(05-03-2015 04:07 PM)UCF08 Wrote:  UK isn't a single payer? Or are you categorizing it differently because it's a single-payer + private options if you have the money?

I'm not classifying it differently. That IS the difference--you have private pay options in single-provider, but not in single-payer. That is how the terms are defined. Read up on the subject.

(05-03-2015 04:17 PM)Owl 69/70/75 Wrote:  

(05-03-2015 04:07 PM)UCF08 Wrote:  UK isn't a single payer? Or are you categorizing it differently because it's a single-payer + private options if you have the money?

I'm not classifying it differently. That IS the difference--you have private pay options in single-provider, but not in single-payer. That is how the terms are defined. Read up on the subject.

Doing a quick google search doesn't show any sort of significance between the two, and shows them used pretty interchangeably. I'd like to see what you're looking at that shows these two to be inherently distinct.

(05-03-2015 04:33 PM)UCF08 Wrote:  

(05-03-2015 04:17 PM)Owl 69/70/75 Wrote:  

(05-03-2015 04:07 PM)UCF08 Wrote:  UK isn't a single payer? Or are you categorizing it differently because it's a single-payer + private options if you have the money?

I'm not classifying it differently. That IS the difference--you have private pay options in single-provider, but not in single-payer. That is how the terms are defined. Read up on the subject.

Doing a quick google search doesn't show any sort of significance between the two, and shows them used pretty interchangeably. I'd like to see what you're looking at that shows these two to be inherently distinct.

That's kind of a "why is there air?" question. That's the terminology. That's how they are defined in all of the literature that I'm aware of. I don't know where you are looking.

Single-provider means you have a large single organization that actually provides the vast majority of health care services, but private entities may compete on a for-pay basis. Single-payer means regardless of who provides the service, you have only one entity that is legally allowed to pay for health care services, and any private fee-for-service arrangements are illegal.

When most on the left say "single-payer," i think--and sincerely hope--that they actually mean single-provider. At my age, a true single-payer system would probably mean that I would have to go overseas for health care, if not permanently.

Quote: That's kind of a "why is there air?" question. That's the terminology. That's how they are defined in all of the literature that I'm aware of. I don't know where you are looking.

It's not even the least like that? Google is where I'm looking, and putting in Single-provider. Not a single source on the front page which notes a distinction between the two, and numerous ones which conflate Single-payer to mean any system which involves universal healthcare, including those that allow private options. As best I can tell, your distinction is yours alone, and I simply asked where you're getting this definition from.

(05-03-2015 05:18 PM)UCF08 Wrote:  

Quote: That's kind of a "why is there air?" question. That's the terminology. That's how they are defined in all of the literature that I'm aware of. I don't know where you are looking.

It's not even the least like that? Google is where I'm looking, and putting in Single-provider. Not a single source on the front page which notes a distinction between the two, and numerous ones which conflate Single-payer to mean any system which involves universal healthcare, including those that allow private options. As best I can tell, your distinction is yours alone, and I simply asked where you're getting this definition from.

That's the distinction within the industry and in the scholarly literature. What I have is print, not online, so I don't know how to give you a link. The two may be used interchangeably in common usage, and that's probably what you get with Google. But they mean two different things to experts.

As I said above, when left wing US politicians say they want single-payer, I think they actually mean single-provider. If pressed for details, what they usually describe is single-provider (like UK) instead of single-payer (like Canada). That would probably explain the confusion that you found.

My "why is there air" comment is serious. When i started working in health care finance in the 1990s, that distinction was made very quickly, I'm not sure from where, and this is really the first time in 20 years that I've ever had anyone question it.

Did you Google "single payer versus single provider"?

I suppose I could point you to the journal articles that I have published in which the distinction is noted, but retaining my anonymity here is far more important to me than your opinion.

I googled that, yeah, and the only thing that came up that would apply here that I see is this blog, but I don't have any reason to doubt you. It's just a distinction that, best I can tell, isn't made in any significant measure in common usage. Hell, the wikipedia for single-payer uses UK's system as an example, so I think you're right about the usage by most people/politicians.

(05-03-2015 07:18 PM)UCF08 Wrote:  I googled that, yeah, and the only thing that came up that would apply here that I see is this blog, but I don't have any reason to doubt you. It's just a distinction that, best I can tell, isn't made in any significant measure in common usage. Hell, the wikipedia for single-payer uses UK's system as an example, so I think you're right about the usage by most people/politicians.

I think you are correct that the distinction is not made in common usage, which is a mistake because it is actually a fairly significant distinction. Politicians and news media are particularly sloppy about it.

I would say the difference is that, while I would not want to live under either one, I think I could live in a single-provider system, but not a single-payer one. The right for my physician and me to exercise some control over my health care is very important to me, certainly worth a few bucks.

(05-03-2015 09:21 PM)Owl 69/70/75 Wrote:  

(05-03-2015 07:18 PM)UCF08 Wrote:  I googled that, yeah, and the only thing that came up that would apply here that I see is this blog, but I don't have any reason to doubt you. It's just a distinction that, best I can tell, isn't made in any significant measure in common usage. Hell, the wikipedia for single-payer uses UK's system as an example, so I think you're right about the usage by most people/politicians.

I think you are correct that the distinction is not made in common usage, which is a mistake because it is actually a fairly significant distinction. Politicians and news media are particularly sloppy about it.

I would say the difference is that, while I would not want to live under either one, I think I could live in a single-provider system, but not a single-payer one. The right for my physician and me to exercise some control over my health care is very important to me, certainly worth a few bucks.

Honestly, my biggest concern for a true single-payer system is the effect it might have on medical research and innovation. I like the idea of a single-provider system because it does allow for market forces to act and allows us to use that innovation for the government services. From what I've read/seen about the UK system, it seems to work pretty well, and it doesn't have the problems that I'd be worried about an almost 'tiered' system like this. Meaning, your service is still pretty damn good even if you can't afford the private options.

(05-03-2015 09:34 PM)UCF08 Wrote:  Honestly, my biggest concern for a true single-payer system is the effect it might have on medical research and innovation. I like the idea of a single-provider system because it does allow for market forces to act and allows us to use that innovation for the government services. From what I've read/seen about the UK system, it seems to work pretty well, and it doesn't have the problems that I'd be worried about an almost 'tiered' system like this. Meaning, your service is still pretty damn good even if you can't afford the private options.

My biggest concern for single-payer is that health care decisions will be made for me by some nameless, faceless, and unaccountable bureaucrat, and there will be nothing I can do about it. Single-provider at least gives me the out of a private alternative, although it is frightfully expensive. Bismarck preserves the doctor-patient relationship.

The UK system is great for simple, routine stuff. If you need something serious be prepared to wait in the queue for a long time. It probably works well for about 80% of the population and sucks for the rest. Even the best single-provider systems have huge problems with queues, and single-payer systems are generally worse.

Bismarck largely avoids the queues by having the private system as an integral part of the system, rather than an out when the system fails. That's the main reason why the Bismarck systems consistently out-perform single-payer and single-provider.