Friday, November 28, 2008

The case for universal health care

I'm a huge believer in capitalism and "the market". However when it comes to health care I've realized that it simply doesn't work. At least not in the form we have it here in the United States. The reason why it doesn't work here is that in order for capitalism to work there has to be a way to actually shop around. Health care is a bad fit for the market because of several reasons.

  • Health care is usually a necessity. It is only in unusual cases that you can choose whether you want to get medicine or have a procedure done.
  • It is hard to even get a price list when you go to a doctor. And if you start asking about prices of what a blood test or other "bundled" services it gets even harder. How are you supposed to shop around to find the best price performance if you can't even know what the price is before you have done something.
  • In a lot of cases the person that makes purchasing decision is not the same as the person that is footing the bill. In a lot of cases your doctor is the one who decides which medication you are supposed to take even though you are the one who is paying for it.

All in all these all sums up to the simple fact that letting the market handling health care is a really bad fit. And if you look at the current state of health care here in the USA it is also fairly obvious. First of all the US spends way more money on health care than anybody else. According to a World Health Organization report in 2000 the US spent 13.7% of GDP on health care in 1997. The second country in the study is Germany which spend 10.5% of GDP. Most of 1st world countries seem to spent somewhere between 6% and 10% of GDP. The difference between all those countries and the USA is that everybody else has universal health care and somehow here we succeed in paying way more than everybody else and yet not have it.

Even if you just count government spending on health care the USA ends up around the middle of the pack of the first world countries (This according to an article in The Economist from a few years ago). And again everyone else have universal health care and here we don't. The same article also made the point that one of the reasons that the USA manages to pay so much and get so little out of it is that in effect the USA is paying the development costs of new treatments and technology for the rest of the world. The question is if we think it is worth it?

Interestingly enough the system we have right now doesn't even work for people who are well off in all cases. For instance a friend of mine who work in the tech industry and which I assume makes a pretty decent living recently got laid off. It didn't take long for him to find a new job and he was back on track. However during the time without a job he lost his health insurance and when he got his new job he had a preexisting condition. So now, he can not get new health insurance that will cover the preexisting condition he had so he is completely screwed. It is through him that I have learned a lot about trying to use health services in this country without health insurance.

One thing I hear often from friends who are against "socialized medicine" (The phrase preferred by people against universal health care) is that they can afford great health care and don't want to be forced to be accept a lowering of the standard of their health care. However that doesn't have to be the case. I would propose the government would provide a minimum level of health care and if you want better care you can still get health insurance and get better care. This is how it works in Sweden (The only other country have a pretty intimate knowledge of) and I think it that is actually a great system.

Then of course the thing I keep hearing is that we can't afford it. I would like to make the argument that we can't keep going like we are now. We are already paying way more than anybody else and we are getting less (The WHO report above ranked the overall performance of our health care system at 37th and at 72nd of overall health out of 191 countries in the study. Basically, we are one of the worst country of the industrialized world when it comes to health care). Given the amount of money we spend on health care we should be able to figure out a way to get universal health care without spending any more money than we already are. Even if the universal health care we get is crappy at first (Which is then improved by health insurance by those who can afford it) it would still be a great first step.

1 comment:

Henrik Johansson said...

Amen brother