medpundit |
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Wednesday, August 22, 2007In the US single payer will not be rationally managed or centrally administered. It will have a myriad of interest groups chasing a finite pot of money; and Congress, the Executive Branch, and any "Boards" or other entities designated as the real decisionmakers (there to keep the costs down, through market power and rational planning) will form a tripartite hydra-headed policymaking mess. And public demands for care will fuel the rest (and fuel the politicos). Health care will continue to be politicized and pressures will always grow to add more and more benefits while running up costs. And always to extend all those benefits to more and more people: do you think the illegal immigrant eligibility issue will not arise? Benefits paid for by citizens for citizens will ultimately - maybe not at first, in order to get it passed - disappear, because political choices will be made to increase costs by expanding eligibility to more people. And of course, there will always be a need to have more, and more, and more, managers of the system - not care providers, but those who look over the shoulders of those who provide care; they'll be needed to carefully and extensively consider the cost benefit of each victim of the system - and there will be untold numbers of appeals, because we are Americans and used to getting our way with health care. The single payer crowd would like a docile population blanketed by rules and regulations, but how often do you think the single payer system is going to say no, when a dispute over care becomes politicized or media-sponsored? It'll be forced to change by laws, or it will agree to change in order to get something else out of the policy makers. The upshot is those with little or no political power in this system will suffer the worst in terms of care and access to procedures. We have to keep costs down, the bureaucrats will explain soberly. You may say this happens now, but how will single payer be fdifferent, except to shift the shaft? Where else will savings be made to pay for the steadily growing costs? Capital programs to renovate or modernize equipment and facilities; drug costs (so that research and development, AS WELL AS profligate marketing, will suffer), and providers themselves will be paid on the cheap (much as they are now whenever medicaid or medicare have problems - or benefit expansions are proposed). There has got to be a better way of providing medical care than single payer. Those who want it are demanding we move to something that does not compare well in care or cost, really, with societies similar to ours. That's what I keep asking myself. Why do people think that a single-payer system would be any better than Medicare or Medicaid? The way things work now, Medicare gets the gold (more political clout in the over-65 population) and Medicaid gets the shaft (absolutely no political clout in that population). posted by Sydney on 8/22/2007 09:33:00 PM 0 comments 0 Comments: |
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