One of the concerns I’ve repeatedly expressed when considering a single-payer health care system in the U.S. are the concerns of whether Americans would tolerate the two-tier health care system that would almost certainly arise, and the potential complications therefrom.
For example, the British N.H.S. seems to be taking the stance that you’re either “in” or you’re “out”, with no fence-straddling tolerated by the comfortable-but-not-super-rich crowd.
From a New York Times story on the subject:
One such case was Debbie Hirst’s. Her breast cancer had metastasized, and the health service would not provide her with Avastin, a drug that is widely used in the United States and Europe to keep such cancers at bay. So, with her oncologist’s support, she decided last year to try to pay the $120,000 cost herself, while continuing with the rest of her publicly financed treatment.
By December, she had raised $20,000 and was preparing to sell her house to raise more. But then the government, which had tacitly allowed such arrangements before, put its foot down. Mrs. Hirst heard the news from her doctor.
“He looked at me and said: ‘I’m so sorry, Debbie. I’ve had my wrists slapped from the people upstairs, and I can no longer offer you that service,’ ” Mrs. Hirst said in an interview. [...]
“People swap from public to private sector all the time, and they’re topping up for virtually everything,” Dr. Charlson said in an interview. For instance, he said, a patient put on a five-month waiting list to see an orthopedic surgeon may pay $250 for a private consultation, and then switch back to the health service for the actual operation from the same doctor.
“Or they’ll buy an M.R.I. scan because the wait is so long, and then take the results back to the N.H.S.,” Dr. Charlson said.
Of course, the way our government seems hell-bent on heading toward bread-and-circuses land, it’s all too easy to imagine an American single-payer scheme including all the expensive upgrades as part of basic coverage, taxes and deficit be damned…but that’s a rant for another day.
