Wednesday, October 20, 2004

The Federal Health System


At the moment, the health system is apparently partly state-run and partly national, although you'd be forgiven for not realising. Health is one of those things which you worry about, but can't do anything about. You pay your taxes, maybe join a private fund, and hope you don't get sick enough to need it. The government are probably trying to fix the problems, but they seem to be virtually insoluble. Doctor, heal thyself!

This article is talking about getting rid of the state-level control over the medical system - whatever that is! If you read it carefully, it tells you that what the states do is run hospitals. The government funds medicare, and the state funds hospitals. This seems sensible at some level, because it brings the money and the hospital closer together. Voters can lobby their state government if the hospitals suck, without having to compete against other more pressing national concerns.

What seems to make sense is to have medicare and the hospital system unified. Certainly it makes sense to standardise wages for hospital staff, put in a decent central computing system to enable the exchange of medical records between venues, perhaps put in a national doctor's network. Monopolies are efficient, if you can trust them not to abuse their power. And if you can't the government, well who can you trust? (Don't answer - it's a rhetorical question.)

Philosophy doesn't have too much to say, except to suggest that having a central point of failure is poor system design. Half of New York lost power when a little bit of their electricity grid caused a cascading failure. If you want something to be robust, break it into little bits. On the other hand, you don't want duplication of effort either. In the end, all philosophy can tell us is that we need to take a lot of care in building the proper system - it could work brilliantly, cutting down on inefficiency, promoting standards, improving communication and patient tracking. On the other hand, it could be consigning the whole lot to a beaurocratic grave.

In the meantime, it might be a good idea to take up jogging.


Blogger said...

interesting article, and i like your site. just one question, is there any reason you don't hyperlink to the SMH and Age articles? i'll be back...

10/21/2004 06:33:00 PM  
Blogger MelbournePhilosopher said...

I try to include the text to important links as the blog posts also go to a plain-text mailing list, which you can find out about at I sometimes forget to make the text into a link. Glad you like the site! It's always great to get comments, even if it's just to say you came by...

10/21/2004 11:16:00 PM  
Anonymous Anonymous said...

I just wanted to add the point that decentralisation can also be efficient. (Indeed, after writing the below, I'm semi-convinced that decentralisation is more efficient as a general rule of thumb) Let's use the power industry and the fuel cells as examples.
Electricity is currently produced in coal-power plants. These plants are much more thermally efficient when running in a centralised manner (argument by assertion, yell if you want details). The inefficiency is that a single turbine is expensive (lack of scale-of-economy) and the electrical power losses over transmission lines. There's also the impact of a single-point of failure (eg Esso gas crisis).
Fuel cells are becoming practical. Due to the nature of the technology, it isn't radically more thermally efficient to run them centrally. But fuel cells can be mass-produced, benefiting from scale-of-economy. We can also reuse our existing infrastructure to distribute fuel (gas or petrol stations) with less losses than transmission over powerlines. It benefits from a massively-multiple-points-of-failure -- which is what you precisely want for a critical infrastructure. It is hence my conjecture that when fuel cells is practical, it'd be better if this critical infrastructure is decentralised.
But more accurately, it isn't decentralisation which makes it more efficient, it is that with fuel cells, we've used "market forces" to act as our centralisation infrastructure. We've also reused existing infrastructure of pipelines, roads, trains, petrol station.
Nor is this an isolated example, the health system should be decentralised, especially general practice as seen in Medicare. Sure, there may be some places where centralisation helps (eg Centre for Disease Control), but in the main what possible benefit does centralisation bring to general practice except that of red tape. The answer of course, is a consistent standard of health care across the country, which is admirable in itself.

10/24/2004 04:46:00 PM  

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