A great short article by Kevin Williamson over at National Review, Thinking Honestly about Health Care, Welfare, and Taxes. He points out what we all know but keep forgetting, liberals and conservatives alike, because we would like European Health Care to fit into a tiny box that we can love or hate: European countries vary widely in their health care/insurance and tax structure. The UK and Norway come closest to the model Bernie Sanders (as well as the anti-Bernies) imagine, that you just show up at the doctor, get seen and get treated, and the government pays for it. But I can assure that's not even true in Norway, where my son was put on a waiting list of eighteen months for elective surgery, and encouraged to call around the country to see if another hospital could get him in sooner. He eventually got an appointment five months later, for which he had to drive 8 hours, stay overnight in a hotel the night before and night after, then drive home. That kind of "free." The Alaskan natives might have the closest thing to that imagining. At least, that's what my son who works at the hospital in Nome describes. He may be jaded and inaccurate, though.
But France, Switzerland, Sweden - everyone really - has mixed and hybrid systems, just like we do in America. It's not as simple as we all like to pretend for our own political needs here.
Seeing the travails of my wife's aunt in London, I would most definitely not be romanticizing National Health in the UK - and consequently, anywhere else.
ReplyDeleteOur system is too damn expensive and highly imperfect, but people that have money, hence choices, still come here to get things done. And you only have to watch any prescribed drug commercial on television to understand why it's so expensive: Playing a hijacked pop song from your teen years, they show happy, energetic fulfilled people in leisure activities, then spend 10 seconds promising a cure for the affliction, and the remaining 40 seconds telling you the horrors you can actually expect in darkly fast-talking undertones. "Do not take this drug if you have suicidal thoughts about your new third arm" Ok, then.
I'll note that many in Europe and Canada also have a cartoon-view of US healthcare provision.
ReplyDeleteBismarck beats Beveridge:
After getting sick in Germany and getting treatment in a German hospital, I did some deep diving into the economics and history of the German healthcare system, and I think the German system is wonderful and would be an excellent model for the USA to try to emulate.
But even assuming that we know what we want as a "destination" for what healthcare should be in the USA; we've got the problem of how we get from where-we-are to 'there'.
Britain's post-WWII government was nationalizing industries left and right at the time it nationalized all hospitals and charity/cooperative/local-government health operations and created the NHS. Nationalizations of industries in the US (when they've happened) have been temporary wartime events unwound at the conclusion of hostilities, or bailouts of obviously failed entities.
So I think the German model that retains private hospitals, GP practices, and insurers, has a slim but better chance of flying in the USA than an NHS would.
We're spending more per-capita tax revenue on our current system than all those countries with universal-of-some-sort systems, but I don't see any legislative fix for the cost problem, which has many interrelated causes. Our pay for doctors averages twice France's, for example, and I don't think that's going to change with a stroke of a presidential pen, even if we could magic away the student-loan debt and liability-insurance cost that makes such salaries necessary.
It's baffling to me that I see new gleaming healthcare facilities going up everywhere I visit in the US, from rural village clinics to big-city flagship academic hospital campuses. There is obviously a LOT of money to spend in that business.
Douglas2
I subscribe to Williamson's The Tuesday newsletter which is where I read this. One of his best in my opinion. Fundamentally the problem is financing, from two angles. False comparisons to Europe get people to believe that 'money can be saved' on overall health care spending. The only way to do that is to overall *buy less health care*. Anything else is the mythical 'waste, fraud, and abuse' BS, and see AVI's story above for what *buy less health care* looks like when it's driven by a third-party payor. The other angle is the oversold idea that anything labeled 'insurance' contains a long-term savings component for your future claims. Current funding goes to make current purchases, regardless of the source of the funding. Call it OSDAI, Medicare, Medicaid, Obamacare, sCHIP, co-pays, deductibles, payroll deductions, insurance premiums, or income tax, the money taken in today gets spent tomorrow. You can rearrange the deck chairs any way you want but it isn't going to make the iceberg move out of the way.
ReplyDeleteThere would be some utility in moving more health care purchasing decisions to individuals and getting away from the 'pre-paid health care' model but it's not reflected in saving money.
Four things to keep in mind:
ReplyDelete1) 90% of healthcare spending occurs in the last 5 years of life.
2) No matter how rich you are, you will eventually die.
3) You cannot find the cheapest doctor in town - they make sure of that.
4) All healthcare is rationed: these is always less supply than demand.
The question becomes: do you want them to tell you the operation is 5 times what you can afford, or put you on a waiting list longer than your remaining lifespan. Sooner or later this question will show up, unless a safe dropped to Kill Moose and Squirrel hits you instead (obscure cartoon reference).