"Free" Universal Health Care

[trysail]

Hungarians Bribing Doctors Increases Health Spending (Update1)

By Alex Kuli

Aug. 28 (Bloomberg) -- For Magdolna Vincze, free health care was never so expensive.

When giving birth to her second son in 2004, her payroll contributions into the state insurance system weren't enough to guarantee the medical care she needed, she said. So Vincze did what she said is expected of patients: She bribed staff at Budapest's Szent Margit hospital more than 100,000 forint ($522), about a month's take-home pay for the average Hungarian.

``Everyone knows it's unethical,'' says Vincze, a 34-year-old telephone company worker. ``People feel pressured. They're afraid they won't get personal attention, the doctor won't even look at them, the nurses won't go into the room, they won't tell them about the newest treatments.''

Hungarians grew up giving communist-era doctors what they call ``gratitude money'' to secure comforts not provided by the state. Hungarians now pay doctors as much as 100 billion forint under the table a year, Health Minister Agnes Horvath says. The practice inflates Hungary's health budget as doctors prescribe unnecessary procedures in hopes of maximizing illicit income, she says.

The debate over bribery comes as the government proposes changes to the way health care is funded and paid for. Medical spending affects the country's battle against the European Union's widest budget deficit, which reached 9.2 percent of gross domestic product last year.

The shortfall forced Hungary to abandon plans to adopt the euro as its currency by 2010. Overspending on health alone last year was equivalent to about 2 percent of GDP, according to the Health Ministry's Web site.

Acceptable, But Unfair

About 60 percent of Hungarians consider medical bribery acceptable, though nearly all of them say it's unfair, according to an opinion survey published July 24 by Median, a private Budapest polling agency. More than a third would ban it, the poll showed.

Horvath's measures to fight bribery include a 300-forint fee for doctor's visits, which used to be free. Patients who pay a fee are less likely to slip cash to the doctor, she said.

Ferenc Odor, a member of the main opposition party, Fidesz, instructed hospitals July 31 to post Horvath's picture on machines where patients pay the fee, according to a party Web site.

``People should know who to thank,'' the statement said.

Horvath's party, the Free Democrats' Alliance, responded by asking Odor to provide patients with bribery envelopes bearing a picture of Fidesz leader Viktor Orban.

Stay Awhile

Some doctors prescribe unnecessary hospital stays because overnight patients are more likely to hand out cash, Horvath said. Slightly more than 2 percent of surgeries were performed on an outpatient basis in Hungary in 2004, compared with 53 percent in Britain and 48 percent in the Netherlands, according to the Health Ministry's Web site.

Doctors hate taking cash and prescribing unnecessary treatments, says Geza Gyenes, chief secretary at the Hungarian Doctor's Chamber. The problem is, doctors are underpaid, with some earning a base pay near minimum wage, he said.

``An assistant bricklayer gets paid better than a doctor,'' Gyenes says. ``If we didn't have gratitude money, not one doctor would have stayed in this country'' after communism collapsed, he said.

Still, many doctors are well paid, and bribes exacerbate income differences, says Finance Minister Janos Veres.

``Who gets the most gratitude money? The professor at the clinic, whose income isn't low,'' Veres says. ``Who gets the least? The coroner in the mortuary, even though his salary is low.''

Commonplace

Medical bribery remains commonplace in the east 17 years after communism collapsed, former Dutch Health Minister Hans Hoogervorst, who served as an adviser to Hungary's health ministry earlier this year, said at a June 14 press conference.

Latvian President Valdis Zatlers, a surgeon, told the Diena newspaper in May that he'd received under-the-table gifts from patients during his 27-year career. He didn't specify when, or how much he'd received. He was fined 250 lati ($495) in July in connection with an incomplete tax declaration, state revenue service spokeswoman Agnete Busta said.

The city of Budapest, which owns Szent Margit and other hospitals, doesn't have the wherewithal to eliminate gratuities, Deputy Mayor Csaba Horvath said July 20.

``It's impossible to change a 40- to 50-year-old practice from one day to the next, that's why banning it wouldn't be effective on its own,'' says Horvath, who is no relation to the health minister.

Options

Criminalizing the practice will only drive it underground, Health Minister Horvath says. Instead, the ministry has implemented rules to ensure patients don't bribe their way to the front of a waiting list, she said.

In June, she awarded 3.3 billion forint to institutions to build outpatient surgery facilities. Hospitals can save an estimated 814 million forint a year by not requiring patients to stay overnight for certain operations, Horvath said at an Aug. 9 press conference.

Hungary's program to overhaul health insurance may help to eliminate bribes, says Mihaly Kokeny, a member of Parliament who heads the Health Committee. By 2009, the state will break its single health insurer into several funds with minority private ownership. The funds will choose which hospitals they'll contract with and may stay away from the ones they deem corrupt, he says.

Competition between providers has eliminated coercive tipping in other formerly communist industries, such as gas stations, said Zsombor Kovacsy, president of the Hungarian Health Insurance Supervisory Authority.

``Without gratitude money, they filled your car with petrol, but didn't clean it at all,'' he said in a May 21 interview. ``Now, I never give gratitude money to the petrol station guys, and they do everything. So I think that the mentality of competition and well-regulated procedures can help a lot.''

Polling data shows that Slovakia discouraged bribery after it introduced visit fees similar to Hungary's in 2003, said Tomas Szalay, a partner at the Health Policy Institute in Bratislava, Slovakia.

Patients ``pay cash and feel that it isn't for free,'' he says. ``Why should they give something more?''

 

[Roxanne Appleby]

Like everything else that people want, health care is a scarce good that must be rationed. For most goods this is done through prices. For example, caviar remains available because its price is so high that few people buy it. The virtue of that system is that it creates an incentive for producers to provide more of the good, and it allows individuals to choose for themselves whether they want it badly enough to pay the price. You don't buy caviar very often, but if you really want it sometime, the choice and opportunity is there. In contrast, if caviar were made "free," or the government imposed a price cap, only the first few people to arrive at the store would get any, plus producers would stop making more.

Applying this system to health care raises a problem: Unlike caviar, having this good or not can be a matter of life and death. As a humane and compassionate people, we are unwilling to condemn those who can't afford health care to death. Nevertheless, it still must be rationed, because there will never be enough to go around, no matter how much of economy we turn over to it.

Europe and Canada have given the rationing function to politicians and bureacrats. They determine who can get what kinds of health care, and how much. They essentially have the power of life and death through the rules they impose. Sometimes the rationing is done in a transparent manner - "Our system will allow you to have a new hip because you are older than 55," and sometimes it's done less honestly, in the form of "waiting lists."

A better system is one that allows individuals to make the rationing decisions for themselves, as they do with caviar, but also solves the problem of excluding those who make less money, or no money. There are a number of proposals for doing this, such as giving government insurance vouchers to the poor, to cite just one. This approach tries to "socialize" all or part of the cost of health care, but leaves its provision in the hands of the private sector. Rationing decisions would still be in the hands of individuals rather than politicians and bureacrats, and producers would still have an incentive to discover innovative ways to provide more for less.

 

[R. Richard]

If something is valuable, it is not free. Well wait a minute, what about sunshine and fresh air? You pay taxes to keep the air free of most of the pollution that would otherwise make it hard to breathe and that would also block out the sun. If you don't believe the last, look at China.

If you provide 'free health care,' then the people with the least to do get all the free health care, because they can afford to sit all day in a doctor's office [they don't give up wages, they don't earn wages.] If you provide universal health care coverage, as does Canada, then you wait in line for medical services that may be the difference between life and death [CAT scan.] If you can't take the specific drug that Canada provides, then you do without. Oh yes, there is one thing you can do. You can go the the US and pay for what Canada provides for free. If you pay, you get the care when you need it, not when your turn comes.

Oh yes, when a government provides 'free health care,' someone has to pay for it. Of course, the taxpayers pay. But the doctors also pay. The doctors get squeezed, because the politicians need to keep costs down. The most obvious place to keep costs down is to underpay doctors. The most obvious result is that doctors vote with their hats. They grab their hats and run somewhere that they can earn a decent living.

 

[Liar]

A better system is one that allows individuals to make the rationing decisions for themselves, as they do with caviar, but also solves the problem of excluding those who make less money, or no money. There are a number of proposals for doing this, such as giving government insurance vouchers to the poor, to cite just one. This approach tries to "socialize" all or part of the cost of health care, but leaves its provision in the hands of the private sector. Rationing decisions would still be in the hands of individuals rather than politicians and bureacrats, and producers would still have an incentive to discover innovative ways to provide more for less.

I'm sure you've thought about this, so I got to ask... how does this system take inrto account that people's need for medical resources are extremely different? Guy A might need ten times as much medical care as guy B to stay alive and healthy. If the answer is "oh, but you get more vouchers depending on your medical needs", then aren't you still in the same buerocrat controlled system, but with another layer of paper?

Btw, I'd hope ration desicions would be in the hands of those most competent to make them. In the medical field, that would be the doctors, and from my experience, it is. You have a tendency to paint the big buerocrat bogeyman on the wall in the weirdest of cases. Can't see what they have to do with assessing health care priorities. A clear cut example of this would be if a hospital have one kidney, and two patients in need of a kidney. This happens now and then, regrettably. Who gets the kidney? First criteria is: is one of them medically capable of waiting? If yes, person 2 gets the kidney. If no, the second criteria is: Who'd get the most out of their kidney? How long a full and healthy life is each person projected to live?

How could this scenario be improved? Who should decide what? Not fully getting it.

 

[Handprints]

Hungarians Bribing Doctors Increases Health Spending
The debate over bribery comes as the government proposes changes to the way health care is funded and paid for. Medical spending affects the country's battle against the European Union's widest budget deficit, which reached 9.2 percent of gross domestic product last year.

The shortfall forced Hungary to abandon plans to adopt the euro as its currency by 2010. Overspending on health alone last year was equivalent to about 2 percent of GDP, according to the Health Ministry's Web site.

Hungary's program to overhaul health insurance may help to eliminate bribes, says Mihaly Kokeny, a member of Parliament who heads the Health Committee. By 2009, the state will break its single health insurer into several funds with minority private ownership. The funds will choose which hospitals they'll contract with and may stay away from the ones they deem corrupt, he says.

Maybe the first point to make about this excellent post is that Hungary's a bit more of a basket case than the rest of Eastern Europe: the government's been very bad at managing the economy and public sector workers have been left far behind in the salary stakes. That really exacerbates problems like bribery and off-the-books treatment in the health service because private sector pay has leapt ahead and inflation isn't well controlled.

Hungary's dentists were the first to be allowed to offer private treatment as well as publicly-funded work. Private treatments earned them something like 400% more than the public stuff, especially in big cities. Hungary appears to produce an outsize number of really good mathematicians, water polo players and dentists, so, pretty quickly, residents of neighbouring countries were popping over to get their teeth done on the cheap (Hungarian dentists are less expensive than private German dentists, and will take patients who have cash without appointments: if you don't have private insurance and fancy a bit of goulash anyway, it's an economical alternative to waiting for a public appointment or buying private insurance.)

When other healthcare professionals saw the money the dentists were making, they started offering their services - illegally - off the books, which reduced the time available to the non-fee-paying public. It's a fairly bribe-heavy culture anyway, so there wasn't a lot of local resistance to overcome, particularly in light of public-sector salaries.

Overhauling health insurance to offer choice - the first small step in providing government-endorsed private healthcare, as opposed to the government-tolerated kind that now goes on - might help but, to be blunt, finding good fund management in the Hungarian public sector is difficult, to say the least. If they privatise the management of the funds, not just the ownership, then I'll be more impressed. If they give these funds a stable currency and economy in which to operate, things will certainly improve at a faster pace.

At the risk of offending anyone, the Bloomberg story might perhaps be better evidence of the fact that very little works well in Hungary, rather than of the notion that socialised medicine doesn't work at all well anywhere.

Hope that's of use,
H

 

[Roxanne Appleby]

I'm sure you've thought about this, so I got to ask... how does this system take inrto account that people's need for medical resources are extremely different? Guy A might need ten times as much medical care as guy B to stay alive and healthy. If the answer is "oh, but you get more vouchers depending on your medical needs", then aren't you still in the same buerocrat controlled system, but with another layer of paper?

Btw, I'd hope ration desicions would be in the hands of those most competent to make them. In the medical field, that would be the doctors, and from my experience, it is. You have a tendency to paint the big buerocrat bogeyman on the wall in the weirdest of cases. Can't see what they have to do with assessing health care priorities. A clear cut example of this would be if a hospital have one kidney, and two patients in need of a kidney. This happens now and then, regrettably. Who gets the kidney? First criteria is: is one of them medically capable of waiting? If yes, person 2 gets the kidney. If no, the second criteria is: Who'd get the most out of their kidney? How long a full and healthy life is each person projected to live?

How could this scenario be improved? Who should decide what? Not fully getting it.

Liar - In the aggregate the individuals affected are always the most competent to make good choices about their health care. You and I can spin all kinds of individual cases where that won't apply, but the total number of good decisions and outcomes will be higher the more individuals have control, rather than anyone else. Hopefull they will carefully consider and balance the advice of experts, and in most cases they will.

I've descrived some details of one system along the lines I mentioned elsewhere - see my "where are the innovators in health care" thread, here http://www.literotica.com/forum/showthread.php?t=531133. The main post of interest is number 9, pasted below; I resonded to subsequent challenges after this post. Here's its text:


You may be surprised by what I view as a "happy future" in health care.

I do believe that health care must be consumer-driven for the reasons the OP article describes. With several reforms in that direction it becomes possible to provide every person in the country with a health insurance voucher that will cover all expenses above $2,500 year. Here's how:

First, we need to repeal the restrictive state licensure and scope of practice regulations that masquerade as consumer protection but actually only protect the provider cartels from competition. This would allow someone like Lucky (with perhaps enough extra training to acheive nurse practitioner status) to open an urgent care clinic that could treat all the various nicks and bruises encountered in daily life (like falling off 5 gallon buckets, or nasty cuts that require a dozen stitches and antibiotics). The cost would be be a fraction of what emergency rooms cost, manned as they are by highly trained MDs who aren't needed for 90 percent of the stuff that rolls through the doors. Naturally our Lucky would have the training to recognize the stuff that she can't handle and would refer it on.

Second, allow binding waivers of liability so you could only sue Lucky for screwing up the thing you paid her to do - sew up the 12 stitches and prescribe the right antibiotic, for example, instead of a bunch of crap that some shyster thinks of afterwards that she should have done. Oh, and Nurse Lucky would only need to charge you around $40 or so for that service, because this reform and the previous one lets her operate her clinic in the most efficient manner possible (think Wal-mart vs. Rodeo Drive boutique.)

Third, every adult over age 21 would be required to buy insurance with a $2,500 deductable. Because everyone buys, including young people who don't get sick much, the costs of those who do get very ill are "socialized," and there's enough left over that the money those healthy youngsters contribute grows sufficiently to cover their own old age costs. And, because of the high deductable and everyone paying in, the cost of this insurance would only be around $4,000.

Fourth, there would be universal community rating - every person pays the same. No "prior conditions," etc. This is impossible without the universal insurance mandate because the incentive is for individuals to "free ride" by waiting until they get sick to buy insurance (in which case it's not insurance but welfare). The only things the $4,000 policy would not cover would be extraordinary end of life expenses - if you wanted you could pay more to get insurance for those, but most people would decide it's not worth it. There would be some variation in the available policies, but not much. The policies would cover children as well as their parents - in the aggregate kids are a very small portion of total health care costs.

Fifth - and here is where you will be surprised - the government would pay for those $4,000 insurance policies for every person. Not just the poor - everyone. No more employer-provided health insurance, Medicare or Medicaid.

Essentially, this plan socializes the cost of health care, but leaves the provision of in to the private sector, and removes the constraints on innovation described in the OP. It is a win-win for every member of our society. I'm sure all those who imagine some socialist paradise will find 100 quibbles over this scheme, but there's no free lunch, including in the single payer plans. This one is sustainable, and the incentives are all in the direction of making it more cost effective and patient-friendly. That is not the case in the government-run systems.

I didn't invent this - it's described by Charles Murray in his "In Our Hands: A Plan to End the Welfare State."

 

[R. Richard]

I'm sure you've thought about this, so I got to ask... how does this system take inrto account that people's need for medical resources are extremely different? Guy A might need ten times as much medical care as guy B to stay alive and healthy. If the answer is "oh, but you get more vouchers depending on your medical needs", then aren't you still in the same buerocrat controlled system, but with another layer of paper?

Btw, I'd hope ration desicions would be in the hands of those most competent to make them. In the medical field, that would be the doctors, and from my experience, it is. You have a tendency to paint the big buerocrat bogeyman on the wall in the weirdest of cases. Can't see what they have to do with assessing health care priorities. A clear cut example of this would be if a hospital have one kidney, and two patients in need of a kidney. This happens now and then, regrettably. Who gets the kidney? First criteria is: is one of them medically capable of waiting? If yes, person 2 gets the kidney. If no, the second criteria is: Who'd get the most out of their kidney? How long a full and healthy life is each person projected to live?

How could this scenario be improved? Who should decide what? Not fully getting it.

In a military environment there is frequently a need for something called triage. When the number of people urgently requiring care exceeds the capacity of the system to deal with the problem, triage is used. Patients who can be cured with 15 minutes of surgery are given that 15 minutes of surgery, because it is an effective use of resources. The poor guy who might survive with six hours of surgery is given pain killers. Why? Because 24 guys can be saved in the time it would take to save one guy. Who does triage? Mainly doctors, although nurses often pre-screen the candidates. Do the doctors just abandon difficult cases? No, they simply concentrate their efforts on saving as many as practical.

 

[BlackShanglan]

Like everything else that people want, health care is a scarce good that must be rationed. For most goods this is done through prices. For example, caviar remains available because its price is so high that few people buy it. The virtue of that system is that it creates an incentive for producers to provide more of the good, and it allows individuals to choose for themselves whether they want it badly enough to pay the price.

I'd just like to observe that this relies on a quite particular meaning of the word "available." Caviar remains "available" in the sense that people with money to burn can find it on the shelves. If it was cheaper, it might not actually be any less "available" in the sense of the number of people who could eat it; it would just be sold out, meaning not "available" on the shop shelf because it was instead "available" to the first hundred people who walked into the store with five dollars in hand.

I agree, of course, that some supplies can be stimulated by profit. We might get an actual, real rise in the whole-system availability of caviar (i.e., more actual caviar coming to market) if people see that it's fetching a huge price and invest in ways to raise more. But in other systems, like shortages of goods caused by war or natural disaster, pricing high only creates availability in an artificial sense. It can keep more of the goods on the shelves for longer, but it can't actually make them reach more people - just richer ones.

 

[cloudy]

I faced a situation this morning that started me thinking about healthcare - specifically, the malpractice suits that doctors are forced to worry about, and insure against.

When my oldest son was young, he was very, very prone to get eye infections. They happened so often, that I could recognize the first signs of one. His doctor realized I had good judgement, paid attention to my child's health, and so if I called to report another eye infection, he would simply call in a prescription for me, saving me the cost of an office visit.

Fast forward some years.

This morning my youngest was complaining about his ear hurting - again. He's gotten so many ear infections in his seven years that, like the older son's eye infections, I know what they look like. He had to have tubes put in his ears at 4 mos. old because of them. We've also gone through surgery for an aortic anomaly with this one. To say the least, we're medically experienced.

He's been with the same pediatrician group since the day he was born, although we've been referred out to specialists as necessary.

I called this morning to report yet another ear infection. "Come into the office," I was told.

A $55 office visit later, the problem is on its way to being resolved. Its not the difference in doctors - this one has just as much faith in my judgment, since I've always been right about simple things, but I have to wonder: why charge me the office visit when it would be so much simpler, for them as well as for me, to just call the prescription in? The end result is exactly the same. Are they so afraid of malpractice suits now?

 

[Stella_Omega]

If you have insurance, it's possible that the insurance company would get on their butts about it.

 

[cloudy]

If you have insurance, it's possible that the insurance company would get on their butts about it.

No insurance.

 

[Stella_Omega]

No insurance.

They should have just written the prescription, you're right.
New girl in the office?

 

[Roxanne Appleby]

I'd just like to observe that this relies on a quite particular meaning of the word "available." Caviar remains "available" in the sense that people with money to burn can find it on the shelves. If it was cheaper, it might not actually be any less "available" in the sense of the number of people who could eat it; it would just be sold out, meaning not "available" on the shop shelf because it was instead "available" to the first hundred people who walked into the store with five dollars in hand.

I agree, of course, that some supplies can be stimulated by profit. We might get an actual, real rise in the whole-system availability of caviar (i.e., more actual caviar coming to market) if people see that it's fetching a huge price and invest in ways to raise more. But in other systems, like shortages of goods caused by war or natural disaster, pricing high only creates availability in an artificial sense. It can keep more of the goods on the shelves for longer, but it can't actually make them reach more people - just richer ones.

You and I have gone around on this point before. Then, I posted the following letter from a forgotten publication:

The excellent article about how price controls explained very well how supressing the rationing effect of prices causes perverse and harmful effects. Brown explained how consumers are better off if retailers engage in “price gouging” by raising the price of ice from its usual $1 to $15 in the wake of a hurricane. This avoids the problem of “the first five people who want to buy ice might obtain the entire stock, (while) one or more of the last five applicants may need the ice more desperately than any of the first five.”

One important addendum to this is addressing the "compassion" issue for people who "can't afford" $15 bags of ice and whose "need" is great.

Let's say the 10th person needs the ice to keep insulin fresh for his diabetic daughter, who will die without it. Where is the ‘compassion’ in a law that prevents the market from operating in such a way as to ensure that the lifesaving ice is available for this customer?

Now, let's say the this person can’t afford $15 ice. That raises a separate issue, which is charity. THIS is the proper realm for compassion. Government is too big and clumsy to exercise effective compassion. Not so individuals, and the institutions of civil society. Odds are, when the situation was explained, the store owner would donate the ice for free to save the diabetic daughter. If not, how hard would it be to raise the money through the institutions that make up what we call civil society: The network of private institutions, community associations, religious organizations, families, friends, coworkers, and their voluntary, from-the-heart interactions? Not very hard at all.

Your response was here: http://forum.literotica.com/showpost.php?p=17899426&postcount=110 . I still don't find it satisfactory, but then, it takes two sides to make a market.

The situation there is different from health care, though, in which I believe the demand is too great to be realistically filled by civil society, and so have adopted the view described in my previous posts here.

 

[JAMESBJOHNSON]

We created an indigent healthcare tax many years ago. We wanted to clear hospitals and E/Rs of poor people and replace them with paying customers and short lines for service.

What we created was a bankrupt general hospital and skimpy care for the poor. This how we did it.

The tax created an enormous pool of money for poor people. With no poor people to treat, the hospital made gobs of cash. The hospital then gave all of the cash to top management, in pay and bonus incentives. A lot! So much that the hospital was insolvent to the tune of 150 MILLION Dollars.

To keep the hospital open, the County took 150 MILLION Dollars from the poor people and gave it to the hospital....on condition that the hospital treat poor people for free. With less money to spend on poor people, the County cut medical services to the poor. But we still have the tax, and the tax money gets used to bail everyone out.

 

[BlackShanglan]

Roxanne, thanks for the link. I think that's one we're always going to disagree upon. To argue that the government is "too big and clumsy" strikes me as a very poor answer when the chief thing needed is centralization of information and distribution of goods. That's what big, clumsy things are actually good at. It's certainly worked for Wal-Mart.

 

[Stella_Omega]

...Odds are, when the situation was explained, the store owner would donate the ice for free to save the diabetic daughter. If not, how hard would it be to raise the money through the institutions that make up what we call civil society: The network of private institutions, community associations, religious organizations, families, friends, coworkers, and their voluntary, from-the-heart interactions? Not very hard at all....

Oddly enough, I feel this is true enough that we can count on it-- most of the time, at any rate. Probably more than we can count on the government to ensure this kind of help, especially in a situation like a hurricane-- quod est demonstrat, god knows.

BUt if the store owner is that kind of foresighted guy, he can put a limit of one bag per customer on his bags of ice. And I've seen plenty places do that.

(ETA)
Eh, I've completely forgotten where I was going with this... and it's so peripheral to the topic, anyway. Mea aopologia

 

[rgraham666]

Roxanne, thanks for the link. I think that's one we're always going to disagree upon. To argue that the government is "too big and clumsy" strikes me as a very poor answer when the chief thing needed is centralization of information and distribution of goods. That's what big, clumsy things are actually good at. It's certainly worked for Wal-Mart.

Well said, Shang. I always wonder why the people who bash the government for 'too big and thus ineffective' never bring up, say, General Electric for example.

The biggest problem with health care being in the private sector is that the private sector has to make money. Unfortunately you can make money by not doing things.

Since I live in Canada, and thus am not too familiar with the US system, I've still often heard that the insurance companies have become very good at making sure that there are exceptions and limits to what they're willing to provide. And who can blame them? They do have to turn a profit. The more healthcare they have to pay for, the less money they'll make.

It's why I prefer Canada's system. Its purpose is to deliver health care, not make money.

 

[Roxanne Appleby]

Roxanne, thanks for the link. I think that's one we're always going to disagree upon. To argue that the government is "too big and clumsy" strikes me as a very poor answer when the chief thing needed is centralization of information and distribution of goods. That's what big, clumsy things are actually good at. It's certainly worked for Wal-Mart.

In ruminating on this:

The "knowledge problem" issue is that central planning will always fail because the planners can never assemble enough knowledge to make it work, due to the fact that the nature of knowledge is that it's "dispersed."

A wise and gentle ruminant recently said this:

". . . I like it quite a lot. It's a neat, tidy way of summing up the inevitable shortfalls of a small number of people trying to predict every result of a very widescale action."

 

[Roxanne Appleby]

Oddly enough, I feel this is true enough that we can count on it-- most of the time, at any rate. Probably more than we can count on the government to ensure this kind of help, especially in a situation like a hurricane-- quod est demonstrat, god knows.

BUt if the store owner is that kind of foresighted guy, he can put a limit of one bag per customer on his bags of ice. And I've seen plenty places do that.

(ETA)
Eh, I've completely forgotten where I was going with this... and it's so peripheral to the topic, anyway. Mea aopologia

If he's that kind of foresighted and good hearted guy he very possibly might do just that. The virtue of the him charging a ton for the ice and making a bundle is that it increases his incentive to be that foresighted and lay in big supplies before the disaster, as well as that of others hoping to make a bundle. In the event most of them would also make the same call and give a big discount to the guy a whose daughter needs the ice to live. And of course the fact that allowing the profit motive to work means more ice will be available in the first place, so the price will be that much lower, also. But you are correct - it's a peripheral issue, and as I said, I believe the demand for health care is too big to be covered by that kind of private generosity.

 

[S-Des]

The tax created an enormous pool of money for poor people. With no poor people to treat, the hospital made gobs of cash. The hospital then gave all of the cash to top management, in pay and bonus incentives. A lot! So much that the hospital was insolvent to the tune of 150 MILLION Dollars.

To keep the hospital open, the County took 150 MILLION Dollars from the poor people and gave it to the hospital....on condition that the hospital treat poor people for free. With less money to spend on poor people, the County cut medical services to the poor. But we still have the tax, and the tax money gets used to bail everyone out.

This is exactly how every government program seems to turn out here (Chicago). People on Lit always question why some of us have so little faith in the government. If you give me a couple of weeks, I could explain it to you.

 

[rgraham666]

And I can spend just as much time recalling data that shows the private sector is no better.

Shrugs. We're all people, regardless of what we do or who we work for.

 

[Liar]

In a military environment there is frequently a need for something called triage. When the number of people urgently requiring care exceeds the capacity of the system to deal with the problem, triage is used. Patients who can be cured with 15 minutes of surgery are given that 15 minutes of surgery, because it is an effective use of resources. The poor guy who might survive with six hours of surgery is given pain killers. Why? Because 24 guys can be saved in the time it would take to save one guy. Who does triage? Mainly doctors, although nurses often pre-screen the candidates. Do the doctors just abandon difficult cases? No, they simply concentrate their efforts on saving as many as practical.

My point exactly. They are the ones who best knows the big-picture long term consequences of their priorities. And this kind of situation happens ever so often in civilian care too. Not enough surgeons, not enough doctors, not enough medicine, not enough kidneys.

The problem with health care is that it is not a market of wants, it's a market of dire needs. Nobody wants to be in the situation where they have to say "no thanks" to treatment, either because they a) can't afford it or b) because they realize they're hogging resources from others in more need. That's the problem I see with putting too much of the mandate to distribute the resources and priorities n the hands of the patients. It requires massive amounts of empathy and an absolute utilitaristic world view from everyone. And that's simply not reasonable to expect, especially not from people in pain and fear of their or their loved ones' well being.

 

[DeeZire]

One figure I haven't seen here is 30%, which is the amount of money going to administration in private healthcare plans, compared to 5% going to the administration of Medicare. Granted, many doctors are refusing new Medicare patients, since the reimbursement schedule is so low, but if that 30% that is now going to insurance company paperwork (and CEO salaries) was going to doctors instead, it seems we'd get a lot more healthcare for the same amount of money.

 

[Handprints]

One figure I haven't seen here is 30%, which is the amount of money going to administration in private healthcare plans, compared to 5% going to the administration of Medicare. Granted, many doctors are refusing new Medicare patients, since the reimbursement schedule is so low, but if that 30% that is now going to insurance company paperwork (and CEO salaries) was going to doctors instead, it seems we'd get a lot more healthcare for the same amount of money.

How much healthcare you get for the money, I think, doesn't depend entirely on the relative rake-offs the administrators take. If the 30%-rake private sector can deliver faster response times, more sophisticated testing and equipment, access to a wider range of expertise and services or other benefits (like not wondering if the hospital is exclusively populated by smelly, drug-seeking patients - a reasonable question in some big-city ERs), then they might be delivering better value, after the rake, than the public sector.

They also might be able to make the argument that only the rake-off makes those things possible. If that's true, then cutting out the expensive administrators would reduce the value of the service offered by private healthcare to that of public, without necessarily improving public healthcare.

These arguments are also forwarded be people who support the privatisation of social security investments. The managers take more money out of the pot than the public servants but argue they will deliver better returns which more than compensate for the fees.

Hope that's of use,
H

 

[S-Des]

One figure I haven't seen here is 30%, which is the amount of money going to administration in private healthcare plans, compared to 5% going to the administration of Medicare. Granted, many doctors are refusing new Medicare patients, since the reimbursement schedule is so low, but if that 30% that is now going to insurance company paperwork (and CEO salaries) was going to doctors instead, it seems we'd get a lot more healthcare for the same amount of money.

Actually, many doctors are refusing any Medicare patients because the government (who runs it) doesn't bother paying it's bills on time (in Illinois, Doctors may get reimbursed sometime in the year the patient is seen). Right now we have a major crisis with our lovely Governor (who is so bad that both parties are talking recall election), that is screwing over all the state budgets. Personally, I'm much more in favor of targeted proposals (i.e. tax breaks & some government assistance) that would benefit doctors who find innovative ways to help their patients get quality care at a reduced rate (for those who need it). I agree with Cloudy, seeing the doctor is a nightmare at this point if the insurance doesn't cover it. I spent $130 on a regular office visit and she didn't find anything wrong or run any tests.

People don't see the doctor because they can't afford it, then they get worse and the costs increase dramatically, becoming something they can't possibly pay for, so it gets passed on to the doctor & hospital (which just gets passed on to everyone who does pay for it).