A controversy far from being over
Well into my eighties, I decided long ago that free-market capitalism was the best system to provide the most and best goods and services to the most people at the best prices. And I’ve never wavered from that belief. The free market is unsurpassed in providing cars, shoes, toasters, dwellings and a gazillion other things we need and want. But there is one area where the market has been a failure: health care.
Health care pricing and quality simply do not lend themselves to regulation by the marketplace. There is no country in the developed world that successfully operates a free-market health care system despite almost universal commitment to market pricing for everything else. In the past, contrived competition has been artificially introduced with mixed results at best. It just doesn’t work.
In making decisions about something as important as health most people prefer certainty and therefore purchase insurance. But the health insurance industry itself is a major problem. Health insurance companies make money when more people stay healthy than get sick. But as coverage expands insurers inevitably wind up having to raise prices on the healthy clients in order to pay the increasingly high medical bills of the less healthy. This of course drives up costs, the healthier begin to drop out, prices spiral skyward, etc., etc.
In our current fee-for-service system physicians are not compensated for keeping us healthy but for doing procedures, including complex, expensive (and sometimes unnecessary) tests. In this environment the patients’ health can take a back seat to the providers’ pocketbooks. It also takes time and patience to counsel patients on the consequences of bad health habits: unhealthy foods, smoking, substance abuse, sedentary lifestyles etc. But in a free-market system providers are rewarded for giving more care to those with unhealthy lifestyles. And people prefer short-term, quick-fix solutions to more difficult long-term lifestyle changes. This is a clear example of ambiguous incentives resulting in poor quality health care at higher costs. In our free-market system providers have little incentive to help their patients prevent disease because there’s so little profit in it. Even more atrocious is the high cost of prescription drugs.
Once on a trip to Mexico I forgot my blood pressure medicine. But I was able to purchase the same identical pills at a Mexican pharmacy at about one-third of what I was paying back home; all without a prescription, I might add. Of course spokesmen for the pharmaceutical industry have ready answers for this disparity in pricing, but they don’t hold water.
The U.S. is clearly the world leader in medical innovation. Pharmaceutical industry spokesmen and politicians attribute this to our free-market system. Horsefeathers! We rank number one because our government pumps billions of dollars annually ($32.2B last year) into research through the National Institutes of Health. And much medical research and development is done in tax-supported state universities. “Big Pharma” is getting a free ride and is lying about it to boot.
In the final analysis, it’s back to the basic question of whether health care is a right or a privilege/luxury. I personally can’t see how anyone who claims to have an ounce of moral fiber or feeling for others, in the world’s richest country could deny anyone health care because of a lack of money. And that’s exactly what the Trump Bill now before Congress will do, albeit over a period of years to disguise the intent and delay the real impact. Expanded choices? Huh!
George B. Reed Jr., who lives in Rossville, can be reached by email at reed1600@bellsouth.net.