Tuesday, June 08, 2010

Single Payer and Politics

National Health Insurance (also known as single payer) has many advocates who offer a number of arguments to support it. However, there are less favorable implications that need to be included in the debate.

They include the inevitability of decisions that seem arbitrary and political interference.

A clear example was the subject of an article in the May 31, 2010 issue of The Boston Globe.

For a number of years, Medicaid paid $140 for medical imaging examinations used to test bones for signs of osteoporosis, mostly for elderly women. The rate attracted commercial operators to provide the service by means of mobile scanners that moved about among medical office facilities. Many doctors also installed the equipment in their offices.

At some point Medicare decided it was paying too much for the test and cut the rate to $50 per exam. This drove a number of operators out of business, but also stimulated a lobbying campaign by doctors, scanner operators, manufacturers and groups devoted to women’s health.

The result was a provision buried deep in the recently enacted health care bill, legislatively setting the rate for the test at $97.

The Globe article pointed out that this price-setting measure was included in a health reform bill that claimed to point the way to a more rational system, where decisions are made on medical evidence and patient outcomes.

But apparently the realities of democratic politics are not to be denied.

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