Any advanced healthcare system has to deal with some formidable challenges due to the following facts:
- Modern civilised societies are not prepared to systematically let people die because they cannot afford standard treatments.
- Health costs are unpredictable and potentially large, creating the need for some kind of insurance.
- Health care is very complex, and poorly understood in its detail by most people.
This creates formidable third person payer and transparency problems. Public funding simultaneously provides insurance and a social safety net, while alleviating information problems - people shouldn't have to worry about whether their insurance is going to let them down. But a national health system is obviously not a perfect solution.
The question is, do you know of a better system? Failing that, can you design a better system that addresses these problems?
James: Why is it that when market care rations health care it is bad but when poltiicians ration health care it is necessary?
The double standards of those wanting national socialized care is astounding. As long as politicians deny the health care then it is fine and dandy but not when it happens in the market. The reality is that there is always more demand for care than is available. Therefore all systems must ration health care. And you prefer to let politicians decide on your behalf what care you will be allowed to have.
I almost said (but my post was long enough) that another big problem is that most people refuse to think rationally about health care and admit that rationing is unavoidable (in any system).
A problem with private health is that it can be hard to make intelligent and informed decisions about insurance when you don't normally use it, and I don't believe health insurers are intrinsically trustworthy. Private organisations are also subject to perverse incentives when market discipline is lacking.
You have got me thinking about this, but until I see a better model, I'd still go for a single payer public system with optional private opt-out, supported by a voucher system if possible.
James: You don't trust insurers -- that is what competition is for -- to force them to offer better deals. But you many not know that many laws in states forbid out of state insurers from selling health insurance. In other words the markets are rigged by politicians and some insurance companies to restrict competition in order to put consumers at a disadvantage. The more monopolistic the market the worse it functions.
Yet you suggest a total monopoly on health care with no competition where we have to trust politicians. Why are politicians so trusthworthy?
You say that private markets have bad incentives when market discipline is lacking. Okay! Not precise but I think I know what you mean. But why is market discipline lacking? The only way to get rid of the market is through political control. This seems to imply that politicians will not act in the interest of consumers so why trust them to provide the health care in the end?
If you are looking for a relatively decent third alternative (which doesn't have the massive problems that infest Canada, France, England, etc.) then investigate the Singapore model.
James L., I don’t believe services in medicine are as formidable or as complex as you make it out to be. I don’t see that the treatments in veterinary care are all that different from that for humans, yet, amazingly, veterinary care is very accessible and prices are very reasonable. Maybe it has something to do with the fact that government doesn't meddle in this market and consumers negotiate prices directly with the providers who run their practices as businesses.
The government ‘safety net’ has led to skyrocketing prices and less accessibility for those of modest means. A total government monopoly would not make service more accessible than a private market would. This MUST a priori be true since government central planning does NOTHING to solve the economic problem of scarcity--only private enterprise does. Government central planning only diverts and misallocates scarce resources, it does not produce them. (Also, under a government monopoly, I imagine you can say goodbye to future innovations and advancements in medicine).
Alright, a free market in anything will never be perfect. After all, it is the product of human activity, and humans are anything but a perfect species. But whatever faults voluntary enterprise may have, government central economic planning CANNOT do better (government is populated by humans--and typically flawed ones, at that--is it not?) and is liable to be a disaster.
We have to wean ourselves off this notion(pounded into us from an early age during our--surprise--government-school 'educations')that government can solve problems that voluntary human enterprise cannot. It cannot. Government socialization of medicine is NOT humanitarian.
A couple examples-- an invasive procedure such as herniated disc surgery usually costs several thousands of dollars for a dog, while I understand such a surgery for a human can cost twice the yearly median income. In Canada, an MRI scan for a dog used to be obtainable on very short notice (before politicians put a stop to it, that is) while the wait for a human was easily around six months.
There are two things government does well when it comes to medical care. The first is that they do an amazing job restricting the supply. Second, they are experts at increasing the demand. Either of those alone drives up costs significantly. The two together are disastrous.
cls: After a little reading, it seems that Singapore is an instructive case, strong evidence that health care can be a lot more efficient than we have come to expect. Maybe not such a good safety net, not sure. It is interesting that there is considerable government involvement, but it is designed to work with the market. But then, Singapore has an unusually competent government.
Thanks for your responses by the way.
Of all the state models the Singporian model is the most efficient. It basically relies on 90% of the public paying for their own care and owning their health savings account with 10% being given insurance as a welfare measure more than a health care measure. Then catastrophic insurance is bought for the populace out of their accounts.
I would say that is superior to the Canadian, UK, French models, et al. And I would say it is superior to the US model which is not a market model and which has been distorted by various interventions. For instance the unions screwed up health care by tying it to jobs instead of to individuals. By forcing employers to provide it as a benefit for employees leaving the job means leaving the insurance scheme and that is responsible for a great amount of problems in the US. Individualized health savings accounts make far more sense. Whole Foods has also implemented a simialr system for their employees and found health costs dropping dramatically.
This also means that each person is basically financing their own care but also building up savings in their health account. In Singapore they can bequeth those funds to their children or grandchildren when they die. It seems far more sensible.
Singapore is an interesting place. It is very free in some ways not so in others. I always found it an interesting place to visit. And they seem to grasp some basic economic concepts -- they were the first to use the road pricing systems.
Commenting by HaloScan
