One of the better health care commentaries I've read was written by Houston Chronicle conservative blogger Chris Ladd last Thursday. His piece, which is a call to Republicans to abandon the free market elitism that is endlessly churned out by the hard-right and libertarian wings of the Republican Party when it comes to health care, is not necessarily a watershed moment in Republican thought. It is however, the realization that there are far deeper issues when it comes to health care than trying to turn to a free market or government-based cure all.
Those in the health care debate generally fall into two camps -- the health care as a civil and human right, advocated by those on the left, and health care as a purely economic good, so regarded by those on the right. Both sides are overwhelmingly undermined by the the lack of a legitimate buffer of altruism that would fulfill their dreams of what the health care system should be in the United States. While we would like to think that the matter of health care could easily reconcile itself to an argument over rights and personal responsibility, the truth is that as health care becomes more advanced, lives are being extended, and we search for more and more ways to provide more effective and efficient care, the stakes become raised as the issues become just as complicated.
An interesting piece from a while back that a friend shared with me, which was a New York Times op-ed that was endorsed jointly by then-U.S. Senator John Kerry, former Speaker of the House Newt Gingrich, and Oakland Athletics General Manager Billy Beane, pushed for evidence-based health care. The idea, coming from Billy Beane's successful approach of using statistical analysis on baseball to find success with what would be traditionally undervalued players, is thoughtful and I was a champion of it for years. However, while I still agree with the premise, I am also aware that ultimately effectiveness costs money and there's a reason why nobody ever has had a 1.000 on base percentage and a 0.00 WHIP and played an entire Major League Baseball season.
The root of changing American health care is ultimately changing how medicine is practiced in the United States. Health care costs have exploded since the 1960s ultimately because new medical discoveries and new effective treatments are being made faster than ever, and as stated before, your money spent on health care is ultimately spent paying for effectiveness and paying for the research and development that actually went into forming that certain treatment -- from medicine to equipment. You can forget about market forces being able to even buoy that with uninhibited success, considering that markets ultimately function in voluntary, mutual transactions based upon an anticipated need. Where one would demand a new computer similar to how they would demand fine dining, web design services, a new house, or a new car, one would not demand health care services in the same fashion because demand for health care services is almost always due to personal demand shock. The aforementioned change in the way medicine is practiced would require attempting to realign practicing medicine to a system that would allow health care to be framed into an idealized regular good or service that would submit to market forces, namely the force of anticipation. That's an absurd and unrealistic expectation, because then and there you would have two forms of moral hazard acting upon each other in an even worse Nash equilibrium game that exists now.
So is it up to the government to save the day? That is an equally disastrous position to take: most American health care laws are driven by emotion and ideology, and less so much critical thinking. The Affordable Health Care Act (which is more or less the maturation of the idea that the Heritage Foundation conjured up in 1989), was driven by the emotion out of a desire to provide health insurance to everybody while at the same time driven by an ideology that yes health care risk could be allocated similar to the risk of getting your car fucked up in a car accident. The AHCA primarily focuses on the intermediary of health care in the United States: the insurance company. It only complicates the actuarial science in regards to developing health care plans and the premiums that go with it: the cost of those premiums would have to be weighted between being competitive in health insurance exchanges as well as having the ability to afford claims. Denying coverage and providing for affordable premiums is completely different than being able to successfully pay out insurance claims.
In the end of it all, it's psychological and cultural. The medical profession, especially in the highest stake positions, is a high paying position where doctors charge based upon their skills and make money on their effectiveness (many get the first part, but forget the second part). The drug and insurance companies, in an advantageous position because of what they provide, could keep health care on the trek of being the first realistic example of a Giffen good. Ultimately, it is about people, just like you and me, to take advantage of others. If we collectively demand an unattainable level of altruism and collectively culturally accept otherwise simultaneously, then it is completely ridiculous to expect that overarching government involvement or the venerable free market could ever manage to a cure all when it comes to reigning in the costs of health care. I'm well aware about preventive care -- however, preventive care, in my opinion, will become the next health care cash cow.
The romanticism of the free market and the vision of the United States becoming a complete social democracy has created debate that is badly off base. We can discuss and lament Obamacare; we can whine and bitch about the insurance and drug companies; we can champion preventive care all day; however, the bottom line is that the health care riddle will not be solved until Americans, in an overwhelming fashion, ultimately decide if health care should be a "right" or should be an economic good. I will say this though -- it comes down to how big of an altruistic bet are Americans, on both the demand-side and the supply-side, are willing to make.
