An interesting piece on ‘rationing care’ in single payer systems. The piece in The Guardian focuses on British patients who are sent overseas for specialized therapies not available in the United Kingdom, with the trips funded by the NHS. And how that compares to the current U.S. system.
Ethan [who has an ependymoma] is in the US because the NHS as yet does not have proton therapy machines, although the UK government has just agreed to fund two of them, in London and Manchester.
Pay for service models will obviously be inefficient and provide a plethora of potentially unnecessary care. There are probably strategies to mitigate the inefficiency of over use in a fee for service system, but they will never be as effective as the central control afforded in a single payer system.
The scary thing about such overt rationing, as in the NHS, is it removes some control from the patient and their personal physician and puts the control in the hands of committees of amorphous physician ‘experts’ and bureaucrats who deem what is appropriate and available care and what is not. The great fear is that such a system will deny effective or questionably effective care as a matter of cost.
The reality is that the U.S. system already does this. Private insurers already deny payment for treatments as being unproven. Centralizing this rationing and making it more transparent and overt may be an answer. Certainly it seems the case with the NHS and proton therapy.