The Opposite of Health

posted at 8:48 pm on June 8, 2009 by Doctor Zero
printer-friendly

The Democrats have released some details of their health care reform proposals, and to the surprise of no one, it includes intrusive regulations and vast government spending. The Republicans will be challenged with crafting a response that includes more freedom of choice for health-care consumers, and keeps the medical industry within the private sector. The latter objective is crucial, for the Democrats desire nothing more than to nationalize this enormous industry, and every plan they propose will be based on this goal. Socialized medicine is a glittering prize that Democrats believe will bring them irresistible, unbreakable political power.

Health-care reform is an extremely complex topic, for the American medical industry is enormous. It comprises about 17 percent of the entire U.S. economy, and includes about two and a half trillion dollars per year in expenditures. These figures increase with every passing year, at roughly double the rate of inflation, as more sophisticated treatments become available, and the population of the country both increases and ages. More people, living longer lives, require an ever-increasing supply of medical resources. Not only is the medical marketplace large, it also deals in advanced science that very few people have the extensive training to fully understand. Very few of the people who have this training are politicians. It is also worth noting that not all of them are good businessmen, either, as anyone who has worked extensively with doctors on their financial arrangements can tell you.

Proponents of socialized medicine should understand that nationalizing this industry will inevitably increase demand and reduce supply. Becoming a health-care provider requires great dedication and ability. People are not going to put the same amount of effort into becoming surgeons and specialists when their reward will be a lifetime of drudgery as a salary-controlled government employee. Or are we going to nationalize the med schools, too? That would be an awfully big expense to tack onto the already ludicrous cost of state-funded health care.

Comparisons to Canadian or European state-run medical systems misses the crucial detail that American industry allows those systems to exist, even at their current miserable levels. Socialist medicine around the world is supported by American innovation and free-market energy. America cannot afford the indulgence of European health care for the same reason it cannot afford the indulgence of European defense spending. The rules for America are different, because its resources and responsibilities are different. The European health care model is nothing to brag about anyway, and given the vast size of the U.S. market, the overall experience for Americans under socialized medicine is bound to be even worse.

There are also some things conservatives should keep in mind about health care. Chief among them is the simple truth that Americans will not tolerate the poor dropping dead for lack of medical treatment. They are increasingly uncomfortable with the tragedy of ordinary people going bankrupt from the cost of life-saving medical treatments. I do volunteer work for a cancer charity, and I have seen many families ruined by the struggle to pay for chemotherapy and surgery. These therapies are very expensive, requiring hours of priceless specialized labor from medical doctors and drugs that cost billions to develop… but they are not optional for those whose lives depend on them. The voters will not embrace a proposal that asks them to treat the lives of mothers, wives, and daughters as expense items on their balance sheet. The challenge for conservatives is to accept this and explain why socialized medicine is a lie that will never live up to its promises. It will not be enough to tell Americans that they are foolish for wanting to believe those promises.

I believe it is a mistake to address health care as one big issue, to be addressed by some form of “insurance.” There are really three broad types of health care: wellness and diagnostic services, treatments for moderate illness or injury, and catastrophic care for life-threatening situations. Bundling all of these things into an “insurance” program makes no more sense than expecting your automobile insurance to pay for oil changes and tune-ups. Pushing a car with serious engine problems up to the door of an insurance company and asking to buy cheap coverage, so you can immediately turn around and file a huge claim to get your broken car fixed, is equally absurd. Decoupling wellness and routine diagnostics from catastrophic care would let something approaching the conventional definition of “insurance” handle the serious stuff. Coverage for pre-existing conditions is not “insurance,” and should not be treated as such.

Wellness and diagnostic services are relatively inexpensive, and produce both savings and increased health for everyone, so they should be encouraged. Companies could sell affordable plans to cover these needs, the same way you can buy prepaid maintenance plans at a discount for your car. Routine examinations require relatively little in the way of expensive equipment or high-value medical specialist labor, and result in dramatic reduction in the need for expensive – and sometimes tragically ineffective – care later on. For example, about 56,000 people per year die from colorectal cancer each year. The five-year survival rate, when these cancers are detected early, is better than 90 percent… but only about forty percent of these cases are detected early. Making early detection and treatment affordable, and readily available, will save lives, and reduce the strain on the health-care system. Affordability and availability are products of increased supply… exactly the opposite of what would happen under state-run health care.

Health care reform will inevitably involve some type of subsidy to ensure lower-income Americans have access to vital services. Let’s be honest: they’re receiving those subsidies now, through the least efficient system possible – the billion-dollar shell game of cost shifting, where hospitals and clinics charge inflated prices to insurance companies and people who pay their medical bills, in order to cover the costs of writing off indigent care. We would save vast amounts of money by dealing openly with the needs of the poor, and giving them access to preventive care and diagnostics. The worst place in the medical system to put the needy is the emergency room. It’s bad for their health, bad for the financial profile of hospitals, and terrible for overstressed emergency facilities.

Champions of market-based reform should also remember that health care is a somewhat unique commodity, in that consumers will never see themselves as truly informed buyers. Most people will not be able to get behind a health-care system that requires them to become medical experts. Competition is desirable and has a role in keeping costs down, but it can never be quite the same as the competition that exists between car dealerships, or fast-food restaurants. People are terrified at the thought their lives will depend on their knowledge of medicine. They will desire guidance, which the current insurance system provides by giving them a choice of approved providers in their area. Perhaps a network of carefully qualified primary care providers could offer wellness and diagnostic programs, to be paid for with pre-tax dollars kept in a medical savings account – supporting good health practices in the best way possible, by keeping government’s hands off the dollars set aside for it.

Combined with true health “insurance” against catastrophic needs, a wise health care system could bring choice and competition into the medical industry, while clearing away the maze of hidden expenses passed along to gigantic government agencies and insurance companies. It would put money in the hands of patients, encourage them to purchase the essentials for general diagnostics and catastrophic insurance, and let them decide where to spend the rest. It would honestly confront the needs of low-income patients, and the growing cost of sustaining our increasingly long lifespans. It would recognize that health care has been only half “private” for many years now, and the government half is desperately in need of reform, too. Regulatory reforms and streamlining the process for bringing new drugs to the market would do a lot to reduce the cost of pharmaceuticals, which are an increasingly important part of any treatment program. We must give private industry the incentives to push forward with radical new technologies that can revolutionize our lives, and bring costs down even further. We’re standing on the brink of some incredible breakthroughs. It would be a shame to stifle them because politicians fool the public into believing that mediocre health care, spread thin by a clumsy and corrupt state, is somehow “free.”

For economic systems, as well as scientific disciplines and living organisms, “health” involves growth, evolution, experimentation, and vigorous competition. Socialized medicine, with its rationing, institutional aversion to experimentation, and emphasis on hiding costs – while it convinces patients to be satisfied with less – is the opposite of health.

Blowback

You must be logged in to post a comment.