Monday, June 21, 2004
Monday, June 07, 2004
Health care systems are incredibly hard to understand, yet people feel very strongly about them. Most Canadians will swear up and down that single-payer is better, the only socially acceptable alternative, and that it makes people healthier at lower cost. (At the same time, Canadians will grip about government cuts in healthcare, waiting lists, administrative snafus, their doctor). Yet most Canadians haven't experienced any other system so it must be the media that's forming their impressions.
The media, of course, is very bad at conveying complex nuanced system characteristics. I was recently pointed at an article with the headline For-Profit Hospitals Cost More. Cost more to whom? To the patient? To the tax-payer? One of the reason that for-profit hospitals cost more, the article says, is because they pay taxes, so presumably the tax-payer carries some of the burden of non-profit hospitals. And why would one believe that this had any relevance for the Canadian debate? It's quite possible that both for-profit and non-profit hospitals are more effective than government-run hospitals. Not that we can agree on what 'effective' means, anyway.
The more I learn about this, the less I know. I have seen government inefficiencies in the Canadian system -- my grandparents don't get their choice of doctor, even if they don't like their doctor, because they live in a small community and they see the doctor they're told to see. They can't drive a little farther, change plans, or pay more (or differently) no matter how much they dislike their doctor. But I've seen lots of inefficiencies surrounding the American insurance system too, particularly the employer-mediated stuff and the requirements for documentation of prior insurance or pre-existing conditions. I don't know. It all makes me unhappy, and suspect that healthcare is simply an intractable, money-wasting or unfair system, no matter how you slice it.
The media, of course, is very bad at conveying complex nuanced system characteristics. I was recently pointed at an article with the headline For-Profit Hospitals Cost More. Cost more to whom? To the patient? To the tax-payer? One of the reason that for-profit hospitals cost more, the article says, is because they pay taxes, so presumably the tax-payer carries some of the burden of non-profit hospitals. And why would one believe that this had any relevance for the Canadian debate? It's quite possible that both for-profit and non-profit hospitals are more effective than government-run hospitals. Not that we can agree on what 'effective' means, anyway.
The more I learn about this, the less I know. I have seen government inefficiencies in the Canadian system -- my grandparents don't get their choice of doctor, even if they don't like their doctor, because they live in a small community and they see the doctor they're told to see. They can't drive a little farther, change plans, or pay more (or differently) no matter how much they dislike their doctor. But I've seen lots of inefficiencies surrounding the American insurance system too, particularly the employer-mediated stuff and the requirements for documentation of prior insurance or pre-existing conditions. I don't know. It all makes me unhappy, and suspect that healthcare is simply an intractable, money-wasting or unfair system, no matter how you slice it.
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