It is incorrect to say that B (the delivery system) is inefficient. I say this becasue about 20 years ago it was decided that the delivery system would become privatized and the units of decison making would be broken down to look like small businesses … and the HMO was born. Market forces then went to work and made the delivery system perfect, or nearly perfect.

Or did I miss something?

Health insurance implies a fee-for-service model, which is not even close to the only option.

We could, for example, have all medical practitioners be salaried public employees who provide services without regard to payment.

Hell, there could even be a ‘medical priesthood’ who support themselves on donations (and owning valuable land and spiritual blackmail). Works for the Catholic Church 😉

One could call these forms of insurance, but that is really stretching the meaning of insurance.

Insurance smooths out some of the edge conditions with a market based allocation of resources (such as “the house always wins eventually” effect). However, markets are not the only way to allocate resources. In some cases such as natural monopolies, commons, and I’d argue healthcare, markets don’t work well even in theory.

Then please tell us – what are these several other ways to improve the system, that don’t involve what amounts to public health insurance?

The problem of paying for services is an availability and delivery problem.

Alan Kellogg –

I would rather have limited options, than no options at all. I can’t afford insurance and were it not for the fact that as a student, I get care through the school clinic cheap – I would be in a lot of pain – as it is, I have been spending a great deal of money just to stay on meds. Now that I am using clinic services it will be much more affordable, but that doesn’t translate to a comprehensive coverage situation.

I would be absolutely thrilled to have medicaid level coverage. Not having to live in fear of what I will do if something horrible happens – not having to fear racking up more massive hospital bills, should I need emergency care – I would happily accept some rationing for that peace of mind.

Health care includes availability and delivery. A country has sucky heath care if only the aristocracy can access it. The aristocracy might have great health care, but the country, no.

Health insurance reform assumes we have a health insurance system. That isn’t even necessary to have a health care system. (Yeah, you can play with the definition of insurance to expand it beyond recognition, but the point is clarifying the issue.)

The US has pretty good healthcare providers (doctors, nurses, ect). We have pretty good medical technology. In the aggregate, we have crappy and inefficient delivery of those resources. That is a bad healthcare system. Health insurance reform *may* be one of several different ways we could improve it.

Because I depend on Medi-Cal to cover the cost of my health care there are services I can’t take advantage of. Services that won’t accept Medi-Cal because Medi-Cal won’t pay enough to cover them. My medical care is already being rationed by a government program, don’t think it can’t happen to you.

Talk with medical professionals in your town, ask them about your state’s Medicaid program and the fees it pays for services rendered. Ask them if Medicaid where you live covers the cost of medical treatment or not. Don’t be too surprised if the answer is, “No.”

Insurance companies have put themselves in a standoff situation where picking up populations of sick folks would put them in a very weak competitive position. They can’t get out by themselves and their marketing methods promote the status quo. It’s not as if they can’t make money. Insurance functions no matter what is in the bag.

On the other hand, what can you say about delivery organizations that hire specialists who alter a database to bill all bedpans as “sterile” so as to get twice the payment? It isn’t exactly a lie, but by the time they are delivered, it is not exactly true.