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 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).
> 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.
Business Week's piece was not much in terms of new ground but it was nice
to see a "Canadian" business defense. Strip away the possibility that the
government might actually succeed at something somewhat, strip away the
increased job mobility, and strip away the improved "fallback" position
that single payer provides and you have a great bottom-line deal for
empoloyers -- somebody else to take care of the health care needs of their
employees at a cheap price.
> 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.
It seems here that Colander (and you) have hit the nail on the head.
Doesn't this make the most sense from an equity standpoint? [see Julian
LeGrand, "Equity, Health, and Health Care," _Social Justice Research_ vol. 1
no. 3 (1987) pp.257-74 for an economic overview]
> Finally, Colander notes that single-payer isn't likely because
> of political opposition. He should have included his own
> contribution here.
It used to be (cold-war wise) that patriotism was the last refuge of
scoundrels. Nowadays it seems that political pragmatism is the last
refuge of scoundrels.
Thanks for the post,
Jim Westrich // [EMAIL PROTECTED]
Hillary Clinton says: "Buy Cheap, Sell Dear"
