LDL&S: Health Care

LDL&S: Health Care February 19, 2008

“The death of one man is a tragedy, a million deaths is a statistic.” – Joseph Stalin.

It would be an exaggeration, though not a severe one, to say that in the modern west we are ruled by statistics. When government acts on a local level, it is relatively easy for it to see whether its actions are having their desired effect. And when business acts in a free market, there are feedback mechanisms which quickly let the business know how well it is meeting its customer’s needs. A large central government, by contrast, must rely on statistics to judge whether its initiatives have been successful. The problem is that is it often easier to manipulate statistics to show that a given problem is being solved than it is to actually solve the problem.

An example of this can be seen in the case of government run health care. One of the chronic complaints about the National Health Service in Britain, for example, is that people have to wait an unconscionably long time before receiving care. To deal with this problem, the Labour government mandated that patients receive treatment within four hours of arriving at a hospital. The result:

Seriously ill patients are being kept in ambulances outside hospitals for hours so NHS trusts do not miss Government targets.

Thousands of people a year are having to wait outside accident and emergency departments because trusts will not let them in until they can treat them within four hours, in line with a Labour pledge.

The hold-ups mean ambulances are not available to answer fresh 999 calls.

Doctors warned last night that the practice of “patient-stacking” was putting patients’ health at risk.

Figures obtained by the Liberal Democrats show that last year 43,576 patients waited longer than one hour before being let into emergency units.

I saw a similar example of this during the last election campaign. At a town meeting event, Tony Blair touted the Labour party’s achievement of ensuring that x percentage of patients in Britain were able to see a doctor within 24 hours. During the question period, he was confronted by several irate women, who had tried to schedule follow-up doctors’ visits a week in advance but were told that they couldn’t do so because of the government quota. Mr. Blair seemed genuinely shocked at this, but I wasn’t terribly surprised. People can be very creative when they have to be.

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  • TeutonicTim

    But I thought waving the magic wand of healthcare mandates fixes everything!

    It reminds me of governments that attempt price-fixing and create mass shortages.

  • While healthcare bureaucracy can be a pain (in Europe and here), I’ve never waited longer than 30 mins at an ER or urgent care and appointments are usually on time or just a few minutes off, both in San Diego and in NorCal, with Pacificare and Blue Shield, PPO and HMO. Back in Austria, waiting times were pretty much expected and could take a couple hours and more. Getting expensive meds approved isn’t automatic there either. And things are getting worse there, with people living longer and having hardly any children. The cushy entitlement state is creaking and croaking (of course it lived off of people like my Dad to begin with – 50% tax, and in return a capped pension, plus far lower salary than someone in his position would get here, probably 1/2 if not 1/3.)

  • radicalcatholicmom

    Gerald: You have to be kidding me! I have been at ERs in Dallas, Vegas, and in Anchorage and I have never had the experience you have had with such great health care. Maybe those who are most adamant about change are those of us who HAVE frequently used our medical system and find it broken, inefficient, and costly.

  • Gerald Augustinus

    Oh it is broken, inefficient and costly – but government healthcare isn’t the answer. It’d be nice if one could stay with a healthcare provider when one switches jobs. The current system of employment based care came out of WW II necessities. Over the decades, it turned into a jungle. I’ve frequently used the system in recent years and am very happy with the care itself. The administration is a different matter entirely. I do not want the European system here, one feels like an alms recipient instead of a customer and there is no option to get better care unless one pays for private insurance on top of the government’s.

  • Daniel H. Conway

    Been to the ER two weeks ago. There was a 10 hour wait. Gerald produces fine propaganda. Just not the truth.

  • M.Z. Forrest

    There is a sort of irony of complaints and public commentary over wait times being evidence of non-responsiveness.

    Having worked on the processing side of the system, I can tell you that private industry can be every bit as non-responsive. Presently the health insurers have been cutting back significantly on customer service, because they are losing money. This is to say that private industry has a couple of very crude impetuses for change: profit and regulation. Presently the profit signals are very weak due to the inability of businesses (and the lives themselves) being able to accept higher prices.

  • Gerald Augustinus

    I am reporting my personal experience, I can’t speak for others.

  • MZ,

    yes, due primarily to the employer supplied health insurance regime we are currently under, there is very little responsiveness. If people start paying themselves for service it’s certain that the process will begin to reverse itself.

    God Bless,

    Matt

  • Donald R. McClarey

    Central Illinois-Emergency room surgery for a child. Twenty minute wait last May.

  • M.Z. Forrest

    One would hope for good response times with roughly twice the expenditure per capita.

    Mr. McDonald,

    Not really. Compare phone service and utility service. See the history of schooling. Were there more or fewer children educated after schools were publicly funded? Heck, go back 60 years ago. Were there more hospital beds per capita or fewer hospital beds per capita then when medical services were primarily funded privately or today with employers and the government paying for many of the services? There is no reason to assume that any additional people who start ‘paying for themselves for services’ will act any differently then the people who presently pay their own way. They will disregard care for as long as possible. When they do need care, the debt will often be sent to collections. When the hospitals and doctors don’t receive money they will close or move elsewhere. See St. Michael’s in Milwaukee.

  • Morning’s Minion

    Like Gerald, I have received health care in both Europe and the US. In my case, my anecdotal experience bears out the statistics– I found health care in Europe far easier and less stressful. In the US, I am among the most fortunate. I have decent insurance. Even so, I need to constantly fight with the insurance company, constantly check thay I am not being cheated by them (they try it all the time), can never see a primary care physician in an emergency, can never get a appointment in less than 2 weeks, and have been forced to go to the ER for urgent care.

    In Europe, I never worrried about paying the bill, I always saw a family doctor when I was sick, and I could get faster appointments.

    Like I saif before, I don’t like arguing from anecdotal evidence, but since statistics seem lost of some people (reality-based community?).

  • Morning’s Minion

    As to the main point of this post: one of the biggest myths in ciculation is that waiting times are so much longer under single payer systems. One reason for this myth is that governments in such systems keep statistics, quite detailed in fact. No similar statistics exist in the US. And yet some people assume that the absence of a statistoic equals the absence of a problem. The survey evidence we do have suggests otherwise– Americans wait longer than those in comparator countries.

  • And when business acts in a free market, there are feedback mechanisms which quickly let the business know how well it is meeting its customer’s needs.

    What neither has though is a ‘fast feedback’ mechanism which makes them act morally. The market is very good at driving certain kinds of efficiency, but ‘good’ and ‘efficient’ are not synonyms.

    Also, customer’s ‘needs’ isn’t the right term, I don’t think. “Desires as expressed through actual purchasing behavior’, perhaps. The porn industry is very good at efficiently meeting its customers’ ‘needs’.

  • Zippy,

    you are correct, morality is not something that a free market enforces. That must principally come from religion, and in a very limited sense from government with due regard to the principles of subsidiarity.

    God Bless,

    Matt