Got into an interesting discussion with a woman from Norway about how their system is different from, and arguably better than the system we have in the US (scroll down to the $52,000 appendectomy thread if you want to see it).
I don't live in Norway, so this is all based on what I've read (for example). But here's what I found.
There are three systems, basically
- A primary care system, which is decentralized and managed by communities.
- A specialty care system, which near as I can tell is centrally managed.
- A private system, which is funded in part by private insurance.
Unlike in the US, everyone pays, and everyone benefits. The system is funded by general tax revenues. In Norway, tax revenue is almost 40% of the GDP, -- which is saying something; Norway has a great economy. Tax revenue is paid by everyone, basically, from a combination of income taxes and value-added taxes.
Couple of things I like about the Norwegian system. There is a certain level of integration; among other things, everything is on a common electronic medical record. I like the decentralized aspects to it. And I like that everyone is covered.
Being, by nature, a free-market libertarian, when I say things like that, my friends' heads tend to explode. Because that does invoke government involvement. All I can say is, if you're trying to manage risk, the bigger the pool the better. The biggest pool of all is "everybody."
That said, there are two problems with government.
- It doesn't have any resources.
- It doesn't know anything.
The resource problem is a biggie. The US has this idea that we can have a good healthcare system, and we can get somebody else to pay for it. Maybe rich people. Maybe corporations. Maybe foreign bond-holders. Problem is, I don't think there's enough OPM (other peoples' money) in the world to finance such a thing. The Scandinavian experience shows us, you get what you pay for. They are justifiably proud of their system, and they do pay.
The information problem is even bigger. A core function of insurance is underwriting. Being able to look at a population of consumers, and figure out how much to charge them for insurance, without going broke. No government in the world has yet figured that part out. Hardly a day goes by we don't see articles in the news about the Canadians or Brits fretting over healthcare budget over-runs. Even Norway faces its challenges, although it's doing better than most.
There's also the problem of lines, which I have discussed elsewhere. This is also an information problem, essentially. Once again, this is something no government has quite figured out how to manage.
Information asymmetry is the defining characteristic of the healthcare market, and there's not a whole lot we can do about that. And in spite of the promise of universal healthcare, sadly it seems government often finds itself at the bottom of the information food-chain.
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