This illustrates a fantastically glaring example of why a centrally managed health care system will fail to provide adequate care for the people it is intended to help. Assuming a health care bill is passed which provides for a single payer system or something like it, we can assume that it will listen to government panels on health policy and practice. This assumption comes from our system of today where hospitals, doctors and insurance companies pay attention since it is, after all, "free" data to apply to their practice. This assumption is reinforced by having the recommendations come from the government which created the single payer in the first place. Unlike a private actor, the single payer system would not have the option, like a single doctor, a private hospital or private insurance company, to make a choice for itself about what actions it would take: it would be locked into what ever the policy is for the area of care. If a blue ribbon panel states that Mammograms for women in their 40s only detect cancer in 1 out of 1,300 women [not the actual numbers] and the possibility to a False Positive is higher than the chance of detection, then to save money and streamline the system or just for plain old political reasons then coverage of Mammograms for women in their 40s will be cut out.
If you are like me, and refuse to allow people to die needlessly, then you will have noticed a small problem with the above sentence. The test "Only" detect[s] cancer in 1 out of 1,300 women." ONLY? That is one out of 1,300 who now has a chance to fight a deadly disease! That is 1 out of 1,300 who has a chance to live instead of a death sentence! That is 1 out of 1,300 who might just live long enough to watch their children graduate high school, or finish running a massive project like a bridge or discover the CURE for cancer if she had only known she HERSELF had cancer. But in a world of single payer, that cancer is not detected in her forties, it's not detected at all until it is too late for even a mastectomy to be of any help. Since the detection rate is too low, than coverage is cut and since it is a single payer system after all, there is no option except to go outside to the "Black Market" to get a test.
Now, lets see the flip side: A world of single payer where the coverage stays put despite pressure to not give it to "low risk" populations. Since it's a right now guaranteed to the people, people get a mammogram every other month, just to be safe. It's ok for them to do this, it's free after all. Mammogram clinics are known for waiting lines and delays and since there is now immediate reward for a person to open a new clinic, the number of clinics stays the same despite the rise in demand. Costs balloon and the entire system, which is suffering the exact same fate, spirals out of control costs wise. Even though all the panels tell people to not get mammograms in their forties, the people do it anyway in hopes that IF they are that 1 in 1,300 then they might have time enough to either get in line for chemotherapy [a 9 month wait for the first visit by the way, those clinics are in much higher demand for the number available] or to flee to a country where health care is not regulated to the hilt and they can get the treatment they need to stay alive.
Government involvement distorts the market place and prevents people from seeing the actual value of and demand for goods and services. Subsides and guaranteed supply make people act rationally to an irrational system: there's only so much of this stuff to go around, but you cannot be denied if you ask for it, so ask for it and "Get yours." This depletes the system and causes shortages or skyrocketing prices depending on the structure of the program. Don't believe me? Look at Canada or Japan. Canada's supreme Cort ruled that access to a waiting list is not access to health care, and ordered the country to alter their system. Japan offers services at centrally set prices which are negotiated across the entire system, but even though prices are semi-market set, there are still shortages due to the cost of care being far FAR lower then what is demanded by the market.
What solution might actually work?
First: Insurance is not Health care. Health care come from a doctor, an insurance company helps to pay for services if you are struck be something unforeseen. Insurance is not designed to guarantee care for all the ailments of life and death. Insurance is designed to spread the risk of fiscal failure due to an accident of fortune. Insurance is designed to be an 'opt-in' system where if you have the ability to pay for the service, than you do. Health care is the Doctor, the Nurse or the hospital which actually gets you well, which saves your life. Insurance is one of MANY options you have to trade resources for that treatment.
That being said; If insurance companies were free to act like insurance companies, than not only would the cost of insurance go down, but the cost of health care would go down as well. Open up interstate competition in insurance and not only will the management and administration costs of insurance go down, giving a savings to the consumer [us], but the increased competition would force companies to increase their quality and quantity of service to prevent themselves from going out of business.
What would this look like to us consumers?
- Wider coverage options for us people on the ground and far more ways of saving up our resources in case of a major illness or accident.
- High risk populations allowed to opt for plans which might not cover it all, and since they are not guaranteed coverage for their specific problem, they will take pains to prevent that problem from happening to they will save resource [money] to pay for the treatment should that risk come true.
- Companies encouraged to by the risk of losing market share and customers to offer 'non-cancellation' plans, where for an extra fee they become contractually bond to NEVER deny service in the event of a major illness or debilitating accident.
I am only one person offering examples of what the industry might do IF it were free to compete openly and honestly for our insurance dollar. Imagine if an entire industry of people were actively fighting for your services and money; imagine what the services might be then.
Remember, when people are complaining about the banks or health care, that the financial and health care sectors are two of the most regulated areas of our entire commercial system. The problems of "Market Failure" also happen to be manifest in these two highly regulated sectors, but who am I to say that one thing has lead to the other.
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