[lit-ideas] Re: The flu

--- Robert Paul <Robert.Paul@xxxxxxxxxxxxxxxxxx>

> Why doesn't the US have a national health plan?
> Because it clings to the notion
> that health care fits the simplistic supply and
> demand model of traditional
> capitalism.
Yes, I know that disease. I guess the basic problem is

On the one hand those running the system have no
incentive to keep costs in control. For a counter
example, we passed the generic substitution here a
while ago, and while I'm not quite sure our
politicians are any less corrupt than yours, the fact
that they have to actually come up with the money to
pay for most of the drug expenses keeps them somewhat
honest. That is drug companies moaned, whined and were
told to deal with it.

On the other hand, the problem is neo-classical
economics. The theories basicly assume that if you
have various parties like healthcare providers,
insurance companies, employers, state and federal
govenment and so involved, the cost overhead is
marginal. Even economist have figure out it doesn't
work like this in general, google transaction costs.
This applies to healthcare in particular:

"In 1999, health administration costs totaled at least
$294.3 billion in the United States, or $1,059 per
capita, as compared with $307 per capita in Canada.
After exclusions, administration accounted for 31.0
percent of health care expenditures in the United
States and 16.7 percent of health care expenditures in
Canada. Canada?s national health insurance program had
overhead of 1.3 percent; the overhead among Canada?s
private insurers was higher than that in the United
States (13.2 percent vs. 11.7 percent). Providers?
administrative costs were far lower in Canada."

The above is a quation from much reported study on the
difference between Canadina and U.S. healthcare costs
(Woolhandler et al, N Engl J Med 2003;349:768-75,
The thing to note apart from the obvious is the
difference in overhead between private and national
health insurance.

Free enterprise is a wonderful thing, but the best
thing it has going for it, the ability to responed to
changes in demand just isn't that important when it
comes to healthcare. The demand is that people get
healthy, period. I am sure there is rooms for
different treatments, but still it is not as if we
have several altermative brands of healthcare. The
other thing is that personally, as a consumer, I have
no capacity what so ever to judge between different
treatments. I mean I can weight the pros and cons of
alternatives the doctor explains, but I don't have the
capacity to make an informed decision on whether the
doctor is reliable to begin with. I can of course get
a second opinion, but how can I compare them?

This might be chancing though. Those with chronic
conditions usually become experts at it. Laurie
Cubbison (I hope I got the name right) who did a PhD
on the subject once argued (on-line, FOP-L I think)
that the internet has enabled sufferers of even rare
conditions to get together and inform each other,
which has serious implications to power and knowledge
relation between doctor and patient. That is implies a
partnership between them.

Other intresting development is the increasing
digitalization of medical records. There are some
sound cost and quality issues driving this, that
medical staff has instant access to your medical
history not only means they can treat you better, but
also saves time and money. Many tests for example are
done unnecessarily because previous results were
unavailable. But this combined with cheap tests also
opens up the option of more thorough information on
your own health, for example you could track your
hormonal levels and so on. (Honey, it's not me
yelling, look at the graph!) I don't know if people
want to do this, for example pathologists routinely
find tumors and other conditions that have simply not
given any symptoms, but if they do it points to a move
to a more personal healthcare and ultimately to a
radical change towards our thinking of our health.
Does know thy self imply know thy body?

Helsinki, Finland

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