Government Health Care and Efficiency
I am always absolutely amazed when advocates of some form of national or single-payer health care argue that such a system would be more efficient. For example, Kevin Drum argued:
A few days ago, during an email exchange with a friend, I mentioned that I don't usually tout cost savings as a big argument in favor of universal healthcare. It's true that a national healthcare plan would almost certainly save money compared to our current Rube Goldberg system, but I suspect the savings would be modest. Rather, the real advantages of national healthcare are related to things like access (getting everyone covered), efficiency (cutting down on useless -- or even deliberately counterproductive -- administrative bureaucracies), choice (allowing people to choose and keep a family doctor instead of being jerked around everytime their employer decides to switch health providers), and social justice (providing decent, hassle-free healthcare for the poor).
I don't think any of these are true. For example, let's take access. Yes, everyone in a universal health care system would have a piece of paper that says they have health care, and the left seems really focused on that piece of paper. But that paper has about as much value as my piece of paper that says I own a hundred shares of Enron. Because someone has to redeem that piece of paper and actually provide the care, and there is the rub, is it not? Canadian David Gratzer writes (vis Q&O):
My book's thesis was simple: to contain rising costs, government-run health-care systems invariably restrict the health-care supply. Thus, at a time when Canada's population was aging and needed more care, not less, cost-crunching bureaucrats had reduced the size of medical school classes, shuttered hospitals, and capped physician fees, resulting in hundreds of thousands of patients waiting for needed treatment—patients who suffered and, in some cases, died from the delays....
Nor were the problems I identified unique to Canada—they characterized all government-run health-care systems. Consider the recent British controversy over a cancer patient who tried to get an appointment with a specialist, only to have it canceled—48 times. More than 1 million Britons must wait for some type of care, with 200,000 in line for longer than six months. A while back, I toured a public hospital in Washington, D.C., with Tim Evans, a senior fellow at the Centre for the New Europe. The hospital was dark and dingy, but Evans observed that it was cleaner than anything in his native England. In France, the supply of doctors is so limited that during an August 2003 heat wave—when many doctors were on vacation and hospitals were stretched beyond capacity—15,000 elderly citizens died. Across Europe, state-of-the-art drugs aren't available. And so on.
I had forgotten about the heat wave. Could you imagine backwards old America having 15,000 people die when the temperature got into the 90's?
As to efficiency, which Drum defines as "cutting down on useless -- or even deliberately counterproductive -- administrative bureaucracies," does anyone really ascribe these characteristics to the government? Really? Even European health care bureaucrats would not agree with this statement:
This privatizing trend is reaching Europe, too. Britain's government-run health care dates back to the 1940s. Yet the Labour Party—which originally created the National Health Service and used to bristle at the suggestion of private medicine, dismissing it as "Americanization"—now openly favors privatization. Sir William Wells, a senior British health official, recently said: "The big trouble with a state monopoly is that it builds in massive inefficiencies and inward-looking culture."
I won't get much into the last two, except to say that we actually have a ton of health care choice in the US today, far more than any other country. And even if we did not, what does doctor choice mean if the best people are driven away from being doctors, as they are in socialized medicine. And social justice? Well, the poor get care in the US, the key is the "hassle-free" in his statement. Would you immediately assume that a government-run service is going to involve less hassle than a private service? Have you renewed your drivers license lately? It may well be that the poorest 10% have such an awful health care experience that they will see things better. But almost assuredly the other 90% are going to be worse off.
Remember this -- Universal health care is NOT a system in which the majority of us who are satisfied with our care can keep our current system, while the poor get a better one. It is a system where all of us are thrown out of our current system and given the same care the poor get. It is roughly equivalent to a Great Society housing program in which not just the homeless get housing, but everyone in the country are forced to give up their current house and live in public housing.
Postscript: There is great improvement to be had in the health care system. It revolves, though, around making the payer for health care the same person who receives the service, as it is for every other product and service we buy in this country. We already have too much single-payer. We need multi-payer. I won't go there today, but I explained here.
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