A person who dies waiting for care, or because the government won't pay for the care he needs, is just as dead as a person who is refused care. It's
the same problem- people aren't getting the care they need- but we're getting there from opposite directions.
As for "perverse incentives", I agree. There are a good number of negative behaviors that are actually rewarded in our system. Public healthcare
isn't the answer, though: we need to clear out the counterproductive regulations that make our system inefficient (like the fact that many doctors are
literally afraid to perform risky procedures, because failure would wipe them out with malpractice suits), and return regulation to its original purpose:
making the incentives provided by the health care system line up with the standard of care we want our doctors providing.
Switching to public health care removes some of those negatives, but it also destroys many of the positive aspects of the American system. Look at the British
system- doctors there have a specific required amount of patients that they are required to serve in a year. After they finish their quota, they are given no
material incentive to help any more patients for the rest of the year. The British, despite having more dentists per capita than America does, provide less
dental treatment per capita because the dentists finish their quotas early in the year, and take the next 6-8 months
off! That's a perverse incentive right there, and one that's a heckuva lot harder to fix than the problems we have in America!
Which requires the least effort- running everything yourself, or letting others run everything, and stepping in when they do something wrong? If your talents
lie in a different field than the setup you're trying to run, which produces the best result- running it yourself anyway, or letting experts do it for you?
If you're trying to build a bridge, you should have a civil engineer running the operation, because you'll get a strong, solid bridge. You
wouldn't put an artist in charge of building the bridge- at least, not if you wanted it to support its own weight when it was done. If you're teaching
kids, a teacher will have a better idea of how to run a school than a lawyer will; the teacher knows what teachers do, and what they need to do it, whereas the
lawyer would give the teachers at the school what he thought they needed, instead. So why do all these people want to
put clerks, lawyers, politicians and accountants in charge of health care? What experience do these bureaucrats have with treating the sick? What motivation
do they have to get it right? A doctor interacts with his patients face-to-face- why should we give bureaucrats, who don't see people, but statistics-
more authority than the doctors in determining what treatments to use and not use? If an American doctor screws up, and a patient dies because of it, it has a
direct negative impact on him. If an NHS bureaucrat makes a decision that kills 10,000 patients, will he even know? Wouldn't he be commended, or even
promoted, for cutting costs?
If I had a choice between entrusting my health to a first-year med school student, or putting it in the hands of a government agency, I'd choose the med
student every time.
My Unitarian Jihad Name is: Brother Atom Bomb of Courteous Debate. Get yours.
I've been writing a bit.
the same problem- people aren't getting the care they need- but we're getting there from opposite directions.
As for "perverse incentives", I agree. There are a good number of negative behaviors that are actually rewarded in our system. Public healthcare
isn't the answer, though: we need to clear out the counterproductive regulations that make our system inefficient (like the fact that many doctors are
literally afraid to perform risky procedures, because failure would wipe them out with malpractice suits), and return regulation to its original purpose:
making the incentives provided by the health care system line up with the standard of care we want our doctors providing.
Switching to public health care removes some of those negatives, but it also destroys many of the positive aspects of the American system. Look at the British
system- doctors there have a specific required amount of patients that they are required to serve in a year. After they finish their quota, they are given no
material incentive to help any more patients for the rest of the year. The British, despite having more dentists per capita than America does, provide less
dental treatment per capita because the dentists finish their quotas early in the year, and take the next 6-8 months
off! That's a perverse incentive right there, and one that's a heckuva lot harder to fix than the problems we have in America!
Which requires the least effort- running everything yourself, or letting others run everything, and stepping in when they do something wrong? If your talents
lie in a different field than the setup you're trying to run, which produces the best result- running it yourself anyway, or letting experts do it for you?
If you're trying to build a bridge, you should have a civil engineer running the operation, because you'll get a strong, solid bridge. You
wouldn't put an artist in charge of building the bridge- at least, not if you wanted it to support its own weight when it was done. If you're teaching
kids, a teacher will have a better idea of how to run a school than a lawyer will; the teacher knows what teachers do, and what they need to do it, whereas the
lawyer would give the teachers at the school what he thought they needed, instead. So why do all these people want to
put clerks, lawyers, politicians and accountants in charge of health care? What experience do these bureaucrats have with treating the sick? What motivation
do they have to get it right? A doctor interacts with his patients face-to-face- why should we give bureaucrats, who don't see people, but statistics-
more authority than the doctors in determining what treatments to use and not use? If an American doctor screws up, and a patient dies because of it, it has a
direct negative impact on him. If an NHS bureaucrat makes a decision that kills 10,000 patients, will he even know? Wouldn't he be commended, or even
promoted, for cutting costs?
If I had a choice between entrusting my health to a first-year med school student, or putting it in the hands of a government agency, I'd choose the med
student every time.
My Unitarian Jihad Name is: Brother Atom Bomb of Courteous Debate. Get yours.
I've been writing a bit.