A health care debate

My good friend Jody Tompson and I agree on football (we’re both Cowboys fans) and beer (we both like it), but not usually on politics. We started this debate on Facebook, with Jody’s post about wait times…

Jody waiting at the DMV….will the doctors’ offices be like this someday soon?

Ted

Now seriously, Jody, how long did you ever wait in a doctor’s office in New Zealand?

Jody

I never went to the doc in NZ. But Abby’s birth was botched and I know ppl who were on waiting lists to have urgent care conducted…like a hernia surgery.

Ted

Okay, we both know we’ll never agree on this! But here goes… I’ve been to the doc at least twice a year for 14 years and have never waited more than about 20 minutes. I can get an appointment the same day, no one asks about my insurance, and it costs 35-45 NZ dollars for a typical visit–about 25-35 US$. Most prescriptions cost $3. And NZ is far from the best example of universal health care, according to international studies. Unfortunately, doctors botch operations occasionally in every country. And of course, what’s rarely said in this debate is that having a public system doesn’t rule out also having private insurance, which we (and about 30% of NZers) have, and which takes care of the wait list problem for those who are worried about it (and costs me about 110 NZ$ per month for a family of 3–one fifth of what it costs me in 1996 in the US). No system is perfect, but the wait list issue is not really that hard to deal with. Ultimately the US pays more than any other country for health care and gets less than stellar health outcomes, especially if you happen to be poor in the richest country in the world. There’s got to be a better way. Your turn… 😉

Jody

We can think of failures and successes in any system. And the waiting is often a symptom of the individual practice, not the whole system. I agree with your last sentence…there probably is a better way. For me, the main issue is this: it’s not the govt’s job to intervene here. It’s not the govt’s job, and the govt is not any good at these things. Schools? not so good. Post office? Nope. DMV? Hardly. Medicare? More fraudulent than ever.If I buy 6 new TVs and fancy cars and a house I can’t really afford…then can’t pay my mortgage, will you bail me out? The govt is insisting that you should.

And will you subsidize my medical care after I neglect my own health?

The better way is how Whole Foods Market is doing it now.

Ted

I liked the Whole Foods article. I’d be happy to see some of those ideas enacted. Some of them would certainly help, but they won’t solve the problem on their own.  It’s great what Whole Foods is doing. But do you think Walmart might follow suit? I doubt it.

The thrust of Mackey’s argument is pretty standard neo-liberal economics: cut taxes, deregulate, and trust the market to solve the problem. How’d that work out in the banking and finance sector? Or the energy sector (ask Enron’s stakeholders). The market already has more freedom to operate in health care in the US than it does anywhere else in the world and what are the results? Systematic practices to deny claims, deny coverage to those who need it most, the most per capita costs for health care in the world with mediocre results.

I understand your skepticism of government-run programs. But you and I both study organizations, so I hope you’re not going to argue that only government organizations are guilty of inefficiency and fraud. Dilbert wouldn’t be funny if that were true!

Ultimately you want to trust the private sector and not government.  But it doesn’t have to be an either-or choice. I like having the choice between the post office and the private alternatives and use them both. I’ve sent my daughter to both public and private schools and both have been excellent. (I went to only public schools and have few complaints). And, people in Medicare are more satisfied on the whole than those in private plans. The market has its place, but it’s not a panacea, as numerous studies comparing private and public sector service industries show.

Not the government’s job to intervene? When the biggest cause of bankruptcy is medical debt? When 15% of the population have no health care insurance? What’s the government’s job if not to address systemic problems like these?