A Famine of Care

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.

Advertisements

4 thoughts on “A Famine of Care

    • It isn’t a right, since the federal government has no business guaranteeing it.

      Pregnancy calls for basic health care, as does any danger to the mother’s or fetus’s life. On balance, the mother’s life is more important.

      One might think that means that abortion should fall into the second category. However, that suggests a long-term medical treatment that includes an abortion, which implies a foreseeable threat to the mother’s life or general health. That would be up to the doctor to decide.

      Another argument might be that an abortion is necessary to maintain the mother’s mental health. In that case a psychiatric assessment is called for, and abortion would be a last resort.

      I would guess that 95% of abortions would then fall into the third category. As an elective procedure that is not medically necessary, abortions in this category could be tightly regulated or even banned by state or local laws.

  1. So much debate is going on pointing out how bad the collectivist approach of the Obama/Democrats will be for our health care, but where is the advocacy of a workable solution?

    Here is a brief outline of where we need to go with US health care:

    The Modern Health Care Solution

    We need to reset our health care system back to a free-market, patient-driven system. Every other successful part of our society runs this way- why not our health care for goodness sake?! We need:

    1. Market-based pricing of health care. We need medical Care/Service/Procedures priced up front like everything else in our society- not the price/cost black-boxes of today’s employer and government-subsidized health care.

    2. Minute-clinics and similar no-appointment, transparently-priced clinics are going in the right direction of delivering this concept:
    http://news.minnesota.publicradio.org/features/2006/01/23_zdechlikm_coninfo/

    3. Just like with the fair, portability of pre-tax 401k’s, we need fair, portable pre-tax health savings accounts for everyone to save their own money over time, make their own decisions on health care, and pay it with their own money.

    4. Make health care ‘insurance’ back into actual insurance. Couple health savings accounts with high-deductible catastrophic health insurance policies that people buy like they do for life insurance or car insurance.

    The above approach gives everyone the access, proper control, and choice over their health- not the opposite helplessness dictated by some far away, faceless bureaucrat.

  2. I would support these kinds of changes. However, they would only work if the tax benefit for employer-paid health insurance plans is eliminated. This is the major reason for the high premiums and for the working person’s inability to afford their own policy.

Instigate some pointless rambling

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s