- Reaction score
- 0
- Points
- 210
Agreed 100%. Which is why I think THIS is where the least change csan do the most good.Thucydides said:But why are people poorly managing the system? Because they are paid to do so and not held to account.
The "everyone plays along" model is nonsense; if it was true then the costs of everything from bread to diamonds would be totally incalculable, but this is clearly not the case in any market, from commodities to professional services. Ask yourself about how accountants, plumbers or RMT's charge for their services?
Before I submitted this post, I had a string of example of exactly this kind of market failure. We all see them every day. But it was too long. So instead, the example I'll use is the elephant in the room, the fully privatized system running just south of the border. If privatization is the key to lowering costs, why is the poster child of private health care never the less the most expensive system in the world? You can make all kinds of arguments in favour of a private system, don't get me wrong, but it seems pretty clear to me that lower costs is not one of them. The test case is even more expensive than what we have now.
I strongly suspect that many of the perverse mechanisms that drive up costs and drive down quality that you cite in Ireland are similar to the NHS model in the UK, where private care providers can "dump" their problems onto the government funded service and are not penalized for doing so (indeed the incentive is greater, since they no longer incur expenses but pass them on to the taxpayer).
Sometimes it's the opposite. There are basket-case patients who have a medical history at tall as you are, and these patients are guaranteed to spend a small fortune in health care costs before they die. 80% of medical costs are incurred in the last 3 months of life. If you can admit a patient to your private hospital 3 months before they die, you will see 80% of the health care dollars that will ever be spent on that person.
A fully private system does not have these perverse incentives.
But it does, that's my whole point. They are incentivized to do something for the sake of doing something, because they get paid whether it was beneficial or not. Pretty much every Canadian kid I know between the ages of about 5 and 25 has been told at some point in their life that they need braces on their teeth. Because if you tell every kid they need braces, some of them are going to pay you to get braces. And it doesn't matter that competitors are driving the price of braces down, the braces themselves are a completely superfluous cost for which you are being rewarded.
Walk into a hospital in the USA without getting a CT scan. Go ahead and try. You will get CT'd. And you will get billed for it.
What is needed is a system which minimizes perverse incentives (any system can be gamed), while providing maximum accountability to the consumer.
This is definitely true, I agree 100%. But the devil is in more that the details here. In private health care practice, the method of accountability is legal litigation. Which is another factor that directly contributes to high costs in a private system. The biggest problem, however, is that the wrong doctors get sued. It's a complete crapshoot. Good doctors get sued for stupid reasons by patients who are angry at their illness, and bad doctors don't get sued because the patients don't know enough to realize that they've been horribly mismanaged. You get all of the costs of a system that should promote accountability, but without the benefit of incompetent doctors being held accountable.
I think the closest-to-ideal system is a fully public system, funded exclusively by the taxpayer, which is well managed and administered. The management and administration part is what we're missing in Canada, and I think we would be best served by attacking that problem, rather than rebooting the whole method of health care delivery.
This is, of course, ignoring all the ethical issues surrounding the problem ("I don't want to pay for fat people's bypasses", and "I don't want to die because the government won't let me spend my own money on a better drug") which muddy the waters a bit. I'm basing this purely on my opinion of what would provide best value for dollar towards maintaining a healthy population. It also happens to be that I think it is the most ethically preferable as well, but that is a whole different discussion.