Had lunch today with a political friend, and was chatting about healthcare; mentioned my distaste for National Health type solutions, and was rewarded with a verbal smack to the head.
What do you think we have now? he asked, giving me the you-moron look.
He referred me to the LA County Budget (a pdf chart is here), and points out that in 2001-2, Los Angeles County spent 23% of its budget
or $3.85 Billion on healthcare. Public Protection, in contrast (Sheriff & Fire) were 20% of the budget, and Social Services (the County is the major provider of welfare) was 29%.
His point is well-taken. We already have publicly-financed healthcare. Its just crappy, inefficient, and relatively ineffective because we persist in making believe that we dont.
This is because the giant institutions
the giant hospitals, and the emergency rooms which increasingly serve as the primary-care physicians for a large portion of the population
soak up an increasing amount of the available dollars, and my guess is that they leave little for the kind of preventative, low-profile, relatively less expensive care which would potentially be less expensive and possibly provide better care.
Now this is a newspaper set of interpretations; Id be most interested in hearing from folks in the field.
But the one concrete point is that we have government financed health care for a large portion of the population, and folks like me who sit around and pontificate on how bad government-financed health care would be need to wake up and look at the real world.
So how do we do it better?
Date: 07/23/2002 00:00:00 AM
It’s hard to compare per-capita costs of our freaky patchwork “public health” system to tthose of a single-payer country, for a simple reason: the populations served by public health (especially Medicare) are far, far more expensive than the populations who are not. Old people, junkies and people who don’t get any preventative care are extremely expensive to take care of. Our “public health” system, by and large, swallows the cost of the most expensive populations, so of course they look bad when compared to another country. You also have to be very careful talking about the health care delivered in emergency rooms in “per capita” terms. Health insurance plans, private or single-payer, know how many members they have. If you don’t see the doctor this month, you still get counted in the divisor, the “per capita” part. On the other hand, an ER only counts you if you’re in the the ER, costing them money.I should blog about this again soon.
Date: 07/23/2002 00:00:00 AM
Roublen –My point is unclear because like lots of other people where this subject is concerned, my thinking is as well.I’ve always believed that the stultifying bureaucracy of the NHS, as noted by a number of UK commentators, was a Bad Thing, and that a true single-payer model would most likely lead us there.I also believe that health in generally a public good, and that it is something on which our dense urbanized society depends for — literally — survival.I’ve just had it pointed out to me that we do have a ‘publicly financed’ health system, it’s just that we do it in a patchwork fashion, which certainly makes it less effective and probably more expensive for what we get.I’m working on it…A.L.
Date: 07/23/2002 00:00:00 AM
I’m not sure what you mean. Are you against health care provided by the government/taxpayers, or are you against health care (partially) financed by the government/taxpayers? To my mind, there’s a big difference between provision and financing.In other words, do you believe universal health insurance is simply not important / not a good idea, or are you just opposed to “national health care”, single-payer type ways to achieve universal health insurance?
Date: 07/22/2002 00:00:00 AM
OK, first question: do we have national health insurance? No, of course not. You answered that question yourself in your example; LA county hospitals are financed by a complex web of county, state, and federal grants to support the system – a system almost ready to collapse and due for major cutbacks.(BTW, LA county health system is a great model for how such systems collapse. Currently there is a huge budget problem. The solution? Close the public health clinics, which provide primary care. Why? Because you have to provide emergency medical care; it’s a federal law. So you shut the inexpensive, cost-effective preventive services and keep the expensive emergency services going. It doesn’t have to make sense; it’s the law.)As Ross pointed out, government health money only pays a fraction of the cost of services, and federal law prevents the hospitals/docs from getting the patient to pay the difference. That means that the private patients – both the insured and the un/underinsured – make up the difference. Whether it’s directly out of your own pocket or indirectly out of your employers pocket, individuals subsidize government mandated health care and federal/state reimbursements.Government sponsored healthcare is one of those beasts that works only because the government sets the standards. Run out of money? Don’t pay and let the administrators decide which service gets cut, who doesn’t get paid, what capital expenditure gets deferred, what medications aren’t available. After all, sick people don’t bitch much- and if you cut off services, they don’t complain long, either.To answer your final question, we do it better by requiring every government mandated program or law passed also have the money to provide those services. If we want universal health care, fine. But we have to also agree to pay for it, and to understand that it will be really, really expensive as the Boomers hit the Medicare barrier. We pay as we go, and we pay whatever it takes to provide the services so that employers aren’t left holding the bag.
Date: 07/22/2002 00:00:00 AM
Funny you mention government financed health care. I have 3 articles on the issue at my site this morning, including one about the Gov. of VT, who wants to repeal the tax cut and use it for universal health coverage.I think you have it wrong about “soaking up” dollars. While many of the Medicaid dollars are being paid to the hospitals, they aren’t generating profits from those services. Most of the time, the amount hospitals receive as Medicaid reimbursement don’t even cover the costs of the care they provide, let alone allow them to generate a profit as, say, a hospital might be able to do if they were reimbursed an amount equal to what they charge for the care.In my community, for example, for every dollar spent by hospitals treating Medicaid patients (the population you discuss), the hospitals receive, on average, 73 cents in reimbursement for those services, so they’re actually losing money at a pretty extraordinary rate by providing care to Medicaid patients.Giving patients universal insurance may not resolve all of the problems — for example, the cost of prescriptions and nursing homes, which are rising by double digit amounts every year and taking up a large chunk of the Medicaid dollars spent. But they will, by encouraging the establishment of a relationship between the patient and a primary care doctor, allow many patients who have problems to get them addressed earlier during the course of the illness, which means less expensive and invasive care, and more care given in an outpatient, rather than hospital based, setting.I don’t have the answers (if I did, I’d be writing testimony to Congress and getting interviewed on 60 minutes, not my blog), but one solution being proposed is consumer-directed health plans, which will put more of the pressure on patients to manage their costs. But this will also demand an increase in information available to consumers/patients, so that they can make an informed choice about their care.Great topic.