Health Care Must be Produced
I read this article on CQPolitics.com that deals with some of the issues of handling health care costs, and also suggests to me that my feeling may be right that the types of savings claimed by the candidates as part of their health care programs may be much more complicated to attain than they would have us believe.
There’s a fundamental qualitative difference between saying that someone has the right to life, liberty, and the pursuit of happiness, and saying that someone has the right to free health care. While there are costs for life, liberty, and the pursuit of happiness, once won, they impact very broadly. In the case of medical care, someone has to produce the care, in fact, many someones. There are physicians who spend huge amounts on their training and go into massive amounts of debt for the privilege of treating us. Drug companies do make profits, but they also must expend a great deal of time and energy on research and development. Those who produce medical equipment again have huge investments. Then we turn around and say that everyone has a right to their services.
Now those who have been around this blog for some time may want to remind me that I have called for universal health care, and this post sounds like I’m arguing against it. But I hope you’ll also recall that I have mentioned the contradiction. The problem is simply this: We’re not going to deny people treatment at the emergency room door. What happens as a result? We do cover those least able to pay but in one of the most expensive and least effective ways possible.
Since we’re going to spend money here–and as a Christian I believe I should do what I can to see that these people are cared for–the question is how are we going to do so more effectively. The article I cited at the beginning lists a number of excellent points. I’m not going to try to reiterate them or argue with them. I confess that I am finding the details confusing, and I don’t think I’m that easily confused.
Here’s the direction my thinking is going. I think we need to define basic medical care that will be universal, and provide the necessary subsidies for that care, possibly through a type of credit on taxes. Then we need to leave the more advanced and experimental care ideas in private hands to be developed over time. As a technique becomes ready for the mainstream, we could change the boundaries of basic medical care.
I believe Nurse Practitioners are one way into the future. I often wonder how people from non-medical families do it. I can call my wife, sister, mother, all RNs, or my brother the cardiologist, and say, “Here are my symptoms, do I need to go see the doctor?” Generally the answer is no. A little sensible care at home and I’m up and running again. Just consider this: Friday was probably the most miserable day I’ve ever experienced in terms of illness, and today I’m sitting here typing, no visit to the doctor involved.
People are concerned with lawsuits, but that is something that could be managed legally as well. Preventative care would be important and could be pursued through more accessible primary care.
But health care plans that simply deal with distributing care won’t provide a long term answer. We need to keep in mind how good health care is produced, and what any new plan will do to that production. Medical practitioners are not merely distributors of an existing good, like water. They are producers, and if we want them to produce we’ll need to deal fairly with them as well.
This is the fundamental problem I have with calling healthcare a right. Even in your solution you ask for a basic medical care to be defined and granted to everyone.
The problem is how do you decide what medical care is basic if you assume medical care is a right. No matter what you decide, you then appear to be denying rights to some people while giving it to others and the whole problem remains.
I think your recognition of the difference between medical care as a product being different from what is recognized as our fundamental rights should lead you away from declaring health care as a right, and therefore any plan that offers universal health care needs to acknowledge that we are not defending a right, but instead offering a benefit that has to be paid for by the taxpayers. And that we are giving what should properly be a market based system to a government to be run as the government sees fit. In the past, this hasn’t worked well if at all, especially in a country where we have freedoms that naturally support capitalism over government based solutions.
Thanks for your very thoughtful comment.
Well, I don’t call it a right. I may have been unclear, but I was arguing against calling it a right.
But if I do not call it a right, but rather a benefit that is useful for society to provide, then I don’t see the problem. Society can draw the line at whatever point is considered best.
As a Christian I desire to have everyone receive whatever care they need. But there are many Christian duties that I do not feel obliged to carry out by means of state power. In fact, there are very few that I do, and I would want to justify the remainder from a secular perspective.
OK, but that’s what I thought I was doing. Like I said, perhaps I was somewhat unclear.
Well, “worked” is a verdict that requires context, i.e. what you expect the system to do. I don’t see the current system–one in which many uninsured folks use emergency rooms for primary care, which is expensive, with costs unfairly distributed–as “working.”
I doubt that we could go “pure market” as a solution, because I really don’t think people would accept the notion of having people turned away from the emergency room doors.
Could you propose a market based solution that would ensure, for example, that children get basic care?
Thanks for the reply. I was arguing more about healthcare being a right as a general statement made by advocates of universal healthcare, not so much that it was your position – just a general ramble sparked by your post.
I’m pretty sure I don’t have a reasonable market based solution for the problem, but I do think there are things to ponder that would be feasible in a market system that would improve the system.
For example, we seem to have lost the concept that health insurance is really insurance. I think insurance ought to be for unexpected events similar to auto insurance. You don’t buy auto insurance and expect to get oil changes and tune-ups with it. If you did, you’d pay a lot more for the insurance and the cost of oil changes and tune-ups would go up simply because you involve a third party payer. I would think that better health insurance would be insurance against catastrophic health events. This has two benefits in my opinion: The risk pooling becomes more identifiable by the insurance companies and thus becomes more manageable and less costly overall and you remove third party payers from basic general medical care which should cut those costs. That way you use the basic medical care system with your own dollars and competition can develop amongst general care givers to drive costs down.
I can see requiring people to carry at a minimum an emergency care policy similar to how you have to have auto insurance to drive. For those who are poor, it wouldn’t be unreasonable to have government purchased ER policies to cover those who cannot afford a premium.
I think that, as you mentioned, a lot of general care can be done by people with less educational background than doctors. This would require some recognition that not everyone will need massive amounts of schooling and interning to perform general care functions. Targeted schooling that is cheaper could lead to lower salary requirements for general care givers and lower costs in the end.
WalMart and others have already shown that the purchasing power of large retailers can bring down the costs of medicines. It’s hard to argue that the government can do better.
Those are just some thoughts.
I apologize for the length of time it took to get that comment out of moderation. I’m not even sure why it wound up in moderation in the first place.
I was busy experiencing the health care system rather than talking about it. I spent overnight in the emergency room, and was very glad to have excellent insurance. They still don’t know what was wrong, but hopefully enough follow up will discover the problem.
Sorry to hear about that! No need to apologize for blogs when you need to tend to yourself. I hope they find what they need to soon and can get you back to normal.