Abortion

[Dannyalcatraz]

Single payer is cheaper- when the payer is a government- has all kinds of advantages of scale, internal efficiency and so forth. These are present in a standard monopoly as well, but the difference is that a standard monopoly has an inherent profit motive that can go unchecked by anyone except the government.

If a government monopoly acts up, "we, the people" can put our foot down.

But generally, government monopolies don't usually operate nearly as cutthroat a manner as private ones do: their predisposition to behave like the bureaucracies they are tends to trump that behavior. They're not hunting to squeeze out more money from the market, they're trying to be better at following their own rules as set down by their regulators.

 

[Neonchameleon]

I don't think this is necessarily true. Single supplier is a far safer bet to drop per-person cost for medical care than single payer. Single payer without the ability - or even the need - to impose top-down price controls doesn't make things better.

Beyond that, single payer for medical insurance doesn't do anything to address the fact that insurance (meant to spread economic risk among large amounts of people) is a poor way to effectively deal with services that are inherently not economically risky (like, say, pre-natal care).

Single supplier = monopoly. If you're going to have a single supplier you want one that isn't financially driven (e.g. the government).

What single payer does do is flattens the administration costs and seriously cuts doctors overheads. To know what medical treatment to give, an American doctor needs to know what insurance scheme you are on. And then there's the ridiculousness that is billing; I did some checking a while back and discovered that almost 75% of a hospital bill in the US is padding they don't expect to receive. And paying people to haggle with the insurance companies.

I didn't say it wasn't. What I said was I don't know that it is economical for the single payer should be on the hook for 100% of this particular bill, which isn't precisely the same thing.

Any single payer system is tax driven. As I understand them, most also have a private option: you can always pay to see a private healthcare provider entirely at your own expense.

What I'm thinking is that you have a single payer system that subsidizes treatments wherever you go, rather than pays 100% in one facility and zero in another. Patient choice of healtchcare provider is maintained. Number of outlets is kept high. Wait times are minimized. The means test prevents more expensive healthcare providers from draining the system- you want to charge more for a service than is approved, the patient is on the hook for the extra- but not entire- amount.

And you have a multi-tier system with good money driving out bad. You have patient choice in the UK. You have longer waiting times in the US than the UK unless you have a gold-plated medical plan (like much of the NHS our current government seems intent on fixing that).

A means test also means that the more money you earn, the more you pay into the system, and the less you get out. Which means the people least able to pay need not fear the single payer being out of funds caring for the children of those who are not at risk of being harmed by money-based healthcare decision making.[/QUOTE]

What? Single supplier = monopoly. When, in the history of economics, has a monopoly led to lower costs for the consumer?

The NHS.

But that's because the NHS is not in any way, shape, or form measured on profits. It's given a set amount of money and told to treat patients for that. And great care is taken to insulate consultants from the direct impact of money.

The "insurance" model is designed, and works well for, cases that are relatively low-probability, but high cost if they do happen. This is a poor model to use for health maintenance, which everyone needs, and is relatively low cost.

Which are precisely the things the "Free at the point of delivery, paid for out of general taxation" model works really well for

 

[Enkhidu]

What? Single supplier = monopoly. When, in the history of economics, has a monopoly led to lower costs for the consumer?

Neonchameleon got it below already - when the supplier is willing to operate at break even or a loss. Governments or non-profits both fall into that category.

That may be, but single payer health programs aren't just about protecting people from catastrophic medical costs. They're also about making sure that medical care, including preventive care, is available to anybody who needs it regardless of their ability to pay for it.

Sort of nitpicky here, but even preventative medical care can be economically catastrophic costs for the very poor.

 

[Umbran]

And then there's the ridiculousness that is billing; I did some checking a while back and discovered that almost 75% of a hospital bill in the US is padding they don't expect to receive.

There was a time, a few years back, that my wife and I were temporarily without health insurance, and my wife needed some care. The bill hit - it was survivable, but I called the hospital billing department and asked about perhaps setting up a payment plan, to make it more manageable. I spoke with a fine lady, who, upon hearing that the whole bill was coming out of my pocket said, "Hold on a minute," I heard some fast typing over the phone, and she continued, "Okay, your balance is now $X", where X was slightly less than *half* of what I thought I was going to have to deal with. And this was without my making any complaint on the matter - the hospital simply had so much padding on those particular items that they could cut us some slack. I suspect they did it because lowering the bill means people are more likely to be able to pay completely and on time, which means less hunting down of small balances by the billing department. Either that, or this was just one really nice lady with rights to do stuff.

 

[billd91]

There was a time, a few years back, that my wife and I were temporarily without health insurance, and my wife needed some care. The bill hit - it was survivable, but I called the hospital billing department and asked about perhaps setting up a payment plan, to make it more manageable. I spoke with a fine lady, who, upon hearing that the whole bill was coming out of my pocket said, "Hold on a minute," I heard some fast typing over the phone, and she continued, "Okay, your balance is now $X", where X was slightly less than *half* of what I thought I was going to have to deal with. And this was without my making any complaint on the matter - the hospital simply had so much padding on those particular items that they could cut us some slack. I suspect they did it because lowering the bill means people are more likely to be able to pay completely and on time, which means less hunting down of small balances by the billing department. Either that, or this was just one really nice lady with rights to do stuff.

That's not just a nice lady, that's a pretty common element of hospital billing and revenue. If they're charging a private insurer, they'll charge substantially more than they will someone paying out of pocket. They use fatter fees from private insurers to balance the tighter reinbursements from Medicare and Medicaid and the write-offs from people who can't pay the bills while still keeping revenue up. And the insurance companies, of course, pass the cost of those fatter bills on to their subscribers.

 

[Janx]

There was a time, a few years back, that my wife and I were temporarily without health insurance, and my wife needed some care. The bill hit - it was survivable, but I called the hospital billing department and asked about perhaps setting up a payment plan, to make it more manageable. I spoke with a fine lady, who, upon hearing that the whole bill was coming out of my pocket said, "Hold on a minute," I heard some fast typing over the phone, and she continued, "Okay, your balance is now $X", where X was slightly less than *half* of what I thought I was going to have to deal with. And this was without my making any complaint on the matter - the hospital simply had so much padding on those particular items that they could cut us some slack. I suspect they did it because lowering the bill means people are more likely to be able to pay completely and on time, which means less hunting down of small balances by the billing department. Either that, or this was just one really nice lady with rights to do stuff.

I'd say you got lucky. Here's some stories I know personally or from the person directly:

a coworker had his first kid while he was a contractor. No insurance. Bill was double what his second kid was with the exact same procedures (c-section). Only difference was he had insurance. The hospital gave the insurance the agreed upon rate and fleeced the uninsured for the higher amount.

I have 3 kidney stones. Doc sent me to get the bathtub sonic stone-outame procedure scheduled. Day before the procedure, the hospital calls me asking how I'd like to pay the $10,000. Not a peep was mentioned when I was booking it that my insurance (aetna) wouldn't cover it. I canceled the procedure as I already have 2 car payments, each for that much money. Aetna can pay more that $10,000 when the stones try to kill me in a more expensive way. I expect to die of cancer or something thanks to their pattern of coverage.

I was sent to get a sleep study for my snoring. Since I don't go to the doctor a lot, I haven't touched my deductible. So I'm told that'll be a straight $2000 for that. Never mind that this required getting a pre-auth from the insurance, and is effectively to see if I have sleep apnea so I don't die and cost them more money.

One of my clients runs a business of scheduling patients for doctors to get diagnostics (MRIs, etc). It's free to the referring doctor. The client tries to find a good match for the patient to what place to run the test. Here's the catch. If they send you to MajorHospital that they have a contract with, they pay the hospital $500 for the MRI for you, and they file on your insurance for $2000 (that's roughly what insurance will pay on an MRI), making a tidy $1500 per patient they send there. They don't make money if they send you to some other rinky dink place near your house. They don't try to railroad you to the big place, but they are plenty happy when they can. One of the many reasons insurance is so pricey, is because of this kind of pricing shenanigans.

A buddy of mine did a stint working for LabCorp (or one of those). His team got new training on a new test that was developed to detect cancer in your poop. Then suddenly, that project was canceled. Why? Because all the hospitals had just spent a couple million on buttprobe machines and didn't want to invalidate the expenditure with a simple $30 test.

Just a few examples of the screwed up nature of the healthcare industry.

 

[Dannyalcatraz]

Just a few examples of the screwed up nature of the healthcare industry.

I'll give you more: a few years ago, my paternal grandmother had to undergo serious surgery. On the bill, the surgeon and the anesthesiologist- the guy doing the procedure, and the guy keeping her breathing and her heart beating- each charged $1500 for their services.

The InsCo compensated each $150, 1/10th of their fee. That wasn't enough to cover costs. And they had no remedy to recover the remaining 90% from her.

My father is in much the same boat: what he charges is almost irrelevant- the InsCos pay him what they feel. The reason he won't talk certain plans is because their compensation is completely divorced from his reality.

This kind of thing, BTW, is one of the reasons pure single payer is a hard sell in the USA: it's tough to work in a field in which you set a price based on your costs & making a profit, but someone else decides what you'll get paid. That is economic nonsense.

 

[Enkhidu]

...This kind of thing, BTW, is one of the reasons pure single payer is a hard sell in the USA: it's tough to work in a field in which you set a price based on your costs & making a profit, but someone else decides what you'll get paid. That is economic nonsense.

Eh, you get the same problems when you look at the mega-corps/supplier relationship. Walmart has been doing this for years.

 

[Kaodi]

While I would have thought this topic fell under those that were why political discussions were forbidden in the first place, I will bite I suppose...

I would like to go back to a point raised in one of the first posts that I am not sure was addressed later on: whether the (potential) father has a right to know. Actually, a related second point: whether this debate concerns men at all and women who cannot conceive.

I can accept perhaps that a man would not have a legal right to know for prudential and safety reasons pertaining to potential mothers that unfortunately persist in our society. However, I think a man does have a moral right to know. Rights conflict all the time, both legal and moral, and the right to safety is going to be the dominant one here. But to deny this knowledge to someone out of hand, when there is no expectation of risk to oneself, is neither neutral nor good morally. My go to inspiration on the abortion issue is Rosalind Hursthouse's classic Virtue Theory and Abortion, and it is from here I derive a notion that to treat men as intrinsically unimportant or unworthy in this process is to actively diminish their moral potential.

This goes to the issue of who should have an opinion on things as well. We can see plainly that many people in the World are just terrible and bent on making living well impossible for others. This has made discussion of feminism and women's right a fraught subject. But I am not sure I can think of any other field where someone would claim that biological capability in some kind of natural limiter on mental capability. The move to remove men from the subject is neither driven by natural or moral suitability, but rather by the practical difficulty that men in positions of power have created. And if someone wants to suggest men butt out of this debate they should frame it in these terms every time. To do otherwise is to just commit to specious reasoning.

Finally, a second-hand anecdote: I remember reading in the paper not to long ago that at one of those "pro-life" protests in Ottawa (I think it was Canada, and our capital at that), there was a group of younger people going on about how they were the "survivors" of the "abortion holocaust" . Which is, to my mind, complete and utter nonsense. Everyone born after abortion became legal is in fact the product of the "abortion holocaust" . Women having abortions was one of the infinite number of necessary conditions of their existence. That is just causality; you know, to tie this to what I was saying in that other thread.