Since the launch of www.healthvoices.com we received lots of feedback on our ideas, some anticipated and some unexpected.
One such tidbit was comparison of our vision of Open Medicine with the political advocacy of Single Payor Healthcare. Indeed both movements are attempting to fix our dysfunctional healthcare system. What do they have in common and what is different?
To start off, we would categorize the problems of the American healthcare system (sometimes affectionally referred to as "The Matrix") into two separate mis-alignments: of the money flow and of the information flow.
The goal of single-payor healthcare is to restructure the financing system, in the process creating universal coverage. If implemented, it would change where the money is coming from (taxes) and who controls access to care (public agencies). There are plenty of arguments both for and against such change. Few people object to the goal of achieving the universal coverage, however opinions differ on whether a single-payer system is the best solution. At the core of the controversy is the argument of whether it will really reduce the overhead and whether consumers will be able to get greater control of their care if they are not paying for it directly.
This is where Open Medicine comes in.
Both supporters and opponents of the single-payer healthcare are passionate in arguing their case. Yet, there is very little hard data to support it either way. We do have anecdotal horror stories from both sides. Of people dying in the United States because HMO did not authorize treatment (profit motive). Of people dying in Canada because the waiting list for their procedure was over a year (rationing). Both cases are equally troubling. And how does this argument scale system-wide?
The idea of Open Medicine is about restructuring the information flow in the healthcare system. The reliability of treatment and payment decisions made in the system is only as good as information used to support them. No matter whether it is done directly by consumers or health plans, employers or government acting on their behalf. No matter who pays for it in the end.
Without opening up the healthcare clinical and financial information flows to the consumer and general public there is no way to make an honest comparison of the financing systems. There could be an open market-based healthcare system that works well (not what we have now) or a secretive single-payer that hides unpleasant facts, such as rationing and reduced choice (which are common criticisms).
We think that openness must come first. Once it happens the society can make honest financing tradeoffs that reflect the prevaling values and priorities.