Browsing the blog archivesfor the day Thursday, January 14th, 2010.

Entitled to Health Care

Health Care

A couple of days ago David Herszenhorn of the New York Times asked two people — Joseph R. Antos of the American Enterprise Institute and Jacob S. Hacker of Yale University who (I think) first suggested the public option — the simple question, why does health care cost so much? Although their answers differed, as Herszenhorn said they both boil down to “normal market forces mostly break down in the American health care system.”

There is a mega-question about whether “market forces” could ever create a sane health care system. There is no place on the planet where 21st century health care is being delivered by a “market driven” system, so any answer we come up with is entirely theoretical, but I say no. However, I’m going to put that question aside for now.

Something else struck me about the two answers that Herszenhorn didn’t discuss. It seems to me that Antos’s response was bristling with attitude about “entitlement” — a word he used twice — whereas Hacker was more dispassionate. Although I agree with some of what Antos said, the implication that patients are somehow being greedy or “demanding” by seeking the best health care they can get is, to me, disturbing.

And then conservatives are always the first ones who start screaming about “rationing” when anyone discusses the best allocation of our finite health care resources. Go figure.

Then Herszenhorn says,

One reason, as mentioned previously, is that people like to live and be healthy. There seems to be no upward limit on the amount of money that most people would spend toward that goal (as evident in the number of medical-related bankruptcies in America). And that, of course, puts the purveyors of health care at a distinct advantage over the consumers of health care.

I’m sorry I don’t remember where I read this — will the author please stand up? — but somewhere I read that health is different from other things we insure because there is no limit to the monetary value of life. If you insure your car, the most the insurer will ever have to pay is the replacement value of your car (overlooking the medical liability aspect of car insurance, which really is a health care problem). Same thing with your house, or other possessions.

But what is the “replacement value” of a life? People facing death generally will pay any price to keep living a little longer. Same thing with chronic pain or physical impairment. And, in a culture that is supposed to value individuality, there shouldn’t be anything wrong with that. Of course people want all the expensive, cutting-edge gizmos anyone ever invented to extend their lives and the lives of people they love.

The idea that one should live or die based on whether you’ve got the money to pay for health care should have no place in an egalitarian society. If thinking that way is “socialism,” then call me a socialist.

But this also, seems to me, points to the ultimate reality that the private insurance model is an inadequate, and even irrational, way to provide for a nation’s health care.

It also points to the ultimate reality that of course “market forces” will break down when you’re talking about something that is beyond ordinary monetary value. Because there is no limit to the value of a life or the quality of a life, “market forces” always will break down trying to provide for life and health. How could market forces not break down, unless everyone agrees on the monetary value of what is being marketed?

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