Yesterday’s post, was tangentially about health care, but it got a lot of responses about health care. It is a funny subject, in that everyone starts from the premise that everything has been the way it is now since forever. The Left has been so good at proselytizing about government run health care for the last 25 years that the public suffers from collective amnesia. We forget that no one complained about insurance very much a generation ago and no one expected miracles from medicine. Health care was just not a big topic.
After a quarter century of chanting about health care, most everyone seems to buy into the belief that it is a fountain high up on Magic Mountain. It is guarded by the twin dragons of Big Pharma and Big Insurance. The keepers of the faith sent their paladin, Barak Obama, to slay the dragons so that the people could dip their cup into the fountain of health care, getting all they need. His failure to accomplish this is proof that the dragons are mighty and therefore the most extreme weapons must be deployed.
It’s all ridiculous nonsense, of course, but that’s where we are with the topic. All goods and services are rationed. That’s an iron law of the universe. There are no exceptions. The rationing is either done though control of the supply or through price. In America, a massively convoluted system to control supply has evolved so that the people do not see the cost of health services. This lets a long list of skimmers attach themselves to the system so that prices go up, even though the quality of service often declines.
The question no one ever asks is how to make it cheaper. Follow the talking heads on the subject and they will never address making the price of services cheaper. Instead, they prattle on about access and risk pools and other terms they think sound clever. The reason is not that they view health care as a right. It is because they see it as a privilege to be dispensed by the Cloud People to the Dirt People. Allowing a free market for health services would take all the fun out of being a Cloud Person.
Even so, the goal of any health care reform should be making it cheaper, especially the common care items. The two areas where health care has gotten much better and much cheaper are dentistry and eye care, both of which are usually paid for out of pocket and have low barriers to entry. Veterinary medicine is the most obvious example of what happens to prices when you have anything resembling a marketplace. That’s also why the people in charge will never allow competition for health services. Their donors hate it.
The other aspect of health care is the quality of medicine. The truth is, the advance of medicine has been very slow and is not looking to speed up in the near future. The great leaps in health are a) diet, b) antibiotics and c) sanitation and d) a crackdown on quackery. All of these things are products of the last century. Some treatments are much better than fifty years ago, but cure rates for most diseases have not budged. Death, of course, remains a universal constant. Medical advances are glacial, not revolutionary.
As Greg Cochran pointed out the other day, a free market in medicine is probably not the answer, any more than a government monopoly has been. The truth is we don’t know a lot of about the human body and the diseases that afflict it. Genetics promises to open the door to a vast new trove of learning about human biology and medicine, but that’s not going to speed up with any government health care scheme. This is a science problem, not an economics problem and that takes the time it takes.
Finally, the problem of health insurance starts with understanding that there is no such thing as health insurance. What we have in America is an elaborate system of cost shifting. The young are forced to pay for the old. The healthy are forced to pay for the sick. The government and their buddies in the insurance business get a piece of the action. Nowhere in America can you buy insurance in case you have a stroke or just for the chance you fall off your roof. Everyone’s plan is designed by the government.
This is a problem that is easily solved in theory, but nearly impossible to solve in reality because insurance companies have billions to spend on politicians. There’s also the fact that generations of Americans have become conditioned to having someone else pay their doctor bills. All the reforms that would work require people paying their own way and that will never happen on purpose. It’s why the current system will mostly likely stagger along until it collapses. At that point, we end up with government insurance.
That’s the truth of health care in America. The system, at its best, is a web of lies designed to shield the citizens from reality. At its worst, it is a complicated skimming operations so the people at the top can squeeze a bit more from the middle-class. It does not have to be this way, but until we resurrect the national razor, nothing substantive will change until it collapses. At which point, the “solution” will be something worse like national health care or single payer insurance.