A reader writes:

Our daughter also needed the ear tubes your reader described. Living in Australia, we have the option of waiting in line for our single-payer system to provide this necessary surgery for free, and most of the time this is what we do. This time we decided we needed to move more quickly (our one-year-old wasn't learning to speak because her hearing was affected) so we took the private option.

We booked in for the surgery the following week with our chosen surgeon. Not having health insurance, we paid the surgeon's and anesthetist's bills (about $1600 altogether) and the government reimbursed us about $600. So yes, I'd say your reader's estimation of an inflation factor of 10 is about right.

The surgery took 10mins, she settled within half an hour of waking, and our silent little girl chatted herself to sleep that very night (while I wept tears of relief in the next room). I'm praying your legislators ears are similarly cleared to healthcare options that benefit the people, rather than the profit-takers.

Equally, what this story says to me is that we'd have a far more efficient healthcare system if more, rather than fewer, procedures were paid for out of pocket.

The severance of the link between a customer and a product removes much of what helps bring market forces to bear. And for many non-emergency medical procedures, allowing for greater areas where patients are not insured, while maintaining catastrophic or minimal coverage, is the best option.

That requires more engaged and knowledgeable patients and more flexibility. Note how in the US we're debating whether to attach a public option to a subsidized private system; in Australia and Britain, they're debating more private options for a state-run public system. It's getting this mix right that's the key.

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