Reply #60: Such a complicated issue, , , ,

[erknm]

but a great political soundbite. Every major presidential candidate since Eisenhower has had health care reform on his platform. It is a complicated problem but we can learn from the mistakes that other nations have made. Frankly there is talk in other nations (like Canada) of moving toward a private system. Each year Britain has effectively gone more private because of a lack of government funds for their health service. Other nations have either completely gone private or are looking into it. Suffice it to say that the objective lense does not completely fill my eyes with optimism about going to a single payer (or worse a single provider) system.

Here are just some of the issues:

Rationing. Currently the price system rations health care in the US. Some people call this inequitable. Under a socialized system, queueing will occur due to the inability to ration by price. Better in this case to mimick the British system (as bad as it is) where you can opt out by choice than the Canadian system where the wealthy opt out by flying to the US for treatment. (This included provincial ministers from Quebec) You just have to allow people to opt out of the queue.

Efficiency. Hate to bag on Canada, but the average stay in the hospital is longer and the average condition for hospitalization is milder than in the US. Canadian hospitals get paid a fixed amount and must stay in budget, so they have an incentive to admit lower cost patients. They cannot turn a patient away if they have capacity, so they keep their lower cost patients longer so that they are less likely to be forced to take a higher cost patient. This is the only way they can stay in budget. A national system must allow a pay as you go type system so that we do not see the perverse inefficiencies.

Queueing triage. Without a price system to ration care, there will be queueing, people waiting for treatment. This can be incredibly inefficient. Worse, people can die while on line. Depending on who you believe, (government vs private researchers), the numbers are incredibly high. Like those in the US who do not get care and then die, these numbers are not easily obtained, thus it is a largely hidden problem. If there is to be a system of queueing, where we do not get the care we want immediately, then the triage system must be more advanced to make sure that people are not falling dead while waiting for treatment. This is a problem that we see now in the US in the transplant business and the experience I have observed there does not fill me with confidence about doing something more systematic.

Research. Far less medical research in Canada and Britain, only France gets close to the US in per capita research spending. A national system must allow for expenditures to increase knowledge.

There is more, but I have already typed too much.

FH