Health Care Myths

This link is to a preliminary draft of an article:

Myth #1 Health Care Costs are Soaring

No, they are not. The amount we spend on health care has indeed risen, in absolute terms, after inflation, and as a percentage of our incomes and GDP. That does not mean costs are soaring.

You cannot judge the "cost" of something by simply what you spend. You must also judge what you get. I'm reasonably certain the cost of 1950's level health care has dropped in real terms over the last 60 years (and you can probably have a barber from the year 1500 bleed you for almost nothing nowadays). Of course, with 1950's health care, lots of things will kill you that 2009 health care could prevent. Also, your quality of life, in many instances, would be far worse, but you will have a little bit more change in your pocket as the cost will be lower.

Want to take the deal?

In fact, nobody in the US really wants 1950's health care (or even 1990's health care).

They just want to pay 1950 prices for 2009 health care.

They want the latest pills, techniques, therapies, general genius discoveries, and highly skilled labor that would make today's health care seem like science fiction a few years ago.

But alas, successful science fiction costs a lot.

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Myth #2 The Canadian Drug Story

Ah … one of the holy myths of the "US health care sucks" crowd.

This should be fun.

The general story is how you can buy many drugs in Canada cheaper than you can buy them in the US.

This story is often, without specifically tying the logic together, taken as an obvious indictment of the US's (relatively) free market system.

This is grossly misguided.

Here's what happens. We have a (relatively) free market in the US where drug companies spend a ton to develop new wonder drugs, a non-trivial amount of which is spent to satisfy regulatory requirements. The cost of this development is called a "fixed cost." Once it's developed it does not cost that much to make each pill. That's called a "variable cost."

If people only paid the variable cost (or a bit more) for each pill the whole thing would not work. You see, the company would never get back the massive fixed cost of creating the drug in the first place, and so no company would try to develop one. Thus, companies have to, and do, charge more than the variable cost of making each pill.^[2]

Some look at this system and say to the drug companies "gee, it doesn't cost you much to make one more pill, so it's unfair that you charge much more than your cost." They are completely wrong and not looking at all the costs.

So, let's bring this back to our good natured friends to the North (good natured barring hockey when they'll kill you as soon as look at you^[3]). They have socialized medicine and they bargain as the only Canadian buyer for drugs, paying well below normal costs. Drug companies that spent the enormous fixed costs to create new miracles are charging a relatively high cost in the free and still largely competitive world (the US) to recoup their fixed cost and to make a profit.

But socialist societies like Canada limit the price they are allowed to charge. The US-based company is then faced with a dilemma. What Canada will pay is not enough to ever have justified creating the miracle pill. But, once created, perhaps Canada is paying more than the variable cost of each pill. Thus, the company can make some money by also selling to Canada at a lower price as it's still more than it costs them to make that last pill.

However, this is an accident of Canada being a less-free country than the US, able to bargain as one nation, much smaller, and next door. If we all tried to be Canada it's a non-working perpetual motion machine and no miracle pills ever get made because there will be nobody to pay the fixed costs.

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Myth #3 Socialized Medicine Works In Some Places

This is a corollary to the "Canada as parasite" parable above. The funny part is socialized medicine has never been truly tested. Those touting socialism's success have never seen a world without a relatively (for now) free US to make their new drugs, surgical techniques, and other medical advancements for them. When (and I hope this doesn't happen) the US joins in the insanity of socialized medicine we will see that when you remove the brain from the body, the engine from a car, the candy from the striper, it just does not work.

So, please, stop pointing to all those "successes" that even while living off the US still kill hard-working people who could afford their own health care while they stand in line for the government's version (people's cancers growing while waiting 10 weeks for a routine scan, which these people could often afford on their own if allowed, is a human tragedy). Even the successes you gin up for them would not be possible without the last best hope of humankind (the US) on the front lines again making the miracles for the world.

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Myth #4 A Public Option Can Co-Exist with a Private Option

This one has been the subject of some hot debate. Let's first define it.

Part of the current junta's plan is to add a "public option" for health insurance. That is health insurance provided by the government (actually provided by you and your neighbors – this is a good thing to remember whenever you find yourselves thinking anything comes from the government, really, if you take away anything from this essay take away this!). They claim this "public option" can co-exist fairly alongside private health insurance, increasing competition and keeping the private system "honest", and not deteriorate to a single payer (socialized medicine) system. They are wrong, or very dishonest, as in unguarded moments they admit that the single payer socialized system is what they really want. The New York Times disagrees with me, thinking the two can co-exist. But the New York Times still thinks Stalin was a pretty decent Joe.

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The government does not co-exist or compete fairly with private enterprise. It does not play well with others. The regulator cannot be a competitor at the same time. It cannot compete fairly while it owns the armed forces and courts. Finally, it cannot be a fair competitor if when the "public option" screws up (can't pay its bills), the government implicitly or explicitly guarantees its debts. We have seen what happens in that case and don't need a re-run.

The first thing the government does is underprice the private system. You can easily be forgiven for thinking this is a good thing. Why not, cheaper is better right?

Wrong.

They will underprice private enterprise by charging less to the purchaser of health insurance, not by actually creating it cheaper.

Who makes up the difference?

Well, you and your family do if you pay taxes, or your kids will pay taxes, or their kids will pay taxes. The government can always underprice competition, not through the old fashioned way of doing it better, they never do that, but by robbing Peter to pay for Paul. They are taking money from your left pocket and giving you a small portion of it back in your right pocket. They do it every day before breakfast, and take a victory lap for the small portion they return.

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Myth #5 We Can Have Health Care Without Rationing

Rationing has to occur. This sounds cold and cruel, but it is reality.

A=A.

If you have a material good or service, like health care, that is ever increasing in quality, and therefore cost, there is no way everyone on Earth can have the best at all times (actually the quality increases are not necessary for rationing to be needed, it just makes the example clearer).

It's going to be rationed by some means.

The alternatives come down to the marketplace or the government. To choose between those alternatives you judge on morality and efficacy.

Everyone on both sides seems to hate the rationing word. People favoring free markets point to the explicit rationing that occurs in other countries with glee, while those favoring socialism point to the number of uninsured who get their health care through emergency rooms and the like (a form of rationing). Both sides are wrong to complain about rationing per se, that's a fact of life. But there are differences.

It is an uncomfortable truth that tough choices will have to be made. There is no system that provides for unlimited wants with limited resources. Our choice is whether it should be rationed by free people making their own economic calculations or by a bureaucracy run by Congressional committee (whose members, like the Russian commissars, will, I guarantee you, still get the best health care the gulag hospitaligo can provide). Free people making their own choices only consume what they value above price, using funds they have earned or been given voluntarily. With socialized medicine health care is rationed by committees of politicians trying to get re-elected and increase their own power, and people consume as much of it as the commissars deem permissible. I do not find these tough alternatives to choose between.

Myth #6 Health Care is A Right

Nope, it's not. But we are at the nuclear bomb of the discussion. The one guaranteed to get me yelled at or perhaps picketed by a mob waving signs printed up with George Soros's money. Those advocating socialized medicine love to scream "health care is a right." They are loud, they are scary, but they are wrong about rights (as the 1980 kid in me resists the temptation to type "TO PARTY" – you had to be there).

This is more philosophy than economics, and I'm not a philosopher. But, luckily it doesn't take a superb philosopher to understand that health care simply is not a "right" in the sense we normally use that word. Listing rights generally involves enumerating things you may do without interference (the right to free speech) or may not be done to you without your permission (illegal search and seizure, loud boy-band music in public spaces). They are protections, not gifts of material goods. Material goods and services must be taken from others, or provided by their labor, so if you believe you have an absolute right to them, and others don't choose to provide it to you, you then have a "right" to steal from them.

But what about their far more fundamental right not to be robbed?

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And In Conclusion

At this point you might accuse me of offering only complaints about the Administration's plans, without constructive suggestions of my own. There is truth to that. But I make no apologies. If people believe crazy things it's first and foremost important to change that before progress can be made. But also, I think we're doing okay enough without radical changes, certainly not hastily panicked changes towards socialism, and also because I lack the expertise to recommend the detailed practical steps that would be productive (in contrast it requires no expertise to see that the myths above are indeed lunacy).