Friday, April 15, 2005

Health Care rumblings

Krugman is on form today, and hits the spot. US health care isn't bad, but it is horrendously cost ineffective and heterogenous.
Docs and Insurance companies pay for MRIs and CATscans without blinking, and put people on long (or lifetime) drug prescriptions; but won't pay for basic physiotherapy, well-baby visits or nurse visitations, which are actually effective at improving quality of life and maintaining health. Insanity.
Paperwork is also monstrous (eg the local ER won't come to agreement with the two largest local health insurers, there is no weekend or evening urgent care, so all medical treatment that is not by pre-scheduled appointment goes through them. But the hospital they are part of does have a deal with the insurers. So the smallest of treatments requires about 12 pieces of paper as the ER company bills everyone, and the insurer orders patients to not pay until the actual cost of treatment is negotiated, individually. Takes ~ 6 months to settle the accounts), and there is a wait for most anything, the mean time until treatment in the US seems to be about the same as in Europe for most procedures and tasks, just not enough time and not enough doctors - US has more high tech facilities in big cities; Europe has more face-to-face contact and prompter.
And the whole thing is tied to employment reducing mobility and amplifying risk for workers. On top of a gov safety net that is already expensive enough per capita to pay for full health care! (IIRC the single largest government health care system anywhere is in the US, but it only covers a small part of the population, and has to interface with not only other parts of itself, and the private sector but also 50 different State level public systems. Argh!)

I've lived under the US system in two States and in range of circumstance (big city; medium town near big city; and small town in rural area). I've also dealt with three very different European systems. The US system is quite good if you have good insurance and are well located, and awful otherwise, and always with the problems above (there is no % in health prevention for any one company unless there's a single payer system, at the crudest level).
On balance the European/Canadian systems work better for most people. Both systems face severe structural problems with some of the near future technological developments, in particular (as was first hammered into me by Leroy Hood at a science ethics/bioethics grad seminar) the concept of individual "insurance" becomes almost meaningless as we understand genetic factors in illness better. But, I think the US system will have a harder crisis sooner. Better hope you or your employer is rich enough that you're on the right side of the transition. Of course a pandemic or effective biowar act (or indeed much of WMD terrorism) would effectively destroy the US funding system for health care.
Single payer systems are not perfect, and are vulnerable to the problems of monolithic state entities, but they're a lot better than nothing, which is what a large percentage of the population will soon have under a pure commercial insurer system.

Interesting times.


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