Thread by @FreedomFriesInc

IMO this info was attainable without leaking because it can be extrapolated if all you know is the billed amount. In any case, hospitals have to use markups in order to cross-subsidize services that are never paid for. This is a poor argument for single payer, among many.

https://twitter.com/Davidlaz/status/1469384297471569922

To clarify, hospital billing markups are not, IMHO, an effective argument for a single payer system. They get portrayed as price gouging, but if you look at them in a politically neutral way, they're more just a reflection of overall provider costs.

I live in a country (NZ) with what Americans would call a single payer healthcare system. It has major problems for individual patients and the country as a whole.

In both countries, AFAIK, a provider is not allowed to turn away a patient in immediate emergency need...

I know there are nuances in that statement but in general, if a provider in the US is asked to provide such a service, they do it then try to recover the cost through billing. A lot of these costs are never paid.

In NZ, a provider would usually send you to a public hospital.

The presence in NZ of hospitals where citizens and legal residents can get free, taxpayer funded care (such as it is) makes it difficult for private providers to be sustainable. They cannot provide most non-surgical or emergency care. Their main business is elective surgery.

A good range of healthcare insurance options allows New Zealanders the opportunity to access non-taxpayer funded care, whether they're working, middle, or upper class. It's not "healthcare for [only] the rich." The insurers don't tolerate excessive costs; keeping costs low-ish.

I don't have detailed, up to date info on the finer points of insurance in both countries, but my sense is that (1) costs billed are vastly higher in the US than NZ and (2) the steep inflation since the 80s is largely due to having excessive layers of non-clinical mgmt staff.

To me, it would seem a more effective policy to target that area of waste in the healthcare services supply chain, than to provide a taxpayer funded system available to all.

Single payer sounds great but it doesn't work. Benefits are unevenly distributed, for starters:

Such systems rely on rationing based on clinical need alone. But who gets to make the gatekeeping decisions?

I argue that a bunch of other variables creep in, esp. post code medicine. Racial, gender, age-based and other discriminatory practices perpetuate inequalities too.

It is much easier for an insurance based system to deliver fairer outcomes than it is for a single payer system.

I argue that individual entitlement (not rationing) of a certain level of service leads to better outcomes across access, safety, and quality.

Now, I acknowledge on Twitter (every day), that proponents of a mixed insurance/gov funded healthcare market in the US tend to be on the political right wing, which has no moral legitimacy unless & until they fully address what they did to the country, esp. in the past 2 yrs.

And so, I am now part of a political minority group of #XGOP supporters & #NeverTrump folk who may or may not oppose liberal/left policies like single payer healthcare, but in any case cannot marshal the voters of the current Republican party to effectively oppose single payer.

All we can do is raise the issue regularly in the hope that if the single payer idea gathers steam, we've helped as many voters as possible open their mind to the full risks and benefits of such a policy.

Influencers tell you it works great in other countries. That is a lie.

The details of why it's a lie would require far more text than I've provided in this thread.

So my goal right now is to raise awareness and promote an evidence-based conversation about how healthcare markets work, and how to regulate improvements in their equity and safety.

And, I'm talking about non-pandemic era healthcare policy.

Just like during a war such as WWI or WWII, a temporary shift toward population-level public health measures is justified. On that I agree with Democrats, no question.

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