Tuesday, December 02, 2008

Health care costs

In response to Ian's comments, and as a sort of "part 2" to yesterday's post, I have to agree that we're getting more and better health care today than we did 20 years ago (or probably even 10 years ago).

But that's only part of the problem with the expense of health care. The other is that it doesn't follow the laws of supply and demand, at least not in any sort of reasonable way.

How much would you pay to be healthy or out of pain? The answer for most people is "as much as it takes". It's worse than racing. There is basically no upper limit that people won't spend, and so there is no incentive to have reasonable prices, or to limit care.

A heart transplant might make sense for a 20 year old, or probably makes even more sense for a 40 year old owner of a small business, but does it make sense for a 1 year old, or a 60 year old? I know I'm callus, but kids are easy to come by (I know specific kids have priceless value to their parents, but to society, they appear to be disposable if the back alleys of any major city are used as reference), and old people are of very little use to society and present a very real drain of resources.

In times past, you had a dozen kids because more likely than not, at least half of them were going to die (and you needed your own labor pool), and old people really didn't stick around much past their useful (to society) working years. The Eskimos are said to have put their old onto ice flows when they were too big of a burden to the clan.

I'm not saying that I want to go back to those times, because I don't. What I'm trying to say is that a capitalistic society is going to have a hard time with health care. It's either priced to the point where many can't afford it, or it doesn't offer all that it can, given a price-is-no-object mentality. We seem to have gone for the price-is-no-object way of doing things, so many people can't afford it.

The politicians are trying to get more people to be able to afford it, and they think that's done with insurance, but is it really? Is socialized medicine the way to go? Maybe. Is mandatory insurance the way to go? Probably not because it doesn't address the root cause of the problem, and from my (limited) point of view, it seems to be part of the problem. It causes people to stop caring about how much something costs (never a good thing if you're trying to keep costs down) and just like in socialized countries, it seems to be causing them to have to line up for months to get service.

The delay in getting service in Massachusetts seems to be partly related to people with new insurance having long lists of saved up complaints, something that probably doesn't happen any more in socialized medicine countries, but mainly it stems from the fact that there aren't enough general practice doctors. The lack of general practice doctors seems to stem from the fact that specialized medicine pays much better. General practice doctors are only paid for 15 minute visits with patients, so they try to hustle patients in and out as fast as possible, again, probably not what people want or are expecting. Jiffy Lube spends longer working on my car.

How can we convince doctors to become primary care physicians instead of specialists? Maybe we pay them more, maybe we pay the specialists less, maybe we fill all the specialist positions so that new doctors can't find any work as specialists and have to go into general practice? I don't know, and I don't pretend to know. Knowing enough to ask the question is sometimes the best that one can be expected to know.

It's a tough problem, all I'm trying to say is that maybe we're trying to treat the symptom and not the cause; that we should put some effort into figuring out the real reason why everyone needs insurance. Insurance may be the answer, but it doesn't really seem like we've determined that it is. It seems like we're just guessing at the answer. If there's one thing I've learned from situations like these, it's that the unintended consequences will hit you hard if you don't know the root cause and don't think things through.

I'm glad the Massachusetts is having a such a hard time, because it tells us that they probably didn't do it right. If we're going to inflict this kind of plan on the other 299 million residents of the U.S.A., we might want to know what doesn't work so that we can do something different. Or at least know what we're in for.


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