I don't do semi-political ranting very much, but this particular topic really irritates me.
Let me state that I am a card carrying Libertarian. I'm a firm believer that the government should stay out of almost everything, and let capitalism and the free enterprise system work. For the most part, government interfering with an industry doesn't really have the desired effect. Look at the attempts at bringing broadband to the masses as a good example. I would love for the government to stay out of this, provided that we could get health care for a reasonable price, and that capitalism and the free market would work in this case. For this to work, there would need to be the complete absence of government regulation, there would need to be a highly competitive market, and so on. This includes such things as: 1) If you can't pay you die. No more 'free' health care provided at emergency rooms and the like. Or stated differently: All medical facilities are free to refuse service based on ability to pay and whatever other factors they decide. 2) Transparent pricing. Have you ever tried to find out how much a specific procedure would cost, all in? A perfect example: A year or so ago, I needed some antibiotics for a chest infection (aka walking pneumonia) I get fairly often at the end of a cold/flu. I knew what it was - all I needed was a doctor to listen to my chest, say 'yep, you've got crud in there', and give me a prescription. Two hours later, a pair of chest x-rays, and $800 of lab work, I have my prescription. All because the doctor was worried that it might be something else so he had to do all the tests to rule out everything else it could be. I would have objected but the chest x-rays seemed a logical thing to do, and how much can a bit of lab work cost, after all? 3) Ability for the users of the service to make cost/benefit analysis choices. This ties in with #2. Using my walking pneumonia example, if they would have said "it's probably pneumonia, and we can send you home with a prescription for $80, but we also think there's a 25% chance that it is condition X, and if we don't catch it now, there's a 99% chance you'll end up dead, and for us to test for that it's an extra $100, and there's a 1% chance that it is condition Y, which if we don't catch right now, it will be a bit more expensive to treat, and the tests for that is another $700", I would have chosen the $180 option. Today they're just loading you up with everything and people are paying. Note that I'm specifically ignoring insurance here. Since that helps with #3, but adds a differing set of unknowable cost/benefit choices. The problem we have today is that we have a system where there is no way for the users to exert any real pressure on the system, and no way for this to be fixed - since you can't just say "I don't need health care". In this situation, you end up with costs spiraling out of control, which is exactly what is going on. Where pressure has been applied it's only made the problem worse since it's been applied to fix the symptoms, not the problems. I think we need to try one of two things in this country: Option 1: Get the government completely out of health care, including setting any requirements on the health care system. Option 2: Switch to a single payer system. Seeing as I'm not aware of a single situation where option 1 has actually worked for a country, and even as much as the libertarian in me is offended by the suggestion, I really think Option 2 is where we are going to have to end up to fix this in this country. I've seen the Canadian system first hand. Honestly, it seems that it works in most cases MUCH better than our own system. In fact, it seems that MOST health services are done more promptly than they are in the US. I was shocked to hear that most doctors visits with your primary care physician are scheduled the following day. There's a lot made about the waiting lines for a MRI and similar in Canada. From what I can tell, that is probably the only major issue where things are worse. They've chosen as a country to keep their health care costs low, and one way of doing that is simply to not buy more MRI machines than you actually need. The only way to have 1-2 day waits for machines is to buy way more than you need, and let them set idle most of the time. But if you need in a MRI machine for an emergency, it's available for you NOW, just like in the US. The BIG difference is that in Canada people actually can afford to go to the doctor when they're sick. Here it's a big hassle, you're stuck with a copay, and who knows how much more when they actually find stuff, so people put things off as long as possible. Not a good thing overall. Canada, you go to the doctor when you need to, and yes, if you need a diagnostic MRI for something elective you may have to wait a few months. There's nothing to say we couldn't decide we wanted to spend a bit more than Canada and fix that particular problem. -forrest
