Wednesday, November 4, 2009

The "Costs" of Medical Care: Part II and III

The "Costs" of Medical Care: Part II and Part III
Thomas Sowell
Wednesday, November 04, 2009

Although it is cheaper to buy a pint of milk than to buy a quart of milk, nobody considers that to be lowering the price of milk. Although it is cheaper to buy a lower quality of all sorts of goods than to buy a higher quality, nobody thinks of that as lowering the price of either lower or higher quality goods.

Yet, when it comes to medical care, there seems to be remarkably little attention paid to questions of both quantity and quality, in the rush to "bring down the cost of medical care."

There is no question that you can reduce the payments for medical care by having either a lower quantity or a lower quality of medical care. That has already been done in countries with government-run medical systems.

In the United States, the government has already reduced payments for patients on Medicare and Medicaid, with the result that some doctors no longer accept new patients with Medicare or Medicaid. That has not reduced the cost of medical care. It has reduced the availability of medical care, just as buying a pint of milk reduces the payment below what a quart of milk would cost.

Letting old people die instead of saving their lives will undoubtedly reduce medical payments considerably. But old people have that option already-- and seldom choose to exercise it, despite clever people who talk about a "duty to die."

A government-run system will take that decision out of the hands of the elderly or their families, and thereby "bring down the cost of medical care." A stranger's death is much easier to take, especially if you are a bureaucrat making that decision in Washington.

At one time, in desperately poor societies, living on the edge of starvation, old people might be abandoned to their fate or even go off on their own to face death alone. But, in a society where huge flat-screen TVs are common, along with a thousand gadgets for amusement and entertainment, and where even most people living below the official poverty line own a car or truck, to talk about a "duty to die" so that younger people can live it up is obscene.

You can even save money by cutting down on medications to relieve pain, as is already being done in Britain's government-run medical system. You can save money by not having as many high-tech medical devices like CAT scans or MRIs, and not using the latest medications. Countries with government-run medical systems have less of all these things than the United States has.

But reducing these things is not "bringing down the cost of medical care." It is simply refusing to pay those costs-- and taking the consequences.

For those who live by talking points, one of their biggest talking points is that Americans do not get any longer life span than people in other Western nations by all the additional money we spend on medical care.

Like so many clever things that are said, this argument depends on confusing very different things-- namely, "health care" and "medical care." Medical care is a limited part of health care. What we do and don't do in the way we live our lives affects our health and our longevity, in many cases more so than what doctors can do to provide medical care.

Americans have higher rates of obesity, homicide and narcotics addiction than people in many other Western nations. There are severe limits on what doctors and medical care can do about that.

If we are serious about medical care-- and we should be serious, since it is a matter of life and death-- then we should have no time for clever statements that confuse instead of clarifying.

If we want to compare the effects of medical care, as such, in the United States with that in other countries with government-run medical systems, then we need to compare things where medical care is what matters most, such as survival rates of people with cancer.

The United States has one of the highest rates of cancer survival in the world-- and for some cancers, the number one rate of survival.

We also lead the world in creating new life-saving pharmaceutical drugs. But all of this can change-- for the worse-- if we listen to clever people who think they should be running our lives.
The "Costs" of Medical Care: Part III
Thomas Sowell
Thursday, November 05, 2009

One of the strongest talking points of those who want a government-run medical care system is that we simply cannot afford the high and rising costs of medical care under the current system.

First of all, what we can afford has absolutely nothing to do with the cost of producing anything. We will either pay those costs or not get the benefits. Moreover, if we cannot afford the quantity and quality of medical care that we want now, the government has no miraculous way of enabling us to afford it in the future.

If you think the government can lower medical costs by eliminating "waste, fraud and abuse," as some Washington politicians claim, the logical question is: Why haven't they done that already?

Over the years, scandal after scandal has shown waste, fraud and abuse to be rampant in Medicare and Medicaid. Why would anyone imagine that a new government medical program will do what existing government medical programs have clearly failed to do?

If we cannot afford to pay for doctors, hospitals and pharmaceutical drugs now, how can we afford to pay for doctors, hospitals and pharmaceutical drugs, in addition to a new federal bureaucracy to administer a government-run medical system?

Nothing is easier for politicians than to rail against the profits of pharmaceutical companies, the pay of doctors and other things that have very little to do with the total cost of medical care, but which can arouse emotions to the point where facts don't matter. As former Congressman Dick Armey put it, "Demagoguery beats data" in politics.

Economics and politics confront the same fundamental problem: What everyone wants adds up to more than there is. Market economies deal with this problem by confronting individuals with the costs of producing what they want, and letting those individuals make their own trade-offs when presented with prices that convey those costs. That leads to self-rationing, in the light of each individual's own circumstances and preferences.

Politics deals with the same problem by making promises that cannot be kept, or which can be kept only by creating other problems that cannot be acknowledged when the promises are made.

Price controls are a classic example. At various times and places, in countries around the world, price controls have been put on any number of goods and services-- going all the way back to the days of the Roman Empire and ancient Babylon.

Price controls create lower prices for open and legal transactions-- but also black markets where the prices are higher than they were before, because the risks of punishment for illegal activity has to be compensated. Price controls also lead to shortages and quality deterioration.

But politicians who take credit for lower prices blame all these bad consequences on others. Diocletian did this in the days of the Roman Empire, leaders of the French Revolution did this when their price controls on food led to hungry and angry people, and American politicians denounced the oil companies when price controls on gasoline led to long lines at filling stations in the 1970s. It is the same story, whatever the country, the times or the product or service.

The self-rationing that people do when prices are free to convey the inherent impossibility of any economy to supply as much as everybody wants is replaced, under price controls, with rationing imposed by government, which cannot possibly have the same knowledge of each individual's circumstances and preferences-- least of all when it comes to medical care, where patients differ in innumerable ways.

Here, as elsewhere, there is no free lunch-- even though politicians get elected by promising free lunches. A free lunch in medical care is one of the most dangerous illusions of all.

Waiting in long gasoline lines at filling stations was exasperating back in the 1970s, but waiting weeks to get an MRI to find out why you are sick, and then waiting months for an operation, as happens in countries with government-run medical systems, can be not only painful but dangerous.

You can be dead by the time they find out what is wrong with you and do something about it. But that will "bring down the cost of medical care" because you won't be around to require any.

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