Monday, October 29, 2007

I hope this destroys any illusions about single-payer

This morning, the blogosphere is abuzz about a report that tens of thousands of Brits who are fleeing the UK's socialized health system because of wait times, quality, etc.

Now, I have said before, here and here, amongst other places, the US healthcare system has deep flaws of its own, resulting in costs that are way out of whack. Additionally, there are relatively few advocates of a true single-payer system in the US- with even Hillary backing away from single-payer, the debate is now centered primarily on different ways of implementing universal coverage more generally (thankfully, most of the approaches at least pay lip service to being "market based"). Nonetheless, I would hope this report is a death knell to the arguments advanced by Michael Moore and others (and believed by those deceived by "Sicko") that socialized medicine works.

Still, a proponent of single payer can legitimately make the argument that the report only tells one side of the story, that it represents a relatively small portion of the Brit system, etc. However, even more telling to me than the report itself is this online discussion of the report. I find the discussion more telling because it reflects the actual opinion of a fairly good cross-section (it seems) of Brits (and expat Brits) about the overall state of the British system. You will notice a near-universal dissatisfaction with the system- these are not the "happy patients" you will see in "Sicko." One other thing you will notice is that there is not a single person suggesting that the system is underfunded (unless you include those complaining about the failure of poor immigrants to pay into the system).

One of the more illustrative quotes about the downside of socialized medicines (and really, socialized anything) comes from someone trying to defend the British system:

People who go abroad are playing into the hands of those who want to see
private health care. It's like people who accept the same pay rise as those who
have given up pay to go on strike for it. They are not doing anyone any favours.

So, people are supposed to let their health deteriorate, waiting exceedingly long for inferior treatment, just so they don't "play into the hands of those who want to see private health care." I don't think James Taggart could have said it better. To put this quote another way, people should accept suffering in order to prove that the government can do things better than the private sector.

An equally poignant refutation of government programs comes from a former NHS employee:
After having worked in NHS, I tend to agree with the article and most of
the comments by readers. Most of the NHS trust CEOs are mediocres and lack
innovative ideas. Degradation is in almost every segment. I came across cases
where even written contracts are not honoured. Its not the funding, but
management which needs to be blamed for all the ills.

The problem of course is that you will have extreme difficulty ever getting a government program in which management is anything but "mediocre" and "lack[ing] innovative ideas." There is, after all, little or no incentive for them to excel and be creative when doing so will not result in a better life for them. In fact, there is a giant disincentive to do so, since questioning one's superiors (who themselves lack any profit motive) means taking a risk of destroying your relationship with your superior and thereby potentially risking your job.