Newsgroups: bit.listserv.politics
Date:         Tue, 21 Jul 1992 16:36:44 -0700
From:         Andy Freeman <andy@SAIL.STANFORD.EDU>
Subject:      Re: Consumer Reports on US health care

>>present in the above.)  It turns out that the low rank is due entirely
>>to certain subpopulations and their non-participation in pre-natal
>>care.  An interesting experiment has been tried; FREE pre-natal care
>>was offered to them.  The result; no takers.  Short of quartering
>>health troops, we can't do anything about that.
>>
>Interesting experiment.  How long did it last?

It's still going on in a number of urban areas.  It wasn't a single
brief experiment; it was a public health program.  It had results; why
do you insist experience is not relevant?

BTW - It's nice to see "data quality questions", but they're
asked only of arguments on one side of a question, some might
get the wrong impression.*

>Was the care at these free clinics comparable to non-free clinics or
>well paid obstetricians?

People who don't show up wouldn't know, so that can't be all that
relevant.

It was done by competent people who really wanted to show that they
had a program that worked.  These folks want to get govt money for
this program, so they're not going to skew the experience against it.

Were the
>mothers treated as important individuals or as nameless welfare cases?
>Were the clinics (assuming there was more than one for the metropolitan
>area) accessible to the subpopulation?  Did the mothers even know such
>a clinic existed?

No, it wasn't run like a typical govt program.  However, if you're
going to argue for govt health programs, you don't want to mention
govt programs.  (Yes, a govt-payer system will start looking like a
govt-controlled then run system.  Money has strings and the govt likes
to be involved in the spending.)

>>The GAO always thinks that a single govt payer is more efficient; it
>>happens to be wrong.  There's no reason to believe that a single payer
>>system can actually increase spending effectiveness, so assuming that
>>it can eliminate unnecessary procedures is pure fantasy.
>>
>Which ignores the reduced costs faced by countries that have a single
>payer system.  Any empirical evidence that the GAO is wrong about a
>single payer system, or is it merely speculation based on extrapolation?

Lower costs for different services in a different population aren't
interesting.

We have several single payer systems in the US.  Which two do you want
to use as examples?  Why will health care be significantly better than
the typical single payer system in the US?

>A single payer system has nothing to do with eliminating the cost of
>unnecessary procedures, merely the huge administrative costs faced
>in this country.  The assertion was that by doing both we could
>reduce costs for those who pay, or have care for all with no
>increase in costs.

Hold it.  The report under discussion discussed two sources of savings
that would be used for paying for health care for those who aren't
getting it now.  One was administrative costs while the other was
unnecessary procedures.  Granting EVERY assumption made by the single
payer advocates, we're left with "If a single payer system can't
deliver BOTH, it can't produce the promised results".  If the single
payer system can't deliver, then how is it going to?

>>BTW - Some of those "unnecessary" procedures may be medically
>>unnecessary, but that doesn't mean that they are actually unnecessary.
>>
>Another non sequitur.  Does actually necessary mean necessary for
>the specialist to make his yacht payments?

Patients have needs other than the medical, even if they use medical
means to satisfy them.  (Note that "defensive" care falls into this
category.)

BTW - It doesn't cost that much to set up a health payer system.
(It's easy to sign up physicians if you're willing to pay them and no
one has suggested that we're going to enslave them.)  If you set one
up yourself, you can decide on adminstrative requirements, membership
constraints and services offered, which will have some effect on
price.  If you're really sure that you can do better (which is implied
by the arguments) and this is is as important as you claim, it's wrong
for you to not do so.

You'll make a buck or two, you'll provide better benefits to others,
and you'll drive the incompetent insurance companies out of biz.  That
sure looks like a moral imperative.  All gain, no pain, if you're right.

If you're willing to bet your money on your beliefs, I'll do so also.
Any takers?

-andy finds that personal risk is a great way to find out if someone
      usefully believes what he's talking about

* - Religious beliefs are not prone to disproof.  Is there any
evidence that the "single payer for US health care" advocates would
accept as showing "if that's true, single payer systems won't work
here"?  Or, is this a "anything that supports our position is good,
regardless of whether or not it is true, while anything that doesn't
is wrong" issue?
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