.
Two examples.
Yes, 2 examples. I gave those specifically to personalize the type of situations find themselves under, so that hopefully people recognize that "Waiting lists? No big deal" is a foolish argument.
Meanwhile, how many people were NOT treated in the USA for necessary and urgent medical reasons because they had no insurance?
I have no doubt that many people were.

But here's the thing: keep in mind that many (probably most) people DO have health insurance of some kind. And those people can often get better treatment (read: faster service, better tools) than people in places like Canada.

Now, the problem when people discuss health care is that not everyone agrees on the same terms. To many, "Single payer" simply means "universal". To others, Single payer is a lot more focused: it means no private insurance at all; everything is covered by the government program. (This appears to be what Sander's plan is. I'd have to look at Warren's plan in more detail to see if it is the same.)

I think the U.S. system needs to be reformed. But I think going to a true 'single user' system is a mistake. The best health care systems are the ones that merge private and public systems.

If you tell people who do have coverage "Your own health care and that of your family will get worse, so that some unnamed person might be better off", you might have a hard time getting broad public support.

Re: Patients not getting treatment with new techniques...

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.
Indeed. Sometimes this does indeed happen. Sometimes. But oftentimes it doesn't too.
But when it does happen, the patient has no options. (Well, unless they're rich enough to become a medical tourist).

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.
It is fully covered now.
Yes, I know its covered now. That's why I said "There was a point" where treatment was not provided in Ontario. It was an accepted treatment in the United States, but the government here said "Nope".

The fact that the government finally adopted it doesn't change the fact that there was a time period when it didn't cover the treatments.
Nothing is being hand-waved away. Single-payer is not a perfect panacea. It has inherent problems, and depending on how each nation implements it, specific problems. But it is proven in hundreds of other countries to be generally a more efficient way of affording and delivering health care.
Not exactly...

Again we have to deal with what exactly 'single payer' means. Universal coverage but with private options for better service? A public option to cover those that private health care missed? True single payer with no private options at all?

The only western country that has adopted a 'no private insurance' scheme (like the one pushed by Sanders) is Canada, and we generally rank near the bottom of various health care rankings. The better options mix private and public in various ways, and usually end up better off for it.

No country ever implements a "true" single payer system. There will always be some form of private health insurance required and involved.
When it comes to basic health care (i.e. not including drugs, vision, dental) Canada comes closest to a "true" single payer. And our system falls behind other countries.

Strangely enough, I have no problem getting fast treatment for vision or dental. But then those are paid for by private insurance. What are the odds?
The Dems know that; they are not entirely dim. So I rather suspect the idea of them eliminating all private health insurance is a GOP fear tactic, not anything to do with reality. Although if Warren does push this particular line, that will be VERY silly.
Well, that is the line that Sanders seems to be pushing.

Under the Sanders proposal, private health insurance companies would be eliminated. Every resident would be covered by a single government insurance program that would pay the entire cost of almost every health care service and product...

Its a plan that goes beyond even what Canada offers.

And then there is Warren's plan:

Private insurance would be eliminated. Warren argues that would save hundreds of billions of dollars in administrative spending, and relieve patients of the hassle of dealing with their insurer.
  • Americans would no longer have to worry about reaching their deductibles or whether their doctors are in their insurance network.
  • They'd pay no premiums and have "virtually no" out-of-pocket costs, according to Warren. They'd have expansive health benefits, including long-term care, audio, visual, and dental.
  • They'd also have no choice about any of this.
The first 2 points may sound great. The last point may cause some problems.
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