Sunday, March 07, 2010

Alice in Health Care Land

This is a four part (to date) series by Thomas Sowell.

In part one, he observes that a lot of the discussion of health care is like something out of Alice in Wonderland.

Alice in Health Care:

One of the biggest reasons for higher medical costs is that somebody else is paying those costs, whether an insurance company or the government. What is the politicians' answer? To have more costs paid by insurance companies and the government. Back when the "single payer" was the patient, people were more selective in what they spent their own money on. You went to a doctor when you had a broken leg but not necessarily every time you had the sniffles or a skin rash. But, when someone else is paying, that is when medical care gets over-used -- and bureaucratic rationing is then imposed, to replace self-rationing.
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Confusion between costs and prices add to the Alice in Wonderland sense of unreality.

What is called lowering the costs is simply refusing to pay all the costs, by having the government set lower prices, whether for doctors' fees, hospital reimbursements or other charges. Surely no one believes that there will be no repercussions from refusing to pay for what we want. Some doctors are already refusing to accept Medicare or Medicaid patients because the government's reimbursement levels are so low.

Similarly, if it costs a billion dollars to create one new pharmaceutical drug, then either we are going to pay the billion dollars or we are not going to keep on getting new pharmaceutical drugs produced. There is no free lunch.

Virtually everything that is proposed by those who are talking about bringing down the costs of medical care will in fact raise those costs. Mandates on insurance companies? Why are insurance companies not already doing those things that new mandates would require? Because those things raise costs by an amount that people are unwilling to pay to get those benefits.

If not, it would be a slam dunk for the insurance companies to add those benefits to the policies and raise the premiums to cover them. What politicians want to do is look good by imposing mandates, and then let the insurance companies look bad by raising the premiums to cover the additional costs.

It is a great political game, but it does nothing to lower medical costs.

Politicians who want a government monopoly on health insurance can easily get it, just by making it impossible for private insurance companies to charge enough to cover the costs mandated by politicians. The "public option" will then be the only option -- which is to say, we will no longer have any real option.

Alice in Health Care: Part II:

By all means look at other countries, but not just to see what to imitate. See how it actually turns out. Yet there seems to be an amazing lack of interest in examining what government-controlled medical care produces.

While our so-called health care "summit" last week was going on, British newspapers were carrying exposes of terrible, and often deadly, conditions in British hospitals under that country's National Health Service. But this has not become part of our debate on what to expect from government-controlled medical care.

Such scandals are an old story under the National Health Service in Britain, one repeatedly producing fresh scandals that their newspapers carry, but ours ignore.

In addition to a whole series of National Health Service scandals in Britain over the years, the government-run medical system in Britain has far less high-tech medical equipment than there is in the United States. Neither in Britain, Canada, nor in other countries with government-run medical care systems can people get to see doctors, especially surgeons, in as short a time as in the United States.
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If those who make international comparisons were serious, instead of clever, they would compare the things that medical science can have a great effect on-- cancer survival rates, for example. Americans have some of the highest cancer survival rates in the world, and for some particular cancers, the highest.

When you can get to see a doctor faster, and get treatments underway without waiting for months, while the cancer grows and spreads, you have a better chance of surviving. That, too, is not rocket science. But it is also something that you are not likely to see featured in most of the media, where people are promoting their own pet notions and agendas, instead of giving you the facts on which you can make up your own mind.

Alice in Health Care: Part III:

With all the controversies, charges, counter-charges and buzzwords swirling around the issue of medical care in the United States, there is a lot to be said for going back to square one and asking just what is the fundamental problem.

The quality of the medical care itself is not the problem. Few-- if any-- countries can match American medical training, medical technology or the development of life-saving pharmaceutical drugs in the United States. Most countries with government-controlled medical care cannot come close to matching how fast an American can get medical treatment, particularly from specialists.

Political hype is no reason to throw all that away. In fact, policies based on political hype over the years are what have gotten us into what is most wrong with medical care today-- namely, the way it is paid for.

Alice in Medical Care: Part IV:

Some years ago, one of my favorite doctors retired. On my last visit to his office, he took some time to explain to me why he was retiring early and in good health.

Being a doctor was becoming more of a hassle as the years went by, he said, and also less fulfilling. It was becoming more of a hassle because of the increasing paperwork, and it was less fulfilling because of the way patients came to him.
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The loss of one doctor-- even a very good doctor-- may not seem very important in the grand scheme of heady medical care "reform" and glittering phrases about "universal health care." But making the medical profession more of a hassle for doctors risks losing more doctors, while increasing the demand for treatment.

A study published in the November 2009 issue of the Journal of Law & Economics showed that a rise in the cost of medical liability insurance led to more reductions of hours of medical service supplied by older doctors than among younger doctors.

Younger doctors, more recently out of medical school and often with huge debts to pay off for the cost of that expensive training, may have no choice but to continue working as hard as possible to try to recoup that huge investment of money and time.
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Although younger doctors may be trapped in a profession that some of them might not have entered if they had known in advance what all its pluses and minuses would turn out to be, there are two other important groups who are in a position to decide whether or not it is worth it.

Those who are old enough to have paid off their medical school debts long ago, and successful enough that they can afford to retire early, or to take jobs as medical consultants, can opt out of the whole elaborate third-party payment system and its problems. What the rising costs of medical liability insurance has already done for some, other hassles that bureaucracies and politicians create can have the same effect for others.

There is another group that doesn't have to put up with these hassles. These are young people who have reached the stage in their lives when they are choosing which profession to enter, and weighing the pluses and minuses before making their decisions.

1 comment:

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