Health Care: The push to reform the system is going in exactly the wrong direction. Instead of minimizing patient involvement in payment for treatment, Washington should be seeking to increase patients' role.
The cost of American medical care is so high that it's thought by some to be a tragedy. About one-sixth of the economy is made up of health care expenditures. On average, each American runs up $7,290 a year in medical bills. Bringing down the costs — without sacrificing quality of care — is a reasonable objective.
But supporters of the health care legislation recently passed in Congress have lost sight of the spending problem — if they ever had any clear concept at all.
There are two reasons why per-person health care spending in the U.S. is far higher than even Switzerland at $4,417 a year, or Luxembourg at $4,162, which rank second and third in the world.
One, America has the best health care on the planet. The smartest doctors, the finest in diagnostic equipment, top-flight treatment and advanced drugs don't come cheap.
Two, our system encourages overuse. And, as any ninth-grade economics student will confirm, an increase in demand forces prices higher.
Obviously, public policy that diminishes the quality of care would be counterproductive. Dealing intelligently with the latter, however, would yield positive results.
The accompanying chart shows why we have a health care cost problem. Patients have little direct connection in paying for their care. Their role has fallen significantly. Meanwhile, the government's involvement has grown, as has that of the insurance industry.
Because so many Americans rely on an insurance policy or a government program to pay their health care bills, the internal governors that temper the rest of their purchases are turned off. When a visit to the doctor's office or a diagnostic test costs them a mere $10 or $20 co-payment out of pocket — or there is no charge at all — cost has little impact on their decision to see a doctor.
"By not knowing the full costs associated with health care, consumers demand more and 'overuse' it," Kenneth E. Thorpe explained a few years back in Health Affairs.
Americans would be more judicious in seeking health care — they would self-ration — if the right incentives were in place. An effective way to cut overuse and bring down costs would be to encourage through public policy the use of health savings accounts. If consumers used HSAs to pay the full amount for medical care at the point of service rather than letting employer-funded insurance or a government program pay the bills, the demand would fall.
The Democrats' health care legislation, however, puts more distance between Americans and the payment process and promotes dependence on government. That will only drive down consumers' out-of-pocket expenses even further and force overall health care spending upward. Under such a regime, the system will be worse off than it is now.
Memo To Foes Of Health Reform: Repudiate The Morality Of Need By YARON BROOK AND DON WATKINS
In the run-up to the Senate's passage of the health care bill, opponents of ObamaCare denounced it as an unprecedented expansion of government control over medicine.
They warned of the proven consequences of government medicine, pointing to the rationing that occurs in Canada and Europe.
They pointed to the low cancer survival rates in places like Britain. They cited statistic after statistic showing that ObamaCare will raise costs and lower health care quality in America.
They were right — yet it looks like Obama will get his bill. And even if the Republicans are able to pull off an upset, there is no question that over the coming years government control over health will continue to grow.
Why? Consider the history of government involvement in health care.
In the 1960s there was a perception that some elderly were not receiving adequate health care. To meet this need, Congress passed Medicare. The same concern was voiced about the poor. To meet their need, Congress passed Medicaid.
The same concern was voiced about those too destitute (or too irresponsible) to buy health insurance, and in the '80s Congress passed the Emergency Medical Treatment and Labor Act, forcing emergency rooms to treat anyone who needed medical attention, regardless of their ability to pay.
The same concern was voiced about parents who were too well off for Medicare, but who nevertheless couldn't meet their children's health care needs, and in the late '90s Congress passed the State Children's Health Insurance Program.
The message is clear: If you have a need, you are entitled to have it fulfilled at others' expense.
The reason we continue to move toward socialized medicine is that everyone — including the opponents of socialized medicine — grants its basic moral premise: that need generates an entitlement.
So long as that principle goes unchallenged, government intervention in medicine will continue growing, as each new pressure group asserts its need and lobbies for its entitlement, until finally the government takes responsibility for fulfilling everyone's medical needs by socializing the health care system outright.
Some believe you can stop this process midstream: The government will intervene only to help those in dire circumstances while otherwise leaving people responsible for their own health care. But that's an illusion. If need entitles one to the wealth and effort of others, then there is no logical reason why the government should restrict help to some small subset of the "needy," and refuse to help the rest.
The only way to effectively oppose socialized health care is to reject the morality of need in favor of a genuinely American alternative. According to the American ideal, men are not their brother's keeper — we are independent individuals with inalienable rights to support our own lives and happiness by our own efforts.
That means taking responsibility for your own medical needs, just as you take responsibility for your grocery shopping and car payments. It means no one can claim that his need entitles him to your time, effort, or wealth.
Where is the willingness to defend this ideal by saying, "Your health care is your responsibility — and if you truly cannot afford the care you need, then you must ask for private charity — not pick your neighbor's pocket to pay for it"?
Opponents of ObamaCare object that it is "too expensive," that the proposed bills are "too long," that Congress is moving "too fast" — conceding all the while that the goal of providing people with unearned health care is righteous.
But if forcing some Americans to provide unearned health care for others is noble, then is it any wonder that America keeps moving toward socialized medicine? Is it any wonder that, while Republicans loudly oppose Democratic attempts to expand government control over health care, they do not challenge the endless need-based interventions that already exist — and instead push for their own need-based programs (such as Bush's prescription drug entitlement)?
Those who truly want to fight against socialized medicine in America must realize that it's time to drop the morality of need and proudly say: I am not my brother's health care provider.
3 comments:
Once Patients Pay, Health Costs Will Fall
Health Care: The push to reform the system is going in exactly the wrong direction. Instead of minimizing patient involvement in payment for treatment, Washington should be seeking to increase patients' role.
The cost of American medical care is so high that it's thought by some to be a tragedy. About one-sixth of the economy is made up of health care expenditures. On average, each American runs up $7,290 a year in medical bills. Bringing down the costs — without sacrificing quality of care — is a reasonable objective.
But supporters of the health care legislation recently passed in Congress have lost sight of the spending problem — if they ever had any clear concept at all.
There are two reasons why per-person health care spending in the U.S. is far higher than even Switzerland at $4,417 a year, or Luxembourg at $4,162, which rank second and third in the world.
One, America has the best health care on the planet. The smartest doctors, the finest in diagnostic equipment, top-flight treatment and advanced drugs don't come cheap.
Two, our system encourages overuse. And, as any ninth-grade economics student will confirm, an increase in demand forces prices higher.
Obviously, public policy that diminishes the quality of care would be counterproductive. Dealing intelligently with the latter, however, would yield positive results.
The accompanying chart shows why we have a health care cost problem. Patients have little direct connection in paying for their care. Their role has fallen significantly. Meanwhile, the government's involvement has grown, as has that of the insurance industry.
Because so many Americans rely on an insurance policy or a government program to pay their health care bills, the internal governors that temper the rest of their purchases are turned off. When a visit to the doctor's office or a diagnostic test costs them a mere $10 or $20 co-payment out of pocket — or there is no charge at all — cost has little impact on their decision to see a doctor.
"By not knowing the full costs associated with health care, consumers demand more and 'overuse' it," Kenneth E. Thorpe explained a few years back in Health Affairs.
Americans would be more judicious in seeking health care — they would self-ration — if the right incentives were in place. An effective way to cut overuse and bring down costs would be to encourage through public policy the use of health savings accounts. If consumers used HSAs to pay the full amount for medical care at the point of service rather than letting employer-funded insurance or a government program pay the bills, the demand would fall.
The Democrats' health care legislation, however, puts more distance between Americans and the payment process and promotes dependence on government. That will only drive down consumers' out-of-pocket expenses even further and force overall health care spending upward. Under such a regime, the system will be worse off than it is now.
Memo To Foes Of Health Reform: Repudiate The Morality Of Need
By YARON BROOK AND DON WATKINS
In the run-up to the Senate's passage of the health care bill, opponents of ObamaCare denounced it as an unprecedented expansion of government control over medicine.
They warned of the proven consequences of government medicine, pointing to the rationing that occurs in Canada and Europe.
They pointed to the low cancer survival rates in places like Britain. They cited statistic after statistic showing that ObamaCare will raise costs and lower health care quality in America.
They were right — yet it looks like Obama will get his bill. And even if the Republicans are able to pull off an upset, there is no question that over the coming years government control over health will continue to grow.
Why? Consider the history of government involvement in health care.
In the 1960s there was a perception that some elderly were not receiving adequate health care. To meet this need, Congress passed Medicare. The same concern was voiced about the poor. To meet their need, Congress passed Medicaid.
The same concern was voiced about those too destitute (or too irresponsible) to buy health insurance, and in the '80s Congress passed the Emergency Medical Treatment and Labor Act, forcing emergency rooms to treat anyone who needed medical attention, regardless of their ability to pay.
The same concern was voiced about parents who were too well off for Medicare, but who nevertheless couldn't meet their children's health care needs, and in the late '90s Congress passed the State Children's Health Insurance Program.
The message is clear: If you have a need, you are entitled to have it fulfilled at others' expense.
The reason we continue to move toward socialized medicine is that everyone — including the opponents of socialized medicine — grants its basic moral premise: that need generates an entitlement.
So long as that principle goes unchallenged, government intervention in medicine will continue growing, as each new pressure group asserts its need and lobbies for its entitlement, until finally the government takes responsibility for fulfilling everyone's medical needs by socializing the health care system outright.
Some believe you can stop this process midstream: The government will intervene only to help those in dire circumstances while otherwise leaving people responsible for their own health care. But that's an illusion. If need entitles one to the wealth and effort of others, then there is no logical reason why the government should restrict help to some small subset of the "needy," and refuse to help the rest.
The only way to effectively oppose socialized health care is to reject the morality of need in favor of a genuinely American alternative. According to the American ideal, men are not their brother's keeper — we are independent individuals with inalienable rights to support our own lives and happiness by our own efforts.
That means taking responsibility for your own medical needs, just as you take responsibility for your grocery shopping and car payments. It means no one can claim that his need entitles him to your time, effort, or wealth.
Where is the willingness to defend this ideal by saying, "Your health care is your responsibility — and if you truly cannot afford the care you need, then you must ask for private charity — not pick your neighbor's pocket to pay for it"?
Opponents of ObamaCare object that it is "too expensive," that the proposed bills are "too long," that Congress is moving "too fast" — conceding all the while that the goal of providing people with unearned health care is righteous.
But if forcing some Americans to provide unearned health care for others is noble, then is it any wonder that America keeps moving toward socialized medicine? Is it any wonder that, while Republicans loudly oppose Democratic attempts to expand government control over health care, they do not challenge the endless need-based interventions that already exist — and instead push for their own need-based programs (such as Bush's prescription drug entitlement)?
Those who truly want to fight against socialized medicine in America must realize that it's time to drop the morality of need and proudly say: I am not my brother's health care provider.
Post a Comment