Talk:Single-payer healthcare/Archive 1

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criticism section

There is no mention in this article of the greatest fear people should have of a single payer nationalized health care system. Countries with such systems put restrictions on costly treatments. They will have to go through the system and come up with conditions for who is eligible for treatments based on cost considerations. The US system is more costly. But there is better availability of medical technology. I for one do not want base treatment options on cost. —Preceding unsigned comment added by 18.87.1.204 (talk) 17:21, 7 May 2009 (UTC)

Since Adam Smith argued in Wealth of Nations for a government role in health care, then by your logic Adam Smith is a Communist.

I think you should re-examine your logic. :) Nbauman 14:12, 8 March 2007 (UTC)

(begin from neutrino78x.blogspot.com) Nbauman, he did not advocate the idea that somehow the government should provide individuals with health care, and take away their choice in health care providers. Certainly, there was no communist health care system in England in Smith's day. The US Constitution, heavily influenced by Locke and Smith, does say that the government should "provide for the general welfare" but this is different from "provide for the specific welfare of any given individual". In other words, if there is a smallpox outbreak/terrorist attack, yes of course the government should try to stop it (via Locke's "social contract"), but it is not the role of government, in my opinion, and, I think, John Locke's and Adam Smith's as well, to make sure Joe Smith specifically has a health care plan; that's Joe Smith's responsibility, and Joe Smith has the freedom to make enough money to buy one, and Kaiser Permanente, Blue Shield etc have the freedom to sell one to him. This is called "the rugged individual theory", aka social darwinism, first articulated by a Brit named Herbert Spencer but highly influential in the United States, and is quite the successful policy here, given our GDP compared to every other great nation in the history of mankind (Greece, Rome, Egypt, UK in the 1600s, etc: paupers compared to the USA in 2007). Personally I do not have medical insurance, but if I want to see a doctor, I don't have to wait 10 weeks like in Britain, I simply call (one of) the local doctor and make an appointment, usually he's available the next day or maybe 2 days later, then go in there, I see him, and pay US$75. If I had Blue Cross medical insurance (one of several private health care plans available in the state of California), I would pay US$35/month, and a doctor visit would be US$10. Not free but pretty cheap, I just haven't subscribed to that because I'm lazy. :) If I have an emergency, I can call 911 (like 999 in the UK), and get free health care at the emergency room. Anyway I have been advised by senior Wikipedia people in the past that Wikipedia is not intended to be a debate society, and I figure that's reasonable, so I'll just leave my suggestions as they are...thanks for everybody's consideration... people can contact me via blogspot to tell me how stupid I am if they want (I know how frustrating it can be to see comments online that make you angry but then you can't email rants to the author lmao), feel free to delete these comments...(end from neutrino78x.blogspot.com) 71.116.71.27 04:27, 11 March 2007 (UTC)

It was not my idea that Adam Smith advocated government responsibility for medicine. I got the idea from Herbert Stein, who wrote it in an op-ed article on the Wall Street Journal editorial page.

You are incorrect to believe that you could get free health care in an emergency room by calling 911. The WSJ has been running a long series of articles about Americans who couldn't get health care because they couldn't afford it, even when their lives depended on it. Here's how successful Herbert Spenser's ideas are in reality [1] Hospitals are required under Medicaid/Medicare laws to treat you, but they can also send you a bill for the services, and they do. The WSJ profiled people who owed hospitals hundreds of thousands of dollars that they had no chance of paying, and were being dogged by collections companies who were confiscating their savings accounts, cars, and any other assets.

You and others like you are thinking of health care in terms of acute problems like a broken leg or food poisoning. You don't realize that the most difficult and expensive problems are chronic disease. If you developed lupus like Nikki White did, you would need $20,000 worth of medical care a year to stay alive, and in places like Tennessee, the hospitals won't give you that care if you can't pay for it. A friend of mine developed Chronic myelogenous leukemia in her 30s, and she is alive today only because she and her parents could spend hundreds of thousands of dollars for the latest treatment. Hospitals turn people with CML away if they can't pay $15,000 cash for an initial visit. If you develop diabetes, $6,000 a year is often the difference between saving a leg an losing a leg.

Where did you get the idea that Blue Cross in California is $35 a month? $300 a month is more like it, and you'd wind up paying $10,000 a year with deductibles and copayments if you actually have a serious disease like diabetes or asthma.

You'd be better off reading some of those footnotes and sources that I and others added to the entry, to find out what the facts really are. The way to write a Wikipedia entry is not by pulling ideas out of the air. If (when) you actually get a chronic disease, you'll find out the facts pretty fast. Nbauman 10:58, 11 March 2007 (UTC)

You make several good points Nbauman but it's even worse than you said: yes, hospitals can treat you and then sent you a bill for tens if not hundreds of thousand, and yes they can transfer you to another hospital (poor/uninsured have had this done to them, some died because of the delay) but it's even worse, they are not "required to treat you" rather they are only required to "Stabilize" you so as soon as they know, or can claim, that you are not about to immediately, or imminently die, they can send you back...the myth is they are required to 'treat' you but they are only required to 'stabilize' you. --Harel (talk) 22:04, 24 July 2009 (UTC)

The issue of criticism is quite complex because this weird term "single-payer" seems to add confusion to the debate on health care. I made a small change today which highlights a problem with single-payer with private practice which does not arise in single-payer with publicly employed practitioners. I feel inclined to think that if this article is to remain, it needs to be split into pros and cons sections, but I haven't the time to do this. --Tom 00:42, 15 July 2007 (UTC)

Why are you calling single payer a "weird term"? It's not a weird term at all. It's used extensively in the medical literature, and is indexed by the National Library of Medicine "single+payer" single payer "Single-Payer System" is a NLM MeSH term, and you don't get more official than that. Nbauman 15:45, 15 July 2007 (UTC)

I accept without question what you say; that the term is already in widespread use and closely defined. But I still think it's confusing. I guess because it's meaning is not self-evident. As my recent article edit implies, total public health care systems (which here seem to be termed as "socialized medicine") are also single payer (in the sense that the government picks up the tab for most care), but the definition here of the term "single-payer" seem to imply that socialized systems are not single-payer! The article also says that single-payer health care is implicitly more efficient. But I don't really see how that can be. In socialised medicine systems that I am familiar with, money is spent on health care according to patient need and the providers work for the state or state institutions. There is no connection between the care given and the cost (on a case by case basis at least) and so there is little need to reconcile or match the two. However, whenever care is provided by private providers and paid for by others (as with the present insurance based system in the US, or, say in an extended medicare type system) then there have to be controls to maintain the interests of either shareholders (as with private insurance) or the taxpayer (if the taxpayer is paying for private care). So single payer is not really the same as socialised medicine with the benefit of competitive private practice, which is how I read the sub-text of this term. I think therefore that the term muddies the water. --Tom 13:08, 17 July 2007 (UTC)

Health policy people have invented a lot of terms to define certain concepts precisely, and "Single payer" is one of them. They needed a term to distinguish systems like the U.K. in which doctors are employees of the government, with systems like Canada where they're contractors of the government. "Consumer-directed health care" certainly isn't self-evident.

I don't know what socialised medicine systems you're familiar with, but the facts, as reported by reliable peer-reviewed medical journals (which is what Wikipedia is supposed to use) are that socialized (and single-payer) health care systems cost less money and have approximately the same health outcomes as the U.S. If that implicitly says it's more efficient, you're entitled to draw that conclusion from the facts.

The facts are that government health care systems control costs better than the insurance companies do in this country. There's tons of comparative data published in major medical journals that we cited here, like Health Affairs.

I don't have to explain why. It's enough for me to say, "these are the facts," and leave it at that.

But I'll explain the mechanism anyway.

In the UK and Canada, health care systems have a limited budget, and they have to work within that budget. In the UK, doctors follow the NICE guidelines, which are based on independent evaluations of the cost and effectiveness of different treatments. That's what keeps their costs under control. And when patients demand useless, expensive therapies, like Herceptin for breast cancer when it's not medically appropriate, the UK doctors turn them down, so they can spend their budget on things that are effective. In the US, in contrast, patients can get it in some health plans. US health insurance companies were paying for Vioxx. I happen to know that Blue Cross/Blue Shield does very good UK-style evaluations of expensive treatments, and they got a bum rap in Sicko. But BCBS only evaluates the most expensive, controversial treatments. The Veteran's Administration system does extensive evaluations of what works and what doesn't work, and their doctors only prescribe what works. You want to buy a medical laser or a CAT scan in Canada? You have to do a tough economic evaluation. American drug companies and device companies hire Canadian doctors to do cost/benefit studies for them. The Canadians and British have better controls over costs and benefits than we do. Here the hospitals won't treat patients with Medicaid and Diabetes, while they advertise for whole body scans (useless, according to the BCBS evaluation).

If I see any articles about this in the medical journals, I'll add them to the article. Nbauman 22:32, 17 July 2007 (UTC)

I posted some criticism, with references, in the section about Canada... my bet is that it will be reversed... rather than edited... within the hour. As a frequent visitor to Canada, I have ample opportunity to hear friends bemoan that their parents feel they have to save up huge amounts of money - often that they can't afford - to travel to the U.S. for important medical procedures. Very few people seem satisfied there.... but maybe that's just the people I hang with. 69.134.54.59 (talk) 05:48, 24 August 2009 (UTC)

As predicted, two well referenced criticism of the Canadian system were reversed. I'm going to request that this page be monitored for vandalism and strong POV. —Preceding unsigned comment added by 69.134.54.59 (talk) 05:55, 24 August 2009 (UTC)

Definition

The definition of single payer is inconsistent. In the first paragraph it is defined as a system in which the government assumes the role of paying for health care; further down it says that there are "two types", one in which the government pays for private doctors, and the other in which the government runs the whole health care system. The only use I've ever heard is the first, the government pays private doctors. Is it ever used to refer to a government-run health care system? Nbauman 19:59, 13 February 2007 (UTC)

Sources

Try to find some sources (preferably in peer reviewed journals). :) Nbauman 21:55, 13 February 2007 (UTC)

USA-centric

Curiously USA-centric for an article about a system which isn't even used in USA. Move most of that stuff to some other article. The "single-payer vs. to socialized medicine" distinction in the intro is also weird in that context. HFuruseth 16:40, 22 February 2007 (UTC)

I thought "single-payer" was an American term. I don't recall seeing it in Canadian, British or Australian medical journals.

Feel free to add material about govenment-run systems elsewhere. Nbauman 02:01, 28 February 2007 (UTC)

Ah. If so maybe it should be "single-payer health care is an American term for..." so e.g. a Norwegian like me won't be led to use it e.g. in British english. Come to think of it, I expect that'd be even more so for "socialized medicine" which this article compares with. HFuruseth 22:11, 1 March 2007 (UTC)

Hfuruseth -- it should be referred to as "communist medicine" in my opinion. ;-) "Socialized" should have similar (negative) implications in the mind of the reader but for some reason, it often doesn't. I think in Europe they tend to support communist solutions because they still have the idea of The King Will Take Care of Us, for which the Americans clearly did not stand. ;-) lol, all kidding aside, my point is that "socialized" is not as politically neutral as "single payer". Some people think "socialism! woo hoo!" others (the majority in the glorious Republic of the USA, including myself) think "socialism! gross!" whereas "single payer" is just a neutral summary of the proposal. It's like, you can say "partial birth abortion" or "late term abortion" and they have totally different political implications.71.116.71.27 08:29, 6 March 2007 (UTC)

Look, I'm not particularly interested in that political debate, or in writing about other health systems. I'm talking about this article, which is quite weird if one comes to it for some other reason than being in the middle of an American debate. In particular if non-American English-language countries do not even use the term. Prefixing the intro with "In American political debate, " would fix it - if that's correct. Is it? HFuruseth 21:25, 13 April 2007 (UTC)

Not only is the article overly U.S.-centric, the opening paragraph sounds strangely like advocacy for the system. First the term should be adequately defined and explained, then arguments pro and con should be in separate paragraphs.--Jsorens 15:30, 24 April 2007 (UTC)

patrick25: There was an article today in an Austrian newspaper (European Union). They found out that people from Europe are much more healthy, happy and grow much taller than americans. Why? Because of their "communist system". Everybody is covered in a first-class health system. People who suffer from the worst diseases receive medication for free. The government is going to pay for every single Euro when it comes to your health. Regardless of your nationality or race. If the medicall Bill is 100 000 Euro then they pay it too. Unemployed people dont get scared. I really do not understand, why do Americans fear the european "communist" policy?? They dont steal your money. The american way of life is just an advertisement and the people who live there are cheap slaves without insurance...

The above comments are not mine.

Yes, I agree that this article is too US centric and uses lots of biased terms, which unfortunately I accidentally found myself using the other day because I was largely talking to a US audience. The term "socialised medicine" should perhaps just be called "public" or "community medicine". People in the US don't talk about a "socialised police", or "socialised roads" do they? I They are just services for the whole community funded from tax. As far as I see, most countries seem to fund medicine publicly from taxation to one degree or another. The article shoud be removed and merged with the Publicly-funded health care They see to me to be the same thing. The US debate is interesting but should be in its own article, not a general one. The criticisms section is mostly one sided against and totally US centric. Even allowing for that, the arguments seems to run counter to the supported citations within the rest of the article that seems to indicate that publicly funded medicine is cheaper, less bureacratic, and overall no less effective in terms of medical outcomes. There are lots of citations in the pro-public medicine case cited in the article but no citations from credible independendent (hopefully academic) sources supporting the arguments against. If the author of the criticism section can cite some research that would be a useful addition to the article. Otherwise it should be removed. --User:Hauskalainen 11:26, 1 June 2007 (UTC)

You made two suggestions above that seem to be contradictory to one another:

• The article shoud be removed and merged with Publicly-funded health care
• The US debate is interesting but should be in its own article, not a general one.

Would the second be served by renaming this article and focusing it strictly on the U.S.? The term "single-payer" is of significant importance within the U.S., and it is much more likely to be the term searched than "publicly funded health care", in my opinion, so even if a merge were undertaken, there would need to be a redirect to it. My concern with the idea of merging is that doing adequate justice to the U.S. debate about health care reform would be accused there of undue weight. There's likely to be added attention to this topic when Michael Moore's film, "Sicko," is released this summer. That said, the debate about how to reform the health care system in the U.S.(and its resistance to joining the rest of the industrialized world in publicly funding its health care system) is of long duration, and I believe it belongs somewhere in Wikipedia, I'm just not sure how this is best handled. -- Sfmammamia 18:30, 1 June 2007 (UTC)

OK. Then the article should be headed with a reference that it is a term used in the debate. I'll make the change. Many of the related articles on this subject also seem highly bound up with the US debate and some of these articles are in fact inaccurate. For example, the UK is depicted in one article as providing "socialized medicine" where the government dictates how health care is provided. But it it is in fact much more decentralized than that. Many GP services, dentists etc. are in practise autonomous, private enterprises, and many hospitals are now independent local trusts, run not directly by the government but by local boards that make independent decisions about new treatments, equipment purchases, etc. The National Health Service (NHS) is funded from general taxation and pays for health services (so it is a single payer) and so it determines what treatements can be provided free of charge to the consumer (the NHS picking up the tab) and which must be paid for privately. Many hospital consultants (senior medical practitioners) do work both for both the public hospitals (on a salaried basis) and for themselves privately (often in the same public hospital, funded by the patient or by insurers, with the doctor renting services from the hospital trust or paying a private hospital). It cannot be really be said that the government runs the hospitals in the UK and tells doctors what to do, but the NHS certainly holds the purse strings. There is a similar parallel private/public system in Finland where the public hospitals are run by the local goverment body and funded partly from taxation and partly from basic access charges on consumers (to give an incentive to avoid wasteful use of public services). As in the UK, I am sure it is doctors and healthcare professionals that make healthcare decisions here in Finland, not faceless buraucrats (which seems to be the fear expressed in parts of this article).

Ideological/Philosophical Objections

This section has no attribution at all. It doesn't quote anyone who holds these views. If anyone actually believes these things, you should be able to find someone to quote. Nbauman 08:25, 10 March 2007 (UTC)

this article is a piece of S***

i dont mean t o be rudeb ut this article is a piece of shit i hae found so many comments in this article that looked like presonal research and random ramlbing about things that are of no interest to anyone. all of the opinions are unsourced and use the more insulting verbiage possbile it reads like an amateur school production instead of a professionally written wikipiedia article. i recommend that the whole article be deleted and merged with the socialize dmedicinde article instead. that it the only way we can fix the article and clear up all of the terrible formatting, grammar, and the choked amount of tags necessay just to keep it clean and organized. this is the problem with wikipedia it doesn't clean up the less popular articles. the main way it can be successful is if it only reported on things that a lot ofpeople searched for since then trashcan aboritons like this article could be find and editted quickly. thats my opinion and im going to be bold and see what i can do for this mess. Smith Jones 00:32, 12 May 2007 (UTC)

 = I believe written by an advocate, it's obvious.

Sicko revision

This page needs some work. The article as a whole is disorganized.

It should be organized to define the subject, summarize it, define the debate, divide the subject into its component issues, and give the pros and cons of each issue.

Many of the paragraphs and sentences are poorly worded and inaccurate, and there is POV or unsupported assertions left. They often repeat themselves, and sometimes contradict themselves.

I believe that every statement should be supported by reliable sources, and for me the best source is a peer-reviewed medical journal. I have my own opinions on the merits of single payer, but I think the article should reflect the pros and cons of all significant points of view.

There is a rather large number of sources to this article -- some of them reliable, others not so reliable.

This is a good time to improve this article, because Michael Moore's movie Sicko is creating increased interest in single payer, and this article comes up near the top on Google searches for "single payer", "single payer health care", and similar searches.

If anyone has any ideas about how this article should be rewritten, or any reaction to my edits, I'd like them to discuss it here. Nbauman 23:19, 6 July 2007 (UTC)

• I'd vote for just deleting this page. It does appear mostly to be some sort of advocacy page. A lot of objectivity is missing, and the references are all moderate to liberal. The definition of single-payer is convoluted, and the polling section is a nightmare.10stone5 21:01, 11 July 2007 (UTC)

I agree that the polling section needs significant pruning and update; however, I disagree that the article should be deleted. I agree with Nbauman's point stated above, that Google searches of related terms, perhaps prompted by Michael Moore's film and attendant publicity, are likely to lead to this article. The article devotes ample space to criticisms, but if the content and sourcing need to be strengthened, working toward that end would be much more constructive than simply deleting the article. -- Sfmammamia 21:32, 11 July 2007 (UTC)

All of the polling data should go. If there is intent to use it as a source, that is fine, but it makes no sense to list raw data in an article. Kborer 23:41, 19 August 2007 (UTC)

It is certainly relevant to an article on single payer to include some information about the level of support from both the general American public and various health professionals. It should be organized, and easy to read, and include references, but should be included. --Harel (talk) 23:46, 13 August 2009 (UTC)

CPA link removed

I will undo the recently added link to the Centre for Policy Analysis. The web site contains articles that contain very dubious claims. Some examples

1 "More than 1 million Britons must wait for some type of care, with 200,000 in line for longer than six months".

Well I don't know where that articles figures come from but I just went to the press release web site for the UK Department of Health (http://www.gnn.gov.uk/environment/dh/) and there is a recent press release that says "The number of patients, for whom English commissioners are responsible, waiting over 26 weeks at the end of June 2007 was 312. Of these 312, 6 were English residents waiting in Welsh hospitals." How many Americans are waiting "for some type of care"? I think we should be told. The British system is honest in that the waiting lists are published. Everyone knows that the urgent cases get priority, so waiting is almost never life-threating. There is a limited amount of medical care available in the UK, just as there is in the US. Its just that it is distributed according to need and not on ability to pay.

2. "In France, the supply of doctors is so limited that during an August 2003 heat wave -- when many doctors were on vacation and hospitals were stretched beyond capacity -- 15,000 elderly citizens died."

So 15,000 French citizens died in hospital because most doctors were on holiday? Actually, that is a complete distortion of the truth. Heatwaves are often silent killers. Vulnerable people, especially the elderly, die because they fail to ensure they re-hydrate. Often the numbers only become clear when the death statistics are collated. Some people did get to hospitals and of course the hospitals were under stress, because of the French love of August as a vacation month. But people did not die for lack of lack of medical treatment by the medical system. There were much wider lessons for governement and the population as a whole. The issue was as much one of public education, lack of air-conditioning in homes, and the failure of the healthy to watch out for their frailer relatives rather than a failing medical system. Maybe because they were all camping down in the South. There were issues in the final analysis for the medical services, but changes would only have eased the stress felt in the hosptials and clinics by staff, and would not have of themselves reduced the number of deaths.

"One (British) cancer patient tried to get an appointment with a specialist, only to have it canceled -- 48 times."

Although this must have been very distressing for the patient concerned, The hospital Trust responsible has already admitted that it was "having problems with a new appointments system" - so this was far from being a systemic problem with the National Health Service, just a technical problem with (what I imagine is) a new computer system. Exceptions do not make the rule.

For these reasons I find it unacceptable to use the CPA as source of reliable information. --Tom 19:34, 27 July 2007 (UTC)

I would not call the claims of the CPA "dubious"; I would call them "verifiably false".

Nonetheless, they belong in this article. According to WP:NPOV:

All Wikipedia articles and other encyclopedic content must be written from a neutral point of view (NPOV), representing fairly and without bias all significant views (that have been published by reliable sources).

The CPA is clearly a "significant" view. As Paul Krugman described, they're one of those well-funded right-wing think tanks that are paid to create arguments in behalf of the interests of those who pay them. You'll find their arguments everywhere. People take them seriously. If you can't answer their arguments you won't get far.

They publish op-ed articles in the Wall Street Journal editorial page all the time, and the WSJ is arguably a reliable source.

If we don't include the other significant views from the beginning, others will do it for us, and the CPA at least well-organized, articulate and well-sourced.

I think that a WP article on something as important as single-payer health care should give all the arguments in favor of single-payer, and all the arguments against it. That's freshman composition 101. I think the CPA's arguments are (usually) ridiculous, and it's very easy to demonstrate that they're ridiculous. You make a much more convincing case when you can show how weak the arguments are on the other side.

That's what the health care debate is all about -- explaining the arguments for single payer, and the facile, erroneous arguments against it. I'm confident that the truth will come out.

As Cicero said, an orator who doesn't understand his opponents' argument doesn't understand his own.

If you want to do something useful, you can quote some of the CPA's arguments against single-payer, and then show -- with links to verifiable sources -- why they're wrong. That would be a useful contribution to this article. But deleting the opponents because they're dubious is not a contribution. It's WP:CENSOR Nbauman 20:17, 27 July 2007 (UTC)

OK I agree with much of what you say. One issue I guess is that adding all the pros and cons makes Wikipedia a bit like a debating place and its not supposed to be that either. And though this particular organisation may be siginificant, it's the reliability that I have called into question. And if the sources are not reliable because they promote falsehoods and half truths it is still odd (in my mind) to keep them as references. But I do understand your counter-arguments and maybe they should be here and/or on that organisations Wikipedia entry. Let me chew over this for a day or two.--Tom 23:05, 27 July 2007 (UTC)

Wikipedia dropped all pretense of being anything but yet another political debate site long ago. Those looking for any non-partisan information on any politically contentious issue would be well advised to look elsewhere.--Rotten 10:38, 28 July 2007 (UTC)

-I wholeheartedly disagree with Rotten on that one! Lets keep WP non-partisan! There are faults to be sure with S-P health care but IMHO they are not the ones listed by its opponents. Its good to stick to the facts and not promote falsehoods. I did quite a bit of reading around on the net after this discussion and was shocked and dismayed that those same falsehoods and distortions that I referred to above were cropping up over and over again. The publishers ain't going to correct them, but at least here it should be possible. --Tom 15:49, 28 July 2007 (UTC)

Think about it. Take a look at John Stuart Mill's On Liberty.

If you read those articles by Himmelstein and Woolhandler in NEJM and Health Affairs, you'll see that they have a section at the end where they discuss objections to their argument, and then answer the objections. That's standard scientific writing format. You have to give the other side. It's not my fault if the other side is deceptive. Nbauman 02:30, 28 July 2007 (UTC)

I only see http://www.pnhp.org/publications/nejmadmin.pdf referenced in the article and I don't see any discussion in there of counter arguments. Has the article you mean been removed from the WP article or have I missed something? PS Sorry not got time to read JS Mill, but thanks for the pointer anyway!--Tom 15:58, 28 July 2007 (UTC)

Look in that Himmelstein article on p. 773, at the bottom of the first column, where he says, "Several caveats apply to our estimates," all the way to "Despite these imprecisions ...." on the next page at the bottom of the second column. That's where they acknowledge and answer all the objections to their article (which were probably raised by the editors and reviewers in the process of writing the article). That's what I mean. That's standard scientific journal style. Nbauman 01:28, 29 July 2007 (UTC)

OK Thanks. I see what you mean but you've got be really deeply into these things to read and understand them. Bu we have to recognise that the vast majority of people needing to make decisions will not be so dedicated to read so deeply into these things. I think its more important to counter the dis-information that is being disseminated by pressure groups, lobbyists and their journalistic collaborators than to be overly fair to them. These guys are just out to deceive people (from what I have read so far), and they do so by appealing to gut reaction based on falsehoods and half truths rather than using scientific argument. The best way to counter that is to uncover their deceit and in that way, good, honest people will then be able to know who to trust and who not. What is the saying? Lies, damn lies, and statistics. ---Tom 13:21, 29 July 2007 (UTC)

I agree. I'm only saying that the way to counter lies and deception is to state the lies and deception, and explain why they are lies and deception. Nbauman 16:25, 29 July 2007 (UTC)

Graphic

That's a cute graphic, but I see a lot of problems with it. The biggest problem is that it's original research.

Usually, when I see a graphic like that in an article, it summarizes the text of the article. But this graphic introduces some concepts that aren't in the article. That's one of the reasons it's wp:or. Nbauman 07:46, 1 August 2007 (UTC)

I think the graphic is permissible -- it is only illustrating very basic concepts. Reviewing wp:or, it does not seem to violate any of the listed exclusions:

• It does not introduce a new theory or method of solution;
• It does not introduce original ideas;
• It does not define new terms;
• It does not provide or presume new definitions of pre-existing terms;
• It does not introduce any argument;
• It does not introduce an analysis or synthesis of anything;
• It does not introduce or uses neologisms

Also, this subsection of wp:or specifically mentions that original graphics are usually acceptable as long as they do not propose unpublished ideas or arguments and are not misleading. Is there anything that is still a problem? Kborer 08:17, 1 August 2007 (UTC)

I think it is a synthesis of new ideas. The whole idea of bringing the elements of the discussion into a schema, which is illustrated by a graphic, is an analysis and a synthesis.

WP:SYN says, "Editors often make the mistake of thinking that if A is published by a reliable source, and B is published by a reliable source, then A and B can be joined together in an article to advance position C."

You're taking concepts such as "government employment" (which corresponds to A), and "government monopoly" (which corresponds to B), and incorporating them into this graphic. This graphic concept is an original idea of yours, which is joining these ideas. That alone violates WP:OR as you quoted it above.

You're also taking concepts such as "government employement" and "government monopoly", which aren't defined or discussed in the text, and incorporating them into this graphic. That alone violates WP:OR as you quoted it above.

If you could find a graphic from a reliable source that would express the same idea, you'd have a stronger case. This graphic idea is original to you. That violates WP:OR.

If you could create a graphic that everyone would agree fairly represents the discussion in the article, you could include it in the article.

What does everybody else think? Nbauman 19:09, 1 August 2007 (UTC)

For this to be a synthesis of ideas, there would need to be some new idea produced from the old ones. This graphic is merely a collection of ideas displayed together, which does not violate wp:or. The ideas might be from different articles, but they are not used to come to any new conclusions. Kborer 20:51, 1 August 2007 (UTC)

One new conclusion is that these different health care systems can be organized into that 4-part schema. That's not my only objection, but it's the clearest one.

My biggest problem is that it doesn't accurately represent the article. What is that "government monopoly" quadrant, with private financing and government employment? That makes no sense. Where is there a system like that? 21:25, 1 August 2007 (UTC)

See government monopoly. Kborer 22:13, 1 August 2007 (UTC)

I'd say we should keep the graphic for now. Calling it original research is a bit harsh. I saw Kborer's other 3-dimensional graphic added to the Universal Health Care] article and although the graphic conveys universality as one of three main differences between various Health care systems, it has a misleading header and does little to enhance the article because it introduces 2 other concepts and there are in fact several other dimensions to heathcare provision. Single Payer is a one-dimensional name but with a two dimensional meaning (distinguishing as it does between itself and socialised medicine). Which was why I thought the term was confusing and misleading when I first heard it. However, I have been persuaded that the term is already in use so it therefore at least also needs a place in WP if only to explain what it means, and the graphic does indeed do that.

Kborer has identified three important dimensions in the types of health care system. I would re-label these as follows

(1) Pluralisation (Private versus government run employment of health professionals)

(2) Universality (Universal versus No Health care)

(3) Compulsion. (Taxation and/or compulsory insurance at one extreme versus free choice insurance or pay-as-you go payments at the other)

Although Kborer has labeled these as Government versus private financing, in my opinion this is a false dichotomy as government funding comes from taxpayers (if one regards employer provided benefits as a form of salary). Taxation and compulsory insurance are effectively the same from the consumers point of view (although the degree of contribution may differ). The degree of compulsion is the important difference.

The issue I would have generally is that the issues in health care are not two dimensional and not three dimensional, but multi-dimensional. Missing factors I would include would be

(4) Coverage ( a measure of the degree of health care coverage in terms of medical services or costs provided by a given scheme),

(5) Resource allocation (which usually boils down to ability to pay at one extreme of privately financed healthcare versus willingness to queue at the other extreme of publicly financed healthcare), and finally

(6) a Safety net measure for those that fall outside. For instance, life threating Emergency Room treatment is nearly always given even if the patient has no insurance and cannot pay.

Several of these factors are not really scalar dimensions, but do need to be measured and an approximate scale could be derived.

I raise these issues not because I intend to extend this article. I raise them because the article is already too long and gives undue prominence to this low utility and partially misleading term. At a guess I'd say the article already says as much as needs to be said in just the main paragraph and that a good third of it could be removed altogther. --Tom 23:08, 1 August 2007 (UTC)

What does "OTT" mean? Nbauman 01:02, 2 August 2007 (UTC)

See OTT. Kborer 01:22, 2 August 2007 (UTC)

Over the top What I meant was that Kborer was probably just trying to explain the issue graphically, not publish original research. I wish now I had not made those edits yesterday - I should never edit wikipedia after a good night out!

Tom, there's a WP rule that you're not supposed to edit Talk. If you go back and change your comments, people can't figure out what the subsequent posts are referring to, or what the original discussion was. You can use strikeout. Nbauman 12:12, 2 August 2007 (UTC)

Just to add another opinion, my main objection to the quadrant graphic has to do with accuracy: My perception, in agreement with Nbauman, is that the lower right quadrant (privately financed, government employment) does not exist anywhere in the world. It would not be enough to wipe the text in that quadrant. In other words, if you don't have four viable systems to dispay in a four-quadrant schematic, there's something wrong with the logic of selecting that method of display. -- Sfmammamia 13:03, 2 August 2007 (UTC)

There is nothing inaccurate about the graphic. Government monopoly is a system that is used in other industries, and it is something that could be implemented for health care. If the image is misleading, we could change the caption text to mention that government monopoly does not happen in practice. However, since the graphic does not make any claims about what systems are implemented, viable, or how well they work, I think that is probably unnecessary. Kborer 15:21, 2 August 2007 (UTC)

I have to agree with Nbauman on one point here: the graphic doesn't appear to motivate the article, and it introduces concepts not particularly explained in the article. It also seems to be motivated primarily by the desire to refer to "single-payer health care" and "socialized medicine" as two fully exclusive concepts, which I think is at least somewhat misleading, since some people use "socialized medicine" to refer to any system where the government supplants the insurance industry, even if it isn't also supplanting the medical industry. Besides that, the graphic is too large. --Dachannien^Talk_Contrib 20:14, 2 August 2007 (UTC)

The information from the graphic is directly related to the text of the article: Some writers use the term to draw a distinction with socialized medicine, in which health care providers are employees of the government, and the government runs the hospitals. Under single payer, doctors' practices and hospitals may remain private and negotiate for payments with the government. Kborer 20:50, 2 August 2007 (UTC)

Then the graphic would seem to be POV, since it describes as factual the opinion some writers have that single-payer health care is different from socialized medicine. I would have the same objection about a graphic that described them as being the same. At least the article text itself presents the "single payer" term in the proper context - the graphic fails to do that. --Dachannien^Talk_Contrib 20:55, 2 August 2007 (UTC)

That is true, the term is misleading. We should change the article title to 'single payer insurance. Until we do, the image should stay as it is, since it would be confusing to have more precise terminology on the image and less precise terminology in the article. Kborer 15:40, 3 August 2007 (UTC)

My sobering up (and embarrassment) continues. Thanks Nbauman for the information about the edit rule. I should have guessed that was the case. At the risk of sounding like a total Jekyll and Hyde, on balance I now think the graphic should be taken out. And I still have problems with the language that is US centric. The term "socialized medicine" is not a term I have heard used outside the US and would confuse any person not party to the ongoing debate in the US. It seems to have been created with a built-in "loaded" term "socialized" to make it sound somehow communistic. One does not talk about "socialized highways" or "socialized policing" so I see no reason why medicine has been the recipient of a loaded term. Neither had I heard of "Single-payer" unti a week or so ago. The terms "public" and "private" are better descriptives for "government run" and "run for profit" institiutions etc. I still think Single-payer is a fairly unhelpful term. Single-Payer is not self-explanatory. The UK NHS system for example, has the government as the single-funder of most medical services, so would naturally be construed to by most people to be a single-payer. But bizzarely it is not considered Single-Payer by this definition. Terms like this should have their own articles explaining what they mean and outside of that they should be used only sparingly in Wikipedia. --Tom 20:26, 2 August 2007 (UTC)

As I mentioned above, the terminology in the graphic directly corresponds to the terminology in the article. If you want to have separate discussions for the relevant articles, that is fine, but the graphic is only illustrating concepts that are already there. Kborer 20:50, 2 August 2007 (UTC)

Kborer, suppose you were contributing to an astronomy article about the planets. You create a graphic based on Bode's law. You include a planet between Mars and Jupiter, even though there is no planet there, because it fits into the schema of Bode's law. Anything wrong with that? Nbauman 05:45, 3 August 2007 (UTC)

Your analogy is unclear to me. Are you trying to argue that because government monopolies of health care are not done in practice that the idea should not be included in the graphic? Kborer 15:40, 3 August 2007 (UTC)

Because government monopolies of health care don't exist, including them in the graphic is confusing. Because they're not discussed in the article, including them in the graphic is confusing. Yes, they should not be included in the graphic.

I don't object to a graphic that makes it easier to understand the ideas in an article. I do object to a graphic that is confusing and doesn't make it easier to understand the ideas in an article. If you could come up with a better graphic, I wouldn't object. But I would object if you try to introduce ideas into a graphic that aren't in the article. Nbauman 18:04, 3 August 2007 (UTC)

I disagree that it is confusing. The graphic does not make any claims about what kinds of systems are implemented, only where certain systems would lie along those two dimensions. If it is important that people know that government monopoly of health care does not happen in practice, that information should be added to the article -- not obfuscated by removing a term from the graphic. Kborer 19:38, 3 August 2007 (UTC)

I would just like to point out that so far, Kborer, you are the only one advocating for your own graphic. As I read this discussion, all other editors' responses have been to remove it. -- Sfmammamia 02:15, 4 August 2007 (UTC)

Added pov tag to criticism section

The criticism section contains a number of thinly-veiled attacks on critics of proposed single-payer systems. For example, the first paragraph wraps opposition by the insurance, pharma, and other parts of the medical industry in critiques of the critics themselves by Oberlander and Moore. The section should contain only the criticisms that opponents of the proposal have, without commentary by other people. Later commentary includes Angell's pro-single-payer critique and the POV paragraph following the second bullet point near the end of the section.

I would fix this problem in short order myself, but I suspect that doing so would simply be met with a reversion by somebody. Therefore, I am offering this discussion first before making any change. --Dachannien^Talk_Contrib 20:41, 1 August 2007 (UTC)

You are correct in that the "Opponents and criticisms" section is poorly named. This is one of the problems that goes back to the origins of the article, which started as a collection of poorly-articulated "pro" statements to which people added poorly-articulated "con" statements.

The whole thing is badly organized. Every time I've tried to organize it, people added details that made it disorganized again.

The whole paragraph starting, "Other criticisms of single-payer health care" isn't attributed to a reliable source. Technically, it should be removed, but I left it in because I thought the article needed a contrary view and I expected somebody would add a reliable source eventually (they didn't).

I've found very good articles in medical journals arguing for single payer, but I can't find good articles arguing against singler payer -- I'm always getting stuck with David Gratzer, who doesn't cite his sources and whose facts often turn out to be wrong.

I think it's too early to work on the "con" arguments, because we haven't articulated the "pro" articles well enough. It looks like a college undergraduate's library notes.

You're welcome to write a "con" section. However, I will exercise my perogative to delete anything that doesn't have a reliable source. We already have too much unattributed personal opinion. Nbauman 22:16, 1 August 2007 (UTC)

Article title

I propose that we change the article title to be less ambiguous. Single payer health care could refer to any system where the government provides the funds which includes socialized medicine. What this article is talking about, however, is a specific type of single payer system, in which health care providers remain private employees. Some sources refer to this incorrectly as single payer, while others use a more precise term: single payer insurance. Kborer 15:45, 3 August 2007 (UTC)

Strongly oppose. "Single payer health care" is the term that most people use. Google has 214,000 hits for "single payer health care", 19,900 for "single payer insurance." There's no correct or incorrect in dictionaries; there's only common usage and formal usage. While I think some people use "single payer" misleadingly, we should explain that distinction in the text. You're proposing this change so that you can keep your graphic in the article. I don't think we should keep the graphic in the article in either case, unless you change it to reflect our objections. Nbauman 17:59, 3 August 2007 (UTC)

Single payer health care and single payer health insurance are two different ideas, not two names for the same thing. Single payer health insurance is a type of single payer health care system in which medical professionals remain privately employed. This article is titled "single payer health care" but it talks about "single payer insurance". Ergo, either this article needs to be renamed, or most of the information in this article needs to be moved to a new article title "single payer health insurance". In terms of the graphic, "single payer health care" contains the left two quadrants, while "single payer health insurance" is the top left quadrant. Kborer 19:27, 3 August 2007 (UTC)

Keep the current article but move some sections to a new article

I think it best to keep the article small and just use it to explain the different usages of the term. The article already makes clear its meaning is ambiguous and is used in different ways by different people. If the pro and con sections are really necessary then perhaps they can go to a new article Single-payer private medical insurance because I think that is what those sections are referring to. The new article could be linked to from the present article. That way, people searching will find what they are looking for and nobody will go away still confused. --Tom 19:42, 3 August 2007 (UTC)

Kborer, you keep making changes that bring in ideological conclusions about economics and markets that you don't have a consensus for. This article is about a single-payer health care system. The most authoritative definition, with the broadest agreement, is the one used by the National Library of Medicine.

The NLM definition says that a single-payer system can be paid by "insurance" or by a governmental unit. If it's paid by a governmental unit, they don't call it insurance. Insurance is a way of managing risk. A single-payer health care system is a way for the government to deliver social services, not for managing risks. Single-payer is broader than insurance.

The ideological point comes when free-market advocates, who believe the free market can and should do everything, argue that single-payer can be delivered through the private insurance market. I don't believe that it can work as private insurance, and AFAIK there is no place in the world where it works as private insurance. When a child is born with a heart defect that requires $100,000 a year to survive, that child doesn't buy insurance. When someone gets AIDS, and requires $30,000 a year to survive, no insurance company would sell him insurance. Health care delivery is not about managing risks.

This article has gotten too long and complicated, and we should start simplifying it by eliminating all the unattributed personal opinion, ideology, and POV, rather than adding more personal opinion, ideology, and POV. Nbauman 21:05, 3 August 2007 (UTC)

This discussion has nothing to do with ideology. The only things in question are definitions.

When people say "single payer insurance" they are talking about government financing, not private insurance, despite how the term might be taken literally. [2] [3] [4] [5] [6]

In the beginning, this article is only about "single payer insurance", a specific single payer system. Later in the article it broadens and contradicts itself by appearing to be about all "single payer health systems". [7] This confusion is exactly why we need to take action. Tom is right that we should clear out this article and put any information about "single payer insurance" in its own article.

That I "keep making changes" is also wrong. [8] Kborer 22:24, 3 August 2007 (UTC)

Kborer decided that rather than resolve the naming and content disputes on this article, he would go ahead and create the article his way, which he did under the title Single payer health insurance. Rather than simply redirecting that term back to this article, I have started the Articles for Deletion process on that article. In general, I feel that Wikipedia would be better served by one good article than by a POV fork. The discussion is at Wikipedia:Articles_for_deletion/Single_payer_health_insurance -- Sfmammamia 23:37, 19 August 2007 (UTC)

If you read the above comments, you will see that this fork was discussed. Nobody responded to my last comment for two weeks, so I proceeded with the process. If you think that single payer and single payer health insurance are the same thing, let us continue the discussion. Kborer 23:45, 19 August 2007 (UTC)

I didn't respond because I thought the discussion was over and we weren't going to do anything more about it. I'm not going to look up WP chapter and verse, but it's clearly a POV fork and in violation of WP rules. That's not the kind of rule violation that I would actively enforce, but if somebody asks me whether it violates WP rules, I have to agree it does. And they did ask me.

Kborer, I wish you would be more cooperative. You can write whatever you want in this article as long as it's on topic about Single-payer health care, as long as you get reliable sources, as long as you don't do original research, as long as you don't arbitrarily delete other peoples' work, and as long as you generally follow WP rules. You're making a lot of drastic changes without consensus. Nbauman 02:05, 20 August 2007 (UTC)

There are referenced definitions for the two terms, and those definitions show that the two terms mean different things. A similar example would be dance and folk dance. As discussed above, the article used both terms interchangeably and was very misleading. That is why I forked the article, and there is nothing POV about it.

If you want to talk about why I deleted the polling section, see the discussion above under the "Sicko revision" heading. If you want to discuss my conduct, or anything else that concerns you about me, please feel free to use my talk page. Kborer 02:28, 20 August 2007 (UTC)

Since the discussion was closed and single payer health insurance was deleted, I'll post my response here.

While a few editors chorused these complaints against it:

1. POV fork from Single payer health care
2. author chose to create this article rather than resolve naming /content disputes
3. Other than content previously disputed and deleted from Single payer health care, this article essentially duplicates the other.

Examining both of these pages, and their associated talk pages, will show that these claims are baseless.

First, the fork was initiated after a discussion on Talk:Single-payer health care. Only three editors decided to voice their opinion: two (including myself) wanted to fork the article, while the third disagreed. After two weeks and no new opinions, I created single payer health insurance using new text and many new references. A few days later, as I was working to focus the two articles on their separate subjects, the new article was suddenly proposed for deletion with complaints similar to the ones above.

I explained and gave references for why the objections were without merit, but no one cared to debate the proposed deletion with me. Even though four editors think that the creation of this article was unjustified, I believe that it should be reinstated.

1. The article's subject is well defined, and the claims in the article are well referenced. The first objection is that it is only my point of view that single payer health care and single payer health insurance are different concepts. However, the references in the new article, the references in the old article, the references which I listed for discussion on the talk page, and even the text of the old article support the claim that they are separate ideas.
2. As I mentioned above, the one editor who opposed the fork gave up discussing it two weeks before the actual fork was made. I think it was reasonable, at that point, to believe that there were no major objections to forking the article. The implication that this fork was used to circumvent Wikipedia guidelines is without warrant.
3. The majority of the article was new content. The new article was not even a rough match to the old article, let alone an exact duplicate. Furthermore, the claim that the new article was being used to house content that was deleted from the old article is simply false. Kborer 01:42, 28 August 2007 (UTC)

As JoshuaZ, the admin who closed the AfD discussion and deleted the article has already told you, if you disagree with the article's deletion, you can always use WP:DRV. However, I'd like to ask again, where are the references to the distinctions between the terms single payer health care and single payer health insurance that you keep alluding to? You inserted a series of links further up on the talk page, but I couldn't see anything in them that was conclusive of a distinction between the terms:

1. National Health Care for the Homeless Council uses the term single payer health insurance, but so what?

2. Cancerweb copied the National Library of Medicine's definition already quoted in the article

3. PNHP's page, What is Single Payer? actually appears to agree with this article, because it makes no distinction between single payer health care and single payer insurance

4. A San Francisco Chronicle article calls SB 840 single payer insurance, but one newspaper article about a state bill is hardly relevant to making a distinction between the two terms we are discussing

5. The Twenty Myths paper uses the terms single-payer systems and single-payer insurance interchangeably, so again, I see nothing that indicates a distinction between the terms.

--Sfmammamia 02:22, 28 August 2007 (UTC)

From this article: Single payer is "An approach to health care financing with only one source of money for paying health care providers." Does socialized medicine fit this description? Kborer 22:42, 29 August 2007 (UTC)

No. Germany has socialized medicine and near universal health care but has multiple funders. We have discussed this before elsewhere ad nauseum. Single payer is about ONE POT OF FUNDING FOR HEALTH CARE and socialized medicine is about GOVERNMENT INTERVENTION IN HEALTH CARE FOR COMMUNITY BENEFIT. They are logically seperate ideas thought they can often appear together. --Tom 18:49, 30 August 2007 (UTC)

Also, because they are logically separate issues I have removed certain reference to socialized medicine when what is really intended is to focus on single payer. I don't think nayone will object. This article is about Single Payer, not Socialized Medicine.--Tom 19:21, 30 August 2007 (UTC)

I object. Both terms are used heavily in the US political debate on health care reform, to varying degrees of interchangeability. --Dachannien^Talk_Contrib 20:42, 30 August 2007 (UTC)

Tom, I have reverted one of your deletions, because I think that most U.S. definitions of single-payer DO use the term to draw a distinction between systems that pay from a single pot and systems in which doctors and hospitals are government employees. It's an important distinction that isolates what we are talking about. I will attempt to slightly revise the wording of the sentence I restored, because I agree that we should leave amplifications on the term "socialized medicine" to the article on that topic. -- Sfmammamia —Preceding unsigned comment added by Sfmammamia (talk • contribs) 20:50, August 30, 2007 (UTC)

The "varying degrees of interchangeability" is what makes this so problematic and also the great deal of mis-information about various types of health systems (mostly put out by pressure groups with vested interests) just adds to the problem. Sfmammamia may be right that some people use the term to draw a disctinction, but we also know that others label the Canadian system as "socialized medicine" so for other people it cannot mean what the paragraph implies. I think WP articles should aim for clarity. Although one might argue that we need to reflect life as it is, the counter argument is that there is a "correct interpretation" and WP should stick to that. For example, just because some people confuse terms as "islamic" and "islamist" is not a good reason for repeating the confusion in the WP articles on these subjects. Knowlegeable people know better and WP should reflect the best of human knowledge, not the worst of pejudices and ignorance. When we discussed the meaning of "socialized medicine" at that article, it became apparent that the best definition of it was regulation and control, and here at "single payer" we are talking about meeting costs from a single fund. Sfmamammamia's revised paragraph has words of uncertaininty like "some people" and "may remain" so it is not an inclusive truth. Having precisely defined what is "socialized medicine" and what is "single-payer", I think it most unhelpful to start mixing them up again. They are not polar opposites of one another, even íf some people treat them as such. No one is advocating making US health providers employees of the government (as far as I am aware) so the need for this distinction is itself fairly meaningless anyway. Removing it from the article would merely improve clarity.--Tom 09:21, 31 August 2007 (UTC)

Tom, I have scanned the article on Socialized medicine and the related talk page. From what I can tell, the discussion there has been ongoing over the last several weeks. So forgive me if I haven't been keeping up with it. Based on that discussion, your comments above, and referenced definitions of "socialized medicine", I have altered the sentence I edited yesterday. I hope it's better, but if you still don't like the last clause, please feel free to delete it -- I think the see reference to the article Socialized medicine in that spot takes the reader there if they are interested in further enlightenment on the distinctions between the terms. -- Sfmammamia 15:35, 31 August 2007 (UTC)

Is single payer the same thing as national health insurance? Kborer 02:11, 31 August 2007 (UTC)

A single payer system could be used to achieve national health insurance, but in the absence of national health insurance, single payer systems can be implemented at more local levels, such as a city (like San Francisco's new plan) or a state (as has been proposed in several places). So no, it would not be accurate to say that single payer is the same thing as national health insurance. -- Sfmammamia 23:26, 13 September 2007 (UTC)

Is national health insurance always single payer? Kborer 14:18, 15 September 2007 (UTC)

No. May I suggest that you read the section on "Funding models" in the article on universal health care? -- Sfmammamia 20:00, 15 September 2007 (UTC)

Who is the single payer?

I just re-read the Aug 30 2003 PNHP proposal carefully and actually it is not prescriptive about whether the single payer is the government.

The PNHP says "Funds for the NHI could be raised through a variety of mechanisms" though it does go on to say that "funding based on an income or other progressive tax is the fairest and most efficient solution, since tax-based funding is the least cumbersome and least expensive mechanism for collecting money".

I guess that does not rule out setting up some other independent body not connected to or directed from government to run the fund and payed for by levies according so some formula. It could in theory be managed by an elected coalition of interested parties (doctors, patients, employers, public health bodies etc.). There are models for such a system, For instance the domestic services of the British Broadcasting Corporation are funded by compulsory levies mandated by parliament (which is a kind of tax), but the difference is that body itself operates completely independently of the government of the day. It is not governed by politicians, and is therefore not subject to political controls or pressures in the way that other public bodies are. Instead it follows a broad set of rules layed down in a charter set by parliament.

Also the National Library of Medicine definition only refers to "one source of money for paying health care providers", and goes on to say that "the payer may be a governmental unit or other entity

So this defintion does not say that the one source has to be the government either.

Because of this, isn't the statement in the article's heading that Single payer is when "the government assumes the role of an insurance company" making a much stronger statement than it should about the source of funding and its management? --Tom 14:20, 8 August 2007 (UTC)

I've reworded the phrase that introduces government involvement, to indicate that it is typically the single payer. -- Sfmammamia 20:38, 8 August 2007 (UTC)

To Sfmammamia. Sorry I accidentally undid your talk page edit..Its reinstated now. Hopefully my meaning behind reinstating the edit on the main page is clear. Although SOME people assume its the government, single payer advocates like PNHP say it COULD be the govt. So the original statement in the main para that it IS the govt was wrong. This possibility that is MAY be the govt and is often assumed to be the govt is made clear in the next to paras. The main para is more factual and in accordance with the definition that follows on from it. I hope that is clear.--Tom 15:03, 9 August 2007 (UTC) I understand what you mean by typically, but should we not take the lead from the original proponents and the medical profession? --Tom 15:12, 9 August 2007 (UTC)

I moved up the existing sentence about the assumption of government involvement, because it is, in fact, typical, and not mentioning it high up in the lead obscures the controversy over the term that occurs in the U.S. Implementing a single payer system without government involvement in the U.S. would be impossible, as only the government can close off a free market. I hope this arrangement satisfies your concern. -- Sfmammamia 15:26, 9 August 2007 (UTC)

You say it would impossible. Can you justify that, or is it your assumption? I gave an eample earlier of the BBC in the UK but perhaps you might better see it with a US example. The Federal Reserve Bank system was set up by government but acts completely independently of political control and its member banks are owned privately. It is part public and part private. Its only acts to protect the currency and the stability and smooth operation of the banking system and it cannot be swayed to serve the vested interests of the serving presidency, the commercial banks or the ruling party in either house of congress. Its mandate is much broader and long term than any one of those groups serve. Perhaps that is what the PNHP group meant when it deliberately left the matter open. A Federal Health Insurance System could be to medicine the what the Fed is to banking. If I were a proposer of this idea who chose my words carefully to define A, which has a subset B, I'd be a bit annoyed if people ignored my careful words and just talked about B, especially if B is loaded with negative connotations (as government control of anything in the US seems to be). It is tantamamount to misrepresentation. I agree that many people may assume B and not A, but surely it's fairer if Wikipedia makes it clear what the proposers said in the definition was A. We are not hiding the presence of subset B or disguising its use by mentioning it immediately after the proper definition. --Tom 00:25, 10 August 2007 (UTC)

Tom, in your example, who established the Federal Reserve Bank system? The government. Even if an independent entity were established to serve as the administrator of a single payer system in the U.S., it would have to be established through legislation. The payment mechanism as well would have to be established by legislation. So even if a government entity is not the single payer, establishing that entity would require significant government-led transformation of a market where, to date, government's involvement has invoked huge controversy. That's the point I'm trying to avoid obscuring in the lead. -- Sfmammamia 14:43, 10 August 2007 (UTC)

Polls section

The polls section looks, quite frankly, like total crap. That's probably why it was deleted earlier. I strongly suggest replacing the verbose and poorly formatted poll data with a short summary of the poll results, with links to the appropriate articles for those who actually need to see the data in that much detail. --Dachannien^Talk_Contrib 10:03, 20 August 2007 (UTC)

The polls are very important in the American health care debate, because when you ask politicians why they don't support single payer, they regularly say that "we" want our employer-based system. The polls rebut that claim.

I included those polls originally (although other people have worked on it). It's not easy to summarize polls. In order to describe polls accurately, you have to quote the specific language of the questions. Paraphrases can be biased or misleading.

If you want to rewrite that section, go ahead, as long as you can accurately describe the polls. If I think you haven't described them accurately, I'll revert it. OK? Nbauman 22:03, 20 August 2007 (UTC)

The polls do not rebut that story at all. You're giving half the story. Clever tactic. --Rotten 23:14, 20 August 2007 (UTC)

As I said before, all of the polling data should go. It might make a good reference in another section, but there is no reason to have a section only on it, and there are many reasons not to dump all of that raw data into the article. Kborer 01:10, 21 August 2007 (UTC)

As one who put a little time into the polls section, I might favor moving the info to a new article, perhaps "single-payer healthcare in the united states," (subsection: political climate) although I don't know if that would be the appropriate wording, as single-payer has not yet been implemented in any significant way in the U.S. outside of Medicare.Tony Clothes 08:08, 23 August 2007 (UTC)

Kborer, you haven't answered my argument. The question of whether Americans favor single payer is important. The polls give the best sense of whether they favor it. Supporters of the single payer system say that the American public wants a single payer system. Politicans like Hillary Clinton who oppose single payer say that the American public doesn't want a single payer system, because they want "free choice". The polls address the question of which of them is right. Do you disagree with anything in this paragraph? 15:04, 23 August 2007 (UTC) —The preceding unsigned comment was added by Nbauman (talk • contribs).

If the above statements are important then add them to the article. However, the polling data significantly lowers its quality of the article and should be removed. Use the data to support the inclusion of a summary, not the other way around. Kborer 03:54, 24 August 2007 (UTC)

Agreed. In fact, this is already covered fairly specifically by policy. I'm not sure what the copyright issues would be regarding adding the poll results to Wikisource, but in any case, we can link to the poll data as a reference while summarizing the important details in prose form. --Dachannien^Talk_Contrib 10:12, 24 August 2007 (UTC)

Which kind, enlightened Wikipedia scholar added this section? How does taking up half the section with polls help people understand what SPHC is? I'm deleting it.--Rotten 10:42, 25 August 2007 (UTC)

That was really uncalled for. Please see Wikipedia:No personal attacks. Kborer 11:41, 25 August 2007 (UTC)

I was struck by the apparent disparity between the deleted polls section and the claim in the "opponents and criticisms" section that there is no political will for change. I was originally quite mindful to think that the polls section was not very relevant (as public opinion can sometimes be quite transitory) but comparing the poll deleted data to the "oppnonents" section I am beginning to think otherwise. I think the poll data is relevent, though perhaps it is arguable whether the full data needs to be in the article. Could it be summarised and a link placed in the article to the source data? I do think dropping the section is rather drastic given the apparent disparity between the poll data and the claim that there is no will for change. I echo Kborer's sentiment that the language used was uncalled for. --Tom 17:17, 25 August 2007 (UTC)

These polls tell half the story. The polls that I've read indicate that while Americans recognize that their system needs a drastic overhaul, they are quite individually happy with their own care, second only to Germany in that respect (from what I remember). Single payer, socialized medicine, whatever-the-preferred-term-is-these-days initiatives failed in the two most "socialist-friendly" states in the Union (Oregon and Massichusetts). The problem is that the, ahem, "individuals" who run Wikipedia try to flood these articles with overlapping data, making it appear ludicrous that anyone would ever oppose socialized medicine (which Americans have done, repeatedly). Why half of this article needs to be about polls is beyond me, other than to push a political position. --Rotten 18:35, 25 August 2007 (UTC)

Exactly. If the opponents of single payer argue that there is no political will for it, then it is relevant to show the poll data to argue that there is political will for it. As I said before, I don't mind if people edit the poll data accurately to make it more concise, but if they delete the entire section, I will revert it.

And thank you Kborer for keeping up the social climate that discourages personal attacks. Nbauman 18:32, 25 August 2007 (UTC)

There is no political will for, not on the scale that it's proponents want. That's why universal care initiatives have failed repeatedly. --Rotten 18:35, 25 August 2007 (UTC)

Interesting position. What evidence do you have to support that claim? Nbauman 01:06, 27 August 2007 (UTC)

Universal care initiatives failed in both Oregon and Massachusetts. Look it up.--Rotten 15:03, 27 August 2007 (UTC)

I think we need a bit of structure to this debate, because we're really getting nowhere in determining what there is consensus on and what is still heavily disputed. Here's the flow of the debate as I see it:

• Should the article include the full poll data, or should that section be replaced by a prose summary? If the full poll data is appropriate, stop.
• What are the relevant items of interest from the polling data? Does the polling data support a conclusion on any of these topics?
  • Public satisfaction with current health care, both individually and en masse
  • Public support/opposition for nonspecific changes in health care policy
  • Public support/opposition specifically for a single-payer health care model
• What conclusions can be drawn on these topics? Can a conclusion not be drawn on any of these topics, and if that's the case, is there other appropriate source data that would allow a conclusion to be drawn?
• Is there other appropriate source data that contradicts the polling data?

We need to answer these questions in the process of determining what an appropriate final state for that section would be. I think the consensus on the first answer is fairly clear - responses in this discussion have ranged from "the polling data is not appropriate to include verbatim in Wikipedia" to "if the polling data were replaced by a prose section that was written correctly, that would be fine". In other words, I think we all agree that including the polling data verbatim isn't necessary. Wikipedia policy also suggests that replacement with a prose section is appropriate. --Dachannien^Talk_Contrib 18:49, 27 August 2007 (UTC)

Dachannien, that's a good summary of the debate. I would add one more point:

Any summary of the polls must quote the exact language of the questions that the subjects responded to. That's standard editing procedure. (That's what the New York Times does, for example.)

Rotten made a good try at a narrative summary but it doesn't accurately summarize the polls and was properly reverted.

For example, I would change:

18. Which of the following three statements comes closest to expressing your overall view of the health care system in the United States: 1. On the whole, the health care system works pretty well and only minor changes are necessary to make it work better. 2. There are some good things in our health care system, but fundamental changes are needed. 3. Our health care system has so much wrong with it that we need to completely rebuild it.

8% - Minor Changes

54% - Fundamental Changes

36% - Completely Rebuild

1% - DK/NA

to:

Only 8% thought that "On the whole, the health care system works pretty well and only minor changes are necessary to make it work better." 54% thought, "There are some good things in our health care system, but fundamental changes are needed," while 36% thought, "Our health care system has so much wrong with it that we need to completely rebuild it."

What does everybody think of that? Nbauman 00:44, 28 August 2007 (UTC)

I agree with Nbauman that a narrative summary of responses on selected questions would be more in keeping with Wikipedia style, although using the verb "thought" seems a little awkward -- how about "chose the statement" or "agreed"? I think we also need to narrow down the number of questions cited from the NYTimes/CBS News poll -- 14 is far too many. The earlier poll results should include a summary statement as well as a sample question, if possible. And I think the 2003 poll results could also be more selective. -- Sfmammamia 14:24, 28 August 2007 (UTC)

"Agreed" may be more objective than "thought" (although the questions asked "do you think....").

It does seem too long, but, the problem is that if you select a few questions, you can easily reflect a POV. You could select responses in which a majority seemed to favor or disfavor government health care. The classic question is, "are you satisfied with your own health care?" which the insurance industry always uses. Large numbers of people always agree. You could say from these polls that 77% are "satisfied" with their health care. Or you could say that 57% are "dissatisfied" with the health care system. If the reader wants to understand the apparent inconsistency, the article has have the exact, full question.

It's very easy for someone to edit this into a paragraph that he agrees with, but it's very hard to edit it into a paragraph that we can all agree is fair. Nbauman 15:27, 28 August 2007 (UTC)

Done.--Rotten 03:23, 29 August 2007 (UTC)

You did nothing of the sort. You simply replaced the section with your own original summary, which we agreed was inaccurate and did not reflect the polls. You're ignoring the consensus. You don't understand the process of collaborative writing which includes ideas of people you may not agree with. Nbauman 19:12, 29 August 2007 (UTC)

I just read the poll data and there is indeed a lot of data. Too much to include fully and probably would be breeching copyright if it was). But I do think the findings are relevant to the article. If, as an outsider to the issues in the US, I was asked to summarise it, I would put it as follows

the poll revealed a strong opinion in favour of change towards a Universal Health Care system in the US based on single-payer health care, even if that means higher taxation. It also reports strong support for the introduction of cheaper access to medicines. The country is divided as to the government's ability to deliver adequate care under any new system, but it is not significantly worse than the skepticism of the insurance companies to improve on the present system. Most people regard the leading democratic candidates for the presidency to have better policies on health than the incumbent president.

This is the impression I got from reading the whole data and I don't claim to have checked the above back to the poll. --Tom 21:14, 29 August 2007 (UTC)

It might be a good idea to find polls from those countries that use this system I also recommend checking the data in the opponents section for what operations are touted by the US system, because opponents have used operations usually payed for by Medicare (most notably hip replacements) to try to show that the American system is better. —Preceding unsigned comment added by 75.69.118.1 (talk) 02:52, 23 October 2007 (UTC)

New graphic

I made a new graphic, but since the last one was so controversial I will post it here for review before putting it up. Kborer 01:49, 22 August 2007 (UTC)

My reaction: no better than the first attempt. Creates more confusion than it resolves. Kborer, we have not reached consensus on the distinctions you draw between "single payer health care" and "single payer health insurance." We need to do that first before agreeing on a schematic that illustrates the concepts in the article. Here's an example: San Francisco is implementing a city-paid, universal health care system for the uninsured. Here's a recent article about it. Note that the article says "it isn't health insurance." To my knowledge, the care is delivered by a mix of public and private (nonprofit) clinics, so they are not all government employees, they are simply paid by the program. So, this is single-payer health care, not single payer health insurance, yes? That is why this article is titled single-payer health care, and that is why the distinction you make between single payer health care and single payer health insurance does not make sense to me. -- Sfmammamia 15:10, 22 August 2007 (UTC)

Kborer, thanks for posting it first. It's easier to understand than the previous graphic, but it still has problems. The most obvious problem is the "Government monopoly" quadrant. Nbauman 18:13, 22 August 2007 (UTC)

Against inclusion. It looks much the same as the old one and it carries many of the same faults.--Tom 19:18, 22 August 2007 (UTC)

My objections to the previous version of this graphic continue to hold true for this version. I don't think any graphic is necessary to explain the concept, and I also think the concept is nuanced enough that a single graphic will tend to confuse rather than clarify. --Dachannien^Talk_Contrib 20:32, 22 August 2007 (UTC)

If anyone has any suggestions on how to improve the graphic, I would certainly appreciate the help.

The Healthy San Francisco project seems to be government health insurance. It is mostly funded through taxes, and as far as I could tell delivery is mostly private. Depending on the details, someone might argue that it is socialized medicine if there are heavy controls on delivery. It is definitely single payer though. Kborer 23:28, 22 August 2007 (UTC)

Calling the Healthy San Francisco project government health insurance definitely would be original research, because the cited source said it was NOT insurance. -- Sfmammamia 23:39, 22 August 2007 (UTC)

They said it was not insurance because there is a limit on where it could be used. That does not make much sense, because most health insurance plans have similar limitations. They are trying to make the point that it is very geographically limited compared to most other health insurance plans by saying, "it's not health insurance" when they actually mean, "you cannot use it outside the city, like normal health insurance." Kborer 00:09, 23 August 2007 (UTC)

Even the Healthy San Francisco web site itself says the program is not health insurance. So I stand by my point, your interpretation is original research. -- Sfmammamia 16:37, 24 August 2007 (UTC)

Medicare, Medicaid and the Canadian system are properly called "social insurance" systems...private delivery system

This quote is given in the article but the link it to a subscription site so I cannot verify it. It seems strange a thing for him to say because it goes on to mention the delivery system as being an important factor. But the important factor about single payer is not the delivery system but the fact that there is a single risk pool. Are we sure that he made that quote in the context of discussion about the term "Single-payer"? If anyone has a WSJ subsription and can verify the full quote for us that would be great. I have no doubt that they are forms of socia insurance ...its just the bit about the coupling to a private delivery system. --Tom (talk) 23:37, 1 January 2008 (UTC)

Canada's hospitals... mostly private or public

The article in one place says the hospitals are mostly run by the provincial governments and in another that they are mostly private. They cannot both be right. Which is correct?--Tom (talk) 23:39, 1 January 2008 (UTC)

The vast majority of Canadian hospitals are public. I corrected the statement and added a cite. --Sfmammamia (talk) 00:47, 2 January 2008 (UTC)

Risk equalization and equalization pools as an alternative to Single Payer

I have initiated an article on equalization pools. In health insurance, a risk equalization pool is a way of achieving a competitive insurance market and achieving universal health care. In essence the payment and premium collection bureaucracy rests with the insurers who now compete on a level playing field and must set prices and coverage publicy and which cannot reject applicants or limit health care coverage, on the grounds of health status or age, nor many they set different co-pays and deductibles etc... i.e. many of the things that people seem to object to most in the present US system. It is therefore an alternative to creating a single payer system, so it is somewhat tangential to this article. It is used in many countries where there is (or is intended to be) a competitive insurance market in health insurance. It requires the government to control an agency to equalize risks between insurance pools to encourage clearer competition and can be the instrument of government funding for health.

Even though risk equalization would be a competitive alternative to single payer health care I am surprised that this article does not mention it. The system is used in three countries that I know of (Germany, Ireland and the Netherlands) but it may be used in others too.

I raise the issue here because (a) someone may be interested to investigate the issue further and (b) might be kind enough to help add to the equalization pool article as they do so (as I have not provided any references as yet).--Tom (talk) 19:50, 17 January 2008 (UTC)

A "see also" link seemed appropriate because it's a generally related concept, but any sort of comparative analysis would require verifiable third-party sources and might be considered off-topic for this article. It might be more appropriate for an article that covers health care models in general. --Dachannien^Talk_Contrib 22:57, 17 January 2008 (UTC)

Single-payer health care as an American term

"Single-payer health care is an "American" term." No, it is just a term. This sentence seems to contradict itself.

Single-payer health care is an American term describing the payment for doctors, hospitals and other providers for health care from a single fund. The Canadian health care system, the British National Health Service, Australia's Medicare, and Medicare in the U.S. for the elderly and disabled are single-payer systems. —Preceding unsigned comment added by 71.146.93.96 (talk) 06:25, 30 January 2008 (UTC)

I think the intent of the sentence was to say that

Single-payer health care is a term used by Americans to describe the payment for doctors, hospitals and other providers for health care from a single fund. The Canadian health care system, the British National Health Service, Australia's Medicare, and Medicare in the U.S. for the elderly and disabled are all described as single-payer systems.

(Please cut me some slack on using the term "Americans" as a synonym for "citizens of the United States" here - I'm just trying to refactor the existing sentence as an illustration here). EastTN (talk) 18:36, 30 April 2008 (UTC)

I don't think the British system is single-payer (I'm not sure about the Australian system but I don't think it's single-payer either.) The distinctive thing about single-payer is that it is a single-payer system, i.e. the government only handles the payment system, but the rest of the system -- the delivery of services -- is in the private market. Nbauman (talk) 04:37, 17 May 2008 (UTC)

At least as used in the US, "single-payer" means that there is only one primary payment system (typically government run). Taken by itself, it doesn't say anything else about the system. Delivery of services may or may not be provided through the private market. It also doesn't require that all payments be run through the "single" system. Incidental payments such as modest deductibles and copayments aren't seen as inconsistent with the term "single-payer." Other, non-routine sources of payment, such as product liability payments covering health care for injuries resulting from a defective product, aren't seen as inconsistent either. In some respects the usage is a bit loose, but it does speak to a basic question - are there multiple finance or insurance schemes funding health care for the population involved, or just one? If the answer is "just one," then most people in the US would call it a single-payer system regardless of the other details of the system. EastTN (talk) 15:26, 17 June 2008 (UTC)

Criticisms - government versus private insurance companies

The article currently says

"A single-payer system could put the government, rather than private insurance companies, in the role of deciding which procedures and medications would be covered"

I am not sure why this is a criticism. It seems more like a sound-bite. Most people in the U.S. get covered by their employer's insurance so there is little or no element of consumer choice with the private insurance coverage they receive. If the government in a single-payer system did not cover certain procedures surely the insurance companies would step in and offer additional coverage over and above the basic national package. This is what happens in the Netherlands for example and it can assure the insured person of the coverage they feel they need. Similarly if a employer's policy in the U.S. for example was lacking, surely the insured person could buy the extra coverage they need. The two things seem to me to be fairly similar. A person has a chance of influencing the health care system in single-payer systems because they are to some extent democratically accountable. I am not sure how an employee could influence his/her employer's purchasing decisions or the employer's insurer's coverage policy. --Tom (talk) 19:05, 25 September 2008 (UTC)