Once again the real world is overwhelming my active participation in the blogosphere. Before I leave again for that real world I’d like to drop a thought for consideration.
The U. S. healthcare system is absolutely enormous and unfathomably complex. Within its boundaries it includes examples of nearly any approach to delivering healthcare services anywhere in the world and, frequently, at sizes that rival those approaches elsewhere. Most of us are probably aware of the fee for services model—it’s the approach to healthcare delivery that most of us encounter on a day to day basis but it isn’t the only approach.
We have not just one but several fully socialized healthcare systems. The largest is the Veterans Administration healthcare system. With spending of $96 billion per year it’s about 2/3’s the size of British National Health. There’s also the Indian Health Service. At roughly $4 billion dollars per year it rivals many other countries’ complete healthcare systems.
HMO’s frequently employ capitation systems. That’s a system under which healthcare providers are paid based on the number of patients they treat rather than what services they perform for these patients per se. Capitation is essentially the system that Italy employs.
The federal government’s employee healthcare system and the Medicare system approximate the single-payer system that some people advocate for the United States. France and Germany both have systems that can in rough terms be considered single-payer systems paid via payroll deductions.
As you can see within our singular system we encapsulate nearly all other systems. What baffles me is that, for some reason or other, the idea that an employer-based private insurance fee for service system is the system we have in this country. But that’s just part of the elephant not the whole elephant.
I think I may have mentioned before that in my real life over the years I’ve had clients who were individual physicians, hospitals, pathology laboratories, big companies, small companies, insurance companies, pharmaceutical companies, and companies that manufacture medical equipment and that the normal course of my business causes me to look at my clients’ books and gain some sort of understanding of how my clients’ businesses actually work. I can’t claim to have a clear view of the whole elephant of healthcare but I’ve learned the views of those who see the trunk very clearly, the ears very clearly, the legs very clearly, and so on and, as a consequence, I think I have a pretty good idea of the general outlines of the elephant and a few flashes of great clarity now and again.
Given that experience and viewpoint I’d like to give you this to chew on. Despite its many good even great qualities our system is looney. There’s no conceivable way that everybody can get all the healthcare they want and healthcare providers can get whatever they want for providing it. Furthermore any system in which the government with its deep pockets and regulatory capability bids against private individuals for healthcare services is neither good nor sustainable. It’s a flywheel ready to spin off.