Sunday, July 5, 2009

The Curmudgeon's Guide to Health Care

I must say I favor a free-market approach to health care: a system in which you can choose your own providers, and where you don't get punished for being taken to the wrong hospital by the wrong ambulance while you're unconscious. You know--a truly competitive system where the good providers get lots of patients and the poor ones get driven out of business because word gets around and nobody will go to them. A system where you and your provider decide what's needed for your care without interference from the corporate beancounters.

Our present system anything but a free market for consumers. Your insurance company dictates what doctor you can see, what hospital you can go to, and whether or not you're going to get that expensive test or procedure. As long as you are well, you are a profit source for them. If you get sick, you become a problem. If you get too expensive to them, they're pretty good at finding ways to dump you. And, as a side-effect of our ingenious employer-based health care payment system, if you get too ill to keep your job, you will automatically end up on the discard heap.

Very few of us can actually afford the kind of care that we might someday need--bypass surgery, say, or cancer treatment. We therefore must have a system in which relatively small payments from the many who do not need expensive interventions help to pay for the relatively few who do need expensive care. That means that the young and healthy need to pay in to the system during those periods of their lives when they aren't using much health care so that their elders can be cared for--and so that someday they too can be cared for in their time of need.

No for-profit insurance scheme will ever provide free-market health care. By their very nature, insurance companies are structured to make profits by denying needed services. They reward the providers who cost them the least, not the ones who save or improve the quality of the most lives.

The great paradox of the Western world is that only way to provide a free market for providers is through universal, tax-funded single-payer health care. In this system, the government serves as the collector and disburser of health care funds. You pay into the health care system--ideally through income taxes--and when you need health services, you go to the doctor of your choice, she treats you, she submits her bill to the government, and they pay. That's the way it works in much of the civilized world, and that's the way it should work here.

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