Single payer: Some common sense talk

Great post on the ills of a single-payer system. Money quote:

If you were to get in a scrap with a mean old junkyard dog and he managed to sink his teeth into your scrotum, from that point forward the dog is totally in charge. You may have the complete use of the rest of your body and even though, from a real estate point of view, the dog has laid claim to a fairly small portion of your property, where that dog goes you will go and you heart, mind, and soul will follow willingly.
Money drives medicine. Not a nurse empties a bed pan nor a surgeon repairs a hernia without money changing hands. This is so obvious that it is almost insulting to mention it. And yet the proponents of a Single Payer system seem believe that, although the government would have its teeth firmly embedded where it counts in every medical decision, nothing but good could possibly result.

(via GruntDoc)

~~As an aside Panda, your blog template doesn’t format correctly in Mozilla.~~ Sorry, the problem was on my end.

Comments

William from The Doctor Job
His blog seems fine for my Firefox.
Evan
Explain for me, Kevin, why the government’s bulldog teeth on my balls are inherently bad, while tiny puppy razor teeth of myriad various insurance companies, self-insured payers, individual persons with no insurance and the slightly smaller bulldog teeth of the government (which still covers 50% of the total cost of health care) collectively gnawing my balls into a bloody pulp is inherently good.
Panda Bear
It’s not good. Not at all. The best system would be one where responsible people bought their own major medical insurance, paid for routine things out of pocket, and we had a social safety net for those who couldn’t.
But you answered your own question. Half of your testicles is still better than none of ‘em.
Anonymous
I’m not in the medical profession nor the health insurance business. I’m just a (very seldom) patient. I agree with the perception of government control of healthcare being a bad, destructive proposition for everyone, except the politicians and bureaucrats; it’s bad for them, too, but they’re too blind to see it).
Kevin
Evan,
The current system needs work, but having many small teeth gnawing away is the significant lesser of two evils. It’s not even close.
Kevin
Dan
So the millions of seniors who’ve been on Medicare (not including part D) for the past dozens of years have been suffering from collective scrotal hemorrhaging at the hands of the government bulldog? I think that’s rather sensationalistic. Yes, too much government interference is bad in many arenas and there will inevitably be problems with whatever system we have. But please don’t blur the fact that single payer is about the provision of _insurance_, a la Medicare, not the provision of medical care per se. Medicare hasn’t been perfect, but it has not been the catastrophe that you seem to be saying it is.
Panda Bear
Dan, you live in cave. Everything is about money and whoever writes the checks can do as they please, especially in representative governments where the mob can vote. The idea that everything is going to be all right and that goverenment is going to pay for your health insurance with no strings attached is so distant from reality that I weep, yes weep for you.
Anonymous
What about the poll last week that showed most americans want universal healthcare but they don’t want to pay for it in increased taxes. That is the problem with our entire healthcare system in a nutshell. Everyone wants to be treated like an arabian sheik but are irate if they have to pay a dime out of pocket.
Anonymous
We have universal healthcare. EMTALA ensured that. Railing that our system is broken makes for great headlines, but the bottomline is there is nowhere I would rather be if me or one of my family members were ill. Stat geeks can quote all of the numbers that they want about the system’s outcomes compared to other countries, but as long as we continue to be the fattest and laziest country in the world they might as well use the paper to wipe their backsides, because that’s about all its good for.
Dan
Panda Bear- Your reply was very dramatic, but didn’t really add anything to any rational discussion. What is it about Medicare parts A and B that are terrible to the point that they would warrant a comparison to having one’s testicles bit by a bulldog? Telling me that you “weep for me” because I “live in a cave” implies that it’s patently obvious that Medicare A and B are working terribly. I don’t doubt that there would be privacy concerns with government involvement. Nor do I doubt that there would be patients who would ultimately not get as good care under a single payer insurance system as they would under the current system. However, I do think that overall the economies of scale created by a system like Medicare A&B provide for a healthier population at less cost. And my impression from all those I’ve spoken to who have Medicare A & B is that while it’s not a perfect system, it’s also not subject to the terrible problems you seem to imply it should be.
Anonymous
Medicare isn’t a catastrophe becuase it is just one of the little dogs hanging on rather than the one big blood sucker. It rides on the back of private payors. If it were the only payor, there would be a crises the likes of which has never been seen in American medicine.
Anonymous
When did it become beyond debate that universal health insurance coverage is good? It seems to me that the value of insurance is a personal decision based on ones own risk aversion. When did we become so security obsessed as a culture that we not only seek to eliminate risk from our own lives but seek to forcibly compell others to spend their resources seeking security which they may not want. Not everyone is so unwilling to take risks that they feel a need to give up their freedom and wealth to insure themselves against all. Not everyone even wants healthcare when sick. Whose life is it anyway?
Dan
Anonymous 5:07- I guess it’s a subjective call as to which you would call a big dog and which you would call a small dog, but the numbers from the latest Kaiser reports are as follows: there’s about 43 million people on Medicare. Of those, about 11 million retirees receive some sort of additional employer-sponsored insurance (and only a few people have other, non-employer-provided private insurance). I feel that saying Medicare is a tiny dog is incorrect.
Anonymous 5:25- We may have a difference of opinion regarding what should be considered a basic right, but as an American and as a health care provider I want certain things covered for all American citizens. For example, I wouldn’t want doctors to tell some healthy 25 year-old that he’s got to either A) spend down all his money and stop working so that he can be eligible for Medicaid (which would cost the public anyway) or B) not get his testicular cancer treated. And I definitely wouldn’t want to tell him that his only choice is B (e.g., if there were no Medicaid). I wouldn’t want to be a doctor in that type of society, and I wouldn’t want a doctor who wanted that sort of society.
Dan
Correction to the numbers I posted above– it looks like it’s 13.6 million receiving employer-related insurance rather than the 11 million I mentioned; however, I don’t feel this affects my point. Also, while I know that some people do choose their job based on health insurance benefits, I don’t think that that is the driving force behind most career decisions. (I am looking at the resources at http://www.kff.org/medicare/index.cfm , for example the Medicare at a Glance pdf. ).
Evan
What’s odd to me is this conversation seems to take place in a vacuum. Like nobody here has ever heard about civilized societies that solve this problem in other ways. Health care in Germany is different than it is in France, Italy, Belgium, Spain, Britain, Holland, Norway, Iceland, Japan or Korea. But all those countries give some version of universal coverage to their citizenry. Even though they use different means, they all seem to have functioning societies. Is it really true Panda, that you think ALL of them have such atrocious systems that the lives of both doctors and patients are substantially ruined by the dog on their balls?
Anonymous
Viv La Medicare! Last year, at 64, I was diagnosed with Breast cancer. No insurance, widow with about $250, 000.0 in pension plans. If I would go to an American hospital I would be a sitting duck for the money-grabbing financial office. I would have to subsidize all beggars coming to the ER for sore throat, and all the “negotiated rates” that private insurances force hospitals to accept.
I opted to go abroad. Now I have Medicare Rx, a private insurance, and I see that they pay only about 25% of the going rates for all services (I get the reports!). So when the doctors lament about the dogs and their balls, they conveniently forget that those private insurance companies have been chewing on their collective scrotum from the beginning of days. The only difference is that 45% of population, the uninsured, either go without, or go abroad, or are forced to pay inflated fees.

Single payer: Some common sense talk

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