Single Payer Is Not a Principle- the Principle Is Universal Coverage(democracyjournal.org)
democracyjournal.org
Single Payer Is Not a Principle- the Principle Is Universal Coverage
http://democracyjournal.org/magazine/single-payer-is-not-a-principle/
5 comments
I think you will find that there is a much more important issue that defines all the other issues:
1st and last) What does it cover ?
Because today the answer is "everything", and that's where a lot of troubles come from. If we just said "lung cancer because of smoking ? You're on your own", that would save multiple percentage points right there.
More generally, if we said, let's take 3-4 nines of all issues a human body can have, and solve those in a standard way BUT if you have anything else palliative care and/or pain control is all we offer, that would fix most healthcare issues (and put Shkreli out of business).
Of course nobody's going to do that. There'll be a very sick baby every 2-3 months or so on TV with an illness that's essentially incurable, but could have a very painful 10-year life if we just pay 1 million $ for every month of that life. And we all know the message on the television will focus on how she could have a "short, but normal life" and not on the fact that there is no such thing as a painkiller that makes 3 chemo treatments per year anywhere close to a normal life.
This decision determines how much it costs, which makes the question who pays for it easy to answer, as well as who has access to it.
Our answer today is very simple "everything, no matter the cost, and no matter the outcome (and no matter the resulting patient discomfort)". The result is perfectly predictable.
But of course changing that would require you to acknowledge that you do not have a right to health, and society does not owe you a healthy life, especially not in cases where that's impossible. Society will provide a certain level of service, but will only expend limited resources to keep one individual alive. If your problem falls outside of that service, society will provide some help in taking away the pain.
1st and last) What does it cover ?
Because today the answer is "everything", and that's where a lot of troubles come from. If we just said "lung cancer because of smoking ? You're on your own", that would save multiple percentage points right there.
More generally, if we said, let's take 3-4 nines of all issues a human body can have, and solve those in a standard way BUT if you have anything else palliative care and/or pain control is all we offer, that would fix most healthcare issues (and put Shkreli out of business).
Of course nobody's going to do that. There'll be a very sick baby every 2-3 months or so on TV with an illness that's essentially incurable, but could have a very painful 10-year life if we just pay 1 million $ for every month of that life. And we all know the message on the television will focus on how she could have a "short, but normal life" and not on the fact that there is no such thing as a painkiller that makes 3 chemo treatments per year anywhere close to a normal life.
This decision determines how much it costs, which makes the question who pays for it easy to answer, as well as who has access to it.
Our answer today is very simple "everything, no matter the cost, and no matter the outcome (and no matter the resulting patient discomfort)". The result is perfectly predictable.
But of course changing that would require you to acknowledge that you do not have a right to health, and society does not owe you a healthy life, especially not in cases where that's impossible. Society will provide a certain level of service, but will only expend limited resources to keep one individual alive. If your problem falls outside of that service, society will provide some help in taking away the pain.
Another option: Nationalize pharmaceutical research/production.
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Controlling costs is section 5 of the article.
The author says the prices are too high, but doesn't explain how to get the prices down.
I can't find a policy that the author proposes to keep prices down, or any evidence of how a policy would affect prices.
I can't find a policy that the author proposes to keep prices down, or any evidence of how a policy would affect prices.
The article talks mostly about the methods for controlling costs in a German style system.
It doesn't talk much about single payer, but that's trivial. Single payer is a monopsony.
It doesn't talk much about single payer, but that's trivial. Single payer is a monopsony.
Monopsony requires mutiple sellers (e.g. Walmart can buy potatoes from tens of thousands of farmers)
Pharma patents prevent this.
Pharma patents prevent this.
The article is about health care in general, not drugs.
But you're still in a better negotiating position if you're a single buyer talking to a single seller than if you're multiple buyers talking to a single seller.
But you're still in a better negotiating position if you're a single buyer talking to a single seller than if you're multiple buyers talking to a single seller.
> Yet another option: Remove patents altogether
Another option: free market, but create a streamlined process for removing patents in a punitive fashion so bad actors like Shkreli can lose their patent within a very short time for price gouging.
Another option: free market, but create a streamlined process for removing patents in a punitive fashion so bad actors like Shkreli can lose their patent within a very short time for price gouging.
How do you determine whether a price is "price gouging"?
OTOH the drug Shkreli hiked the price at was already out of patent. So you can see the "free market" issues. Nobody cared about bringing competition as the price was too low.
Why couldn't hospitals.. create a union... where they negotiate together for better drug prices, AND they ALSO become the insurer-- your primary hospital is your insurer--you pay them monthly to keep you healthy. They get recurring income from sick/healthy people alike, they get to control the costs...and they could set prices to be related to income...say 4% of income goes to healthcare... When someone travels to another hospital, their primary hospital picks up the bill...etc... I think costs could be a LOT lower because w/out insurance agencies there's more money for the hospital directly and being MRR the hospital can have a better idea of how much revenue they bring in on average per month.
I believe this is basically Kaiser Permanente and it exists. The main thing missing is the income-based payments.
Paying for it will always be the problem, but not just who pays for it, but whom will be paid for those services. IMO the problem with today's healthcare and insurance dilemma is that everyone wants to get in on the gravy train. Doctors, specialists, and everyone in between, are eager to take a fee. Pharmaceutical companies charge just about whatever they want because they know, eventually, they'll get paid. Insurance is best left to the private market, because if it goes universal through the government, then there will never truly be any limitations on what is covered, how much is paid, and the system will collapse upon itself.
For those that want to draw parallels to other nations, please remember those nations tend to be considerably smaller than the U.S., and they've had a LOT longer to work on these problems.
For my two cents, healthcare in America could be greatly improved with the following:
1) No one gets turned down for insurance, no matter what. Even if it's just basic prescription drug coverage, some basic level. 2) The cost of insurance is tied to your income, with the price gradually increasing as your wage increases so people are not forced to keep a low paying job for low paying insurance, unless of course that's what they want. 2a) The longer you have continuous insurance the more coverage you get, and the lower your costs. Incentive people to get, maintain, and keep insurance. 3) A cap on the price of drugs that have been on the market for more than 2 years. 4) Exclusive patents on drugs no more than 4 years. 5) Insurance is available nationwide, portable, and covers you no matter where you live, work, or go. 6) Finally, if you cancel your insurance you may not reapply for insurance for six months. Stop people from dropping insurance and waiting to pick it up only when they need it.
There are a dozen holes you can poke in that, I understand, but it's a start, and it's a short law that I think many would agree with.
For those that want to draw parallels to other nations, please remember those nations tend to be considerably smaller than the U.S., and they've had a LOT longer to work on these problems.
For my two cents, healthcare in America could be greatly improved with the following:
1) No one gets turned down for insurance, no matter what. Even if it's just basic prescription drug coverage, some basic level. 2) The cost of insurance is tied to your income, with the price gradually increasing as your wage increases so people are not forced to keep a low paying job for low paying insurance, unless of course that's what they want. 2a) The longer you have continuous insurance the more coverage you get, and the lower your costs. Incentive people to get, maintain, and keep insurance. 3) A cap on the price of drugs that have been on the market for more than 2 years. 4) Exclusive patents on drugs no more than 4 years. 5) Insurance is available nationwide, portable, and covers you no matter where you live, work, or go. 6) Finally, if you cancel your insurance you may not reapply for insurance for six months. Stop people from dropping insurance and waiting to pick it up only when they need it.
There are a dozen holes you can poke in that, I understand, but it's a start, and it's a short law that I think many would agree with.
Article points out that the important thing is that everyone has healthcare that they can access as they need to. Many ways to get there, and Single Payer isn't the only option. Rather partial to the German system myself...
The real underlining principle is a question: Should healthcare be the responsibility of an individual, or a collective responsibility of a group?
Without some agreement on this principle, we will continue to spin our wheels.
Without some agreement on this principle, we will continue to spin our wheels.
1. Who has access to it?
2. How much does it cost?
3. Who pays for it?
This article mostly addresses (1) and somewhat (3), but doesn't really give enough attention to (2). If pharmaceutical companies are granted a patent for a drug, then they have the sole capability to set the price, which the purchaser of the drug will be required to pay. The most obvious example is that of Martin Shkreli, who bought a patent for an existing drug and hiked the price.
How do you fight someone like Martin Shkreli who raises the price?
One option: don't buy the drug until the price is lowered. Collateral: anyone who doesn't have access to the drug. Problem: it is "unethical" to not pay for a drug that could save someone's life. (That is, our emotional brains set the value of a life at infinity).
Another option: set price controls for drugs. Problem: pharmaceutical companies will inevitably lobby the government so that the "right" price control will be a very high one.
Yet another option: Remove patents altogether. Problem: This removes the incentive to produce pharmaceutical drugs with a low barrier to entry (which is practically all pharmaceutical drugs).
So, any discussion of healthcare that says we need "universal coverage" needs to balance all of these issues. So far, everyone seems to ignore (2).