Market selfishness

One of the more interesting things about the health care debate in this country-is the argument being made that the free market does not, of itself, impose any sort of rationing on health care services.

Ezra Klein recently did a pretty good job blowing a hole in that theory:

"Look at Canada," says Charles Krauthammer. "Look at Britain. They got hooked; now they ration. So will we."

So do we. This is not an arguable proposition. It is not a difference of opinion, or a conversation about semantics. We ration. We ration without discussion, remorse or concern. We ration health care the way we ration other goods: We make it too expensive for everyone to afford.

I’ve used these numbers before, but let’s repeat them. A 2001 survey by the policy journal Health Affairs found that 38 percent of Britons and 27 percent of Canadians reported waiting four months or more for elective surgery. Among Americans, that number was only 5 percent. This, Americans will tell you, is the true measure of our system’s performance. We have our problems. But at least we don’t sit in some European purgatory languishing without our treatments. That’s rationing.

But as Klein expertly notes-there is flip side to valuing only the size of a persons credit line:

There is, however, a flip side to that. The very same survey also looked at cost problems among residents of different countries: 24 percent of Americans reported that they did not get medical care because of cost. Twenty-six percent said they didn’t fill a prescription. And 22 percent said they didn’t get a test or treatment. In Britain and Canada, only about 6 percent of respondents reported that costs had limited their access to care.

The numbers are almost mirror images of each other. Twenty-seven percent of Canadians wait more than four months for treatment, versus only four percent of Americans. Twenty-four percent of Americans can’t afford medical care at all, versus only 6 percent of Canadians. And the American numbers are understated because if you can’t afford your first appointment, you never learn you couldn’t afford the medicine or test that the doctor would have prescribed.

We ration. And if the numbers and the surveys don’t convince you of the point, this is what it looks like when we ration.

The problem with the health care as just another product analogy-is that it does not work very well. For example, I can put off or never buy a TV and it won’t kill me-I have alternatives for entertainment: Books, magazines, walks, etc. However I do not have an alternative to health care-especially if you are on the bad side of 50 as I am. Preventive health care, early detection, paying attention to my body’s signals are no longer things I can blow off. To do so is to invite destruction. For that matter it never was an option to simply not have preventive care. I consider myself fortunate to have been in a career field that demanded a comprehensive physical exam each and every year. Annoying as the finger wave and turning and coughing was, the idea of not having prostate or testicular cancer made the indignity worthwhile.

Rationing by price is still rationing just like rationing by need is (even though no program currently being considered has rationing by need.) Just because a service is available doesn’t mean I can access it. That is rationing, allocating a limited supply of healthcare to those who can pay the most for it. The question is, "Is rationing by price the most effective way to get healthcare to those who need it?" My answer is no.

But since the government is not involved in that rationing-as John Cole points out, that somehow makes it better? Again,  the answer is a big fat no.