I had my annual physical yesterday. Even though I am no spring chicken, I remain in good health. Other than high blood pressure, for which I take a pill every day, I have no health concerns. I exercise frequently and watch my diet, but I am not like the guys in this story from the Weekly Standard. I take few supplements and I refuse to starve myself into a skeleton. I’m not interested in living forever. If it means looking like this guy, then I’m certainly not interested.
There was a poster on one wall of the examination room graphically describing the horrors of smoking. It featured pictures of brown lungs and mangled faces. The poster was sponsored by one of the nicotine patch makers. There was a calendar sponsored by a local disability lawyer. There was a poster for some drug that must be aimed at fat people. Next to that was a poster for botox. I started thinking about John Kerry. What in the world would possess someone to have that done? I’m as vain as any other man, but immobilizing your face sounds crazy to me.
Looking around, it occurred to me that one reason America has such a dysfunctional health care system is we have convinced ourselves it is not a business. We think health care is this weird fusion of mystical religion, government service and natural resource. It is none of those things. It certainly should never be any of those things. Europeans made it a government service for the proletariat. It’s cheap and does the basics, but there’s a reason their elites don’t use the system.
Health care is just another service. It is a business. If we looked at it that way, like we do veterinary services, we would do ourselves a world of good. When I take the cat to the vet, I pay for the service. I once had a cat with a heart problem. I was able to get first world, cutting edge cardiac care for the animal at a price that was trivial. A one hour visit with a world class doctor and his cutting edge machines cost $300. For large animals, heart surgery is now available to fix things like heart valves, again, at reasonable prices.
At no time is there any doubt that the transaction is exactly that, a transaction. My vet charges a fee and hopes to make a profit from my business with him. I decide whether the services are worth the money. Normal market forces drive prices down and innovation up. In my little slice of heaven, there are more veterinarians than physicians. The wait time for the vet is the next day while I had to wait over a month to see the nurse practitioner for my physical. That last bit is important. I see a real doctor for the cat. I’ve never met my doctor, just his nurses.
The response whenever I bring this up is “But you can put your cat down. People need lots of care when they are old and you cannot choose to put them down.” That’s not entirely true. We withdraw life saving measures all the time. Living wills are for exactly that. Doctors have been telling families “there’s nothing we can do” for generations. The realities of death have been dealt with since the dawn of time. It is only of late that we struggle with the concept. In Europe, poor people are given pain killers and sent home to die. We used to do the same thing until the reformers came along.
Health care is a math problem. In any society the care and feeding of the helpless members is a top priority. Altruism is one of the oldest human traits and it is what allows us to live in large communities of strangers. We are not going to leave the poor and sick to die in the streets untended. The question is how best to supply that charity to these people. Everyone else should be paying their own way for health services just as we pay our own way for clothes and food. But, when you live in a society run by lunatics with magical thinking about observable reality, you get what we have now.