psychologists, and all of these factors play significant roles in determining health outcomes, but they escape the orthodox economic analysis and expose a severe [*712] limitation of a model that assumes maximizing behavior. An understanding of the psychosocial variables that explain and predict health behaviors, and thus good health, could valuably inform health care policy. n21
This Article proceeds as follows. Part I challenges the conventional presumptions that motivate Medicaid policy , chiefly, that an insurance gap is responsible for health disparities. It reports evidence suggesting that an individual's insurance status is largely a choice variable , and that improving inequalities in insurance status and access to health care is unlikely to end health disparities. Perhaps more significant, disparities in consumption of health care itself - let alone health insurance - may have little effect on health disparities . This relates to a broader and increasingly popular claim that the United States over-consumes health care without enjoying material improvements in health. n22 Thus, a policy geared to improve health by providing health insurance is doubly flawed. NHI results in lower quality care—long waits, reduced quality, price controls, funding crises, physician shortages, and poor medical technology. Fleming 6 — Kevin Fleming, internist and geriatrician in the Division of General Internal Medicine at the Mayo Clinic, M.D. — Creighton University School of Medicine, fellow in Geriatric Medicine at Mayo Graduate School of Medicine, 9-22-2006 ("High-Priced Pain: What to Expect from a Single-Payer Health CareSystem", Heritage Foundation , Accessed Online at - health-caresystem) Policymakers should ignore imagined outcomes and focus closely on the performance of existing models : the British, Canadian, and other state-run systems . In these systems, health care is subject to bureaucratic and political rationing and driven by political and budgetary pressures. This leads to inevitable adverse effects, including: Long waits and reduced quality . In Britain, over 800,000 patients are waiting for hospital care . In Canada, the average wait between a general practitioner referral and a specialty consultation has been over 17 weeks. Beyond queuing for care or services, single-payer sys - tems are often characterized by strict drug for mularies, limited treatment options , and discrimination by age in the provision of care. Price controls , a routine feature of such systems, also result in reduced drug, technology, and medical device research . Funding crises . Because individuals remain insulated from the direct costs of health care , as in many third-party payment systems, health care appears to be "free." As a result, demand expands while government officials devise ways to control costs . The shortest route is by pro - viding fewer products and services through explicit and implicit rationing .
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