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."
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?
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?
1 Comments:
By 
, 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
