Tyson’s remarks about “rationing health care” got me thinking about some of the silly economic models people like to use in an attempt to seem scientific about public policy. He wrote:
I understand the arguments against healthcare rationing because no one likes being told there’s not enough of something to go around, especially when it comes to your life or that of your loved ones. But you have to ask yourself, don’t we have healthcare rationing right now, except that it’s done by the market and insurance companies? When you have to decide between better coverage and a higher premium, that’s rationing. Whenever you apply for a treatment or operation and are rejected, that’s rationing.
In the current mêlée, “rationing” is being used disingenuously, as if there were going to be some sort of artificially induced famine of health care. The principle is that supposedly the government will seek to tightly control the delivery of health care, thus destroying the perfectly balanced market forces that now provide it in abundance.
The market-based consumer model of health care, in my opinion, is ridiculous. It treats health care choices like buying groceries, and the use of it reflects an instrumentalist view of people. This level of dehumanization is not what I expect of “conservatives,” much less “Christians.” It is symptomatic of a vicious Social Darwinist mentality that should have been driven into the ground long ago.
From a triage perspective, there is necessary basic health care; then there is more complex medical treatment; then there is vanity care. That is, there are people who can be made healthier right now; there are people who are going to be sick no matter what is done right now; and there are people who are not sick right now. Care for the first is in the domain of public service; the second needs to be rationed by doctors; and only the third is a consumer product.
I think that defining the parameters of basic health care is what we should be working on now, and insurance companies don’t need to be part of that discussion at all. In fact, if any insurer has any opinion on this area, I would tell them to shut up. I have no interest in their “right” to speak on basic health care issues. Likewise, I’m not saying that everyone has a “right” to basic health care; I’m just saying that those who provide it need to be doing it without regard for profit, seeking only to recover basic costs.
The second category of service needs to be rationed by licensed experts (doctors, etc.), not by insurance companies; but it is an area where private insurance and public insurance could play a part. This is an area where patients should be fully informed and allowed to choose treatments, but, like it or not, most of them just aren’t capable of sorting out the technical questions. For most people, this will involve buying a catastrophic illness policy or paying for long-term remedial treatment. Go ahead and let all the experts gang up on this and come up with the best ways of providing it and paying for it, as they already do. However, there should be no free ride for insurers; their job is to find a feasible way to pay for what the doctors recommend, not to figure out who should die in order to bump their P/E ratio by a point. That is where reform is needed for this category.
The third category is the exclusive domain of private providers and private insurers. It includes not only obvious things like cosmetic surgery and smoking cessation, but also anything that the state-licensed providers don’t want to deal with, like aromatherapy and acupuncture. I realize it isn’t very nice to let doctors tell you that you aren’t really sick or some treatment is quackery, but we have to draw the line somewhere. Let the free marketeers go wild with this, as they already do. If enough people can document real illnesses or effective treatments in this area, something can move into the “medical treatment” category, as celiac disease and chiropractic have. This area only needs improved transparency so that consumers can be better informed.