Thursday, August 13, 2009

Rationing of Health Care?

Maybe you have heard it said that we already ration health care, and that it is unjust. Therefore, we need the civil government to ration it fairly. I heard this in a public forum and no one challenged it.

This clever trope is deeply misleading and trades on an equivocation. The distribution of scarce goods is not always "rationing." When the state takes over anything, it rations by coercion. People in charge make decisions that are the final word.

No, health care is not perfectly implemented as it stands, but we have a relatively discentralized process that is not subject to top-down abuses. Please read this essay on that topic.


ryan said...

I usually agree with you Dr. G, but I think your wrong on this one. Its deplorable that there are two main rails when it comes to health care; profit and the well being of humans. And when those to collide the winner in our system is profit.

Health care is not like ice cream, shoes, or any other consumer good that should just be left to the free markets. It is a necessity. Just like electricity, water, or other utilities that are regulated in our culture. These things are vital and needed for everyone. You simply cannot leave them exposed to supply and demand at the detriment of those who would not be able to afford them.

Imagine of power spiked to $1,000 dollars a kilowatt, or water went to $500 dollars a gallon. We would all be outrage and think it despicable that a needed thing to survive was being deprived to our fellow citizens, due to a greater loyalty to an economic system.

While I am a committed capitalist there are somethings, like things people need to live, that must not be thought of first from a profit point of view.

Doug Groothuis said...

This is a false dichotomy: profits or people. The alternative is: individual liberty or statism. ObamaCare is statism: government run, government-deciding, government-limiting medicine.

The market isn't entirely free now: we have medicare, etc. Many of the uninsured make over $50,000 and they decide not to have coverage. That is their right. Many are temporarily uninsured. Yes, some are uninsured, but they can still get medical care through ER (not the best, granted) and through free clinics, etc. When people are free to use their money as they wish, they are free to offer help creatively according to their values. That is far better than statism: the centraliztion of power, money, and property.

Health care is not a right given us in the Constitution. It is not directly the province of the state, but rather the individual, family, church, and voluntary associations.

Rudolf van der Berg said...

Dr. Groothuis, your replacing one dichotomy with another and it is just as bad. What healthcare is is an insurance system. Insurance systems work best when the chance of something happening to you is quite real, but also quite randomly distributed among the population. This way strategic behaviour is hard for individuals as they can't assess how this will affect them. Car insurance is a quite good example. We all pay, more or less the same.

With health the trouble of costs lie at the start and end of life (above 50-60). The costs are so high that many people individually never will make enough money in their life to be able to afford their medical bills. It is the collective insurance that make the bills payable. If for instance young people shirk away from paying their dues they aren't only hurting themselves, they are hurting the collective. Furthermore the way society is organized often means that young people are the least likely to be in a position that comes with insurance or being able to significantly afford it.

A collectivised solution brings average costs down. It allows more people to receive a higher quality of care. And yes this means that some kind of allocation mechanism is necessary to protect the commons. This doesn't mean that such a mechanism is necessarily evil. In The Netherlands such a system used to exist through the churches. Catholics would be helped in Catholic hospitals, protestants in protestant hospitals. When the dominance of the church fell away the state first took over and now there is a combination of market and state that provides insurance and care. The effect is that in The Netherlands the country pays 10% of its GDP on healthcare, but has 99% of the nation insured and receiving advanced care. In the United States you pay 16% of your GDP on healthcare and a significant part of the nation is without advanced care.

A very practical example is my 85 year old grandmother who has received two new hips in recent years even though she is on a very small pension. All the care and revalidation was done in the finest hospitals and she can walk for years to come.

The facts don't lie in Western Europe people pay less for healthcare and more people receive an equal or better kind of healthcare then in the United States. Scaremongering about rationing doesn't help. Any system rations and the rationing is never according to the free will of the one needing care as that person will only want more.

A simple challenge for you as a Christian Philosopher might be to design and promote a healthcare system that fits your values. How would you design the rationing that inevitably has to take place?

ryan said...

Dr. G, I ask in all earnestness, are utilities being regulated by the government wrong then? What about our public education system? Or for that matter the fire department or police?

All of which we have agreed are vital for all people to have access to even in a capitalist society.

I am not saying that free health care is a "right" given to us by the constitution but I do believe it should be affordable to all. Just like utilities are.

Also I am failing to see how this is a false dichotomy when we have testimony before Congress of health insurance executives who have stated their bonuses were based off how many claims they could deny. This is clearly a case in which a desire for profit trumps the well being of the human.

Jon said...

I saw this argument in the latest copy of Reader's Digest, which was in turn reprinting an editorial that ran in a major newspaper. (Sorry, I don't have the RD here with me, so I can't remember the paper or the author.) I am guessing this is where the person in the forum heard this argument.

Perhaps someone who is familiar with the article in question can provide more details than I, or provide a link.

Floyd Collins said...

Another false dichotomy is the presumption that individual liberty and statism is a binary proposition. The US as it currently exists represents a dynamic compromise between free-reign, individual liberty and centralized, federal control. The founding fathers expected and intended that - whether in the present balance or not is debatable. (It is notable that both left and right support and reject governmental regulations as it intersects their own areas of concern.)


Doug Groothuis said...

I do not have time to create an entire system to reform American health care, but I know statism and the supression of liberties when I see them.

Doug Groothuis said...

There is no rationing under a non-Statist system. Here a few things that would help the present situation:

1. Tort reform to end needless lawsuits against doctors.
2. Decrease taxation to free up the ecomony for more productivity and more money available for charity.
3. Closing the borders so that millions of illegal (and uninsured) aliens stop taxing our medical system. Perhaps 10 million do this now.
4. Let people opt out of personal health insurance if they want to. It should be their choice.

For other ideas, go to the Heritage Foundation.

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