Health care: you get what you can afford

Filed under: Hazlehurst |

A couple of years ago, I briefly dated a woman who was recently divorced from a local orthopedic surgeon.
One evening she complained mildly about her ex’s unwillingness to fund some kid-related expenditure.
“After all,” she said, “It’s not as if he can’t afford it.”
“So how much does he make?” inquired the nosy journalist.
“Oh, about 80,” she replied.
“An orthopedic surgeon only makes $80K?”
“I meant a month.”
I thought about this exchange last weekend. Rummaging through the basement, I found a copy of the New York Times dated Aug. 17, 1993, carrying this headline: Clinton Outlines Health Care Plan Paid by Employers.
The then-president was quoted as saying “I don’t pretend to have all the answers, but I am absolutely sure that this a problem that America cannot let go, that we cannot walk away from.”
Pointing out that health care then accounted for 14 percent of gross national product, Clinton predicted that it would soar to 19 percent by the end of the decade.
Clinton’s prediction was wrong. Although health care costs soared, so did the rest of the economy in 2000 — so much so that health care costs actually declined as a percentage of GNP, from 14 percent to 13 percent.
But, as John Madden might say, wait a minute!
As the Johns Hopkins Bloomberg School of Public Health reported, Americans spend considerably more money on health care services than any other industrialized nation, but the increased expenditure does not buy more care.
Researchers found that the United States spends 44 percent more on health care than Switzerland, the nation with the next highest per capita health care costs. At the same time, Americans had fewer physician visits and hospital stays were shorter compared to other industrialized nations.
The study suggests that the difference in spending is caused mostly by higher prices for health care goods and services in the United States.
“As a country, we need to ask whether increased spending means more resources for patients or simply higher incomes for health care providers,” said Gerard Anderson, Ph.D., lead study author.
And wait another minute! A report by the Alliance for Health Reform recommends changes in the way that we provide care to patients with multiple chronic diseases, “because a minority of very sick patients in the U.S. account for a high proportion of national health care expenditures. Payment policies that support integrated, team-based approaches to managing patients with multiple, complex conditions — along with efforts to engage patients in care self-management — will be of paramount importance as the population continues to age.”
And although health care costs actually declined as a percentage of GNP between 1993 and 2000, they’ve risen since, and are now close to 17 percent of GNP. Just as Clinton predicted that health care costs would rise to an unaffordable 19 percent of GNP, experts today predict that we’ll reach 20 percent within a few years.
Read almost any article about health care, and you’ll find that the system is expensive, inefficient, unsustainable, and about to collapse under its own weight — sort of like our very own Soviet Union.
Like the tax system, or public schools, the health care system is complex, ponderous, vital to all of us and needs reform. But whatever its faults, much of it works reasonably well, so we’d better be sure that any fixes don’t simply make things worse.
Michael Moore notwithstanding, Cuba’s health care system is not a replicable model for the United States — although it’s a great tool for selling inflammatory documentaries.
A simple proposition: health care costs money. Good health care costs more than cursory health care. And superb health care costs a great deal.
A corollary: there’s no free lunch. Someone pays.
Many of us have the admirably democratic notion that health care should be an entitlement — that, like transportation infrastructure, public safety, parks and the military, it should be provided equally to all, regardless of one’s ability to pay.
That’s a defensible proposition — unless we examine exactly what we mean by “health care.”
Does health care mean that all of us should provide for the feckless? Does it mean that the smoker who contracts lung cancer, the motorcyclist who won’t wear a helmet and ends up with disabling head trauma, or the morbidly obese diabetic who refuses to lose weight or exercise should pay no penalty for his/her behavior?
Should it be delivered, then, according to Marx’s classic dictum: from each according to his ability, to each according to his need?
That’s the very definition of socialized medicine, and it won’t work.
Health care, like any other business, is the delivery of goods and services for consideration. The more of the latter (i.e., money) that you have, the more of the former you’ll get.
Consider Medicare, which reformers often cite as a model for single-payer health care delivery.
In theory, Medicare pays for everything, but in practice, care is rationed. That’s because reimbursement rates to providers are well below the market, so physicians and hospitals alike have developed strategies to avoid treating Medicare patients.
Or consider the “free” health care offered to our active-duty military. The horrific news about conditions at Walter Reed should remind us that all systems for delivering health care are eventually governed by money — by government budgets, by insurance reimbursements, by direct patient payment.
We need a more efficient, less costly system for delivering basic health care. But we need to recognize that basic no-frills, preventive health care is not going to pay for everything. This is a capitalist country, and just as rich people get to live in The Broadmoor, rich people get better health care.
For example, my knee’s getting a little stiff. I might need a knee replacement one of these days — and I sure don’t want to be cut open by some half-awake butcher who graduated next-to-last in his med school class.
Nope, I want the best of the best — the kind of guy who makes a million a year, and is worth every nickel. The kind of guy who’ll fix my knee so that I can run marathons again, not just limp down the street.
I want my friend’s former husband, and I’ll pay the going rate. I may not live in The Broadmoor, but my knee’s more important than my address.
And I’ll leave my Medicare card at home.
John Hazlehurst can be reached at or 227-5861.