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Open Medicine vs. Single-Payor Healthcare

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Since the launch of 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.

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Comments (4)

Submitted by hippocrates on Sun, 11/27/2005 - 2:22pm.

Over at Dr.Helen's blog, there is a lively debate over single-payor healthcare. Both sides accuse each other of relying on "anecdotes and propaganda" rather than facts. Another reason to encourage healthcare information openness to get to the bottom of the issue. We are long way off.

Submitted by Bill Lottero (not verified) on Fri, 08/11/2006 - 11:28am.

Hippocrates asserts that single payor system has government as payor and as owner of infrastructure. That is not true. A single payor system can combined all existing government funded health treatment funding streams like Ryan White Dollars, Maternal and Child Health Funding, SAMSA funding and others. It can then tax all citizens according to a many reasonable approaches and thus capitalize (with relatively low tax burden) one single payment stream. Efficiencies of this model include the single payor power to negotiate price, the spreading of risk across a giant pool instead of fractured risk pools inherent in private insurance models. The basic coverage of the single payor would be as rich as any top notch blue cross plan we now have. Supplemental insurance can be private and be added by those of wealth as they choose.

Hippocrates asserts that a single payor system must resort to rationing and points to the apocryphal stories of those citizens of the Canada and UK models who must wait for elective surgery.  (Please take in the meaning of elective in elective surgery)  This is a misleading argument as all health care systems are rationing systems. Some are more rational in their rationing. Clearly the US rationing system, which has 44 million uninsured, is one rationing method. But I doubt one would argue that it is rational. Furthermore the rationing effect of longer waits for elective surgery in the UK or Canada model can be overcome, when their citizens purchase supplemental insurance. No one is saying that wealth does not have influence not receive preference in these systems. The US system currently has no rational approach nor will market force cure it. No market system will remove the reality that those who are wealthier may be advantaged over those with less. However, a single payor system would ensure all necessary health care is equitably distributed. Indeed distributive justice is at the core of all of these discussions.

Finally Hippocrates asserted that there was only anecdotal evidence for the success of a single payor system, that facts on these models’ success are not available. How is it that he disregards the objective metrics for both the per capital cost difference and the outcome measurement differences of all the industrialized nations various single payor systems e.g. France, Germany, Australia, UK, Canada, Japan...

Submitted by hippocrates on Tue, 08/15/2006 - 1:02am.

Bill - get your facts straight.

Any healthcare system, single payor or private insurance involves rationing, since there are limited $$$ to pay for all care in the insurance pool. The difference is under single payor all decisions are made by the wise, all-knowing politicians and bureaucrats, while consumers and physicians have to put up or shut up. In Canada, purchasing care on private market was a crime until the landmark Supreme Court decision.

Who wants to turn all their life-and-death decision to our Congress with 20-30% approval rating that is spending the nation into bankruptcy? State legislatures are not far behind.

Take a clue from FDR. When the Great Depression hit he did not abolish capitalism but fixed it through better regulation and transparency. This was of course a blow to commies who wanted to use hard times as an excuse to push their ideology. 50 years later socialism and central planning are defeated globally and capitalism is doing fine, thanks.

Single payor has nothing to do with solving real problems. If it was, why criminalize the private healthcare financing?

Submitted by Anonymous (not verified) on Sat, 10/10/2009 - 8:46am.

when you start your defence of the single payor plan, i would suggest that you get all of your FACTS straight..your 44 million uninsured number has been revised yet again, just so that you know...we need to step back (more time) and have a serious debate (not rush rush rush) over how to best solve the Health Care issues..screw and do it, HIGHER TAXES FOR EVERYONE isn't the solution.

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