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Hi Vijay, in response to your (email) response that a single payer is incompatible with the market-based model b/c it involuntarily uses tax dollars... it seems like under any healthcare system, short of simply denying treatment, which is currently illegal, there will be involuntary taxes that go toward healthcare. You acknowledge that under your model, people will still need to buy catastrophic insurance, yet without a "mandate," there will be people who don't buy it or can't afford it b/c they have a pre-existing condition, etc. So, there's still an "uninsured" population, and the entities that serve them (e.g. County hospital) will always be funded by tax dollars--at the city, county, state, and federal level. So, I just don't see how your vision of efficiency and choice can't exist in and benefit a single payer system. Without single-payer, people will still be paying an involuntary baseline for healthcare, and they still have to pay on top of that to get adequate healthcare for themselves.
And for every reason that a public, outcome-driven agency can fail, a private, profit-driven agency can fail. Both have their saving grace in the discontent of the population--like you said, if it swings too far one way, something will happen to oppose it. And I don't think this sort of reform happens any faster in one system than the other. The market works just as slowly as the government does. Just today, two people said they chose to buy new PCs b/c of convenience even though they find Macs superior. And 30-some years after the invention of the personal computer, we still have only 2 options? And a significant proportion of the population still can't afford either--which is ok for computers, but not ok for healthcare.
That's not just a moral stance. It makes economic sense to keep a population healthy.
My point is not that transfer is wrong (I think it has to happen at some level...healthy to sick, rich to poor). I have no problem with it when its explicit (say to fund refundable tax credits at some level). I do have a problem when its lumped into an "insurance" model that tried to be everything to everybody--and in doing so loses all accountability and focus on the needs of individuals.
In the private sphere, when that happens, a company goes bankrupt. In the public sphere, when that happens, we pay more in taxes for an increasingly entrenched bureaucracy. That is why i think blanket single payer is a bad idea.
Could not find your contact information on your blog. I would like to talk to you about some ideas. Feel free to e-mail me at gidoc@hotmail.com.
Pankaj
Perhaps I'm misunderstanding, but my question remains... why can't your model co-exist with single-payer?
And with regards to increased taxes... can you give me an example of increased taxes that didn't result in a benefit to the public? I know that as far as County hospital, a public entity, it is subject to the same financial pressures and much more responsibility than the private sector. A company can give up and declare bankruptcy (or close hospitals that aren't profitable), and it's not liable to its customers or patients. County can't do that, and it certainly isn't easy demanding more tax dollars to fund it.
How many private road or bridge building companies do you see? How many private airline security screening companies (allowed to develop own methods)? How many private air traffic controllers? Are there any insurance companies signing up the 65+ population outside of guidelines set by Medicare?
As to taxes, I don't think you want to go there. There are plenty of examples of high taxes stifling economies and innovation (see Western Europe). The question is not: was there some benefit to society (which in many cases is still questionable), but really was the benefit disproportionate to what people could have done by being able to allocate that spending themselves?
Your information/rating service appeals most to physicians who work fee-for-service and patients who have the freedom to choose any physician. This is a small minority, so your service will take time to catch on.
In a single payer system, the proportion of physicians who take insurance or fee for service shouldn't change. But, now ALL patients will have the freedom to choose any physician.
The way I see it, your service will be key to how everyone chooses their physicians, and there will be a greater demand for your service than there is now. Do you disagree?
How else would single-payer work? If they just paid whatever people wanted, you'd bankrupt the entire country.