The bad news is that socialized medicine creates dependence. The good news is that you can choose otherwise.
Over at the Reason Hit and Run website, Charles Oliver writes:
In the United Kingdom, the National Health Service is looking to eliminate or reduce several different surgeries to cut costs and reduce “unnecessary or risky procedures.” The treatments NHS officials want to cut include tonsil removal and procedures for carpal tunnel syndrome, hemorrhoids, and varicose veins.
In the comments various people talked about how bad that is because people won’t be able to get those procedures if the government authority deems them to be ineligible.
That would be horrible if the National Health Service (NHS) deemed them ineligible and then went further to prevent the person from getting the procedures even if the patient paid his/her expenses out of pocket.
But that is not typically what the NHS does. Typically, if you’re in Britain and you’re willing to pay for your own health care, you can get it. The problem is that many people have become so dependent on the government that they don’t think of that option as a real live option.
You might think that that’s because those private payer options are so expensive and, therefore, people haven’t planned for them. Sometimes that’s true. Sometimes, though, perhaps even often, that’s not true and people have gotten out of the habit of paying anything for their own health care.
A few years ago, an acquaintance who moved here from Canada told me that under Canadian’s single-payer system, his wife was in a years-long queue to get her foot operated on. This was a big deal because one of his and his wife’s regular pleasures was to go walking together after dinner and her foot problem made that difficult.
Once they arrived here, he got good health insurance from his employer and his wife quickly got the surgery. The surgery worked, and he and his wife started doing their evening walks again. And their out-of-pocket expense for the surgery, which cost a couple of thousand dollars, was a little over $200.
All good news, right? That’s what I would have thought. Can you see what’s coming? His wife complained bitterly about the $200.
One other point: If we’re ever to rein in spending on Medicare and Medicaid, it’s likely going to come about due to government officials making decisions about who qualifies for what kind of health care. If they decide that people over a certain age don’t qualify, for example, that’s a step in the right direction, not the wrong direction. Of course, it would be nice to have some notice about it. And it wouldn’t be legitimate for them to, say, cut off paying for ambulance service with zero notice that they are cutting it off.
READER COMMENTS
Alan Goldhammer
Jul 5 2018 at 1:11pm
And our current system of employer provided insurance is no panacea either. Premiums and co-pays are going up and things that are covered are going down. This ProPublica study is particularly informative as the patient couldn’t figure out why his insurance company wasn’t negotiating the best price. He was on the hook for 10% of the total inflated hospital bill as per his insurance policy.
Thaomas
Jul 6 2018 at 7:03am
I’d think that the most “Libertarian” reform would be to remove all the subsidies for employer “provided” health insurance, remove the wage tax and let everyone buy private insurance with a tax credit. Such a system would subsume Medicare and Medicaid and could be funded with a consumption tax.
Alan Goldhammer
Jul 6 2018 at 7:34am
This proposal has been around for over ten years and was detailed by Victor Fuchs and Zeke Emanuel. When I was still working at PhRMA I had Emanuel come down and give a seminar on the proposal. I still think it’s a viable option and clearly it addresses ‘universal’ access and the problems with Medicaid and Medicare.
Thaomas
Jul 7 2018 at 5:45am
Far be it from me to claim originality on a good idea 🙂 even if the idea apparently never entered the minds of people who wanted to “repeal and replace” ACA.
SaveyourSelf
Jul 7 2018 at 7:19am
Liberty means absence of violence. That said, a libertarian approach could only be complete removal of violence from the rationing/decision process. Forcing everyone to buy “private” insurance with a tax credit is just a different way of using force to influence decision making. The tax is the coercive element. You have to get rid of the tax for healthcare to function as a healthy market.
Thaomas
Jul 5 2018 at 7:42pm
The NHS system seems like a reasonable system, thought I’d hope that the decision making process was driven in principle by a cost benefit analysis of the procedures, not cutting certain procedures to meet a budget constraint. From what I’ve heard about the Canadian System, they don’t spend enough to prevent queues for high value services like the foot of the woman in the anecdote. I wonder if the budget constraint is that their system is under-funded by a regressive wage tax like the US Medicare system?
JK Brown
Jul 8 2018 at 4:46pm
The Adam Smith Institute recently had a post on their blog about GPs in Britain demanding that a cost at time of service be imposed. Of course, those visits are already paid for by the taxes, but the fee is being pushed to impose some “skin in the game” for patients to reduce the workload on these frontline doctors.
A youtube couple, Paul and Kathy Short, in Newfoundland, have some videos after his experience with a heart attack and the Canadian healthcare system. He found a wait that could have been more than 4 weeks for a dye test (US protocol is to have the test within 20 minutes of arrival at the ER), all the while using up an intensive care bed. It turned out to be shorter than that, possibly due to their online advocacy and media interviews. Whereupon he had the surgery and got on to recovery so he could return to earning money in their small specialty repair shop. Here’s a recent update also relating the death of a man waiting for care.
Tom West
Jul 9 2018 at 12:53am
Given the substantial differences in spending between the US and Canada, I have to think that the fact that over-all health outcomes between the two countries are very similar would indicate that the Canadian system, in aggregate, hits the “sweet spot” for over-all “bang for buck”.
However, I’d agree that this comes at the expense of the Canadian 20th percentile or higher who could probably afford better health-care than they’re receiving now once you factor how many other Canadian’s health-care they’re financing through their taxes.
I’d also agree that achieving this sweet spot is possible because of Canada’s proximity to the US, allowing Canada many of the long-term benefits of an inegalitarian health system (healthy research budgets, for one), without having to sacrifice the health security of a significant portion of the population.
And one shouldn’t discount the psychological benefit of the unity brought by the universality of the system. There’s a reason why Canadians seem to rate our health-care system as one of its greatest elements. This may be myth, but myths are important to our happiness.
After all, we spend most of our life healthy, so its important to judge a health-care system by how it makes people feel when they’re sick *and* when they’re healthy. And I have to say that very few Americans of my acquaintance (with massive selection bias here) seem to be happy with their system when they’re healthy.
Alan
Jul 13 2018 at 4:40am
An anecdote of mine demonstrating this point: My parents live in Britain (and have done for decades) and my mother has been having symptoms that are suspected to be epilepsy. This could be a sign of a brain tumor. Furthermore, she has been advised not to drive until she is diagnosed and (if it is indeed epilepsy) her disease is under her control. The latter won’t happen until she gets a prescription, which won’t happen until she is diagnosed. To be diagnosed, she needs an EEG but there is a long waiting list which she has been on for months. I found that she can have a private EEG within a week for less than £200 and informed her of this. She found it interesting but did not seem to even consider it as an option. I prompted her that I would wire her the money if that was an issue, but she scoffed and said not to be silly, she would just wait for the NHS. The idea of paying has become ludicrous to her.
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