----- Original Message ---- From: Michael Pollak <mpollak at panix.com>
Single payer wouldn't fix everything (nothing does). But I don't see anything in your rundown that persuades me it wouldn't fix this.
[WS:] I agree, and I do support a single payer system to any other alternative. My point was different - the form of payment is only one contributing factor, but here are other, which cannot be easily solved by changing how we pay for the service (that is a simplistic economism, imho.)
For example, many providers now require cash payment in full for their services, and then the patient has to obtain reimbursement (which typically amounts to a small fraction of the actual cost) on his/her own. Sometimes, providers' offices help to file the paper work with the insurer, sometimes they do not. I cannot see how the single payer system can change such practices. Of course, providers may be required by law to accept public insurance payments as full payments for their services, but that goes well beyond restructuring the insurance system - am not even sure if forcing someone to enter a contract is constitutional.
It is not unlikely, that in the near future we will have a two-tier health service sector - one providing first class services to those in a position to pay for them, and the other one providing substandard services to those who must rely on third party payments (private insurance, medicare etc.). This is just a natural logic of capitalist development and the social stratification it produces, and all other markets already follow that logic. Lavish housing for the rich, substandard housing for everyone else; expensive boutique shopping for the rich - Wal-mart for everyone else; expensive private schools for the rich - substandard private schools for everyone else; and so on. I do not see why health business should be expempt from that logic, and how the single payer system is going to change that short of forcing providers to deliver their services at the price determined by government.
Again, this is not to argue against the single payer system (which I strongly support,) but that the problem is much, much deeper than that and has its roots in capitalism and social stratification it invariably produces.
Wojtek