Hybrid Health Care?

In case you didn't know, in the next few years there is going to be a major battle over the future of health care in the U.S. If a democrat is elected president, some sort of large scale, universal (almost) system will be proposed. The battle between the drug/insurance companies/republicans and the democrats on this issue will be huge.

I just watched Michael Moore's Sicko this weekend. While the juxtaposition of the "perfect" health systems in France, Canada, and Cuba to the "hellish" one in the U.S. was a bit oversimplified (you can likely find people with health care horror stories in any country), Moore does bring up some very good points.

One of these is that the interests of health care organizations and especially drug companies, which are desperate to be profitable, in the U.S. are diametrically opposed to those of patients. A patient wants the system to spend as much money on him/her as possible, while an insurance organization, especially one which is publicly traded, has an incentive to spend as little on the patient as possible and to seek reasons to deny care. This point is insightful because, whether or not health care functions better in the U.S., the system is still set up in an adversarial way. Instead of feeling like they are cared for, patients become the opponents of the system that is supposed to help them get well. When you walk into a doctor's office in the U.S., the first thing you think of is not "How am I going to get well?" but "How much will this cost?" and "I know I am going to get screwed!"

Another interesting point Moore brings up, which lies at the center of his argument, is that not all industries function better when privatized. As examples of "socialized" institutions, Moore gives the U.S. postal system and the public school system. I would agree with him that both these institutions are public, but they coexist alongside private organizations which offer similar and often higher caliber services. Fed Ex and UPS are superior to USPS, but also more expensive. With respect to education, private schools at all levels are quite often (not always) superior to their public counterparts. Of course, like good health care, excellent private schooling is only available to those with money and excellent public schools are usually found in high income areas.

My guess is that a new health care system in the U.S., if it ever comes to pass (and that is a big IF), will likely be similar to the differences between public and private schools. The wealthy will continue to have private health care and will get the "best of the best". At the same time, the rest of the country will have a public system with a mixed level of quality (a small number of very good facilities and large number of mediocre ones)...but at least it will be mostly free. It is unlikely that drug costs will go down anytime soon though.