A response to an old friend, and their belief in Single Payer Nirvana

A friend goes on for a bit about how single-payer is the one true path, and how NHS and CanHealth (NHS-Lite) are really great...

Note, I didn't say that I don't believe our system is fouled up to some extent. I am stating that I think that our current direction takes us from bad to worse, and that single-payer simply accelerates the process. I worry that, unsupervised, "efficiency" and "saving the taxpayer money" folks (recall that elected sorts, who've done so very well at other things, will be the ones allocating the funds and making the rules) will triumph over caregivers and individual patient interests..

I'd really much rather see us go from bad to better, but that doesn't appear to be in the cards at the moment. Small steps, letting each state find its' own way, seem the best bet to develop a system that works better...rather than putting all our bets on one option and hoping that we got it right. 50+ chances to get it right, rather than one big bet.

Some level of malpractice reform might be a good start. A subsidized catastrophic coverage policy for folks below a certain income level (both the income level and the threshold for "catastrophic" are separate discussions). A modification to EMTALA such that ER's aren't such huge money pits that hospitals are closing them. More community clinics, locally run and funded, operating on sliding scale. Legalizing shopping for insurance across state lines. Implementing high-risk pools for the uninsurable. Separating (as has one of my doctors) the practice of medicine from the practice of paperwork (he refuses ALL payment other than cash up front, but is happy to make records available to patients wanting to make claims with second or third parties - says he spends more time with patients, at lower cost, and is able to provide better care as a result than he could if he was running a paper mill....

I want to keep the gov't well out of it, though, because I count on government to keep an eye on both practitioners and insurers - and however limited they are in competence at that project, they will do far better than supervising themselves. Folks seem capable of EITHER "regulator" OR "regulatee" - but not both at the same time.