Having had two melanomas and most likely to have more and having grown up in Denmark with universal health-care and now living in the US with insurance based healthcare I have been thinking about health care in general a lot.

Some random thoughts:

You can never spend enough on healthcare. There is always new machines, new technologies, new drugs, new treatment types, better educated doctors we could spend our money on if we wanted to. Furthermore we are treating people earlier and earlier and for more and more things. The old saying that if you are not sick it's just because we haven't found the right diagnosis for you seems to be true.

In effect whether you are in a private healthcare system or a universal one whether you pay double or your get taxed 100% there will never be enough money for healthcare.

Now depending on whether you have private healthcare or public healthcare the way you measure it is completely opposite. In a private healthcare system everything is a potential profit center. I.e. the more people who are sick the more money can you potentially make.

In a public universal healthcare system everything is a cost center. You have a budget and you have to deliver to a politically decided standard.

Both have pro's and cons. To give you an example.

It took me 3 weeks to get a time with my dermatologist in Denmark, when i finally got it it was the day before I moved to the US. The Danish dermatologist found one they considered troublesome, but they couldn't themselves do the biopsy and I had to get a time at a hospital to get it.

I decided to wait until I got to the US ignorant as I was I thought it was just a question of formalia. But no I had to wait a whole month for my insurance to work (that is a whole other discussion for another time)

When I finally got it though, I got a reference for a dermatologist same day and they did the biopsy, same day. Today I am at Sloan Memorial with one of the best dermatologist in the world getting checked every 3 months having a complete 3d scan of my body (in blue speedos and a white net) and hopefully we will be able to make sure that I am being managed properly.

What I am trying to say is that the level of expertise a private healthcare system allow for is more flexible than a public one because it allow for the allocation of resources. On the other hand if you look at those let fortunate than me, with worse healthcare plans etc they will get a less favorable treatment. I.e. the system isn't evenly distributed.

What the public healthcare system secures is that it's mostly evenly distributed but with less of a flexibility to build experts as there are budgets and a bigger need for priorities in any publicly funded system as it's a cost center.

So you have fundamentally two system where one covers only those with insurance but allow them to potentially pay their way to the latest treatments with the best doctors and the other where everyone gets treated but you don't have the same amount of experts and potential treatments.

Neither systems are really optimal. Do we want to have people die because they can't get healthcare coverage or because they can't get the necessary treatment because it doesn't exist in the country they live.
I know it's more complicated than this of course but in broad strokes thats at least my perspective and this has lead me to the following observations.

1) Both systems are fundamentally financially unsustainable in the long run. Whether the system succumbs to it's own weight by costing the tax payer too much to pay for everyone while only delivering average treatments or whether it's impossible for the insurance companies to secure a large enough part of the population without leaving too many without proper coverage. Both just doesn't sound "right" (I know Germany, and Switcherland have some variations that sound more right but I am not sure they don't fall into the trap of either the cost center, or the insurance cost issues.)

2) One way to solve it is to ensure that people pay for all the normal encounters they have with the doctors (sore troth, hernia, back pain etc) but that you insure yourself against long term illness. In other word we should pay for normal things but no one should be going bankrupt because they can't pay for long term or serious illness.

3) By removing the insurance part from a lot of the normal encounters with the healthcare system and only putting it towards more serious conditions hopefully doctors will start to compete against each other rather than spend all their time fighting with the insurance companies.

4) I have a naive hope that technology could somehow limit the cost of many of the more complicated treatments. Over time hopefully many of the things that are wrong with us can be treated via gene-therapy hopefully not requiring too many people to do the actual treatments.

5) I think we have to come to terms with the fact that none of the systems really work and that all of them have solutions to problems in the other systems. That way perhaps we can start to break down healthcare into more discreet parts rather than the giant monster that it is today.

Thoughts?