Tuesday, July 27, 2004

The Monger and Medical Economics

I am extremely heartened to see that The Monger (M.D.) has weighed in with some analysis of Our Treasured National Identity, i.e. the health care system, at least in part spurred by my post regarding supplier-induced demand yesterday.  It is lengthy and rather awesome.

His biggest objection to my take was that it views our present system as an axiom, "a metaphysical reality to which we must all adjust, like gravity."  Hell, that's as well as I've ever seen the present political reality articulated.  Anyway, no:  I was intending to refer to publicly provided health care, regardless of whether it is the only, or even the biggest, game in town.  We seek to control or limit demand for most government benefits, welfare for instance.

But to be clear from my end:  the fact that our governments seek to disallow, discourage, and restrict private trade in medical services between willing consumers and providers is a bloody abomination, which not only weighs down the public system, but is an indefensible restriction of our rights and freedoms.  The fact that every last "mainstream" proposal to reform the system from within further reduces our freedoms underlines this cruelly.

You'd better believe I don't want Citizen Monger or health bureaucrat Bob determining which of my health care demands are reasonable.  I don't even want Public Physician Monger making that determination.  The only things that they should be permitted are a say in A) which demands should reasonably be paid for by a public system, and B) how soon I should receive my public treatment.  If I don't like their assessment of the situation, I should be able to go spend (or waste, as you like) my own money on the treatment I believe is appropriate. 

This would arguably mean that the rich get better health care.  Great, who cares, it happens already, whatever.  As long as the poor are getting good health care, it don't mat-tah.  As The Monger alludes to, if the rest of our society was managed like health care, we wouldn't be able to buy steak or Cadillacs.  Private security systems and personnel would be illegal, because they mean the rich might be safer than everyone else.  It is absolutely insane.

The other point The Monger makes is that I don't give enough credit to physicians under the present system for considering the costs of their decisions, and the point is taken.  There is an aspect of professional pride which, for example, dissuades Doctor X from sending every last patient with a headache for a CT.  Doctor X wants to be perceived as competent and able, and thus is reluctant to bombard his specialist colleagues with referrals which may be frivolous.  There is also the issue of concern for their (and all) patients as a group; Doctor X doesn't want one patient who really needs to see Specialist Y to be stuck in line behind another patient whose need is less obvious.  This reality of rationing should not be dismissed by me or anyone else; faced with such a reality, I should think medical doctors are as reliable a profession as any at apportioning limited resources.

The Monger's frustration with the system (and as such with his de facto only possible Canadian employer) just about jumps off the screen.  I feel for him, and it looks like we agree that the system is the problem, far moreso than any particular aspects of it.

On the whole, I still believe just about every problem with our public health care system leads back to this:  the government has got to give up the notion of equal health care for everyone, and focus on good health care for those who need it.  Once this jump is made, and the lies stop, a lot of the "problems" with our system will sort themselves out. 

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