Sunday, December 05, 2004

The blessings of single-payor healthcare 

The next time you hear somebody propose a single-payor healthcare system, such as in Canada or the United Kingdom, send them a link to this article. Britain's National Health Service has announced a plan to train nurses to do surgery, so that "no one will wait longer than 18 weeks for treatment from GP referral by 2008."
Under the Government's plans, a wide range of operations, including hernia repair, vasectomies and arthroscopies (internal examination of joints), will be performed by surgical care practitioners - nurses, physiotherapists and operating department assistants - after two years of training.

Now, nobody has more respect for nurses than TigerHawk, and the libertarian in me generally supports liberalization of professional credentialing requirements. Paralegals should be able to do lots of things now reserved to lawyers, pharmacists should be able to prescribe many drugs, and I'm sure that there are certain kinds of surgery that nurses could perform effectively. That's not the problem with the NHS's proposal.

The NHS is resorting to training nurses to perform surgery because it faces an enormous imbalance between demand for healthcare and its ability to meet that demand. There are more than 850,000 Britons waiting for surgery right now. If the United States faced the same supply/demand imbalance as a proportion of its population, there would be more than 4,000,000 Americans waiting an average of five months or more for surgery.

Why does the NHS have such a long waiting list? Because it allocates healthcare services primarily by queuing -- standing in line. In the United States we use queuing as well, but most queues are short and of little consequence to health. Popular doctors or certain types of health benefit plans use queuing to allocate appointments, and emergency rooms triage patients. American queues generally last a matter of days or hours, though, and patients can often bypass the queues by going elsewhere.

In the United States we do not necessarily have a superior system. We allocate our healthcare services by auction, meaning that people get treated based on their ability to pay or (more often) the extent of their healthcare benefits. Critics of the American system complain that it is unnecessarily costly (this is probably true) and that it is a raw deal for the working poor (this is less certainly true). The problem is, if you don't allocate healthcare by auction, you have to allocate it by queuing -- and eventually accept such compromises as surgery by nurses -- or bureaucratic fiat, meaning that coverage decisions are made by policy. Americans have seen this third method in its private form -- health maintenance organizations -- and probably would not like it any more if the bureaucrats denying coverage were paid by the taxpayers.

So those are our choices for allocating healthcare: Auction, which bears the burden of inequality, queuing, which resolves supply/demand imbalances by making patients wait in line (where many will die), and bureaucratic fiat, which in its most sensible and cold-blooded form denies healthcare for individuals based on statistical models that predict when treatment will be cost-effective. Those are the alternatives. There is no fourth way. Which do you prefer?


By Anonymous Anonymous, at Mon Dec 06, 01:18:00 PM:

I remember what my own private doctor said years ago when asked what he thought of managed health care. My employer had just joined an HMO, which meant I could pay only a dollar a visit and see all the specialists I might need under one roof. At first blush, it seemed like a pretty good deal, but old Doc Brown set us straight. Because the HMO must focus on the bottom line, your interests are secondary. Your ability to make health-care decisions – in consultation with your physician – are compromised. As he put it, the doctor was now working not for you, but for the HMO.

Single-payer health system, heal thyselfSissy  

By Blogger jobs123, at Sun Oct 02, 10:59:00 PM:

Hey I just love your blog. I also have a love dating
blog/site. I mostly deals with love dating
Please come and check it out if you get the time!  

By Blogger Tom Naka, at Thu Oct 06, 12:48:00 AM:

I've stumbled across your blog when I done some health insurance news
research in Google. You're doing a pretty nice job
here, keep up the good work! check out health insurance news

By Blogger ioio, at Fri Oct 07, 04:13:00 AM:

Great Blog! Ilike it.I have Totally Free dating site for singlesTake a look if you have a minute. Thanks and have a good one!  

By Blogger gesticulatively resources, at Fri Oct 07, 10:33:00 AM:

I was looking for a place to submit my business article and stumbled across your blog. I enjoy reading blogs with my coffe in the morning before work. its fun to see whats up with people around the world.

Anyway, I did find a free blog and article submission site here Site Submit/Article Submission

Anyway, I enjoyed your blog. Have a nice day : )  

By Blogger Bill Lottero, at Fri Aug 11, 02:56:00 PM:

Is your concern really about nurses trained --and you forgot to mention certified to perform these surgical tasks-- what is really troubling you? Or is it your libertarian streak that blinds your view of a Government system. You seem to be focusing on one issue of a health care system that covers all its population. You disregard the fact that it has by all objective metrics delivers a far superior performance on every population health measurement compared to the US system.

Additionally, You disregard the fact that anyone in the UK that chooses to can buy a supplemental insurance coverage and thus jump ahead in the queue.

You dare to suggest that there would be more than 4,000,000 Americans waiting an average of five months or more for surgery again disregarding that fact that currently 44 million American have NO Health Insurance and that although that will be treated in the emergency room for urgent care they are none the less handed a bill for that care and often forced into debt collection and bankruptcy because of medical related debt.

I for one think a CERTFIED Nurse is a far better choice than your vision of the future.  

Post a Comment

This page is powered by Blogger. Isn't yours?