Posted on 10/11/2017 8:16:49 AM PDT by SeekAndFind
Editors Note: Pascal-Emmanuel Gobry, a conservative writer and fellow at the Ethics and Public Policy Center, is writing a series of columns on uncomfortable truths about health care in America. Some will make conservatives more uncomfortable, others will make progressives more uncomfortable, but most should make everyone uncomfortable.
The poor you will always have with you, says the Good Book. Jesus might as well have been speaking at a health-policy seminar.
We dont, mostly, speak about health-care policy in the cold language of efficiency, productivity, and resource allocation. We also use a moral language about fairness, justice, and righteousness. And rightly so! Health affects us in a profound and immediate way so that health services have a different moral valence than most other goods and services. The rain falls on the just as well as the unjust, and while conservatives are stubbornly opposed to government-provided help for those who can help themselves, when it comes to health, the calculus is different.
Conservatives believe that a free-market system would abound with so much innovation that everyone would receive much better care, and with such price competition that even the poor would find the best treatments affordable, and I agree. Progressives, meanwhile, view as a profound moral outrage the idea that two different people might receive a different standard of care simply because they have different economic resources, and I agree.
But the uncomfortable truth is that under any conceivable system, the poor will always have worse health outcomes than the rich.
The first reason for this is that health is not only determined by the health care one receives but also by ones environment, and that pretty much every unhealthy thing you can think of correlates with poverty. Obesity? Check. Alcohol abuse? Check. Substance abuse? Check. Smoking? Check. Over the past decades, a growing body of research has accumulated to show that other softer variables linked with poverty have a negative impact on health, such as personal behavior, job stress, the psychological environment of work, and social networks and social support. Whats more, the research suggests that all of these negative inputs not only accumulate over the course of life, but even that they can be passed on across generations by parents to their children.
All of that means that, however your health-care system works, poor people will be worse off simply because theyre going to be in worse health over the course of their lives. In a sense, this is almost tautological: Poverty is not just material deprivation, it is exposure to all those negative things that are associated with material deprivation, which necessarily have an impact on our health. This is the reason why poverty is bad and why we should seek solutions to alleviate it.
All right, fine, you might say, maybe poor people start off at a disadvantage, but perhaps theres a way to design a health-care system that ensures they get an equal level of care. And the answer there is still, no, sorry. The reason for that is that resources are limited. Medical innovations, whether they are drugs, devices, or processes, do not spring fully formed from the thigh of Jupiter in every hospital and doctors office. Imagine a world where every bureaucratic and market constraint is suspended. It will still be the case that an experimental drugs effects will only be partly understood at first, so that it will have to be tested on some number of people before it can become widely available. It will still be the case that the earliest version of a new magical medical device will be imperfect and only the third or fourth version can be rolled out widely. It will still be the case that not every doctor can always stay abreast of the latest medical research so that at least some doctors will, without gross negligence, apply outdated procedures and remedies.
Take the most egalitarian of all rich-world health-care systems, which is Britains National Health Service. Unlike most single payer systems where the health system is at least privately run, with the government acting as funder and regulator, Britains NHS is centrally run as a government body, like the Veterans Administration. Conservative critiques focus on the dramatic inefficiency of such state-run systems, and rightly so. But heres my point: Not every cardiologist in Britain is as good as every other cardiologist; not every trauma surgeon in Britain is as good as every other trauma surgeon. Even if the NHS were run by perfectly well-intentioned and omniscient bureaucrats, it would still be the case that some NHS hospitals would be better than others which is why the private sector publishes rankings of these public hospitals so that some people will get a lower standard of care than others. Even if money doesnt matter, getting care in the best hospital will depend on having inside information and, perhaps, inside pull which correlates really well with socioeconomic status.
Even if your primary objective was egalitarianism, and even if you could implement policies perfectly, you just could not have an egalitarian health-care system.
Indeed, the NHS example is analogous to an old conservative talking point against Communism, which is that Communist societies, on top of everything else, are extremely inegalitarian since a coterie of apparatchiks enjoys a de facto plutocrat lifestyle while everyone else trudges along in deprivation. Socialists would have us believe this happens in capitalist, not socialist, societies, but experience has shown otherwise. So even if your only concern is economic inequality, you still should be a capitalist rather than a socialist. On top of everything else thats horrible about it, Communist North Korea is also the most economically unequal society on Earth.
But by the same token, while the poor are undoubtedly better off under a free-enterprise system than under a truly socialist system, it is still the case that any system will have poverty. What is true about political economy in general is true about health care.
All of this might sound like quibbling: Of course, we cant have perfect equality, but its still true that some systems are better for the poor than others, and surely thats got to count for something. And I completely agree! The problem is that this is a big taboo in American politics. We want the rising tide to lift all boats. The idea that one person might get a lifesaving treatment and another not through no fault of their own is intolerable to us, and quite rightly so. Conservatives say that if you let the market work its magic, everyone will have the health-care equivalent of a BMW. Progressives want the government to buy everyone a BMW. In reality, whatever we do, most people will get a Honda, and only some will get a BMW. This is tragic, but that this is tragic should not make us willing to delude ourselves that it can be otherwise.
Lie! I have been in healthcare for decades. The poor use much much much more healthcare for illnesses that we gather up the strength to go to work with.
Sure not every doc takes Medicare. Fix that problem. I see Medicare patients accessing top specialists while I am going broke from a surgery that I had to have to continue work. No specialists for me.. too expensive for me.
“Egalitarian?” You mean take money from those who earn it and give it to those who don’t?
The left is obsessed with “equal” outcomes for unequal input. They live to take all the money earned by smart, creative, driven people and give it to dumb, moronic, lazy slobs.
That’s “egalitarian” for them.
Even in countries that have gone down this road it is devolving into a tiered system. One level of basic, pedestrian care for the indigent, and another for those with resources to pay for it. Likely that is where we will shake out as well.
“Its not possible to design a truly egalitarian health-care system”
Free markets are egalitarian.
Socialism is elitists and exclusionary, contrary to what liberals believe.
The system that will give the widest possible access is Free Market medicine with the government totally uninvolved beyone its Constitutionally mandated function of guaranteeing weights and measures which can legitimately include
truth in labelling. The poorest will have greater access because the price of medicine will be far lower and real charities will take up the slack for serious illness as they did before large scale government involvement. It will be better of the poorest because emergency rooms and clinics will not be clogged with simple colds and minor discomforts and people there for social reasons.
The rich congress people didn’t mind keeping their Obama care exemptions...Progressives in congress had NO PROBLEM getting better health care than the poor...Progressives,democrats and liberals,are lying sacks of s### ...+...
who are “the poor”?
those down on their luck for a time- few years?
those who worked but for some reason (family/injury/situation?) just don’t have enough to cover healthcare costs for everyone they are responsible for?
those who don’t care to work as much as they could? (either lazy, addict, etc reasons people prioritize over working to fully support themselves)
those who work but squander their money on things they want but don’t have money for essentials like health care needs/insurance?
those who just want things (food, utilities, housing, health care, etc) for free?
I don’t think many people at all should be poor their whole life. Enabling and hand outs keep many people “poor”.
LOL - an elitist take on '"Qu'ils mangent de la briocheCARE'... I'm sooooo embarrassed for this man. This is silly.
Pascal-Emmanuel Gobry has added a new level of insanity to the debate: 'let them eat cake Care' which is one step more insane than 'DoctorCare (where laws are written to help doctors live with the benefits of being a doctor in the 1950's while using the advantages of modern medical technology. (Like a minor with a pick ax being allowed to charge the same prices per ton while using modern mining machinery)
Or Jonathan Gruber's 'InsuranceCare' - - accountants TELL doctors how long a patient can stay in a hospital based on 'averages' and the money flows to people who have zero understanding of patient care... or PharmCare (obvious) or GovernmentCare - (a badly run version of InsuranceCare...) etc etc. So now we have 'let them eat cake if they can afford it Care and if not well, we'll eat cake and THEY can 'adjust to their station in life'... .
Yes, there is an answer - it's 'HealthCare' and it's cheap and better - - we're almost there (within a few years). So keep the system open to change and the good choice will happen. And this man - Pascal-Emmanuel Gobry? He can eat crow.
There is a third variable: time. It is widely understood that if socialists had instituted price controls on computers back in Apple II days, we would still be living in an Apple II world. It is only because of elasticity of demand that the resources necessary to develop modern chips have been dedicated to that work, resulting in Moores Law. The same phenomenon has been going on in health care; the primary reason why an American secretary today would have to think long and hard about changing places with Queen Victoria is that although Victoria was fabulously rich, health care as we now know it did not exist and could not be bought for any price. If it could have been, she would not have been a widow the last 20 years of her life.To attempt to give everyone BMW medicine," even if successful, would be to condemn future generations to never having anything better than present-day BMW medicine. The irony of calling socialists Progressives is that their nostrums assume away the possibility of progress.
Great post on a great article.
Thanks!
>>who are the poor?<<
democrat voters irrespective of income or citizenship status.
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