The Brute Facts about Health Care

This sat in my drafts a while because, I realized, I was trying to turn it into an essay. That wasn’t working because the whole point of this post is to make a simple list of obvious things–living room gorilla things–that liberals and idiots who bleat “health care is a right” refuse to acknowledge. So, only slightly ordered, the list:

  • Health care is an economic good. Even if you think that health care should be a right, you must deal with the fact that its availability and quality are subject to the same dynamics that determine the prices and quality of high-def TV’s. If you don’t admit this, you’re as fucking dumb as someone who thinks that making a recreational drug illegal stops people from using it. If you don’t take economic dynamics into account when proposing policy, you are a stupid menace.
  • No law that hasn’t been read and understood by most legislators voting for it can be a good law, unless you think that ignorance is bliss. How did that sausage get made?
  • No law that is more than 100 pages can be a good law. I’d actually prefer to say 5 here, but I’m accounting for triple spacing and large fonts and such.
  • Innovation is the most important thing in health care–the woman that Obama is shilling who’s being treated for leukemia without insurance, at high cost: what would here fate have been 50 years ago, regardless of universal health care? 200 years ago, they’d have put leeches on her. Nobody would accept 100% coverage at the level of care available 50 years ago. Or even 10 years ago.
  • The state-of-the-art for economic goods (of which health care is one) is always horrendously expensive. Only rich people or those who have taken a lot of money from rich people can afford them. I have a 61″ TV that cost $1200 (I got a deal) because 10 years ago several rich men got a 40″ TV that cost $50,000 and they got it a decade before I got a good TV. If you don’t accept that the rich get better TVs and health care, you will kill innovation in both TVs and health care. And your child will die of a disease that she could have been saved from while watching a hospital TV smaller than it needed to be.
  • Health care will be rationed one way or another because it is an economic good. There isn’t an unlimited supply. What’s the best way to ration? Price? Government mandates about your behavior, your age, your social utility? Insurance company rulings about what’s in and out of “the standard of care”?
  • Pure price rationing drives innovation best. It makes the rich pay huge amounts to make things work that the rest of us can afford. Like TVs. Actual effectiveness of health care depends almost entirely on innovation, not universality. Anything that reduces innovation condemns us all to old treatments that really do suck compared to the innovations that happen every day in America.
  • Let me put it another way: the possibility of wild rewards for wild risks drives innovation. (NOTE: the drug companies have taken this lottery ticket factor and turned it into a predictable business. Nearly all drugs they try don’t work out. Is it a bad thing that they’ve professionalized this?)
  • We wouldn’t have a health care cost crisis if health care weren’t improving. So it’s important to understand why health care keeps improving. Should health care keep improving? Most of the innovations in health care keep people alive longer who are not contributing much economically. Old people (statistically) are rich. They’re scared shitless of dying and willing to pay a lot not to, unless we take away their choices and incentives.
  • Health insurance is very different from other insurance. Other insurance guards against unusual events that affect a small minority of people. The point of insurance is that everyone who is at small risk from an unusual event pools their money to even out the risk for the unlucky few. What do $10 co-pays for well baby visits have to do with that? Insurance is a shitty model for dealing with events that are likely and common for most people. (NOTE: Except for term, life insurance doesn’t fit this model, since everyone dies. Except for term, note how much life insurance costs. If you want to advocate a health care model like whole life insurance, let’s go. I’ll just say that whole life isn’t really insurance but an investment plan. And not a great one.)
  • You cannot cover more people without it costing more. The notion that ER care really costs more is bullshit. I have learned a little bit about how emergency room economics works, how they radically over-bill for those who aren’t insured. First, they swing for the fences. I took an adult to an ER recently and he was there less than 2 hours and they did nothing except calm him down and draw blood. I signed for him because I was so worried. $7000 bill to me. I paid not a penny of it, eventually, because I’m not (shock!) easily intimidated. My point is that the costs that are reported for ER treatment are wildly list price inflated. Think: why should ER treatment be all that more expensive than any other kind? The US system is riddled with bullshit accountancy.  But there’s extreme arbitrage too. It’s really costing about what it’s costing, no matter the sign on the door. Covering people with insurance won’t much change it except make it slightly worse, since people who before would only go to ERs will take advantage of that $10 copay.
  • Fixing health care by cutting out waste and fraud is a fantasy.  First of all, by the most generous estimates, fraud and waste are 20% of the problem.  Handling all fraud is a discount, not a solution.  Nobody talks much about waste and fraud for lettuce prices or plasma TVs, do they?
  • There’s a thick gray line called malingering. Any government or even flat rate medical system encourages people to act as sick and disabled as possible. No campaign against waste and fraud short of Arbeite Macht Frei is going to make a difference from the top down. In case you haven’t noticed, I’m in favor of bottom-up price rationing.

Robert Heinlein wrote about a society where extreme longevity became a possibility, but it couldn’t be distributed evenly. The result was horrible.

I think his point was that when it comes to my life and death, I’m going to claw and grasp and do whatever it takes to get to the front of the line and not drown. And I will hate everyone in front of me. And I will destroy everything if I have to.

Maybe we all will be happier if we die together, and our grandchildren die of the same things we do, as long as nobody makes it out alive if we don’t. Maybe this is an existential debate and politics and economics mean nothing if they don’t satisfy everyone’s justified fears of going alone into the great dark.

In extemis, everything in us wants more to draw one more breath more than to save millions not born yet.

That’s what Pelosi and Reid and Obama are counting on to make you go along with them. No more and no less than the most primitive religious leaders, they play on your fear of death to make you submit to their rule.

Bring on the leeches. For everyone.

UPDATE: Via the Washington Post, a Robert Wood Johnson Foundation study finds that the uninsured go to the ER no more than those with insurance. People go to the ER mainly because they want care right now, not because they’re uninsured. In Massachusetts, ER visits went up after socialized medicine was implemented, presumably because of longer wait times for regular care. Guess who does use ER’s more than the privately insured and the uninsured? Medicare and SCHIP patients–I presume also because they have to wait longer to see a doctor than most people. The point here is that if wait times for other kinds of care are the main driver of ER visits, then socialized medicine, which is notorious for ridiculous wait times, is going to increase ER usage. I wonder if this has proven to be the case in Canada and England, or if ER triage has become more draconian (or, hey, get the wait times in the ER up high enough, and you can discourage people from going).


One Response to The Brute Facts about Health Care

  1. Anthony says:

    “liberals and idiots”; Redundant, my good sir!

    😀 Kidding aside, this point is the most important: “You cannot cover more people without it costing more.”

    How do you cut costs with tens of millions going for care, and supply stays the same? Or maybe I’m wrong, and health care will drop from the sky!

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