SOCIALIZED MEDICINE VS. SINGLE-PAYER

Advocates of “single-payer� health care become very touchy when it is equated with socialized medicine. And this is understandable. They wish to depict government-run health care in a positive light, and socialized medicine has a well-deserved reputation for inefficiency and poor care.

But is there any real difference, in practice, between these two types of government-run systems? As it happens, both versions have been in the news recently, and the reports suggest that “single-payer� health care and socialized medicine produce equally dismal outcomes. 

Great Britain’s National Health Service is, of course, a socialized system. The Daily Mail reports on a new study confirming the NHS as an utterly abominable health care system:

The study found that the Health Service is still one of Europe’s worst healthcare providers, in the same league as countries such as Slovenia and Hungary which spend far less on health.

Why? Well, among other problems, the NHS produces abysmal cancer survival rates:

The study backs up a recent Italian report which placed Britain near the bottom of a European table for the chances of its patients still being alive five years after being diagnosed with cancer.

Meanwhile, in Australia’s “single-payer� health care system is also letting its patients down. The Sydney Morning Herald reports the following:

Thousands of X-rays and other medical scans are not being interpreted by radiologists in Sydney hospitals because of outdated technology and a national shortage of radiologists.

And this has dire implications for Australian patients:

The Opposition health spokeswoman, Jillian Skinner, said the backlog at some hospitals was putting patients in danger by delaying the diagnosis of potential conditions, including cancer. 

Outdated technology, physician shortages, patients at risk—this is government-run health care. And government-run health care, whatever you call it, always produces the same unacceptable results.

Comments 15

  1. Matt wrote:

    OK, you’ve convinced me, it’s a bad idea. What’s your plan?

    Posted 06 Oct 2007 at 10:38 pm
  2. Catron wrote:

    Same answer as the last time you asked this question. Basically, a reduction in the government’s role in the system.

    Posted 07 Oct 2007 at 7:57 am
  3. Matt wrote:

    “deregulation and tax reform”? OK, in what way? How are you reforming the tax code and what are you deregulating? And what effect will it have?

    Posted 07 Oct 2007 at 8:19 am
  4. Marc Brown wrote:

    Funny how we are still getting endless stuff from abroad but still nothing from the US. What exactly will ‘ a reduction in the government’s role in the system’ achieve if there’s nothing to fix?

    For the record, comparing cancer survival is fraught with difficulties – the reason why the UK comes out lower is because we have one fo the most complete cancer registries – the US does well because you’re often counting conditions that would never have threatened survival, and also of course many people – especially the uninsured- fall outside the stats altogether.

    As for breast radiology, that’s long been a shambles in the US. Some 40% of your mammography units fail to meet federal guidelines each year. Your Institute of Medicine, in a 2004 reports, notes this – just one of several cutting points:

    ‘In the United States no organization collects or monitors data to promote high performance levels and guidelines are only voluntary. (The Mammography Quality Standards Act [MQSA] requires facilities in the United States to collect quality data for internal use, but does not require the facilities to use the data in any specific or documented approach for quality improvement.)

    In Sweden and the Netherlands, which both report low rates of false positives, screening takes place in outlying centers and diagnosis and’workup takes place in centralized facilities. Great Britain has developed a quality assurance self-assessment program, the only one of its kind in the world, which, while voluntary, is used by 90 percent of that nation’s radiologists to identify weaknesses and improve interpretive skills.

    By contrast, in the United States screening services are rarely integrated within a comprehensive breast cancer center, and typically separated from treatment, counseling, and support services. The MQSA addressed the technical quality of mammograms, but does not require standards to improve delivery of services and quality of interpretation, or quality assurance and a continuing education program intended to enhance the accuracy of interpretation.

    To improve services in the United States, the committee recommended:

    Health care providers and payers should consider adopting elements of successful breast cancer screening programs from other countries. Such programs involve centralized expert interpretation in regionalized programs, outcome analysis, and benchmarking. (Recommendation A1)

    At this time, one of the few regulations directly relating to the quality of interpretation in the United States requires physicians who interpret mammograms to read a minimum of 960 exams in a 24-month period, which averages out to 480 per year. By comparison, breast imaging specialists in the United Kingdom are required to read at least 5,000 each year.’

    Come on David – at least get real.

    Posted 07 Oct 2007 at 1:59 pm
  5. C M Hughes, MD wrote:

    In the frontlines of healthcare FINANCE? (From your “about me.”) I guess this explains a lot, particularly the aversion to a system which will gut thousands of jobs like yours, hopefully. I do not wish you unemployment, rather I wish you useful, meaningful employment in some other sector of the economy. (How many people do you suppose are in the trenches of healthcare finance around the world? And how many trained nurses in other countries are working in the health insurance industry?)

    I don’t have time to rebut all of the silliness in this post, so I suggest you go over to my blog and click on “rationing” and Private health insurance” and especially US/World comparisons.

    But I will say this, the reason we don’t like equating single payer with a socialized system is because they AREN’T EQUAL! Socialized systems, like England’s, are ones in which the government owns everything, like our VA. You know, the socialized system that provides the POTUS with his healthcare. The one that has been transformed into the premier healthcare delivery system in the US. (Click on my VA links for more about this.)

    Single Payer systems, like the most succesful systems around the world, are like our Medicare and medicaid programs. The best ones are funded appropriately and fairly. Some of the major problems with both Socialized and Single payer systems occur when governments try to skimp and underfund to the detriment of their populations.

    Cheers,

    Posted 08 Oct 2007 at 6:44 pm
  6. Catron wrote:

    The reason we don’t like equating single payer with a socialized system is because they AREN’T EQUAL!

    Ah … But their effects ARE. The essence of socialized medicine is not in the nominal ownership of the providers, but in the idea that central government planning is somehow superior to the operation of the market. History has shown that to be a delusion.

    But, since we already have a single-payer system (called Medicare), we don’t have to speculate about the inefficiency of such systems. Here’s a Health Affairs piece that explores but a few of that program’s many flaws.

    Oh, and BTW, if my position on this were based on my personal employment status, I would be ecstatic about single-payer health care. For one thing, I can make a great living helping financially naive physicians excavate themselves from beneath the mountain of problems under which government-run heath care would inevitably bury them.

    Posted 08 Oct 2007 at 7:37 pm
  7. Matt wrote:

    Unfortunately, your position consists solely of being an “aginner”, with little in the way of positive action for change. Other than vague platitudes about tax code changes and “deregulation”. If there’s more to your position than just those terms, I’d be interested to hear it and what you think your proposals will accomplish. Although, your theory that Medicare should pay physicians more is somewhat odd, given that you give no clue how you would pay for this increased cost.

    Or maybe your position is that hey, healthcare is expensive and should be and I like the status quo. It’s a valued commodity. Which is fine, but just say so.

    We get how you feel about single payer, so the question is now what do YOU think we should do?

    Posted 08 Oct 2007 at 8:15 pm
  8. Catron wrote:

    Matt, you need to get some new material. Asking the same question over and over again is not interesting.

    Here, however, is something that IS interesting. It discusses insurance market distortions caused by government, and how they can be ameliorated.

    Posted 08 Oct 2007 at 8:45 pm
  9. Matt wrote:

    I have to keep asking because you won’t answer what you would do beyond vague statements. Is the link you posted your answer? Coupled with increased medicare reimbursements?

    Seriously, you have clearly studied this at length. I am interested in your proposals.

    Posted 09 Oct 2007 at 7:30 am
  10. Catron wrote:

    Sigh ….

    Posted 09 Oct 2007 at 8:36 am
  11. Matt wrote:

    Indeed, it’s exhausting trying to get straight answers from you.

    Posted 09 Oct 2007 at 11:22 am
  12. Marc Brown wrote:

    ‘For one thing, I can make a great living helping financially naive physicians excavate themselves from beneath the mountain of problems under which government-run heath care would inevitably bury them.’

    I guess you’ve forgotten your comprehensive rebttal by Ron Chusid:

    ‘For over twenty years I’ve been involved in the billing and administration of a medical practice. Every week I see what is and what is not paid, and where my staff wastes time fighting with insurers. Medicare is the least of our problems. Generally we submint a claim to Medicare electronically and in about three weeks we have a check. When there is a rejection I can usually go on line to their web site and find the pertinent rules so that I can adust the claim to get it paid. My staff often spends hours on the phone trying to fix problems with other insurers.’

    Posted 09 Oct 2007 at 2:43 pm
  13. Catron wrote:

    Chusid is a prime example of the kind of doc I’m talking about. His comments on Medicare are hopelessly naive.

    I can pretty much guarantee that his practice incurs significant losses every year pursuant to his self-complacent cluelessness. I have been called in on many occasions to prevent such hardheads from going bankrupt or getting into serious compliance trouble with CMS.

    Posted 09 Oct 2007 at 2:59 pm
  14. C M Hughes, MD wrote:

    Oooh, my hero!

    I’ve poked around here in your blog, and I agree with Marc, you really have the bean counter’s sense of the world. You demonstrate no real knowledge of healthcare, and by that, I mean the taking care of sick people part. The putting yourself in their shoes part. The seeing wasted healthcare dollars by private insurers (beyond Medicare stupidest dreams). You understand finance, apparently. Good for you. So do the people in the French, Belgian and other well functioning systems where all are covered and all share the benefits and burdens based upon need, not income.

    Good luck with that. Do you think God will put you with the Sheep or the Goats at the end (Matthew 25)?

    BTW, I could make lots of comments abut your apparent “self complacent cluelessness,” but that would bea cheap shot.

    Cheers,
    Cheers,

    Posted 09 Oct 2007 at 9:53 pm
  15. Catron wrote:

    You really have the bean counter’s sense of the world.

    If you weren’t so busy with your moral preening, Chris, you’d realize that this sort of comment proves my point.

    Posted 09 Oct 2007 at 10:13 pm

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