Centerfield

C3,

As far as a crisis facing the country, I'd say Medicare and Medicaid are two crisis issues that will need to be addressed.

As far as what affects me on a day to day basis, I couldn't find it on the list. I'm not a doc...I'm a commercial lender with a portfolio that is about 80% medical. We are seeing a dramatic increase in the number of docs that are going bare. Malpractice insurance rates are just out of control, especially in specialty fields. Many are having a patient sign a waiver before they will treat them, but we have serious concerns about the effectiveness of such an agreement, and thus a bare doc isn't really something I can work with. The docs blame the trial attorneys, the trail attorneys blame the insurance companies, and nothing seems to be done.

As far as the uninsured crisis--the 40 million--I'm just not too sure what to think of that. Yes, there are Americans who are not insured that need to be, but there are also quite a few who chose not to be insured for a variety of reasons--cost, religious beliefs, etc. It's a problem, I'm just not sure the 40 million is a completely accurate number.

I'm not sure how you'd control pharms...I support a free market, but at what cost? I'm not sure...

Just a few thoughts...

If we supported totally free markets--the "Naked Capitalist" Randian line--we'd have no public roads. No public schools. No state police. No army. Etc. Except as people voluntarily agreed to cough up the bucks to pay for them. Such things are public goods. We pay for them as a society because they benefit society as a whole. And because they're public goods, the cost of them is apportioned over the entire tax base.

If health care is to be a private market, then we're saying that health care is a private good, something society doesn't need to get involved in. But that's already been answered--health care is considered at least partially a public good. Medicare. Medicaid. And the continual question of the un/underinsured. Health care is at least partially a public good. And the more that a good is public, the more that the government has a big say in how it's distributed.

That's not to say that the services must necessarily be provided by the gov't itself. We contract out roadbuilding and other functions. There are efficiencies in private provision that the government can't seem to achieve on its own. Market pricing works--just not always in the way we'd like it to. It's a limited-trick pony.

So the question is, how much (or what level) of health care is a public good? Where do we slice the Big Cheesy Enchilada?

"There are efficiencies in private provision that the government can't seem to achieve on its own."

The relative amounts spent on "overhead" by Medicare vs. your average HMO strongly suggest otherwise. There are colossal amounts of waste inherent in our for-profit health-care system. A few examples, in no particular order: the administrative burdens imposed on health-care providers who have to deal with dozens of different, constantly evolving insurance plans and levels of coverage (I can't count the number of times I've been stuck in line at the pharmacy while the pharmacy assistant tries to figure out what another customer's co-pay is supposed to be!); prescription-drug advertising, much of which is for "lifestyle" drugs, many of which are slight reformulations of existing products; and executive salaries, which are orders of magnitude greater in the private sector. Malpractice insurance premiums are a part of the equation too, of course, but let's not overlook the other manifest inefficiencies in private-sector health care.

My greatest concern is the degree to which health care is sucking the life from the rest of the economy. Virtually the only growth sectors of the economy are health care and government. And half of every health care dollar is from government.

Manufacturing is flat; technology is flat; transportation is moribund.

And a lot of the profits in health care are concentrated in very few hands. The entire situation isn't good for the society as a whole.

So, vaara, we can mark you down in the "unified single-payer model" column, right? :-) Beware of narrow-focus interpretation. I'm over in that direction myself, for many of the reasons you cite. Health care financing overhead (and avoidance of same) eats up enough money every year to cover all of the uninsured.

But note that single-payer is not the same thing as making all facets of health care provision, including research, supply, delivery, etc., a branch of the federal government. Just as the government doesn't build schools or make pencils. It pays to have schools built, and buys pencils. Which was the point. There's a lot more to the health care system than just the payment & financing structure.

Dave;

And a lot of the profits in health care are concentrated in very few hands. The entire situation isn't good for the society as a whole.

Hey, its job security for me ;-)

Vaara;

There are colossal amounts of waste inherent in our for-profit health-care system.

Much of what you say makes logical sense but I'm not sure its confirmed by research. See my previous post about "mixed medical markets"

I'm curious, I've heard talk that in Canada (which has a public health care system) and a number of other countries that have publicly funded systems it's actualy illegal for private providers to provide certain services (something about not "competing" with public providers).
Does anyone know what the facts are on that?

I'm not neccesarly opposed some public funding of essential health services. However, I'd be adamantly oppossed to anything that smacks of a government monopoly over services. You should be able to obtain any service from any private provider that you can from a public one, if you are willing to pay for it.

Cengal;
I'll look into Canada. i know England has a thriving private healthcare industry (for those who can buy up).

C3,

There was a great article the other day...wish I could remember where I saw it. (Yahoo! News maybe?) Anyway, it was about the waiting lists in the Canadian system. In particular, they discussed the 10,000 women on a waiting list in one of the provinces to be treated for breast cancer. Several were coming to the US, including one lady who travelled by bus to Vermont once a week for radiation treatment. One lady was flying to Turkey for treatments.

In some Canadian provinces you must wait for several months for an electrocardiogram. I am told the letters sent to verify the scheduling include an apology just in case the would-be recipient is already deceased. But if you want to spend your own money you can get it done tomorrow.

We are not the only country running head-on into the limited resources vs. unlimited wants dillemma. (We ARE the most expensive.) ALL major nations are hitting that same wall. Technology is outstripping cost availability, and when it comes to something that means life itself, demand will always be greater than supply.

The question still remains: what level of health care do we consider a public good, justifying the universal billing of taxation? And what level should be on your own dime?

OK Cengal I found some info on Canada. From the Long Island Business Journal (I have no idea why they care). Key quote:

Initially, the program was well received, but rising demand soon exceeded the government's ability to fund it. Services began to deteriorate while facing stiff competition from the private sector. Dissatisfaction caused more and more Canadians to opt for private health insurance. This exodus from the system to private healthcare jeopardized its survival. Thus, in 1983, the government under Pierre Trudeau passed the Canada Health Act, or CHA. The CHA enshrined five principles: It must be administered by a public authority on a not-for-profit basis and provide reasonable access and comprehensive coverage for all. The act made illegal the provision of healthcare services outside the government-run system

This article points out the phenomenom of a growing private sector

For example, every time a medical service is taken off the list covered by our public healthcare system, for-profit health companies are quick to add the service to their private insurance plans.

And irony of ironies it appears that a large part of the spending outside of the governmental health system is for drugs!

By the way, the Canadian Healthcare system is called Medicare.

Thanks Chris, reading that LIBJ article further really illustrates what a disaster Canada's health care system has become. Which is what I've heard anecdotaly but didn't really know before.

It definately should be required reading for anyone that's been pining for us to get a public health care system "like Canada has" - no thank you. Again, I'm not against some sort of Public Health Care system in principle.... and I'm willing to believe there are ways to do it well, but Canada is clearly not an example of one.

Like so many things, with Public Health Care, the devil is in the details.... it can be implimented well or it can be a disaster..... unfortunately we all know the sort of track record large Federal Bureaucracies tend to have with implimenting stuff. That, more then anything else tends to drive my opinions against large publicaly funded systems like Health Care.... I just don't trust the bureaucrats not to royaly screw it up... regardless of best intentions.

One area that often gets overlooked when comparing health systems is the cultural influence. Apparently the British and other countries are ok with some not getting what they want for the "greater good". Many Health policy writers have commented on how we Americans like our choice, like our freedom not to be told who we can and can't see and mistrust our government to manage our personal affairs. The system that works well for one country may be a big problem for another.