NY Health Bureaucracy Endangers Disabled Patients
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  • gooch mango

    “… 300 million New Yorkers…” ???

  • Jim.

    “300 million New Yorkers”

    My, how New York has grown.

  • The most humane way to care for the elderly and insane is at home with their families.

  • Chase

    HMO’s to the rescue! The perfect red state solution, and of course they are so popular with the public.

  • Andrew Allison

    Prof. Mead, I submit that healthcare is an exception to the “blue is broken” rule. It seems clear to me that the only was we can afford to provide the level of care we wish to is via some variant of the blue model, specifically, a single-payer system for everybody who can’t afford or chooses not to insure privately. It’s really very simple: increasing longevity means exponential increase in cost. The only way to deal with this it to minimize the overhead. It is my understanding that Medicare’s overhead is 3%.
    If we consider that up to 25% of service providers’ revenue are wasted on dealing with insurance, and the insurance industry keeps in excess of 50% of every premium, the answer should be obvious.

  • Well, WRM and Andrew Allison I live in a country where neither socialized medicine nor private medicine are broken – and they are not broken precisely because they are cannily pitted against each other. Neither has a stranglehold on health care. I agree with you Andrew that the US needs some variant of the Blue model “for everyone who cannot afford of chooses not to insure privately.” Sometimes health care should be a public service. An extreme example for clarity: Not 100 yards from where I sit a 17 year old girl recently licensed lost control making a turn, mounted the curb and ran over two teen age girls on the sidewalk. On was thrown onto railroad tracks, the other was under the car. We literally picked the car up and threw it off her, but she was having convulsions and had obvious head injuries. A special ambulance was required. It was plain to me as an American that when this happens in America the ambulances come and the hospital does much the same thing initially as happens in Australia. The difference is that it does not mater if that young girl’s parents are employed or have any private insurance – she will get the best Australia has to offer for as long as it takes. In America her treatment will depend on her parents insurance and if they have none the hospital will still provide the treatment because in fact no modern prosperous society would deny that girl treatment. But the American hospital will generate bills that can’t be paid by the parents and the government will fund the hospital one way or another in an administratively inefficient manner. The precise details will differ from state to state and jurisdiction to jurisdiction. But it will be inefficient. Generally it will cost twice as much as the Australia equivalent. (US 16+% of GDP for health care, Australia 8.5%.) So I think what is needed is a safety net public system and a private system that competes with the public system. Adjusted for competition correctly, if the public system gets gummed up by bureaucracy as Prof Meade describes people will pay for private health insurance. If the private system gets too expensive people will choose to depend on the public system. Australia started universal healthcare in the 70s under a Labor government and it has been modified over the years to provide a good balance between the two systems. At first Labor pushed the idea that the private system wasn’t really needed and began to squeeze it, but the opposition eventually got it right by strengthening the private system and giving people who paid for private insurance a tax break to take pressure off the public system, It worked. We have Labor back in now, but they don’t seem to be messing with the basic arrangement. I’m rising 70 and have a non life threatening heart condition. The public system was content to treat it with medication, but since I have private insurance I have been able to arrange to have a procedure that has a good chance of curing the condition. I’m not working in a single payer environment. The Australian system is only single payer within the public system – and that lets them control costs. But it is not a monopoly – there are many private insurance companies and private hospitals that operate on what those insurance companies pay because if gaps get significant people opt for the public system. That is effective competition. We already pay for a public system in America but it is patchwork of programs and state and federal funding. It is going to have to change to operate efficiently in the post Blue world.

  • Mark Michael

    I gather that Australia is an interesting approach with its adopting both a government-run health care component and a private sector one that competes with it. (Hmm. Is it a stable situation? Usually, when a public agency competes with a private one, the public agency spends lots of time and energy trying to undermine the private one. Put it out of business. Can any Aussies comment on that?)

    Even people who believe in the free market think that health care is different from the providing of other goods and services in that people don’t “purchase” care for catastrophic illnesses very often – maybe only once or twice – hence, they have no or little experience to draw on to be a “good, discerning” customer. So the medical community can charge them too much and they won’t know the difference.

    My comeback to this scenario is that I know I could logically refute this using other goods and services that are similar – and the private market works better than if a government monopoly supplied it, but too few people buy it. It’s too indirect.

    So my suggestion is that the R’s should take an important half-step to putting “customers” (patients and their families) back in charge by adopting Health Savings Accounts (HSAs) and catastrophic (very high deductible) health insurance policies first. (This assumes that they elect an R prez and an R Congress come November!) Insist that this be used nationwide for at least a decade – and see what happens. See how the health care industry responds. See how families respond in their usage of health care services. See how health industry companies evolve their paying for those (much fewer) catastrophic illnesses covered by their policies.

    If you’re not familiar with HSAs, they are before-tax savings accounts that are deducted from your paycheck. When you have any medical expense that’s below your deductible (say, $5000/year), you pay for it out of your HSA. If a medical expense exceeds that $5,000 deductible your insurance kicks in.

    If you don’t use your entire HSA in a given year, you (in essence) get to keep the savings. A young person, typically, will seldom use the full HSA amount in any given year. Now, the details of how you get to “keep” those unused funds – stop paying into the HSA at some dollar amount, or simply accumulate it like a 401(k) tax-deferred savings account for your retirement, etc. depends on how the HSA law is written.

    One example of this approach is Indiana and their state workers. Mitch Daniels put IN state employees on HSAs with catastrophic insurance 4 or 5 years ago. (The WSJ had several stories on it.) Indiana has saved a lot of money already. I think 70% of those state workers now use HSAs (they can stay in a traditional policy if they like, although I think it’s tilted towards using the HSAs).

    Now, obviously, this approach still has a third party paying for very large, seldom-occurring illnesses, so you might think it wouldn’t solve that alleged problem I noted above.

    I think it will foster a more customer-centric culture within the health care industry than we see today or that you see in, say, Great Britain with its NHS (National Health Service) and its well-known DMV-like culture. That competitive culture will also control how those clinics, hospitals, doctors handle those more-rare illnesses. They’ll continue to be prudent and customer-centric. (Well, that’s my theory and I’m sticking to it! I think Adam Smith and F. A. Hayek are right – and the leftists are wrong!)

  • Jim.

    @Andrew 5-

    The fact is that Medicare pays out so much more because the amount charged per claim is much, much higher. When old people get sick, the bills are much larger.

    If you actually compare apples to apples — how much Medicare spends on any given bit of paperwork, say — Medicare actually spends MORE money shuffling paper around than private insurance does.

    Your understanding that Medicare’s “overhead” is 3% comes from wishful thinking promulgated by people who are deluding themselves or who wish to deceive others.

  • Kris

    [email protected]: “It seems clear to me that the only was we can afford to provide the level of care we wish to is via some variant of the blue model”

    It seems clear to me that the only way we can afford to provide the level of care we wish to everyone is … no way. Not doable. We can ensure that practically everybody receives ever better health care, but we cannot provide the latest and greatest to everyone. No way. (Well, except for the special case in which we eliminate medical advances. Which doesn’t seem to be what we would wish for ourselves.)

  • Kris

    Not that anybody cares, but when I wrote “the special case” in my previous comment several eons ago, it was because I was blanking on the term I was actually looking for: “the degenerate case”.

    The prodigal memory returns, slaughter the fattened calf! Hello? Hello? Oh well, on to newer posts.

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