I guess we’ll have to think of another reason to oppose single payer

If there’s one thing everyone hates about single payer health systems it’s waiting lists for treatment. The trade-off is that costs are lower in single payer systems and everyone has access to care.

We can rationalize the situation in the US by saying we’ve decided not to make the trade-off. We’ve decided as a country that we don’t wan to “ration” health care or artificially limit its supply. Assuming you have access to the system you should be able to get as much care as needed to make you better.
But maybe there isn’t a trade-off. The US spends more on health care per capita and as a percent of GDP than anywhere else in the world. Massachusetts is the highest spender in the US. And Boston is the capital of the state and of its health care system.

Yet according to a new study reported in the Boston Globe (Dangerous delays to see skin doctors; Hub patients wait longest, study says), patients in Boston wait an average of 10.5 weeks to see a dermatologist for a “changing mole” –perhaps the closest thing in dermatology to an emergency. At the Brigham and Women’s Hospital, patients wait 3.5 months on average for a routine visit!

No one can really figure out what’s going on, especially when Boston has so many dermatologists.

  • Some physicians say the data must be wrong
  • Others cite the expansion of cosmetic services
  • Others blame it on the high percentage of researchers

In any case, no one’s accountable. (By the way this is not the first time physician access in Boston has been shown to be wanting.)
Just for kicks, I had a look at the UK’s National Health Service website, which has detailed, up-to-date information on waiting times by specialty. I looked at the “Provider Based Hospital Waiting Times for 1st Outpatient Appointments: England,” and checked the “Effective length of wait from receipt of GP written referral request to first Outpatient attendance (weeks). I’m not expert in reading these tables –so maybe I’m reading something wrong– but according to my calculations:

  • 37% of patients were seen in under 4 weeks
  • 63% in under 8 weeks
  • 98% in under 13 weeks

These numbers aren’t directly comparable with the Boston statistics. Still, it shows something terribly wrong with health care in my fair town.

January 8, 2007

10 thoughts on “I guess we’ll have to think of another reason to oppose single payer”

  1. Dave,

    You know what’s wrong: we talk about it all the time. It’s overuse of medical services.

    Supply is adequate. Demand is out of control.

    Why do we continue this charade of asking primary care physicians for referrals? In practice I cannot say no.



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