What is the best eay to ration health care? By need or ability to pay?

Simple question. How should health care be rationed in this country. Should those who need it the most get it first? Or those who can pay the most?

 

Or if ther is some other means by which you feel health care should be rationed out, please post it here.

 

That is really a good question. It really focuses the entire issue about health care.

I think there has to be a compromise position. It might be prohibitively expensive to provide unlimited health care to anyone based simply on need. On the other hand, I believe people should have access to basic health care regardless of ability to pay.

I think a mixed public/private system like we have for education might be best. Have a publicly funded (though taxes) government provided system of hospitals and health care that provides basic, but not unlimited health care. And then have a parallel private system where people who have the means can pay for a higher (or at least private based) level of care if they want to.

 

What is Single Payer?
Single-payer is a term used to describe a type of financing system. It refers to one entity acting as administrator, or “payer.” In the case of health care, a single-payer system would be setup such that one entity—a government run organization—would collect all health care fees, and pay out all health care costs. In the current US system, there are literally tens of thousands of different health care organizations—HMOs, billing agencies, etc. By having so many different payers of health care fees, there is an enormous amount of administrative waste generated in the system. (Just imagine how complex billing must be in a doctor’s office, when each insurance company requires a different form to be completed, has a different billing system, different billing contacts and phone numbers—it’s very confusing.) In a single-payer system, all hospitals, doctors, and other health care providers would bill one entity for their services. This alone reduces administrative waste greatly, and saves money, which can be used to provide care and insurance to those who currently don’t have it.

Access and Benefits

All Americans would receive comprehensive medical benefits under single payer. Coverage would include all medically necessary services, including rehabilitative, long-term, and home care; mental health care, prescription drugs, and medical supplies; and preventive and public health measures.

Care would be based on need, not on ability to pay.

Payment

Hospital billing would be virtually eliminated. Instead, hospitals would receive an annual lump-sum payment from the government to cover operating expenses—a “global budget.” A separate budget would cover such expenses as hospital expansion, the purchase of technology, marketing, etc.

Doctors would have three options for payment: fee-for-service, salaried positions in hospitals, and salaried positions within group practices or HMOs. Fees would be negotiated between a representative of the fee-for-service practitioners (such as the state medical society) and a state payment board. In most cases, government would serve as administrator, not employer.

Financing

The program would be federally financed and administered by a single public insurer at the state or regional level. Premiums, copayments, and deductibles would be eliminated. A single payer system as embodied in national legislation (H.R. 676) could be financed in several ways. One progressive option would be to fund it with a combination of existing federal and state revenues for health care, a payroll tax on employers (4-7 percent, much less that what employers pay today to provide less secure coverage), a 6 percent tax on unearned income, a 6 percent surtax on the highest 5 percent of income-earners, and a small tax on financial transactions.

Under this plan, 95 percent of people would pay less for health care. (Gerald Friedman, "Medicare for All" would save billions, and could be redistributive. Dollars and Sense, March/April 2012).

Administrative Savings

Harvard researchers estimate that administrative costs consume 31 cents of every health care dollar in the U.S. Slashing that to Canadian levels would save $400 billion annually, enough to cover all the uninsured and to improve coverage for everyone else. A study by the General Accounting Office estimated that single payer would save 10 percent on total health care costs by slashing administrative waste, enough to cover all the uninsured.

Cost Containment

Single payer is the only plan which features effective cost control measures like global budgeting, negotiated fees, bulk purchasing, and capital investment planning. As a result single payer can reduce the growth of health spending. Whereas health spending is projected to increase to 20 percent of GDP by 2020, if single payer were adopted in 2012 it could contain costs to 17 percent of GDP (Friedman, Dollars and Sense, 4/2012). A study by the Congressional Budget Office also projected that single payer could reduce health inflation.

Different Perspectives on the Benefits of Single-Payer

Patients

Each person, regardless of ability to pay would receive high-quality, comprehensive medical care, and the free choice of doctors and hospitals. Individuals would receive no bills, and copayment and deductibles would be eliminated. Most people would pay less overall for health care than they pay now.

Doctors

Doctors’ incomes would change little, though the disparity in income between specialties would shrink. The need for a “wallet biopsy” before treatment would be eliminated; time currently wasted on administrative duties could be channeled into providing care; and clinical decisions would no longer be dictated by insurance company policy.

Medical endorsements include PNHP (18,000), the American Public Health Association (30,000), American Association of Community Psychiatrists, Massachusetts Academy of Family Practice, American Medical Women’s Association (13,500), Alameda-Contra Costa Medical Society, American Medical Student’s Association, D.C. Medical Society, National Medical Association (6,500), American College of Physicians (Illinois Chapter), Long Island Dermatological Society, Islamic Medical Association, National Nurses United (160,000), American Nurses Association, the D.C. chapter of the American Medical Association, and the Hawaii Medical Association.

Hospitals

The massive numbers of administrative personnel needed to handle itemized billing to thousands of private insurance plans would no longer be needed. A negotiated “global budget” would cover operating expenses. Budgets for capital would be allocated separately based on health care priorities. Hospitals would no longer close because of unpaid bills.

Insurance Industry

The need for private insurance would be eliminated. One single payer bill currently in the House (H.R. 1200) would provide one percent of funding for retraining displaced insurance workers during its first few years of implementation.

Business

In general, businesses would see single payer limit their health costs and remove the burden of administering health insurance for their employees.

Congress

Single payer would be the simplest and most efficient health care plan that Congress could implement.

Physicians for a National Health Program
29 E Madison Suite 602, Chicago, IL 60602 ¤ Find us on a map
Phone (312) 782-6006 | Fax: (312) 782-6007 | email: info@pnhp.org

 

I am also a fan of the single payer UHC system implimented in other countries.

 

Who are we giving this power to determine "need"? IMO, ability to pay is the most fair way to determine who gets certain treatment.

 

A panel of bureaucrats, no doubt.

 

Of course: Adding more and more unnecessary government bureaucracy is the Progessive movement's answer to all of life's problems.

 

Need is the wrong choice. Whether you pay or someone else does, you still need it.

There is only one choice, rationing by cost. No dinero, no healthcare whether is is personal cost, insurance, or government. When you turn it over to government then healthcare tends to be structured for the lowest common denominator and by that I mean a bureaucrat decides what equipment is necessary and what healthcare is necessary and there is less incentive for innovation bringing healthcare to a lower standard for everyone.

 

If they just managed the vast amounts of wealth they already possess more efficiently and responsively, like the private sector, we could easily cover everyone who is "poor" or "unfortunate" with "basic" health coverage without running insane deficits and accumulating debt. I have heard an idea that mostly scientists, engineers, mathematicians and the like should be elected to governmental positions, as they would be far more efficient and data-oriented in their management. The problem is that the scientific community is not terribly amenable to politics given their reliance on REALITY to make decisions.

 

For the purpose of the question, it doesnt really matter. Lets just assume that whatever care that is recomended as needed, truely is needed.

 

Great plan for the 1%.

But not so great for those who because of their job or pre-existing condition can't get insurance.

Let the poorer folks die outside the emergency room. They deserve it anyway, right?

Thank God I'm not a conservative.

 

Good question, I picked need but think need and pay should be carefully balanced. Should a young working stiff get turned down for a life saving surgery because he lacks the money and insurance coverage? Should a rich person get the best health care just because they are rich? In a supposedly Christian Nation I would hope people get placed before money.

 

Missed the point I see. First, the 1% are not affected no matter what you do. Second, if you like long lines then you like government healthcare. That way you can die while waiting or like in Natasha Richardson's case, die because government did not fund for equipment.

Thank God I'm not a statist.

 

Government can never manage money well and never can because it runs on a 'needy' basis due to the fact it does not have to make a profit. I do like the idea of tapping the 'egghead' contingent in this country. I would NOT make them government wonks however, I would have them design a computerized system that supplants the FED. That would be a start.

 

Oh yeah healthcare..First off Doctors take an oath to treat those in need and here in the U.S. emergent need is fulfilled. The COST of that care is the question and the access to healthcare by those with limited funds for somewhat less emergent medical issues. So...the bottom line is $$$$.

 

Would a National Sales tax of 10% generate enough revenue?

 

erm...doctors maybe ? you know the ones with qualifications in medicine who can determine 'need' in such situations

 

yeah totally, cause thats what they do in other countries with universal health care, its totally politicians and pen pushers who make medical assessments all the time the last time I went to the ER I got my ankle set by an accountant would you believe

 

indeed, and cancer treatment can cause millions, does your average american have millions to spend to save their own life ? or their partners or child's ? of course they don't, the vast majority can't afford that, so it has to be decided on need not ability to pay or you are just selling life to the highest bidder, it can't possibly be seen to be fair that a poor man wouldnt get the same treatment for his illness as a rich man and the poor man would die and the rich man live, is that really the sort of society you want to live in ?

 

indeed, and cancer treatment can cause millions, does your average american have millions to spend to save their own life ? or their partners or child's ? of course they don't, the vast majority can't afford that, so it has to be decided on need not ability to pay or you are just selling life to the highest bidder, it can't possibly be seen to be fair that a poor man wouldnt get the same treatment for his illness as a rich man and the poor man would die and the rich man live, is that really the sort of society you want to live in ?

 

By need, generally. But there should be still low regulatory payments, just to keep useless procedures down and remind people that nothing is free. Also, a paralel private healthcare should be available, to get the best of both worlds.

 

What about on cost to benefit why spend more for a new drug unless there is a serious benefit over older less expensive treatments at are "good enough"?

 

I live in Russia my job is connected with health care ( medical equipment ). I often go on business trips to hospitals of different cities. I see the construction of new hospitals, repairing old, equipping hospitals with new equipment. It is part of a larger national program to modernize health care But at the same time healthcare remains largely free ...

.For example : Last year my mother ( she is 79 ) broke her leg . She is also diabetic . She spend in hospital about 3 weeks . She underwent surgery and a titanium implant was inserted in her leg . A month later she was able to walk. It cost our family about 1000 $ for titanium implant that she chose instead stainless , stainless implant was free . Of course you should have medical insuranse for this , but it is also free . Certainly not all everytime is so well, sometimes there is a veiled extortion from the part of medical staff ,and conditions in public hospitals are not very comfortable.

When my little daughter is sick and has a fever, I call the hospital and pediatrician comes to us and prescribes medicine. Or ambulance arrives. It is also free.


But there are also private clinics. They are expensive, more comfortable, but the result better than in public hospitals is not guaranteed...There is meaningful only if you want to quickly make some analysis .

 

What Cuba Can Teach Us About Health Care


http://www.wired.com/wiredscience/2010/04/cuban-health-lessons/