Public Health Does Not Suck

Andrew Stephens, Tuesday the 18th of August, 2009

As the song goes, we don't know how lucky we are in this country and one of the things we take for granted is our public health system This post was automatically imported from my old blog. It may look a little weird since it was not originally written for this format.. It may not be the most well-oiled machine, but if something needs doing then it gets done in a timely manner and nobody ends up bankrupt. New Zealand (along with most of the rest of the Western world) has decided that individual health is a public problem, so the public will support the individual if they get ill. It works out much cheaper for everyone, but that is just a nice bonus.

I have been watching the recent furore in the US where President Obama is busy trying to introduce something similar there. This being the USA (a strange place), half the public seems to be convinced that public health is some sort of evil plot to destroy capitalism, enslave the population, and end the American way of life™. These people are, of course, idiots but they are not wrong about the effects of public health being far-reaching.

In New Zealand, we have a mixture of public and private hospitals. Going public usually means joining a waiting list but is much (much!) cheaper, and urgent stuff gets done straight away. Private hospitals are more expensive but are usually much nicer to stay in and you don't have to wait so long. The actual quality of care is comparable; it is common for medical professionals to work in both public and private hospitals so in many cases the same person will be performing the operation in either case. Health insurance is considered a bit of a nice-to-have.

Compare and contrast with the US: hospital care there is ridiculously expensive, much more so than the average private hospital in NZ. The reason for this is that everyone (everyone who counts, at least) has insurance. It doesn't bother the insurance companies that the rates are so high because they arrange bulk discounts with the hospitals, a very cosy arrangement that benefits both parties but not the public. By law hospitals cannot refuse urgent treatment even if someone comes in without insurance, but the hospital charges the inflated amount anyway because they know that the few people who do manage to pay off the full amount will make up for some of the deadbeats.

But isn't health insurance a great thing that everybody should have? Well, health insurance is a funny business even by funny insurance standards. If you insure a car and it breaks, the insurance pays out unless the car broke due to a known defect, in which case the manufacturer's warranty will cover it. But with health insurance, a defect is called a pre-existing condition which no insurer will touch with a barge pole - and the manufacturer is conspicuous by His silence. Anyone unlucky enough to have a chronic long-term illness is an anathema to insurance companies - they don't want to know. Someone who continually crashes their car will pay higher and higher premiums until they are forced to learn to drive or give up car ownership, but an ill person does not have that option.

One effect of high health-care costs that I haven't seen mentioned elsewhere is the inflation of lawsuits. We have all heard the stories about people getting injured in car crashes (for example) suing the manufacturers of the car (or the city) for millions of dollars, even if they seem to be at fault. These lawsuits are not all about greed (although that may be a factor as well) but are a consequence of paying hundreds of thousands of dollars in health costs. Often the insurance company or hospital will encourage the lawsuit just to get their money. It is a vicious circle.

I do not envy Obama. If he succeeds in his goal he will be remembered as a hero, but he seems besieged by loons, many of whom seem to be protesting against their own interests. If they react so badly to an NZ-style public health system, I shudder to think what would happen if they ever found out about ACC!

Anyway, my friend James is a (sane) American is trying to get a pro public heath website off the ground - National Health Care Does Not Suck. There is not much there at the moment, but hopefully it will turn into a nice repository of positive experiences with public health. On the other side of the coin, try this series of testimonials about bad experiences with US-style hospitals.

We don't know how lucky we are in this country.

We don't know how lucky we are.