Health Care: We Are All Going to Die

From Tyler Cowen at Marginal Revolution:

2. A rejection of health care egalitarianism, namely a recognition that the wealthy will purchase more and better health care than the poor.  Trying to equalize health care consumption hurts the poor, since most feasible policies to do this take away cash from the poor, either directly or through the operation of tax incidence.  We need to accept the principle that sometimes poor people will die just because they are poor.  Some of you don’t like the sound of that, but we already let the wealthy enjoy all sorts of other goods — most importantly status — which lengthen their lives and which the poor enjoy to a much lesser degree.  We shouldn’t screw up our health care institutions by being determined to fight inegalitarian principles for one very select set of factors which determine health care outcomes.

From a New Republic article about Remote Area Medical:

(Robin) Layman and her family offer a stark example of the law’s potential impact. Two years ago, her son, then 16, was hit head-on by a speeding driver high on drugs. Her son’s girlfriend was killed; he suffered severe internal injuries and recently underwent colon surgery. Now 18, he will soon age out of Medicaid coverage. 

And Layman, a gregarious 38-year-old, recently lost coverage for her own considerable problems. She suffers high blood-pressure, for which she takes three medications, purchased at a discount from the county health office. She suffers sciatica stemming from the time eight years ago when a co-worker at a dollar store let slip a heavy box of wrapping paper Layman was handing up to her. Layman lunged for it and badly hurt her back, for which she takes the nerve-pain medication Lyrica.

[Highlighting is mine.]

Q: Guess which one points at a moral failing?
A: Both.

***

We are all going to die.

You, me, Mitch McConnell, John Roberts, Barack Obama, that guy who cut you off, the teenager who chunked a firecracker at me -- all will die. Someday.

Given that, here's what health care does:

Tier 1: Treats illnesses & injuries that would kill you quickly if left untreated -- heart attack is the most common; however, many types of trauma would also fall into this category


Tier 2: Mitigates symptoms for illnesses that will eventually kill you, but will kill you much more slowly if treated -- many forms of cancer & diabetes


Tier 3: Mitigates symptoms for chronic conditions or injuries that severely impact a patient's quality of life -- Parkinson's disease, Crohn's, some types of diabetes, ligament and bone damage, arthritis


Tier 4: Treats or corrects issues that have a mild to moderate impact on a patient's quality life -- nearsightedness, warts, morbid obesity


Tier 5: Corrects cosmetic issues -- nose jobs, liposuction

Note that the top three tiers are diseases or injuries no one wants under any circumstances. Sure, some lifestyle choices accelerate the development of some of these illnesses (tanning leads to skin cancer; a diet of steak and burgers leads to a heart attack; etc...). I can think of no rational person, though, who consciously wants to experience anything in the top three tiers.

Yet, at some point, we are going to experience a deadly and/or debilitating injury or illness. Until then, we will have no need for any of the necessary treatment. (Something no one says: "Let's get a bypass, then top it off with some chemo!")

This is why the normal supply/demand curve is useless when applied to health care. Until I have a need most types of health care, I won't purchase it. Once I have a need, there's nothing I wouldn't spend. A doctor could ask me to go into indentured servitude in order for him to treat me when I'm having a heart attack and I'd have to agree or die. No time to shop around for a better deal.

What is lacking is choice. Most consumers don't choose to enter the health care market and they don't control when they leave. Whatever is trying to kill us will dictate our "consumption" needs -- not our socioeconomic status.

Arguments that we should ration health care according to income, that people should bear a "responsibility" for getting a life-threatening or life-altering illness are morally unacceptable. Even for those who made poor choices -- too many Mountain Dews and cigarettes, too few early morning runs -- should the consequence be an early death because of lack of treatment?

If you believe that, then visit a Remote Area Medical free clinic* when it's in the area. (Heck, visit any local free clinic.) Look at a patient like Robin Layman and all of her dependents in the eyes and tell them that yes, sustained and successful treatment is possible, but you must learn a lesson first.

****

The blown supply/demand curve is why we have health insurance. The status quo has been private insurance for some; decent government insurance for the elderly; lesser government insurance for the young or extremely poor; and pool of 40 to 50 million who are one trip to the ER away from financial ruin.

Today's Supreme Court ruling paved the way for nearly all Americans to be covered for illnesses in the top three tiers list above. It also gave desperately needed consumer protections to us. (Ask Robin Layman how important that is.)

To those who argue against this ruling on the grounds that it infringes on some notion of freedom or that it's a tax increase, again, I invite you to visit a free clinic and make your case.

Look them right in the eyes.

* Some may argue that the very nature of a free clinic is that its services are, well, free. I could offer a long rebuttal about how receiving care at a free clinic is a far cry from the comprehensive treatment afforded by health insurance. Or you could, again, take my advice to visit one and offer that argument. This is what will happen to your logic: