:On Mon, 4 Apr 1994, Jim Devine wrote:
:
:> With the single-payer plan, "the government, not individuals,
:> would decide what health care individuals would receive, and
:> government would pay the providers of that health care."
:
:The "government" (presumably some quasi-democratic, quasi-medical board) would
:decide how much money to give providers of approved services and how much
:money to give hospitals and other instituional health settings. The
:providers and hospitals would then decide what health care individuals
:receive (an important distinction because of informational problems). I
:as an individual ignorant of health care (but knowing what "works" and
:what causes dis-ease) never decide what health care I receive, I only
:initiate an episode of health care.
This may be the way it works in some Canadian situations but in
Ontario, the NDP government has policed the doctors in what procedures they
can and cannot do - has given the doctors a maximum number of procedures per
day that they can bill for, has told the doctors they must reduce that by 5%
in 1993-94 fiscal year (ends March 31, 1994), and has put a cap on total
billings per year for a physician. For instance, one dermatologist reached
his limit on billings within three months - so he closed his office. In the
hospitals, there has been so much cut from the global budget that there is
not enough nursing staff to go around. My 82-year-old father who is now
thankfully out of hospital was in for four weeks in Feb-March. One night he
was left sitting up in a chair all night because the little staff there was
did not get to him - his legs swelled and he had some setback in his
recovery as a result.
:This issue seems central to single-payer versus managed competition
:methods of cost control. Canada gives power to somewhat democratically
:controlled boards to set some rules for physicians and hospitals who then
:wield the most power over health care (I think Canada gives too much power
:to physicians but otherwise is pretty good). Managed competition gives
:power to profit-maxing companies (and their army of business school grads)
:to control physicians/hospitals but in a pretty inelegant/inequitable way.
:Canada has the potential to control costs dynamically better than the
:Clinton proposal (managed competition has not controlled health cost
:growth yet) but not through social insurance per se but through state
:planning of technology (the main cost of medical inflation).
I would favour democratically controlled boards - however,
government directly orders what ought to be done. There is no laser heart
surgery, the number of operating rooms in Ontario for heart surgery is
restricted, and people with cancer waiting for radiation, have to wait up to
6 months (while the cancer spreads etc.). I am sure that a board could do
better. There are boards which decide who should get dialysis - but the
number of slots is restricted (thus, in our region, even if dialysis is
required, the board may not give it because of lack of spaces - and that
means a very slow and painful death. My father-in-law was denied service
because he had a heart condition and I watched him die. In Ontario, if the
government provides it at all, you cannot pay for it yourself, even if the
government has denied you treatment - the only alternative is to go to the
U.S. and pay for it privately. My wife who is quite sick for the last two
months has been diagnosed by the primary physician as having hypothyroidism
but her primary physician has done nothing to alleviate the problem except
refer her to a specialist - whom she can't get an appointment for until
June. That means she can't get out of bed some days which is a burden on the
whole family. No board would do that unless they were out of money and I
suspect the single-payer plan will only work with lots of money - more than
what Clinton (Mr. & Mrs.) sees as feasible. The way Canada keeps costs down
is to reduce service by either not permitting new procedures or by queuing.
:
:> This ignores Business Week's conclusion that Canadian-style
:> single-payer would preserve the individual's freedom to choose
:> a physician and the autonomy of the doctor. It also ignores
:> the way in which HMOs and medical-insurance plans currently
:> "decide what health care individuals receive." BTW, Colander
:> conflates the Canadian and British systems.
I have lived in Britain and experienced their system too. I would
not recommend it. I do think it might be wise to look at the German or
French systems if one wants to achieve health care for all while at the same
time preserving choice - those are not single-payer plans as the Canadian or
British systems are. In Britain, queuing is according to the professor at
LSE who taught me the first course I took in health economics, the method of
allocation of resources.
:> Colander also suggests that since under single-payer, medical
:> care is "free," it would have to be rationed. "Medical
:> problems with the 'highest social benefit of treating' would
:> be covered down to where the allotted money ran out."
:> As if we don't have rationing now. Nowadays, the "highest social
:> benefit" is determined by those with the most money.
This statement is true - rationing will occur and does occur - what
makes you think though that rationing by queue is superior to money? There
is no real evidence of that. I do not find the rationing of the government
any fairer when government officials can jump the queue and go to a federal
defense medical establishment. There is no necessarily higher benefit in
government officials being treated first - how would you like it if Packwood
got treated before some other officials? We have had situations like that
here in Ottawa.
:> Finally, Colander notes that single-payer isn't likely because
:> of political opposition. He should have included his own
:> contribution here.
Well, I can understand the need to cover by insurance the 37 million
who need coverage - I can also understand the reasons why you need to get
control over the poor coverage many others have and the perniciousness of
the insurance companies - BUT, really be careful about a single-payer plan -
it can be dangerous to your health.
:
:
--
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Doug McCready, Ph.D. Full Professor of Economics
Wilfrid Laurier University
Waterloo, Ont. N2L 3C5
(519) 884-1970, ext. 2563 FAX: (519) 884-0201
e-mail: [EMAIL PROTECTED]
Core Faculty: Walden University, Minneapolis MN. admin/man. and health
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