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Monday, November 20th 2006

What Must National Health Care Look At?

A short and sweet look on four things universal health care would have to achieve, which are special for the Untied States.

1) It cannot provide less, or less rapid, coverage than the typical American policy does now. Over three quarters of Americans are happy as clams with their health care now; to the extent that they support national health care, it is because they fear losing what they have. Nationalisers, therefore, cannot sell a programme by guaranteeing them that they will lose some of what they have now. Horror stories aside, most Americans, despite their copays, have much more lavish coverage than that available elsewhere, with unfettered access to their doctors, semiprivate hospital rooms, expensive machines around every corner, and so forth. In what other country would my eighty-eight year old grandmother have had her hip replaced two weeks after the doctor decided it was time? That two weeks being the period needed for my mother to arrange her schedule so she could take care of Mom. That is the baseline of care, not whatever is currently on offer in France, no matter how fond the French may be of their system. Countries with national systems set them up a long time ago, when the median voter had no insurance at all, so whatever crap the government gave you was an improvement.

2) It cannot substantially lower the wages of medical workers. They all have powerful lobbies, and they vote on their interests. Doctors in Britain may be thrilled to make 60K a year in return for the shot at someday, if they’re very lucky, exiting the system for a private hospital. You will not get American physicians to take the same deal; they’ve already got hefty mortgages and kids in private school. Between the right of exit and the lobbying power of the unions, it will be some time before we can even eat into doctor’s pay with inflation; I would expect the pay of lower level medical employees to rise (New York’s experience is instructive here).

3) It cannot ration end-of-life care. The AARP is the most powerful lobby in America. Anyone who thinks that a nationalised system will ration all those dollars poured down the drain in the last few months of life is engaging in fantasy–a particularly ludicrous and risible fantasy because we already have nationalised health care for end-of-life care RIGHT NOW and we’re spending like eighty shrillion dollars on it.

4) It will not cover immigrants, at least not until they are citizens. That means at least 12 million people will remain uninsured. It also means that emergency room usage will remain high, since that is where illegal immigrants tend to get their health care. Not that this really matters. It doesn’t seem to me that emergency room care for routine ailments is actually more expensive to provide than clinical care; it’s just that hospitals price it to cover the cost of dead, uninsured trauma patients and so forth. I don’t see how a triage nurse, a doctor, and a waiting room are more expensive to provide because they’re on the first floor than they would be on the fifth. But perhaps I’m missing something there.

A system with those restrictions makes you want to barf, doesn’t it? But I gotta admit, I agree with it. Hell, I’m spending time in organized medicine meetings fight for #2. Good to see him compliment them AMA :)