Tuesday, July 17, 2012

Five On Health Care: I -Downsides

Europeans and Canadians all have something approaching universal health care run by government – what we would imprecisely but not inaccurately call socialised medicine.  They like that.  They think there is something wrong with Americans for not having it.

They have wait times for medical procedures, which they agree are a problem.  They see these as a result of inefficiencies in the system, which can be gradually improved, not as the automatic result of government controlling a scarce resource.  Americans – some Americans, at least – see the wait times as part of the system, eliminated only by great increases in cost.  Solving 90% of a problem costs X.  Solving 99% does not cost X plus a little.  It costs 2X or more.

There is a death rate in those wait times, BTW.  Plus whatever discomfort your untreated condition costs. 

There are also quality losses, not always easily visible.  Two from the Telegraph       (Caveat: in neither report do we get much of a compared-to-what?) These are also seen as bugs in the system, to be contained by greater regulation, monitoring, training, etc.  The long-term effect of medicine becoming a less-attractive profession, attracting fewer of the best, goes unnoticed.

Still, they get pretty decent health care.  Only about 1 in 700 Canadians foregoesfree care in order to pay for it in America (presumably highly concentrated around the border and medical centers, so perhaps even 1 in 100 in places), and David Cameron wants to introduce some market safety-valves into the NHS, but really - not bad.


Anonymous said...

There is also a significant difference between the UK/Canadian systems and many of the European ones. The UK/Can are completely government run systems while the Euro ones tend to be funded through a government insurance scheme, heavily regulated but largely run privately. From what I've seen the outrageous waiting times and treatement limits occur more frequently in UK/Canada.

Assistant Village Idiot said...

I think that is likely true.

Texan99 said...

Pretty decent compared to no healthcare at all, pretty crappy compared to the healthcare they could get if the government didn't muck it up?

I'm not very encouraged if the best we can say about a system is that we could definitely have made it worse, but in the meantime we're going to outlaw the very obvious steps that could be taken to make it better.

Donna B. said...

A quick look at UK guidelines (NICE) for bladder cancer treatment appear to be less aggressive and less comprehensive for the lower-risk superficial tumors in the UK than in the US (NCCN).

Appears to be - IANAD and I didn't spend much time looking for info.

The huge difference comes in treatment of the high-risk bladder cancers where removal of the bladder is recommended. Much of the UK guideline I was reading was devoted to where the procedure would take place. Their goal seems to be a few highly specialized treatment teams for the entire nation. That may seem efficient, but I think it's at least part of the cause of the delays in treatment and even in diagnosis, as the GPs must refer suspected to cases to these centers for a confirmed diagnosis.

The wait time from referral to initial appt for diagnosis for bladder cancer is almost 3 months in the UK. For testicular cancer, it's less than a month. I find the difference in the delays puzzling.

Anyway, it looks like the UK is doubling down on semi-centralization. Geographically and monetarily that may end up working out quite well for them. I can't see that working in Canada where there's half the population and 4 times the area.

Nor will it work in the US with 5 times the population and an area similar to Canada's.

Sam L. said...

As Coyote says at coyoteblog.com, it's a problem of incentives. The gummint health care folks have no incentive to improve patient care

Texan99 said...

Yes, the monopoly hazard is a very great one, in medicine as in public schools, the DMV, the Post Office . . . .