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[rthigpen <rthigpen AT nc.rr.com>]

Benjamin Brunk wrote:

> Probably true, but it's also the BEST in the world.  Other countries
> practice healthcare RATIONING.

In practice, scarcity rations healthcare resources everywhere. The US 
system simply rations these resources differently for different 
individuals, depending on wealth, insurance coverage, etc.

A key problem with this issue is that people don't tend to be 
comfortable considering healthcare in economic terms.

Personally, I'd say any system held up as an ideal would have to [1] 
produce appropriately high levels of care, [2] do so efficiently and [3] 
distribute care in an equitable manner.

The problem with these standards are that they are far from absolute 
known quantities.

It's nearly impossible to get any kind of agreement on [1]. In general, 
what is the value of a life, and how much should we spend to save it? 
Individuals' market behaviors express vastly different ideas of what 
constitutes a reasonable level of spending on healthcare. And yet there 
persists the idea that when "lives are on the line" that no amount of 
effort or spending is too high. This issue is political poison, and I 
don't expect to see it realistically addressed in the public forum 
within my lifetime.

Free-market based systems tend to do well on [2], but there are some 
serious kinks in how US healthcare markets operate. Much of the body of 
healthcare reform seeks to straighten out these kinks and use the 
resulting efficiency gains to squeeze more out of dollars already being 
spent. There are gains to be had here, but also powerful entrenched 
forces feeding off of those market kinks. These forces act to invoke our 
fears, and the public votes that fear.

Criteria [3] is another social issue, one that calls for value judgements.

Do you define equitable as a fixed amount of spending per person, per 
year? Or over a lifetime? Perhaps you prefer a needs based system? Or a 
cost conscious, needs based system? Should age be a factor(infants v. 
seniors)? Do the rich deserve better care? Is it wrong to take money 
away from the rich to provide more balanced levels of care across the 
board?  Is it wrong not to?

These are some tough questions. But ones that our society/market is 
making defacto decisions on every day. But my belief is that we just 
might be able to organize a system that would encourage better decisions 
if we didn't shy away from these tough questions.

Just thinking out loud, I'd say US system seems to do pretty well on [1] 
and [2], but arguably has room for considerable improvement on [3].

Oh, and just so we're clear, I don't have a plan for changing any of 
this any time soon and I don't expect anyone even vaguely electable does 
either.

--rt