OK so I asked the one health-care blogger I know of, Alwin Hawkins of View From The Heart what he thought about my post, and he answered in the comments section below. It’s too good to risk folks missing it, so here it is:
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: 07/25/2002 00:00:00 AM
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Date: 07/24/2002 00:00:00 AM
To be fair, Alwin, that quote originally referred to programming, not health care. Needless to say, they aren’t the same thing. A.L: it’s only existing for some… the whole problem with the current system is that some get good/fast/cheap (many don’t pay their insurance, after all; whether you get insurance depends more on whether you’re lucky enough to get a job with a company that has benefits and doesn’t tie you to a half-assed HMO), and others (those whom don’t get benefits, don’t work, etc.) get poor/slow/deadly.
Date: 07/24/2002 00:00:00 AM
Alwin:I’ve always thought that the slow pace of NHS and other bureaucracies was a form of rationing…if you really want it, you’ll wait, otherwise you probably didn;t need it so badly.And I think it’s only Good and Fast for some of us; even in my (damn well-insured) case, I had to hassle for months and pay almost $3K out of pocket to get the sinus surgeon I wanted.And the problem as I see it isn’t the “me’s” of the world, but my nanny (who I pay damn well on a W-2 but can’t afford to insure…or rather she can’t afford to work for what I offered to pay her if I insured her) who uses the ER as primary care.And as I’ve noted, her health, and the health of all the other uninsured directly influences mine.A.L.
Date: 07/25/2002 00:00:00 AM
Sorry, Demos; I heard it from an old intensivist over a decade ago and not in the context of programming.And you’re right; right now good health coverage is dependent on whether you belong to that shrinking group of people well-insured by their employers. It’s part of the death-spiral that has plagued US health care for years. The government didn’t cover the costs of providing care, the hospitals and docs shifted the cost of that and indigent care onto the privately insured. When the insurance got too expensive to provide, some employers dropped out- and *those* cost were shifted to the privately insured, driving the rates up faster.You already know the rest of that story.So how do you restore balance to the system? By making sure that everybody pays their way; no more cost-shifting, no more accounting tricks, no more free rides for anyone. If you can’t pay, you can’t play.
Date: 07/24/2002 00:00:00 AM
Canada has it’s own budget woes; they have long waits (months) for what would be considered urgent surgery here in the US. They send patients to the US to get fixed (much as the UK is now sending patients to the Continent to get treatment). There is a universal law of medicine in the world today: You can have it good. You can have it fast. You can have it cheap. Or any two of the three; but the three of them are mutually exclusive. Canada/UK has Good and Cheap; the US and Germany Good and Fast.Americans aren’t good at waiting in line for things, so I doubt we could manage a Good/Cheap system.
Date: 07/23/2002 00:00:00 AM
Oops. You already addressed this in the post below …