If I encounter a health issue I can choose between public and paying more to a private instance.
While like most countries the Australian system has problems, it also seems to work fairly well as a hybrid system. However, like in the UK, there is a move to get rid of public health systems here and require private insurance. I think this is driven more by ideology than evidence.
One thing that would help the US system is standardization of reporting codes. I forget the exact amount saved, but it was like 25% saving on costs. A medium sized hospital in Canada, according to a report I read several years ago (Newsweek?), needs one insurance clerk. The US equivalent needed 400 people. Doctors also spend a whole day a month (but not all at once) filling in paperwork. Its not government doing that, its the myriad private insurers. One reporting code, standardized, would bring down costs and give more time back to doctors to treat patients.
No system is perfect. They can all be improved. I do not however think a private versus public debate is the main issue. I think the real issue is managed medicine. HMOs telling patients they cannot have life saving treatment. Government bureaucrats determining what is or is not permitted for doctors to do. Standardization of treatment such that if your own best treatment is not recognized you are out of luck, regardless of whether its from private insurance or government funded treatment. Medicine needs both regulation and flexibility. People are not made from Lego blocks.
This is where EBM, evidence based medicine, is becoming an issue. Its being used to restrict and control medical treatment. Its about denying services, and standardizing treatments. This applies equally to countries with private medicine, or state backed medicine, or hybrid models. It should be about determining better treatments as a guide, not strict rules.
The underlying principles of EBM are sound, but it needs to be recognized they are primarily managerial not scientific methods. However how EBM is being used and promoted is very far from good public health policy. Globally we are moving to a situation where only some treatments will be available, and if they do not suit you then too bad.
One thing I do want to say about the US system is that doctors have more latitude to fight administrative nonsense providing the doctors are not in a managed healthcare organization. I do think they are slowly losing that fight though. Something has to change.
PS My comment is also related to issues in this thread:
http://forums.phoenixrising.me/index.php?threads/medical-practice-too-standardised.42761/
