No More Free Lunch at the Health Care Buffet

All this health care talk can sometimes get confusing. Who doesn't want better health care for less money? I'd love to pay less for my insurance as long as I could still go to the doctors of my choice, the hospitals of my choice, and get the procedures and treatments of my choice. I'd like my prescription drugs to be cheaper too. I don't want to wait several weeks to get in to see a doctor, and when I get in, I want the comfort of knowing that he or she is qualified to do what I expect.

I want all of this, and I'm sure you do too. Who doesn't? But, this isn't what the health care debate is really about. Let me be politically incorrect and state the obvious.

The rich will always be able to get the quality health care they want because they can simply buy it. But the poor cannot get quality care, because they simply can't afford it. If they're going to get health care at all, it will have to be given to them for free, or nearly free. The vast majority of us somewhere in the middle simply want to continue getting the best health care we can afford while paying for only our "fair share" and not being taken advantage of. We want the biggest bang for our buck without being played for fools.

The real issue in the current health care debate isn't about the rich or the middle class, however. It's about the poor and the best way to provide them free services without ruining the whole system for everybody else. Liberals look to Europe and Canada as examples, believing that socialized medicine is the solution. Conservatives believe that would be exactly the wrong way to go. We want less government in health care, not more. We want more market dynamics in the process and we want to allow people more ownership over their health care decisions. We believe this will solve most of the current problems and greatly improve the entire health care system without having to overcorrect, panic and hit the "HillaryCare" button.

There's one fundamental dynamic that must be changed in our health care system, whether we go the liberal or the conservative route, and it has to do with basic human nature. If something is free, it will be undervalued, underappreciated, taken for granted with a sense of entitlement, over-consumed, and ultimately wasted before finally being rationed. Think of those cafeteria-style restaurants with an all-you-can-eat buffet. Would we get healthier people and waste less food by giving them a "Free Buffet Coupon" every day for dinner or a $20 bill and the choice of ordering off a menu and keeping the change?

Obviously, someone does pay for the "free" healthcare provided to the poor: the American taxpayer. But, instead of taxpayers handing a "Free Buffet Coupon" directly to the cashier for all the poor, what we've got to do is provide the poor-and all health care consumers-with a greater sense of ownership, individual responsibility and choice to eliminate the incentive to overeat and waste food. The best way to do this is with money, either in the form of cash or credit. After all, if we want people to save for college or retirement, we offer them a tax-free IRA. If we want people to buy houses, we allow them to deduct the mortgage interest from their taxable income. And, if we want people to save money for health care, we should let them open a tax-free Health Savings Account. And, if we want them to buy health insurance, we should allow them to deduct the health insurance premiums.

Put simply, if we want people to lead healthier lives, we need to give them the incentive to do so. The message has got to be, "An unhealthy life costs you money, a healthy life saves you money." If you lead a "high risk" lifestyle, you should expect to pay a higher premium on your health insurance than someone who is more health conscious. If good drivers with clean records can get a discount on their auto insurance, then why can't those who lead a healthy life get a discount on their health insurance? This isn't discrimination, it's the market doing what it does best: analyzing risk and fixing cost.

We've got to come up with a way for the poor to take ownership of their health care and the best way I know of to do this is with money. If we don't do this, I'm afraid liberals will convince a majority of voters that HillaryCare is our only option "for the poor," and we're going to lose the best health care system in the world.

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Australia: Surprise! Patients shun disaster hospital



It is a damning indictment of what the NSW public thinks of its health system - a deserted waiting room at Royal North Shore Hospital's emergency department. Only a week ago the same waiting room was crawling with people and staff so busy they were unable to attend to a woman who miscarried in a toilet.

Health Minister Reba Meagher today admitted relations between emergency doctors and the NSW Health Department have broken down. She said emergency staff "feel pressured to perform and they feel pressure to meet the targets around performance that are set for them." Ms Meagher said she met with senior staff last night. "It came out during the course of the meeting that relationships had broken down between the Department of Health and our senior emergency physicians. That's a concern to me," she said. "I understand there have been some difficult industrial negotiations recently and I'm also confident with the position that was put to me by the emergency physicians that they feel pressured. "There is no doubt that there is pressure. Demand for emergency services is rising very rapidly. For June this year it was an 8.8 per cent increase on last year."

However the admission came as demand at Royal North Shore Hospital was reaching record lows, with staff telling The Daily Telegraph they had never seen the ward empty and were concerned patients had turned their backs on the hospital. As the exclusive photograph shows, the waiting room at 1.15pm yesterday was like a ghost town - with critically ill patients choosing to attend other Sydney hospitals. The decline in admissions follows a week of horror stories emerging from the hospital. A nurse in the hospital's emergency department told The Daily Telegraph the waiting room had never been empty. "We have never seen it like this - it has been like this since last week when all the attention started," he said. "Normally there are at least 20 to 30 people and we are run off our feet."

The only people entering through the hospital's emergency doors were the elderly or those who were being transported via ambulance. "All we are doing is restocking supplies," the nurse said. "There is nothing we can do but we have to turn up for work."

One person who has vowed not to return to Royal North Shore is Cathy Wastell of Cromer, who was given a bucket for her miscarriage in 2005. "I received excellent care in the foetal department but I would never go back to emergency," she said last night. "I have lost faith in the system - I can understand why people would not want to go there." Mrs Wastell, who now has a one-year-old daughter Mia, was at Royal North Shore for six hours before being told to put her lifeless baby in a bucket. "I was bleeding profusely and a nurse gave me a fresh sanitary napkin. That was the level of medical care I received," she said.

As the State Government refuses to accept the health system is in disarray, it has also emerged that paramedics are having to store critically ill patients on the floor of ambulances. Yesterday The Daily Telegraph revealed the Ambulance Service was spending $53 million in overtime because of staff shortages. Paramedics have said there are now serious concerns a death will occur because crews are being delayed for hours at blocked emergency departments - leaving no ambulances to respond to urgent medical calls elsewhere in the city. "If we are stuck in the emergency department and an urgent call comes through, then one of us has to stay behind with the bed while another officer attends the job," the paramedic, with 15-years service, said. "We have had to place patients on the floor. "I don't like working overtime . . . some do it because there is just not enough ambulances out there."

Health Minister Reba Meagher was last night holding a crisis meeting with hospital emergency department heads to address the litany of problems. Doctors and nurses are split over whether a Howard Government plan to install local hospital boards will improve patient care or lead to an abdication of health planning.

Opposition Leader Kevin Rudd has attacked the plan even though his own $2 billion health policy states "regional and local communities would directly participate in the management of public hospitals'

And Health Minister Tony Abbott denied the plan would add yet another layer of bureaucrats to health care management and said hospital board members would "work for the love of it and not the money".

Australian Medical Association president Dr Rosanna Capolingua said local hospital boards would "bring management responsibility right back to the community". "It is a good idea," Dr Capolingua told The Daily Telegraph.

The NSW Nurses Association feared the Howard Government would use local boards to "meddle in the employment conditions of nurses and other hospital staff". But mother of two Therese McKay, who publicly condemned Royal North Shore Hospital as having the conditions of a "third world country" after her husband Don died last May, welcomed the plan. "At least with hospital boards it is more personal, you can go and speak to someone and thrash it out," she said. "After Don died I tried to make a complaint and it was like shadow boxing, no one was listening."

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