Tuesday, February 19, 2008

Cutting Down on Wait Times Government Style

Waiting too long in the hospital for a bed in Britain (more than four hours)? The government has a solution: You can wait in the ambulance. The average in the United States is closer to thirty minutes for critical care, though average treatment time is closer to four hours when non-serious injuries and illnesses are taken into account. Why is this the case? Well, part of it is certainly due to the fact that trips to the ER won't necessarily cost you anything. Because ER's treat regardless of ability to pay, they are an attractive alternative to visits to the doctor's office to deal with minor bumps and bruises or minor illnesses for those who don't have health insurance. Those without health insurance have to pay for trips to the doctor at the same rate HMO's pay, and HMO's pay a rate much higher than what the market would normally bear because removing the responsibility of paying for doctor's visits from the hands of those who would normally pay them (i.e. the patients) and places them in the hands of the HMO's, and ultimately the employers who offered health benefits to their employees. The cost of health care being thus dramatically reduced for the insured, they consume health care at a rate far higher than they otherwise would, increasing the price of health care and causing a shortage of health care, leading to the increased wait times in both ER's and doctors' offices.

The fact that ER's are required to treat regardless of the ability of their patients to pay means that a further segment of the population is receiving, in effect, free health care, and this further increases the size of the health care shortage, as well as its price, as hospitals pass these unmet increased costs on to patients in more long-term situations who either can pay or have to pay. Illegal immigration only compounds this as illegal immigrants, who are generally not the wealthiest folks in the world, are taking full advantage of this, in some areas becoming the majority of hospital patients, straining resources to the point where some of these hospitals are little better than the ones in Mexico, even causing many of them to close.

On top of this, Medicare and Medicaid, though well-intentioned, further subsidize the demand for medical care, exacerbating its costs and shortages. What makes these increases particularly pernicious is that the federal government pays for health care these programs no matter the cost, causing increasing in both the net and proportional share of the federal budget taken up by health care spending, inhibiting its ability to fulfill its other obligations, never mind the effects of an aging population and the additional costs of an increasingly bloated and sclerotic bureaucracy rife with increasing inefficiency. Furthermore, the fact the government's payment for treatments through programs like Medicare once again shields the consumer from the incentive to mitigate cost, driving demand up further and increasing costs and shortages further still.

Litigation drives costs higher still, as litigation insurance drives the cost of doing business higher than it would otherwise be. Doctors also tend to perform more and more unnecessary procedures to reduce the likelihood of being sued for malpractice because they somehow managed to miss some obscure condition that only three people have had in the past hundred years. Now, it is certainly true that doctors who, say, amputate the wrong leg or leave surgical instruments inside of patients or maltreat their patients in some way should be subject to legal action, but doctors should be protected from litigation and criminal proceedings when they have made a decision in good faith, and the burden should be on the litigants to prove maliciousness or negligence on the part of the doctor, not for the doctor to prove he wasn't. Also, in cases where the litigants lose, they should be required to pay they attorney's fees of the defendants. Attorneys are expensive, and many times even the prospect of a lawsuit is enough to prevent a doctor doing what he believes is in the best interest of his patient if he is not sure of its prospects for success.

With the possible exception of an aging population, the federal government bears a large portion of the responsibility for creating the conditions which have precipitated today's health care problems, from increased costs to shortages of care. And what is the solution to this problem? Allowing the market to function effectively to reduce costs and alleviate the health care shortage, while relying upon the good will of the American people to see that those in need get the help they need? Remove the government imposed barriers to a functioning market for health care? Well, if you're a Democrat running for president, your solution is more of the same: increased government interference in the market that will inevitably increase costs, cause shortages, curtail innovation, and reduce overall quality of care. We don't need more health insurance, we need less of it. We don't need more government regulation, we need less of it. We don't need more employer-provided benefits, we need less of them, which will free up the resources of corporations for increased investment, wages/salaries, and whatever else corporations feel the need spend money on to operate more effectively. We don't need more litigation, we need less.

There are certainly problems in the health care system not caused by the government, but getting the government mostly out of the health care business will go a long way to creating an environment where solutions to the health care shortage can be found. If you get the government more involved the only way to reduce your wait-time in the hospital will be to wait in the ambulance.

No comments: