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From both sides, what we're really dealing with is scarcity. We need more health care than we can provide. In this situation, no matter what mechanism we use to

From both sides, what we're really dealing with is scarcity. We need more health care than we can provide. In this situation, no matter what mechanism we use to allocate it, we're going to end up with rationing either by government fiat or brutal market forces. There are two things we've got to get a handle on. 1) It doesn't matter how we allocate it, there are going to be losers. The moral thing to do would seem to be to diffuse the loss onto the greatest number of people, not let it break the unlucky randomly: "we're all in this together". Sidebar: Anyone who says that they can provide healthcare for all is lying. 2) We're actually ridiculously bad at providing healthcare. We spend most of our time (and political might) trying to find some sucker class to pay for it without trying to take the more rational step of trying to make it cheaper. This is because the latter is freaking hard. The only thing that will finally put this thing to bed is to figure out a way to care for ourselves that is within our means and then agree on a political system that will distribute it (if not fairly) evenly. Hard? "We choose to ... do these things not because they are easy, but because they are hard, because that goal will serve to organize and measure the best of our energies and skills, because that challenge is one that we are willing to accept, one we are unwilling to postpone, and one which we intend to win."

vidarh 13y ago
A first step for you to make it cheaper: Someone needs to have a financial incentive in minimizing cost. For example by paying them based on the number of people in their area, and on good outcomes, rather than by the number of procedures etc. carried out. GPs in the UK are paid this way - the practices are almost all private, but all practices that takes NHS patients (the vast majority) are paid mainly by a formula that makes it really bad business for to shirk on preventative care. And since the NHS is not paid by the procedure as a whole either, they put massive resources into running ad campaigns to get people to recognize symptoms of various problems earlier and go see their doctor, rather than wait until things leads to expensive hospital visits. NHS hospital trusts are given budgets based on demographics, and will find themselves placed in special measures and have their top management fired if they compare too unfavourably with other trusts or keep running over budget, so they too have incentives to minimize cost of providing health care in the areas they serve. Meanwhile, in the US, for large parts of your health care system there is no benefit at all to reducing health care costs. Your incentives are all wrong. The NHS costs each UK tax payer on average less than the US government spends on health care, never mind private insurers....

vidarh 13y ago

A first step for you to make it cheaper: Someone needs to have a financial incentive in minimizing cost. For example by paying them based on the number of people in their area, and on good outcomes, rather than by the number of procedures etc. carried out. GPs in the UK are paid this way - the practices are almost all private, but all practices that takes NHS patients (the vast majority) are paid mainly by a formula that makes it really bad business for to shirk on preventative care. And since the NHS is not paid by the procedure as a whole either, they put massive resources into running ad campaigns to get people to recognize symptoms of various problems earlier and go see their doctor, rather than wait until things leads to expensive hospital visits. NHS hospital trusts are given budgets based on demographics, and will find themselves placed in special measures and have their top management fired if they compare too unfavourably with other trusts or keep running over budget, so they too have incentives to minimize cost of providing health care in the areas they serve. Meanwhile, in the US, for large parts of your health care system there is no benefit at all to reducing health care costs. Your incentives are all wrong. The NHS costs each UK tax payer on average less than the US government spends on health care, never mind private insurers....