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VA vs. Medicare
2009-07-01 22:47Previously I linked to this article comparing the VA and Medicare, to VA's advantage. I'd only skimmed a bit into the article before; reading it properly now, I feel it could use some quotes. A lot of it is about the wonders of electronic data systems. It's embarrassing, at least for the $6000/capita, "best in the world" private side of US health care. But it's also about systematic market failure: most US doctors and insurance companies don't have an incentive to keep you health, especially over the long term.
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Summary
The article finishes by musing that rather than closing VA hospitals as veteran populations fall, we should open them to the general public in return for public service of some kind.
For my part, I've generally assumed that Medicare For All would be the best and simplest way out for the US. Probably is simplest, but now I wonder if it's best. Canada's Medicare seems to do better than UK's NHS -- well, Canadians live longer -- but the VA's own history shows quality of a centralized system can vary widely. Wish I knew more about France and Sweden's systems.
One difference is arbitrary legalism -- the VA is allowed to negotiate drug prices down, Medicare isn't.
But this goes to show how the current US system is almost optimized for poor outcomes overall. Employer-tied insurance and adverse selection of individuals means depression of entrepreneurship, self-employment, and small businesses; it also leads to employer and insurer unconcern for long-term outcomes, since you'll likely have left them; for the really long term, everyone switches over to Medicare, so there's really a disincentive to care about your long term health. And of course per-service for-profit care gives an incentive to the doctors to do as many tests and procedures as they can get away with, which when it comes down to tests and surgery for microtumors that would kill you by the time you were 130, are likely harmful for your health.
( Read more... )
Summary
The article finishes by musing that rather than closing VA hospitals as veteran populations fall, we should open them to the general public in return for public service of some kind.
For my part, I've generally assumed that Medicare For All would be the best and simplest way out for the US. Probably is simplest, but now I wonder if it's best. Canada's Medicare seems to do better than UK's NHS -- well, Canadians live longer -- but the VA's own history shows quality of a centralized system can vary widely. Wish I knew more about France and Sweden's systems.
One difference is arbitrary legalism -- the VA is allowed to negotiate drug prices down, Medicare isn't.
But this goes to show how the current US system is almost optimized for poor outcomes overall. Employer-tied insurance and adverse selection of individuals means depression of entrepreneurship, self-employment, and small businesses; it also leads to employer and insurer unconcern for long-term outcomes, since you'll likely have left them; for the really long term, everyone switches over to Medicare, so there's really a disincentive to care about your long term health. And of course per-service for-profit care gives an incentive to the doctors to do as many tests and procedures as they can get away with, which when it comes down to tests and surgery for microtumors that would kill you by the time you were 130, are likely harmful for your health.