One of the leading advocates on the left for universal health is Ezra Klein. He offers some provocative thoughts on all of this in his post, "What is Life Worth?", especially this comparison of health systems in the U.S. and Britain:
People often compare American health care to Canadian health care. It's the wrong comparison. The inverse of the American health care system is the British health care system. Where we are the priciest, they are the cheapest. We refuse to make any explicit decisions, instead denying care based on criteria that makes the denial the fault of the patient rather than the system. You don't have enough money for the treatment. They make all their decisions explicit, relying on criteria that makes the denial the fault of the system's judgments. We don't think that treatment worth the cost. Their system gives patients someone to be angry at. Ours has no connection to value. Their system creates more blame, ours engenders more tragedy.Beyond the techno-babble of "explicit decisions" and "treatment worth the cost," we have Klein making an essentially normative argument pitting state control versus personal responsibility in health provision.
Which works better? Well, while we're on the British case, recall the big story from last summer on Britain's experience with the nationalization of dental care. Access to good dental health declined in Britain with the advent of a single payer system, as this Telegraph story indicates:
The shake-up of NHS dentistry has been a disaster with standards of care dropping and almost one million fewer people being treated on the health service under the new system, a damning report by MPs has found ....For folks like Ezra Klein - who have been pushing for a radical expansion of the state sector - well before the economy started cooperated with a collectivist-inspiring crisis of capitalism - the key will be to demonstrate how an expansion of state-control and governmental mandates will not worsen care in the United States.
Instead of improving access to NHS dentistry the reforms have made it worse, the report by the House of Commons Health Select Committee found.
The number of dentists working in the health service has fallen, the number of NHS treatments carried out has dropped and in many areas patients are still experiencing severe difficulties in finding a dentist to treat them.
Worryingly, complex treatments carried out on the NHS have dropped by half while both referrals to hospital and tooth extractions have increased.
This suggests dentists are simply removing teeth rather than taking on complicated treatments because they have become uneconomical to provide ....
The Government hoped the new contracts would give more patients the chance to register with an NHS dentist, encourage more preventive work and reduce the "drill and fill'' culture.
They were also designed to simplify the payments system, so that instead of being paid per treatment, dentists were given a flat annual salary in return for carrying out an agreed amount of work known as units of dental activity (UDAs).
However, the select committee found that as a result of the changes, dentists no longer had any financial incentive to give appropriate treatment.
Rather than build bureaucracy and limit choice among service providers, government should seek to increase competition in insurance markets, and find ways to subsidize, through grants and tax incentives, the affordabiliy of health coverage for lower income and disadvantaged Americans.
9 comments:
Choice is already limited by the insurer or HMO if that is what you belong to Mr. Douglas. Try getting an individual policy that actually covers well. A national health insurance plan is in the best interests of our Nation. It would take the burden of health insurance cost off business. What is preventing this is right wingers like yoursef scaring people with your accusations of socialism and other lies.
I just cannot wait for the government to run our medical system.
I hope it is just like they run the Social Security system. I just called SS and had to wait 30 minutes for someone to answer the phone. 30 minutes. I have a disabled adult child and he was supposed to be reimbursed funds by SS and the money never arrived. When an actual person in customer service picks up the phone and talks to me, all of a sudden they have no idea what money I am talking about. I may as well take the phone and bang my head with it.
You get forms to fill out and immediately fill them out and send them back. Two months later you get letters "second request" stating that I have failed to fill out these forms and do it now.
Forget going to the SS office, the people are lined up for hours and hours. The local SS office told me that they have less employees now than in 1983, when there was a lot less seniors.
Here is the deal. If the government runs the medical system either one of two things will happen:
1)All doctors in the system will agree to make the same compensation that a teacher would;
or
2)People will die because the system is so monetarily out of control that medical care will be rationed.
Guess which one will happen !!!
And if anyone thinks that what I wrote is just scare tactic...you're only fooling yourself. There has to be a better solution.
Professor,
please describe how a competitive insurance market would function.
What regulations would you accept in this market and how would they affect the outcome?
The last several times me or a family member went to the doctor, although we had an appointment it was a minimum of 45 minutes to get into the exam room. Then another at least 15 minutes before the doctor came in. What does the wait have to do with insurance Norm? And there are millions of people in this Country who thank God that FDR started Social Security. I hope your disabled son gets the benefits he's entitled to soon Norm. Or would you rather put an end to Social Security and trust that your fellow man will send him a check and help pay his medical bills every month. Good luck with that friend.
@truth101
I guess you miss my point that a government run system would be inefficient user of taxpayer money.
For example, each year Congress set aside funds to pay benefits in the future. Then they took the money back, placed an IOU in the jar, and spent the money for other things....every year since the 1960's. You approve ?
I have nothing against providing
SS for the elderly and disabled.
And when I call my medical insurance company I get a human being very quickly who answers my questions efficiently.
Thanks for the kind thoughts for my son.
If it were run correctly national health insurance as well as many other government programs would be wonderful and benefit all. I wish I could defend governments penchant for taking good ideas and screwing up their implementation. Thank you for the dialogue Norm and thank you Mr. Douglas. You run a fine blog sir.
Norm,
Here I may actually agree with you. Running a social system in America is sort of like trying to make a groundhog climb a tree.
American values have, throughout its recent history revolved around the individual. It has been the breeding ground for some of the greatest achievements of humanity as well as some of the worst examples of greed and selfishness that exists in society.
These two competing values make it rather difficult for America to implement policies that do not serve the vested interests of select individuals who hold the reigns of power.
About a year ago, PBS (I think "Frontline") did a very nice and surprisingly balanced and candid evaluation of several countries' health care systems. If I remember correctly, they covered Canada, England, Germany, Australia and Japan. None of them was perfect: each had flaws. Sadly, our press and most of our citizens do not want to consider the problems that do exist in, for example, Canada.
Our system does, indeed, need repair. But, in light of the government buying out everyone else, how in the world can the public afford this now? And, it's a bit scary to think that the government will be in control of so much. People forget that the government can provide health care ... and it can also deny health care.
A bizarre example just came to mind (pardon the randomness): a friend has been living in Paris for several years working at the Louvre. She has been in the French system for several years now. She suprised her mother with the news that the French system will not pay for cancer treatments for anyone over 60 (maybe 65)? So, there's socialism for you: at an elderly age, you are no longer useful or productive. So, why should the state pay for your expensive medical treatments?
Choice is not limited as much in our present system, as it would be in a single-payer system ... as KMacGinn has illustrated.
I speak as the head of a household that has historically been a "power user" of health benefits. I've even had to consider changing jobs because my wife's accumulated medical bills were approaching the lifetime cap on out-of-network benefits.
But at least I had the option to go somewhere else and get better support. Again, as KMacGinn has shown us, a single-payer system will leave us with nowhere else to go in this nation ...
... with a potential for civil-liberties abuse that makes the PATRIOT Act and the Left's worst nightmares about Mr. Bush seem downright libertarian by comparison ...
... and with a potential to replace the healthcare-cost burden on employers with an EVEN GREATER tax burden.
Like any form of socialism ... or any bureaucracy ... the incentives inherent to a single-payer system at its various levels work parasitically, instead of symbiotically, with human nature to drag it down.*
Actually, you want to make the system better ... move it away from group health insurance, and more towards indivdual plans ... with one piece of government intervention in place: an insurer must accept ANYONE, regardless of pre-existing conditions, that applies and pays the premiums.
That way, you maintain competition, keeping both providers and insurers honest ... you maintain the cost-benefit feedback loop more tightly around the individual, which will control costs ... while not allowing insurers to cherry-pick the lowest-risk customers and leave the others out in the cold, ripe for the picking by politicians who will promise them healthcare security in exchange for their civil liberties.
-------------------
*In fact, this is one reason why private charitable efforts are more efficient and effective in many cases in delivering social services than government programs are ... when others can correct your errors by drying up your funding on short notice, instead of having to wait for the next election (or the next, or the next ...), you either tend to make fewer errors, or you are soon replaced by someone who makes fewer than you do.
Post a Comment