Monday, July 20, 2009

Health Costs, Rationing and Hypocrisy

July 20, 2009, 9:00 a.m.

Two Thoughts on Medical Bills
(brought to you by*)

There are a couple aspects of "the cost of health care" I'm going to try to put briefly this morning.

1. I believe that those public officials, and the campaign contributors who fund them, who so willingly handed over trillions of taxpayer dollars to some of America's wealthiest bankers this past year are now morally precluded from using "cost" as a reason for continuing to deny health care to Americans.

Am I concerned about sickness costs accelerating at a rate four times wages? Of course. It's not a trivial concern. But there are responses other than voting "No" on any and all proposed solutions.

(a) They talk of the added costs "over ten years." But a trillion dollars over 10 years is $100 billion a year. They gave that much to individual companies! To be able to provide health care to every American for the same amount puts both their prior generosity, and their current miserliness, in a clear, stark perspective.

(b) Where did this idea come from anyway that we can only have the quality of health care other countries provide their people if we can do it for no additional money? Of course it's going to cost money! We don't apply that standard to the defense budget. We don't apply it to earmarks and other corporate tax breaks, subsidies and giveaways. Why does it suddenly become our Polaris of navigation when it comes to keeping America healthy?

(2) "Rationing" health care. One of the arguments of the special-interest advocates, and their purchased public officials, in opposing universal, single-payer and public option plans is the bugaboo of "rationing."

(a) We already have "rationing." The rationing decisions are made by the executives of for-profit companies that make more profit, and pay those executives larger bonuses, by refusing to provide any insurance, or care for some, and denying the claims of others (all the while raising premiums). There are procedures, and drug treatments, they simply refuse to pay for. They try to suggest that there is no rationing in the present system, but that it would be imposed by "government bureaucrats" in the proposed reforms.

Give me a choice between a greed-driven rationing and even an incompetent (but at least not self-interested driven) rationing, and I'll choose the latter every time.

(b) We cannot provide every conceivable medical procedure known to everyone who might like to have it, regardless of cost. We can't, won't and don't pay for that approach whether with the insurance premiums paid to for-profit providers or with the taxes that support a public system.

There needs to be some metric, some way of thinking about, the benefit-cost returns in any health care system, private or public. It is not only economically essential, it is rational and reasonable, for a public system to focus on providing "the greatest good to the greatest number" by insisting that no one go without the relatively low cost procedures and medicines that can provide them more "quality years" of life -- even though the result may be that the very most expensive treatments have to be curtailed as a public expense (while retaining the option of a patient paying for them with cash, or an additional private insurance plan). The point is, that's what we do now. The very wealthiest get care the rest of us do not; we can't afford it, and our insurance policies won't cover it.

The advantage of a public option is that we would save the system money by getting the uninsured out of the emergency room and into a doctor's office (at a fraction of the cost). By providing medical care to all at the onset of disease, or immediately after an injury, by offering relatively cheap routine checkups, we'd not only improve Americans' health we'd also save the far greater future costs of treating more serious conditions.

Would this mean that some of us, some of the time, would not get public coverage of some treatment we might now get with our private for-profit insurance? Probably. But the opposite might also be true; there would undoubtedly be some treatments a non-profit system would conclude are cost-effective than a for-profit system refuses to provide. Regardless, we would have the benefit of a nationwide level of health -- of infant mortality rates, and life expectancy -- that would bring us closer to the standards of the rest of the industrialized world, with all the economic, humane and moral consequences of such a system.

This morning's blog entry was inspired by the following thoughtful, analytical, balanced article in yesterday's New York Times Magazine: Peter Singer, "Why We Must Ration Health Care/'Public Health Insurance Should Pay Up To $__________ For a Treatment That Would Extend a Patient's Life for One Year,'" New York Times, July 19, 2009, p. MM38.

If you're at all interested in this subject you need to read it.

* Why do I put this blog ID at the top of the entry, when you know full well what blog you're reading? Because there are a number of Internet sites that, for whatever reason, simply take the blog entries of others and reproduce them as their own without crediting the source. I don't mind the flattering attention, but would appreciate acknowledgment as the source, even if I have to embed it myself. -- Nicholas Johnson

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Nick said...

Notice Regarding Advertising: This blog runs an open comments section. All comments related to blog entries have (so far) remained posted, regardless of how critical. Although I would prefer that those posting comments identify themselves, anonymous comments are also accepted.

The only limitation is that advertising posing as comments will be removed. That is why one or more of the comments posted on this blog entry, containing links to businesses, have been deleted. -- Nick

sajohnson said...

Very well put!