Saturday, June 30, 2007

A post script on French health care.

Economist Don Boudreaux, whose blog I read regularly, mentions something that happened in the last couple day while he was in France. And it is directly related to my previous post on French health care.

Boudreaux was visiting the parents of a friend. This couple had acquired a new dog due to the fact that dog’s owner, a neighbor, had died. Here is how Don described the situation.
Conversation at lunch revealed that the neighbor, who had a history of heart trouble, suffered severe chest pains a few weeks ago. He wisely went to the hospital seeking treatment. He was told that there was no space available for him. He was advised to go home and call back later to see if a room might have become available. He did so, but was told repeatedly that the hospital remained full to capacity. Several days later this man died at home, never having received hospital treatment.
Don notes that this anecdotal though true and then points out the real lesson, “merely declaring, statutorily, that every citizen has a right to health care, or that health care is ‘free’ to every citizen, does not make health care available to all or ‘free.’”

That is the point I keep trying to drive home. But some people see a condemnation of nationalized health care as an endorsement of the US system as the alternative. The US system is NOT the alternative. It is the most regulated, state controlled segment of the American economy around. I have never defended this bastardized hybred created by decades of politicians substituting their own decisions for those of consumers.

The point I am making is that the nationalized, politically-controlled health care systems that are proposed by ideological socialists and frauds like Michael Moore are much, much worse than those people will admit. I have lived in four countries with nationalized services and in the United States so I have some point of comparison. And I grew up around hospitals since my mother was a nurse.

Yes, socialized health care is cheaper but anyone can do that by using the same methods they use. They tend to refuse treatment to some patients for various reasons. They tend to refuse certain procedures or treatments. What care they do offere is often only available to those who wait long enough (or live long enough as in the story above). They tend to underpay their staff. Some systems do one of the above, some do more than one. But it is easy to cut costs if you deny care and every nationalized system denies care one way or another.

Again that doesn’t mean the US system couldn’t be cheaper than it is. It could be. The incentives in the US system are screwed up due to the distortions created by all the political tampering over decades. And some of those distortions encourage people to spend money needlessly. In addition we have the problem of the trial lawyers who have turned medicine into a risky business. These vultures swoop in and raise the costs dramatically.

Consider a patient who has a 99% chance of having one problem and a 1% chance of having a different problem. The physcian is fairly confided it is the first problem. Tests for the second problem might cost $200. If he orders them he raises the costs needlessly in 99 out of 100 cases. If he doesn’t order the test in the 1 case out of 100 where warranted he can personally be sued for malpractice. To interacting with the vultures he orders tests he knows will be useless most of the time. But the cost for those tests don’t come out of his pocket but they do drive up health insurance costs for everyone. And he knows the malpractice suit will cost him money. The legal systems basically creates incentives that forces him to order tests he knows will be useless just to cover his own ass.

It is this sort of thing that simpletons like Moore don’t consider. The US system needs changes. But before those changes are made people need to understand the perverse incentives that currently exist . And that means knowing something about economics. Unfortunately none of the major politicians screaming for health care reform seem to have taken economics or understand it. Certainly Hilliary and Obama are clueless. And Michael Moore, he has shown a repeated reckless disregard for facts.

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