It is mighty embarrassing if a sick person is turned away from hospital to die in the street because he has no money. So the kindly government insists that sick poor people be treated for free.
But if the hospital is going to treat poor people for free, then the hospital is going to besieged by people with carefully memorized symptoms for vague and difficult to treat diseases who show up looking for a bed, some food, and some human contact.
So, the next thing the government should do is empower to the hospital to turn away unwanted patients with a jab from a stun gun. But they don’t, because that looks kind of bad. But they do kind of sort of give the hospital some kind of monopoly power, and some power to hurry up patients who are taking too damned long to die. And then to the government’s surprise they find the hospital is mistreating and murdering affluent middle class patients. The government also finds that it still running up gigantic medical bills on bums, who are supposedly getting all sorts of extremely expensive medical treatment, though in fact they are getting this super expensive treatment only in the most superficial manner or not at all.
The hospital is rushing middle class patients out the door or into the morgue, while every corridor is piled high with incredibly expensive (and profitable) bums piled three to a urine soaked bed. (Yes, Canada, I am looking at you.)
When the government empowered the hospital to be quietly and furtively brutal and murderous, the intent was that the hospital only be brutal and murderous to the horde of bums besieging it – but they could not actually say that out loud, and if they had said it out loud would still find it difficult to get compliance.
So now the hospital is massively over treating bums, massively undertreating people who are genuinely ill with genuine diseases, and murdering any of its customers who are too sick and weak to protest. And medical costs are soaring.
So what should the government do?
Firstly, needs to hit who everyone lays down his head on a hospital bed with a high enough deductible that anyone who is not all that sick and who has to pay the deductible will not go near the hospital bed. It does not have to be all that high, does not need to be nearly as high as the Obamacare deductibles. Five hundred should do it. First thing that should happen on intake is a wallet inspection.
But suppose the patient does not have five hundred in his pocket, nor an acceptable credit card, and seems unlikely to pay. Then the nice friendly hospital for nice respectable middle class people sends him to the hospital for poor bums staffed by big ugly lesbian nurses with thick mustaches, where the first thing he meets is the death penal, with a big male guard holding stun gun, a baton, a taser, and a twelve gauge shotgun standing uncomfortably close beside him, and the death panel decides whether his treatment is likely to be cost effective.
Now at the nice friendly middle class hospital for nice middle class people we try to organize things so that the doctor and the hospital has to please the customer, if they are going to make some money, and the patient bears enough of the cost to scream bloody murder if overbilled or billed for nonexistent or barely provided services. Deductibles need to be high enough to hurt a bit, but not so high that they are, like Obamacare deductibles, frequently unpayable.
And at the hospital for poor bums, we provide all the wonders of socialist medicine so beloved by Bernie Sanders, modeled on the wonderful success of Cuban healthcare. </sarcasm>
If the hospital is in the business of handing out free beds and food, it is going to need to be able to whack undeserving customers with a baton, jab them with a stungun, and throw them into the street hard enough to bounce several times. On the other hand, you would probably prefer to send your elderly grandma to hospital that does not do that sort of thing. So we need to keep a good separation between the hospital that hands out freebies, and the hospital that does not hand out freebies.
Or, equivalently you need to have very different rules in place for treating the people who are getting free food and free beds, from treating the people who want to get out of hospital as soon as they can. You have to treat one lot pretty much the opposite of the other lot.