In order to think about institutional choices related to health care, I’ve learned to ask two questions. First, who pays? And secondly, who makes decisions about the care provided? The first question is important because medical providers pay the most attention to the person or institution that pays them. If I pay my grocer myself, she will make sure she stocks food that I like. If she is paid by someone else (for example, the corporation that owns her store), then she’ll be sure to put what that person wants on the shelf, and pay less attention to my requests. The second question is important because different decision-makers may have different objectives to fulfill in their determination of the care you receive
and on Canadian health care vs. American HMOs:
The commonality between HMOs and single-payer national health care systems should have made Michael Moore more skeptical about the European, Cuban and Canadian systems. You see, each of these countries has a health care system that is, in effect, a single, national HMO.The quotes are from The Skeptical Liberal, and you can read his extremely well-thought out and defended opinion on Michael Moore's Sicko and the effects ofHMOs on American health care in their entierty here.
Because I know Canada the best, I’ll use it as an example, but the point applies to all the rest. The questions are: who pays? And who decides? Moore makes the same mistake that most of us make regarding national health care systems when he says that “everyone” pays in such a system (remember the golfer scene?). The better answer to the first question is that the provincial health ministry pays, because it controls the revenue that doctors, diagnosticians, and medical service providers receive. The answer to the second question is the same: each provincial health ministry in Canada decides what medical goods and services will be available in any given year. A budget is set for the year, and the health care system has to stay within that budget. A bureaucracy is rewarded with more funds when it stays within its budget, hence the goal in any given year is to minimize costs: exactly the charge Moore brings against the “greedy” for-profit HMOs . A national health care system is simply a single HMO for everyone.