[ExI] public health care (was re:Dogs of immortality)

[Tom Nowell]

2008/7/16 Lee Corbin <lcorbin at rawbw.com>:

> It's called socialized medicine. First, by taxing the bejesus
> out of everyone, only the very rich will still be able to afford
> private health care, private doctors, and private hospitals.
>
> The rest of us will just have to take a number and pray.

Well, I hate to break this to the lovers of the US free market system, but unless you're rich, you *are* taking a number and praying. After all, your insurance will probably insist you go to an "approved healthcare provider", and make an appointment with them. Your doctor's treatment will have to conform with what your HMO is likely to pay for, and they will be aware that if they want to do anything new or expensive there's a risk it won't be covered.
 Also, when you get that emergency treatment or get cancer, you need to pray your claim won't be declined. There you are, finding you or your family in a medical crisis, you go for treatment as fast as possible and submit the paperwork to the insurance company. Unfortunately, some lovely person in the claims department* has to follow company rules and decline you due to something in the small print. You are left massively out of pocket, unable to get further treatment without paying for it and are busily complaining. Sure, it might get overturned on appeal or your lawyer might be able to sort it out, but that can take months. Months in which you're out of pocket and medical treatment is continuing at a snail's pace. Why do you think US TV dramas keep featuring "oh my god! Jimmy's car accident treatment isn't covered by the insurance!" as a plotline, if it wasn't something their audience could relate to?

Another point on healthcare: all medical systems are constrained by factors other than the best evidence. Taking the jokey Christmas issue article of the British Medical Journal
http://www.bmj.com/cgi/content/full/319/7225/1618
as my text, there are several confounding factors:
Nervousness based medicine -Fear of litigation is a powerful stimulus to overinvestigation and overtreatment. In an atmosphere of litigation phobia, the only bad test is the test you didn't think of ordering.

and from the letters in reply, a researcher in Heidelberg's unit of cybermedicine wrote: One alternative - which may be especially prevalent in private practice and fee-for-service based remuneration systems - is definitively profit-based medicine (also known as opulence based medicine): The conscientious, explicit and judicious use of the most profitable and lucrative interventions when making decisions about the care of individual patients.

Tom

*the people in claims departments are often lovely. As an underwriter, I've worked with many people in claims departments and got on well with most of them, but I wouldn't have the heart to decline people's claims on some of the arguments used by companies I've worked for.


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