http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2007/07/25/BU44R6ES62.DTL
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Our system is more like the US than Cuba.
The government provides money to organisations that commision services.
So money goes to groups (called commisioners) who then negotiate service level agreements with different providers.
So at present we have both independent and private sector providers, as well as public sector providers being commisioned for different services.
For example specialist ortho treatment centres in some parts of the country are able to provide the same or better service for less money so they get the business from the commisioning group who spend the governments money on them. In the same part of the country its quite possible that a public hospital is better value and they win the contract.
The net result of this is that care remains available to all but some public sector providers are going out of business and some hospitals are closing or will be very shortly in spite of the public outcry about this. This I have no problem with, if they cant be financially responsible they should not be in business.
All of our primary care doctors are self employed. All of our secondary doctors are independent practitioners who have contracts with their organisations.
The true employees of hospitals in the UK are management, admin and nursing staff.
This passage from the linked article was amazingly disingenuous:
“Bush wasn’t being entirely accurate when he derided the notion of government-run health care for every American… Rather, advocates of health care reform are seeking government-run insurance for every American, leaving the health care part to those who know best - doctors and nurses.”
It’s a matter of common observation that whoever controls the purse-strings for any program in effect controls the program. Ergo, government-run medical insurance = government-run medicine, so the distinction above is meaningless.
Of course, it can legitimately be complained that our existing system already suffers a similar fault, inasmuch as health-care decisions for most of us are now being made by HMOs rather than doctors and nurses. That in itself is a result of our long-term statist approach to medicine, as over the years special tax treatment for medical-insurance benefits has led to the use of insurance for purposes for which it was never designed, which in turn has led to mushrooming costs, then to special HMO legislation to control those costs, etc. (I analyze this process much further on my website.) Now the statists want to take the final step in the ongoing process of socializing medicine. Maybe people should be asking themselves instead how we got in this fix in the first place. Too bad we don’t have a president who is visionary enough to address THAT issue.
So the government run it and we get poor quality and all the issues associated with the state running anything i.e. they cater to the lowest common denominator, poor quality, rationing, waiting lists, high costs due to bureacracy and so on and so forth
A private company runs it and their motivation is to make cash so its clearly not in their interest to cover people that are high risk or people that could be. It also does not make much sense for them to pay out and cover as much as possible or as much as might be needed because every payout is essentially a loss.
So whats the third option? A government offers treatment to all irrespective of ability to pay. A private company will as much as it can restrict treatment in an effort to minimise losses. Both are in a position, and do, in countries where they exist negotiate the notional best volume price for completing a procedure so whats a better alternative.
Where a company is incentivised by profit it will certainly not carry out loss making treatments. Where a company / organisation is motivated by the “greater good or society” (you know what I mean, socialied medicine might be an example) you risk escalating costs, decreased innovation (if Art is right) and all the other things that blight it. So offer me a practical, implementable (is that a word) better way of providing health care to the masses.
“A private company runs it and their motivation is to make cash so its clearly not in their interest to cover people that are high risk or people that could be. It also does not make much sense for them to pay out and cover as much as possible or as much as might be needed because every payout is essentially a loss.”
With any third-payer system, whether it be a private company or the government, you necessarily have that same problem. The payer must minimize its costs, which means covering as little as possible and as reluctantly as possible. In that respect, our current half-socialized HMO system and a fully socialized system (i. e., universal government-provided health insurance) are equally bad.
“So whats the third option?.. So offer me a practical, implementable (is that a word) better way of providing health care to the masses.”
I don’t accept your premise that either the government or armchair theorists like ourselves should be designing a plan for “providing health care to the masses.” I believe that health care is something for individuals and families to obtain for themselves. At best, we can discuss what kind of environment would make it possible for them to do so most effectively.
To start with, health care should not be insurance-driven. Insurance should be reserved for unforeseeable, catastrophic expenses. The assumption that all medical expenses will be paid for by a third-party insurer is largely an artifact of our tax code, which creates an incentive for employers and employees to arrange for an ever-larger portion of compensation to be in the form of low-deductible medical insurance. This leads to a number of really negative consequences; I discuss a number of them on my website, but I’ll just list a few here. Patients have little or no incentive to shop around for the most cost-effective health care provision. They have less incentive to make lifestyle choices that will decrease their long-term medical costs. They get stuck in jobs they hate because they are afraid of losing their current insurance coverage, especially if they find out that they have serious long-term illnesses or conditions (e. g., HIV). Doctors have to make their decisions with an eye to what insurance will cover, rather than basing them on the best up-to-date medical opinion. And patients are left with virtually no decision-making power at all on what is literally a life-and-death issue.
In a system that allowed consumers to obtain health care from the provider of their own choice, rather than being stuck with the decisions of a third-party payer, you would not find yourself scratching your head over the dilemma of choosing between a cost-minimizing single private provider and a cost-minimizing governmental provider.
I’ve never delt with the medical system in Australia. All I know is if you have just about anything other than a gun shot wound, serious knife wound, or a seriously broken bone (ie, through the skin, bleeding) medical condition in France, the UK or Canada just pray to God you can get back to the US as fast as possible.