Gotta Love Those Rs on Health Care
Republicans love them their free markets. In response to any problem, we hear about markets. Free markets require rational, knowledgeable buyers and sellers, acting freely. Advocates tell us free markets will always allow us to achieve optimum outcomes. That’s the mantra!
Rational? Easy it is to talk about too much spending in the last year of people’s lives, but if it’s your mom or dad, well … that’s different. I’ve been there, at both ends of the spectrum. When you love someone, don’t expect rational judgments.
Knowledgeable? Uh, no! We spend a fortune educating and training health care providers, and I say we because, while students pay tuition, we subsidize health care education at every turn, heavily. We spend this money because we want to be healthy and live long, productive lives. (Students pay tuition because they love helping people, find medicine fascinating, want to make a living, etc.)
Per force, we have a knowledge gap. But knowledge gaps exist in many markets. I know more than my clients—many of them, anyway, for I represent some pretty sophisticated people, and plenty of lawyers—do about law. Home builders know more about construction than purchasers. Etc. Medicine, though, brings with it at least three special features.
The Quantum of Necessary Knowledge. With the Internet, we indulge in the fantasy that we know something about medicine, but smart people know it’s a fantasy. Sure, we can read up on a healthy lifestyle, and learn about our disease process, but we’re no match—even a little—for the physician who knows the known unknowns we’ll never know.
The Provider’s Honest—and Otherwise—Profit Motive. Our system, still, rewards activity. The Affordable Care Act includes many not widely publicized provisions which shift toward outcome-based medicine, but a few years doesn’t change a decades-old profession’s ways straightaway.
Then there is waste, fraud, and abuse. In a system which takes in and spends ~16% of our Gross Domestic Product, money sloshes around. Much of it gets spent very well, but in such a huge market, there will be wrongful conduct. (Read National Health Care Fraud Takedown Results in Charges against Over 412 Individuals Responsible for $1.3 Billion in Fraud Losses. Lots of money, and about .04% of all health care spending.) Much of that waste, fraud, and abuse arises when providers get their counterparties—that’s fancy for patients—involved in unnecessary and, sometimes, dangerous care.
The Consequences. Every transaction carries with it consequences. In no endeavor, however, do the transactions matter more than in medicine.
Finally, there’s acting freely. I’m still debating a purchase of dark chocolate later today. My choice, but I am, truth be told, feeling tethered to my dark chocolate purveyors. On the other hand, I never felt free when I had fainting episodes, years ago, which took me to the Emergency Room. Now, maybe some people—almost always, it seems, people with health insurance provided by the government or their employer—think I had a choice when the ambulance arrived. Ever met an EMT? They’re big and strong, and they don’t take sh*t from anyone, especially people who were unconscious moments earlier.
We do have choices on health care, including declining treatment. For some, in end of life situations, passing makes perfect sense. But if freedom and free markets means having a system which lets healthy people die because care costs too much, we are truly an exceptional nation, for no other developed country offers such a form of freedom. (For another day: why does the richest nation on Earth never seem to have money for any public goods?)
What Say You, Teddy?
Truthfully, I don’t expect most Republicans in Congress to pay any attention to the public, the biggest player in the health care market. But I do expect them to listen to the other side: providers and insurers. So, when I saw Insurers condemn Cruz-Lee plan to loosen insurance rules in Politico, I asked myself: how will free-market advocate Senator Ted Cruz respond to insurers telling him and us his plan is “unworkable as it would undermine pre-existing condition protections, increase premiums and destabilize the market.”* Best guess? He’ll go forth, ignoring the insurers or, alternatively, tell them he knows better. Almost 72 hours have passed, since the linked article appeared. I haven’t seen a response from Senator Cruz. We’re waiting, sir!
*Senator Cruz gets the media credit for his load of crap plan, which amounts to letting insurers sell whatever they want, so long as they offer at least one plan which complies with the ACA.