Tuesday, July 03, 2007

Single-Payer Systems

Sicko may be Michael Moore's best film yet, but I do not agree with him that a single-payer system is the way to go. Both the UK and France have a mix of public and private healthcare providers, while Canada is the poster child of a single-payer system. Interestingly short films to counter Sicko are starting to appear on YouTube, and organizations like Timely Medical Alternatives are being cited by opponents of a single-payer system.

Moore cites the postal service and the school system as examples of where the government plays a large role, and concludes that the medical system is too important to leave to private entities. While I use the US Postal Service 90% of the time, I do like having the choice of using UPS or FedEx when I want to really track my packages (the US Postal Service tracking pales in comparison). Similarly, some parents prefer sending their kids to private educational institutions. Politically speaking, it is easier to sell a system that gives people choices.

Ideally we make Medicare available to anyone who wants it, and let the HMO's compete with Medicare. The competition will make both systems more "customer friendly" and we all benefit from having a responsive system. I think most people will opt to use the Medicare system for all but a few of their needs, while some people will opt to go with HMO's completely.

The devil is in the details of course. To lower costs, the US system needs to streamline its Information Technology and billing/claims systems, have meaningful TORT reform to lower malpractice insurance, lessen the grip of the AMA and allow foreign trained family doctors an easier path towards practicing in the U.S., allow Medicare to negotiate directly with pharma, etc. These recommendations alone imply going against lobbyists representing lawyers, doctors, and big pharma! Perhaps electoral reform (i.e. public financing of elections, instant runoff, etc.) is the necessary first step to have any meaningful shot at getting things done. Hmmm, electoral reform sounds like the perfect topic for the next Michael Moore film :-)

At the end of the day, any national healthcare system has to scale to 300M people, and still pay for itself. Tax increases may need to be part of the equation. Immigration reform will need to be enacted: the U.S. has legal and illegal immigrants on a scale that other developed nations would have a hard time absorbing.

Most importantly, as Michael Moore points out, there needs to be an adjustment in attitude in the U.S. We need to go " ... from a nation of me's, to a nation of we's".

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