Wednesday, August 08, 2007

Health Care: Government vs. Private

Sometimes the advocates of socialized medicine claim that health care is too important to be left to the market. That's why some politicians are calling for us to adopt health care systems such as those in Canada, the United Kingdom and other European nations. But the suggestion that we'd be better served with more government control doesn't even pass a simple smell test.

Do we want the government employees who run the troubled Walter Reed Army Medical Center to be in charge of our entire health care system? Or, would you like the people who deliver our mail to also deliver health care services? How would you like the people who run the motor vehicles department, the government education system, foreign intelligence and other government agencies to also run our health care system? After all, they are not motivated by the quest for profits, and that might mean they're truly wonderful, selfless, caring people.

As for me, I'd choose profit-driven people to provide my health care services, people with motives like those who deliver goods to my supermarket, deliver my overnight mail, produce my computer and software programs, assemble my car and produce a host of other goods and services that I use.

There's absolutely no mystery why our greatest complaints are in the arena of government-delivered services and the fewest in market-delivered services. In the market, there are the ruthless forces of profit, loss and bankruptcy that make producers accountable to us. In the arena of government-delivered services, there's no such accountability. For example, government schools can go for decades delivering low-quality services, and what's the result? The people who manage it earn higher pay. It's nearly impossible to fire the incompetents. And, taxpayers, who support the service, are given higher tax bills.

Our health care system is hampered by government intervention, and the solution is not more government intervention but less. The tax treatment of health insurance, where premiums are deducted from employees' pre-tax income, explains why so many of us rely on our employers to select and pay for health insurance. Since there is a third-party payer, we have little incentive to shop around and wisely use health services.

There are "guaranteed issue" laws that require insurance companies to sell health insurance to any person seeking it. So why not wait until you're sick before purchasing insurance? Guaranteed issue laws make about as much sense as if you left your house uninsured until you had a fire, and then purchased insurance to cover the damage. Guaranteed issue laws raise insurance premiums for all. Then there are government price controls, such as the reimbursement schemes for Medicaid. As a result, an increasing number of doctors are unwilling to treat Medicaid patients.

Before we buy into single-payer health care systems like Canada's and the United Kingdom's, we might want to do a bit of research. The Vancouver, British Columbia-based Fraser Institute annually publishes "Waiting Your Turn." Its 2006 edition gives waiting times, by treatments, from a person's referral by a general practitioner to treatment by a specialist. The shortest waiting time was for oncology (4.9 weeks). The longest waiting time was for orthopedic surgery (40.3 weeks), followed by plastic surgery (35.4 weeks) and neurosurgery (31.7 weeks).

As reported in the June 28 National Center for Policy Analysis' "Daily Policy Digest," Britain's Department of Health recently acknowledged that one in eight patients waits more than a year for surgery. France's failed health care system resulted in the deaths of 13,000 people, mostly of dehydration, during the heat spell of 2003. Hospitals stopped answering the phones, and ambulance attendants told people to fend for themselves.

I don't think most Americans would like more socialized medicine in our country. By the way, I have absolutely no problem with people wanting socialism. My problem is when they want to drag me into it.


Australia: Sydney public hospital patients pay up to beat chronic health queues

PATIENTS are paying up to $600 for private treatment to avoid queues at crowded public hospital emergency departments as the state's casualty crisis deepens. Baulkham Hills Private Hospital and Sydney Adventist Hospital, two of three Sydney private hospitals with emergency facilities, reported a 30per cent rise in the number of admissions this year. On Thursday it was reported that most patients were forced to wait an average of eight hours in public hospital emergency rooms.

The nurse unit manager at Baulkham Hills Private, Lea Mitchell, said the number of patients visiting its emergency department had risen by nearly one-third compared with the same period last year. "There are patients who come here because they're not prepared to wait," she said. "We get that all the time. Patients are seen very quickly by the nurse and then they may have to wait a short while for the doctor. The longest anyone has had to wait is three hours." Ms Mitchell said that at the busiest periods, there would be between four and six people waiting. "That's when we're really, really, really busy."

State Opposition health spokeswoman Jillian Skinner said the numbers flocking to private hospitals were a reflection of the lack of community trust in the public sector. "It's a degree of the frustration of the community," she said. "They know that sometimes you are stuck in an ambulance or a waiting room for hours."

At Sydney Adventist Hospital, which has the state's largest private emergency section, doctors see 21,000 patients a year. Its director of emergency care, Greg McDonald, said most patients pay between $300 and $350 for treatment, with Medicare giving a rebate of about $100. Fees can reach $600 in cases such as heart attacks, which require specialist care and invasive procedures. "People ring us up from the public hospitals and they go, 'I've been waiting here five or six hours and it doesn't look like I've got a chance', and we say, 'Come here. You'll be able to see a doctor sooner'," Dr McDonald said. "We are more generous, more liberal in the way we deal with patients, in the way we try to find them beds."

But in winter, the emergency department is 10 per cent busier, mostly with patients aged older than 75 or younger than 16. Dr McDonald said the hospital treated the same extensive range of emergencies as a public hospital, and often saw trauma cases even though they were officially not meant to. "Sometimes the ambulance brings them to us because they think they need more urgent attention," he said. Dr McDonald is lobbying the Federal Government for funding of the private emergency sector so that they could better supplement the public health system.

However, a spokeswoman for Federal Health Minister Tony Abbott ruled it out, saying hospitals should talk with the State Government instead. Meanwhile, elective surgeries have been postponed at public hospitals in northern Sydney and the Central Coast due to staff shortages caused by a flu and viral outbreaks. The acting chief executive at the region's area health service, Terry Clout, said surgery would be rescheduled as soon as possible.



For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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