Reason for a New Age

The Cost of Health Care – Part 2

Posted by publius2point0 on 2010/01/06


Continuing on from part 1, I examine more theories to explain the price discrepancy of health care in the US and other nations.

Wait lists decrease the number of cases of elective (optional) surgery
Some countries require that care be based entirely on need rather than on finances or personal availability. In such places if you want, for example, liposuction, then you will have to go onto a waiting list. The theory is that this will discourage elective or unnecessary medical use and overall save money.

The theory does seem to hold. Though, for whatever reason, the US seems to have fewer cases of elective surgery than others without wait lists. (Here is another comparison, dedicated to just plastic surgery.)

Unfortunately, I’m not sure to quantify this in terms of an actual dollar amount. That there are European nations without wait lists and more cases of elective surgery, but who do not pay anything near what the US does for health care indicates that this is not a significant added cost.

Now while I have no particular issue with decreasing usage of plastic surgery, most uses of elective surgery are more than cosmetic, they’re for comfort or to to make life easier. I also imagine that usually the individual pays the largest chunk of the bill in such cases, so it really is just a matter of whether they are made to wait so far as my tax bill or insurance premium is concerned. It may count towards overall health spending, but it only affects the individuals who opt for the surgery.

The question then is whether people should be prioritized by need. Certainly, this would seem to make the most medical sense and in terms of being able to ration use whenever costs needed to be reduced.

Care, however, is really something which should be earned. Covering a person who has still never paid any money into the system at the age of 40 is a kindness not a necessity. The US has enough affluence to say that lazy bums don’t deserve to simply be left in the street to die. True, there may also be some amount of self-interest in this sort of kindness as well. We want to fight the spread of diseases which, leaving a sizeable segment of the population free to fester, would hinder. And of course those who are desperate may be more willing to steal money or cause other problems.

Of course, outside of children, retirees, and housewives, almost everyone is employed and earning a salary. The number of cases of people who would not be paying into the system, for inexcusable reasons, is really quite small. You could always set up a two-tier system whereby those who have gainful employment, are a child, are an elder, or are married to someone who is employed receive a set level of care, and those who are none of these receive a set, lower level.

Or, you can do as we do now where the first comer who is willing to pay for a thing is the first to receive that care.

If your goal is simply to achieve the highest average lifespan for the entire population, a system which entirely prioritizes by need will achieve this goal. Saying that those who work will receive equal care and those who don’t work receive lesser care is, one could easily argue, a fair system.

Personally, I would argue that the profit motive to better the world is a more important goal. The best medical treatment of today will almost certainly be but a shadow of what can be accomplished in 80 years. You would rather be at the lowest level of care in 80 years time than have the best care of today. This progression of medical technology is thanks to the profit motive. Being able to give better for yourself, your family, and your children is a primal urge pressing you on to push the envelope and get the sort of future where you’d rather have the worst of it than the best of today.

In the long run view, achieving the highest possible health for everyone will be achieved more by continuing the improvement of the world. Hindering that for short term gains is not the best option.

Preventative medicine costs less
Similarly to how I said that there may be some self-interest in keeping the needy at least somewhat cared for, there is the idea that in the long run it is cheaper as well. A wound or ailment left to fester ends up costing more to treat than earlier, preventative care would have. (This is assuming that, eventually, the person will be cared for; which is likely going to be the case.)

This theory doesn’t seem to bear out. In the long run, the price is probably similar.

http://www.nytimes.com/2007/08/08/business/08leonhardt.html?ex=1344225600&en=d7df12bae3f08026&ei=5090&partner=rssuserland&emc=rss
http://content.nejm.org/cgi/content/full/358/7/661

Though, of course, price isn’t the only issue. Preventative care leads to happier, healthier workers. People with festering wounds and severe ailments are not contributing to society and possibly acting as a drag on society by infecting others. If you can achieve preventative care for the same or similar cost, you would probably prefer this.

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