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October 12, 2007

The Achilles Heel of Health Care Finance Reform

medical%20finance%20101207.jpgIn an interview years ago, the late Milton Friedman summed up the basic problem with a nationalized system of health care finance:

There are four ways in which you can spend money. You can spend your own money on yourself. When you do that, why then you really watch out what you're doing, and you try to get the most for your money.

Then you can spend your own money on somebody else. For example, I buy a birthday present for someone. Well, then I'm not so careful about the content of the present, but I'm very careful about the cost.

Then, I can spend somebody else's money on myself. And if I spend somebody else's money on myself, then I'm sure going to have a good lunch!

Finally, I can spend somebody else's money on somebody else. And if I spend somebody else's money on somebody else, I'm not concerned about how much it is, and I'm not concerned about what I get. And that's government. And that's close to 40% of our national income.

However, even more troublesome than the illusion that A will get top-flight service from B when C is forced by government to pay the bills, who is going to provide the health care under such a system?

Posted by Tom at October 12, 2007 12:05 AM |

Comments

Greetings from Canada, eh!
Seriously, I am attending the Family Medicine Forum, Canada's national Family Medicine conference in Winnipeg. Patients in Canada have wait times of 3-8 weeks to get a new patient appointment with a Primary Care doctor- because no one is going into primary care. Medicare patients , like my own grandmother, can not find new doctors when they move because no one wants to take new, difficult patients at $45-90 per visit. You lose money that way. Large group practices make money off of ancillary services- radiology, derm procedures, and the like. Our system (and Canada's) do not pay enough for doctor's to do primary care full time. The pay isn't there. So the ones in primary care work insane hours to keep up with demand and they burn out. The Canadian goverment is trying to increase funding for primary care, but docs are retiring faster than they can be replaced.

On a related note, most of us do not take CHIP because it pays 40% of what private insurance pays, and we'd go broke if we saw too many CHIP patients. I'm not exaggerating. I don't see any Medicaid patients because they've lost my application 3 times.

Posted by: Kenneth Author Profile Page at October 13, 2007 8:01 PM

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