Saturday, October 19, 2013

Public Health Coverage and Private Health Coverage

First, a study linked to by Tyler Cowen. From the abstract:

"We found that privately insured patients had lower risk-adjusted mortality rates than did Medicare enrollees for twelve out of fifteen quality measures examined. To a lesser extent, privately insured patients also had lower risk-adjusted mortality rates than those in other payer groups. Medicare patients appeared particularly vulnerable to receiving inferior care."

Yes, that says Medicare not Medicaid. The evidence that Medicaid patients have less access to care and lower quality of care is so overwhelming that even opponents of Medicaid reform (and advocates of Medicaid expansion in its current form) admit that Medicaid doesn't offer nearly as good care as private coverage. More on Medicaid from Avik Roy if you are interested.

The important finding here is that even Medicare, which does not have the same reputation as Medicaid with regards to quality, offers significantly lower quality coverage than private insurance. This is likely because of lower provider reimbursements as well as the additional paperwork required to get paid by Medicare (not that private insurance companies are easy to deal with either).

Second, despite the fact that everyone is entitled to "free" (tax financed) health care in Ireland, almost half still pay for private health insurance. This is, by the way, also true of China where many people still find it necessary to pay for private coverage despite having already paid for public coverage through taxes. I visited China some time ago. I asked a college age Chinese girl why the Chinese do this and she said (in broken English) that the public health coverage offered such long waiting times and such low quality that anyone who could afford not to use it would pay the extra to get decent health care. 

Finally, Canada is moving towards private medicine. Sweden is doing the same. Both are doing so out of necessity. Public health care simply doesn't offer the quality health care that patients in 21st century developed nations demand.

The main point here is that private medicine offers substantially better quality than public or government medicine. We see this when comparing public systems and private systems within the USA. We see this when we look at nations with very governmental systems that have patients that still pay additionally for private insurance despite having already paid for public coverage through taxes. We also see this in nations where the government is trying to beat the consumers to private medicine by moving towards health privatization.

In nations with public health care systems, private health care has been quite taboo, but that is changing as citizens and governments move towards it. People demand high quality health care, and government simply can't deliver. The private sector, quite simply, can.

This is not meant as a criticism of public health care, but one cannot escape the conclusion that, given all of these realities, public health coverage is woefully inadequate in providing for a 21st centur population that is wealthier and more demanding than ever.

Despite claims that moving towards single payer or government run health care is inevitable or necessary, the experience from both within our nation and from other nations may suggest that real progress means more private medicine, not less.

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