"Hi I'm Dr. Smith and the Government Coerced Me to See You Today"
The WSJ has an article today that illuminates the major flaw in universal healthcare insurance schemes - they don't ensure care. The article chronicles the experience in Massachusetts where universal coverage was the goal of legislation passed under Governor Romney. There is a doctor shortage and those who now have insurance under the new law cannot get in to see a doctor. Twice in the article we hear the refrain "Health-care coverage without access is meaningless." Indeed. The basic flaw in the law's logic is that insurance coverage is the supply of healthcare. Insurance is not supply, just a method of paying the supplier.
Additional problems come with how do you define access and how do you ensure it. Is access to healthcare a Johns Hopkins-trained doctor or a state college trained one or is it some lower qualified technician? If we've legislated price caps to keep insurance affordable, what if our caps are lower than the Johns Hopkins-trained doctor will accept, what if they are lower than any physician will accept? How do we match a doctor with a patient? If we don't do it through price, we must force that doctor to see that patient. Do we really think we can tell some of our most highly educated citizens who they must accept and provide their expertise to? Even if we thought we could get away with that for a time, do we really think that this won't change the incentives to become a doctor over the long term? This is the dangerous game we are getting into when we claim that healthcare is a right and we travel down the road of "universal" schemes. People who spend hundreds of thousands of dollars and over a decade building up an expertise are not going to stand for getting meaningless sums of money for their highly skilled services. (I regularly hear complaints from talented young doctors who are getting paltry sums like $300 for a minimally invasive procedure like a gall bladder removal.) Surely people will choose other careers if they see that monstrous expenses and years of difficult training will win them the privilege of performing $300 appendectomies.
The fatal flaw of "universal" heathcare is that regardless of how one pays for healthcare (with cash, an insurance claim, or a government check) you have to "contract" with a willing supplier of care. A doctor's training - his/her expertise, skill and proficiency - is their property. We have no claim upon it or right to it save what we can negotiate with him/her. We can spout platitudes about our rights all we want, but unless we convince a doctor to supply us with care, to meet our demand, there is and can be no healthcare. Once we get into the business of dictating prices that the doctor must accept to avail patients of his training and skill or mandating that he/she see certain patients, we are, at best, changing the incentives that lead our best and brightest to become doctors and, at worst, engaging in coercion. Our world-leading quality of heathcare will not long endure if this is how we are going to treat physicians under whatever "universal" schemes that our politicians cook up and manage to pass. The only alternative that preserves incentives for the highly talented and motivated to become doctors, constantly improve their expertise, and treat patients with the highest level of care is the price system. We must not dictate prices to physicians or mandate who they must treat, but instead focus on encouraging innovative ways to pay the prices that prevail for their services.
Additional problems come with how do you define access and how do you ensure it. Is access to healthcare a Johns Hopkins-trained doctor or a state college trained one or is it some lower qualified technician? If we've legislated price caps to keep insurance affordable, what if our caps are lower than the Johns Hopkins-trained doctor will accept, what if they are lower than any physician will accept? How do we match a doctor with a patient? If we don't do it through price, we must force that doctor to see that patient. Do we really think we can tell some of our most highly educated citizens who they must accept and provide their expertise to? Even if we thought we could get away with that for a time, do we really think that this won't change the incentives to become a doctor over the long term? This is the dangerous game we are getting into when we claim that healthcare is a right and we travel down the road of "universal" schemes. People who spend hundreds of thousands of dollars and over a decade building up an expertise are not going to stand for getting meaningless sums of money for their highly skilled services. (I regularly hear complaints from talented young doctors who are getting paltry sums like $300 for a minimally invasive procedure like a gall bladder removal.) Surely people will choose other careers if they see that monstrous expenses and years of difficult training will win them the privilege of performing $300 appendectomies.
The fatal flaw of "universal" heathcare is that regardless of how one pays for healthcare (with cash, an insurance claim, or a government check) you have to "contract" with a willing supplier of care. A doctor's training - his/her expertise, skill and proficiency - is their property. We have no claim upon it or right to it save what we can negotiate with him/her. We can spout platitudes about our rights all we want, but unless we convince a doctor to supply us with care, to meet our demand, there is and can be no healthcare. Once we get into the business of dictating prices that the doctor must accept to avail patients of his training and skill or mandating that he/she see certain patients, we are, at best, changing the incentives that lead our best and brightest to become doctors and, at worst, engaging in coercion. Our world-leading quality of heathcare will not long endure if this is how we are going to treat physicians under whatever "universal" schemes that our politicians cook up and manage to pass. The only alternative that preserves incentives for the highly talented and motivated to become doctors, constantly improve their expertise, and treat patients with the highest level of care is the price system. We must not dictate prices to physicians or mandate who they must treat, but instead focus on encouraging innovative ways to pay the prices that prevail for their services.
posted by Donny Baseball at 8:43 AM
2 Comments:
There is a shortage of doctors in UK. It seems that the natives don't want to be doctors. So they import doctors who are willing to work for less from places like Pakistan and Jordan.
Exactly. I have a few friends who are brilliant young doctors and they want to leave to work for hedge funds because they are making paltry money to perform miracles of science. They'd rather analyze the prospects of drugs and devices for big money. This is totally sad. Sad, sad , sad.
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