Health care debate demands more analytical rigor

BY MICHAEL LUMLEY

Too often, as is the case in the recent debate over health care, people involved in the rhetoric of political argument overlook the value of analytical thinking. In our arguments, we neglect to remember that not every Democrat is a communist, and we fail to concede that not very many Republicans are highly paid insurance executives and/or Satanists. (Yes, there is a difference.) Americans need to ask themselves what they really want when it comes to healthcare, and unless it’s another 20 years of partisan bickering, limited access, and soaring government deficits, they need to shut up and listen. If we choose to rationally analyze costs and benefits or causes and effects, then we have a reasonable chance to design a more efficient, responsive and accessible health care system. Otherwise, we are stuck with more of the same.

I freely admit that, like most Senators and Representatives who will actually vote on the bill, haven’t read the 1017 page document that now rests before Congress. But having read the CBO cost projection analysis and the CRS bill summary, I have a few thoughts on the principles that should guide Republicans and Democrats alike as they seek to draft a workable plan.

Some form of universal coverage, if not a moral imperative, is at least a practical necessity. There’s simply no way around it – in almost all cases, individuals who can not afford health coverage will receive treatment in some form. In addition, costs associated with the lost productivity of unhealthy workers are a significant invisible drain on society at large. Instead of focusing on excluding those who are unable to pay from the system, we should instead concern ourselves with identifying the most cost-effective means for treating these individuals – because the emergency room is not the answer.

Employer sponsored healthcare sucks. It sucks because coverage is selected by an employer, whose primary concern is not quality of care, but the bottom line. There is no competition in the current system because in almost all cases, end users have no control over the final choice of provider. Just because a market is private, does not make it free. Individuals should purchase the coverage that is best for them – on an open market, free from compulsion. Unfortunately, current tax law unfairly subsidizes employer healthcare benefits, artificially raising the relative cost of privately purchased alternatives. Addressing this issue would go much further toward sparking competition than any ‘public option’ plan.

Keep a watchful eye on program costs and societal benefits. The guiding principle of whatever health care system emerges can not be that ‘every human life is priceless, and any cost is justified in saving it.’ While America may be the wealthiest nation on the planet, it will not continue to be wealthy for much longer if we adopt a generous healthcare system that does not attempt to match costs and benefits. So called ‘Death Panels,’ while politically unpopular, are a good start. (After all, doesn’t it make sense to spend more money treating a young mother of two than a washed up heroin addict?) But even without an expensive new healthcare system, America has $11.8 trillion dollars in debt and $59 trillion in unfunded liabilities to social security, Medicare and other government programs. This trend cannot continue.

Incentivize healthy behaviors. Luckily, over 70% of all health care costs are directly attributable to human behavior – behavior like smoking, over-eating or lack of exercise. If we can encourage individuals to kick the habit and go for a jog instead (by lowering premiums for individuals who engage in healthy behaviors) we can reduce overall costs. Unfortunately, such behavioral incentives are expressly forbidden in the new bill, and neither party is pushing to include them.

Insurance is not a consumption scheme. Insurance exists purely to distribute risk. It can never lower the cost of health care – on average, all participants must pay in at least as much as they take out. Health insurance makes sense for high risk, variable cost procedures like brain surgery, but not for predictable, set cost expenditures like checkups, vaccinations, or pregnancies. When no risk is involved, insurance is kind of like a dinner party. Several friends go out to dinner, splitting the bill afterwards. Knowing this, each might go ahead and order a second (or third) cocktail, knowing that in the end they’re only paying a fraction of the price. With a small group of friends, maybe that’s just how the good times roll. But to quote economist Russ Roberts of Geroge Mason University, “Never split the bill with a bunch (a few hundred million, lets say) of strangers. That’s how you get the buffet from hell.”

Michael Lumley is a 1L.

Comments