May 08, 2017

The Healthcare Follies (or alternatively The Way Things Are)

At Mass, a substitute priest gave a short but potent homily about The Way Things Are.

Specifically he asked, rhetorically, why God goes to the trouble to want helpers. Jesus was big on having helpers, his apostles and disciples, and yet often enough the apostles were a hindrance to his mission. He could've done things more efficiently alone.

God is so big on instrumentality that I sometimes picture God saying, "Gosh, I hate to put on such a big show to Saul on his way to Damascus instead of using human beings, but I need someone with a high intellectual capacity to bring my message to the Gentiles." Interesting enough that He chose an pharisaical Jew. If the world was making the choice of whom to send to the Gentiles, it would likely be a recent Gentile convert, someone who knows how Gentiles think and is "one of them". So God chose the opposite to prove he could. And of course St. Paul was as effective an evangelist as there ever was and likely will be.

So why the helpers? This priest said he thinks it's because it goes back to how we fell. "Adam and Eve were tempted so they were certainly not in Heaven. They were meant to work together to get each other to Heaven and they did the opposite. So God wants to rebuild humanity as he originally intended." With humans helping humans, even if it's an inefficient method. No wonder men want to be gods.

Speaking of wanting to be gods, there's a whiff of that in the health care debate. How about us, wanting to overthrow scarcity! The great thing about being a liberal is you can say things like "health care is a human right, not a privilege!" and it's just as fantastic slogan as "free money is a human right!" You can't beat that with a stick. I really have the sin of envy when it comes to how free and easy and wonderful it must be to be liberal. I don't see how you can lose if you just throw out bromides without specifics, which is one of the things that Pope Francis does with glorious regularity.

Kevin Williamson of National Review throws water on the parade in a post titled "We Cannot Vote Away Scarcity":
Our ongoing troubles with health care stem from an unwillingness to deal with certain facts. One of those facts is scarcity. “Scarcity” is a term from economics, and it refers to the fact that there is never enough of anything to satisfy every possible desire — the universe holds only so much, and human desire has a way of outgrowing whatever we have. So we have to come up with a way of dividing up that which is scarce. We have tried many different ways of doing that — war, caste systems, central planning — though mostly we’ve relied on the fact that everybody wants lots of different things, which makes it possible to trade. But buying and selling stuff is not, to be sure, the only way to divide up that which is scarce.

Medical care is scarce: There are only so many doctors and hospital rooms; the pill factories can make only so many pills, and there are real limitations on the raw materials used to make those pills; heart stents don’t grow on trees, but, even if they did, they would be scarce, like apples and oranges and pears and avocados.

Because of scarcity, medical care eventually reaches the point where one of three things happens: Somebody puts out his hand and says “Pay me,” an officer of the government or an insurance company refuses to approve some treatment, or you die. Because we are a largely cooperative species, we do not like that very much. It seems unfair and unkind. So we try to make an end run around scarcity with things such as health insurance and government medical plans, both of which are based on the same economic principle: Someone else pays. But scarcity does not care who is paying: Scarcity is scarcity. In the most monopolistic public-health systems (e.g., the ones in the United Kingdom and Canada), there is a lot of saying “No,” though it is what we might call a “Japanese no” — saying “no” without actually saying it. They put you on a waiting list and hope you die before they actually have to say “No,” or they simply expect you to accept that some services and treatments are categorically unavailable. There is a reason New York City’s hospitals are full of rich Canadians who cannot afford the free health care at home.
Of course if liberals have an easy job "Free health care for everybody!" then conservatives do too with the catchy (if far less popular): "No such thing as a free lunch!". Where it gets interestingly difficult is middle strategies, of trying to mitigate things. But there's not too much of a constituency for that else John Kasich would've won the presidency. We're no doubt getting the government we richly deserve.

This whole health care debacle, from Obamacare to Trumpcare, would be so amusing if it wasn't so serious. It's an attempt to square a circle, and both parties have no fallen prey to that hardy myth, and have lined up at that circular firing squad, to mix circle metaphors.


Steven said...

I agree with the spirit of this, but perhaps not so much the language. One needs to examine the sources of scarcity, for example. Is there scarcity or is there a scarcity that is artificial, designed to inflate prices, for example. I have no significant knowledge that could lead to resolution of the question.

I do wonder how so many things have become "rights" and how few obligations seem to accompany those rights. I do believe that every person should be cared for and that they should not be denied treatment because of lack of ability to pay. However, that system already exists. I don't believe that only the wealthy should be able to afford health care--but that too is a straw man. I do believe that if you want your rights, you should pony up on your responsibilities--like not abusing a healthcare system by wandering into a doctor's office for every hangnail or cold. How much abuse occurs? Probably not as much as I imagine, but when I hear tell of taking children to the doctor because they have a cold or have a 99.3 degree temperature for eight hours running, I wonder.

Respnsible use of scarce resources needs to be a mantra as much as making those scarce resources more widely available.

In short, people should not be deprived of food or water or medical care for life- or limb- threatening conditions; however, how often do these things happen in present-day society? Maybe more often than I am aware. Maybe.

But health care as a right is an interesting proposition. I'm not certain how many rights I believe in that hinge on entities outside our own integrity. Not certain so of no opinion as to validity.

TS said...

Interesting about the emphasis on responsible use of scarce medical resources. I'd not even heard that mentioned in healthcare discussions but it sure is a good point. The problem with subsidized health care is people will use more of it simply because it's "free" or below market. I know folks on Medicare who go to the doctor every other day. Certainly the fact that so many doctors now refuse to see Medicare patients is a worrisome indicator of scarcity.

There probably is some artificial scarcity (can't we import more doctors from outside US?) and I think we need to get drug costs down even if it cuts research and development.

There seem no good answers because nobody wants the market choosing who lives or dies, nobody wants the government doing so, and nobody wants insurance companies. Who's left? And we can't afford our current semi-socialized approach. So we're left with squaring the circle.