Imagine if all roads were turnpikes with tolls. Single payer has the government pay those tolls. But for local roads, we would rather remove the toll booths and allow free and easy access. The same could be true of preventative care, basic access to an NP or similar, well child care, and such.
I never thought of the issue that way but now that I hear it I absolutely agree. I do not plan on having a child... ever so this may sound a little trollish but please bear with me here.
Anyone who is against gender discrimination (or thinks there is no discrimination against women based on gender) should be FOR free of cost and generally available quality child care for all. I think a lot of bias against women in the work force will go away if we don't have a mindset that women will quit the workforce once they have children.
I'm not sure I follow?
If families have access to free of cost quality child care, they are now making a choice based on their preference as opposed to a decision bring made for them by environmental circumstances. This might help decrease perception of hostility.
On our behalf, collectively, with our money. Some people still haven't processed just what "single payer" means.
(this assumes, perhaps incorrectly, that you live in the US)
In food, grocers are (roughly speaking, here) analogous to insurers and food is analogous to care utilization. Grocers want to maximize sales of food at the best price possible: they make more money by moving their product. Insurers want to minimize utilization: they make less money by "moving" their product.
In the case of food, the grocers' and buyers' incentives are aligned: people need food, and grocers want to provide it. In the case of medicine, this isn't the case: people need care, and the access providers don't want to provide it.
It makes sense to me that an insurer would never be a good analogy for a grocery store, but that problem seems specific to the insurance model, rather than to medicine itself. That's more what I meant to ask about. If we imagine that hospitals and patients work like grocery stores and their customers, a few obvious problems come up:
- Healthcare is too complicated for patients to make informed choices. - Emergency medicine is too urgent for patients to have much choice anyway. - Demand for care is unevenly and unfairly distributed, because of conditions people are born with.
So I guess my question is, how much of medicine (in terms of dollars) hits those problems? Cancer treatment seems to hit at least two out of three. But on the other hand, a lot of dentistry seems not to.
Of course you have incentives. Hospital administrators want to cut costs, doctors want to redirect patients to their private offices, suppliers want to increase profits (and will offer kickbacks to doctors and administrators), etc.
If you have humans, you have incentives. Regulation can change some, but not eliminate them.
You will find that the jurisprudence surrounding those clauses bears no resemblance whatever to what the clauses actually say. For example, look up Wickard v. Filburn and see if you think that Supreme Court decision used a reasonable interpretation of what Congress can regulate under the guise of "interstate commerce".
Interestingly, though, the clause under which the individual mandate was found constitutional was actually the Taxing Clause--the Supreme Court said it was not constitutional under either the Commerce Clause or the Necessary and Proper Clause, which was how the government had argued the case. In other words, the Supreme Court said that, while it was not constitutional to require everyone to purchase health insurance, it was constitutional to tax people who didn't. Go figure.
The full opinion is here:
Wage controls during WW2: http://www.npr.org/templates/story/story.php?storyId=1140451...
Without either the individual mandate (which is itself a half-assed approximation to single payer healthcare) or group health insurance (through employers or some other non-health-related cooperative), people put off getting health insurance until they get sick, the risk pool stops being a pool and the whole concept of "insurance" falls apart.
In an individual-pays system, those with expensive conditions or those who are poorer lose out. In a government-pays system those without political leverage lose out - often still those who are poorer.
The British NHS, for example, has been the target of much ire due to different (and arbitrary-seeming) spending priorities in different parts of the country, often called the "postcode lottery".
However, as your reduce the cost of providing healthcare with single payer systems you increase society's ability to provide high quality healthcare. Remember, if a doctor sees 1000 people a month then you can detect fraud by randomly sampling 20 cases. However, if 10 companies each need to check for fraud they may investigate 10 cases each, but with 10 X 10 that's still more effort. Further, they are each going to try and cost shift to the others, which is an expensive zero sum game.
Or they'll coordinate to avoid the duplication, usually by having some kind of industry society/non-profit that does the checking.
It makes far more sense than single payer, because it cannot be traded away easily by the recipients during bad decisions, so it is a stronger safety net.
But it is also far cheaper and more efficient than basic income, because buyers don't compete so prices don't go up across the board "patio style".
Private insurance companies and employers (the two places most Americans get their health insurance from) may not want to pay for the higher costs associated with higher risk people like this. Employers would be especially susceptible to this sort of discrimination if proposed legislation allowing employers to demand genetic tests of their employees passes.
https://www.washingtonpost.com/news/to-your-health/wp/2017/0...
Because a single-payer health system (like the NHS) largely prevents this discrimination.
Seriously though, I quoted the reference exactly in my question, since I knew people would be touchy about the subject. Based upon other people's reaction to my question, some people are very touchy about the subject even when addressed elliptically and without pre-formed notions.
Thank you for your answer.
Also, because it's Hacker News and a lot of folks here are engaged in start-ups, I wonder why I hear relatively more from tech about basic income than single-payer health. While basic income goes further, single-payer health removes a major burden / friction for creating a start up.
Also, from a labor standpoint, decoupling health benefits from work allows start-ups to play with less-than-full-time employment arrangements. Having more people fractionally employed might be just the safety valve we need until automation job loss is more comprehensively addressed. But I digress.