Understanding single-payer health care; can you say rationing or perhaps more friendly; medically necessary?

Promises, promises. let’s make health care free; cover virtually all services and save lot’s of money in the process. Hey, they do it in Europe, right? Not exactly, and that’s a little secret those trying to buy your vote don’t talk about. The fact is you can’t have it all and not pay for it one way or the other. 

I have been trying to point that out for years and most recently related to the Sanders Medicare for all plan. Sanders simply fails to understand that Americans view health care very differently than Europeans (even if they don’t know it). 😷 

Here is another take on the subject. 

Bloomberg View 1-21-16. 

European countries manage to keep their health spending down by reducing patient choices on diagnostic tests, new technologies, expensive drugs and costly procedures such as hip and knee replacements to what their governments define as “medically necessary.” Administrators and physician panels, not patients, decide what’s necessary. Another word for this is rationing.

Rationing would have to take place under the Sanders plan, too. He would have a “board of medical experts” decide which elective procedures, cosmetic surgeries or prescription drugs patients could get.

The U.S. spends about $3 trillion a year on health care, or about $10,000 a person. Sanders claims that, by getting rid of third-party claims processing and the need for insurers to make a profit, and by making the health system more efficient, he could cut $10 trillion over 10 years in costs.

But as my colleague Megan McArdle wrote, what Sanders is really saying is that, after cutting out insurers, he’d still somehow force about a third to a fifth of existing costs out of hands-on patient care. And that means hospitals and doctors would have to accept far less in reimbursements. Patients would go from fighting insurers over claims to fighting the federal government to approve the procedures they want to have and the specialists they want to see.

Politically, it’s a hard sell. Remember the ruckus during the Obamacare debate over a comparatively modest proposal to let Medicare cover end-of-life patient-care counseling? Opponents likened the counseling boards to “death panels” and the proposal died. What’s more, Sanders conflates “healthier” with “happier” by failing to see that what makes Americans happy is good health plus the ability to see specialist doctors when they want, obtain second and third opinions and have aging body parts replaced so they can keep playing tennis past their prime years.   


5 replies »

  1. It is not about having “it all and not pay(ing) for it”. It is about having it all and having someone else pay for it. Bernie is promising what Americans really want. You can quote me as I have been saying the same thing over and over since I attended a federal government financed focus group “Health Care That Works For All Americans” in Cincinnati back in 2004 – It is clear that “American’s want the best health care YOUR money will buy.”

    Bernie is promising others will pay for your coverage and medical needs.


  2. We have to make choices every day to buy something or not to save money. Why not healthcare. I saw where a drug that cost $10,000, may extend a terminal patient’s life 3 to 6 months. Is that really a good use of healthcare dollars. At some point we have to ask is it worth it. Extend someones life .7%, that has already lived 70 years. I do not know the answer, but sometimes someone has to make the call. What if a drug was not available, we would use the healthcare dollars for something else.
    Everyone knows smoking is bad for you, so do we pay for a $500,000 lung transplant for someone who was a life long smoker, or do we use the money to treat childhood cancer? With limited dollars and an aging population, we are going to have some tough questions ahead. I do not know who is in a better position to make the choices, is it really the doctors who work for the hospitals that make more money the more test done per patient? A government panel of doctors approving medications at the FDA do not seam to have much of a good track record. When money is involved motives are skewed.


  3. I do not think you have to look to Europe for examples of rationing. In some areas of America, patients die waiting for appointments at VA hospitals and clinics. If the federal government cannot run a hospital system for a small percentage of the population, our vets, why does anyone think they will be able to run a system serving 325+ million people?


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