Sunday, June 24, 2007

The Sickness in Sicko - Part I

This is part one in a series where I challange Michael Moore's Prescription for Health Care. Mr. Moore's first proposal is that every American must have full, uninterrupted health care coverage for life.

"every American"

What determines American? Is it American citizen? What about a visitor who is accidently ill? What about illegal immigrants? Should we deny them coverage? Let's suppose we are generous and say everyone who inhabits our borders is American and should have full, uninterrupted health care. Illegal immigrants do not pay taxes. Is it fair for them to receive health care paid for by some else's tax dollars? Should they get it for free?

"must have full"

Who determines full? If the full health care, Mr. Moore is imagining, was possibly available, there would be no economic system of health care. There would be no need to determine how to allocate a scarce resource. Let's suppose we want to allow full health care available. Let's even suppose government had the funds to deliever that to "every American". How would the distribution be determined? Who could fairly distribute this resource? Health care providers who are experts in their field already dispute regarding the choices of therapy regimens.

"uninterrupted for life"

How would uninterrupted be determined? For example, how would hospital discharge (a big cost saver in health care) be determined? If capped reimbursement incentivized hospitals to decrease hospital stay, how much more would a single government provider?

The urge to implement comprehensive health coverage stems from a belief that the market failures of health care are due to a lack of government regulation. Kirzner writes in The Perils of Regulation, "the urge to regulate, to control, to alter these outcomes must presume not only that these undesirable conditions are attributable to the absence of regulation, but also that the speedy removal of such conditions cannot be expected from the future course of unregulated market events."

I believe the market failures Sicko addresses are not due to a failed government system but to an epidemic of unhealthy lifestyles that cannot be supported economically. Preventable illness comprises 80% of the burden of illness and 90% of all healthcare costs. Preventable illnesses account for eight of the nine leading categories of death. No medicine, surgery or treatment can reverse the damage caused by a lifetime of smoking, poor eating and lack of exercise. By simply increasing treatment that buys time, ignores the inevitable need to align patient's economic incentives toward healthy living. This is the innovation needed in the economic system of health care, not just more health care.


Anonymous said...

The "who determines" part of your argument is easy. Look at the existing examples in other countries. The choices you raise change the potential size of the coverage pool by - what? - five percent at most? This is far smaller than the pool of citizens who have poor or no private health insurance today.

In fact, all of the economic questions you raise have been worked out in programs in effect in the other industrial democracies. The limit on health care appears to be rationing of treatment based on need, unlike the rationing based on ability to pay here in the USA.

On the other hand, despite HMO claims, there appears to be no incentive toward preventive steps here in the USA except the ones you criticize, like the Asheville, NC, diabetes control project.

If universal, mandatory health care is so bad, why do the results in other countries, in terms of public health measures and cost effectiveness, beat the American system?

Perhaps you should see the movie before your next posting.

Shit Buster (aka Shan)) said...

Damon, u know i miss u.
i think every american = every body who are inhabiting the country. that is the visitor, on the start of the visit, shld be given an option to but the health care coverage.
i guess, the next Q u will ask, at what price? and i think that is the issue, the cost of the health care system.

more over, the illegal immigrants, if the checks are made out to them, they do pay taxes, they just dont file the income tax returns (then they might be paying more than they owe), except a few who work for cash, then they are working for less, saving the money for the american who is hiring them for less, so the american might use that money for health care or if it is in a bank - might pay the tax on it.

Full means, treat the ER patient, provide the meds necessary for chronic therapy, and perform any needed procedures. it doesnt matter, if the Docs differ on the regimen, then the pt will have the right to change the dr, and stay with the Dr which the pt agrees with or in a good case, the pt might go from one to antoher, and all might say the same thing- and he will be stuck with the decision.

if my english is not wrong, uniterrupted does not mean 25 yrs stay in the hospital bed, it means that the pt is provided with the availability of ER and Primary care physician when needed, and the meds that they need to take to be healthy for the 25 yrs.

i didnt understand the 4th para, it had too many big words in it, but it might be due to lack of govt regulation, read my note on facebok: UM DAILY 1.1

i went to a seminar kind of thing, Alternative Decisions for Destructive and Drunk Driving - in which they said they do not like to use the word Accidents, cause they think that car crashes are preventable (it made me really sick)
i think neither accidents are preventable, and nor are preventable disease preventable. and hence we just need to change the terminology. cause if u see, lets say at birth the child is disease free (so all the dxs are acquired after the birth) and hence all are preventable, but that is not the case. exercise, is one issue u r striking right on, but the social culture needs to change - the common man does not have enough hours to do the right exercise or have enough money to buy the right food.

u r also right on smoking, i think they shld be totally eliminated - it is only possible if u r other economist frieds stop citing the benifits of smoking industry on the capitalistic economy.