The real health-care problem isn’t moral, but structural | Hacker News Reader

The real health-care problem isn’t moral, but structural

city-journal.org

10 pointsbyrneseyeview10 comments

Once again, this discussion insists on equating health care with health insurance. As any good hacker knows, the solution should directly address the cause of the problem, not merely the symptoms of the problem.

The problem is the quickly rising cost of health care and the amount that we, as a society, spend on it each year. The cause of the problem is that people don't buy their health care like they do just about everything else -- it's all paid for by insurance.

After reading this article, which was recently on HN, virtually everything I've heard from experts and policy makers sounds silly:

http://www.theatlantic.com/doc/200909/health-care

The problem is structural all right: the US could afford to provide universal, single payer (Canadian style) health insurance for what it currently spends on Medicare and Medicaid, given that current per capita public spending on health care is actually a bit higher than the OECD average.

If the public sector inefficiencies related to means testing and the private sector inefficiencies related to risk selection, bureaucracy and profit were eliminated, current public spending on health care would be plenty to provide universal, comprehensive coverage based on medical need.

The current bizarro-world hybrid system combines the worst aspects of private and health care while still leaving some 50 million Americans uninsured and at least another 50 million with only partial insurance that won't actually cover them in the case of a serious medical emergency.

You can play all sorts of games with health insurance. But insurance isn't care. This is a point the article makes:

On paper, poor patients have great government insurance; their only problem is that they can’t find a doctor.

My question, to proponents of "universal" health care is this: how will you make the physical provisions for additional health care to be delivered? I'm not asking about money, just resources (an hour of a doctor's time, a bed in a hospital).

If the system is being underused (i.e., doctors going out of business due to lack of patients, empty ERs, etc), that should be easy: just direct the unused capacity to new people.

But if the system is currently at capacity or being overused, where will the additional physical capacity to treat 50-100 million new patients come from?

My question, to opponents of universal health care, is this: How do you explain the fact that universal health care ACTUALLY WORKS in every country that implements it in some form?

How do you explain the fact that your simplistic market-based analysis fails to predict the overwhelming success of universal health care at both delivering comprehensive health coverage and at efficiently allocating resources where they're needed?

You seem to be ducking the question.

In any case, I'm not entirely sure what you mean by "actually works". I'll assume "actually works" means "life expectancy in the range of 70-80, no major health disasters."

The answer is simple: medicine beyond the essentials (trauma care, birthing, vaccines) doesn't improve health very much. It does almost nothing compared to flush toilets, clean water, refrigeration, vaccines and other benefits of being wealthy. In fact, most variations in medicine can't be shown to have a statistically significant effect on health.

So maybe some of those countries do a great job, maybe they don't. It doesn't much matter either way. See this source for a good review of the literature.

http://www.cato-unbound.org/2007/09/10/robin-hanson/cut-medi...

Now can you answer my question? I'm asking because I'm genuinely curious about the worldview of government health care proponents.

How silly of me to think that we were long past this argument since it contradicts with everything that happens in other countries.

You can keep your system privatized if you really want to. Just look at the Dutch system:

-All citizens are required by law to have private health insurance

-All health insurance companies are required by law to accept all applications

-All health insurance companies are required by law to provide a government mandated care package

-Low income citizens are supported by government health subsidies

The people get affordable, universal health care. The insurance companies can compete on price, service and additional coverage. The government can control the health care coverage and subsidies.

The health insurance problem is most certainly a moral/ethical problem. The problem is that insurance companies are rewarded for denying care to insured, when working (as most are) as a for-profit company.

The cost-shifting argument is curious.

The simplified version of it runs:

- medicare (etc) say: 'this is what we reimburse for this procedure', non-negotiable

- providers that take medicare charge the private sector more than the price medicare dictates

...then the argument runs that medicare is forcing private health-care purchasers to make up the shortage / subsidize its low premiums.

The curious part:

- if the private-sector purchasers (whether individuals or insurers) aren't getting their money's worth why are they buying?

if the private-sector purchasers (whether individuals or insurers) aren't getting their money's worth why are they buying?

There may be a massive consumer surplus being eaten up by this price-fixing. In Europe, that consumer surplus comes in the form of low costs. In the US, it would come in the form of high profits for a little while, then higher competition.

"Richest country in the world" - only if you don't count debt.

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