Universal Health Care?

Ahh, Universal Health Care (UHC) – a term being thrown around quite a bit this election cycle (well every cycle in recent memory, for that matter). After a recent discussion with a friend about health care in the US and the varying perspectives Americans bring to the table when examining and debating the current state of our nation’s medical/health care system, I would like to explore the definitions, history and empirical data relating to this hot-button political issue. Let’s start by speaking clearly about the actual definitions of these words. Nothing can be “universal” that is not also “mandatory”. Since everyone is different in what they want, in order for everyone to have anyone’s version of “universal” anything, it has to be mandatory for all individuals. To put it another way, in the words of Thomas Sowell, we are talking about forcing people to belong to whatever program the politicians and bureaucrats come up with, regardless of what the people themselves might prefer.

Now, someone’s overall “health” is actually an all-encompassing term used to sum-up the end result of several things – diet, genetics, exercise, lifestyle choices, etc – which government cannot control, and a few – doctors, hospitals, medicines – that government can control. What we are left with when we talk honestly about UHC is politicians and bureaucrats forcing people to get their medical treatment and pharmaceutical drugs the way the politicians and bureaucrats decide since all other things relating to health care are outside of the scope of government control.

As I mentioned to my friend during the conversation, it always seems implied by proponents of UHC that the government would do a much better job than the private sector does on health care, and at a much-reduced cost. While I have trouble coming up with two things that the government does better and cheaper than private individuals and organizations, mostly anyone could give you a laundry list of things our government does worse and at higher costs. Running hospitals, administering pharmaceutical companies and managing doctors is an extremely costly and cumbersome venture currently handled by the private sector. There is no logical argument that can be made that will convince me that this cost is going to be somehow magically reduced by the addition of the hundreds of government bureaucrats and massive amounts of red tape it will take to effectively remove the private sector from this enterprise – quite to the contrary, I believe the cost will go up exponentially while choice and benefits go away.

Now before we go on to comparisons between the US private health care system and some government-run “Universal” health care plans around the world, let’s get some common “misconceptions” about health care out in the open.  First, one commonly held belief in UHC circles is that a lack of insurance coverage equals a lack of medical care. This is a LIE.  Another one is that health care and medical care are the same thing.  Many people who are currently uninsured in the US have no coverage by choice. They can afford to buy insurance, but would prefer to spend their money elsewhere, counting on their youth and perhaps good luck to keep them from medical bill catastrophe.  (I know – my wife and I did exactly this during the first few years of our relationship and marriage)  When the financial burden of medical bills is not offset by insurance, people are more likely to be more careful about what they choose to go to the doctor for, which can bring down costs overall.  Conversely, in an emergency, ANYONE can go to the emergency room and be treated, US law says no person can be turned away for any reason – of course most Americans today would laugh at you if you suggested they should pay for this type of care themselves…

Virtually every aspect of the so-called health care crisis boils down to the fact that everybody wants somebody else to pay for health care.  The basic underlying fact that is not going to change is that medical care is costly, whether those costs are paid by HMOs, the government, the patients or anybody else. We can try to pretend that these costs don’t exist or hope to force somebody else to pay them, but none of that changes the costs or the fact that they have to be paid.

With our country’s record prosperity, surely it is not too much to expect adults to face up to trade-offs. We are not talking about going hungry so that a child can have an appendix removed. We are talking about not eating out as often, or not buying so expensive a watch, so that a mother can spend another day or two in the hospital.

Politicians see all this very differently. They leave trade-offs to economists, who don’t have to get elected. Politicians win votes by passing laws creating “rights” for patients to get this or that, without either providing any money to cover the costs or expecting the patients to cover the costs. The additional costs will be left to be paid “somehow.”

It is a great game for those in the business of getting re-elected. But the costs don’t disappear, no matter how much they are shuffled around.

If you ask most people about the cost of medical care, they may tell you how much they have to pay per visit to their doctor’s office or the monthly bill for their prescription drugs. But these are not the costs of medical care. These are the prices paid.  The difference between prices and costs is not just a fine distinction made by economists. Prices are what pay for costs — and if they do not pay enough to cover the costs, then centuries of history in countries around the world show that the supply is going to decline in quantity or quality, or both. In the case of medical care, the supply is a matter of life and death.

All the existing efforts to control the rising expenses of medical care — whether by government, insurance companies, or health maintenance organizations — are about holding down the amount of money they have to pay out, not about reducing any of the real costs.

There is no fixed amount of medical “need.” There are some minor ailments that you may either ignore or treat with some over-the-counter medication, perhaps with the advice of a pharmacist. There are some other ailments that might cause you to phone your doctor for advice but which neither you nor he considers serious enough for an office visit. And of course there are other things that require immediate and perhaps extensive medical attention.

When you are paying your own money, you sort these things out accordingly. But when someone else is paying, then the trivial and the urgent are both likely to find their way to the doctor’s office. This means that both are likely to get less time and that patients with serious problems are the biggest losers.

Prices not only ration existing supplies, they also determine how many new supplies will be forthcoming. When a new pharmaceutical drug costs an average of $800 million to develop, there is no point talking about “affordable” medications.

Either the $800 million is going to be paid or the supply of new drugs will dry up. Controlling prices does not change that.

Well, it appears I’ve gone on much longer than I originally anticipated, and this blog on the health care situation in the US will have to be carried in to multiple blogs, or a “blog series” if you will.  See you there.