Monday, July 16, 2007

The patient's dilemma

Over at Pink Batts, Welly Girl has the solution to health funding issues:
I personally would like to see some privatisation of the hospitals and see people taking out medical insurance, I would happily take out insurance if it means I am going to get better care and treatment in the hospital. Currently I would happily pay to stay in a private hospital when I am sick, but I do not have the funds and they do not have the facilities to look after me when I am at that point.
Anna, it is not facilities which private hospitals are lacking. Indeed, as I am sure your new-found friends in the National Party will tell you, private hospitals are marvellously well-endowed. However, they are unwilling to use their facilities for your benefit, unless you are paying. This is called Capitalism. It is really good way to run a dairy and a really bad way to run a health system. You might like to take a look at the marvellously private American system. You might like to consider how scared ordinary American people are of ill-health and ageing.

Pamziewamzie, your blog needs you.

6 comments:

Blair said...

I would say capitalism was a really great way to run a health system for precisely the same reason it's a good way to run a dairy. In fact, I would further suggest that the health system is too important NOT to be as efficiently run as the "dairy system" is.

There are deficiencies in the American system - although it is important to note that it is illegal to be refused treatment for accidents and emergencies in the US. On the other hand, when you have six figure waiting lists, what's the difference? I'd argue that it's better to have a few poor people that can't afford care than it is to have a large segment of the population who die while waiting in line for it.

The reality is that in both countries, there are prohibitive psychological factors: In America people die on account of not wanting to put themselves in debt; in NZ, people die because they gamble on the public sector being able to provide for them better than the private. The services are there, but the mindset is not geared to value human life in crude dollar terms. Is your life worth ten grand for an operation? Nobody seems to think that way, and maybe they should.

I wonder if anyone has actually done an objective study of socialist versus capitalist healthcare (Mike Moore? Yeah right!): How many people die on direct account of each? How many are inconvenienced? I have no idea, but I'm guessing on balance, advocates for nationalised health might be surprised...

Psycho Milt said...

I don't think the drawbacks of the US approach - making fat profits from the sick by providing wonderful health care for all who can afford it and leaving a sizable section of the population who can't afford it to just snuff it - is really comparable with the drawbacks of ours, in which a large number of people who could afford health insurance or even to go private at their own expense, choose not to do so and end up on waiting lists for the public system.

As with its approach to freedom ("All the freedom you can afford!"), so with libertarianism's approach to the health system ("The finest health care you can afford!")

Josh said...

Also, one of the biggest problems with the US system (and this is one of the points that Sicko labours) is that even if you are insured, you're not guaranteed to receieve treatment, because the insurance companies (who are in the business of making money, not stopping people from dying) use every trick in the book to avoid paying out. It's not just "poor people who can't afford insurance" who are dying; it's people who can afford insurance, who then get told they can't get treatment because their insurance company won't pay out.

Pamziewamzie said...

Ah yes, that capitalism thingee. Not something I would blog in support of. Unfortunately for Red Fe, i've moved on to better things, such as putting my face on facebook and bebo profiles...

Stephen said...

Here's one well-educated, well-off person's account of dealing with American health insurance.

The best quote is at the very end:

"That's a fact about health care finance I haven't seen much reference to in the literature: what seems like at least a marginally reasonable process if you imagine a healthy well-educated person dealing with it becomes less reasonable if the person is poorly educated or very sick."

I'd argue that it's better to have a few poor people that can't afford care than it is to have a large segment of the population who die while waiting in line for it.

Maybe (although that's a starkly utilitarian argument). However, I don't think that's the choice we have to make. It's more like a large number of people up into the middle classes forgoing care because they can't afford it, and living in fear of unemployment lest they lose their insurance benefits, vs that same group waiting interminably for non-essential surgery.

(I wonder how much the famous US productivity is driven by fear: at-will employment + healthcare through your job = terrified devotion to work).

Is there an industrialised country apart from the US that has what Blair would call "capitalized care?" I can't think of one.

Russell Brown said...

The reality is that in both countries, there are prohibitive psychological factors: In America people die on account of not wanting to put themselves in debt; in NZ, people die because they gamble on the public sector being able to provide for them better than the private. The services are there, but the mindset is not geared to value human life in crude dollar terms. Is your life worth ten grand for an operation?

Dude, if your health insurer retrospectively decides not to pay out on the ambulance you take to the hospital, you have a $US4000 bill right there. The actual operation will cost an order of magnitude more.

The most distressing story in Sicko is that of a little girl with a blood infection in desperate need of urgent treatment. But someone in a call centre at her mother's insurer won't approve treatment at the hospital she's at, or even an ambulance to get her across town (the advice is to put her in a car). Eventually, she is transported to the approved hospital, where she dies, needlessly. That's obscene.

Yes, you will see rationing in a public system, typically in the case of waiting lists for non-urgent surgery. But if you need lifesaving treatment in New Zealand, you'll get it, promptly and at high quality. Our family had more involvement with the system than anyone would want last year, and the standard of care and the dispatch with which it was provided were hugely impressive.

The circumstances in which you would be denied lifesaving treatment are those where treatment is novel and very expensive and where alternatives exist (herceptin), or in a case like that of Rau Williams, the Northland man denied dialysis a few years ago because he was dying anyway. And then, well, you can still have health insurance anyway.

Measures of effectiveness? Cost per capita? Cost per patient? Life expectancy? Infant mortality? The US system loses on every count. Public systems certainly aren't perfect, but they do wash up better. That's why every developed country but one uses them.