Which country has the best Health Care System?

[muon2]

BTW I would agree with Senator States that healthcare here is excellent, but the costs are rising rapidly. Even huge corporations like General Motors are staggering under the weight of medical costs for their employees and retirees. I think something is going to give sooner or later.
Neither Republicans or Democrats seem inclined to consider free market solutions, so my guess is that the country will adopt a more socialist plan.

My observations of socialist systems lead me to believe that they progress something like this;
1) Euphoria- everything is free!
2) Costs rising- This is visible to the politicians but not necessarily to the citizens.
3) Further rising costs prompt politicians to raise taxes.
4) Citizens get angry with high taxes.
5) Politicians realize they must do something to cover costs but are fearful of raising taxes.
6)Politicians enact  wage and price controls to keep costs down. Costs keep rising. Doctors get angry.
7) Politicians create rationing schemes. Shortages occur. Waiting lists occur. Patients get angry. Costs keep rising.
Doctors begin leaving the system because of wage limits. They advise young people to avoid the profession because the compensation does not justify the years of schooling required. Doctor shortage begins to appear.
9) Goes downhill from there.

Just my opinion.

Your points are very good, but fail to note the cause of the problem.

Fundamentally the problems with health care delivery in the US is that it became entrenched as an employer-based program. 50 years ago when the majority of working families could expect a wage earner to stay with a single employers for their career an employer-based system provided a useful connection for the country. 40 years ago patches to the system were added because the retired and poor populations had no connection to the employers. As the 80's showed, the workforce was far more mobile than a half century before, and insurance portability was a problem resulting in higher costs to cover those at risk who changed jobs. The HMO system came into being, but it too has failed to live up its promise to hold down cost increases for employers.

There really is no basis for a connection between the employer and health care, and it hurts business as much as the healthcare consumer. Unfortunately the US population over the last three generations has come to expect a health insurance benefit. In a thread a few months ago I drew the comparison to police services, and I do believe that the  wider public now has an expectation of critical services from the health care system the same way.

I think that some of your fears about the effect of the political system on health care are justified. However, when such a large fraction of society expects the benefit, poiltical forces are going to reflect the desire of the public.

If government must be involved, I think we should utilize smaller jurisdictions. Like the police, critical health care services can be delivered at a scale far below that of the whole nation. Security uses a mix of public and private options - but at a local level. Health care could use some of that same model with critical services provided by localities (eg. county hospitals and clinics), and a wide range of other services left to consumer choice.

[muon2]

Your points are very good, but fail to note the cause of the problem.

Fundamentally the problems with health care delivery in the US is that it became entrenched as an employer-based program. 50 years ago when the majority of working families could expect a wage earner to stay with a single employers for their career an employer-based system provided a useful connection for the country. 40 years ago patches to the system were added because the retired and poor populations had no connection to the employers. As the 80's showed, the workforce was far more mobile than a half century before, and insurance portability was a problem resulting in higher costs to cover those at risk who changed jobs. The HMO system came into being, but it too has failed to live up its promise to hold down cost increases for employers.

There really is no basis for a connection between the employer and health care, and it hurts business as much as the healthcare consumer. Unfortunately the US population over the last three generations has come to expect a health insurance benefit. In a thread a few months ago I drew the comparison to police services, and I do believe that the  wider public now has an expectation of critical services from the health care system the same way.

I think that some of your fears about the effect of the political system on health care are justified. However, when such a large fraction of society expects the benefit, poiltical forces are going to reflect the desire of the public.

If government must be involved, I think we should utilize smaller jurisdictions. Like the police, critical health care services can be delivered at a scale far below that of the whole nation. Security uses a mix of public and private options - but at a local level. Health care could use some of that same model with critical services provided by localities (eg. county hospitals and clinics), and a wide range of other services left to consumer choice.

Muon I disagree on the cause of our healthcare woes.  I am a firm believer in competitive free market captialism. Healthcare is the portion of our economy that seems to be in crisis now and it is a part of our economy which does not operate as a competitive free market.

If I want a house I don't expect the insurance company or government to buy it for me. If I want a car I don't expect government to give me one free. If I need groceries I don't need the insurance company to buy them for me. When I want any of those things I just go buy them myself. Same is true for you and anyone else. And yet even though houses, cars and groceries are expensive we don't have a crisis in those things. Only in healthcare do we have a crisis.

As you point out people have come to expect someone else to provide their healthcare. That, in my estimation, creates a disconnect in the free market forces that would normally keep costs under control.

Insurance should be used to cover very expensive and rare occurrences which would be unmanageable otherwise. It should be used to spread out the risk as Richius said earlier. But we expect it to cover all medical expenses, from routine office visits to prescription drugs. That won't work in a free market. 

I understand your position, but it doesn't take into account the reality of our situation. The root problem is that health insurance is provided as an employment benefit for all full-time, and many part-time workers. Given as a benefit there is no pressure from the health care consumer to make the market respond with appropriate costs for health care services. It is fine to talk about going to a full free market, but you can't there from here.

I don't know that whta I'm saying any more realisic, but I think it at leats recognizes some of the real structural problems. If we can separate the unusual high-cost items due to acute or chronic illness (I'll these the critical healthcare services) from the rest of health care, I think that the market can be made to function for the non-critical items. Routine care and medicine, minor illnesses might be accepted by the public as a reasonable cost as long as the fear of catastrophic covereage is out of the picture. I think these are equivalent  to your examples of cars and groceries.

For the critical expenses, I think they are not the same as cars and groceries. They are much more like robberies and fires. We do pay for insurance to protect ourselves from these losses, but we also expect the government to provide emergency response in the form of police and fire services. And we pay taxes to support those services.

[muon2]

http://www.thisislondon.co.uk/news/articles/10271940?source=Evening%20Standard

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Lovely.

This quote comes from the link Richius provided above.

" But hospitals say the £1 million (MRI) machines often lie idle due to lack of staff. "

This is a characteristic of socialist systems. Surpluses in one area and shortages in another, which render the system non-functional. Government planners can never match the efficiencies of a competitive free market system.

There is a free market concern with machines like the MRI as well. The machines are just affordable enough for most hospitals to acquire, so most do to be competitive. In order to recover their investment they need to be used a lot, but in many urban markets there are too many for the number of tests actually needed by the population. In many cases they become over used so that the hospitals get the needed return on their investamnet. This then raises the cost of health care to businesses supporting their employees and their families and to taxpayers supporting Medicare and Medicaid.

[muon2]

http://www.thisislondon.co.uk/news/articles/10271940?source=Evening%20Standard

You must be logged in to read this quote.

Lovely.

This quote comes from the link Richius provided above.

" But hospitals say the £1 million (MRI) machines often lie idle due to lack of staff. "

This is a characteristic of socialist systems. Surpluses in one area and shortages in another, which render the system non-functional. Government planners can never match the efficiencies of a competitive free market system.

There is a free market concern with machines like the MRI as well. The machines are just affordable enough for most hospitals to acquire, so most do to be competitive. In order to recover their investment they need to be used a lot, but in many urban markets there are too many for the number of tests actually needed by the population. In many cases they become over used so that the hospitals get the needed return on their investamnet. This then raises the cost of health care to businesses supporting their employees and their families and to taxpayers supporting Medicare and Medicaid.

This may well be the case in the US, but as I have said before our healthcare system does not operate as a free market. In many, if not most cases, the person getting the MRI is not paying for it out of pocket. His insurance probably pays, or medicare. The patient may not question the need for the MRI, but if he has to pay a few hundred bucks out of his pocket he will be more inclined to question the need for it as well whether it can be purchased for less at other facilities. That puts cost incentives back in the picture and helps to keep costs down.

I had an MRI 10 years ago. There was no waiting period as I recall. It was only a matter of getting a mutually agreeable date, maybe two weeks. The MRI was done not at a hospital, but at a small facility that specializes in it. Everything was quick and easy. My insurance covered everything. Cost was never discussed. Therein lies the problem. In every other decision we make as consumers we consider cost.

If cost were no object I would live in a mansion on a lake, but I can't afford that so I settle for a nice house in the burbs.

I would like a state-of-the-art computer, but I know that speed comes at a premium, so I buy one thats somewhat slower and costs a lot less.

I would like two cars but I really only need one so thats all I have.

We have a cable internet hookup. The ISP offers speeds ranging from .5 to 4.0 MB/sec.  If cost was not a factor I'd get the 4.0, but cost is a factor so I settle for .5 which meets my needs and costs less. I also switched from a higher cost cable company last year.

In each case cost was a factor in my decision. In each case I chose something that met my needs at the lowest cost. Most people do the same thing at least to some degree. That's what keeps competitive pressure on sellers and keeps costs down.  The MRI and most other healthcare items don't work that way, so costs get out of control

I don't disagree with anything you have said here. However, I think that your well-taken points can't lead in the direction that you imply. If they could go that way, then you are correct, health-care decisions would become more market-driven.

On a personal note, we did some active health care shopping twelve years ago. It was during the seventh month of my wife's pregnancy, and we discovered that the ob-gyn team assigned by my health care plan at that time was not going to give my wife adequate care. We decided to go off-plan and out-of-pocket. We interviewed seven different providers associated with different hospitals and found an excellent provider at a fair price. That experience helps me agree with many of your statements.

Unfortunately I don't believe that health care acn return to the market. The problem is that two or more generations have been raised to expect high levels of insurance coverage. Forget about Medicare, the problem is that we have built health care into the American psyche as a benefit of work. Medicare and Medicaid merely extend this benefit to some of those not now working. This expectation will not be unlearned in my lifetime. So, I want to deal with the reality.

In the end, far too great a majority expects to get health care coverage from somewhere. As you point out the market fails wheter that coverage comes from employer-based insurance or a government program. As I talk to people I find the expectations for health care to be not unlike the expectations of security. People expect a basic level from the police, and know they can pay for extra alarm service or guards if they like.

Given the level of expectation, I find no reason to connect health care (like security) to one's place of employment. Let a minimum level be given to all (like catastrophic coverage and basic wellness service), and place the rest back to the consumer.