Quote:
Originally Posted by Azure
Sure, you can adjust the tax numbers to try and accommodate them. But in the end, providing health care for 10x more people would cost a lot more money than can be gained by the taxes gained from having a 10x bigger population base.
|
On what do you base this claim? The corollary would be that in a country 10x smaller than Canada, the money spent on health care would be more than 10x less - and eventually, if you were a country of one, health care would be practically free.
There are large fixed costs that are the same no matter what level of health care you are providing - hospitals and clinics need to be constructed, drugs need to be bought, diagnosis machines purchased, etc. Then there are the human costs of staffing and administration. Nowhere does that cost MORE than 10x as much to serve 10x as many people; properly run, economies of scale should make it LESS costly for things like administration.
On the flipside, sufficiently large organizations have a tendency to not be properly run, which usually obviates the theoretical cost savings, and also tend to be inflexible, which can cause problems if you are trying to deliver a service in many different locations with different local needs. So you have to balance between being too small, and being too big.
If *I* were in charge of creating such a system, I would set it up in some ways much like a Walmart or Costco - all purchasing would be through a central agency to allow that agency to drive the costs of expensive medical equipment and drugs down. In other ways it would be much more like a municipal government model, where there would be thousands of local *elected* health organizations responsible for delivering health care and universal insurance in their area, and supported by a budget drawn half from local tax and half from federal funding derived from a per-capita flat rate, which would serve to somewhat alleviate the inevitable difference in funding available in poorer areas from richer ones.
Private hospitals and clinics would be allowed, but would have the choice of working within the system at scheduled rates and with budgetary transparency, or outside the system entirely. Much like we have in Canada now, doctors would work under the aegis of the local health authorities, and would bill directly to that authority.
I think the key is to identify what needs to be organized on each level, and divide the responsibilities appropriately. I also think that elected health boards are important, as that drives accountability.