Monday, February 9, 2009

Beware of "Single Payer" Healthcare Systems

There has been much talk in America about a single payer health care system. Basically, we'd all pay into a government sanctioned, sponsored or manadated "insurance" program in order to get low-cost (cheap) health care. It turns out that cheap health care results in cheap health care.

First of all, I don't like the government running things. The top of their resume should be the Veterans Administration, which we all know works just great. My father has to schedule his VA appointments one year in advance. How's that for service to a Korean War Vet? I suggest you speak to anyone who is on the new Medicare prescription drug plan. The people I've spoken to are too please with that government program.

Secondly, when prices for products and services decline, people tend to buy or use them more. See Supply and Demand. I've seen this in action. When people I know (including me) had a high deductible health plan, they went to the doctor less. It's a lot easier to grin and bare a cold when it's going to cost $100 to get some antibiotics that don't kill viruses anyway. My deductible wasn't high enough to prevent me from seeking treatment for a more serious condition, however. I believe people who have a simple $20 co-pay plan seek care frequently for less severe ailments like a common cold when they could just wait it out. As a side note: companies and schools that require a doctor's note for every little absence are contributing to this problem. If I feel like shit, let me stay home without fear of reprisal.

Finally, does our healthcare system really have the capacity to treat two or three times the people who would be seeking healthcare for every little thing? Perhaps you live in a neighborhood where you can get an appointment with a specialists within a week? I doubt it. I've never managed to get an appointment with a specialists in under a month. I suppose it might be possible to get in sooner if I was coughing up blood and pissing out puss, but I'm not so sure.

Sandy at the Junkfood Science Blog points out a recent tragedy in Japan. As always, she has well researched content and many links to the data she uses. Here are some snippets:

A tragic casualty: Many of us have been reading in the medical journals for years Japanese doctors discussing the growing financial crisis in their countrys medical system...

Mari Yamaguchi, reporting from Tokyo, said that more than 14,000 emergency patients were rejected at least three times by Japanese hospitals before getting treatment in 2007, according to the latest government survey. In the worst case, a woman in her 70s with a breathing problem was rejected 49 times in Tokyo...

Single-payer medical insurance systems fail in part because of what they called the tragedy of the commons*.

Doctors working in countries with nationalized health insurance responded to the BMJ article, noting other consequences to the tragedy of commons. Dr. Akira Ehara with Koala Medical Research pointed out the serious shortage of doctors, providing government statistics showing that by 2002, there were only about half the number of pediatricians needed to cover pediatric departments in Japanese hospitals. Doctors were working 32 consecutive hours and could not continue without burn-out, he said.

However, health insurance system in Taiwan is impending bankrupt due to overcrowded grazing on the common land, he wrote. The solutions being proposed, he said, include ever increasing health taxes and co-payments, and tighter managed care to discourage patients from seeking medical care. [That was striking because Massachusetts, testing such a system here, ran into financial solvency problems and moved towards these solutions within the first year.]

Please read the full article here: Junkfood Science: A tragic casualty.

Perhaps some of my UK and Canadian readers will share their experiences...

* I added the link to "tragedy of commons."

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