[ExI] How to get a healthy country

J. Andrew Rogers andrew at ceruleansystems.com
Wed Oct 17 08:16:09 UTC 2007

On Oct 17, 2007, at 12:00 AM, Damien Broderick wrote:
> quoting from somebody on another list:

I appreciate the anecdote, but it does not recommend anything.  I'm  
not against universal healthcare per se, I'm just against replicating  
every bad mistake made in other universal healthcare systems.  Most  
proponents of copying various socialized medicine systems from other  
countries tend to willfully overlook the serious downsides to those  
models which does not help their position.

On the purely anecdotal level, I grew up on "free" US healthcare so  
it is not exactly a foreign concept to me.

My study of the subject leads me to the following "facts" of sorts:

- US-style healthcare is economically inefficient in many ways

- European-style healthcare delivers relatively poor outcomes  
compared to what is possible

- Both the US and European models are considered fundamentally broken  
by economists for different reasons, and they suggest new models that  
no one is using.

- US healthcare delivers significantly superior average outcomes that  
set the benchmark for absolute quality

- European healthcare delivers significantly more even access to  
treatment at less cost

- The average health of citizens has almost nothing to do with  
healthcare access, as that is primarily a function of lifestyle

We can do a lot better and it does not involve copying someone else's  
crap system.  The world needs a system that is willing to invest in  
maximizing outcomes like the US, but without the byzantine  
inefficiency and conflicting incentives.  The world needs a system  
that is more accessible like Europe, but without sacrificing  
improving average outcomes to rationing and equality of access.

Moving the US system to a European system would be a disaster because  
it destroy average healthcare outcomes and would kill a lot of people  
needlessly.  Also, the entire world benefits from the amount of  
research the US actually does toward improving outcomes, so  
disincentivizing the US would be bad for everyone.  At the same time,  
there is no reason whatsoever for countries with European style  
healthcare to copy the inefficient and byzantine structure of US  
healthcare; it is not the inefficient and byzantine parts that  
produce the superior health outcomes.

In short, show me something better rather than differently broken.   
In the particular case of the US there is some value in maintaining  
an incentive structure that tends to improve outcomes even if it is  
grossly inefficient as currently implemented, primarily because there  
is no one else waiting in the wings to pick up the slack if the US  
stops investing in this.  If a major European country switched to a  
US-style system it would be no great disaster, but if the US switched  
to a European-style system it would affect everyone.


J. Andrew Rogers

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