Alice in Health Care

Alice in Health Care
Thomas Sowell
Tuesday, March 02, 2010

Most discussions of health care are like something out of Alice in Wonderland.

What is the biggest complaint about the current medical care situation? "It costs too much." Yet one looks in vain for anything in the pending legislation that will lower those costs.

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.

Money is just one of the costs of people seeking more medical care than they would if they were paying for it with their own money. Both waiting lines and waiting lists grow longer when people with sniffles and minor skin rashes take up the time of doctors, while people with cancer are waiting.

In country after country, the original estimates of government medical care costs almost always turn out to be gross under-estimates of what it ultimately turns out to cost.

Even when the estimates are done honestly, they are based on how much medical care people use when they are paying for it themselves. But having someone else pay for medical care virtually guarantees that a lot more of it will be used.

Nothing would lower costs more than having each patient pay those costs. And nothing is less likely to happen.

One of the big costs that have actually forced some hospitals to close is the federal mandate that hospitals treat everyone who comes to an emergency room, whether they pay or not. But those who talk about "bringing down the cost of medical care" are not about to repeal that mandate. Often they want to add more mandates.

The most fundamental issue is not whether treating everyone who comes to an emergency room is a good policy or a bad policy in itself. If it is a good policy, then the federal government should pay for what it wants done, not force other institutions to pay for it. Then let the voters decide at the next election whether that is what they want their tax money spent for.

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.
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Alice in Health Care: Part II
Thomas Sowell
Wednesday, March 03, 2010

What is most like Alice in Wonderland is discussing medical care reform in the abstract, as if there are not already government-run medical care systems in this country and elsewhere.

Yet there seems to be remarkably little interest in examining how government-run medical care actually turns out-- medically and financially-- whether in Medicare, Medicaid, Veterans Administration hospitals in this country, or in government-run medical systems in other countries.

We are repeatedly being told that we need to have a government-controlled medical care system, because other countries have it-- as if our policies on something as serious as medical care should be based on the principle of monkey see, monkey do.

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.

It is not uncommon for patients in those countries to have to wait for months before getting operations that Americans get within weeks, or even days, after being diagnosed with a condition that requires surgery. You can always "bring down the cost of medical care" by having a lower level of quality or availability.

But, again, you may never learn any of this by following most of the American mainstream media. It is not that they don't make comparisons between medical care in different countries. But they tend to feature news that will promote government-controlled care.

One of the statistics they spin endlessly is that life expectancy in some countries with government-controlled medical care is higher than in the United States. What they don't tell you is that, in some of these countries, all the infants that die are not included in infant mortality statistics, as they are in the United States.

More important, both political and media supporters of government-controlled medical care consistently confuse medical care with health care.

Much, if not most, of health care depends on what individuals do in the way they live their own lives-- including eating habits, alcohol intake, exercise, narcotics and homicide. A study some years ago found that Mormons live a decade longer than other Americans. But nobody believes that Mormons' doctors are that much better than other doctors. When you don't do a lot of things that shorten your life, you live longer. That is not rocket science.

Americans tend to have higher rates of obesity, narcotics use and homicide than people in some other countries. And there is not much that doctors can do about that.

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.
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