The Defects Of National Health Insurance Schemes In Other Countries Could Be Remedied By A Few Reforms.
The characteristics described above are not accidental by-products of government-run health care systems. They are the natural and inevitable consequences of politicizing medical practice.
Why are low-income and elderly patients so frequently discriminated against under national health insurance? Because such insurance is always and everywhere a middle-class phenomenon. Prior to its introduction, every country had some government-funded program to meet the health care needs of the poor. The middle-class working population not only paid for its own health care but also paid taxes to fund health care for the poor. National health insurance extends the "free ride" to those who pay taxes to support it. Such systems respond to the political demands of the middle-class working population, and they serve the interests of this population.
Why do national health insurance schemes skimp on expensive services to the seriously ill while providing so many inexpensive services to those who are only marginally ill? Because the latter services benefit millions of people (read: millions of voters), while acute and intensive care services concentrate large amounts of money on a handful of patients (read: small number of voters). Democratic political pressures in this case dictate the redistribution of resources from the few to the many.
Why are sensitive rationing decisions and other issues of hospital management left to hospital bureaucracies? Because the alternative is politically impossible. As a practical matter, no government can make it a national policy that 9,000 people will die every year because they will be denied treatment for chronic kidney failure. Nor can any government announce that some people must wait for surgery so that the elderly can use hospitals as nursing homes, or that elderly patients must be moved so that surgery can proceed.
These decisions are so emotionally loaded that no elected official can afford to claim responsibility for them. Important decisions on who will and will not receive care and on haw that care will be delivered are left to the hospital bureaucracy because no other course is politically possible.