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.


Anonymous said...

There is such a thing as a government funded system that still allows choice (and even the choice to go private, not for profit or for profit, insured or not). It seems to work OK, although waiting lists can be tough for the poor. I'm talking about New Zealand, although Australia and the UK have somewhat similar systems (veiwed from a few thousand miles away, anyhow).

The choice is important. If it is particularly critical to you or your employer that your health care be dealt with as expeditiously as possible, whatever the cost, then so be it. It's a fairly expensive option.

The crucial part is that emergency care is free to all, no questions asked. This avoids all the problems of trying to deal with insurance or payment in the ER, a combination that makes no sense whatsoever; often enough, the patient need not even be identified until hours after treatment starts (although there will be someone trying to do so, it's low priority).

Stephen Purpura said...

In America, you can always opt for catestrophic care insurance with $10k deductibles and sign-up with an all cash set of doctor providers. It allows you to choose what you want.

But the more interesting question is why spend money on healthcare at all? So that you can live longer or work more effeciently? If you work more efficiently, then cost is relative to how you're paid. If you live longer, then cost is a type of leisure expense (or still a work efficiency issue).

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