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At 02:23 PM 2/22/98 -0500, Geoff Forbes wrote:
 
> If you developed a single-payer system, would that
>not save money? The current system clearly needs a beaureaucracy  to
>administer the regulatory apparatus to control the corporations. Add that
>cost in, and I find it hard to believe that you would not save money. And
>perhaps your infant mortality rate would come up to standard, too!
 
Couldn't agree more Geoff; but you still run into the problem of rationing
with a single payer system.  There are 'market forces' of internal medicine
competing with slash it open surgery; health promotion competing with
curative services; renal dialysis guys competing with liver transplanters.
 
Rationing is the next problem the single payer system has to address.
Unless you expand the % of the GNP you spend on health.  But that can only
be done at, say, a decrease in expenditure on education.
 
I'm looking for answers on this one as I have an MPH assignment to write and
would love any input!!!
 
Rationing access to a 24 hour ED when the user does not have to pay
anything, not even a small co-payment as a slight disincentive is my problem.
 
I live in a town of 27,000 and our ED Census is 32,000.  Some of those
extras are tourists - up to 13% in the season - but I'm sure you'll get the
picture.
 
The economic rationalist in me can see the point of using market forces to
make things work 'efficiently'; but the social-libitarian-democrat in me
sees the market as not the most just way of getting things done.  Economic
efficiency is not the only goal in life.  Otherwise parents would never have
children!
 
Greg
 
 
=======================================================
Dr Greg Winterflood  BA MBBS DA DRCOG
Director Emergency Department
Alice Springs Hospital
 
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