“If you think health care is expensive now…” *
D.A. Ridgely on Jan 27th 2008 12:16 pm |
Those of us who are entirely indifferent this morning to which Democrat Caroline Kennedy thinks is most like her daddy might consider instead this opening paragraph from the (UK) Daily Telegraph:
Smokers, heavy drinkers, the obese and the elderly should be barred from receiving some operations, according to doctors, with most saying the health service cannot afford to provide free care to everyone.
First things first, a bit of Borscht Belt humor: “You’re charging $10 a pound for lamb chops?!? Across the street at Stein’s I can buy them for $8 a pound!” “So go buy them at Stein’s.” “I can’t, he’s out of lamb chops.” “So when I’m out they’ll be $8 a pound here, too!”
It isn’t that the British national health service cannot afford to provide free care to everyone but that it cannot provide free care to anyone. Hidden costs are real costs nonetheless and the fact that the typical British citizen (or journalist) is unaware of the real cost he personally bears for his health care is irrelevant to the fact that it exists.
What the surveyed doctors are thus saying is that while it is not only proper but necessary for smokers, heavy drinkers the obese and the elderly to continue to contribute toward a socialized medical system, they should nonetheless be deprived of the very benefits they are most likely to need. That sounds fair, doesn’t it? I do hope you think so because it is, sadly, only a matter of a decade or so and maybe sooner before Americans find themselves the, um, beneficiaries of a similar health care system.
Be that as it may, let’s get one other point straight. One thing else the doctors are noting, a point which happens to be entirely correct, is that health care, like every other good in the world, is scarce in the technical economic sense that its supply potential demand exceeds its potential demand supply. [See comments.] Otherwise, we could have all the MRIs and liver transplants and stomach staples and cosmetic surgery and quadruple bypasses and whatnot our bloated, cholesterol clogged hearts desired.
Alas, we can’t. Oh sure, we can take some measures right now to increase, for example, the supply of livers for transplant, and according to my thanaphobic friend Ron Bailey we will someday live in a golden age of genetic medicine when cloning yourself a new liver or simply repairing your old one to its pristine condition will be as simple as microwave popcorn, but we’re not there yet. One way or another, medical treatment is going to be rationed and the only question left is whether that rationing is going to be conducted by the market or by the state.
Admittedly, deciding who gets a new liver on the basis of who can best pay for it or, worse yet, who can pay the most for it, strikes most of us as unfair. Health care, we feel, shouldn’t be like Ferraris or Picassos, available only to the wealthy, but like movies and Coca-Cola – plentifully available and affordable to all. Bill Gates and Warren Buffet can both drink their Cokes out of solid gold goblets while they watch Walk Hard in the comfort of their private home theaters but the Coke won’t taste any different and the movie will still suck. And that, we feel, is how health care should work.
Well, it doesn’t. For one thing, unlike many other modern services, it remains highly labor intensive, requiring skills ranging from neurosurgery to the folks who have to mop up all your messy bodily fluids after the operation. For another, the economics of medical technology (the machines, not the medicines) is such that all the emphasis is on performance, not on greater cost savings. That is to say that if we were willing to live (and die) with 1960s level medical technology, we could save a great deal of money. But we’re not. We want those MRIs and whatever the next generation of cutting edge technology might be and damn the cost.
A post or two ago, I mentioned a Weekly Standard column claiming that “[t]he moral vacuity of dogmatic libertarianism is poisonous to public life.” As absurd as that column was, I would agree with that statement but for the critical fact that what dogmatic libertarianism I have encountered over the years has had absolutely zero effect on public life. It’s around, though, if you want to seek it out at, say, any Libertarian Party social function. Be that as it may, the authors made yet another claim worth quoting here: “[E]conomic libertarianism, elevated to the status of inviolable first principle, leads to moral libertarianism.”
To which I can only add, damn, I sure hope so! Moral libertarianism, if it means anything at all, must mean something like the claim that I can’t know in advance how important that medical treatment is to you, your family and friends and you can’t know in advance how important it would be to me. Not, at least, in any absolute, “let’s-make-a-rule-for-everyone” sense. And that’s exactly what the rationing of socialized medicine perforce does; makes one-size-fits-all rules.
Markets are morally imperfect because people are morally imperfect. Letting people themselves decide what medical services they want or need and making them recognize that, one way or another, they must pay for those services entails a certain sort of unfairness. The problem with socialized medicine, however, is that its solution to that problem is far, far worse.
* “… wait until you see what it costs when it’s free.” — P.J. O’Rourke
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I think you need to fix an important error DA. You wrote:
One thing else the doctors are noting, a point which happens to be entirely correct, is that health care, like every other good in the world, is scarce in the technical economic sense that its supply exceeds its potential demand.
I think you meant “the potential demand for it exceeds the supply.” The way it’s worded would suggest health care was a free good!
D’oh! Thanks.
Some years ago I did not understand why some similar technology cost more in the medical field than in industry. Reliability was not an issue. It has always been assumed that it has been some one else’s fault that the cost of heath care was high, rather than the health care industry itself. Pay and charge whatever, because most patients have the Lazarus syndrome. Abuse in the medical system encouraged, by the doctors and insurance companies, getting paid by the numbers and insurance not covering enough of the cost. Now many years later it is our fault for wanting decent health care and thinking it shouldn’t cost more than the average weekly salary.
I want to agree, I realy do, I like libertarian arguments. But the fact is a lot of people I know would be dead now if their access to healthcare had been dependent on their personal income. I know this is an emotional response not a rational one and rationing on any other basis is at least as bad. Basically I can’t accept that anyone benefits if doctors have to say.
’sorry Mr X but you are too poor/fat/drunk/stupid for me to save your life’
I’m trying to see why this is a good thing but I just can’t.
[...] Contra national health care, a position I’m aligned with certainly. [...]
“One way or another, medical treatment is going to be rationed and the only question left is whether that rationing is going to be conducted by the market or by the state.”
In most developed countries “rationing by the state” means that it’s the doctors who try to decide how to make the best use of the limited resources. For example, if obese smokers are less likely to benefit from surgery due to increased post-op mortality, they might be discriminated against.
Of course there is the danger that physicians will use inappropriate criteria (e.g. make moral judgments instead of clinical ones). But I’m not convinced that auctioning transplant organs to the highest bidder would be an improvement. Drug research, where the greatest minds and resources are focused on conquering hair loss and prolonging erections, is a good example of how the market allocates resources in health care.
In most developed countries “rationing by the state” means that it’s the doctors who try to decide how to make the best use of the limited resources.
Yes, but they have little to no say over how limited those resources are. Those decisions are made by the state, not the market. Moreover, the physician decision making process is itself typically regulated and monitored by the state.
Drug research, where the greatest minds and resources are focused on conquering hair loss and prolonging erections, is a good example of how the market allocates resources in health care.
As does how much we spend on pets, junk food and various form of mindless entertainment by contrast to medical research or humanitarian relief. Which undoubtedly says much about our species. But what it doesn’t say is (1) that the state could or does do a better job of giving people what they want and believe they need (as opposed to what, oh, say, you think they want or need) or (2) the state or you or I have any right to force our ‘better’ vision on others.