Tuesday, May 19, 2009

Health Care Reform

If the current health care debate were just a rhetorical miasma, as Peggy Noonan said, things would be bad enough. See my comments here.

But, as the anonymous psychoanalyst who blogs as Shrinkwrapped points out, the debate traffics in fantasy and wish fulfillment. It has little to do with reality or reason. Link here.

I am most impressed by Shrinkwrapped's high-concept take on the issues. The point should be obvious, and has occasionally been debated. It has never, to my knowledge, been stated as incisively.

If our goal is to make health care: universal, high quality, and affordable, we will ultimately fail.

In reality, Shrinkwrapped says, you can have two of the three, but not all three. Take your pick!

Universal high-quality health care will be unaffordable. Universal affordable health care will not be high quality. High quality affordable health care will not be universal.

He concludes that anyone who is telling you that you can have it all is a fool or is lying.

Shrinkwrapped makes another point, one that resonates with an idea I began to develop in a previous post. Link here.

How many of us complacently indulge bad habits that we know will make us sick because we believe that the world's greatest health care system has our backs?

Shrinkwrapped takes it a step further and says that if we really want to encourage people to adopt good habits, we need but return to a time when people took full responsibility for their health care.

If you knew you had to pay for the bypass surgery and the lung transplant would you be less likely to smoke?

Shrinkwrapped is correct to say that anyone who would dare suggest such a thing would have the armies of compassion beating down his door. Still, it is an intriguing thought.

As it happens, it is partially at work today. Many people today have health insurance that only covers major medical expenses. If you have this kind of policy, anything less than major you pay for yourself.

Do these policies encourage people to live healthier lives and to use the medical system more judiciously? Perhaps so. And if so, making them more universal would perhaps decrease the cost of health care, both because the services would be used less frequently and because they would encourage better personal habits.

Today the country does not seem inclined to adopt such an approach. The reason is the 50,000,000 uninsured.

I do not want to belabor the obvious, but everyone should know by now that this number is a fantasy. Of the 50,000,000 a third are illegal aliens and a third qualify for Medicaid, but have not signed up. Of the final tranche, many are young and healthy.

And, as we know, having health insurance does not guarantee access to health care.

Finally, the urge to reform the health care system is not about health or care or reform. If it works as advertised we will have less health and less care. The system will not be reformed, it will be deformed.

It all reminds me of Voltaire's famous remark about the Holy Roman Empire... to wit, that it was neither holy, nor Roman, nor an empire.

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