Map of life expectancy at birth from Global Education Project.

Friday, June 30, 2017

Common Sense

The various affluent countries around the world have somewhat different ways of organizing and financing their universal health care systems, but they all cover everybody, and they spend about half as much or less than we do. Right now the British system happens to be under strain because the conservative government is underfunding it. Vote Labor back in and they'll put in enough money to fix it.

But I want to talk about rationing. It just seems bizarre to me that people argue against universal health care schemes on the grounds that they require "rationing" or denying some services to some people on the grounds of cost. Yes, that is necessary, because resources are finite and taxpayers only want to reach into their pockets to a certain depth. Ergo, you don't spend a million dollars on the small chance that it will extend the life of a horribly sick person by a week. You have to draw the line somewhere.

But obviously, that already happens right here in the U.S.A., but in a worse way. Lots of people, even with the ACA but mostly because of states that didn't accept the Medicaid expansion, don't have insurance and can't get health care and yes, they die. That's the current reality. And, before the ACA, insurance policies typically had annual and lifetime limits. Insurers also won't pay for many treatments they consider too expensive, and they found ways to kick expensive people off of their policies. The whole pre-existing conditions thing means that if you need insurance, they won't sell it to you. That's rationing, but of a particularly arbitrary and cruel kind.

Whether a very expensive treatment that doesn't do a whole lot of good should be offered to people ought to be a decision that is democratically accountable. That's what they have in Britain. These decisions are made by a body called the National Institute for Clinical and Health Excellence (called NICE) through a transparent, open process. If people object to a given outcome -- and occasionally they do, although the process is generally accepted and supported -- they can complain to their MP. Parliament oversees the National Health Service and NICE, and they can guide policy. Which you can't do with your insurance company.

Update: There was interest in how we can get to universal health care in the U.S., given the institutional obstacles to implementing a single payer system here. Scott Lemieux discusses the possibilities. He isn't totally explicit, but he seems to endorse a Swiss type system, which is sort of ACA on steroids. 

Update #2, Baby Killers: I believe somebody suggested that the case of Charlie Gard proves that single payer systems are evil. Actually it's largely irrelevant to this discussion. This is an English baby with a mitochondrial disorder who is more or less already dead but is being kept on life support. The hospital wanted to turn off his ventilator but the parents went to court to stop it. Meanwhile they were crowdfunding a couple of million dollars to fly him to the U.S. for an "experimental" (actually quack) treatment. The British court said no, the treatment is useless, and it is in the best interest of the baby to turn off the machinery. The European high court has now agreed. So this is comparable to Terry Schiavo and it has nothing to do with the National Health Service or what kind of insurance the family has. There is, however, tangential relevance: spread that $2 million around properly, and you could save a hundred children's lives -- say African kids dying of diarrheal disease, by getting clean water supply to their villages. Think about it.

9 comments:

Don Quixote said...

Thanks for the extremely informational blog today.

Reality-based articles. I love 'em.

kathy a. said...

Thanks.

Anonymous said...

Right now the British system happens to be under strain because the conservative government is underfunding it. Vote Labor back in and they'll put in enough money to fix it.

And if labor keeps losing?

Cervantes said...

Well then, the voters will get what they apparently want.

Anonymous said...

If we had a single payer system wouldn't it still be possible to buy supplemental insurance that would cover you when our version of NICE rejects your treatment?

Then you'd have no death panel controlling your life.

Anonymous said...

"Well then, the voters will get what they apparently want."

And in the US?

Cervantes said...

Anonymous -- yes of course, rich people can still pay for stuff the NHS won't, you can even buy private insurance. The NHS is basic insurance for everybody, but there's nothing to stop you from spending your own money however you want, should you be fortunate enough to have some.

Hillary Clinton won the election by almost 3 million votes. More people voted for Democratic members of congress than for Republican members. The system is rigged.

Anonymous said...

Yes, the voters (states) got what they voted for.

It's called the Constitution. This ain't the Republic of America, Suzie!

Anonymous said...

...but there's nothing to stop you from spending your own money however you want, should you be fortunate enough to have some.

Depends on what model is used. In Canada, private insurance for medically necessary hospital and physician services is illegal in 6 of the 10 provinces.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC80881/

All provinces except 2 (New Brunswick and Prince Edward Island) specifically prohibit extra-billing by opted-in physicians. In other words, opted-in physicians cannot bill patients more than they or the patient would receive from the public plan, including amounts for non-insured goods or services they provided in connection with the insured services.