Toothache Update and Private v. Public insurance
by Kevin

Natalie Solent and Jeanne were kind enough to offer their condolences on my toothache, and to wish, in Natalie's words, that "has" has become "had". Unfortunately, the dentist seemed to have made the situation worse. On the plus side, the pain has made me surly, so people are staying out of my cube, and I am getting more work done. So that's good.

Natalie also pointed out horror stories from the British Medical System, and this rather even handed, if depressing, look at how the British Medical System performs overall.

The thing is, I am still not convinced that private medical insurance is inherently superior to public medical insurance. I am perfectly willing to admit that the British system is terrible. But the French, the German, the Swedish, etc systems seem to work well. My point is not that public insurance will be a panacea - only that private insurance is not. The number of uninsured working people in this country is growing, the cost of medical care is rising again, and choice is largely a memory. We have many of the same problems that single payer systems (long waits, frustrating bureaucracy, limited access) have, and we don't even manage to insure everyone. I am not wed to the idea of public insurance. I am wed to the idea of a system in which everyone receives decent, timely, effective health care. I think the benefits to society and the economy would be enormous. I am open to being convinced that private insurance can produce such a system, but at the moment, I do not see how it can. The profit motive discourages covering people who truly need insurance, it discourages expensive treatments, it discourages any treatments, frankly, and it requires that money that could have gone to medical care be spent on duplicated bureaucracy and profits. I understand the argument that "efficient" private businesses will do things to encourage preventative care, negotiate better deals with drug companies and hospitals, and generally manage patient care more efficiently, thus putting a brake on costs without cutting services. That may even happen, to a certain extent. But its also the hard way to make a profit. Running a business well takes work. In insurance, it is much easier to refuse insurance to truly sick people, pay doctors to limit treatment, deny care and ride out the appeals process, shift more and more of the costs unto employers, and use contractual loopholes to get out of paying claims. And, as anyone who has spent five minutes in corporate America can tell you, making money is the goal. How one makes the money is not often addressed.

Yes, some public insurance systems are crap. Yes, some private insurance companies do things the correct way. But they are the minority, and the problem appears to be structural. I do not see how to correct the problems facing the American health system while still working under a system in which profit is the motive, and the easiest way to make a profit is to limit choice and care.

| Other weblogs commenting on this post