Heidi, thank you for reading it that closely. You answered the harder question inside the easier one.
A single payer would fix one specific thing the piece is about. Today, one of the two parties to the dispute also calculates the number the dispute turns on, and a single public payer would at least end that particular conflict of interest. The benchmark would be set once, in the open, by a party that is not taking a cut of the spread.
What it would not fix is the part your second question points to. The number would still be set far from the bedside, by people who have never met the patient and will never sit with the consequence of getting it wrong. The author would change. The distance would not. And distance, more than ownership, is the thing I keep returning to: the further the person setting the number sits from the room where the care happens, the easier it is for that number to drift from what the care actually was.
My honest answer is that single payer would remove the conflict and leave the distance, which is why I'd challenge us to treat "who pays" as the smaller question, and "who sets the number, and how close are they to the work" as the larger one.
David, I so appreciate reading this side of No Surprises. Would a one-payer system solve this? Or would the decision-making still be too far removed?
Heidi, thank you for reading it that closely. You answered the harder question inside the easier one.
A single payer would fix one specific thing the piece is about. Today, one of the two parties to the dispute also calculates the number the dispute turns on, and a single public payer would at least end that particular conflict of interest. The benchmark would be set once, in the open, by a party that is not taking a cut of the spread.
What it would not fix is the part your second question points to. The number would still be set far from the bedside, by people who have never met the patient and will never sit with the consequence of getting it wrong. The author would change. The distance would not. And distance, more than ownership, is the thing I keep returning to: the further the person setting the number sits from the room where the care happens, the easier it is for that number to drift from what the care actually was.
My honest answer is that single payer would remove the conflict and leave the distance, which is why I'd challenge us to treat "who pays" as the smaller question, and "who sets the number, and how close are they to the work" as the larger one.
I see the gap. And another application to real life for genchi genbustu. Thank you for putting your thoughts and experience in writing!