For background, I was the CFO of one the largest Medicare/Medicaid contractors, the VP of one of America's largest private health insurance companies, and the CEO, CFO, and COO of various very large health care providers.
What has always bothered me is to read people advocating health care systems based on their personal ideology rather than a comprehensive understanding of the pros and cons of the different systems in the world.
I hope your grandpa is not the victim of the biggest problem with government funded or managed health care systems. These problems are frequently evidenced in the Canadian health care system. Government health care systems lack the profit motive and as a result do not respond to consumer demand especially changing demand for specific services or total demand at the regional level. All of these systems have built in mechanisms to "ration" care and often that "rationing" effect is reflected in the "wait times" to get care. In other instances, including in Canada, it has influenced whether or not the health care system will expend the resources to try to "save" someone when the cost is high and chance of success is low (logical, but it looks far less attractive, when you or a family member are being written off).
When you operate a resource managed health care system (virtually all government systems), those in charge have to do the best with what they have and that means making decisions regarding who gets care and who does not.
The machinations of how this works varies by country, but the result is the same. Some people are denied needed care for "the greater good" of an affordable health care system.
Private systems where individual providers are paid for what they do are characterized by short wait times, excessive care (at Medicare we estimated 30% of all care delivered was unnecessary), and high cost (the high cost is especially problematic where the patient has little financial responsibility for the care they receive, instead the bill is paid by the government or employer).
I spent a career working in the health care system, during most of which I occupied an executive position where I could see the effects of the different systems or had access to research related to them. Government funded health care systems are excellent at managing the overall health care costs of a "population" and at achieving an overall acceptable level of health care (usually reduced to life expectancy and quality of live measures for the population as a whole). But as you highlighted, people fall through the cracks.
Private health care systems are much more individual patient centered. Personally, I prefer the latter, but I also recognize some of the negatives of a patient centered health care system. To function properly government has to play a role and the private sector has a role to play. Government’s focus should be to ensure pricing is reasonable, provider abuse is punished, and funding is available to the poor.
For a private health care system to work well, patients must have enough financial risk to make good decisions. This is hard, because people have different income levels, but unless people pay something towards the cost of their health care, they make bad decisions and if it costs too much relative to their income they make bad decisions. Finding the sweet spot causes patients to use the health care system appropriately.
Patients need help making health care decisions from someone who does not directly benefit from what decision they make. Managed care has emerged precisely because study after study confirms that physicians tend to recommend up to 30% more health care than patients need, and most patients have no way to evaluate those recommendations. But managed care companies often have conflicts of interests just as physicians do. Perhaps AI someday could emerge to fill this role.
Personally, I think Kaiser Permanente comes closer than most systems to aligning patients interests with the health care system. Kaiser is most profitable when you are healthy and don't need health care and the physician receives no compensation for ordering unnecessary care.
Kaiser needs to satisfy patients, or they can leave and go elsewhere (not something you can do with a government health care system unless you are rich). I like the fact, that Kaiser is constantly monitoring my health (I have a few chronic issues) to keep me from having my health issues turn into big problems. Medicare does not do that, and most private physician offices don't either.
The problem with the "Kaiser" model is that it requires a pretty extensive health care system to work and a large patient population. Kaiser does "ration" resources to keep costs down, but that rationing can't reach the point where patients say I am switching to another plan, government has no such restraint.
Again, there is no perfect system, but as an individual, I prefer a patient centered one over a population centered one and I am prepared to submit to a system that attempts to help me avoid unnecessary care over a system that simply does not have the resources to treat necessary care.
