Tuesday, May 20, 2014

Government-Run Health Care:  You Just Wait

All things come to those who wait,
They come, but often are too late.

Lady Marie Currie (1890). French physicist and discoverer of radioactivity

ObamaCare is often accompanied by these cries:  “You just wait, things will get better.”   Or, “You just wait, you will like it once you get used to it.”

The truth is:  things are not likely to get better if they perform like purely  government-run systems -  like the VA, or national systems in Canada, Britain, Sweden, and elsewhere.    All are characterized by long waiting times to see doctors.  

All are scrambling to introduce private insurance or direct-pay practices to supplement the over-run government systems and to please restive citizens  and constituents  seeking timely affordable care, and all are unsustainable economically because of demand and aging populations.

Government systems always result in “rationing by waiting.”   Health care is a bottomless economic and human resources pit. There are never enough resources to go around.   The pressure to demand  free-care at the expense of others is irresistible.   

Yet government must account for every penny.   Constituencies must be satisfied.  Bureaucracies grow.  People within the bureaucracies seek to please fellow bureaucrats rather than to serve patients.  Bureaucrats  will get their bonuses and keep their jobs regardless.

The art of waiting by rationing becomes an elaborate bureaucratic game.   Secret waiting lists evolve.   There is little incentive to see more patients more quickly.     Patients die while waiting.   Operations are deferred.   Wait lists lengthen.  Doctor shortages grow  because doctors tend to dislike meetings and government-game plays.

Bret Hume, a level-headed political analyst, says of the unfolding VA events:

The spreading scandal of delayed care at Veterans Administration hospitals and the unraveling efforts to cover-up the problem have resulted in predictable calls for the resignation of VA Secretary Eric Shinseki. The VA has been plagued with patient backlogs for as long as I can remember. The problem has defied all efforts to solve it. "

"The fact is long waits for care is common to government-run, taxpayer-funded health systems. Think of all the complaints you've read about long waits for care in the socialized medical systems in Britain and Canada. They are what happens when the government owns and operates the hospitals, pays the doctors and nurses, and finances it all out of a central budget."

Of Medicare and Medicaid,  where government does not provide the care, but pays the bills,  he says the following:

Medicare may be popular because it is supposedly free, but people who can afford  to payextra insurance to cover its gaps.”

Medicaid is free too but good luck finding a doctor who will treat you. The number of physicians who take Medicaid has been declining for years. A recent study of 15 major cities found that half their doctors now treat Medicaid patients.”

ObamaCare is unlikely to get better.   Medicaid lists are growing,  Medicare cuts are kicking in. Fewer private doctors are accepting Medicaid and Medicare patients.  Waiting times to see doctors in Massachusetts,  the prototype for ObamaCare, are the longest in the nation for seeing primary care doctors.    The incentives for being efficient and for shortening waiting times are simply not there . Reimbursements are low for Medicare and Medicaid,  they are even lower for those enrolled in health exchanges plans,  and the expense of complying with government-standards are skyrocketing.

Tweet:   Long waiting times due to endemic bureaucracy and doctor shortages lie at the root of the VA scandals of death while waiting.

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