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Health care
There's an interesting article in this week's New Yorker. The author, a doctor, visits a county in Texas that has (according to Medicare) the most-expensive-per-capita health care in the nation with the most-expensive-per-capita health care in the world, in hopes of finding what makes that county (and perhaps the US) so special. He concludes that it's not the general health of the population, nor the quality of care and facilities, [ETA: nor malpractice awards] but massive overutilization of tests, medications, and procedures. And why does this particular county have so much overutilization? Because of a culture of individual profit among the local doctors and hospitals. Kickbacks are routinely requested, and apparently given, for doctors referring patients to particular hospitals or specialists. The author contrasts the situation with other cities and counties that have unusually low health care costs and high quality, where groups of doctors pool their income so no one of them has a strong incentive to perform extra procedures or skimp on patient time.
A purely free-market health care system would probably be much cheaper and more efficient than our current system, with the usual free-market problems of distribution and fairness: hospitals and doctors would be only in rich neighborhoods, and millions of people would die of preventable or treatable problems.
A thoroughly socialized system would also be cheaper and more efficient, as witness almost every other developed nation. It would have some of the usual socialist problems of overutilization and freeloading.
Our current system is the worst of both worlds: private profit from public payment. Insurance (whether government or corporate) acts like a "common resource," and is predictably consumed at far above its efficient level. To avoid this, either the costs have to be more individualized or the benefits less so. Doctors in the low-cost, high-quality cities and counties mentioned in the article have taken the latter course.
A purely free-market health care system would probably be much cheaper and more efficient than our current system, with the usual free-market problems of distribution and fairness: hospitals and doctors would be only in rich neighborhoods, and millions of people would die of preventable or treatable problems.
A thoroughly socialized system would also be cheaper and more efficient, as witness almost every other developed nation. It would have some of the usual socialist problems of overutilization and freeloading.
Our current system is the worst of both worlds: private profit from public payment. Insurance (whether government or corporate) acts like a "common resource," and is predictably consumed at far above its efficient level. To avoid this, either the costs have to be more individualized or the benefits less so. Doctors in the low-cost, high-quality cities and counties mentioned in the article have taken the latter course.
Re: Comparisons
Interesting. I lived in Canada for a year, and took advantage of their health care system shortly before leaving: I cut my finger open with a tape gun while packing boxes, and my first aid supplies were already packed away, so I went to my landlord next door, who took a look and said "You don't need a band-aid, you need to see a doctor." An hour later I walked out of the hospital with three stitches in my finger, and nobody had mentioned money. It worked very well in that situation.
The puzzle is how they prevent the kind of over-utilization described in the article, if the doctors choosing the treatments are also getting paid for them. And as I recall, when I lived in Canada there was a national scandal about how expensive and inefficient Canada's health care system was, compared with every other developed nation (except of course the U.S., which remains in a league of its own).