July 2, 2012

Healthcare Is Not a Marketplace, or Don't Repo My Kidneys Please

This post has been brewing in the back recesses of my gray matter for quite a while, but in light of SCOTUS's decision on the Affordable Care Act last Thursday it seems like the proper time to unleash it on you, dear reader.
Here comes a post about healthcare...

First point: the Democrats, and the Obama Administration specifically, have done an awful job of educating the public about the Affordable Care Act.  The results of this poll from Reuters and Ipsos proves how misinformed the general public is.  The Republican strategy of fiction-based truth strikes again.  The fact that a majority of Americans oppose the act on the surface, but overwhelmingly support the provisions therein shows how Republicans have successfully spread enough FUD, misinformation, and outright lies to hoodwink the country into opposing something that is ultimately in it's best interests.  That is weak, Dems.  Here, let me help you get started: How Today's Supreme Court Decision Will Help Unleash American Innovation - Technology Review

(That the Republican Party is so bent on obstructing the Obama agenda they would make it their primary mission to fight a healthcare reform structure that is both popular and identical to the one their own presidential candidate enacted in Massachusetts is a separate post entirely.  Your intrepid blogger needs to focus the outrage machine on a single target from time to time...

...but I can't resist letting the cross-hairs wander for a second.  This begs the question: if the Republicans oppose this version of healthcare reform that is chock full of compromise and ample protection for private insurance companies, then WTF do they support?  So, we had Marco Rubio swearing up and down to Jon Stewart that Senate Republicans really aren't obstructionists, but the True Alternative Party, and it's the mean old Democrats that won't let him bring the Republican's alternative healthcare plan - the one that totally exists wink, wink - to a vote.  What?  You've never heard of their totally awesome alternative plan?  Well, according to this Forbes article, their plan is nearly identical to the Affordable Care Act.  Hey, it turns out the Republicans also noticed that eliminating discrimination based on pre-existing conditions, covering children up to age 26, etc. are popular among voters.  But, we already knew that.  Or are they just going to reprise their Medicare part D expansion routine, a.k.a. the Giant Taxpayer Funded Giveaway to Big Pharma...)

Ok, I've gone a little astray from the main goal of this post, which is to set forth this thesis:

Healthcare - or the practice of medicine by doctors to heal sick and injured people and prevent disease - is not a marketplace.

Obviously, we can be absolutely certain it is not a free market wherein transactions are unregulated.  Having worked for a sports medicine company in the recent past, I can assure you that nothing happens unless it's covered by Medicare.  Not even the private insurers will authorize something not reimbursed by the government.  We already have a de facto national health care plan.  But, every time we hear one of the Alt-Party demagogues decrying "Obamacare" on TV, he always says something like, "there is a free market solution to healthcare reform."

Yes, in healthcare services are rendered, and often goods are purchased.  However, the fundamental quantity involved in the transaction, health, is difficult to place a value on, if not utterly priceless.  For there to be a market for health both parties involved in the transaction of goods or services need to agree on the value.  That is next to impossible to do when we are talking about the state of your health.

Not convinced?  Let's look at it from this perspective.  Let's say you are the recipient of a transplanted kidney, and are unable or unwilling to pay the price demanded by the surgeon.  What happens next?  Do they come after you and repossess your new kidney?  What about if you can't pay the hospital bills for the birth of your child?  Do you have to return your little bundle of joy?  Ok, that is a bad punchline to an overwrought setup, but you get the point.

Dammit, Jim!  I'm a doctor, not a businessman.
Here's an even better example taken from experience.  The amount that the hospital invoiced my employer's insurance company when our son was born would have bankrupted just about any household.  There were a lot of unforeseen expenses due to an unpreventable emergent situation, which led to hospital stays for my wife and our son.  Our household is technically in the top 10% of income in the country - though living in coastal San Diego County takes a very large bite out of our earnings - and if not for medical insurance, this would have crippled us financially.  Like contemplating Chapter 11 crippled.  We did not choose to rack up a bunch of charges for unnecessary tests and care.  The decision to perform services was not a choice at all.  Lives were at stake.  It's not like I had the chance to go shop around at different hospitals to find the price for service that most closely matched the value I put on my wife's and son's life.  See, not a marketplace.

Besides, we already know what free-market health care looks like, and "HMO" is a dirty word as a result.  Or just go read anything by Dickens if you want to see what real Capitalism is like.  None of this modern social safety net coddling for you, young Master Twist.

The profit motive does not work in medicine.  (See also: How the U.S. Health Insurance Boondoggle Stifles Innovation - Technology Review)  The sooner we all recognize that, the better we all will be.  It's about priorities.  We can choose as a nation to keep people healthy.  You know, so they can go do things like earn a paycheck, buy stuff, not go bankrupt, and all those nice things that grow the economy and create real jobs.*  I'm quite sure there is a ton or research out there showing that it's much cheaper to keep our citizens healthy than to go kill the citizens of another country.  There are plenty of time-tested examples from around the world of what works, and what doesn't, in universal healthcare.  We are smart enough to figure it out.

*We are hatching another post about who the real job creators are.  Stay tuned...

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