OK, so I\u2019ve gotten some pushback from my modest number of readers (small gripe about the BlogSpot platform:\u00a0 I can\u2019t get it to register the instruction to not track my own pageviews, so I don\u2019t know how many real people actually read my writing \u2014 but I suppose any number, however small, is enough to keep me honest and focused on writing for an audience) about whether the state has any responsibility with respect to its citizens basic needs.\u00a0 But I\u2019m going to bracket that for the moment; maybe I\u2019ll return to that topic and work through that later.<\/p>\n
For the time being, let\u2019s take it as a given that the state should be concerned with\u00a0its citizens\u00a0access to\u00a0and ability to purchase healthcare services.<\/p>\n
What\u2019s the best way to do it?\u00a0 <\/p>\n
The easiest approach, and the one chosen by most countries, is some variant of \u201cMedicaid for all\u201d on a single-payer or provider reimbursement model.\u00a0 I use \u201cMedicaid for all\u201d deliberately rather than the usual formulation of \u201cMedicare for all\u201d since in practice, there end up being two types of providers:\u00a0 those who accept the fixed reimbursement levels as payment in full and those who either require supplemental payments or who operate outside the national healthcare system entirely, with patients paying privately or via private insurance.\u00a0 As far as hospitals go, there are ward (or 3- or 4-bed rooms) for national health insurance participants, and private rooms for privately-insured payments.\u00a0 And there are private hospitals\/clinics which only accept private-pay\/privately-insured patients.\u00a0 The waiting lists for procedures, the horror stories of poor treatment, and\u00a0the \u201cLiverpool Pathway\u201d in which the terminally ill (or maybe those who are just elderly) are put on a fast-track to death, are all a part of the national healthcare system \u2014 in such countries, the private system (which can be entirely separate, where you pay full costs, or just require upgrades at additional cost) gets you to a much more pleasant and civilized healthcare system.\u00a0 <\/p>\n
This system has advantages \u2014 everyone has at least a minimum level of healthcare in a cost-controlled fashion, with the limitations and undesirability of the national healthcare system motivating people to move into the private system.\u00a0 It is, I suppose, like the difference between Cook County (now Stroger) Hospital and the amenity-laden all-private-room new hospitals through the area.\u00a0 It would be similar to a \u201cbeans and rice dispensary\u201d approach to providing food to the poor:\u00a0 get all the beans and rice you want free, and pay for your New York strip steak.<\/p>\n
With respect to doctors, the system wouldn\u2019t be that difficult to implement:\u00a0 set a reimbursement level that keeps enough providers in the Medicaid-for-all system to handle the inflow of patients, but low enough to produce wait times and other access limitations as well as ensuring that the providers\u2019 offices are just a little dingy and the receptionists a bit grumpy, so\u00a0that anyone that can afford the private system chooses to pay for it.\u00a0 For hospitals, the answer isn\u2019t as clear \u2014 far too many hospitals have been on a building spree, and I\u2019m not really sure what would happen if \u201cMfA\u201d were to be implemented, with smaller reimbursement rates and an expectation that they would have to pare down the amenities rather than expect private-pay patients to cover the gap, in the way that now happens with Medicare.\u00a0 Of course, part of the \u201cMfA\u201d hospital cost control would be restrictions on availability of procedures in the first place.\u00a0 Oh, and medications?\u00a0 Generic only.\u00a0 <\/p>\n
Regardless of whether this is a good idea or not, ould this work?\u00a0 I don\u2019t know.\u00a0 Would Americans accept it?\u00a0 \u2014 that is, would Americans accept a system of free\u00a0deliberately-minimal healthcare provision for all?\u00a0 I don\u2019t know that either.\u00a0 Readers, what do you think?<\/p>\n<\/body><\/html>\n","protected":false},"excerpt":{"rendered":"
OK, so I\u2019ve gotten some pushback from my modest number of readers (small gripe about the BlogSpot platform:\u00a0 I can\u2019t get it to register the instruction to not track my own pageviews, so I don\u2019t know how many real people actually read my writing \u2014 but I suppose any number, however small, is enough to […]<\/p>\n","protected":false},"author":2209,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-928","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"yoast_head":"\n