I had previously opened up a discussion on this important topic but had not revisited it in a while and since it is likely to be a major issue in the coming months I thought it was worth addressing again. I presume it goes without saying that we all agree that there is a problem, that our current health care system is incredibly messed up and that unless we make some major reforms in the coming years we will experience a major meltdown.

Speaking for myself I am open to any solution from pure free market to single payer nationalized, the key issue is that the proposed system will actually work rather than simply create new problems or just make us feel better for a while. For me the issue is not how we solve it but simply that they solve it.

On first glance I am not hopeful that a pure free market setup will work. While we don’t really have such a system now we did in the past and things didn’t work very well in terms of providing full coverage. For profit systems do have their advantages in terms of pushing innovations and also in enabling hospitals to obtain the newest equipment.

But they have the flaw of being for profit and thus being unable to provide services to everyone. If you are trying to make a profit then you can’t really care for those who need tons of free services. This leads to the problem we currently have where many people are forced into long waits at the emergency room which tends to cost the government more but helps with the bottom line of the hospital.

Looking at my own case for example, I am self employed and thus have to pay for my own insurance. Because I am single and reasonably healthy I have pretty basic ‘hit by a truck’ coverage for health and equally basic vision and dental coverage that costs me about $ 2,000-$ 2,500 a year in premiums.

It’s great coverage when I need basic checkups or exams but when I recently had to go to a specialist for some tests I had to pay about $ 1,000 or so out of pocket. The expense was well worth it since it involved my health and I was quite pleased when all the results came out perfect. It took me a while to pay off the extra bills and I had to give up plans for a trip to visit friends in LA.

Of course in my case it was hardly a major sacrifice, I do not have a family to support and the costs are relatively low compared to what many people pay. But it was a minor burden and something that could have caused a bigger problem had the test results not gone well and had I needed further treatment.

At the same time it does demonstrate that it is possible for most people to obtain basic coverage, though in the long run that coverage is not always sufficient.

On the opposite end of the scale I am also doubtful about a full blown nationalized single payer solution to the problem. Like the free market idea the single payer program has both good and bad points. On the good side it provides coverage to everyone, so people do not fall through the cracks.

But on the bad side because they are basically in the business of rationing health care the coverage provided to everyone is not always the best. We’ve all seen stories about long waiting lists in places like Canada and Europe where people with non life threatening conditions have to wait months on end to have pretty important procedures.

There is also the risk of abuse of the system in the sense that when something is free we are far more likely to take advantage of the benefit. For example I recently had a minor bout with athlete’s foot like symptoms (sorry if this is TMI) and so I naturally began to channel my inner hypocondriac. I went on the internet to do research and began to get images of all kinds of major infections and problems I could have.

Of course deep down I knew it was just a litttle fungus and if I went to the doctor he’d tell me to get something at the drug store and use it for a few weeks. Because I would have had to pay to see the doctor I decided to just do what he was going to tell me anyway and see what happened. Of course in just a few days things began to clear up and now everything is just fine. I saved myself the cost of the doctor and prevented wasting his time.

But had it been free under a national system, I probably would have gone to the doctor and had him tell me to do just what I did. I would not have solved anything but it would have cost money to the system for me to go in. If you factor in millions of other people with colds, flu and other conditions that basically cannot be solved by a doctor visit you could see where a lot of waste could be built in.

Indeed in the days before health insurance (it didn’t really become a work benefit until during WW2 when wage/price controls prevented wage hikes) people did engage in what you might call reasonable rationing. If you really needed to see the doctor you did, but if it was something you could solve your self, you also did that. I’m not saying we need to go back all the way to such a system as there were clearly problems. But we do need to make a balance to prevent people from abusing the system

Because both extremes provide both good and bad soliutions, my guess is that the ultimate solution to the problem will probably be some mix of both free market and government and that the real question will be what kind of mix.