When deciding how you’re going to fry your eggs, you can go one of three ways, depending on your Budget and Quality priorities:
- Budget requirement: High priority. Quality requirement: Low priority. Buy the absolute cheapest thing that can do the job. It won’t do the job well, it will be finicky, burn your food, cook it unevenly, and it will be tedious and difficult to clean it. But it will allow you to fry your eggs. Ish.
- Budget requirement: Low priority. Quality requirement: High priority. Buy the absolute best, most expensive, solid, multiple alloy, multiple layer pan you can find, and hire a professional chef to come cook for you every morning. Breakfast-time will be a breeze; your eggs will always be perfect, and no cleanup!
- Budget requirement: Medium priority. Quality requirement: Medium priority. Find something in the middle that both won’t break the bank, but won’t be a PITA to use and will give decent results.
This is how most people make decisions (if they bother to put in the effort) in a well-balanced, market-driven, capitalistic environment.
But when you apply this thinking to a specific kind of healthcare, everything breaks down: life-essential care.
When a healthy person gets an annual physical, they can make smart decisions, as above. When they get a nuisance-level health problem, or something chronic or serious—but cheap and easy to treat—they can do the same.
But when a life-threatening or expensive issue arises, the Budget and Quality factors above are thrown off kilter, and a new factor is introduced.
The Budget Factor
For the budget requirement, people find it immensely difficult to consider cost when it comes to their own life-and-death decisions. Anyone can see that it’s reasonable to think of excessive costs being unacceptable; e.g., “Joe’s treatment will result in saving his life, but it’s so expensive that 10 people with life-threatening but cheaper problems will die because Joe used the limited resources available for himself. It’s not ok for him to do that.”
But if I replace Joe with myself, it’s almost impossible to believe that last sentence. Maybe it’s not ok for me to take the resources, but I’ll do it anyway.
Now, remove all visibility of that resources question, and make it so it’s just my own money that I’m spending. Of course I’ll take on any debt imaginable to save my life. This is the system we have. While the resources issue ALWAYS exists at the macroeconomics level, it’s hidden by our capitalistic model. The repercussions of this hidden issue are starting to show today, because insurance rates are skyrocketing.
If national health care came into being in the US, the costs wouldn’t change; just the payer (because people would still always choose to take the expensive treatment instead of die). So instead of super high insurance premiums, we’d have super high taxes.
Alternatively, pressures to reduce costs to the taxpayers (i.e., the taxpayers voting to lower taxes and thus force the healthcare system to operate more cheaply) will result in reduced care quality. So people will have to wait a long time for some care, or be outright refused certain kinds of expensive care. E.g., you need an expensive cancer treatment, but the doctors (at the command of the people) decide to deny you that treatment because, “You’re 90 years old and the treatment is only 10% effective for people your age. You’re not worth the cost.”
In our system, the 90-year-old can still get the care, and probably waste the resources, but that person would never choose not to. Meanwhile, everyone else is feeling the pain of that wasteful choice. Some people look at this problem like this: Everyone has a “duty to society to die” when living becomes too costly. Costly not just to that person’s immediate family, but to society at large. This “duty” idea is a good solution to the problem, because it lifts the responsibility from the society to decide who should get resources (and thus, live or die), and places the responsibility to make that choice on the person that is creating the cost.
Put another way: One side of the issue has society saying (through complex laws, taxes, insurance coverage policies/standards, and doctors), “We’re going to let you die because that means more other people can live. Sorry about that, but it’s our call.”
The other side of the issue has individual sick people saying, “My life isn’t worth the cost I’m placing on society. I will die so that others may live.”
Sounds much more humane, right? But it fails because the vast majority of people are far too selfish to make that sacrifice for, essentially, strangers. Through another lens, it actually becomes inhumane for society to expect people to make decisions like that.
The Quality Factor
Remember when I was talking about frying eggs? Ok, so now for the other factor that gets put off kilter when life-threatening or costly health issues arise: The prioritization of the Quality requirement.
This issue is pretty simple: no one will consider anything but the best when it comes to life or death (the same is often true when it comes to quality-of-life decisions). We want the best chances of survival and/or a successful outcome from treatment, so there’s an incentive for us to not only ignore cost for required care, but for us to ignore cost for the BEST care as well.
This may seem obvious, but it there’s a consequence of this kind of decision making that isn’t so obvious: when the best care available is different depending on where you are. If the healthcare system in your country only offers a certain “highest level of care,” and that level of care is affordable to that system, you’re golden. But what if your neighboring country offers a higher—though unaffordable—level of care?
If you live outside the USA, this is the case for you. If you live inside the USA, well, unless you’re rich, this is kind of still the case. Which brings us to the “new factor” that gets introduced when you’re making life-or-death decisions instead of fry-my-eggs decisions.
The New Factor: Environment
The Budget and Quality issues I’ve discussed are very different depending on where you are. Because the USA has the latest, greatest, cutting edge technology and research, the best care is available here. It’s not available to everyone, but if you’ve got the money, the USA is the place to go for healthcare.
This exacerbates our problems with the Budget and Quality decisions, though. Because in the USA, when a person ignores cost and goes for the absolute best care, they are choosing care that is both fantastic, and fantastically expensive.
To wrap up my point, consider a person in France or Canada, getting the best treatment those countries have to offer—at essentially no personal cost to that patient—for their life threatening disease. That person would have a greater chance of survival by coming to the USA and getting the best treatment available here.
But we can’t afford to pay for that treatment for everyone that needs it, whether you’re a citizen of the USA or not. I don’t argue that the human race shouldn’t have universal health care for all. It absolutely should. It is a basic human right to survive for as long as our society can support it, regardless of cost.
It’s just not one we’ve figured out how to pay for yet. Whether it’s a right or not, we don’t currently have the resources to provide it. Could we fix that without increasing our resources? I.e., could we overhaul our system to be more efficient, and have fewer resources go toward making big pharma, investors, political entities, et al, massively rich? I definitely believe so… but we haven’t figured out how, yet.
I think it is our duty, as a society, to solve these problems. I personally cannot condone an option that has anyone making life-or-death decisions for someone else (which is necessarily the case for government-run healthcare when resources aren’t unlimited). However, if the end result is that more people live longer, healthier lives at lower cost… well, I won’t complain too much.
In the end, I do believe that we will figure out how to sufficiently reduce costs through technological advances such that the best healthcare available is also affordable to everyone, regardless of whether it’s run by the government or the market. But until then, we must find solutions that are better than what we have in the USA right now.
I also believe that there are solutions that don’t require our government to take over this problem. I think it’s unfortunate that government-run systems appear to be the best choice because they are successful elsewhere, in countries where the tradeoffs appear acceptable. I think that the USA has the ingenuity, the creativity, and the capability and willingness to innovate that will allow us to find a solution that’s even better. If we hand the keys to the car to the government, history has shown that we will never get them back. Right now, we have both the power and the opportunity to ignore “better” and go for “best.”
Because, really, it’s the best healthcare that we have a right to, isn’t it?