Single-Payer Health Care: As Goes Canada, So Goes Vermont

The Something Awful Forums > Discussion > Debate & Discussion > Single-Payer Health Care: As Goes Canada, So Goes Vermont

Lyesh: Apr 9, 2003

forgot my pants posted:

I understand all that. However, I've heard people (who are not experts) say that this sort of care is rationed in single-payer countries. I'd like to know if that's actually true.

It's rationed to the same extent as care is rationed to insured people in the US. Take a look at exclusion lists sometime, they are quite long.

# ¿ May 5, 2014 16:42

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# ¿ May 22, 2024 12:51

Lyesh: Apr 9, 2003

forgot my pants posted:

I didn't say anything about euthanizing the disabled, so please be more precise with your wording.

Anyway, I may be misreading what you're saying, but it seems like you believe there is an infinite amount of healthcare to go around, if we just prioritize it. This just isn't true, as evidenced by previous posts about rationing of care in single-payer systems, which you admitted occurs. A good example of this is radioisotopes used in PET scans. There are a number of different molecules used, but they are all produced by just a handful of nuclear reactors in the world. In the past, when these reactors have had to shut down unexpectedly, it's resulted in shortages of these radioisotopes worldwide. There's lots of drugs that we have periodic shortages of as well, but radioisotopes are illustrative of the supply problem. Right now we can only effectively produce them in nuclear reactors, so increasing the supply would be a difficult undertaking that would require a decade or more of work.

While the specific circumstances I laid out in my original post have a small (but disproportionate) effect on the cost of healthcare, there are many similar questions, which cumulatively have a large effect. For instance, do single-payer systems pay for surgeries on terminal cancer patients when those surgeries will not statistically benefit a patient? Will they pay for double mastectomies in unilateral breast cancer patients who are unlikely to develop cancer in the healthy breast, yet want to prevent that possibility altogether (while risking additional complications from the more invasive surgery)? I know the UK uses quality adjusted years of life scores to account for these questions, which seems fair. But the average American seems to believe they should be able to get any treatment they demand, in the vanishing hope that it might prolong their life. Places like Cancer Treatment Centers of America exploit this mentality quite effectively. I think that mentality needs to be changed before it will be palatable for the federal government to create a standard like QALY that dictates what care you can receive.

Have you ever dealt with an American health insurance company? They love, love, LOVE denying procedures like that. People have died in the US waiting for their insurance company to approve procedures that would literally save their lives. You might be okay if you can pay for it yourself, but it sure as hell is not a guarantee that you'll get healthcare no matter how medically necessary or how many physicians approve of it if the insurance company has excluded it.

# ¿ May 5, 2014 20:45

Lyesh: Apr 9, 2003

forgot my pants posted:

I'm talking about unnecessary medical procedures (ie, ones with neutral or negative QALY scores).

Even NECESSARY medical procedures get turned down by insurance companies all the time. Unnecessary ones are even more likely to be turned down.

Of course, there's always the private insurance market and private healthcare if you really want to spend a bunch of money to get unnecessary care. Most single-payer systems do allow these, though I personally dislike them because they stratify care by income.

Edit: The point that healthcare is already rationed by bureaucracy need to be put out there a lot more. There's also plenty of related anecdotes and such, but there's also a point that a lot of Americans think health insurance works fine for them and they don't want change because they might lose the thing paying for their (relatively) cheap conditions. Which is valid but also horrifically selfish and something that really should attract more shame than it does.

Lyesh fucked around with this message at 00:33 on May 6, 2014

# ¿ May 6, 2014 00:27

Lyesh: Apr 9, 2003

wateroverfire posted:

Umm. It's 5-6% of the labor force, which is (say) 5% of 130 million or so (BLS will have the number.) or about 6.5 million.

Those 5-6% are different people at different times. There's a lot of turnover in the economy.

About 4.5 million million people a month have been hired for the last few months. A lot of those are going to be unemployed people cycling into jobs. It takes time for people and positions to match. Depending on where people live they may have up to 99 weeks of unemployment benefits to help them out while that happens.

Now they've got 26 weeks max. EUC is gone and shows no real signs of ever coming back. Long-term unemployed workers (people who are over 26 weeks unemployed) make up 3.5 million of those jobless people and they have a harder time getting hired because employers vastly prefer to hire someone who's still working.

If they live in a state with reasonable Medicaid, then they're probably okay for health insurance. If not, the wealthiest nation ever certainly can't afford to spend money on long-term unemployed people with cancer or anything else that's non-acute.

It's also not all that big a distance for someone to fall from unemployed to long-term unemployed. Your chances of getting a job every month work out to around 10% (obviously with enormous variance), so on average you're going to end up flipping a coin to determine whether or not you end up there.

# ¿ May 9, 2014 21:08

Lyesh: Apr 9, 2003

Fat Ogre posted:

FYI well over half the country already had healthcare.

Most healthcare costs aren't emergency related.

That you guys are resorting to screaming about privilege and conservatism instead of admitting your point isn't valid is priceless.

Worst case scenario emergency healthcare costs are barely 10% of all medical expenses. Let's get angry about posting prices so that people can shop because reasons!!

Many people have never needed an ambulance so to say you can't shop for healthcare because a few people need an ambulance is sheer ridiculousness.

What is your real argument against hospitals posting their prices for people to see?

It would be great for them to post prices, but it's a tiny bandaid at best. Stuff like cancer is so expensive to treat that it's not going to be affordable to anyone who has insurance (and a lot of people who do). Even a broken limb isn't something that most people can pay for without insurance. Cost-controls are necessary, but they aren't something that patients need to be directly involved in, especially when their economic status so strongly affects what they can pay.

The real problem is that our healthcare system is set up as the equivalent of a triage center that puts a black tag on anyone who doesn't have insurance and can't afford treatment.

# ¿ May 10, 2014 20:30

Lyesh: Apr 9, 2003

Fat Ogre posted:

There are a number of local places opening up medical care centers that specifically don't take health instance ( if you have it you have to do the filing yourself). They post the prices beforehand and are doing quite well people skip going to the emergency room when they can spend $50 and get a checkup and know that their antibiotics aren't going to go over $20 at most.

This is already happening by doctors fed up with the current system. I'm saying we should force all places to do this to get some basic competition going. When a for profit hospital sees that it loses a ton of business because the place down the street is cheaper across the board it forces them to lower prices. Which means insurance gets cheaper for everyone.

Until we get UHC it would help quite abut to know how much things are.

The problem is that this isn't incredibly helpful for the expensive (but still routine) treatments which are the bread and butter of hospitals. Surgery for a broken back. Hip replacements. ACL repairs. Pretty much everything that involves an ongoing relationship with a specialist or extensive followup care. There are way too many procedures that are really important but also so expensive that someone making retail wages wouldn't be able to pay for them across a decade.

There are already plenty of free-market solutions for low-cost stuff like urgent care. The things that aren't priced openly tend to be be in the above category.

# ¿ May 10, 2014 20:47

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# ¿ May 22, 2024 12:51

Lyesh: Apr 9, 2003

AYC posted:

This was posted in the midterms thread:

Thoughts?

That's pretty much incoherent. The allowance for no contraception coverage with ACA-compliant plans has shown us that it's plenty easy to ignore scientific/medical fact with the ACA.

# ¿ May 13, 2014 21:47

The Something Awful Forums > Discussion > Debate & Discussion > Single-Payer Health Care: As Goes Canada, So Goes Vermont