Burn of the Day

The problem with designing a system to provide and finance medical care and long-term care is that no system can satisfy all the preferences people have. There are always trade-offs. You have to pick something and live with the downside of that something. Congress and state legislators are unwilling to do that, so we’re left with a puzzling patchwork.

Art:
While 19th and 20th century advances in medicine often returned working-age folks to the workplace, most advances today extend the life of those well beyond working age at a time when (because of lower birthrates) fewer younger workers are around to tax to make up the difference. Even socialist economies can’t run on air.

In Australia we have both Public and Private healthcare. Bulk billed Medical Centres allows a person to see the doctor (GP) through their Medicare (government funded Healthcare system) OR you can choose a doctor that bills patients. We go to one that bills adults but bulk bills kids. Sometimes the doctor may decide that day to bulk bill for whatever reason.

Likewise with hospitals, there is choose to go to Public and Private hospitals. Some Public Hospitals are better than others. If you choose to have Private Health cover then in the case you end up in hospital your Private health insurance along with Medicare pays for you to be treated at a Private hospital. The specialist however, can charge whatever they want. It’s usually higher than a specialist in the public system because of the liability insurance the doctor has to personally pay.

The Public system is overwhelmed already and without Private Hospitals and Private Health insurance the Public system would not cope. The government pushes you to take out Private Health Insurance because you get hit with a special tax levy if you don’t have Private Health insurance. Again, pushing people away from the overwhelmed Public system.

But with everything, there are pros or cons to both, as the insurance for doctors is high it pushes their treatment fees higher. But at least you have choice – choice of GPs, choice of specialists and choice of hospitals.

I’m not sure how a country with the population with the size of the USA could purely rely on a publicly funded healthcare system. You need to take the pressure off an overwhelmed system by pushing people into personally funded Health Insurance. It’s a tricky balance.

I’m not sure how a country with the population with the size of the USA could purely rely on a publicly funded healthcare system. You need to take the pressure off an overwhelmed system by pushing people into personally funded Health Insurance. It’s a tricky balance.
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In this country, optical shops are commercial enterprises, pharmacies generally are (hospital dispensaries the exception0, clinical laboratories can be (though are often subsidiary to hospitals or ambulatory clinics), and imaging centers can be (though, again, commonly incorporated into hospitals or ambulatory clinics). Ambulatory care can be commercial enterprise (called ‘urgent care’ or ‘prompt care), stand alone guild enterprise (the conventional sort), or provided by clinics incorporated within hospitals. Hospitals may be run by public agencies, by stand-alone government corporations, subsidiary to public universities, subsidiary to private universities, by stand-alone philanthropies, or (now and again) subsidiary to commercial companies. In New York, somewhat north of 20% of the hospital beds are to be found in public sector institutions. Not sure whether it be lower or higher in other states. Acute care hospitals are the segment of medical care most likely to be found in the public sector. Long-term care can be provided by commercial, philanthropic, or public entities. Over many decades, the proportion public has declined and such institutions have grown more variegated in terms of their clientele and service option.
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Government programs now account for north of 60% of the revenue of medical and l/t care service providers.
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The suggestion Milton Friedman offered a generation ago was to have public insurance programs which kick in over a high deductible, with households responsible for charges out of their own resources short of the deductible. He also suggested mandated contributions to medical savings accounts. The idea was that we could limit socialization of costs to a specific share of gross domestic product and provide for an actual price system to emerge in the invoices issued to families who had not hit the deductible this year. The ratio of out-of-pocket charges to total personal income flow would be contained by market preferences, as is the case in other sectors.
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The upsides are that we have stable actuarial pools which cover nearly everyone, that public financing grows pari-passu with gross domestic product and no faster, that we’re not rationing with administrative directives or with queues. The downside is that families have to prepare for thousands of dollars in out-of-pocket expenses each year.

Poor service is not a danger of ‘private health care’. It’s a danger when you have organizations run by human beings. We’ve made use of commercial prompt care a number of times over the last decade and been satisfied each time. It’s not omnicompetent, but it has its niche. The strangest place we’ve been was the state medical center in Syracuse. (I was told when I moved into the area that there had been controversies involving it. A dozen years later, we had a surgeon who was on the attending list there so had to use their services).
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‘Cutting costs’ is a cuss word for what might also be called ‘finding slack in the system’.