Monday, September 03, 2007

What Your Future Healthcare Might Look Like

In the wake of Michael Moore's latest highly dishonest (but I repeat myself) propaganda piece on the healthcare industry, "Sicko," ably taken apart by Michael C. Moynihan at Reason Online. It might be a good thing for us to take a look at the reality of socialized healthcare.

We'll start with a short video that deals with a Canadian man and what started as a series of headaches. Had he passively accepted what the Canadian healthcare system was offering in the way of care, he'd be dead now.

My sister just returned from a visit to the UK where she discussed the subjectof "free" healthcare with several people, including some of our own relations. Here is what she had to say when she came back:

"We heard enough in two weeks, even from people defending the NHS, to solidify opposition. eg. The NHS is closing the Airedale oncology unit. Not for lack of custom, but for budgetary reasons. People in the dales and well beyond will have to find some way to get into Bradford [roughly 40 miles of country "A" roads] for their chemo.

e.g.: They're closing a hospital near Scarborough. Again, not for lack of custom. In fact, given the number of out of town visitors they have, they actually have far too few beds available already.

e.g.: [a male relative], who has recently had cancer, was forced to make a 90 minute drive for his chemo treatments. Friends from church helped out by taking turns driving him. I don't know what would have been done if he had not had friends...or was too depressed to bother. [he lives in a South Coast town of some size]

e.g.: [female relative]'s husband [G---], a diabetic, dropped a knife on his foot and got a nasty cut. The NHS bandaged it up nicely. A week later, he was in hospital with a line drawn around his ankle, marking the spot where they were going to amputate if his gangrene didn't clear up. Luckily, it did. He shared a 4-man room with a very loud-mouthed expat Brit who had broken his ankle in the US and somehow hobbled onto a plane so he could get his "free" treatment in Britain.

e.g.: [G---], by the way, is only allowed to see a diabetes specialist once a year. His local GP/gatekeeper, (who is mainly occupied by his other job as chief doctor for the British Sculling Team), won't approve him for any other visits. Period. No matter what.


About 3-4 years ago, another relative's husband had a mild heart attack. He went to the hospital they stabilized him but it was determined that he needed bypass surgery. In the US, if you are found to need bypass surgery, you need it RIGHT NOW and you will be in surgery in a matter of hours. In this case, he was put on a waiting list and had to wait over 19 weeks before finally getting the surgery.

The above are just examples from my own family of what socialized medicine delivers compared to what it promises. Americans would never put up with that.

Of course we've all heard the arguments about 47 million uninsured Americans but the reality is, nobody goes without treatment. If you show up at a hospital, you must be treated. I have underwritten some hospital transactions for medical equipment financing. If you know anything about the presentation of profit and loss statements, you have seen that companies will show a gross sales line and a net sales line. The latter is gross adjusted for returns and discounts. For most companies in non-health related fields, this adjustment is relatively trivial. Not in healthcare. I have seen hospital profit & loss statements where the gross to net adjustment is as much as 50%, occasionally more. The hospitals have to write off enormous amounts for unreimbursed care, either indigent care or the difference between the price of treatment and what insurance will reimburse. Then you start the deductions for cost of treatment, administrative costs, salaries, etc.

Is our system perfect? No. But it isn't irretrievably broken either and the way to make it better is with free market solutions and less interference therein by various governments. Health insurance mandates that differ by state, mandates for coverage that people don't want or need (e.g., maternity coverage for single men) all interfere with efficient service delivery. People need to get over the idea that someone else, whether it be government or an employer, should be responsible for their healthcare. As things stand now, we don't really know what our healthcare costs because we don't pay for it directly. If we did and if we werre free to purchse only the insurance we need, we'd see costs coming into line pretty quickly.

Update 9/8: I wrote the bulk of this last weekend. An interesting article was posted at TCS Daily two days ago. Michael Cannon argues that socialized medicine is closer than we may think.
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