The Hungry Burghers of Burgerland want Burgers…
But not everyone can afford them, and burger inequality is rife. How can we solve their problem?
- Pay as you go
Let’s imagine you want a burger, but there is no system for burger provision, just lots of independent providers.
You have options. You could go to a fast food outlet. You could visit a supermarket. You could buy the ingredients for your own home-made burger. If you’re in need of gastronomic enlightenment, you could search for the world’s best burger, perhaps made from Kobe beef, lobster and a hint of truffle, served with a Dom Perignon ’96.
With all these options you’ll get a burger. And with all these options, you’ll be expected to pay.
Your choice will be informed by various parameters. Cost may be an issue. Quality of the burger might be important, regardless of price. Or perhaps you might be more interested in how long you’ll have to wait, or how far you would need to travel to reach your burger.
If you don’t have much money, you’ll probably choose a cheaper burger, but it might be less tasty. If you don’t have any money at all, you’ll go without, or take out a loan.
And burgers in Burgerland can be pretty pricey.
- Private insurance
You probably want to know that a burger is available for you if you suddenly need one. Perhaps the solution would be to have an insurance system? Everyone could pay a regular insurance contribution, and then if you do need a burger urgently the payment could come from the insurance company.
Insurance systems spread risk. So, no-one with insurance would find themselves bankrupted by a sudden unexpected need for a burger. And with plenty of money available for burgers, from the big insurance pot burger providers will multiply as they compete to get hold of the money. Burger joints will strive to stand out, to offer the best burgers. They will advertise, they will pay top salaries to the best burger chefs, they will invest in the latest burger-cooking technology. Meat and bun producers will also advertise, encouraging the punters to consume more burgers. Prices will be high, but the cost will be spread amongst the people paying insurance.
Of course, you might not even be able to afford the insurance payments, or you might choose to take a risk and not pay, hoping you won’t need a burger. If you do need a burger unexpectedly you will be in even worse trouble than under the pay-as-you-go system, because the insurance schemes have driven prices up. And even if you are insured, your insurance will still be pricey, because the cost of all that investment in burger technology and staff will have to eventually make its way back to the burger consumers as premiums rise to compensate.
And insurance companies are generally out to make profits. So they might try to avoid paying out, by turning down claims for burgers. And you might only discover that your claim has been turned down after you’ve eaten the burger. If you claim lots of burgers on your insurance, the insurance companies will soon spot that you are a high-risk customer, and raise their premiums, or even refuse to insure you in the future.
- National Burger Service
Burgers are a key need of the burghers of Burgerland. So perhaps the state should provide them to anyone in need, free of charge? That way, when you need your burger you could simply claim it from the National Burger Service.
A state-run National Burger Service would be funded by tax. Taxes would have to be raised in Burgerland to fund this scheme, but for the average citizen it would still cost less than a private insurance scheme. And people who earn the most usually pay more taxes, so the poorest people would get the best deal. People with no income at all would still receive free burgers, even though they don’t pay any taxes.
There may well be some economies of scale – the government could bulk buy the ingredients and some of the process of making the burgers could be cheaper if it was centralised. And, of course, the Government won’t be trying to make a profit, which removes another layer of costs. Demand for burgers may not rise as much as in a privatised system, as no-one will be encouraging Burgerland citizens to eat more burgers than they actually need. In fact, the government will have an incentive to educate people that too many burgers aren’t good for you.
On the other hand, discouraging unnecessary consumption can soon start to look like rationing, and no one wants the government deciding whether they should have a burger or not. Are they really the best people to run a burger provision system? Each election could lead to a change in strategy – the new Government might decide to focus on Pizzas and reduce spending on burgers, and the NBS might struggle to make ends meet. As a result, waiting times might increase and burger quality might suffer.
The NBS would be practically a monopoly supplier of burgers (although some very exclusive and expensive private burger restaurants might survive, for people who could afford to pay). Monopolies, especially when Government-run, can lead to poor quality service and poor efficiency. And the NBS would be a monopoly employer for burger chefs, who might have a fight on their hands to earn a decent wage.
The quality of burgers on offer would be the same for everyone – people expecting Kobe beef and lobster in their burgers might find that the National Burger Service refused to fund them. There might not be so many individual burger providers, and you might have to queue for a burger, and share your table with someone else.
Perhaps none of systems 1-3 are perfect. So how about combining them?
A hybrid system might include a co-payment (pay-as-you-go) from the consumer, covering a little bit of the cost of the burger. There might be a mandatory insurance system, subsidised by the State (with exceptions for people who really couldn’t afford it). The funding generated by the State insurance scheme would go to private providers of burgers, with the Government having a say in the tariffs for each type of burger.
It’s a bit more complicated, but it might avoid some of the pitfalls of the other three systems. Everyone would have coverage. The co-payments would reduce unnecessary demand for burgers, and those who really couldn’t the co-payments might be exempt. The state control of insurance would prevent higher premiums for people who needed more burgers, but the hospitals would be run by the private sector, hopefully encouraging competition, preventing a monopoly, and leading to good quality burgers.
On the other hand, a hybrid system also combines some of the disadvantages of systems 1-3. Co-payments might put off people from seeking burgers when they really need them. The increased complexity means that costs will be higher than if the government ran the whole system. And competition has downsides as well as upsides. Some burger joints may fail and close, while others succeed. And while no-one wants to go to a failing burger place and eat stale greasy burgers, everyone wants to have a burger available close by in case of burger-related emergencies.
Take your pick…
In the end, the burger provision system you choose is going to depend on your priorities.
If you believe everyone should pay for what they use then pay-as-you-go burgers are for you. But you’ll have to live with a very unequal society, in which the poor simply can’t afford burgers.
If you want Government involvement minimised, but to allow some risk sharing so that more people can afford burgers, and you also want your burger chefs to be well paid, and to have access to the latest technology, then a private insurance system is for you. But your burger insurance will be very expensive. And some won’t be able to afford insurance, and they won’t be able to afford the high prices out of pocket either.
If you want the cheapest way to ensure burgers for all, that must be the National Burger Service. You’ll get complete equality of access to burgers, but you’ll have to live without the fanciest burgers on the market, there might be a queue, and an ineffective Government could make a big mess of running it.
If you want to achieve the best of all these systems, you could try a hybrid burger service, but you have to watch out for all the disadvantages creeping in too.
Disclaimer: Hopefully, if you’ve read this far, you have spotted that this article is really about healthcare. I take no responsibility for any burgers consumed as a result of peckishness brought on by reading this post.