American Healthcare - Part V: Impractical Expectations
July 1st, 2012 | Back to Blog Listing
Obviously every medical emergency is different and every patient unique. However, if you take that story into consideration without applying any type of political bias, there is at least one point of comparison that should stand out above all else. How is it that the price of one health care option is able to outweigh another by twenty fold? Is it actually possible that I, or any other patient, could have been the recipient of twenty times the level of care? It is highly unlikely.

Had I been comprehensively insured at the time of my accident, it is a fact that that I would have received the highest level of care immediately following the accident. Furthermore, it is highly unlikely that I would have questioned any of the associated finances with the examination since I would not be directly responsible for them. But in a healthcare system whereby finances must be accounted for in one way or another, the question still remains of how the two estimates of care could have varied by so much. This is why having a thorough grasp on the economics of modern health insurance is so important. These huge cost differentials are common and due to the fact that there is no incentive to control costs within any step of the process. Insurance companies and medical corporations massively benefit from the liberal and often unnecessary applications of their products. This is exactly why the hospital bill would have been so much more expensive than the minor care facility turned out to be; I would have paid twenty times the cost for a fractionally more accurate diagnosis, all the while experiencing a barrage of the latest and greatest medical technologies.

The question that should be asked of all Americans is whether our expectation of a healthcare system is to save lives, or to provide individuals with every advanced comfort available regardless of the broader scope of costs. It seems that the expectation from most people who supported the healthcare bill is the latter; every medical condition should be accounted for, regardless of the costs involved. Not only is this impossible, it is unconscionably selfish. There are a finite amount of monetary resources available within the United States and every medical procedure uses up some of these resources. When we waste precious resources in an effort to make fractionally better diagnoses, there are simply less resources available for the greater good. The consequence of this will be an increase of medical spending across the entire country, albeit abstracted through insurance premiums. Of course with any type of spending increase, those at the bottom are always going to get hit harder than those at the top.

In the nineteenth century it would have been considered a medical luxury for one to have access to a drug like acetylsalicylic acid. Despite the comfort it could have provided to millions at the time, there were still costs involved in its production and thus it was generally administered only when absolutely necessary. As medical and technological advancements were made, the drug became cheaper to manufacture. Eventually it became readily available, albeit as something called Aspirin. This type of history is significant to our current predicament. Not all medicines can be made instantly available to those who need them. If politicians had a genuine interest in helping to solve the American healthcare debacle, they would be working to reduce healthcare costs. They would be ensuring that the costs of modern drugs were decreasing and becoming more accessible to Americans, much like Aspirin once did. They would not be instituting policies guaranteed to increase the level of medical spending under the false pretense that this will somehow result in better healthcare.

Any politician who would attempt to convince people that the intent of mandatory insurance is to put everyone on equal footing should have his or her motives severely scrutinized. The notion is both impractical and illogical. If we assume for a moment that every single American were somehow provided the exact same quality, convenience, and cost of healthcare, then we would also have to assume that not one other American (of over 300 million) would attempt to find a medical product or service even slightly better, more convenient, or cheaper. Of course human beings simply do not function in that way. This is why the tenants of capitalism, despite the flaws, are what drive a free society. Perhaps not surprisingly then, the bill also addresses at least one capitalist enterprise.

The healthcare act of 2010 curiously contains a provision for levying additional taxes against tanning salons. This is actually one of the mechanisms installed to cover the additional costs, albeit a seemingly small one. The idea behind the tax is that since tanning salons are unnecessary (according to the state) and increase the risk of skin cancer, then they should be taxed accordingly. The idea is actually quite logical; the higher the risk of adverse health effects, the higher the tax should be. But this is an extremely dangerous precedent we have permitted the government to set for itself. By what authority does the United States federal government have to dictate what is “good” for us, and what is “bad” for us? Moreover, who makes that decision?

While I personally believe a tanning salon is a ridiculous waste of money, many would say the same of a motorcycle. Many might also say that a motorcycle is far more dangerous; why not tax motorcycles in the same way? Statistically speaking, they pose a far more significant risk to riders than those of cars. What about the correlation of fast foods to obesity and diabetes, or perhaps the ratio of adventure activities to injuries, or promiscuity to pregnancy and disease? There is an almost never-ending list of causality in our world. It would stand to reason that within this government-controlled framework, any type of non-essential, higher-risk activity could be subjected to arbitrary government taxation in the name of better healthcare. If I had to guess, I would imagine tanning salons simply lacked the necessary lobbying power in Washington prior to the bill’s passage.

Allowing the government to be the judge and jury of what constitutes acceptable risk would lead to a nanny-state of unfathomable dystopian proportion. The United States was founded on the idea that people control their government, not the other way around. This basic concept is responsible for the entire western notion of democracy. But given the obvious dependencies we all have on healthcare, is it really so wise to promote a system that exploits this dependency in the name of better health? The Bush Administration made a case that it was necessary to forgo certain civil liberties (outlined in the Patriot Act) in order to remain safe from terrorists. These types of hollow promises in the name of security and well being run contrary to the American foundation of liberty. They exploit the fears and needs of Americans to promote policies that benefit others. The healthcare bill has is no exception to this rule.

I would completely agree that nobody in the United States, citizen or otherwise, should have to suffer unduly at the hand of a medical catastrophe. The country is far too wealthy and technologically advanced to accept such a subpar standard of human accountability and compassion. But at the same time, neither should any person be legally mandated, especially at the federal level, to provide private industry of any kind with his or her business. While about half of the country might still be convincing themselves that their party would never have led them astray, the reality is that in due time, the healthcare bill will prove to be far worse than having done nothing at all. We cannot have a system built upon financial risk mitigation whereby nobody loses and meanwhile expect it to become more affordable; it is a mathematical impossibility.

The basic misconception lies with people believing that smaller incremental costs are somehow better or cheaper than one lump sum. This might be true if we spread those costs out ourselves, but in reality, we just wind up paying substantially more for goods and services that we never needed in the first place. This is very similar to the idea behind gift cards that we explored earlier in the book. The more you abstract the cost of something, the less likely people are to consider the price, and the more wasteful they ultimately become. But that does not change the original cost of the good or service from existing. Rest assured, we do pay for those costs, as well as all of the administrative costs that go into managing them. They are merely abstracted into smaller monthly or quarterly payments.

continued in "Part VI: Practical Healthcare Proposals"