The danger is that people will over-use the public system. Governments can solve this by offering a really bad customer experience (Soviet architecture, putting an experienced nurse at the front desk rather than a cute 20-year-old girl, bad food, less choices, and so on). People often prefer private hospitals, even when public hospitals offer superior treatment. This takes the load off the public system, allowing it to serve the people who need it.
> The danger is that people will over-use the public system.
How does that work exactly?
I'm trying to think of how I could even deliberately overuse health care, in the event that I decided health care were something desirable rather than something I tend to avoid because it's boring. The best I can come up with would be to hit myself with a hammer occasionally, necessitating treatment of the injury. I'm not sure why people with a public system would deliberately do something like that.
I'm not really trying to be facetious. This seems to be one of the ways in which health care isn't like any consumer product: people really do not want as much of it as they can get. In terms of preventative medicine, just getting them to use it can be quite a chore. In terms of treatment of disease or injury, I don't see how using it for its intended purpose qualifies as "overuse."
This is actually a common problem with what is, in practice, an already socialized portion of American healthcare: Emergency Rooms
Since emergency rooms cannot turn patients away, there are a lot of people to come to the emergency rooms for things like pains in their big toe, menstrual cramps, and so on.
This is why the emergency room is so absurdly expensive in the United States. Health care here really isn't very expensive so long as you go nowhere near the emergency room.
But your logic here is flawed. People go to the ER for those things, which are normally legitimate problems, because they can't afford to go to a regular physician. It's sort of ironic that you would pick this example. The idea that health care here really isn't expensive outside of ERs ... is just kind of ridiculous. I think it would be a better argument to say "I don't care about them, screw them if they can't pay" than to use this reasoning -- at least it has the potential for being realistic.
Some people go to their GP and that helps reduce the load. But see the need for out of hours doctors clinics being placed in the same place as A&E units - Swindon has electronic signs telling you the estimated wait times for each unit, with big signs telling you where out of hours doctors unit is.
Continuing to remind people about pharmacists, NHS_Direct, GPs, and out of hours GPs is helping reduce pressure on the NHS, but still.
See also the gently cheeky "Acute admission units" - a method for A&E units to avoid the penalties for keeping people longer than 4 hours by cycling people out of A&E and into aau for monitoring and then release or admission into hospital proper.
Over the past 5 years I have seen many A&E units; and spent many many hours in them. They have all been very busy, and often with many people who probably didn't need to be there. (Although I have no way on knowing that; I am not a doctor and I have no medical training and there's no way of telling just by looking at someone if they should be there or not.)
The most serious problem in all of them was people turning up for things that were very minor - a splinter; a bruised ankle; some other very minor injuries. These are the kind of things that may need treatment, but you don't need to go right that instant to hospital. I didn't even mind the people who were waiting quietly, but you hear people grumbling about the wait times. I'm not sure they realised that there are minors, majors, and resus, and that if there are 8 ambulances outside it's likely that majors is chock-a-block and all the clinicians are a bit busy tonight.
But someone with a broken arm is in a lot of pain; someone with X is at risk of death. And if you have people that need to be triaged that's one less nurse for treatment (because they're triaging) and the triage queue gets long.
And the people with a graze are likely to have to wait a very long time, because (for some reason) it's not acceptable to tell people to go and see someone more appropriate. These people also count against the hospital for the 4 hour wait limit for A&E patients.
Your blaming the patients, without considering the lack of primary care in the US. Some HMO "covered" Primary Care Providers(Physicians) have a 2-3 week wait for an appointment etc.
Certain hospitals have "express care" or "urgent care" on premises, that will treat patients without insurance, same as the ER. Santa Clara Valley Medical Center has a pretty efficient "express care" clinic.
Firefighter / paramedic (/ IT geek) here: I took a patient today out of the ER (via ambulance) to a skilled nursing facility. There were a lot (for us, 6+) ambulances in the receiving bay. Patient comments: "Wow, busy. Usually when I'm going to the ER, and I see that many ambulances, I say to my friend "we'll come back tomorrow when it's quieter"."
Seems clear that if this is a real problem, then there needs to be a system to siphon off those people so they aren't clogging up the ER for those concerns.
Actually, triage is to ensure that those who have the most life threatening conditions are treated first. So you might have a life threatening condition that will kill you in an hour, but a gun-shot victim might die immediately. He goes in front of you.
The problem isn't that demand is insatiable for all people. Economists assume that every individual's demand is insatiable for ... dubious reasons.
I think it's more the "80/20" customers - old people who are bored. Drug addicts begging for pain killers. Hypochondriacs. People who have done their own diagnosis and want the doctor to give them their antibiotics (when it's really a common cold, and antibiotics won't help). There's a common meme on HN that free services attract bad customers.
Ordering unnecessary scans or tests; being prescribed medicine you don't really need like antibiotics, painkillers, or antidepressants; demanding second/third/fourth opinions.
In a public system, patients cannot order scans or tests; that is the doctor to judge. Also, ideally, a doctor isn't paid more if he orders more tests/does more work.
One thing people can and will do is not so much 'demanding second opinions', but 'revisiting the same doctor to get reassured'. The latter does not have to be that expensive, if the cultural norms are OK. There are countries with costly culture where a visit to a doctor must end with a prescription or treatment. In other countries, patients leave happily with the message "it does not look broken and it isn't infected; if the swelling does not go away in two weeks, come back"
