Taking Apart Health Care Costs, intro

Busy day on the WSJ’s editorial page.  Top center is a nice letter-to-the-editor proposing a realistic compromise concerning mark-to-market and regulatory capital.  See, I knew I wasn’t crazy.

Jim Curley will be thrilled to see someone else advocating for smaller businesses, down in the lower right hand section of the letters.  Not sure how one would make it happen, but there is a valid point: if a business is “too big to fail”, it is too big.   You can’t have your whole economy living and dying on the wisdom of a single CEO or board of directors.  An alternate view: maybe no company is too big to fail.  You can let it be big, as long as you are willing to let it fail.  Something to think about it; I don’t have a fully-formed opinion yet.

And then the topic I do want to cover today is introduced in “National Health Preview”, a critique of Massachusetts’ health reform results.  Not supportive to say the least.

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Health care reform and universal health care coverage is a thorny issue, and I wanted to break apart the cost structure, and maybe add a few other comments, to help us think about it.

The first thing to keep in mind, and forgive me for stating the obvious, is that someone has to pay for it. I say so because health care is expensive, and if you won’t or can’t pay your own bill, it comes out of your neighbor’s pocket.  If you are a person who has good health care coverage, can pay your own bills, and lives comfortably, take a look at your budget.  What several thousands of dollars a year in other spending are you willing to give up so that your less-fortunate fellow citizens can enjoy the same health care benefits you do?  A less expensive car?  A smaller house?  You have to be willing to sacrifice, if you really mean to provide everyone in America with the health care that we tend to consider our due.

And that leads to a problem: Everyone dies. And bunches of us won’t do it on the cheap.  A lot of us are going to die after a long illness that can be treated for a time, to prolong our life and make it more comfortable.   What is an an extra year of life worth?  It is priceless.  How much is it worth to ensure that you or a loved one does not suffer needlessly in the final days, months, or years of your life?

–> When it comes down to it, our wants and needs for health care are almost unlimited.  And a sordid reality is that there is already a tendency to resort to euthanasia when the money runs short.   A health care solution that encourages people to die early so as to ‘not be such a burden on society’ is not a health care solution, it is a nazi regime.  Whatever we do, we need to guard against this vigilantly.

Making all this even more complicated, is that medical science is far from exact. Not only do we wonder whether it is worth the expense to give mom that chemotherapy, we aren’t even sure whether chemotherapy is really what she needs.   And she might or might not want it as part of her treatment, no matter how beneficial the rest of us find it.

–>  As a result of this, nationalized health care systems are very popular with people whose alternative is no treatment at all.  But those who can afford to pay for the treatment of their choice (or would be able if only they weren’t being taxed to pay for everyone else’s treatment) often beg to differ with the medical bureaucrats’ decision over what treatment is the best one.  A just health care system would take into account both sets of concerns.

Likewise, there is much argument about what deserves to be covered as a ‘health care cost’ and what does not.  For example, under a typical insurance program in the US today, it is pretty easy to get coverage for a surgery that will restore your ability to use an injured leg.  But coverage for adaptive equipment that compensates for the loss of use of that same limb can be ridiculously difficult to obtain.  Even if the equipment in question costs less than the surgery.  Not proposing here that we use equipment instead of surgery.  Am proposing that part of the equation is a review of what we mean by health care, and what our goals are.   A just health care system extends benefits fairly, not treating some conditions as more privileged than others.

Finally, we should keep in mind that like all problems, health care issues need to be attacked from a thousand angles.  This or that program by itself won’t fix everything.  You have to constantly be looking at malpractice issues, at the system for educating a licensing medical professionals, at the management of costs, at the way our health care businesses are organized, all of it.  Insurance programs are only one part of the picture.

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Enough for today.  I’ll keep going in the next installment.  Have a good weekend.