Public Medicine
TWELVE MONTHS before the next election, the media is already saturated with political commentary. The polls show, we see, that a majority of the people would like to have health care nationalized, and even to pay as much as $150 a month to enjoy it.

One has to wonder what they have in mind. Presumably, they do not imagine that every doctor would cost the same amount; the ones who have been lucky recently, and had very few patients expire, would have long lines of would-be patients waiting to be seen.

If good doctors charge more than poor ones, then all doctors will be more or less equally busy, but some people will be spending much more than others: one would suppose that women of child-bearing age will be far more concerned to keep healthy than would grandmothers.

One solution to this variation in demand is familiar; it is the catastrophic medical insurance policy, which covers the expense of treatments that only a small proportion of the population will ever require.

However, the medical profession perceive that this is a misconceived solution. The best strategy is to spend money on prevention, rather than treatment; almost, if not quite, everyone would benefit by having advice and, perhaps, certain procedures before they ever suffer any symptoms.

Once we think in terms of health, rather than sickness, the problem becomes soluble. What we ought to do is to pay, not for the expense of treatment, but for the benefit of being well. Thus one should join a genuine health maintenance organization - one in which you paid a fee every day you were well, and stopped paying when you were sick. The organization would have a strong incentive to get you better quickly; its treatments would have a kill-or-cure character. Young wives and athletes would join expensive HMOs, retired persons would gravitate to cheaper ones - there might even be some, run by teaching hospitals, which charged only a token fee (and gave only token treatments.)

This is, obviously, an example of paying for results, not for expenses - something which is all too scarce in these United States. Masses of workers are paid for the time they put in, not the product they put out: one of the few exceptions is that drivers are paid so much for every sixty seconds' worth of distance run. But it should not be new and strange -- we remember the “Apollo” astronaut who was asked what he thought about when he was in orbit, and replied, “I reflect that to get down again I rely upon a thousand systems, and every one was made by the lowest bidder.” (Or perhaps not all of us do remember that thought: I just looked in Wikipedia for “Apollo,” and this anecdote was not included.)