Joseph Cramer, M.D.: Saving our health care from the tragedy of the commons

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  • Invisible Hand Provo, UT
    March 19, 2014 9:34 a.m.

    @Testimony: So are you OK with a system that denies you access to the latest cancer therapies but once you get so sick that you need critical care, then you can get care? You want a system that denies you access to a knee replacement that could greatly enhance your quality of life and allow independent living, but gives you free in-home nursing service?

    I think you should get the health care plan that you want. If you want what I just described, then I'm sure the private marketplace could come up with an insurance plan that provides that, probably at low cost. That is the beauty of a private system. You have control over your health care dollars and we don't all have to agree on what the system will do for us. What drives me crazy is people demanding that we move to a "one size fits all" socialized system where people don't really have any other options.

  • Testimony Philadelphia, PA
    March 18, 2014 2:30 p.m.

    InvisibleHand, There is no rationing for critical care. Or for in-home nursing service, or PCP visits. Or for a host of other things you can't even get here on Medicare, but have to pay for yourself.

    Do they "need" another healthcare system? Probably not, but do they need their highly stratified class system, for that matter? Nonetheless, there it is, for those who see themselves above "commoners."

    My wife is English, and much of her family and several of her friends are still there, as are their aging families. To her knowledge, none of them has ever "gone private." Any griping I've heard from NHS patients has been trivial compared to what I've heard and seen and experienced here in the US.

    I've had a number of relatives die here in the U.S. who I think would have had better care and lived longer under the more patient- and outcomes-oriented system of the UK.

  • OlderGreg USA, CA
    March 18, 2014 12:49 p.m.

    I've experienced the Canadian system of "managing" the commons. Nearly 3 years wait to get a primary care physician. Seldom an MD available for the local hospital ER.

    Xray here, fine. Scan (depending on what kind) is hours away. Oops, *the* techy called in sick, you are back on the waiting list.

    Need a joint replacement? Get on the list. Sorry, that budget is all used up this year. Go ahead and try some other community's list. Now you are too old for that.

    Need cheap drugs? There is a "dispensing fee" for each unit.

    About to be discharged and your home doesn't have the mods we say you need? That's OK, your home will be confiscated to pay for your keep in a "suitable" place.

  • Invisible Hand Provo, UT
    March 18, 2014 9:53 a.m.

    @Testimony: If the English system is so great then why the need for a competing private one? I have talked to both providers and patients from European systems. The difference is their rationing is done by making patients wait or denying service while our rationing is done by ability to pay. Let's not pretend that there is some wonderful system out there that will solve all our health care problems. There are tradeoffs to everything.

    Also I take issue with your assertion that they pay less and get superior outcomes. It would take a lot of space to lay out the case against the way those misleading statistics are computed, but the bottom line is if you have a premature baby, its chances are much higher being born in the US. If you have cancer, your odds are better in the US. If you suffer a catastrophic accident, your chances are better in the US. If you need stitches or blood pressure medicine you may get a better result in the UK, and cheaper.

  • Spangs Salt Lake City, UT
    March 18, 2014 9:23 a.m.

    I must say, Dr. Cramer, this "cooperation" thing smacks of socialism!
    And, unfortunately, it makes a whole lotta sense...

  • Testimony Philadelphia, PA
    March 18, 2014 8:30 a.m.

    The main thing wrong with the author's analysis is ignoring the fact of our for-profit health-care system. How do you tell a hospital corporation that they can't compete for imaging business with the university hospital down the street? You might as well try to tell a for-profit insurance company that they can't make any money for their shareholders.

    There is a solution, but it's not one that we Americans will ever be allowed to implement. The entrenched interests of the industry are supported through vast spending on lobbying and political contributions.

    Take a look at the English system. Their highly-regulated National Health Service basically covers everyone in their country for less public expenditure per taxpayer than our mish-mash patchwork quilt of private and public systems does to cover only a fraction. And, despite the much lower outlays, their system paradoxically has overall superior outcomes to ours. Plus, it's free of premiums and copays for almost everything. Further, for those who don't want to rub elbows with the hoi polloi, there's an excellent private health system, too, complete with private health insurance plans.

  • Invisible Hand Provo, UT
    March 18, 2014 8:12 a.m.

    "If one MRI machine is adequate, the two hospitals in town don’t both buy one."

    This is the kind of "cooperation" that keeps prices high and restricts access to health care. I would like Dr. Cramer to tell us who this all-knowing person is who knows the right number of MRI machines that a community needs. The analogy of health care as "commons" paints a false, collectivist picture. It assumes that the size of the pie is fixed, so we must figure out how to divide it equally. This scarcity mentality is outdated and dangerous.

    A true market approach to health care will allow competition, encourage innovation and drive down costs. I'm not opposed to a social safety net, but most people should buy the health care they want in a free marketplace. If more people choose to pay for MRI examinations, then the hospitals will buy more MRI machines. These aren't common assets, they are private investments. In a free market we will have more of what people want and lower prices, not some finite amount of "commons" and a bureaucrat deciding who gets to use it.

  • FDRfan Sugar City, ID
    March 18, 2014 7:44 a.m.

    Bravo. Utah can lead the way - if the radical elements don't take over.