One Pediatrician’s Perspective on Universal Healthcare

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  1. Avatar E.D. Kain
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    says:

    Even patients with “comprehensive” coverage have their care rationed.

    Exactly. Another great post, Dan.Report

  2. Avatar greginak
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    says:

    Yes great post. Straight reality for those who are open to hear.Report

  3. Avatar Matthew Dallman
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    says:

    Weak post, if you ask me. “Rationing” means nothing if it is supposed to mean all these things. Trying to change, twist, or radically alter commonly held meanings of words is the first task of the person with a weak underlying argument.Report

    • Avatar Mark Thompson in reply to Matthew Dallman
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      says:

      I’m obviously a free market advocate, but this criticism doesn’t make sense to me. “Rationing” exists whenever you have a scarce resource; the argument for free markets has always been that free markets provide a better way of rationing than central planning.Report

      • Avatar Mark in reply to Mark Thompson
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        says:

        Except it’s quite clear that having a bunch of insurance companies set reimbursement rates and requirements is vastly less efficient than having one clearing house for such issues. Forcing a doctor to employ multiple employees to take care of billing is not a credit to the free market.Report

    • Avatar Jaybird in reply to Matthew Dallman
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      says:

      If you don’t like the word “rationing”, would you prefer calling it “deciding how it is allocated”?Report

  4. Avatar greginak
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    says:

    Or how about rationing through neglect or rationing by work status/ income. The use of term rationing is definitely aimed at those who are trying to derail any change in our health care system: OOOOH ooga booga the scary government will ration health care. So Dan is correctly pointing out that our current system gives far differing levels of care to people based on various criteria.Report

    • Avatar Jaybird in reply to greginak
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      says:

      So Dan Summers, the pediatrician, is deliberately using a term that is (let me quote this here) “definitely aimed at those who are trying to derail any change in our health care system”?Report

      • Avatar Chris Dierkes in reply to Jaybird
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        says:

        no g is responding to the earlier comment and how the word “rationing” in its original sense is really an ideological spin word meant to be used a scare tactic. Dan has, as it were, un-spinned it. Dan has just pointed out that whatever else you think about gov care it doesn’t make sense to say–if we do this then we will have rationing. We already have all kinds of rationing. It just isn’t decided by the government.

        As Arnold Kling said, there’s affordability, universality, and high quality. You can only ever get 2 out of those 3. Like Heisenberg’s Uncertainty Principle. If you get affordability and quality than you lose out on universality (via rationing of any sort). If you get affordability and universality you typically lose out on some quality. If you don’t care about affordability or universality you can get some fantastic quality–just only for the rich.Report

  5. Avatar greginak
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    says:

    Yes , what Charles said. My comment was directed at Mathew’s post. Thank you, C, for understanding what i meant instead of what i said.

    It does appear that many other countries have found a way to get all three: affordability, quality and universality. In any case we have one out of three and only for some people. We have a very expensive system that is not universal, which provides high quality care to some and mediocre care to othersReport

    • Avatar Jaybird in reply to greginak
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      says:

      Now that I understand what you are saying, allow me to respond properly (rather than improperly, I apologize for that).

      “It does appear that many other countries have found a way to get all three: affordability, quality and universality.”

      It strikes me that the other countries are able, in part, to do this because of something analagous to the free rider problem as well as, really, offering a two-tiered system (where the US is the second tier).

      Ironically, this was somewhat acknowledged recently by the NHS when Collette Mills wanted to privately purchase some cancer treatment that the NHS wasn’t willing to fund. The NHS said that if people purchased drugs that the NHS wasn’t willing to fund, it would create a two-tiered system… so they said you are either working under our umbrella or outside of its protection.

      “Universality” does not, necessarily, strike me as a good in and of itself… nowhere near to the same degree as quality (or, to a lesser extent, affordability).

      What does universality mean IN PRACTICE? It seems to me that it leads to such things as the above. Is the above an acceptable price to pay?Report

  6. Avatar Jaybird
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    says:

    “I am unbothered by the idea that “rationing” will be one of them. I already know what rationing looks like, because I’ve been dealing with it for years.”

    My fundamental issue is the following:

    X is a positive good of which there is a fixed amount… which is to say that it must be rationed lest it disappear.

    The question then comes “How Best To Ration?”

    One can open up one’s economic textbook to see what happens when the supply of X does not increase at the same rate as the demand of X… the price will go up. If one is hoping to contain costs, one can either increase the supply or punch down the demand.

    Rationing by price seems unfair, surely, but it also seems like it is most likely to result in an increase in supply… you’ve got all of these kids out there who think “hey, if I could become a doctor, I could make a lot of money!” and there is more practitioners, which means more supply, which will result in folks competing for customers… which means lower prices.

    Rationing through where you are in the queue strikes me as likely to lead to a two-tiered system where those with cash will either go to another country to buy care or to go to a black market (that will, inevitably, spring up).

    The latter strikes me as worse because it strikes me that there will be no incentive to create more supply (doctors, sadly, are not widgets)… and as the supply stagnates, and demand stays the same, the price will, inevitably, go up.

    Brief aside: when I was a kid, people said stuff like “If you want to make a lot of money, become a doctor.”

    I don’t think that people say stuff like that to kids anymore.Report

  7. Avatar greginak
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    says:

    Doctors make plenty of money in general, especially specialists. One of the advantages of universality is that it sets a basic, good enough level for everybody. Nobody dies because of lack of care. That is a good thing. So if somebody wants extra special treatments like fake platinum boobies or an super duper erection they can pay for that themselves. I’m not familiar with the case involving the NHS, but I don’t think having two tiers is bad as long as the bottom tier covers everybody and is good enough. If that is the case then where would a black market develop?

    This is one of those cases where listing fundamental laws of economics isn’t all that useful since apply differently regarding medical care then consumer goods. There is far more to it then just supply and demand. The incentives for more supply/care is not just money, but also the desire to do good. There is not necessarily a fixed amount of health care and by providing some more health care to people who don’t have it, we can decrease the need for more expensive care down the road.Report

    • Avatar Jaybird in reply to greginak
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      says:

      “but I don’t think having two tiers is bad as long as the bottom tier covers everybody and is good enough.”

      But the problem comes because “good enough” isn’t good enough if there is something better out there that someone else is getting. There will, I swear to you, be someone (a member of The Children, probably) who will have a disease that will demand one more something. One more treatment, one more specialist, one more prescription, one more *SOMETHING*. And the child won’t get it in time and the child will die. (Because, sadly, people die.)

      And people will ask why, if this is America, did this child die? Could this experimental treatment have saved her life? If only we didn’t have two tiers, we could have done something. Stephen Stills had this same disease and he was able to afford a timely application of this extra treatment… is that fair? Are we killing our children now, on the altar of saving money? What kind of monster are you to suggest that this *CHILD* shouldn’t get the same treatment as Stephen Stills?

      And so on and so forth.

      It’s like a weird inversion of the story of Solomon and the two mothers and all of us become the mother of the dead baby. It’s not fair that Stephen Stills be able to afford a treatment when this child dies.

      Better to split the baby on the altar of universality than to have a two-tiered system.

      I don’t think that an official two-tiered system will work… to this point, I think that the only two-tiered systems that have are the unofficial ones (that is to say, the ones where the rich hop on a plane (quietly) and come to the US).Report

  8. Avatar greginak
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    says:

    I agree that some people will complain no matter what. I would hope that if Stephen Stills gets a certain treatment then David Crosby gets all the drug trt he needs although i think Neil Young had more talent then both of them. And he is Canadian.

    FWIW it’s worth there are Americans who go to Mexico to get trt because they can’t afford the costs here. It is easy to point out potential problems but that doesn’t mean we shouldn’t try to improve.

    I doubt you disagree with part of this statement but, nobody would ever dare criticize our ability to make the newest shiniest way to blow the crap out of people. But start to talk about getting health care for everybody and all of sudden there is nothing but “ooh we can’t do that.”Report

    • Avatar Jaybird in reply to greginak
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      says:

      The problem with the difference between “killing everybody” and “health care for everybody” is that everybody, without exception, is going to die. Killing them merely speeds that up… and health care only slows that down.

      You can always say that so-and-so would have lived longer if s/he had only received the medicine that The Rich have access to.

      But that seems to very much ignore the very, very unpleasant truth that you are going to die… and that’s the difference between killing someone and keeping them alive.

      Keeping them alive only puts off the inevitable.Report

  9. Avatar Dan Summers
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    says:

    Jeepers! This went up sooner than I expected. Thanks for the opportunity to post again, Gents!

    And thank for the clarification of my point, Chris. I probably wouldn’t have been able to state it so eloquently myself.Report

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