Monday, October 20, 2008

Public health care + ACC = no accountability

This appalling set of cases reported in the NZ Herald are not the sort of thing Michael Moore describes when he waxes lyrically about how socialised health care is so wonderful. Take this:

"Patient 1 - Aug 2006: A suspected retinal detachment in Whangarei is referred to specialists at Auckland DHB.

Ten days later: No word from Auckland; patient asks Whangarei doctor to follow up. Auckland confirm they have the referral.

Feb 2007: Still no action from Auckland. Patient again asks doctor what is happening. By then the condition has worsened too much for the treatment.

Nov 2007: Patient's left eye is removed."

It can be explained, at one level, by the following.

- Capture by providers, who get funded according to what bureaucracies recommend, and certainly not based on what consumers want;
- ACC protecting providers from being sued.

ACC, you see, is an absolute travesty. It provides a one-size fits all socialised insurance scheme, where you get what the scheme dictates - because you couldn't have chosen another provider. The insurer doesn't claim it from the incompetent or the incompetent's insurer (which is ACC too), doesn't hike up the premiums from the incompetent. The incompetent says sorry, and the victim loses an eye.

Yes, fantastic system, so low cost - except for the victim of medical malpractice.

Yes, in the USA it would take months for a lawsuit to proceed, maybe years with appeals. However, the incompetent ones would seek to settle, to avoid those costs, and the mere fact of having to face up to these costs directly changes behaviour.

ACC is the socialist way of spreading the cost of accidents among everyone, including those who don't cause them, don't have them, and the costs for victims are flattened, ironed out, so you don't get more than "your share".

It needs to be opened up to competition, at all levels, so that people can choose the cover they want, so insurers can charge premiums according to risk, so that the incompetent face their costs, and others do not.

In the meantime, it will be simply another "oh we're very sorry" to those who lose an eye, have cancer spread potentially fatally, and have another stroke.

At this election, ACC has barely a mention. National will consider re-opening the employers' account to competition, which wont touch this. ACT would open all of ACC up to competition, which would make a difference. Libertarianz would open all of ACC up to competition, privatise it and restore the right to sue.

So what do you think? Would competition in ACC be enough, or should health professionals face being sued for their incompetence? I don't mean the crazy subjectivist US tort cases where people sue for their OWN incompetence, but clearly establishing on the balance of probabilities that the other party has been unreasonably negligent.


Mr Dennis said...

What is often forgotten in this debate is that ACC provides accident cover for everyone, not just people in work. If you had private work-based insurance schemes this would cover much of the country, but not the housewife who sticks her finger in the blender at home.

ACC has many faults for sure, but it does cover people who may not be covered if we just had private insurance. And if you move partly to private insurers, then the burden of those people not paying premiums is spread over fewer people paying for ACC, which would make ACC more expensive, send most people away, and leave the housewife out on a limb with no money for treatment.

There may certainly be a role for private insurance instead, I am generally not a fan of state schemes, but this is one major feature of ACC that needs to be preserved if we were to move to private insurance.

Having said this, I personally don't feel it is fair that workplaces have to pay through their ACC levy for injuries incurred by people who choose to get drunk and take stupid risks, or for people who choose to do highly dangerous sports without taking out their own insurance. But we do need cover for genuine accidental injuries incurred during everyday life, such as the housewife in my example.

macdoctor said...

You have focussed mostly on a very small area of ACC - that of medical malpractice. However, the introduction of contestability into accident insurance would mean that ordinary accident victims would have to look for compensation through the courts. This would produce a massive log-jam in the court system and leave disabled people without proper support for years.

PS. I am a doctor and I would much prefer my lawyer to deal with my mistakes than ACC!

libertyscott said...

mr dennis: I'd envisage there being a period where the only difference with ACC is choice and contestability, and everyone is covered by a default provider.

macdoctor: You have a point, which is why moving ACC first to individualised and dare I say compulsory, insurance is a first step. You then have the responsibility to choose, the only next step being to remove compulsion. It is about changing the culture to one where first you think about ACC because of competition, and because your risk reflects your premium.

I'd rather insurers spread the risk by actual risk, than by treating everyone the same.