After reading Vennochi this morning, I keep thinking about the “bigger is better” mantra that is pushing nationalized health insurance.
Bigger doesn’t always bring costs down. And people don’t always flock to bigger. How do they decide?
In MA, we’ve made health insurance bigger, but it hasn’t had any impact on costs. If the problem was the increase in health insurance costs, for the state and the individual, mandating insurance didn’t solve the issue. This was a no-brainer. We could have simply compared our mandated car insurance costs to realize to realize that insuring in MA is more expensive than other states. But let’s not look there.
If bigger is better in terms of bringing down costs, why not embrace the regionalization of school districts and municipal government? In other parts of the country, superintendents receiving comparable salaries for managing districts that are ten times the size of our own. Ditto for much of municipal functions — highway, tax collection, assessment, etc..
And if bigger is really better, why don’t the countries of the EU move to create one massive EU health insurance pool? That analogy would be much more akin to what the U.S. would undertake in creating nationalized health insurance. It would be closer to the numbers of people, closer in economic diversity of regions, closer in trying to put under one umbrella a system that is unique in each state, closer in terms of the undertaking of centrally managing a system of that magnitude.
I suggest that part of why people think bigger health insurance is bigger but bigger school districts aren’t is driven by emotion. There’s a corporate identity to blame in health insurance that blinds them from the fact that they are asking for an even bigger more nameless/faceless government identity to take its place.
In schooling, paying more is seen as a good thing because it delivers more services. But paying more for health insurance is now demonized. Why? Compared to the world, we spend the most in both categories.
As we’ve found out in MA, selling a plan based on projected savings is risky business. Health insurance pushers need to do a risk assessment and ask themselves, if the worst of the predictions came true — long waits, no cost reduction, no quality improvement — will it have been worth it?
Consider that if and when nationalized health insurance fails it’s very difficult to go back. Look only to public schools which are failing the poor, and the resistance of the left to even the most modest privatization attempts such as vouchers.
Sources:
http://www.boston.com/bostongl…
Can economies of scale and other efficiencies be realized by a bigger operation? Yes. But all too often, the management of these enormous operations is less than optimal, oversight on autopilot, quality control non-existent, accountable to no one…and then you have just one gi-normous bureaucracy providing half-assed service, and arrogant enough to call it “quality.” The key is management.
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What would you suggest as an alternative?
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p>Which country has the best model for the US to emulate?
I don’t think anyone arguing for healthcare reform is arguing that the bigger it is, the better it is — or that the slogan “Bigger is better” should be applied Stalin-style to all aspects of life.
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p>What is clear is that we pay 6% more of GDP than most other advanced industrialized countries. Our healthcare is certainly not better and there’s significant evidence it is worse.
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p>There are other factors at play when it comes to cost. My reading of the article to which I’ve linked is that this happens when medicine becomes more of a business and less of a profession.
The cost isn’t on the insurer’s side, it’s on the provider and consumer side. Insurers can drive down the cost of care IF they have the market clout and the wherewithal to use that clout. Bigger insurers have the market clout, but bigger means fewer insurers and less competition, so less incentive to reduce those costs.
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p>As long as we only focus on how we pay for health insurance, and not on how much or what we’re paying for, the costs will continue to escalate. There is a lot of expensive technology and people in the system that someone has to pay for, or purge from the system. The only way to make money to pay for all these expensive things is to either charge more or crank up the volume. And crank up the volume we do.
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p>These are “other factors” in the article KBush cites.
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p>Squawking about increased waiting times, lack of access, or less care is a red herring. Countries with a lot less of this stuff than us are healthier than we are. Perhaps it’s not a question of how long do we have to wait, but why are we waiting at all?
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p>Does all this expensive “stuff” make us healthier? Are we?
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p>When we reform the providers and WE CONSUMERS we will have healthcare reform, and paying for care may not be so big a problem.
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Many people die each year from diseases they caught at the hospital. Despite that, doctors often have a profit incentive to order procedures and patients are often anxious with choices like observation, diet, exercise, rest, etc. and prefer that the doctor do something. The result is bad risks for patients coupled with increased healthcare costs.