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Politics : A US National Health Care System?

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From: TimF	7/10/2009 3:11:58 PM
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"Canadafornia" Medical Care David Henderson Here's an excerpt from my chapter, "Free and Healthy at Half the Cost," in The Joy of Freedom: An Economist's Odyssey. I was writing about the single-payer health care system in my native Canada. "It's hard to say that the Canadian government guarantees health care, at least in the usual sense of the word "guarantee." In fact, what the government really guarantees is that if you get health care, you won't be allowed to pay for it, and it is this guarantee that makes you have to wait to get it. The government also guarantees something else: If health care providers try to set up their own clinics and charge willing patients for medical care, the government will shut them down." I was reminded of it by an e-mail I received yesterday from an economist friend in California. He has asked that I not use his name. The term "MediCal" is California's version of Medicaid. He wrote: "My wife is a psychotherapist and accepts many low-income patients who are referred to her by the County Mental Health Dept. which also reimburses her (at less than half of her normal rate). Some of those patients are covered by MediCal and their funding has been yanked due to the budget crisis. My wife offered to continue seeing these people as private patients at a very low rate, e.g. $30/hr. She was informed that such a transgression would not only cut her off from all future County referrals but might also cost her her license to practice her profession." econlog.econlib.org Michael writes: David... Another Medi-Cal story for you: I am a Nurse Case Manager in a busy pediatric surgical subspecialty. Last year it became apparent that we were losing money in spite of being very busy. The fundamental problem was our payor mix. We found that every time we saw or did surgery on a Medi-Cal patient we lost money, did not even pay our overhead. Every time we saw a private patiet we made money. As long as the mix, the ratio, of private to public, was 60/40 or better we could stay in business. We decided that we had to change the mix. We set up an unwritten set of rules. We would see any private patient for virtually any reason on demand. For Medi-Cal patient we began a strict screening process based upon medical appropriateness, essentially evidence based practice standards. On a daily basis we refuse physician referrals that don't meet these standards. My rough estimate is that we deny approximately 20% of referrals. This routinely frustrates or infuriates doctors and parents who strongly feel they are being illegimately denied care they need and desire. This is Obamacare in microcosm. It is two tier medical care and we can all look to a similiar outcome with any public option. econlog.econlib.org

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