Single Payer System does NOT provide all treatments

[azhiker96, BSN, RN]

On these forums I've seen the issue of changing to a government run single payer system, such as the NHS in the UK, come up repeatedly. It sounds great, everybody is covered for everything they need. However, I wondered if that were true so I cranked up Google and did a single search for "NHS denies treatment". It took 0.17 seconds to find just over 50k references.

Apparently, Prostrate treatments are denied,

Arthritis drugs and other drugs are denied,

and A Mother of four denied breast cancer treatment.

The main thing I find is treatments are rationed because there simply is not enough money to provide everything for everyone. This is not limited to cosmetic or elective procedures.

NHS Rationing leads to Patient Deaths.

Anyway, I just wanted to take a closer look at the model before it comes up in elections. If we go to a government system, we have to be prepared to explain to an occasional patient that there is a treatment but the government will not pay for it.

[pickledpepperRN]

I'm away from home sharing a friends lap top.

With Single payer the providers of care stay the same. They must compete because everyone can really choose their provider.

Now most of us muct "choose" from "preferred providers" in a book.

It is NOT socialized medicine like they have in Great Britian where the providers are employees of the government. Our Veterans Administration and military healthcare are examples of American socialized medicine.

Single payer will have the government the insurer such as our current Medicare.

Here is one link. I'm sure others will add more information.

http://www.guaranteedhealthcare.org/facts

[pickledpepperRN]

I do think that IF the American people were to condone denial of care in OUR health system it could happen here.

It does now too.

I think we are a kind people who will want to ensure that so long as we are guaranteed we get the care we need we won't begridge paying our tsaxes so others also are cared for.

After all it could be our family next.

THAT is what insurance is about.

[Jolie, BSN]

Call it rationing, age limits, denial of care, whatever you like. It will happen with any system. Those who decry limits of private insurance policies are naive to believe that a single-payor or government system will be any different. The government plans already in existence (Medicare, Medicaid, and military health plans) have limitations and deny care in certain circumstances, just as private plans do.

It simply is not financially feasable under any system to provide unlimited care to everyone in every situation.

[HM2VikingRN, RN]

I thinnk the goals of any system need to be patient centered, fairness, equity and evidence based care.

The prostate cancer issue relates to evidence of effectiveness issues:

Instead of it being available to all prostate cancer sufferers, it will now be restricted only to those who have already failed to respond to conventional treatment and whose cancer has returned.

I think that with a political process involved that new treatments will be added. They must prove to be effective through research.

[azhiker96, BSN, RN]

The prostate treatment is not being limited due to a lack of evidence if it's effectiveness.

The groundbreaking ultrasound therapy has been shown to kill nine out of 10 prostate tumours, and five years after treatment, 80 per cent of patients show no sign of the cancer recurring.

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Compared with surgery or conventional radiotherapy treatment, it is not invasive and is far less likely to lead to devastating side effects such as impotence or incontinence.

It's simply economics. They want to use the cheapest treatment possible. While that is a laudable goal, the patient is out of the loop on deciding what treatment they prefer.

I do agree a single payer system will help solve confusion, especially when there is overlapping coverage, Medicare, Kaiser, United coverage confusion.

And our legislative process can work to fix problems when they arise, Utah Medicare patients denied treatment.

For an eye-opener, go to www.medicare.gov. Check out the coverage for different procedures in your state. I found that for anesthesia for outpatient surgery, I get to pay 20% of the medicare approved amount after I pay a $131 deductible. Not free but not too bad either.

[MBANurse]

I thinnk the goals of any system need to be patient centered, fairness, equity and evidence based care.

The prostate cancer issue relates to evidence of effectiveness issues:

I think that with a political process involved that new treatments will be added. They must prove to be effective through research.

Yet, I believe that I saw posts from you in the thread about the young lady that died awaiting a liver transplant about how the denial of her procedure was nothing but pure evil by the insurance company. How can you be so supportive of the government denying a claim; but not of insurance denying claims?

[HM2VikingRN, RN]

I am not supportive of government denying claims. I am supportive of evidence based practice.

See:

There is a myth that, with national health insurance, the government will be making the medical decisions. But in a publicly-financed, universal health care system medical decisions are left to the patient and doctor, as they should be. This is true even in the countries like the UK and Spain that have socialized medicine.

In a public system the public has a say in how it’s run. Cost containment measures are publicly managed at the state level by an elected and appointed body that represents the people of that state. This body decides on the benefit package, negotiates doctor fees and hospital budgets. It also is responsible for health planning and the distribution of expensive technology.

The benefit package people will receive will not be decided upon by the legislature, but by the appointed body that represents all state residents in consultation with medical experts in all fields of medicine.

Source: http://www.pnhp.org/facts/singlepayer_faq.php#run_healthcare_system

[MBANurse]

I am not supportive of government denying claims. I am supportive of evidence based practice.

See:

There is a myth that, with national health insurance, the government will be making the medical decisions. But in a publicly-financed, universal health care system medical decisions are left to the patient and doctor, as they should be. This is true even in the countries like the UK and Spain that have socialized medicine.

In a public system the public has a say in how it's run. Cost containment measures are publicly managed at the state level by an elected and appointed body that represents the people of that state. This body decides on the benefit package, negotiates doctor fees and hospital budgets. It also is responsible for health planning and the distribution of expensive technology.

The benefit package people will receive will not be decided upon by the legislature, but by the appointed body that represents all state residents in consultation with medical experts in all fields of medicine.

Source: http://www.pnhp.org/facts/singlepayer_faq.php#run_healthcare_system

Viking,

I appreciate your point of view; but that source far from objective; in fact it is from a group that WANTS socialized health care. It is very much like citing a union propaganda piece to show how great the unions are. That is the way that they would LIKE for it to be. To get a more balanced view one would have to look at the way that Medicare pays today. What kinds of claims will be paid and what will not be paid.

To say that the doctor and patient will come up with the plan of care is great... but that hardly means that the government will pay for it.

[azhiker96, BSN, RN]

I am not supportive of government denying claims. I am supportive of evidence based practice.

See:

There is a myth that, with national health insurance, the government will be making the medical decisions. But in a publicly-financed, universal health care system medical decisions are left to the patient and doctor, as they should be. This is true even in the countries like the UK and Spain that have socialized medicine.

In a public system the public has a say in how it's run. Cost containment measures are publicly managed at the state level by an elected and appointed body that represents the people of that state. This body decides on the benefit package, negotiates doctor fees and hospital budgets. It also is responsible for health planning and the distribution of expensive technology.

The benefit package people will receive will not be decided upon by the legislature, but by the appointed body that represents all state residents in consultation with medical experts in all fields of medicine.

Source: http://www.pnhp.org/facts/singlepayer_faq.php#run_healthcare_system

True, in the UK the final decision is left to the doctors and patients. The options though are decided by the appointed body. I've seen many references from the UK on how it matters very much where you live as to what options are available. I don't think we would allow different treatment options in different states. A lawsuit would only need to reference Row V Wade. Fairness doctrine in the US would demand that treatments be available in all states.