The Elephant in the Healthcare Room

Spurred on by the prior post of Doug’s and in attempt to start something more of a conversation here, I’ll offer some thoughts on healthcare.

Liberals and progressives like to hold forth the ideal that healthcare should be affordable and available to everyone. After all, we’re a wealthy country. However, this is one might say a Juan Ponce de Leon gambit, that is holding forth a search for the fountain of life which alas doesn’t exist. Health care suffers from one basic problem, which is so far insurmountable (although I’ll suggest how it might be surmounted at the close of this little essay). The problem is, of course, that health care is infinitely expensive. The amount of care which might be applied to the dying grows almost without bound if one disregards cost. For almost a decade we have been told that the biological “sciences” have been expanding their capabilities exponentially (Moore’s Law) like the computer sciences except … at an even faster rate (the doubling period of capabilities is shorter). However this hasn’t substantially been, as yet, bringing down costs, just making ever more expensive options tantalizingly available. Cancers which would kill 5 years ago are sometimes defeated today, however at great financial cost.

The elephant being missed is, alas, rationing is a necessity. The question is comes down to, how to ration.  Does the market decide unfettered? Do the knuckleheads in our legislative offices decree how rationing will go down. The conservatives would claim that ability to pay is fairest. The liberals and progressives largely deny the existence of the elephant, which is alas either a lie or some other form of self-induced insanity/delusion. 

I would suggest that, like social welfare that a subsistence level of care, including cost capped emergency treatment, vaccinations and preventive care be provided to those who cannot afford their own care. Otherwise, you get the care you can afford. It would be nice we could separate health care insurance from employment … but I’m not sanguine enough politically to suggest how to go about doing that.

I would offer that as a general principle (I proposed this once as an Amendment), that our Legislature be prevented from ever offering insurance-like services, that is to say the government should as a matter of principle get out of the insurance business. Election and the requirements of the ever present “promises made” at today’s election always minimize costs or push any payback/cost to the (far?) future. Just consider Social Security and the budget. Actuarial mathematics are fairly well understood and have nothing to do with electoral promises, reqirements and dynamics, but instead have to do with risk and cost. Witness New Orleans. On an actuarial basis, the cost levied for “flood insurance” by the State was far far far far below any reasonable risk/cost estimate. If the cost of insurance was too high (as it should have been) nobody would have been living below the water table, in a hurricane region, protected by inadequate levies, and then there would have been no tragedy either.

One might ask, why is health care so expensive. 200+ years ago, it cost a years salary to buy a good pair of boots, and a shirt would cost two weeks or more’s wages. Today, a T-shirt is cheaper than a beer. The reason is, of course, automation or mechanization. Machines and mechanization enables one worker to produce what took hundreds in earlier eras. Nobody pays a machine anything, people are the only creatures getting paid anything for anything you buy or for which you spend money. Health care remains human intensive. Until there is a machine (or machines and systems) which allow one trained human to offer healthcare to orders of magnitude more people in the same period of time … the cost will not go down by orders of magnitude like manufactured goods did. “Single payer” does nothing at all to alleviate the labor costs involved in health care. Until the labor costs of healthcare is addressed, costs relative to those goods which can garner the advantages of the multiplication of human power via mechanization will only rise.

One might ask as well, is pushing market further away and inviting those wonderful “efficiencies” of our bureaucracy further and further into the medical  industry going to increase or decrease the flexibility and innovation which might, someday bring automation into the medical industry? I’d offer that it will make mechanization and automation less likely and therefore should be viewed as a step in the wrong direction.

Filed under: Conservative • Government • Liberal • Mark O. • Medicine • Politics

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