Why Public Health-Care is Difficult

A reply to Tore, who is probably partly wrong. I don't claim the U.S. system is good or bad, I don't know it. But I don't think public (which he seems to imply means free) health care is as easy as he suggests. I'm starting at his assertion that

Very few people break their legs intentionally to stay at a nice hospital. [Health care] is not a resource likely to be wasted once people are given free access to it.

The case of a broken leg is easy. What about chronic illnesses, especially those difficult to diagnose (some kinds of back pain, psychological problems, ...)? What about bored old people who spend their days talking to doctors about how bad getting older is? Easily available (cheap or free) health care has lead to hospitals being swamped with people with minor issues to the point where people with serious problems died because hospital staff didn't get to them in time. And, because the state's budget is not infinite, hospitals become badly run institutions with always-overworked staff leading to even fewer people wanting to work there etc. This has happened in the UK, for example (I think the system I have been reading about ages ago has since been replaced by a different one.) Switzerland doesn't have this problem (to this extent) because we really care about (this means, here: throw money at) our health system, but the result is that the mandatory health insurance becomes insanely expensive. There is talk about half the population needing state subsidies to pay for their health insurance within the next few years. Which, of course, will just move the cost from the whole population (via mandatory health insurance) to the whole population (via taxes) so I don't quite see the point...

You'll note I don't propose solutions either. But I think it's important to acknowledge that health care is a difficult topic because, in the end, it always comes down to the question How much money should be spent on this person's illness? which is a very, very bad question. We try to sidestep it by only taking about statistics etc., but no matter how you look at it, you either do 20'000€ per week medications for 80 year old patients who will die soon anyway and get a system society can't pay, or you don't and you get a system where the rich are better off than the poor. Or you delegate the decision to the doctor or the insurance or ... and try to minimize the number of people who “deserve” (can you see it, the hard question didn't get away!) treatment but don't get it.

Update 20090508 - Response to comments I'd like to thank you for commenting. I didn't know (and — sorry about that — didn't care to research) that the U.S. system is even more expensive than ours, since my main message is just that health care is about hard decisions. Some people always will be left out. Elaborating a bit on the 20'000 € a week medication: partly, I agree with Adrian and Tore: patent-supported monopolies on medication plays a part. Partly, because I stipulate there will always be rare illnesses where a few cases per year worldwide will have to “pay for” all the research and production of the medication. Of course, the cost can be distributed so that the patient (or his insurance) doesn't have to pay it, but society as a whole will still pay. So the hard question won't go away easily, now it's just become Do we fund research for this rare illness with fewer than five cases per year worldwide? Of course, now we're not speaking of people anymore, but already just of cases, and we're not cutting treatment for an actual person but we're just cutting budget on research, so it may be easier on the conscience, but it's still fundamentally the same question. Conclusion? Health-care will always be a difficult topic, and it will never be free. The cost can just be distributed in different ways.