Thursday, August 13, 2009

Three Points to Health Care Points from a Brit

Point One: All health care involves rationing of some sort.

"Lord knows, the NHS has its problems and, yes, there's a degree of rationing. But there's rationing in just about every system. It just depends on how that rationing is organised and, to some extent, whether its existence is admitted."
Alex Massie

Those who fear a government-run system because it would ration their care are sadly mistaken if they believe it isn't rationed already. What the government would ration in any government program is currently rationed (albeit differently) by the health insurance companies and by our selves (by purchasing what we can afford).

The president and the Democrats on the hill, it should be noted are not offering a single-payer system. If the new plan includes a public option (and by that I mean a government-financed program) Americans will have but one more way to have their health care rationed - one that makes the purchase of health insurance coverage more affordable for those who do not have it now and one that, it is hoped anyway, would bring down the costs of health insurance overall as insurance companies search for a cost-effective means to provide their clients health insurance without sacrifices needed care.

The health insurance companies will survive if they can offer their potential clients more services at a higher (higher than the public option's) but still affordable (for most Americans, that is) premium. Hence, the Obama's emphasis on preventive care. Hence his declared support for a shift towards results-based reimbursements. And hence the need to reform and limit medical malpractice lawsuits (yes,Democrats, the Republicans have a point here).

The administration may be offering us what is, at least in effect, a two-tiered or three-tiered health care system whereby the working poor who currently do not health insurance can purchase a plan that offers a mutually-agreed upon baseline in minimal care, the filthy rich can purchase 24-hour doctor coverage (the Michael Jackson treatment, let's say), and the lower-to-upper-middle class workers can keep their employer-based coverage.

Point Two: The American system tends to provides more health care for those who can afford it if and when they are covered by their provider while the British system provides less though it is guaranteed.

"Fundamentally, however, the difference between the systems is psychological. In Britain you worry what will happen when you fall ill; many Americans worry about what will happen if you fall ill."

Ezra Klein
, who linked to Massie in his blogpost on The Washington Post's web site, expands upon a third point which Massie raised: that the other developed countries didn't see fit to copy either the British or the American health insurance model:

"The NHS and the American system are both outliers. The American system biases doctors toward overtreatment by paying them for everything intervention they try. The British system does the opposite by paying them a lump sum for each patient, and every treatment comes out of that total. The effects are predictable: The American system is extremely expensive. But the British system is extremely cheap. Uncommonly cheap. Weirdly cheap. About 41 cents for every dollar we spend per capita cheap."

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