It’s more than a little intimidating to even try and approach the question of what type of healthcare system is “better.” Besides for being immensely complicated on a policy level, questiitons about healthcare touch on basic moral and ethical questions that are understandably very controversial. For example, is there a right to healthcare? And if there is, how can we even think about a system that doesn’t provide healthcare to every possible individual? It’s also not so simple to define “better”–there are tradeoffs associated with anything as massive and complicated as modern healthcare.
For me, the questions can be fundamentally reduced to the classic adage “there’s no such thing as a free lunch.” At the end of the day, no matter what sort of system you’re in, someone needs to pay for it. I’ll return to this point a little later, when I talk about the advantages of a private healthcare system.
A story I like to tell that I think is illustrative of the basic differences between public and private systems is about my MRI. Last winter, I was training for a marathon, and ended up with some leg pain that was keeping me from training. I was worried it might be a stress fracture, given that I had had those in the past. I was able to get an appointment with an orthopedist the next day, and he told me to call a local imaging center to get an MRI. I called, and sure enough, they told me I could come in tomorrow. However, it would cost me $350, even with my insurance. Given my injury didn’t feel so urgent at the time, I decided to pass. Fast forward two years, and I’m currently studying in Israel, which has universal healthcare coverage. I’ve still been running, and sure enough, I started having leg pain again. To see an orthopedist (or a specialist of any kind), I first had to see my general family doctor, who then gave me a referral. The next available appointment was about a week away. The doctor here also sent me for an MRI, which wasn’t available for nearly a month and a half. However, the whole thing was free. From family doctor to orthopedist to MRI and back to the orthopedist, I didn’t take my wallet out a single time. So that, in a nutshell, is the two ways of providing healthcare–we’ll give it to you tomorrow, but it’ll cost you; or you might need to wait a while, but it’ll be free. As another crude rule of thumb, it can be said that private systems can provide exceptional care for a smaller number of people, and public systems can provide a baseline level of care for a much greater number of people.
When all’s said and done, it’s hard to say conclusively that one system is “better” than another. It’s even hard to compare one country to another, because most countries are not a pure public or a pure private system. Even countries with a public health system generally allow an individual to purchase private health insurance that gives them more benefits if they so desire. And the US, known for its largely privatized health system, has government health programs (Medicare, Medicaid, and others) for certain populations. Both public and private models have significant advantages and disadvantages, and a healthcare model that tries to be entirely one or the other is doomed to failure. So, rather than declaring one or the other better, it’s more helpful to have a clear understanding of the pros and cons of each. Then, you can decide which set of pros is more important to you, and which cons you’re not willing to tolerate. So, here are some of the pros of a private healthcare system:
- Choice and flexibility: Generally speaking, private healthcare systems give you the most choice. There are many insurance providers, a wide variety of plans, and the ability to switch plans more or less whenever you want. If you want to get multiple second opinions and consult multiple specialists, you’re free to do that. If you’d rather have a procedure done at one hospital over another, you can do that too. For many people, this is an important factor.
- Access to state-of-the-art healthcare facilities and technologies: Private healthcare systems are not as concerned with maximizing efficiency, so they can afford to spend more money on the latest and the greatest. Going back to my MRI example from before, my appointment was scheduled a month and a half out, and I was supposed to be at the hospital by 6:00 am. MRI units run just about 24/7 here, and appointments can regularly happen in the middle of the night. There are a limited number of units in the country, and they are maximally scheduled for efficiency. In the US, MRIs are ubiquitous in hospitals and imaging centers.
- Ability to fund cutting-edge research and development: This point seems to become more and more relevant every year, as the cost of groundbreaking, lifesaving medicines reaches astronomical heights. For example, a single round of CAR-T therapy for cancer can cost over $500,000–a cost that would quickly bankrupt any government trying to provide it for a large number of its citizens. Of course, a balance has to be be found that keeps life-saving drugs affordable for those who need them. However, the research and development process is in itself very expensive, and the ability to recoup some of that investment is essential to maintain the pace of innovation. Private systems that don’t have to be as concerned with maximizing efficiency can afford to put more money into experimental treatments and diagnostics. And indeed, the US, the prototype of private health systems, is heavily over-represented in many areas related to innovation in medicine–Nobel Prize winners in Medicine or Physiology, discovery of new pharmaceuticals and diagnostics, and clinical trials. In fact, according to the WHO, the US performed nearly 135,000 clinical trials in 2019, which is nearly triple the next leading country, China, with 46,000.
- Longevity: In many ways, our healthcare systems are victims of their own success. As the human lifespan gets longer and longer, we have many more people using healthcare resources for more years. This is compounded by the fact that as most people age, they will use exponentially more healthcare resources to maintain a lower quality of life. This is the core problem of purely public systems, and the rationing of care that this entails is less of a problem in private, for-profit systems. As an example of this issue, the United Kingdom’s National Health Service (NHS), recognized as one of the best public healthcare systems in the world, is facing serious financial concerns that unchecked, could lead to serious instability and disruption of care.
- Doctors and other care providers are paid significantly more in private healthcare models, and this incentivizes a higher level of talent. Of course, doctors and nurses do not enter their fields solely because of money. With that said, human nature is what it is, and the financial incentives that private healthcare allows for go a long way in attracting and retaining the the best in the field.
At the end of the day, I think it’s clear that there are ups and down to any method of providing 21st century healthcare to everyone in the world. As we become the physicians of tomorrow, it’s vital that we learn and think not only about anatomy and pathophysiology, but also about the real world economics and policy of how healthcare is delivered.