Health care choice comes with a cost

By Miles M. Weinberger, M.D.
The San Diego Union-Tribune, March 17, 2017

The position of House Speaker Paul Ryan and his colleagues is that people should have choice regarding medical care, and that the efficiencies of competition will make health insurance more affordable than government-controlled health services.

Since that is a goal to which we Americans should strive, I suggest that we extend that philosophy to other services.

Let’s have competition in fire and police services. Instead of the government controlling these services, let’s privatize them.

Instead of taxes, people will choose fire and police insurance to buy from the companies of their choice.

Of course, there may be a problem for those who don’t purchase that insurance, but that is their choice, isn’t it?

Perhaps we can even extend that to the military. Since the federal government is so inefficient, privatizing the armed services with competition so that Americans can choose the military service they want to protect them.

That seems to be popular in some African countries.

Does any of this relate to medical care? Like the police and fire services, we expect the hospitals, emergency rooms, physicians, nurses and other health care personnel to be there when we need them, whether we’ve subscribed to a service for health care or not.

We also expect the police and fire services to be there when we need them, and we choose to support those services with taxes.

Is having a multitude of private medical insurance companies better than a central service, for example such as Medicare?

Medicare isn’t perfect, but its overhead costs are far below that of profit-oriented private insurance companies. Medicare provides universal coverage for those over 65.

What is magic about age 65? Why not extend Medicare to all?

The money saved in administrative fees, by physicians and hospitals having to manage their billing for hundreds of policies from dozens of private profit-oriented insurance companies and the administrative costs and profits of the companies themselves, could be directed to the actual delivery of medical care.

What would such a system do to the quality of medical care?

A new study published by the Annals of Internal Medicine explores differences in survival between patients with cystic fibrosis in the U.S. and Canada.

The research, which was funded by the Cystic Fibrosis Foundation, found that Canadians with cystic fibrosis will likely live an average of 10 years longer than their U.S. counterparts.

Cystic fibrosis is a progressive genetic disease of predominantly Caucasians (those of Northern European descent) associated with eventual disability and early fatalities. Considerable progress has been made in improving survival.

Whereas few survived childhood just 50 years ago, survival has resulted in the number of adults now equaling the number of children with cystic fibrosis.

Having access to specialized medical care is critical for survival of individuals with this disease. Universal insurance in Canada provides payment for universal access that is not assured in the U.S.

Those who expect universal access to police and fire services should consider the advantage of similar expectations for universal access to health care, as is present in our Northern neighbor whose health benefits are apparent at lower cost than in the U.S.

Dr. Weinberger is professor emeritus of pediatrics, University of Iowa, and a visiting clinical professor of pediatrics, University of California, San Diego.

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