Re: OT: Software Economics was RE: Ada 95 for an ARM-based bare board?

[Bill <wclodius@lanl.gov>]

Bill Tate wrote:

> Preben Randhol <randhol+ada@pvv.org> wrote in message news:<mailman.1030445042.8161.comp.lang.ada@ada.eu.org>...
> > "Marin D. Condic" <not.valid@acm.org> wrote on 27/08/2002 (12:41) :
> > > When a government provides health care - choices go out the window.
> > > Quality goes down. Costs go up. Rationing takes place. etc.
>
>
> > This does not apply to hospitals at least.
>    Says who? I'm not sure where you are getting your information but
> rationing is for real in both Canada & Britain which hardly strikes me
> as being examples of better quality or more efficient. And their costs
> are going up....
>
> Regardless, what I don't want is some faceless gov't bureaucrat trying
> to tell me that they care more about me or my family than I do.  Your
> system means their choices & their decisions on what is in your "best
> interest."  Excuse me if I find that whole notion abhorent,
> condescending & elitist.

As opposed to a faceless industry beaurocrat? Any attempt to pool resources to reduce risks and leverage buying
power requires some means of deciding what is best for the participating parties. In some fields that can be
determined directly by a simple contract, but that has never been fully the case in a rapidly changing and diverse
area such as health care.

Health insurance has always required a beurocracy. In the US, employer provided health care plans have dominated
the health care system as a relatively direct means of identifying large groups of people available to pool
resources. While private plans are available which are more flexible than the employer plans, the combined effects
of higher costs of finding people to join the pool and cost control by excluding people with know problems have
made those plans inappropriate for most people.

For many decades the high per capita income in the US, relatively young population, and strong unions mitigated the
effects of this beaurocracry, for most citizens. But the aging of the population has increased the fraction of the
population needing frequent care, and many medical advances have allowed improvements in treatment but at a much
higher incremental cost. These costs have in effect forced all insurance plans to examine cost controls, rationing
in particular. The weakness of the unions means that in employer provided health care plans, the employer is likely
to pay less attention to the desires of the employees in reducing costs. When the US resisted a wider government
provided health care system in the early 90's, the net result was that some of the population lost all coverage as
their employers dropped their plans, and most of the remaining covered population had their coverage changed to
HMOs. If you think HMOs don't impose more rationing than the plans they replaced then I have a bridge in Brooklyn
I'd like to sell you at a very cheap cost.

While HMOs are not yet as bad as the British health care system, they have been significant for only about ten
years, the British system has had over fifty years to get into the state its in.  Lets see what happens to the pool
of doctors, nurses, hospitals, and pharmacies over the next twenty five years.