> They are selling services without providing prices...
And it takes a state license for them to operate. The state could require them to provide an accurate and up-to-date price menu in order to remain in business.
I think the problem is also related to the opaque negotiated prices that "in network" providers negotiate with insurance companies, driving up the cost for uninsured or "out of network" consumers.
There are perfectly rational solutions short of single-payer.
Charlie Gard has nothing to do with single payer. In the UK, if the NHS won't fund something (normally because it doesn't work or is horrifically expensive - see NICE for the gory details) you're free to go private.
In Charlie Gard's case, the parents have raised the money to take him to the US for the pioneering 'treatment'. The court's barred them from taking him because they've ruled that doing so is not in his best interests, and that he should be allowed to die. Which is pretty damned unusual for the English courts, to be honest. And given he got a full hearing at the supreme court, and his own advocate, and it's not a matter of money, I'm inclined to believe the doctors and the judges.
But even if you think they're wrong, it's still not about single payer.
Single payer wasn't the problem with his case. No health insurance company would have voluntarily paid for an experimental treatment for him.
The state has power, even in the USA, to make decisions for the benefit of children if the state decides that the parents aren't acting in the best interest of the child.
There is a perfectly valid argument to be made that the state should not have intervened (this is subjective), but it had very little to do with the NHS being single payer.
And by choosing to use the single most emotionally charged case, you are also skipping all of the perfectly rational arguments against the broken health care system we have now.
In the U.S., the doctors do not have standing to appear in court and order treatment, or non-treatment, for a patient. That is solely up to the family, and if there is no family, the court appoints a guardian. There is no way this situation could have happened in the U.S., where the parents were forbid to pay for own treatment.
I think it does concern single-payer. I can only think of the quote, "A government powerful enough to give you everything you want, has the power to take everything you need away". In this case, where the government controls healthcare, it can make decisions for you, even if that is not what you want, or are willing to pay for yourself.
I'm not entirely sure that's true in the US, that people can make medical decisions on behalf of a minor without any legal coverage of whether it's in their best interests, but I'm not familiar enough with US law.
"One of the factors that influenced this decision was that Charlie’s brain was shown to be extensively damaged at a cellular level. The clinician in the US who is offering the treatment agrees that the experimental treatment will not reverse the brain damage that has already occurred.
The entire highly experienced UK team, all those who provided second opinions and the consultant instructed by the parents all agreed that further treatment would be futile – meaning it would be pointless or of no effective benefit."
Edit: oh yes, and the court submissions are interesting reading (via twitter:) https://t.co/Wjs7KrRWMU
> When the hospital was informed that the Professor had new laboratory findings causing him to believe NBT would be more beneficial to Charlie than he had previously opined, GOSH’s hope for Charlie and his parents was that that optimism would be confirmed. It was, therefore, with increasing surprise and disappointment that the hospital listened to the Professor’s fresh evidence to the Court. On 13 July he stated that not only had he not visited the hospital to examine Charlie but in addition, he had not read Charlie’s contemporaneous medical records or viewed Charlie’s brain imaging or read all of the second opinions about Charlie’s condition (obtained from experts all of whom had taken the opportunity to examine him and consider his records) or even read the Judge’s decision made on 11 April. Further, GOSH was concerned to hear the Professor state, for the first time, whilst in the witness box, that he retains a financial interest in some of the NBT compounds he proposed prescribing for Charlie. Devastatingly, the information obtained since 13 July gives no cause for optimism. Rather, it confirms that whilst NBT may well assist others in the future, it cannot and could not have assisted Charlie.
The issue is who gets to decide for the child. In the U.S. it's the parents, not the doctors or the court.
My concern is that if there is a single payer health care system here in the U.S., the patient will lose control of their health care decisions, as it appears the parents of Charlie Gard did.
Charlie Gard's parents were free to pay for experimental treatment throughout the course of his illness up until the point where legally they were stopped from doing something that was considered bad for him. Here in the UK we have a single payer public health service and privately paid services. People are free to choose which they use.
Even ignoring that fact though, the idea that hundreds of thousands of people should face financial ruin and all the negative societal effects that carries with it because extreme outliers need to be handled separately is an utterly broken way of running a healthcare system.
Note to bystanders: Trump mentioned Gard on Twitter; he's clearly being invoked in the context of the attempted Obamacare repeal. There is a very large industry invested in convincing people that healthcare that doesn't arbitrarily bankrupt people is a bad idea.
Yeah, it won't work. It works in every other developed nation in the world, and they all pay less money for better healthcare outcomes, but hey, the US is Totally Special.
> It works in every other developed nation in the world
The cost side works in every other developed nation? Surely you're aware of how much more expensive health care costs are in the US, so what might you be referring to?
Friend of mine ended up in hospital in the US for a while. He had an accountant visit him at his bedside! WTF does an accountant have to do with healthcare?!
The US already has single payer for a good fraction of the population and we still spend more than other nations on that fraction. The NHS in the UK can decide that certain treatments are not cost effective but in the US we have people raising the cry of "Death panels! Death panels!" at even vague gestures in that direction. And the US had never had a particularly high level of bureaucratic efficiency compared to most countries.
Which isn't to say that single payer wouldn't be an improvement on the current system. Just don't get your hopes up for how much money it'll save.
> The US already has single payer for a good fraction of the population
No, we don't. Medicare is not single payer, though it has (for a subset of the services covered by Medicare) a default public option; it also has private, partially-public-subsidized pland; Medicaid, at least in many states, is not single-payer, either, even at the state level, even before considering overlap with Medicare and other insurance.
Reminder: the US already spends more public money on healthcare as a percentage of GDP than Belgium, the UK, Switzerland, Finland, Canada and many others.
In addition to being wrong about the massive cost differential, this disparagement also ignores the fact that U.S. longevity hasn't kept pace for decades:
Before I answer this, let me frame my opinion: I very much want single payer in the United States, and were it plausible to do it on a state-by-state basis, I would support it.
Apparently, states are unable to restrict entry into state benefit programs such as healthcare. They can't set up a waiting period for people moving into the state before they are eligible; that was declared unconstitutional by a previous Supreme Court. So if states were to do their own single payer system, in theory sick people could move into the state and immediately gain free healthcare simply by virtue of being a resident. Conversely, they could then move back to their home state that doesn't charge higher taxes.
So it wouldn't be feasible on a state-by-state basis unless a future SCOTUS reverses their precedent. This is unlikely in the short term, given the current Court's make up.
> Changing things so all taxpayers are getting robbed rather than just the individual being treated
Government programs set maximum reimbursement rates and also mandate cost accounting mechanisms to assure that actual reimbursement is not merely within pre-set rates but also justified by actual provider costs. The government isn't buying services with no advance information about what the charges may be.
Private insurers impose similar controls.
So single payer (or even universal coverage through private insurers) eliminates the particular kind of “robbery” from undisclosed charges being discussed.
