What Should You Be Asking About Health Care in America?
Do market forces actually work in distributing health care?
Is Healthcare a commodity best left to profit driven markets?
My answer: No.
For several reasons, some of which are discussed in a recent op-ed piece by David Brooks
(NY Times http://nyti.ms/2neIP0U )
Briefly, here are my reasons for rejecting market-based solutions to health care problems:
1) Health care is principally funded by taxpayers in the US. We have an annual health care cost in the US of more than $3 trillion, of which about two-thirds comes from taxation. What market starts with $2 trillion in taxes? This makes Americans the most taxed people in the world, bar none, for health care. Why should these world leading taxpayers be left without financial support for health care when they need it?
2) The inverse relationship between price and demand which characterizes a true market (i.e., lower pricing increases demand) does not hold for health care. We do not buy an appendectomy because it is on sale this week. No one really wants health care unless they are persuaded (usually by a doctor) that some intervention is needed.
3) Higher quality does not cost more in health care, it costs less. When health care delivery is optimally caring for patients, the overall cost of care falls. This is very un-market-like.
4) The buyer can not beware in health care. The old adage “caveat emptor” or let the buyer beware is untenable in health care. Buyers of health care are patients. They can not shop. 80% of health care dollars are spent in urgent settings when shopping is obviously not possible. But even if it were, patients do not have the experience and training needed to decipher what health care services and goods are needed.
5) The seller of health care goods and services should not first and foremost have its self-interest (i.e., to make the most profit) as its goal. Rather, health care should be first, foremost, and always, about the health and comfort of patients. The emphasis of professional ethics for medicine and nursing is to provide the best care for patients without regard to personal comforts of the health professional—this is not how markets work.
6) The transaction between buyer and seller of health care (patient and provider) is of interest to all of society. When a patient has active tuberculosis, it is in the interest of all of society that he/she is provided with state of the art treatment, thus reducing the burden of communicable disease exposure throughout the community. Market don’t function well when multiple parties have an interest in the outcome of a transaction.
The essential and primary mistake of American health care policy is to assume that market forces will efficiently distribute health care goods and services. This is not the case, has never been the case, and can not be the case in the future. Let us stop pretending that profit driven, market-oriented, business as usual in American health care is anything other than a continuing catastrophe. Time to find a new way of thinking about health care delivery.
No comments:
Post a Comment