> I haven't looked at the literature in a long time, but as I remember
> it, the U.S. health system stood out as the world's most expensive on
> every score - cost of drugs, fees, equipment, hospital stays,
> administration, everything. There's no single culprit - they're all
> guilty.
Agreed; except for the hospital stays which are very short because they make more money doing procedures and getting you out.
Quoting Marvin Gandall <marvgandall at rogers.com>:
> There are a lot of problems - and misconceptions - about the Canadian public
> single payer system. But it is to the US system what parliamentary democracy
> was to absolute monarchy, an advance. Apart from the all-important equity
> issue, it is administratively more efficient and single payer appears to be
> the most effective means of applying price pressure on Big Pharma.
I agree with it being an advance and the equity issue is a very big advantage. My point is different though. Canada relies on a for-profit health care delivery system. Other nations that use a more socialized delivery system deliver better care for less money. Another point that should be obvious is that the US is a very different place than Canada. Even if the US got single-payer, I very much worry about the influence of Big Pharma, Big Nursing Home, Big Hospo, Big Doc, and Big Equip (even if they are lesser problems in Canada).
Quoting Gar Lipow <the.typo.boy at gmail.com>:
> Not so sure you are right. Last figure I heard close to one medical
> dollar in three goes to administration in the U.S.
First off I want to mention I know I am in the minority on this and in the many discussions I have with people I make it clear that I postulating against the varied received wisdoms. But Dartmouth's Center for Evaluative Clinical Services estimate that 40% of Medicare costs are medically unnecessary (they derive this from guidelines and the enormous practice variance across the country). Add that to the Big Pharma shills that write the "medically necessary" guidelines and we're talking a bigger problem. This is what I base my point on (and not on the fact that neither of the "problems" are fully addressable through policy).
Also, I think you make many useful points about payment policies. That is exactly the kind of thing that should be in proposed policy BEFORE we try to get people worked up about progressive solutions. I just disagree with people who say we should solve "insurance" first and solve that "other stuff" next. Because then I don't see any rational reason why the effort shouldn't be on fixing medically unnecessary care and pecuniarily guided research.
quoting jthorn65 at sbcglobal.net:
> I think it's easier to imagine Government reigning in costs if a Govt.
> backed single-payer system was set up. Right now there is less
> incentive to intervene.
Yes. It is easier to reign in costs in single-payer, particularly because of the incentive effects you mention. Although, as I mention above, I am not so naive about the political system in the US--look how badly our two parties fucked up Medicare Pharmacy benefits.
Anyway, one could reign in costs to the same level without single-payer (many states had "all-payer" fixed price systems that controlled costs OK). I just don't see socialized insurance as a sufficient way to control costs (it has not worked in Canada), even though it has A LOT of other progressive benefits--why not get direct state provision of the basic health care (i.e., Finland, England)?
I realize their is political calculus involved, but that those are precisely the issues everyone seemst to think was sorted out years ago and the reason why "single-payer" support is so stale. My goal is to hopefully get more people to think about explicitly about costs. I recognize there are seemingly massive challenges for changing all the issues talked about here. I just think that what "ordinary people" face is a lot of fear around keeping their insurance and the costs they have to pay. I want to make sure those costs are front and center on any health policy agenda.
Viva la Finland!
Jim
"You have found yourself Trapped in this Incomprehensible maze Where's your head at?"
-Basement Jaxx