Jay Reding.com — Why Universal Health Care Keeps Failing

Jay Reding.com — Why Universal Health Care Keeps Failing

In the midst of analyzing the failure of California to drink the Universal Coverage koolaid comes the following money quote:

Universal health care has a basic and fatal flaw, you can’t simultaneously reduce the cost of a service and increase access to it. If you have universal access, you have to find a way of paying for people to get that access, which raises costs. If you want to keep costs down you can only economize so far before you have to restrict access. Universal health care is a bit like a perpetual motion machine—it would be wonderful in theory, but it can’t actually exist in reality.

Not without astonishing taxes, anyway.


  1. Steve Lucas says:

    What is interesting is the Democratic Congress is distancing itself from universal coverage saying the candidates proposals carry too high a cost. People somehow think we can have a system where, once insured, you have open ended access to all of the nice new technologies and only branded medicine. Not going to happen.

  2. Universal heath care does exist. Many countries have it. And they pay less for it than the U.S. does for our health care. I recommend watching this. Taiwan has universal ooverage and pretty much no waiting to see a doctor. What I think Americans can’t accept is the idea of rationing when it comes to healthcare. They figure they should have as much access as they can afford.

  3. Keep in mind James that the third part of the fatal flaw is profit. In socialized medicine there are not stake holders other than the providers (in Ontario it’s part of the law). In the US system, if you want to increase access either cost or profit will have to suffer unless there is a massive increase in efficiency. Unless you want to increase the size of the system by 15% or so (number of people who will “join” the system) something’s got to give.

  4. Universal health care exists only where the universality is defined to mean everyone who is a citizen is covered. “Coverage” is what is limited, in every case where government-run or government-mandated insurance exists. Coverage is limited by queue, waiting for expensive services or referrals, by availability of operating room time for non-life-threatening procedures, by unavailability of medications not on approved formulary, by small numbers of specialists, and by outright denial of certain services based on age or co-morbidities.

    They pay less for many reasons. Certainly there are fewer fingers in the pie, so to speak, when there is one entity writing the check. And, like with U.S. Medicare, there are outright price controls. But when you ration, and those countries you speak of certainly do ration, directly and indirectly, there is just less consumption overall. Now some people say that has to be alright, as life expectancy and infant mortality and other statistical indicators show longer life expectancy and lower infant mortality elsewhere. There are arguments that there indicies are not apples-to-apples in the way they are obtained (what, for instance, counts as an infant “mortality” among premature births–there are differences), but even where comparable, is life expectancy directly correlated with health care service availability, or perhaps a result of many factors, only one of which is availability of medical and other health-related services? Saying that the people of Japan or Singapore or France spend less per capita on medical care and appear “healthier”, even if true (and factoring offset costs in education between systems), doesn’t mean that universal access using their same models here will necessarily result in the same outcomes here. Consider that our society may be different enough in other ways that delivering services on the socialized health care model, or government insurance model, might result in worse, not better outcomes using the same statistical indicators we presently use to make these comparisons. I don’t think that is beyond imagining.

  5. NJ ED Doc says:

    You want doctors and hospitals to provide more efficient and less expensive care? Give me real malpractice reform and liability protection from catastrophic outliers. A realistic approach to “patient satisfaction” would also help. Just the savings from all the unnecessary CT scans would be enormous.

    Would there be tiny, but real, increase in missed diagnoses resulting in pain, suffering, and death? YES. And there’s the rub. As a nation of 300 million people, are we willing to sacrifice these people for the resulting cost savings? I doubt it.

    Americans seem to always want it both ways.