devil wrote:
> Hospitals, HMOs are large corporations, owned by a small number of wealthy
> physicians. Who run a monopoly so they are free to set fees sky-high, and
> merrily prescribing use and overuse of expensive equipment.

Actually, there is competition betwene HMOs. If one hospital doesn't have a
fancy MRI machine, but the hospital across the street does, the first hospital
will lose business because HMOs will want to associate themselves with the
fancy hospital that is better equipped in order to promote their health plan.

This results in hospitals becoming over-equipped with too much capacity for a
region. From the hospital point of view, being a business, the accountants
state that in order to make the MRI investment profitable, they must have X
paying customers going through the machine per day.

Airlines will lower the price of tickets when not enough passengers book in
advance. Hospitals don't compete on price, they compete on features and charge
as much as they want. And when they don't have enough customers to warrant
investment in an MRI machine, then the doctors will start to over prescribe to
"fill the seats".

Patients don't care because it is paid by the insurance company. And it is
pretty hard for an HMO to second guess a doctor's opinion that a patient needs
such and such treatment.

This is where national health care plans are quite different. There is no
oversupply of fancy equipment, so the doctors don't have to overprescribe its
use. In fact, it is more of a question of supply not matching expected demand,
with doctors having to decide whether an MRI is really necessary or not and
only sending cases where the MRI is truly necessary.

And this is where you start hearing stories of people waiting months for some
treatment: they give priority to patients who really need access to facilities
that have limited capacity, and if you have some problem that isn't serious
then you are put in a waiting list where you are in the airline equivalent of
"stand by" for the next free spot.

And the lack of an oversupply of facilities also forced the doctors to use
more common sense and perhaps more conventional treatments which, in the end,
work just as well even though they are not right out of a science fiction movie.

One could argue that hospitals in countries with national health plans are in
fact far more efficient in their use of resources than USA hospitals which
have an over supply of resources and use these valuable resources for cases
that don't really need them.

The advantage of a national health plan is that there is one customer who also
happens to be the owner (the government) And it can then dictate the
allocation of resources so that for instance, one hospital per region has an
MRI machine and other hospitals in the region won't have to "compete". You
just get sent to that hospital if you really need an MRI, otherwise, they'll
fix your broken leg with conventional x-ray machine and a cast.

IN fact, in rural areas, if a doctor really feels that you require an MRI and
there is none in your region, the government will often fly you to a hospital
that does. It turns out costing much less than installing MRI machines at
every street corner.

People in developped nations now take health care for granted. And this is a
problem with regards to rising costs because you expect to be treated for
any/all ailments. And whereas people used to accept that heart attacks were
fatal, they now expcect to survive those and see them as just an inconvenience
and figure that technology will fix your heart. This is especially true in the
USA where expectations are very high.

The problem is that in the USA, hospitals and doctors want more patients. Drug
companies want more business so they give doctors all sorts of incentives to
prescribe their new drugs (which often exist to solve some non exsitant
disease, but are marketed as the perfect solution for a problem that the drug
companies say is extremely serious (such as having to urinate during a
baseball game because you can't hold it)).

HMOs have patients as customers. And if the HMO refuses a procedure, it may
lose the customer.

When the HMO is a single government entity, it doesn't fear losing customers
and can decide that certain procedures are purely elective and won't pay for
it. (patents must then see doctors in their clinics and pay for elective treatment).

And when the HMO is a single government entity who also owns the hospitals and
has doctors on its payroll, it can decide how much it pays. So there is no
overcharging by doctors and hospitals. And because the budgets are tight,
hospitals have been forced to clean up their operations to increase efficiency.

And yes, you do have strikes in the health sector (there was on in France
yesterday) when the government refuses to provide the staff the salary
increases that they want. But the government has clear incentive to keep costs
under control since its revenus do not increase if there are more patients who
are sick. Its goal in fact is to reduce the demand on the health care system,
whereas in the USA, the hospitals and doctors want to increase demand in order
to increase profits.