Thursday, September 17, 2009

Somewhat socialized medicine

A recent article in Forbes ("the Capitalist Tool") gave high marks to Germany's hybrid public/private health insurance scheme:

The German system costs about half as much as ours (as a percentage of GNP per capita) and by many measures it delivers better care.

The German system has its virtues, and I think it is superior to what we currently have in the U.S. It is more rational, which involves some rationing, but when done in a judicious manner rationing provides overwhelming positive benefits for society as a whole.

But the German system is far from perfect. Doctors receive low wages--a fraction of what their counterparts make in the States--and they have been agitating for more pay over the last several years. And, personally, I'd rather have a well-paid, happy doctor looking down at me as I lay on the operating table.

After a playground accident a few years ago, my daughter Rebecca spent a few days in a German hospital. In many ways, it was much better and much more rational and professional system than is the norm on the side of the pond. We were never asked for insurance information; meals were cooked on the floor and customized for kids' individual tastes; bottle of alcohol and peroxide were not thrown out at regular intervals but shared between patients in a room.

On the other hand, we did not speak to the surgeon before our daughter's operation, and only just briefly afterward. It seemed that we were expected to trust the doctors to do their job and not interfere. It worked out fine, but I like the illusion (if nothing more) of being informed and having a say.

There is no rush to get patients out quickly, and while contact with surgeons is minimal, there is a much more intimate and sustained relationship between patients and nurses.

Germany's system, with its predominant public option and explicit rationing of services, is both more economically rational and more humane than our unwieldy and impersonal system. There is a lesson to be learned from Old Europe.