Single payer healthcare?

[asterroc]

What is it?

This time I'm looking for the three paragraph synopsis. The three four sentence synopsis I got about it this weekend is as follows:

Money goes from the person to a fund and *then* to the health insurance company. People don't sue doctors at all. It saves you money. It's better than the current system and has no drawbacks whatsoever.

I have no clue if that synopsis is true or not. It certainly seems to me that sentences 2-4 do NOT necessarily follow from sentence 1, which is what people were trying to convince me of. So: explain.

Edit: People also appear to be claiming that SPHC is identical to universal health care, and it's my understanding that the two are orthogonal (independent) concepts.

Comments

[q10.livejournal.com]

i'm pretty sure there aren't any robust pairwise logical dependencies between any of those four sentences.

[zandperl.livejournal.com]

*nods* That's my point. They have to be drawing these conclusions from additional information - information that I do not have and am requesting.

[q10.livejournal.com]

my point was that the lack of things following from each other was even worse than what you'd explicitly remarked on.

[sammka.livejournal.com]

There are no health insurance companies. The government is the only payer. This produces efficiency gains because there aren't all different insurance companies reproducing the same work over and over and using conflicting forms (in Canada, "billing" departments even at very large hospitals are only a few people; in the US, medical billing is a huge industry because of how complicated it is). You also don't get companies trying to reproduce each other's actuarial work, and spending tons of resources trying to play hot potato with undesirable clients, get better deals from doctors than those doctors get other companies, or argue with other companies over who pays what. The efficiency gains supposedly are expressed in savings on how much money overall is spent on health care.

I have no idea why suing doctors is in your synopsis. Single-payer health insurance and malpractice tort reform are theoretically different things.

[zandperl.livejournal.com]

Okay, so "health insurance companies" are the current "multiple payers," and the payees in either are the doctors - I didn't get that before. So in SPHC how much coverage you get and what percentage it is, you don't have any choice? Or does the patient/employee not contribute ANYTHING and the gov't pays everything? And if this latter situation is the case, won't that up taxes hugemendously and therefore it isn't clear outright whether people pay more or less overall?

Maybe I misunderstood what others had told me, and really the cost savings is from the billing departments?

[sammka.livejournal.com]

So in SPHC how much coverage you get and what percentage it is, you don't have any choice?

It depends. For example, Medicare is in some senses a single-payer system (just restricted to a certain population), and there are a few options (Medicare A, B, and C) that you can pick depending on which is most convenient. In Canada, people who want more coverage and fewer deductibles get supplemental insurance, but overall it's single-payer because Canadian Medicare is everyone's main insurer.

Or does the patient/employee not contribute ANYTHING and the gov't pays everything?

The government (or, theoretically, some other single payer with a monopoly on the population) is your insurer, basically. It can decide what to cover and may impose some sort of deductible, but that's the idea overall.

And if this latter situation is the case, won't that up taxes hugemendously and therefore it isn't clear outright whether people pay more or less overall?

It does up taxes; the amount spent on health care per person in the country, though, theoretically goes down. You pay more taxes, but most people will save because they don't have to buy health insurance anymore, and more people are covered who otherwise wouldn't have gotten health insurance. The fact that taxes will go up doesn't mean that it "isn't clear" whether people pay more or less overall. You know how much taxes will go up, theoretically, and you know how much people are currently spending on health care.

In a free market system, any innovation that cuts costs (without imposing new ones elsewhere that exceed those savings) at any point in the health care industry, will save people money. Suppose I go to a doctor, who charges me $100. $20 of that reflects the amount she has to pay her billing service (doctors actually hire people to do billing for them). If billing gets way easier, the doctor can find someone to do billing for $2. Competition among doctors will mean that prices will go down to reflect those cost savings, and I will end up paying $82 instead of $100. This is an oversimplified model, but that's the basic idea.

[zandperl.livejournal.com]

So your argument is that billing costs are reduced in SPHC and therefore we'll probably pay less. Doesn't the fact that there's competition now make our costs lower than they could be, though? And what about the bureaucracy inherent in having the gov't do it, won't that make costs higher too?

Has anyone actually done studies that really concretely show that SPHC would save me money?

[sammka.livejournal.com]

I wouldn't say it's "my" argument. It's a major argument people make for SPHC.

Competition does not always make costs lower. In fact, monopolies in many industries may be more efficient than competition; I am sure, for instance, that the soda industry would save a lot of money if someone bought both Coke and Pepsi and they wouldn't have to spend so much on advertising. The problem with monopolies is that they have less incentive to streamline and that for-profit monopolies absorb any efficiency gains themselves; the cost isn't passed on to consumers. Government monopolies, while they may get tangled up in inefficient bureaucracy, don't have the same profit incentive as for-profit monopolies, though, and are held accountable to some extent by voters, so they don't "eat" the efficiency gains themselves like a for-profit monopoly does. At least in theory.

Competition among insurance companies can also be actively inefficient - for example, instead of competing for better quality and better streamlining, companies often just compete to cover the healthiest people, which is not helpful if your actual goal is covering everyone efficiently.

Studies comparing single payer health care systems in other countries to our country show that much less money is spent on health care per capita in countries with single-payer health care. The part of people's tax bills that reflects health care costs is at least not higher than what most people pay for health insurance here, and everyone is covered. The usual argument is not that it doesn't save money but that it delivers lower-quality care, but I can't really argue that one way or another because this is honestly not my field. I think it's pretty well-established that it saves money.

[seekingferret.livejournal.com]

There are two ways to do universal health care. SPHC is one of them, and it's the one that's more free market friendly. It allows for-profit health care providers, but the government is the insurer that pays for health care for everybody. The theory is that this will streamline billing systems, reduce malpractice suits, and cover people currently not covered, yet without requiring the government to maintain an entire health care system like, say, England has.

My favorite part of your cute little synopsis is the "It has no drawbacks whatsoever" line. Nothing has no drawbacks. To start with the obvious, it'll mean raising taxes as the government will have to cover costs it currently doesn't. (To counter this, those in favor say that the tax money is money people would have spent on private health insurance- this is only partially true). Then there's the question on the other hand of whether SPHC is actually better than true government-run universal health care- does SHPC allow too much room for corporate price-gouging? It depends on the implementation, obviously.

I had an enlightening conversation the other night with a candidate for Congress. His wife framed the health care question thusly: Either we say 'to hell with the money', it's really important to make sure everyone has health care, or we say 'we just can't afford this' and try to work out regulatory compromises. There is no good answer.

[zandperl.livejournal.com]

reduce malpractice suits,

How? I can see it reducing suits over bad billing, but not over doctors' actions.

To start with the obvious, it'll mean raising taxes as the government will have to cover costs it currently doesn't. (To counter this, those in favor say that the tax money is money people would have spent on private health insurance- this is only partially true).

Ah yes, that's one of my questions. We'd need a detailed analysis of the cost to answer it, though.

I'm under the impression that in many countries with a SPHC system, it's impossible to see a specialist. Do you know if this is a necessary result of SPHC, or just some implementations of it?

[sammka.livejournal.com]

It can theoretically reduce malpractice suits by reducing the percentage of people who can't pay their medical bills. Many people who sue for malpractice are people who had really bad outcomes that lead to serious disability and high medical bills; they've lost their jobs and thus lost their health insurance and have sky-high medical bills and can't pay them so they try to stick it to some doctor who may or may not have made a mistake. Many victims of medical negligence don't want to sue their doctors, it's too much of a pain and they like their doctors, but they feel they have to because of financial distress.

Theoretically a single payer could also give doctors incentives to do better work, and fewer incentives to cut corners, but it really depends on the single payer's behavior, not the fact that it is a single payer.

The "impossible to see a specialist" argument is sort of a bogeyman. Yes, it is harder to see a specialist in Canada. It's also hard to see a specialist in the US depending on what kind of health insurance you have. Different insurers will make different calculations regarding how often most people really need to see specialists, and many want to discourage specialist use because specialists are incredibly expensive (some may say overpaid); HMOs in the US will make you go through your primary care provider every time you see a specialist. It's a cost-saving method that any insurer may use, and not an inherent part of a single-payer system. Just as people in the US may choose higher-priced insurance companies that are more liberal about letting people see specialists, people in Canada who want to have an easier time seeing a specialist may get supplemental health insurance.

[seekingferret.livejournal.com]

I think it's all in implementation. I don't think qualitative analysis of this is actually very interesting to debate. Problem is, quantitative analysis of the details is very complicated and very difficult and very contentious because it requires speculative math. But Ken has promised me that he'll take me through the quantitative details if I can find a good run-down of them, and this is exactly what Ken does for a living, so...

[sammka.livejournal.com]

Also they're not independent concepts; most single-payer models are universal. If you have only one entity acting as an insurer, it's usually the government, so generally the government will want to just cover everyone (I mean, we also have "universal" highways and postal service. We don't have universal social security, but that's because there are still other companies managing pension funds, so it's in some sense also not single-payer). Not all universal models are single-payer; for example, Massachusetts' "universal" health care model involves everyone getting insurance from somewhere, anywhere, including but not necessarily government-subsidized insurance funds; it still preserves the private health insurance industry.

[zandperl.livejournal.com]

I'm under the impression that Medicare/Medicaid is a SPHC system, but it is clearly NOT universal. Or there could be a SPHC system only for public employees - especially if it's my union arguing for it.

[kadath.livejournal.com]

Massachusetts' "universal" health care model involves everyone getting insurance from somewhere, anywhere, including but not necessarily government-subsidized insurance funds; it still preserves the private health insurance industry.

Oh do not even start on that mess. It's "universal" in the sense they assess you a penalty come tax time if you didn't buy insurance during the previous year. Make certain that such insurance is affordable? What are you, some kind of commie?

[sammka.livejournal.com]

Yeah, it's a real mess. I blame the federal government in large part (ERISA, a federal statute that regulates employee benefits, has made it incredibly difficult for states to attempt serious health insurance reform).