Monday, July 30, 2007

Some Sicko Stuff

My fiance, (who needs an appropriate nickname for the purposes of this blog- Future Mrs. Lonely libertarian perhaps?) saw Michael Moore's Sicko while I was busy studying for the bar

As you can imagine, it led to a small argument over health care policy upon her return from the movies, an argument which culminated in my slamming my fist down and exclaiming "No more Michael Moore movies for you! Ever!"

We had a more civilized discussion in the car this past weekend. What my fiance took from Sicko was that for-profit health insurance companies have a vested interest in denying expensive life-saving treatments and that the for-profit insurance system conflicts with the best interests of patients. The blatantly obvious flaw with this premise- as has been pointed out by many others in the media and over the blogs- is that you can have the exact same problem with government run systems. Perhaps there won't be as much scrutiny of the bottom line in a government run system, but in the end, costs are always a consideration, and decisions on what sort of treatments to approve are being made by someone, whether they work for an insurance company or a government bureaucracy.

Let's just take a look at a little example. Say Patient X has cancer, and there are three treatment options, A,B, and C. Treatment A is the standard treatment, which costs $10,000. Treatment B is somewhat newer, is potentially more effective, but costs $20,000. Treatment C is very new, is very technologically sophisticated and potentially avoids all the unpleasant side effects of Treatments A and B. Treatment C costs $50,000.

If we had to pay for this treatment out of pocket, we'd weigh the costs and potential benefits of each individual treatment. Under our current system, your health insurance provider will decide which treatments they will and will not pay for. And under a system of government care, the very same cost-benefit decisions would have to be made. It's not that the choice between treatment A, B, and C is a problem with no solution- the point is that these choices shouldn't be problems at all. Choices are the advantage of living in a free society. In a universal system however, the only choice will be the one made by the government. Not only that, but the fact that we have choices here in the United States is a testament to our (somewhat) free system. If the government was to control all health care spending, there might not be such a push toward new expensive treatments in the first place. (Just the same as pharmaceuticals- why do you think it is that most innovation comes from the United States- people are motivated by the promise of money.)

The other issue that Sicko fails to address is that there is a tremendous difference between unexpected tragic conditions and routine health costs. For some reason, everyone likes to group all these costs together, but the fact of the matter is, expensive cancer treatments are in a completely different universe from your annual physical ... and yet, we pay for them out of the same insurance pot.

I always wonder if those who call for universal health coverage would have the government pay for the costs of aspirin, antacids, cold medicine, and lactaid pills (to help with my lactose intolerance). After all, I think I spend more on these over the counter self medications than I do on other routine medical costs.

By the way, in case anyone was wondering, I am no defender of the status quo. I think we've perpetuated an inefficient and bloated health care system for over fifty years, the costs of which can be seen everyday. We should end the employer provided health care by eliminating the tax incentives that make it possible- if people need more money for their health costs, maybe the government should, I dunno, cut taxes so people have more money in their pockets to pay for health care. A system of health insurance is fine, but people need choice, not mandates- without real choice, which we don't have today, you don't really have a functioning market. Covering routine medical costs through insurance shouldn't be abolished, but under a more functional system, people should realize that such an arrangement makes absolutely no financial sense. If we know certain expenses are routine, why siphon off money to a third party (the insurance company) to pay for those routine expenses.

To say that we should pay for our own health care does not mean that we should let sick people die on the street- I only think that the way we pay for health care should be the same way we pay for other necessities like food and shelter. I believe the burden of proof is on those who would treat health care differently from other necessities, and until someone can show me evidence that a free market for health care does not work, I'm going to reject all calls for universal care.


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