Ideology of Healthcare

Healthcare is fertile ground for debate. Views of correctness range from the cult of the invisible hand (if everyone follows their own vested interest things will magically work out OK in the end) to the doctrine of eternal fairness (where everyone gets every possible medical procedure—and a white pony—for free).

The WSJ has, among several fair things to say, a silly and torqued conclusion:

There are only two ways to allocate any good or service: through prices, as is done in a market economy, or lines dictated by government, as in Canada’s system. The socialist claim is that a single-payer system is more equal than one based on prices, but last week’s court decision reveals that as an illusion. Or, to put it another way, Canadian health care is equal only in its shared scarcity.

I gotta say it. I can’t help myself. In the US, there is a large and growing portion of the population for which the waiting list is not just long, but infinite. It’s not just the “lazy and weak” who go without. It’s the small business owner who cleared 30K/yr, put two kids through college and is having his 63rd birthday with a bad hip. Also, the US system is vastly inefficient in terms of dollars spent for health care outcomes received.

The ‘with us or with the bad guys’ assertion that there are “two ways to allocate any good or service” is silly. There are a zillion ways to do this but it illustrates an important ideological difference. For me, healthcare is not about market mechanisms, it is about how a society chooses to care for itself.

Is it reasonable for a society that can afford to provide medical care to all of it’s citizens to choose not to? Is it reasonable for a society to enforce a monopoly when the monopoly cannot provide timely access to care?

My own view is that some level of citizen funded healthcare is inevitable. Not because single payer isn’t a better allocator of resources—it is better, by a long shot. It’s inevitable because the cost of care, as it’s current provided, will become unsustainable.

There are four aspects of public healthcare that can be managed: timeliness, universality, comprehensiveness and affordability. In the face of an aging population demading more and more expensive treatments it is not possible to have a purely public system that is timely and universal and comprehensive and affordable (given current levels of taxation).

If that premise is true, and I think it is, then the healthcare debate should be about what is the best compromise. Is it better to increase funding dramatically to keep the universality, the comprehensiveness and reduce the wait time? If we can’t afford to put enough money into it, should we allow wait times to increase

My own view is that we should have timely, universal access to affordable “basic” care and let people make their own decisions about how to provide for the gap between comprehensive and basic care. But, I can afford private care. Other people may have different views.

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