Monday, June 21, 2004
Off the books health care costs
[Waldemar Ingdahl, "His Hip, Hooray!," Tech Central Station, 4 June 2004.]
Doing something and doing it well -- or in a timely manner -- can lead to very different outcomes. This is one of the basic issues that proponents of universal health care fail to acknowledge. It also creeps up as a problem in current health care delivery in progroms such as Medicaid where rich benefit packages do not square with the reality of what is available.
For instance, Medicaid reimbursement rates are set artificially low. Doctors and nursing homes still agree to work with these rates, but there is a cost. This cost can come in terms of the quality of care provided or in the form of rationing or waiting lists. In other words, there is no such thing as a free lunch.
Stories of waiting lines in countries with socialized medicine illustrate this point well. Here's a recent example from Sweden:
Sweden's prime minister, Göran Persson . . . . was diagnosed to need an urgent operation for his arthrosis in the hip [last year]. Persson has obviously been in great pain, walking with a limp, and he has reportedly been using strong painkillers.
Now, after waiting for more than eight months he finally received his operation yesterday (June 3rd).
Persson shares his hip troubles with many others of his age, but in Sweden a hip replacement is a very complicated affair, even if you are the prime minister.
Sweden's "egalitarian" health care system features the same serious problem as all other centrally planned systems: shortages, due to a culture of rationing. For an operation like hip replacement, a procedure that typically takes less than two hours, there is a waiting list ranging from a minimum of seven months to more than two years. More than 5,000 Swedes are estimated to be waiting in line for this procedure alone (not counting those that still have to get an examination from a doctor, and a diagnosis).
The problems of the Swedish health care system are well known in the country, and the fabled image of the welfare state, with the government providing for everything from cradle to grave, is gone. Or rather, we still pay the same high amount of taxes but we do not get the same amount of government services for them.
In public health care you pay for a queue line ticket, in private health care you pay for health care. All citizens have to pay taxes for the public health care (about 50-60 percent of your wage), and most cannot afford to pay again to get health care privately.
When the centre-right parties discuss reforms of the public health care system they always confine themselves to what appears today as politically possible. Those who concern themselves exclusively with what seems do-able in the existing state of opinion always find that even this becomes politically impossible as the result of changes in a public mood which they have done nothing to guide.
A truly radical alternative, contrasting to the old industrialist health care system, could inspire people to change. It would have to consider the introduction of new technologies and changes in people's preferences, towards less curative health care and towards more palliative health care. But it would also include dynamism and decentralization, putting the patient in the position to decide on his or her own health.
Until we see such a political alternative offered, we will have to wait in line for health care, just like Göran Persson. Or buy it abroad.
[See Brian Lee Crowley, "The Top Ten Things People Believe About Canadian Health Care, But Shouldn’t."]
Thanks to Benjamin Pratt for this story.
[Waldemar Ingdahl, "His Hip, Hooray!," Tech Central Station, 4 June 2004.]
Doing something and doing it well -- or in a timely manner -- can lead to very different outcomes. This is one of the basic issues that proponents of universal health care fail to acknowledge. It also creeps up as a problem in current health care delivery in progroms such as Medicaid where rich benefit packages do not square with the reality of what is available.
For instance, Medicaid reimbursement rates are set artificially low. Doctors and nursing homes still agree to work with these rates, but there is a cost. This cost can come in terms of the quality of care provided or in the form of rationing or waiting lists. In other words, there is no such thing as a free lunch.
Stories of waiting lines in countries with socialized medicine illustrate this point well. Here's a recent example from Sweden:
Sweden's prime minister, Göran Persson . . . . was diagnosed to need an urgent operation for his arthrosis in the hip [last year]. Persson has obviously been in great pain, walking with a limp, and he has reportedly been using strong painkillers.
Now, after waiting for more than eight months he finally received his operation yesterday (June 3rd).
Persson shares his hip troubles with many others of his age, but in Sweden a hip replacement is a very complicated affair, even if you are the prime minister.
Sweden's "egalitarian" health care system features the same serious problem as all other centrally planned systems: shortages, due to a culture of rationing. For an operation like hip replacement, a procedure that typically takes less than two hours, there is a waiting list ranging from a minimum of seven months to more than two years. More than 5,000 Swedes are estimated to be waiting in line for this procedure alone (not counting those that still have to get an examination from a doctor, and a diagnosis).
The problems of the Swedish health care system are well known in the country, and the fabled image of the welfare state, with the government providing for everything from cradle to grave, is gone. Or rather, we still pay the same high amount of taxes but we do not get the same amount of government services for them.
In public health care you pay for a queue line ticket, in private health care you pay for health care. All citizens have to pay taxes for the public health care (about 50-60 percent of your wage), and most cannot afford to pay again to get health care privately.
When the centre-right parties discuss reforms of the public health care system they always confine themselves to what appears today as politically possible. Those who concern themselves exclusively with what seems do-able in the existing state of opinion always find that even this becomes politically impossible as the result of changes in a public mood which they have done nothing to guide.
A truly radical alternative, contrasting to the old industrialist health care system, could inspire people to change. It would have to consider the introduction of new technologies and changes in people's preferences, towards less curative health care and towards more palliative health care. But it would also include dynamism and decentralization, putting the patient in the position to decide on his or her own health.
Until we see such a political alternative offered, we will have to wait in line for health care, just like Göran Persson. Or buy it abroad.
[See Brian Lee Crowley, "The Top Ten Things People Believe About Canadian Health Care, But Shouldn’t."]
Thanks to Benjamin Pratt for this story.
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