nos-trum. pronunciation: \nos'-trum\. noun. Etymology: Latin, neuter of noster our, ours.
1. a medicine of secret composition recommended by its preparer but usually without scientific proof of its effectiveness.
2. a usually questionable remedy or scheme.
See here for more discussion.

Tuesday, June 1, 2010

Canada's Bankrupt Health Care Forced Into the Private Market

While Canada provides another example of the dead end of single payer, cradle-to-grave care, the US stumbles down the same road.

According to Reuters (May 31),
"British Columbia is replacing block grants to hospitals with fee-for-procedure payments and Quebec has a new flat health tax and a proposal for payments on each medical visit -- an idea that critics say is an illegal user fee. And a few provinces are also experimenting with private funding for procedures such as hip, knee and cataract surgery."
As we've seen with other countries like Great Britain, universal, subsidized health care works for a while, until the cost outstrips the ability of the country to tax its wage earners.  Margaret Thatcher (vilified by the reformers on the Left) once said, "Socialism works until you run out of other people's money."  The BBC reports that Britain's National Health Service is considering such horrible measures as cancelling all hip replacements for a year to reduce cost.  That means about 60,000 people will need to tough it out, taking pain medicines while they wait for the government to get enough money together to start authorizing surgery again.

No country has solved the problem of health care cost.  The ones, like Canada, who have been held up as the example for the US to follow, are experiencing the same problems.

I read somewhere that economists say that once more than 50% of the citizens are recipients of major government benefits, then a tipping point is reached:  the voters can never re-establish self-reliance as a goal--the majority who are receiving the free benefits can vote down any attempt to roll them back.  I'm not sure it's true, and the US is not there yet.  At this point not quite 50% pay no taxes in this country--the number is 47% percent, who are supported by the rest.

It's still a shocking number:  47% percent pay no federal income tax.  (yes, they pay sales tax, etc, but so does everybody quibbling).

But the experience in Greece shows how catastrophic a reliance on ever-increasing government benefits can be.
As I've posted before, the new US law does nothing to control costs and drives the government into conflict with the elements of the health care system (doctors, insurance plans, drug companies, etc) as money gets tighter.  Likewise the people's demand for more and better care continues to grow.  So US government regulators will find themselves in the same position as their counterparts in Canada and Great Britain.  Rising costs, no money.

In a capitalist system, markets are competitive and the most efficient way to provides goods and services.  But before you point to the health care system in the US as an example of free market failure, let me just say this:

It wasn't a free market system.

States regulated what could be included in heath insurance plans.  The federal government drove costs for Medicare and Medicaid using formulas that had nothing to do with supply and demand.  The competition necessary for markets to work didn't exist.

Critics of a private system of health care attack the US system by making the point that in a free market the buyer and seller must have a way to accurately evaluate what they are buying and selling.  A patient has no way to know the "value" of the health care they're receiving--they can't get the information needed to make a cost-effective choice:  is this a good doctor? is that expensive test available elsewhere for less?

The critics are wrong.   A case in point is the Whole Foods alternative.  The company employees vote on what benefits they want to include.  Each employee is given a fund to draw on for their health care; if they spend less by shopping wisely, the employee keeps what is saved.  This provides an incentive to control costs.  It puts control into the hands of the consumer.

But can consumers get the info to make a wise choice?  The cheapest hospital may not be the best, but neither is the most expensive.  The answer is yes, you can make a wise choice.  The data on quality, complication rates, patient satisfaction and the like are increasingly available to everyone.

Here's an example.  When I needed an operation last year, I went to my insurer's website and called up the data on area hospitals.  I could see what each hospital's quality was for my type of operation:  hospital-acquired infections, mortality, re-admission rates, etc). 

Not that the system is perfect, because more transparency is needed.  I should have been able to call the hospitals on the list above and ask what my operation would cost, on average.   A system that involves me in assessing and deciding what care I want is much easier and cheaper to legislate than creating over a hundred new federal agencies to run the health care system (which our new law did).

Ultimately I think people will be happier with care THEY choose, and will welcome the opportunity to spend wisely. 
What won't work is for people to sit back, not make the effort to be in charge of their health care, and insist it's a civil "right."
Because there ARE no rights when the government decides what health-care treatments patients are eligible to receive and when they can receive them.
Doc D

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