Too Late to the Debate

There has been an ongoing and rousing discussion over at Right Michigan the past few days concerning health care. I was out for the weekend and did not have time to give them my two cents worth.

When I finally did have a chance to sit down today I discovered that my comment was probably too long for anyone to read particularly as the 61st comment. So I thought I would post it here. At least here I am wasting Google's resources.

Here goes...

I hate to burst the bubble of everyone here, but there is no solution to the rising cost of health care if we are to accept the parameters and definitions that are being hoisted on the health care infrastructure by advocates. No solution at all. And, I'm an optimist!

The only reason that anyone can afford car insurance or house insurance or life insurance these days is because these insurances operate differently than does health insurance. In all of these other insurances the risk is spread out among all policy holders while at the same time what we are insuring against is the anomalous. (Life insurance has a few variations but is principally the same.)

There would be no affordable automobile insurance if each and every car on the road was wiped out by accident every few years. No, what we see in junkyards are primarily cars that spent their 15-20 years on the road and then rusted out, or had an engine blow out, or lost a transmission, etc. In these cases the car is no is longer worth the investment of a major overhaul to its owner. Therefore the risk of vehicles that were tragically smashed can be spread among all cars driven because, thankfully, most cars are not destroyed by smashing.

But advocates want health insurance to be different, and because of this they are not peddling insurance as we have grown to understand the term at all. There is currently little spreading of the risk in health insurance because death is not anomalous and postponing death is very expensive.

Enter our savior, the government.

First, our government is already inextricably linked to health care. This began years back when an earlier generation of bureaucrats thought they could solve the problems of health care. Then later generations of bureaucrats thought that they could fix the blunders of the older bureaucrats. Alas, they ultimately created even more complicated blunders. Wash, rinse and repeat. Forward that until we now have a system so complicated with bureaucracy and regulation that now, short of a total government bankruptcy and ensuing anarchy, government will always have its big fat butt firmly planted in our doctors' offices, forever.

Our government is notorious for attempting to manipulate the price of things, especially when they are footing so much of the bill. Of course, price and cost are two different things, and by arbitrarily reducing the price of health care and not considering the associated costs we will automatically get a shortage of supply. This shortage will include personnel, equipment, hospital bed space, more advanced medications, etc. That does not mean that there will not be any advances here and there, but it does mean that the rate of advance will be significantly curtailed, and that these advancements will be themselves only available to qualified patients.

As shortages become more and more apparent, rationing will become more and more necessary because the need for care will grow with the complications created by rationing. (You know, when that nasty growing mole that could have been removed routinely was allowed to grow into full fledged malignant melanoma that will require a surgical team to remove.) Rationing will not only amount to long delays in appointments and procedures but will also entail a designation of patient qualification. Certain patients will no longer be considered for certain procedures. The 80 year old will no longer get bypass surgery. The 70 year old can forget about that new hip. The 60 year old can kiss his Viagra (and perhaps his wife) goodbye. The 50 year old will finally be able to get that mammogram, though the mastectomy cannot be scheduled any sooner than 8 months after the tests are finally read.

Health care providers, if they want to keep their license, will ultimately be denied the right to operate outside the bounds of the system. This is the only way to make certain that all the rules of the game are followed. The rich, of course, will still get their care, they will just do so by flying to India or another nation willing to capitalize on our shortcomings. Rich Canadians will also go to India because the hospitals in Detroit and Buffalo will no longer be able to accept Canada's elite. I would not expect all of these things to happen in the first year or even five years, but they would develop over time as the system itself begins to creak under the weight of its own constraints and as the next generation of advocates try to fix the problems caused by the most recent fix.

The problem is, of course, that today's system, though not "national health care" is still replete with so many glitches that costs have outpaced the ability of many to pay. We also have to recognize that research and the introduction of new medicines and equipment are hugely expensive and that these costs are largely borne by the medical customer of this country because it is here, in our current system, that most of these advances are made. That is why I (amongst millions of others) do not have health insurance today. So, I am not defending the status quo, though I do believe it is a better system than it will become when it is ultimately handed over to any President and his group of bureaucrats.

I recognize that we have a dilemma and few people are happy with the way that health care costs have risen of late. Yet, the only proposal gaining any traction these days has been to enact a national system that will do little but add layer upon layer of bureaucracy to the current disaster. No one has had the backbone to suggest that government be totally extricated from the problem it by and large created.

The fact is that health care has always been rationed. In the past the free market allowed for rationing on the basis of wealth. The rich got everything they wanted, the middle class got most of what they wanted on the installment plan, and the poor did without or received the charity of the rich. But wealth has never been a acceptable way to dole out care, particularly when, as a percentage of population, poor and middle class people outnumber the rich, and it is voters that will drive the debate.

So, what we will ultimately end up with will be a system where rationing is decided by the bureaucrats, but this only after they have successfully absconded with another few percentage points of GDP. The new system will not be as efficient, it will reduce medical advances, it will strongly contract the medical industry, will lead to a shorter life expectancy in this country, and it will slowly restrict the freedom of citizens that wish to engage in sinful activities that might drive up the cost of Uncle Sam's medical bills such as smoking, consuming sugary drinks, eating fried foods or pork, riding a bicycle without a helmet, or mountain climbing. These intrusions into our private lives would have been enough to send the founding fathers to war. Today we are better at hurling insults.

Given a choice, and I say this as a non wealthy man, I really would prefer a system where wealth and common sense (providing free medical care to indigent illegal aliens and death row and other heinous criminals is insane) dictated who received care. When you lift the stifling hand of government off of the free market we get a much better product that is more affordable to everyone.