Healthcare Reform

I interrupt my reminiscences to address the issue of healthcare reform. Putting aside my displeasure at the inability of our congresses and administrations to effect any change over fifty years of deliberations, the nation is not having an honest debate. We have been and are dancing around the question: “Should every resident, or citizen, of the United States have access to the latest and greatest of medical care?” If one only considers the altruistic and politically expedient aspects, the answer is clearly “Yes.” However one must consider the fiscal consequences. If, having considered the fiscal issues and arrive at the same answer, and I do not think that is the right answer personally, then taxes must be increased substantially. If taxes are not increased overtly, then the most insidious of taxes, inflation, will take care of the problem.

A great many people seem to think that universal health insurance will fix the problem. Health insurance does nothing to reduce the total cost of health care delivery. On the contrary the administrative cost of insurance management and associated profits only add to the overall bucket of costs associated with health care delivery. (One potential exception is the cost reduction associated with preventative care, should the incentives influence more individuals to take care of medical issues before they become extreme.)

Why should I have the right to a heart transplant any more so than I have the right to an eight-thousand square foot mansion on a beach with expensive cars in the five-car garage? I should and do have the right for either one if I can afford it.

On a constructive note, I think that the major efforts should be to reduce the total cost of health care delivery. After all, these costs are paid for in only two ways: by the healthcare recipients and taxes. No, insurance does not pay for any of these costs, it adds to the overall cost. I like to take a thermodynamic view of healthcare delivery costs. Draw a boundary around all of the costs:
• Hospital buildings
• Bedpans
• IV kits
• Doctors, nurses, dentists, etc pay
• Hospital administrative costs
• Insurance company administrative costs
• Insurance company profits,
• Etc. (and there are many etc's)

These costs are paid for by healthcare recipients (deductibles, co-pays, insurance premiums) and by taxes (federal, state, and local.) The only way to reduce the amount to be paid is to reduce the costs within the thermodynamic boundary described above. So let us argue less about how all of these costs are to be paid for and focus on reducing the total cost.