Health care going to the dogs

Posted by Marc Hodak on August 9, 2009 under Invisible trade-offs, Unintended consequences | Read the First Comment

There was a wonderful article in the WSJ yesterday comparing veterinary care to human health care in Britain.  The care of humans was found wanting:

As a British dog, you get to choose (through an intermediary, I admit) your veterinarian. If you don’t like him, you can pick up your leash and go elsewhere, that very day if necessary. Any vet will see you straight away, there is no delay in such investigations as you may need, and treatment is immediate. There are no waiting lists for dogs, no operations postponed because something more important has come up, no appalling stories of dogs being made to wait for years because other dogs—or hamsters—come first.

The conditions in which you receive your treatment are much more pleasant than British humans have to endure. For one thing, there is no bureaucracy to be negotiated with the skill of a white-water canoeist; above all, the atmosphere is different. There is no tension, no feeling that one more patient will bring the whole system to the point of collapse, and all the staff go off with nervous breakdowns. In the waiting rooms, a perfect calm reigns; the patients’ relatives are not on the verge of hysteria, and do not suspect that the system is cheating their loved one, for economic reasons, of the treatment which he needs. The relatives are united by their concern for the welfare of each other’s loved one. They are not terrified that someone is getting more out of the system than they.

The last statement is particularly insightful.   The overwhelming rationale for socializing health care is the sense of fairness it’s supposed to satisfy in our society.  Yet anyone who has experienced socialized anything knows that the system reinforces the notion that we are all playing in a zero-sum game, that what you get must come at my expense, which it does, of course, when we’re paying for each other’s stuff, and there is no way to economize except by rationing.

My only quibble with this magnificent piece is the repetition of this canard:

A few simple facts seem established, however, even in this contentious field. The United States spends a greater proportion of its gross domestic product on health care than any other advanced nation, yet the results, as measured by the health of the population overall, are mediocre.

Well, that’s what you get for measuring the health of the population overall.  You get dubious statistics about British life expectancy being comparable to that of Americans, or the French having an even higher life expectancy, and the Japanese even higher.  But when we look at health by population segment, the picture looks quite different:  French-Americans live longer than French in France; British Americans live longer than the average Brit across the pond.  And the Japanese, who have the longest life expectancies on earth, don’t live as long as Japanese-Americans.  No need to resort to convoluted and unconvincing excuses about lifestyle and diet.

What the health care reformers don’t want to tell us, and possibly don’t want to know themselves, is that equalizing health care for all will mean worse health care for most so we can provide better health care for a few.  One may or may not believe that is the way to go, but we should at least be honest about the trade-off we are considering in this debate.