The Last Word on Healthcare

My last word, that is. When I set this site up I vowed to myself to focus on the historical, the technical, occasionally the literary, and stay the hell away from the political. But alas it seems strange, here on the eve of perhaps the greatest change in our government since Johnson’s Great Society, to say nothing at all. So here are two coins with very little copper in them, on the subject of healthcare.

First, healthcare is no different than shoes and shingles. If I want a pair of shoes, or I need shingles for my roof, I have to find people who make shoes or shingles, pay them the costs of their labors plus some profit, and carry away my goods. I don’t have a right to shoes and shingles if I don’t have the money to pay for them. Same thing with food and fuel, both of which, by the way, cost me a lot more on a yearly basis than health care. If you think healthcare represents some special category of stuff, more important than food, fuel, shoes, and shingles, then I think the burden is on you to explain that position.

Second, it disturbs me when I hear healthcare described as a right. Healthcare isn’t like life, liberty, and the pursuit of happiness. None of those things are tangible goods. Healthcare is provided by people who invest huge amounts of time and labor into it. Doctors invest eight to ten years of schooling, nurses two to six. Pharma companies invest billions in the creation of new drugs, health management companies billions into the building and maintenance of hospitals. And the problem, the main problem at any rate, is that we don’t want to pay for the results of their labors. We want someone else to pay.

Specifically we want insurance, apparently some sort of magical artifact that allows the wearer to consume, on demand, thousands of dollars worth of expensive, specialized goods and services, while paying little or nothing in return. And because we would feel bad if we were the only ones who possessed the enchanted item, we want everyone to have one just like ours. Then we can all consume as much as we wish. Tragedy of the Commons, anyone?

Third, if you don’t want to pay for something, and you succeed in convincing someone else to pay for it on your behalf, you lose the power of the purse in that relationship. One of the reasons people are so upset with healthcare, apparently, is that employers and insurance companies have too much say in the kind of treatment patients receive. They have a lot of say, because they’re writing the checks. Shocking, I know. Personally I don’t care if you prefer to have your employer pay, or the government, or some insurance company. The only thing that matters to me is that you don’t want it coming out of your pocket.

If you succeed in that, then in the end you’re going to get what you pay for. Costs will continue to rise, but even faster, because demand will have been expanded without addressing supply. Supply will stagnate or decrease, because the incentives to succeed will be bled out of the system. The payers will have even more power, and even more incentive to regulate access and pricing. All of that is already happening, not because we have single-payer government-provided insurance, but simply because we want our employers and insurance companies to pay our bills.

So, fourth and finally, you’re dreaming. Healthcare is a tangible and limited resource. If you think the government can somehow step in, manage the whole mess, and that suddenly you’ll be paying less, getting more, and be more in control over what you spend and get, then all I can say is that I hope you aren’t in a position of any serious responsibility. Of course, lots of people who do believe that are in such positions, so God help us all.

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