kenberg, on 2012-April-05, 07:26, said:
Well, whatever the arithmetic, I think everyone agrees that a lot of money could be saved. Since most agree that money could be saved, the question arises as to why it isn't done. I have thought some about this.
All the things you outline can be achieved in a public system - indeed, it has been demonstrated they can be delivered more effectively if you want to live in some of the colder parts of Europe. The reality is when you compare 'care delivered' against 'care recommended by the WHO' (as the only yardstick we have for 'what you should do') the NHS delivers roughly the same amount as the US. The FUNNY part is that that is only like 60% on average (topping out at like 70% in some categories, wooo). The different countries are also better at different things - the US delivers better cancer care than the NHS, but the NHS has got your back if you have chronic illnesses of different types. At the end of the day, your care experience is pretty similar.
The problems are really
A) It's REALLY HARD to get from A to B. Look at the political cost Obama paid for Obamacare, which is frankly weak. Full Finlandisation (bwahaha) would probably be impossible politically as well as purely from an implementation point of view.
B) It's not possible for the US government to implement something equivalent to the Pharmaceutical Benefits Scheme due to the influence of lobbyists - or more frankly governmental corruption in both the GOP and Democrats. Collective bargining here is critical and no achievable for the US
C) It relies on other social structures outside of the healthcare system. Part of the huge cost savings that the UK and Finland can produce is a massive decrease in the cost of supply. This is because they spend a tiny part of their education budget on free training for doctors. Also, collective bargaining is more accepted, and they are willing to pressure big pharma.
Ultimately the US is tooling around a local maxima. Getting to the absolute maxima requires traversing a huge gulf that no-one has the willpower to do.