Sunday, July 12, 2009

The question is not whether people might die...

Dana over at En Tequila Es Verdad discusses health care reform, quoting Rep. Paul Broun:

"...and that's exactly what's going on in Canada and Great Britain today. They don't have the appreciation of life, as we do in our society, evidently. And, um. Dr. Roe, a lot of people are gonna die, this program of 'government option' is being touted as being this panacea, the savior of allowing people to have quality health care at an affordable price -- is gonna kill people."

Let's get this straight. EVERY form of health care will lead to deaths.

Any society has finite resources. Any time you spend those resources on anything whatever, you're not spending those resources on saving a life that might have been saved otherwise. Even when you're spending the resources on saving a life over here, you're not spending them on saving a life over there. If you install that traffic light, you might have spent it on heart medication. If you build that school, you might have spent it on cancer research. If you build that bridge, you might have spent it on an MRI machine. But the traffic light, the school and the bridge also improve survival...

And it's not just government expenditure. Buying a boat rather than donating money that could save lives is a health care choice too.

The one constant then, is that under any form of health care, under any form of public and private expenditure, people die. It is a nonsense to pretend otherwise.

The question is not whether health care will be rationed. It always is. The question is not whether bureaucrats will be involved in health care decisions. They always will.

The question is when and where resources will be spent. This always comes down to what treatments are effective and where to get value for the resources that are spent.

Currently an overwhelming proportion of health care expenditure in the US is spent to keep very old people, mostly very wealthy people, alive for another couple of months, at the expense, frequently, of children and babies, had some of those resources been spent on younger, poorer people.

Any way you try to allocate those resources, people die. The thing is, if you reallocate only a tiny amount of that expenditure toward younger, poorer people, the overall impact on survival can be very dramatic indeed.

The UK and Canadian systems (and for that matter, the Australian one) are imperfect.
As far as I understand, they all involve some form of judging what is effective treatment.

If there are two similar treatments, but one costs twenty times as much for only fractionally better outcomes, the public systems will tend to plump for the cheaper one - because you can treat twenty times as many people with it! (As Cujo rightly points out in comments, similar decisions happen with private providers in the US as well - though obviously their priorities are slightly different.)

Overall, these decisions do a fairly good job of allocating resources away from less effective or marginally-effective-but-hugely-expensive treatments, in order to make the health of the society as a whole somewhat better. But government involvement in providing some minimal health care doesn't stop wealthy people being able to buy additional health care.

Every system involves rationing. The present US system rations health care quite dramatically. Firstly, millions of people don't have health cover at all, and for many that do, their provider strictly rations what health care is provided - the main problem is that their decisions are not only predicated on value for money. Again, the question is not "will health care be rationed?", the question is "what is rationed, and in what circumstances?".

On its northern border, the US has a neighbor that has universal health care. However, it is not a single system - there's a different system in each province. There's been a long-running experiment right on the doorstep of the US, with different approaches to providing health care (link is to Snopes article debunking claims about Canadian health system).

It would be easy to examine what works well and what doesn't about each system. There are many other systems around the industrialized world, with different methods of paying for care and different approaches to providing it. The US is in a uniquely privieleged position to see what works, and has the ability to find out what the users of each system think of their health care and its costs.

I live in a system that has private and public components. It is not cheap, and it is far from perfect, but it is still cheaper than what you presently have in the US and (usually) does better at providing a minimal level of basic health care to the poor.

The US has a unique opportunity to get it right. But there are some people whose aim is to scare you out of making a considered decision, and the private health industry is spending enormous amounts on lobbying politicians (and people in the media) to make sure that you don't. The result is you get told a lot of lies and half-truths and get conclusions based on bad assumptions. If you pay attention to the scare mongers (mostly politicians with pockets filled by the private health insurers and incredibly wealthy media people whose concerns are very different from that of the ordinary working person), they will create so much smoke that proper, considered decision making will become politically impossible. And the only certainy then is that no matter what health care system you get, you will end up with worse health care than you could have.

So, Rep. Broun, do we spend a little and save perhaps a dozen babies, or is extending the painful death of someone in the unavoidable process of dying, for perhaps another few days, really more important to you?

edit: fixed link. Added a couple of paragraphs and a link


Dana Hunter said...

Looks like a prime candidate for COTEB, here, laddie. I hope ye're plannin' to submit. Otherwise, I be filching it for me own nefarious purposes before too long. 'Tis a good perspective, and ones ignorant Americans need to hear.

Cujo359 said...

In the American system, insurance companies often do the same sort of evaluations about effective vs. ineffective treatments. Anyone who thinks that will only happen if we go to single-payer or a public option is kidding himself. It's happening already. Plus, as you mention, there are always priorities for how money is spent. Sometimes those priorities are unwise, and sometimes they're unfortunate for particular people. That's how things are.

george.w said...

Part of the strategy of obfuscation is always to pretend that people who think and speak clearly about the issue are big ol' meanies. Congratulations, big ol' meanie!